Sweden's soft touch in the age of narrative control
The only major Western country in the "hot zone" of the Covid-19 pandemic not to have imposed large-scale shutdowns of public facilities and the economy has been Sweden. They have closed higher education (although not grade schools, which have remained open), banned bar seating and congregating around bars, banned large gatherings, and encouraged voluntary distancing. This policy has been spearheaded by Sweden's state epidemiologist Anders Tegnell, who has argued that shutting down society, with all of its inevitable negative economic and health consequences that are difficult to predict and quantify, makes much less sense than focusing restrictive measures on isolating the most at risk within the population. While distancing themselves from the idea that their policy is based on achieving so-called "herd immunity", in unguarded moments Sweden's health officials admit that that's not inconsistent with their purpose.
The reaction in international media has been scathing. Sweden was experimenting with human lives (as if lockdown countries weren't) and ignoring the unequivocal advice of global health experts and organizations. Surely they would soon lead Europe in Covid-19 cases and deaths. Week after week new headlines intoned about some new ominous figure from Sweden, a blip in the trend-lines that, in reality, broadly followed those in the rest of Europe. Each new story was careful to compare their numbers only to those of their Scandinavian neighbors, which were doing better than them, but never compared them to Belgium, France, the Netherlands, Italy, Spain, or the UK, which were performing either significantly worse or comparably to Sweden on a per-capita basis but with much more economic and social dislocation to their populations. Many pointed out that Britain had initially adopted a strategy much like Sweden's, only to panic and impose lockdowns when cases and deaths began to skyrocket. In time, they said, Sweden's health experts would also be brought to their knees, and then to their senses.Â
Health and government officials in Britain had, in fact, panicked, but it wasn't because of some unexpected jump in cases and deaths that they were observing. It was because of the publication of a single model by epidemiologist Neil Ferguson at Imperial College London. Based on very thin data the world was only beginning to learn of, let alone dissect, the Imperial College model predicted 500,000 British deaths and 2 million US deaths if no restrictive measures were imposed. They later drastically revised down their numbers, provided, they said, that everyone continued to stay in their houses.Â
The whole sorry episode reflected a wider bias in Western coverage of the outbreak. If a person were to restrict himself to establishment media sources -- the networks and print media that were always featured on charts my liberal friends posted during Russiagate as the most trustworthy -- he would think that 97% (sound familiar?) of epidemiologists, virologists, and other health experts believed Covid-19 such a threat to public health that the only rational response was to close everything down across the globe and order everyone into their homes. You had only to broaden the net of acceptable sources ever so slightly (I'm not talking InfoWars here) to find that there were a not-insignificant number of qualified health experts, including epidemiologists, who thought the lockdowns were crazy, or at least unjustified, due to the likely negative economic and health effects of the lockdowns themselves, all of which were just as unquantifiable as the effects of this newly identified virus. Surely any policy that sought to err on the side of caution would take into account the other side of the equation when determining what was cautious?
That says more about the state of our trusted media sources than it does about Sweden and its health officials. It should have been clear to anyone looking at the situation objectively that there was more than one informed and educated view about the proper public policy response to the pandemic, and that only one side of those views was being presented as worthy of consideration. That dynamic is not unusual. It's a feature of journalism the world over that media outlets defer to the pronouncements of the officials and elites of the countries in which they're based. Officials who impose policies that cause hardship in their countries don't like policy nonconformity. If another country in similar circumstances can be shown to be faring comparably in their objectives while avoiding authoritarianism, that makes it that much more difficult on officials in the more restrictive countries to claim, as many have in this country, that they know best and that to question them is dangerous and irresponsible. In extreme cases, that can mean significant harm is caused before cooler heads prevail and even the Purveyors of Truth® begin to take a second look.
As so often happens when facts seem get in the way of the dominant narrative, the goalposts have shifted often in the coverage of Sweden. When predictions of runaway death failed to materialize and instead the country showed up in the upper-middle of the pack in terms of deaths attributed to Covid-19 per capita, all kinds of reasons were put forward for why that was the case there but surely wouldn't have been elsewhere if the same policies had been adopted. Sweden had a much lower population density than countries faring more poorly like Belgium and the UK. Sweden wasn't testing enough and was therefor understating its true infection and death rates. Swedish people were more responsible than Americans and were voluntarily adopting distancing and social isolation to such a degree that government-imposed restrictions would be superfluous. And finally, Sweden had socialized healthcare with universal coverage which made its policy possible without runaway deaths. Let's take each one of these in turn.
Sweden's population is roughly the same as Belgium's, at about 10 million. However, Belgium's population statistics show it has a population density of about 974 people per square mile, with a total area of about 12,000 square miles, while Sweden, a much larger country geographically (almost 174,000 square miles), has an official population density of 60 people per square mile. So on that basis you would think disease transmission would be much less likely in Sweden than in Belgium (built-in isolation!). But what those statistics don't show is that vast tracts of Sweden, most of the northern two-thirds of the country, are mountainous and very sparsely populated, so that most of the country's population is concentrated in the southern one-third. That still doesn't create a population density comparable to Belgium in the area where most Swedes live, but it significantly skews Sweden's official population density downward. Sweden's population is 85% urban. That's not to say that there aren't places in the world where population density can make a big difference. The New York metropolitan area is one of the highest-density population areas in the world. It may be that more restrictive policy prescriptions make sense for these areas.
