Though Sweden is a small country of about 10 million people, its response to the Covid-19 pandemic has captured the world’s attention.  As almost everyone knows at this point, Sweden followed a different path than its neighbors.  Schools have stayed open, businesses have (for the most part) stayed open, and mask-wearing was never mandated.  

It is difficult to overstate the level of media interest in how Sweden is faring during the pandemic.  The New York Times alone has devoted at least 14 articles (listed below, in reverse chronological order) to this topic.  There may be more – this list includes only those whose title explicitly mentions Sweden!  The language of these titles seems to reflect a newsroom reaching an increasingly clear and confident verdict on the success of the ‘Swedish experiment’.

• “In Sweden, Infections and Calls for a Lockdown are Rising” (12/17/2020)

• “As cases surge and criticism swells, Sweden rethinks its response” (12/16/2020)

• “Abandoning its loose approach to virus controls, Sweden clamps down” (11/18/2020)

• “Making Sense of Sweden” (10/12/2020)

• “Pandemic Exposes Holes in Sweden’s Generous Social Welfare State” (10/08/2020)

• “How cuts to Sweden’s social welfare state led to a wave of death in nursing homes” (10/8/2020)

• “Vilified Early Over Lax Virus Strategy, Sweden Seems to Have Scourge Controlled” (9/29/2020)

• “Sweden Tries Out a New Status:  Pariah State” (6/22/2020)

• “Sweden Stays Open. A Deadly Month Shows the Risks.” (5/15/2020)

• “I Live in Sweden.  I’m Not Panicking” (Opinion, 5/15/2020)

• “Coronavirus and the Sweden Myth” (Opinion, 5/4/2020)

• “ ‘Life Has to Go On’:  How Sweden Has Faced the Virus Without a Lockdown” (4/28/2020)

• “Is Sweden Doing it Right?” (Opinion, 4/28/2020)

• “In the Coronavirus Fight in Scandinavia, Sweden Stands Apart” (3/28/2020)

Closer to home, a recent guest column in the Daily Hampshire Gazette  (COVID Wars, Thérèse Soukar Chehade, 12/22/2020) discussed the question of why “the media went on the attack” against Sweden, which seemed, in the author’s view “driven by a strange and mean-spirited wish to see the country fail.”

As if on cue, today (1/1/2021) the Gazette published a reply from Shelly Berkowitz, MD, entitled “Columnist pushes ‘pseudo-scientific’ fraud.”  Dr. Berkowitz writes:

Advocating for people in the U.S. to value the Swedish approach to the pandemic is a little like selling hydrogen for dirigibles the day after the Hindenburg crashed and burned in 1937.

Soukar Chehade seems to be unaware that the Swedish “experiment” has been universally recognized as a crushing failure and that the Swedish government has abandoned this disastrous policy of seeking “herd immunity,” and has issued COVID restrictions that are in line with most European COVID responses.

Sweden’s immediate Scandinavian neighbors — Norway and Finland — have COVID death rates that are 8-10 times lower than Sweden’s catastrophic pandemic carnage.

Is it true that the Swedish ‘experiment’ is a ‘crushing failure,’ let alone that it is universally recognized as one?  

Let’s start by comparing Sweden to other European countries, as Dr. Berkowitz has done.   Dr. Berkowitz is correct that in Sweden, Covid-related mortality has been 8-10 times greater than in its neighbors Norway and Finland:  According to the latest data from Johns Hopkins, Sweden has had 85.70 deaths per 100,000 population, while Finland has had 10.17 and Norway 8.20. 

Many other European countries, however, have had substantially higher Covid-related mortality than Sweden; to take just a few examples from various parts of the continent, Belgium is at 170.97 deaths per 100,000 population, Slovenia at 130.46, Spain at 108.80, and Switzerland at 89.77.  After approximately 9 months of this pandemic, Sweden’s death toll is entirely unremarkable in this broader European context; it is near the middle of the pack.  Norway and Finland are the outliers in Europe, at the extreme low end of Covid-19 impact.

