Nordic COVID Deepdive - Does Sweden's economic leaning virus policy justify the high death toll?
I've been tracking the data for Sweden for the last few weeks and I think it's worth taking a deep dive to look at what it actually all means.
Most of the text will be under the charts, but I want to address a few misconceptions I've read recently.
What's the best comparison for Sweden? I believe it's the other nordic countries. They were all largely spared from a heavy first wave. Other than Denmark, they don't have large land borders with highly infected countries. (Maybe Norway and Finland are better comps.) They share many social traits, especially high trust in government (contrast France/Spain/Italy) and high social cohesion. So yes, Sweden isn't necessarily much worse off than the hardest hit parts of Europe, but that's not a meaningful comparison.
Some are claiming that unlike other Nordic countries, Sweden was hit hard early and that makes the comparison unfair. I'm not sure where this comes from, but when you look at the death rate chart, note that Denmark had a larger and earlier spike in deaths per capita than Sweden did. So again, generally a fair comparison.
Sweden had some big outbreaks in nursing homes early on. Totally true. My view is that this is a risk of the herd immunity / limited lockdown strategy. If you're aiming for 70% of your population to be infected vs. under 10%, you're putting your seniors at a much higher risk. But regardless, Sweden got a handle on those outbreaks, and their death ratio for seniors vs. younger victims is now similar (or even younger) than other Euro countries. So yes, it was a significant part of their first peak, but hasn't been a factor for at least a month.
There's been a lot of press coverage that Stockholm is only at 7% immunity. That was true of the data they released, but there's a huge time lag. If you include the people infected since then (mid-April), and those currently sick, Stockholm is probably approaching 20% today. Still nowhere near herd immunity, but that 7% number isn't meaningful or useful today.
I start with testing, because that's crucial to understanding reported case counts. Is Sweden's number of cases really higher, or is it a testing artifact.
Per capita, Sweden has done about one fifth as much testing as Denmark, and about half as much as Norway.
Per case detected, it's closer to 10:1 or 20:1 lower testing than the other Nordic countries. Sweden is focusing testing mostly on hospitals, and not encouraging widespread testing other than ongoing sero testing for antibodies.
Comparing apples to apples, Sweden's reported case counts are likely significantly under-reporting the true spread.
Sweden's case counts have been largely static over the past two months, consistent with their goal of keeping under the hospital and ICU capacity in Stockholm.
The other Nordic countries have reduced their case counts about 90% from the peak.
This graph is not per capita; Sweden's current 600 cases would need to be halved for per capita comparison.
The other Nordic countries are a month into reopening with no hint of an uptick in cases yet.
I generally prefer comparing death rates because they're less influenced by the huge differences in testing rates. This chart is per capita.
Sweden had an initial surge with outbreaks in nursing homes, but that was largely contained by the end of April. Since then, their death rate has probably been trending down a bit, or was trending down and now back up a bit? Hard to tell.
Meanwhile, note that Denmark's death toll per capita jumped earlier and higher than Sweden's did. Denmark locked down early, on March 12. Their death rate peaked like clockwork 28 days later. (22 days average from infection to death, plus 7 days for a weekly rolling average = 29 days lag.)
Sweden's current death rate is running about 10x higher. Norway has nearly eliminated COVID-19.
Here's a per-capita look at total death tolls. Sweden is running about 4-5x higher than Denmark and 10x higher than Finland and Norway. and the trend is increasing the gap.
If current trends continue to herd immunity, Sweden will end up with about 25,000 deaths, vs. 2,500 or so with the policies of the other nordic countries.
The economic estimates I've heard are that Sweden is at about 20% unemployment, which suggests that their economy is probably doing a bit better than the others. It will be a while before we have good data on suicide rates or other factors, but so far no indication of an increase that approaches the COVID death tolls.
The end point also isn't clear. Will we get to next summer to find that no vaccines are available? Will we get to next summer to find that immunity doesn't last and herd immunity isn't possible? Can the other Nordic countries use test-trace-isolate well enough for complete reopening?
It's going to be a long time before we can write the final chapter. For now, it's 4000 extra COVID deaths in Sweden, on track for 20k extra by year end.
Summary
Barring an immense outbreak in the other Nordic countries - and there is zero evidence that one is on the way - Sweden has suffered a much higher death toll.
Now we wait to see the benefit. Was their economic impact lower in Q2, and if so, by how much? And what happens over the rest of the year and 2021? Does Sweden have an economic advantage, or are the other Nordic countries able to recover as much or more because their epidemics are under control?
Clearly they've paid a huge toll in deaths, now we wait to see if the economic and social upside was worth it. We probably won't have a solid answer there until year end.