Sweden's Cautionary Tale
Whatever happened to Sweden?
I thought maybe you’d be curious too.
For a long time, Sweden was the media’s favorite Covid villain. Time called Sweden’s approach to Covid “a disaster”; the Washington Post said “it flopped”; the Guardian proclaimed last January that “it failed”; the New York Times called Sweden “a cautionary tale” and “a pariah state”.
Over the last few months, however, we’ve heard nothing. Well, almost nothing…
The New York Times’ “coronavirus briefing” of October 6 tells us that “the jury is out” on whether Sweden’s Covid strategy was a success or a failure. Wait…are we talking about the same strategy that turned Sweden into a pariah state and a cautionary tale for the rest of the world? Now that strategy might actually be a success?
The NYT reporter informs us that Anders Tegnell, Sweden’s chief epidemiologist, “doesn’t think we are in a position to pound our chest with pride”. Well, I doubt anybody would pound their chest with pride for this global calamity – it would be quite inappropriate. Least of all Anders Tegnell who, unlike many other epidemiologists, is very humble, pragmatic and honest about how much we don’t understand about the virus.
Still, in a recent interview, Tegnell did say in no uncertain terms that if faced with a new pandemic, he would recommend the same approach that Sweden has taken during the past two years.
Let’s see if we can help “the jury” with some data: How has Sweden fared?
In Covid deaths per million population, Sweden sits in the lower half of Europe’s rankings, with 1,459. Yes, that’s three times higher than Denmark, not to mention other regional peers Norway and Finland. But it’s better than France and Spain, a damn sight better than Italy and less than half the record numbers of Hungary, Bulgaria and Czech Republic. (Worldometer data from October 7.)
Let’s broaden the lens a bit beyond Europe for added perspective:
Both the UK and the US have done considerably worse than Sweden (about 30% worse in fact); And just for fun I’ve added in New York State, with a Covid mortality twice as high as Sweden. Who’s the pariah state, then? I don’t remember the New York Times calling out New York’s “cautionary tale”
Now let’s look at overall excess mortality[i]. To me this is more important than Covid deaths, for two reasons: First, we might have misclassified deaths (missed some Covid deaths, and recorded some people who died with Covid as having died of Covid.) Second, the response to the pandemic can lead to fewer or more people dying of other causes (more cardiac fatalities as people felt too scared to go to the hospital; fewer traffic deaths as more people stayed in lockdown). Here is the chart for Europe, where I got comparable data from Eurostat:
On this metric Sweden does even better: it’s in the bottom six, just under Germany.
So why all the fuss?
Sweden was singled out because it tried to follow the science—not "The Science", but the science.
It decided not to impose widespread lockdowns, because it judged they would be unsustainable. It never imposed a mask mandate, because there is very little evidence of the effectiveness of masks; it kept schools open because the evidence indicated that Covid posed an extremely low risk to kids and schools were not a significant source of contagion.
It did impose some restrictions on restaurants and large events; for a period (December 2020-July 2021) it recommended wearing masks on public transport at rush hour; it encouraged universities to move to distance learning; it recommended social distancing, because it is effective in reducing contagion.
Overall, Sweden did adopt sensible precautions; but it did not follow the orthodox playbook of shutting everything down and imposing masks nearly everywhere nearly all the time. And it candidly recognized how much we do not know instead of peddling fake certainties.
A cautionary tale
I strongly recommend you watch Anders Tegnell’s interview. You will be struck by his pragmatism and humility. He recognizes that at times he was wrong and that mistakes were made. But he points out that, in the uncertainty, they targeted their restrictions to what they saw as the main sources of contagion; they weighed benefits against costs (such as the adverse impact that school closures would have on children); they sought a sustainable strategy because they thought this would be a long-term game; they relied on the population’s common sense and responsibility.
For this, they were pilloried by those who think people cannot be trusted with nuanced information and must be coerced into the “right” behavior; that disinformation is justified if it serves the “right” agenda; that it would be dangerous and irresponsible to debate the Covid response even though there was so much we did not understand.
Almost two years later, with Sweden showing one of Europe’s lowest excess mortality rates, it turns out the Swedes were not crazy after all.
Sweden’s true cautionary tale is that killing scientific debate with rushed conclusions and superstitions and treating citizens like dull-witted subjects costs lives.
[i] Excess mortality is expressed as the percentage rate of additional deaths in a month, compared to a “baseline” in a period not yet affected by the pandemic. The baseline adopted consists of the average number of deaths that occurred in each of the 12 months during the period 2016-2019. The higher the value, the higher the amount of additional deaths compared to the baseline. If the indicator is negative, it means that fewer deaths occurred in a particular month compared with the baseline period.