The same picture emerges if, instead of focusing on recorded deaths from Covid-19 itself, we focus on the total number of excess deaths in each country, from all causes, as compiled by Euromomo.  In these z-score plots, the number of deaths is substantially above the seasonally-adjusted, predicted number of deaths when the solid blue line is above the dashed red line; see the Euromomo site for technical details.  Note that these plots allow direct comparison of the relative numbers of excess deaths in countries of different sizes; in any country, a solid blue line that reaches a z-score of 5 means that a country’s death count is five standard deviations above the expected count for that country, in that time of the year.

In the three plots below, we see that Sweden did indeed have a ‘wave’ of excess deaths in the spring of 2020, which was not present in Finland or Norway.

But now compare Sweden to Belgium, Slovenia, Spain, and Switzerland.  

Here we see, again, that the Covid-19 pandemic has had a less severe impact in Sweden than in these other countries; we also see that these countries differ substantially in when the toll of the pandemic was felt.  In Spain, like in Sweden, the death toll was mostly in the spring; in Slovenia and Switzerland the toll was mostly in the fall, though Switzerland also had a smaller wave in the Spring; in Belgium there have been two clear waves, with another small wave in between.

Is there a justification for focusing specifically on Norway and Finland as the appropriate comparisons for Sweden, as Dr. Berkowitz does, and as many other media outlets have done?  The implicit assumption seems to be that because the three are all Scandanavian countries, in close geographical proximity, Sweden would have done as well as Norway and Finland if only they had adopted more stringent lockdown measures.  

But does geographical location actually predict the severity of a country’s Covid impact? There is little indication that it does.  Covid mortality per 100,000 population is much higher in Spain (108.80; again, all data from Johns Hopkins) than in Portugal (67.17); it is much higher in Belgium (170.97) than in the Netherlands (66.89); much higher in the UK (110.73) than in Ireland (46.09).  In a statistical model predicting the severity of a country’s Covid impact, it is not clear that geography, or even the severity of the impact in adjacent countries, would play much role at all. Thus, there is no clear reason to judge Sweden in comparison to Finland and Norway, as opposed to judging Sweden in comparison to, say, Belgium or Slovenia.

Finally, let’s consider the impact of Covid in Sweden compared to the U.S., rather than to European countries, as well as the impact compared to Massachusetts and Hampshire County specifically, where the debate in the pages of the Daily Hampshire Gazette is taking place.  The U.S. has experienced 105.68 Covid deaths per 100,000 people – higher than Sweden, at 85.70.  Massachusetts has experienced 180 deaths per 100,000 people – more than double that of Sweden!  Even Hampshire County has experienced 123 deaths per 100,000 people, more than Sweden.  (These last two values are computed based on the latest state and county-level death counts from the NY Times.) 

We are left, then, with no evidence that the Swedish experiment has been a “crushing failure,” as Dr. Berkowitz puts it.  Nine months in, Sweden’s choice not to ‘lock down’ has left it in the middle of the European pack, in terms of Covid impact, and with fewer Covid deaths per 100,000 population than the U.S., Massachusetts, or Hampshire County.  At the same time, Sweden has managed to continue to educate its children, and has avoided many of the other health costs and economic costs of lockdowns.  This bears repeating: Sweden has a lower Covid death count, per 100,000 population, than Hampshire County, despite the fact that we in Hampshire County have closed our schools and colleges, shuttered businesses, and enforced social isolation.

Ms. Chehade is right:  It is an interesting question why the media and expert opinion have been so eager to condemn Sweden’s response. It is, perhaps, as interesting as the question of whether Sweden’s response is the right one.

Adrian Staub (astaub@umass.edu)

Thanks, as usual, to Rosie Cowell, Carlo Dallapiccola, and David Huber.

Addendum: For added visual impact, I attach a plot of the number of daily COVID deaths (weekly average, to smooth over fluctuations in daily reporting of data) for Sweden and Massachusetts, normalized by population (i.e. deaths per 100,000 people). As can be seen, except for a span of about 7 days at the very beginning, at no point during the pandemic has the death rate in MA been lower than that in Sweden, and much of the time it was more than a factor of two higher.

Carlo Dallapiccola