Is Sweden Risky Strategy Really Worth It?

 Denmark was among the first European countries to go into lockdown.  Sweden went for the path of herd immunity, making it a rare case among developed economies to do so. There was no total lockout, and it advised but did not enforced strict social distancing.

Visits to care homes were temporarily stopped to protect those most vulnerable, they banned gatherings of over 50 people, and they encouraged universities and colleges to adopt remote learning.

But apart from that, life is relatively unchanged: many schools, restaurants, shops, clubs, and gyms remain open, and people observe social distancing.

A lot has been said about Sweden's approach.

Leaders of the UK, the US, and other nations were put under raising pressure to lift lockdowns, the issue of whether Sweden's policy is working is of global interest.

Looking at the data, the outcome is not promising: in the first three weeks in April, Sweden reached a record number of excess deaths

During the 21 days before April 19, 7,169 people died. That is 1,843 more people compared to the deaths average during the equivalent weeks between 2015 and 2019. That is an increase of 34.5%.

The Swedish statistics office, on Monday, said the number of deaths in the week finishing April 12 was the largest of the current century, exceeding a milestone placed in the first week of 2000 when deaths were 2,364. Three of the four weeks with most deaths od the last twenty years occurred this month.

In Denmark, the numbers draw a very different picture. Over the corresponding three weeks compared to a five-year average, Denmark had 201 extra deaths, an increase of 6.5%.

The contrast with the recent events is minimal. Also, when we take into account the size of its population. Sweden has a population of 10.3 million people and Denmark of 5.8 million. The difference between the two is enormous.

For several months, maybe even years, the full extent of the effects of COVID-19 will not be explicit — but for now, the two Nordic countries go on different tracks, not just on how they tackle the virus but also on the outcomes so far.

Denmark had a much more stringent approach. Schools, restaurants, gyms, cafés closed on March 11 and banned gatherings of people. They began lifting restrictions on April 15, resuming schools first.

A proper like-for-like comparison between nations is a complicated job.

Daily governments data, including deaths and number of tested people, are frequently recorded differently in separate countries. There are then particular circumstances, like where and when infection occurred in a community, demographic factors, and the ability of health care systems to deal with pandemics, all of which differ between nations.

For that reason a metric known as "excess mortality" is considered by much of the scientific community as the most reliable measure of the real death toll related to the new outbreak, even though the accurate cause of each death is not identified.

Excess mortality is the least flawed of measures. It studies the number of people who died on top of what is expected at any given time of year by calculating the gap between the total deaths, and the historical average for that area and time of year.

Sweden's policy remains popular with most voters, despite some criticism from the country's scientific community.

Support for prime minister Stefan Löfven has risen, and state epidemiologist Anders Tegnell, the face of the country's battle versus the virus, is a familiar name.

And the truth of the programme, as opposed to the way it is presented, has several complexities. For example, Sweden has seen a dramatic reduction in mobility, considering the fact that voluntary initiatives are still in place.

According to Google reports that use Google Maps data to map movement trends, sectors like restaurants, theatres, and other retail and recreation places has a 22% fall by April 1 compared to usual activity. Transportation stations and workplaces fell 38% and 29% each, while parks and residential areas rose 27% and 11%.

Data produced by Apple draws a similar pattern.

Those who have tested positive for the virus in Sweden and Denmark isn't much different.

By April 27, Sweden reported 1,846 cases per 1 million people, while Denmark reported 1,480 cases per 1 million, according to Our World in Data figures, researchers project at the University of Oxford.

Nevertheless, below the surface of all those figures, there are substantial differences.

A comparison within nations based on the number of officially positive cases alone is an incomplete task because it is mainly linked to the number of tests. If fewer tests are carried out, the possibilities are higher that positive cases go missing.

That has been a critical issue in the UK, which held all community testing when the outbreak expanded and is only recently working to scale it up but remains well short of the government's intention of 100,000 tests a day by the end of April

The World Health Organization has regularly emphasised the importance of mass testing.

The seven-day rolling average of recorded COVID-19 deaths published by Our World in Data indicates Sweden's rate of 9.6 deaths per million and Denmark's rate of 1.8—and the gap between the two nations has increased this month.

Given the lagging existence of fatalities data, the exact pandemic death numbers in both nations are likely to be adjusted upward over time.

Compared to the number of positive cases, a distinction is not simple based on number of deaths which are reported daily.

The initial data are fed from a limited number of sources which are more readily accessible, such as hospitals.

It takes time to determine and confirm a cause of death, and is not always a comparable system across nations.

Governments report and present daily data differently. Some governments, for instance, only include hospital deaths.

For this reason, the mortality rates released by national statistics agencies are a better metric for comparison. They record all deaths occurring in a country over time, suggesting a cause of death where possible.

Excess mortality will catch both those who died directly from the virus and those who died due to the outbreak-related reasons — for example, whether people have not been seeking or receiving medical treatment for other diseases.

The number of deaths reported in Sweden in the first three weeks of April is 2,354 - 2,505 and 2,310, respectively, which compares to 530, 755 and 558 excess deaths related to the average between 2015 and 2019 for the corresponding three weeks.

All three weeks has more deaths than earlier highs recorded in the previous five years.

The equivalent numbers in Denmark are 1,152, 1,138, and 1,061 deaths, that into excess of death are 96, 69, and 36.

In both nations, more recent statistics are preliminary and expected to be revised upwards.

The Swedish government said that deaths in care homes have contributed to the country higher toll than other neighbouring nations.

Some reports suggested that the virus has reached up to 75% of Stockholm's care homes.

The Swedish epidemiologist Tegnell told the BBC last week that nearly half of all deaths happened in nursing homes and the government should have responded sooner to shield the vulnerable. But the death rate itself doesn't automatically weaken the whole strategy, he said.

Tegnell has said that Sweden's modellers are beginning to see immunity build up as the virus spreads through the country, one of the factors that many regard as essential before lifting restrictions significantly.

The WHO has warned, however, that there still isn't sufficient evidence to state that those who recover from coronavirus are safe from reinfection.

Another of Sweden's senior epidemiologists, Professor Johan Giesecke, criticised other states' more stringent lockdowns, claiming in an interview with UnHerd that nations such as the UK exaggerated to a report provided by the Imperial College London.

The report had informed of hundreds of thousands of deaths without restrictions, and its model has greatly influenced many governments' response to the outbreak.

Reacting to the criticism

Professor Neil Ferguson, one of the authors of the report, remarked that per capita, Stockholm's death rate is close that of New York. He told UnHerd that he anticipated those numbers to keep rising day by day. "It is a policy choice for the Swedish government whether they want to allow that," said Ferguson. "I don't think it's a choice other nations have made."

Giesecke predicted that death tolls would even out with time as governments lift controls, and as a result, more will get infected where lockdowns were most stringent.

Health specialists in the country have stated that Sweden's hospital capacity and health service were not overloaded at any point during the crisis, which is one of the key goals underpinning all countries' policies, regardless of the rigidity of the particular steps each has put in place. Last week in Stockholm, more people left hospitals than entered.

It is too early to judge steps to tackle the pandemic overall, and much of the coronavirus itself is still not understood. It will be a reasonable amount of time before the whole debate is played out, and even the best information will be subject to revision.

But, for now, the evidence indicates that the different approach to Sweden causes a more substantial death toll.