It’s Almost As If Some People Want Sweden To Fail

By Dr Michael Jackson

Sweden has become the go-to Covid-pandemic-whipping-boy. Their response to the global virus has been framed as reckless; a failed experiment; radical. But why? What has Sweden done to receive such criticism?

Well, while New Zealand, the UK, Belgium, and many other countries enforced severe lockdowns and enacted new laws to restrict peoples’ freedom of association and movement, Sweden has not. They opted for a different strategy. Most of their schools, businesses, bars, and cafes remained open throughout the crisis. The Swedish government produced guidelines for social distancing, the size of gatherings and specific hygiene methods, but these were not enforced by law. While Sweden did introduce some restrictions, the government decided to manage the pandemic using a strategy to minimise overall societal harm.

To give you a sense of how different Sweden’s response has been we can compare countries’ Stringency Index (SI). This is a measure of how strict a government’s response to Covid has been since the start of the global pandemic. The SI is scored between 0 to 100, where 100 is the strictest. So how does Sweden fare? Well, if we look at figures for April (the first full month after most countries locked down), Sweden’s SI was about 38. By comparison, New Zealand’s was 96, Belgium’s 81, and the UK’s 76. Evidently, Sweden’s approach was much less strict. So, what’s wrong with that?

The argument is that Sweden has had a higher per capita death rate than lockdown countries, and this is taken as evidence of a failed experiment. ‘Perhaps they should have followed our lead and enforced a lockdown to protect their people’. The problem with this argument is that there’s no empirical evidence of a relationship between lockdowns and death rates – not in Europe, not in the USA, not anywhere. Take Belgium, for example. They enacted a severe lockdown (SI 81) but their per capita death rate on June 16 was 833 deaths per million (Sweden’s was 483). Also, look at Japan – a country of 126 million people. They didn’t enact a severe lockdown (their highest SI was 47) and their death rate is just 7 (seven) per million – that’s on a par with New Zealand (SI 96). Clearly, the factors driving death rates in each country are highly nuanced and multi-faceted, but accumulating data strongly indicates one thing - they’re not related to lockdowns. In fact, lockdowns may be causing more harm than good. But, despite the lack of evidence for the effectiveness of lockdowns, the headlines keep coming.

Take this headline “Sweden’s death rate per capita is amongst the highest in the world - a sign its decision to avoid a lockdown may not be working”. What’s peculiar about this article is that the three figures they produce to back up their claim actually show that lockdowns might not be a very good idea at all. In each of their figures, every one of the countries that performed worse than Sweden all enacted severe lockdowns e.g., UK (SI 76), the Netherlands (SI 79), Belgium (SI 81), Spain (SI 85) and Italy (SI 93).

Sadly, the desire to paint Sweden as having made a mistake doesn’t stop at Covid deaths to-date. A recent article in a New Zealand newspaper predicts that “56,000 more people may yet die”. But the article has several flaws (see here for a detailed critique). Here’s one example. The author assumes an infection fatality proportion (IFP) of 1% based on serology tests from just two countries, but this estimate isn’t supported by the findings at the time. The Centre for Disease Control (CDC) published their estimate of 0.26% (four times lower) four days before the NZ article was published while meta-analysis published earlier in May (19th) which accounts for serology results estimates an IFR between 0.02% to 0.40% (almost identical to the estimates from the Centre for Evidence-Based Medicine at Oxford University). The list goes on.

Lastly, let’s look at how Sweden performed compared to early projections based on the much-criticised Imperial College London modelling. Without a shift in strategy, Sweden was predicted to exceed 40,000 deaths by May and 100,000 by August. But, what’s the reality on the ground? In May the total number of deaths was 2,586. That’s 15 times less than predicted. Current estimates (June 16) put Sweden’s final death toll at about 6300 – that’s 93,700 less than predicted.

Has Sweden made mistakes? Yes - their own government has admitted as much. "We did not manage to protect the most vulnerable people, the most elderly, despite our best intentions" Prime Minister Stefan Löfven admitted. But so have lockdown countries like the UK, Italy and Spain as well as other countries like Iran. In April the Flemish Minister-President Jan Jambon openly admitted mistakes in the handling of the crisis. So why is there such a strong focus on Sweden? Why aren’t commentators criticising Belgium’s handling of the Covid pandemic, for example, in the same way? Why is there a desire to paint Sweden as a failed experiment while ignoring other countries?

Well, Professor Levitt, Nobel Laureate, has an idea. “The problem with epidemiologists is that they feel their job is to frighten people into lockdown…So you say ‘There’s going to be a million deaths’ and when there are only 25,000, you say, ‘It’s good you listened to my advice.’ This happened with ebola and bird flu. It’s just part of the madness”. The New York Times journalist, John Tierney, also has his own take. “In creating their models and presenting their data, they’re rewarded for skewing negative, because scary predictions will bring them more attention, more funding, and more power. Their worst-case scenario may be utterly implausible, but it’s newsworthy”.

The truth is, we won’t know if Sweden’s strategy has been ‘successful’ for many years. Sweden may, for example, develop herd immunity and return to normal life within months. In the meantime, New Zealand may be stuck at level 1 waiting for a vaccine for years. Only time will tell. But one thing is absolutely certain - every country, including New Zealand, will have to account for the myriad of indirect lives lost due to lockdowns in their final death toll - as well as the lasting social and economic costs. Until then, maybe people should hang fire on proclaiming Sweden a failed experiment.

Dr Michael Jackson is a postdoctoral researcher at Victoria University of Wellington.

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