The Swedish mirage: the verdict is already written

What's happening in Sweden?

As shown in the above chart from OurWorldinData, a second wave has not spared Sweden, the country that is famous for pursuing "herd immunity through community spread."

Despite the complete lack of confirming data, the idea that Sweden's strategy may work refuses to die. The talk is that "in time" we will see the wisdom of the Swedish way.

But we don't need more time. The strategy has already failed. There is almost nothing that could happen in the future that could rescue it.

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Look at the trend of Covid-19 deaths in Sweden compared to its Scandinavian neighbors:

(This chart was adapted from one first published by ArsTechnica, which I discussed on Junk Charts last week.)

The death rate per capita in Sweden from the start of the pandemic is 10 times worse than in Norway and Finland, and 5 times worse than in Denmark.

If the "herd community through community spread" strategy works, the Swedish outcome must improve over time relative to Norway and Finland. But as the chart above shows, counting only the last four months, we find Sweden doing even worse - the fatalities per capita is now more than 10 times higher than all three neighbors.

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In spite of those numbers, some commentators say we've got to wait. What might happen in the future that would rescue this policy?

A devastating second wave would have to hit Norway and Finland while sparing Sweden, inflicting deaths per capita 10 times higher than in Sweden. The data from OurWorldinData tell us this isn't happening at all:

Finland and Norway have kept infections down while Sweden has not. Denmark has also suffered a spike but one that is not as bad as Sweden's.

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Let's suspend our disbelief, and assume that somehow in the next six months, Finland and Norway would suffer 10 times the deaths per capita as Sweden, thus evening out the cumulative outcome. Does that constitute a validation of the "herd immunity" strategy?

Absolutely not!

All that show is that Sweden's policy accelerated the deaths of a lot of people. A proportionate number of Finns and Norwegians eventually also died but they lived longer, and during those extra months, there was a chance that an effective treatment or vaccine might arrive and save them.

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When people say they need more time to evaluate the Swedish way, what they are waiting for is the extremely unlikely scenario that Finland and Norway would suffer substantially more than 10 times more deaths than Sweden in the next six months. There is zero indication that this "miracle" will materialize. Not only are recent fatality rates moving in the wrong direction but the case rates are also running away from this scenario.

I'm imagining a football (soccer) match in which one team falls behind 10-0 in the first 10 minutes, and the other team's coach is asking supporters to be patient and wait for the comeback.

Comments

[Michael Droy]

???? Since when have deaths been the measure of a successful Covid policy. Surely not since about April when it became clear that this is flu equivalent disease.

The correct measures are the maintenance of the Economy and the health of those who have life expectancies of > 2 years.
On that basis Sweden has done very well.

(And if you want to persist in counting tiny numbers of deaths and claiming they are important, shouldn't you be congratulating Sweden for avoiding the flu epidemic that killed off many elderly in Denmark and elsewhere in 2019?)

[TBW]

I think the other part of the argument is that Sweden would have suffered less economically. So, even if the rate of deaths evened out, Sweden could "win" by having a better economy. I don't believe they avoided much in the way of economic hardships, but I suppose presumably their economy could still recover faster? I'm not buying it, just saying that's what the people clamoring about the Swedish approach would say.

[Kaiser]

TBW: I'm sympathetic to the economic argument. It's all in Chapter 2 of Numbers Rule Your World - where I was talking about foodborne illnesses such as salmonella, for which a typical outbreak results in zero deaths (not 200K in the U.S. and over 1.1 million worldwide). We routinely destroy an industry sector for six months based on dozens of cases. I asked whether that is the right price.

In this case, we are not yet engaging in a dialogue about the key issue - putting differential prices on human lives. By doing very little, Sweden is forcing a group of people to sacrifice their lives - possibly leading to death - for the sake of the rest of society. The sacrificial group is not randomly selected but highly biased. Is that acceptable or not? That's up to society to decide.

[Kaiser]

MD: It may eventually become flu-like but it isn't flu equivalent today. Flu causes 20-30K deaths in the U.S. in a typical year; SARS-CoV-2 has caused 220K deaths in eight months, and we're still counting.

[Kaiser]

MD: I am not sure what happened to your other comment. It shows up as published on the backend but I don't see it. I'm replying to it in the hope that it will eventually surface.

