Coronavirus DK: Is there a verdict on Sweden?

Is it possible to judge Sweden’s singular coronavirus policy yet? Denmark’s neighbor has diverged from the rest of the world in refraining from locking down large sectors of social and business activity. It has kept restaurants and schools open and has not issued social distancing rules. Like its Scandinavian neighbors, it citizens exhibit a high degree of social trust in one another and in the government, and it has relied on people to behave sensibly of their own accord. For a while it seemed to be working well. The number of infections and deaths in the country were not significantly higher than in similar countires. It was praised by critics of lockdown policies in other countries for showing the strict regulations that harm the economy are unnecessary. So what is the status of the experiment?

It has now reached almost 4,000 deaths (DK), in comparison with 562 in Denmark. Its population is around twice as large. It has 398 deaths per million persons in comparison with 98 in Denmark, 44 in Norway, and 55 in Finland. I have thought that the spread of the infection has been higher in Denmark than in Norway because the first cases involved superspreaders who returned from hotspot ski resorts in Austria and northern Italy, and Norwegians do not need to travel south to go skiing. So if Sweden’s most comparable neighbors are Norway and Finland, its fatality rate is about eight times higher.

Elusive herd immunity

The person behind the strategy, Anders Tegnell, the head state epidemologist, has defended the policy all along, contending that is too early to judge the results. If the objective was too reach “herd immunity” by allowing most of the population to become infected and afterward immune, then there would inevitably be more infections and deaths in the beginning stages. In countries that conduct extensive lockdowns, when people who have isolated themselves begin to emerge, many of them will become infected and the country will see additional waves of infection, goes the rationale.

On several days last week, the fatality rate in Sweden (DK) was the highest in the world. On day 60 of the epidemic, the rate was even higher than Italy’s at the same stage, and ten times as high as Denmark’s. And the country is still far from herd immunity. There were earlier predictions that around half of Stockholm’s population would reach immunity in June, but a recent count of persons who have developed antibodies to the disease was only 7.3 percent, and that is much higher than in the rest of the country. There is much uncertainty in identifying immunity, and the WHO had warned Sweden in April that not everyone who is infected develops immunity.

Unrealistic expectations

Now criticism is growing (DK) both inside and outside the country. For example, former state epidemologist Annike Lind said that if the country had closed down early it could have done more to protect the most vulnerable people. Tegnell had said that they would protect the elderly, she said, but it “had little relation to reality.” A large share of the deaths have come in nursing homes. 

Tegnell denies (DK) that Sweden could have done anything differently to protect the elderly, arguing that the poor quality of Swedish nursing homes made them vulnerable. He also says that the objective has never been herd immunity, which is not possible until there is a vaccine. But he maintains that if people don’t change their behavior they will continue to see a decline in the number of infections.

Playing with statistics

Another Swedish researcher recently defended the strategy (DK). Matti Sällberg, a professor at the Karolinska Institute, argues that if you do not measure the epidemic by the fatality rate but rather by the number of deaths in relation to the number of infections, then there is little difference between Sweden and Denmark. With an infection rate of 6 percent in Sweden, the fatality rate is about 0.6 percent. In Denmark, the infection rate is about 1.0 percent and the fatality rate 0.8 percent. That is not necessarily the most significant statistic, says Søren Riis Paludan, Professor of Biomedicine at Aarhus University. It indicates that Sweden has been as good as Denmark in treating people who have become infected, but not whether not it has been successful in containing the epidemic.

Tegnell has maintained that it will be years before one can judge what strategy is best, and he thinks there may be not be large differences between the results in various countries. Does he have a serious case of confirmation bias or will he prove correct?

(No post tomorrow. Back on Thursday.)