What Is Really Happening In Sweden?

As some sources are touting how well Sweden's approach to C19 is working, and more importantly, how it is going to work, while other sources are rating it a disaster or more importantly, going to be a disaster, I thought I would try and find out what is really happening. I had a couple of little thoughts about some pieces that might be overlooked, as everyone chose their favorite data trying to prove their points.  My little thoughts turned out to range from very true to completely mistaken.

Composing this post in my head, I have several times put together a lead sentence beginning "FIRST,..." or "The first thing we need to keep in mind..." but I keep changing what the first thing is.  I have to say I don't know what of the following is most important, nor what bits are better introductions to the rest.  Should myth-busting be primary or should I attempt to find what are the most likely driving forces going forward and hammer those home?  Dunno.

FIRST, the Swedes are not at all unified on this.  While the Prime Minister is not acting solo, his idea of keeping things open has most of his own medical community up in arms.  The epidemiologists think he is flat wrong. Doctors, nurses and other health care workers are petitioning the government to institute stricter measures. Their repeated argument is that the very lax standards of the early weeks, where nursing home workers were not even encouraged to wear gloves and masks, nor given hand sanitiser at work, led to many needless deaths.  The government's response has been "Yes, that's true, sorry about that, but that's fixed now so we aren't going to do more."

It is unusual for Swedes to act this way.  Getting along, compromising, smoothing things over, not making a scene in front of the public - those are second nature to them.  Those are my mother's people and "Don't make a scene," said quietly through clenched teeth was a cultural anchor point. Relatedly, there is usually an elephant in the room whenever Swedes hit controversy. Up until about 1990, it was their behavior during the Second World War and the Cold War, and since then, the elephant has been the behavior of immigrants. A commenter a month ago over at Maggie's had said that the deaths in Sweden have been wildly disproportional among immigrants and residents of large nursing homes in Stockholm.  From that I suspected that Malmo and to a lesser extent Gotheberg were going to have high numbers because of their African and Middle Eastern populations, but this did not turn out to be so.  Stockholm is the center, all other regions trail.  I did eventually find an article that discussed C19 and immigrants, unsurprisingly written by researchers from Georgetown, GWU, and Australia, not Sweden. The short version is that the Somali population follows none of the guidelines and are heavily overrepresented among the deaths. As they are less than 1% of the population, this will burn through them, and they will carry the disease to others during that time, but that this may be self-limiting.  I don't know that I'd want to rely on that, frankly. I can't think of an historical example where that has happened.

I had heard that Sweden was partially shut down, but as it is voluntary it has avoided the overreach of the governments of other countries.  Sweden is actually quite shut down, not much more open than other European countries.  I can see a considerable advantage to the voluntary nature, as it removes some of the arguments about end points, and government officials can be less worried about being blamed if things go wrong.  However, that may not provide the advantage we expect. Sweden already has "recommended guidelines"

...most preventative measures don’t involve involuntary quarantine.  Instead, individuals are expected to act responsibly and follow the given recommendations, including immediately seeking out medical assistance if signs of infection appear.  If the recommendations are not adhered to, a designated physician in the relevant medical region can decide on mandatory quarantine or isolation. (underlining in original)

Swedes are a responsible, cautious people, and thus their level of voluntary compliance may be similar to Americans' mandated compliance.  They themselves say they don't think America has the culture for this.  Here are the guidelines put in place April 1 according to the US embassy in Sweden.

On April 1, Swedish Public Health Agency expanded guidance for individuals and organizations to comply with Sweden’s Law on the Prevention of the Spread of Infectious Diseases:

    Shops and shopping centers should limit the number of customers at the same time, develop alternative solutions for lines or indicate how far customers should stand between each other.

    Local sports teams should hold practice outside, postpone matches and competitions, and limit the number of spectators.

    Employers should ensure that staff and visitors stay away and that employees work from home to avoid unnecessary travel.

    Public transport companies should limit the number of passengers and adapt their schedules to avoid crowds.

    Individuals should keep distance in public places, refrain from attending events such as parties, funerals and weddings, and avoid travel during rush-hour and any unnecessary travel.

    People who are over 70, or belong to other risk groups, should limit all social contact and avoid public transport, shopping in pharmacies, supermarkets, or crowded places.

The Government of Sweden has banned public gatherings of more than 50 individuals.

This looks very similar to everyone else's mandates.  If they are following this, their situation is actually not that different from other countries.  As I noted above, however, if it is voluntary you can get a lot of the overkill eliminated quickly.  People will say - this is nuts.  I'm going fishing anyway. Having the default be that the citizens are trusted is just not the same thing as mandating.  Whether that will work with Americans is another discussion, which I am not having here.

The Swedes do put the pressure on, also , whatever you have heard.  They covered  a park with chicken manure so the college students wouldn't break distancing by drinking there.  Also, however voluntary they say it is, if you break those guidelines they will close you down.

The current data is that Sweden is 6th-worst in the world in deaths-per-million, and pulling away from 7th-11th slowly.  It may pass France for 5th in the next month or so. I don't see how it goes higher than that, though.   Stacked against that are the bits of expanded information I noted above:  Okay, we got it badly wrong on the nursing homes, but we fixed that and things should level, and also if you take out the Somalis and a few other immigrant groups who just don't get it, the conditions for the other Swedes look pretty good.  I find that only marginally persuasive, because every country could advance some exceptions why their numbers are better than they look.  The US could say "well, take out New York."  The Swedes have decided not to call out the Somalis and other Muslims and treated the added deaths as a sunk cost, but think they are still going to be okay in the long run.  The evidence for this is that they can recite the new magic words "herd immunity," which is somehow supposed to stop all further discussion.

Sweden has an economy that is less tourism-dependent than others, and has a lot of jobs that can be done remotely. The other Scandinavian countries, plus Estonia and Germany are their best comps , and they are doing far worse than all of them in deaths-per-million, but only marginally better in economy.  Even if their idea plays out moderately well and they don't get hit as hard this fall, they are already so far ahead of Norway, Finland, and Denmark in damage that they will still be worse.

Their hope has been that keeping their economy afloat while others are tanking will be good in terms of general prosperity, and better in the long run in terms of economic advantage. Yes, I hear that.  I get it that this is the theory. I also know that Sweden started with enormous initial advantages, but is still behind.

So far, it hasn't worked, and  it hasn't worked, but you can find lots of articles that say it might work, or that the theory is that it should work, or that, well, it's not any worse than what's happening elsewhere. The places that have reduced deaths in practice are South Korea, Singapore, Japan, Taiwan, and Hong Kong.

We actually don't know what the herd immunity numbers are for this disease, and neither do the Swedes or anyone else.  Native Americans did eventually get herd immunity to European diseases, yes, after 90% of them had been wiped out. Europeans still don't have a lot of herd immunity to malaria, though, and even Africans still die in droves from it.

There may be good evidence for the relative safety of opening up the American economy from our own experience here, or perhaps from other countries.  There isn't much to write home about from Sweden.  The most one can say is that 1) maybe it might not be worse in the long run, 2) we have this theory how it could be better, 3) the higher death rate might be mostly fixed, and 4) all this is dependent on have a culture like ours.