I'm glad to hear that you experienced some good fortune with your health situation. And I value your comments here, as this is the kind of conversation that society needs to be having.

Your comment points to one of the key decisions that need to be made. Is the life of the cancer patient worth more than the life of the Covid19 patient? I don't pretend to have an answer to this question.

[TBW]

I am sympathetic to the economic argument in principle, in this specific instance I am very dubious. Sweden very clearly took a big hit economically, while it probably wasn't as bad as the hit it's neighbors took, it also wasn't as dramatic a difference as some people would like to pretend. Given that the cost for whatever marginal gain was received was borne by a relatively small subset of people on an involuntary basis, even if it was "worth it" it was probably the wrong thing to do morally.

[Fred]

The idea that the maintenance of economics is the most important measure by which Sweden is a success is not borne out by data.
Comparing Q1+Q2 GDP in 2020 to Q1+Q2 GDP in 2019,

Norway -2.7%
Sweden -3.5%
Denmark -3.9%
Finland -3.9%

Maybe you could still argue that 0.4% GDP growth is more valuable than 5,000 premature deaths of mostly seniors, but I doubt you will be able to garner a whole lot of support for that position.

[Swedish Resident]

Herd immunity has never been the Swedish policy, although that has become a very sticky rumor. So, some fact checking would perhaps be a good idea for all debating the pros and cons of a policy that has never existed in the first place. Especially for sites that claim to have a scientific approach.

The Swedish policy is based on a high level of trust in the people to follow the (quite strict) guidelines issued by the government. This is something most residents in other countries seem to have a hard time grasping and therefore need to come up with alternative theories - like the rumored “herd immunity policy”.

So analyzing Swedish COVID-19 data from a herd immunity perspective is utterly pointless since that was never a goal.

[Kaiser]

SR: That's an important point to bring out in this discussion as well, and certainly, some cultures are more embracing of restrictions. I think this Science article is a reasonably balanced account of the Swedish policy. It's very hard to decipher Dr. Tegnell's intentions because he denies he's interested in herd immunity, just the same he denies the goal is protecting the economy - and trying not to overwhelm hospitals sounds like "flattening the curve." It's sticky in the States because opponents of restrictions like to point to Sweden as a model of success.

[Michael Droy]

MD/TBW
The Swedish Economy is very linked to other economies so any divergence between Sweden and other countries was always going to be limited. Moreover even with zero lockdown, Swedes are going to have most of the social effects of Covid simply because Swedish society and media are so integrated with the rest of Europe (esp the English language media).

Kaiser - the other comment was on your "i don't like the term herd immunity" as I was replying there. Glad you read it.

"Your comment points to one of the key decisions that need to be made. Is the life of the cancer patient worth more than the life of the Covid19 patient? I don't pretend to have an answer to this question."
Well I think the answer is easy to uncover. Certainly we do know that Covid19 patients that die are the oldest or nearest to death patients, and saving them saves only a few years of life for nearly all. Whereas cancer patients can live 30 or 40 years longer because of timely treatment.
The unit of this analysis is the QALY - quality adjusted life year.
It is well established in Health Economics. How much longer (or shorter) a patient will live adjusted for life quality (eg x1 in full health or x0.5 in poor health). In sensible economies like UK (on this point) or Sweden where heath is publicly funded with a limited budget there is a great deal of calculation of the QALY effects of different treatments and of things like Economic growth or decline. It is the standard tool. For example the NHS rates all drugs and operation procedures on the basis of cost per QALY generated.

If someone says "the science says" we should do this or that, then the unit of calculation must be the QALY.
If they fail to mention QALYs the suspicion must be that the science says something else or they just haven't done the arithmetic. Almost certainly the latter.

Flu - the estimate for 19/20 flu deaths in US was 24,000 to 62,000.
Given that plenty of immunity has occurred for even recent strains of flu as well as significant herd immunity, both strongly backed up by repeated vaccination, then it does seem fair to compare it with Covid19. Particularly if we ignore the lowball guesses of who has been exposed to Covid19 this year. This is year 0 for Covid, we have hundreds of years of fighting off flu.
50-100m died of American flu in 1919 since when the world pop has quadrupled.