Tuesday, September 12, 2023

How is Sweden the poster child for COVID policy?

As summer winds down and COVID-19 ramps up again, it's interesting that Sweden is being held up by the anti-lockdown crowd here in Canada as the poster child for how NOT to lock down. 

Maybe you remember, back in the na├»ve days of 2020, everyone else was locking down hard (or not so hard, depending on the country). But Sweden - sensible, judicious, progressive Sweden - was doggedly bucking the trend, and doing its best to pretend that nothing was happening (I wrote about it here). 

Actually, to say that Sweden had no lockdown is a big exaggeration. It had social distancing measures, limits on gatherings, visits to nursing homes were banned, working from home was strongly encouraged, etc. But most measures were suggested rather than imposed, reliant on Sweden's much-vaunted public spirit and common sense, and many businesses did voluntarily close down, although that aspect was under-reported at the time.

Anyway, as the months dragged on, it turned out to be a poor decision, as Sweden registered a much higher death rate than neighbouring countries, and one of the highest per capita COVID death rates in the world. Even Sweden's top doctor, once the most ardent advocate of the laissez faire policy, admitted that the policy had probably led to many more COVID than necessary, and was overall a mistake. Certainly, even today, the country admits that it failed to protect its elderly.

Fast-forward to September 2023, after the dust has well and truly settled, and the right-wing in Canada is arguing that there should be no lockdowns (actually none has been suggested), and Exhibit One for their argument is that Sweden's no lockdown policy - exaggerated, as I have explained - led to the lowest rate of excess mortality in Europe (4.4% excess deaths, compared to Europe's 11.1% and Canada's 7.6%, says this article), and far fewer deaths "no matter how you measure it".

Say, what? How does that gel with previous reports that Sweden fared much worse than other countries. Well, partly it is due to the use of excess deaths statistics rather than deaths directly from COVID. Excess deaths are a measure of how many more people die each month (or year) from all causes compared to the "normal". 

It attempts to cast blame on events like COVID-19 for deaths of all kinds, even long after the main waves are long passed. It is supposed to take into account the impact of the pandemic on things like delayed medical care, the effects of isolation, etc. Is this a "better" measure of the impact of a disease, and of a country's performance in many dealing with it? Maybe, maybe not.

At any rate, as the National Post article mentioned above crows, this measure often puts Sweden in a very good light, better even than the likes of Australia and New Zealand, which had strong lockdowns and very, very few COVID deaths.

But measuring excess deaths is by no means easy (there is no internationally-agreed methodology, and it involves all sorts of assumptions). A detailed report in the Spectator, which the National Post article largely relies on, makes this point very well. OECD statistics, for example, do show Sweden lower than most other developed countries cumulatively (i.e. after 3 years), but much higher than many others back in 2020. Also, excess deaths per 100,000 population shows Sweden best in class using some methodologies, but much worse than New Zealand, Australia, Denmark and even Canada when using Data from Germany's Max Planck Institute. So, "no matter how you measure it"? Not quite. 

I understand the desire to look at cumulative deaths as (maybe) giving a better long-term impression of how a country did. But, using the well-regarded Our World In Data stats for cumulative deaths from COVID, reasonably considered the gold standard for statistics of this sort, Sweden appears middle-of-the-pack, better than the UK and US, but significantly worse than Finland, Denmark, Norway, Australia and Canada

Our World In Data's cumulative excess deaths stats show a pretty similar picture. There is Sweden, better than the UK and US, worse than Denmark, and pretty much exactly the same as Australia, Norway, France, Germany, Finland and Canada. Go figure.

So, "no matter how you measure it"? Not quite. 

And anyway, to assume that Canadians, without government mandates, would be as sensible and public-spirited as Swedes is a huge stretch. Sweden is a very special place in that respect. Voluntary measures might fly in Sweden, maybe even in some parts of Canada. But large swathes of Western and Central Canada, for example, would have no intentions of doing the right thing, not if it interfered with their God-given right to do whatever the hell they want.

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