On the testing front, as of this writing Sweden has tested almost 120,000, which is almost 12,000 tests per million population, with the number of tests being conducted having increased by mid-April to 20,000 per week. On a per-capita basis, that's fewer tests than most other Western countries have conducted. Only France is slightly lower in Western Europe, with 11,000 tests per million. That could obviously have an effect on number of confirmed cases being reported. It seems less likely that that would be significantly impacting the number of deaths attributed to Covid-19 because those being prioritized for testing are the ones with the most severe illness and the most at risk of dying from the disease.Â
It's unclear whether Sweden's guidelines for attributing deaths to Covid-19 have the same built-in biases as in the US. Here, the CDC's guidelines for coding disease and filling out death certificates weigh heavily in favor of finding Covid-19 as a cause. The guidelines call for attributing deaths to Covid-19 even in some cases where the death is only presumed to have been caused by the disease. In some cases, that's even in the absence of novel coronavirus testing having been performed at all, not just in cases where there's been a positive test but uncertainty as to actual cause of death due to comorbidities (a big problem due to the vast majority of Covid deaths being in those who are old and who were already sick, although not a problem limited to Covid). And it's true that hospitals get higher reimbursements for coding Covid-19 in the US. Only when statistics have been compiled for total mortalities during the last couple of months from every cause (not broken down into causes) will we know whether and to what extent there has been an unusual jump in deaths. That's true in the US, in Sweden, and everywhere.
The idea that Swedes are just more responsible people who do the right thing without being told to is a hard one to evaluate objectively. However, assuming that the "right thing" is to stay home, it IS possible using aggregated Google data to determine whether Swedes chose to do that (thanks to Jamie Gates for pointing me to this resource). As of April 26, the most updated report available, mobility trends for retail and recreation in Sweden, which includes places like restaurants, cafes, shopping centers, museums, and theaters, had decreased 13% compared to baseline. Grocery and pharmacy mobility had decreased 5%, transit stations 31%, and work places 11%. Meanwhile, mobility trends for places of residence had increased by 4%, while parks had increased by 82%. So, as one would expect in a global pandemic in which the rest of the developed world was shutting down, Swedes did choose to reduce their traffic to some public spaces. But it seems the bulk of that traffic transferred to parks with wide open spaces. Compare those numbers to the locked-down United Kingdom, and you find that there retail and recreation was down 78%, grocery and pharmacy 37%, parks 10%, transit stations 64%, and workplaces 48%. Residential mobility was up 14%. By most accounts, unlike lockdown countries Swedes haven't deserted public places but are generally practicing distancing measures to a degree as they go about their lives.
The belief that Sweden's socialized healthcare system is what permits it to take a more lax approach is a hard one to dislodge because it's based on an almost religious belief that the sole factor in differing health outcomes among advanced countries is the type of health systems they have. In any event, as recently as 2017, Sweden had a relatively low number of hospital beds and intensive care unit beds per capita, lower than most countries in the EU. And Sweden's advice to those with symptoms that are suspected to be caused by Covid-19 has been, like in the US and most other countries, to stay home unless their symptoms become severe enough that they would be hospitalized even in the US without insurance. Even now, as the number of active cases in the US has surpassed Western Europe by a large margin, Western Europe has suffered more than twice as many deaths attributed to Covid-19 than the US. Sweden has had more deaths than they hoped to have by now when they instituted their Covid policy, but they attribute that to a higher number of deaths in nursing home facilities than anticipated. Making a comprehensive comparison of global healthcare systems is a complicated topic that's beyond my scope here. Far be it from me to defend America's bloated system with all its flaws and over-reliance on the insurance model for even the most basic services. But the US also has a higher obesity rate than any other developed country -- a full 10% higher than the UK -- and obesity is linked to almost every chronic disease that Westerners die from, from heart disease to diabetes to many cancers and strokes. Many of these conditions are also comorbidities to Covid-19. And yet, if official statistics are to be believed, the number of deaths has been far higher in socialized-medicine Western Europe despite a comparable number of total, accumulated cases as the US.
Ultimately, time will tell if Sweden's health officials and politicians made the right choice by their own standards. You can always say that fewer cases and fewer immediate deaths would have occurred had they implemented a lockdown like the rest of Europe. The mechanics of disease spread say that's likely true, although not nearly to the degree that those with the most dire early predictions attribute to the effect of lockdowns. But it's also true that global lockdowns have already created huge negative economic consequences (including 30 million new unemployment filers in the US alone) that will ripple through the lives of millions of people. Medical procedures for conditions as serious as cancer have been canceled in some cases as hospitals geared up for overwhelming numbers that in the vast majority of places, thankfully, never materialized. The long-term negative effects of the shutdowns in terms of employment, physical health, and mental health won't be known for a long time. And the government's assertion of powers it has never before exercised but will now be more emboldened to invoke creates its own risks for civil liberties in the future, however much some want to minimize it.Â
Those who once lauded American federalism praised the virtues of having fifty state policy laboratories in which various public policies could be tested against each other, with the best rising to the top and being adopted in other states. Yet we've reached a point where, not just at the level of American states but even on a global basis among developed countries, that virtue is seen as a vice. All are expected to conform and never to doubt that something far worse awaited at the end of the road not taken. Nevertheless, Sweden persisted.Â
Richie Graham is based in Little Rock Arkansas USA and writes from a free-market libertarian, anti-interventionist perspective.