This is, ah, quite a headline.
Jazz Shaw wrote about Sweden’s approach to coronavirus a few days ago. They’re following the original British strategy, the one Boris Johnson was planning to implement before the Imperial College’s model of the contagion convinced him that up to 500,000 people might die if the country didn’t start following aggressive social distancing measures. Initially Johnson’s plan was to encourage older and ailing Brits to quarantine themselves as thoroughly as possible while the younger, healthier part of the population went on more or less as usual. Infection would spread rapidly; many would get sick to various degrees and some would die, but at the end of this relatively quick mega-storm of disease, the country would have acquired something like herd immunity. Then the old and infirm could reemerge.
No go, said the Imperial College. Waaaaay too many young and healthy people would die. And logistically, it’d be hard to wall off the old and ailing from them entirely.
Sweden’s going ahead with it, though. Swedish scientists are mortified:
The global pandemic has closed down Europe’s economies and confined millions of people across the continent to their homes. But here, schools, gyms, and (fully stocked) shops remain open, as do the borders. Bars and restaurants continue to serve, and trains and buses are still shuttling people all over the country. You can even, if you wish, go to the cinema (it smainly indie fare: The Peanut Butter Falcon and Mr Jones were on at my local arthouse over the weekend)…
Panic, though, is exactly what many within Sweden’s scientific and medical community are starting to feel. A petition signed by more than 2,000 doctors, scientists, and professors last week – including the chairman of the Nobel Foundation, Prof Carl-Henrik Heldin – called on the government to introduce more stringent containment measures. “We’re not testing enough, we’re not tracking, we’re not isolating enough – we have let the virus loose,” said Prof Cecilia Söderberg-Nauclér, a virus immunology researcher at the Karolinska Institute. “They are leading us to catastrophe.”
The government’s taking some basic precautions to limit the spread. No gatherings of more than 50 people, for instance, and work from home is encouraged. Those over 70 are asked to isolate. High schools and universities are closed. But not elementary schools, and there are no lockdowns. Is it paying off for them? Not yet:
Sweden took a laissez-faire approach to COVID-19 while their neighbors shut down public life and sealed the borders. It looks like we're finally seeing the results. (Graph is cumulative deaths: Sweden yellow, Denmark red, Norway blue; screenshot from /r/Denmark) pic.twitter.com/Jg1qfqo1Ei
— Connor Harris (@cmhrrs) March 30, 2020
Jazz posted that graph and noted that Sweden has twice the population of Norway and Denmark. True, but even if you control for that, the numbers are grim:
For context, those death tolls are about **2-3x worse on a per capita basis** than the number reported in the United States yesterday, which was quite bad.
— Nate Silver (@NateSilver538) April 1, 2020
The counterargument would be that of course Sweden’s infection and death rates are accelerating faster than other nations’. That’s the point! They’re not really trying to flatten the curve. They’re going to get this over with as quickly as possible, whatever that means for Swedish hospitals over the next month.
Sweden’s also expecting its unemployment rate to rise this year despite its willingness to remain open for business, although “only” from seven to nine percent. The rate in lockdown countries like ours should be far higher. On the other hand, much depends on just how deadly Sweden’s minimally controlled spread proves to be. Cities in the U.S. that took social-distancing precautions against the Spanish flu in 1918 recovered economically more quickly than cities that didn’t. “Some Swedish economists have also criticized the government’s strategy as shortsighted, warning that the cost of an out-of-control epidemic could outweigh the benefits of avoiding lockdowns in the short term,” noted the Wall Street Journal in a recent story.
Swedes are already practicing social distancing of a sort, though:
[E]ven some of these proponents say it might be hard to replicate outside the specific context of Scandinavia. In Swedish culture, they note, generations don’t interact as much as they do in, say Italy. More than half of Swedish households consist of a single person, according to official data. This means less risk of younger people passing on the virus to their elders.
It may also explain why a disproportionate number of Sweden’s Covid-19 deaths occurred within the country’s Somali community, whose members tend to live in cramped accommodation in poorer neighborhoods, with more intergenerational mingling and less access to government information.
Whether you like the strategy may depend on how you feel about raw numbers. Assuming a case fatality rate of 0.2 percent, infecting every last person in Sweden’s population of 10 million should produce some 20,000 deaths. That’s a big number in the abstract but it’ll be dwarfed by death tolls around the world. Italy, with a population six times bigger, already has close to 14,000. The U.S., which is 30 times bigger, should reach 20,000 deaths in the next week or so. Maybe Sweden feels it can “absorb” 20,000 deaths in the interest of avoiding economic ruin. But they’re gambling a lot on that fatality rate. If the rate is more like one percent then suddenly they’re staring at 100,000 dead, the equivalent of three million in the United States. That’s a big number for a small country. What if the rate is more like two or three percent? What if hospitals are so overwhelmed that preventable cases of, say, heart disease go untreated for the next two months and deaths spike in that group too?
This isn’t a hypothetical. I wrote last night about how there are many “excess” deaths in northern Italy this month. There’s an official death toll from COVID-19, of course, but the number of official COVID-19 deaths doesn’t remotely explain the massive overall spike in deaths seen this year when compared to the number of deaths in northern Italy in 2019. Others have applied the same analysis to Spain: Do the official coronavirus numbers account for all of the extra deaths in Spanish hot spots this year compared to last year or are there some “excess” deaths too? Per TPM and the Economist, there do appear to be plenty of unexplained ones. Enlarge the image in this tweet to see:
THREAD: Might the death toll from covid-19 be higher than the official fatalities attributed to it so far? Data emerging from the worst-hit places in Europe suggest so. (1/9) pic.twitter.com/bGMebMckI7
— James Tozer (@J_CD_T) April 2, 2020
Whether the unexplained deaths are cases of COVID-19 that went undiagnosed or cases involving unrelated causes that weren’t treated properly due to hospitals being besieged is unknown. A combination of both, presumably. But that’s what Sweden’s staring at right now. The “natural” fatality rate for coronavirus may be higher than anyone expects, or the crisis they’re about to unleash on their hospitals is going to make mundane care for life-threatening afflictions unavailable for awhile. Or both. Good luck to them.