The World Health Organization’s tally of Swedish infections and deaths

If you’re a regular reader of the mainstream media, you likely believe Sweden is struggling worse than the rest of the world with the pandemic because of its democratic approach to non-pharmaceutical interventions for battling SARS-CoV-2.

“Sweden registered 22,319 new coronavirus cases since Friday,” the Reuters news agency reported on Tuesday. “It was the highest weekend figure since the start of the pandemic and compared with 20,931 cases recorded in the corresponding period one week ago.

“Sweden’s death rate per capita is several times higher than that of its Nordic neighbors but lower than several European countries that opted for lockdowns.”

The former claim is true, the latter badly off. But it fits nicely with a narrative that began near the start of the global crisis when Sweden decided to ask for the cooperation of its citizens instead of ordering them how to behave.

One would think the media – especially the U.S. media born of the idea of broad-ranging freedom of expression and ideas – would be all over an objective assessment of the effectiveness of the Swedish approach to the pandemic, but one would be wrong.

The narrative has focused on the early and preconceived conclusion Sweden failed to protect its citizens and thus thousands died, and one of the key problems with the media today is that once such narratives are established they are seldom challenged.

There is no doubt Sweden overlooked the danger of the SARS-CoV-2 virus in old folks’ homes, something for which rogue epidemiologist Anders Tegnell apologized back in June. 

A government commission has now agreed with that conclusion, and it has become international news. The Associated Press described the commission’s decision as “a stinging official report….

“The Scandinavian country has stood out among European and other nations for the way it has handled the pandemic, for long not mandating lockdowns like others but relying instead on citizens’ sense of civic duty.”

This was pitched as a bad thing.

The numbers

There is no doubt the elderly in Sweden were hard hit by the SARS-CoV-2 virus that causes the sometimes deadly disease COVID-19.

“As of December 17, 2020, the highest number of deaths due to the coronavirus in Sweden was among individuals aged 80 to 90 years old. Indeed, 3,315 deaths out of the Swedish death toll of 7,893 deaths related to people aged within this age group,” the Statista website reported.

Those deaths among the old, or what some might consider the very old, accounted for 42 percent of all deaths in Sweden. Most of them happened in care homes, according to the AP. 

The Swedes should have done better, but despite that they are not doing so bad compared to the other members of the European Union (EU). Among the 27 member states in that organization, the average death rate as of Tuesday according to the data compiled by Oxford University’s Our World in Data was 64 per 100,000.

The Swedish death rate was 79 per 100,000 (though WHO reports 80 per 100,000) which tied Sweden with Croatia for ninth on the list of EU countries. That’s three times more countries than several.

The Swedish rate was less than half that of Belgium, which ordered strict lockdowns early, relaxed them in summer, and then imposed them again when the pandemic blew up once more in the fall.

Sweden is also doing as well as Switzerland, a non-EU member, and better than Italy, Spain, France and the United Kingdom, no longer a member of the EU. Here’s a full list of EU countries from first to last as of Tuesday based on Our World in Data numbers:

• Belgium: 161/100,000
• Italy: 115
• Slovenia: 114
• Spain: 105.4
• Czechia: 97
• Bulgaria: 97
• France: 94
• Hungary: 86
• Sweden: 79
• Croatia: 79
• Romania: 75
•  Luxembourg: 72
• Poland: 67
• Netherlands: 62
• Portugal: 61
• Austria: 60
• Ireland: 44
• Malta: 44
•  Greece: 41
• Lithuania: 38
• Germany: 32
• Slovakia: 30
•  Latvia: 25
• Denmark: 18
• Estonia: 14
• Finland: 9
• Cyprus: 8

The UK is at 101 deaths per 100,000, and the U.S. at 98 per 100,000, according to Our World in Data, with a huge variation across the continent. The Worldometer tracker puts the U.S. range of deaths from 208 per 100,000 in New Jersey, near three times the Swedish rate, to 18 per 100,000 in Vermont, near one-fifth the Swedish rate.

Alaska is at 26 per 100,000, which puts it at fourth-best behind Vermont, Hawaii at 20, and Maine at 23.

Lockout versus lockdown

Hawaii – like New Zealand (0.5 deaths per 100,000) and Norway (5.4 deaths per 100,000) – controlled the spread of SARS-CoV-2 with a lockout on travelers and quarantines of new arrivals that helped keep the virus out of the islands.

That presented a problematic issue for a state with an economy heavily dependent on tourism. Hawaii couldn’t keep tourists away forever without committing economic suicide.

Thus an opening began in October. It did not go well.

“Mostly virus-free Kauai hit by pandemic after Hawaii travel resume,” USA Today headlined on Sunday.

“….Local residents spent the first seven months of the pandemic sheltered from the viral storm,” said the AP story below the headline.

“Early and aggressive local measures coupled with a strictly enforced statewide travel quarantine kept Kauai’s 72,000 residents mostly healthy — the island had only 61 known coronavirus cases from March through September. But on Oct. 15, the state launched a pre-travel testing program to reignite Hawaii’s decimated tourism economy.

“Kauai then went from having no active infections at all in the first part of October to at least 84 new cases in the ensuing seven weeks. The surge seeded community transmission and led to the island’s first – and so far only – COVID-19 death.

Travel to Kauai has again been shut down.

“Despite Hawaii’s cautious effort at reopening that allowed travelers who tested negative for COVID-19 before they flew to the state to sidestep quarantine rules, the Kauai spike illustrates the difficulty of preserving public health – even on an isolated island – when economic recovery relies on travel,” the AP said.

The situation in Hawaii illustrates that COVID-19 is not a simple problem to solve in a world where economics have gone global. This is especially so when the natural realities – COVID-19 kills mainly the old and infirm – are weighed against the costs to the working majority of people when businesses are shutdown.

The tradeoffs are difficult and assessing where they have made differences even more so.

The responses to the pandemic have not been much different in Norway, with its low death rate, than in its neighbor Sweden, with its much higher death rate, though the media attention has been different because the words “herd immunity” were never used in Norway.

Herd immunity – the idea that the infection stops spreading after large numbers of people have caught the infectious disease, recovered, developed antibodies, and thus ceased to be available as carriers – was from the start of the pandemic and remains a much-debated topic.

There is now widespread hope newly available vaccines will help speed herd immunity, but as Dr. Roy Anderson of the Imperial College of London noted in a commentary published by The Lancet, “data on immunity to other coronaviruses suggest that immunity to SARS-CoV-2 might be short-lived, perhaps 12 to 18 months in duration. Whether past infection will prevent severe COVID-19 on re-exposure to SARS-CoV-2 is not known at present.”

Eventually, this will all work itself out because that is how natural selection, the cornerstone of evolution, works. To put it simply, the weak die, and the strong survive to reproduce.

The progeny of the survivors become more adapted to fending off the pathogen, and the species is likely to fight it to a standoff as it has other coronaviruses now in circulation among the common-cold viruses.

The flu is illustrative of the evolution though COVID-19 is not at all like the flu at this time even though it was once worse. The Spanish flu killed an estimated 50 million people worldwide in 1918, according to the national archives. 

At a similar death rate today, about 217 million would die. The global count of those dead from COVID-19 to date is just over 1.7 million. Despite the staggering number of deaths in the early 1900s, humans adapted to the Spanish flu and went on living.

Flu outbreaks continue to this day, but none have been as deadly as in 1918-1919. Vaccines have helped reduce flu deaths, but people still die from the disease.

COVID-19 is likely to go the same way over a number of years. The public policy issue revolves around how to manage the crisis in the interim.

Misinformation easily variable as such doesn’t make this easier. It only undermines trusts in established institutions of which the media is one. And the lack of trust isn’t making things better.

Personal safety

The best way to slow the spread of this or any infectious human disease remains for people to stay away from each other.

Granted, that’s easier said than done. Humans are social animals, and certain interactions are needed between them in order to allow the economy that supports all to survive.

As a result, many countries are masked up,  which may or may not help, in an effort to allow life to go on something like normal. Studies and models differ on exactly how much masking reduces the spread of the disease, but it is one of the few things people might be able to do to help slow the spread in close encounters, especially indoors.

The difference between outdoors and indoors is obvious in the infection rate since the summer shift from eating and meeting outdoors before the weather pushed everyone indoors.

The U.S. infection rate has been soaring since October as might have been expected. One study found the risk of indoor infection almost 20 times greater than outdoor.

Pretending COVID-19 isn’t a threat doesn’t change this. But neither does fear-mongering its danger to those at low risk or chastising other countries for their handling of the disease.

No matter how the Swedes have done, they’ve done better than the U.S., and they’ve done it with a whole lot less public acrimony. which is something of a win in and of itself.

Correction: The date of the Spanish flu was incorrect in an early version of this story.