Man behind Sweden’s controversial virus strategy admits mistakes

https://www.bloomberg.com/news/articles/2020-06-03/man-behind-sweden-s-virus-strategy-says-he-got-some-things-wrong

by nreece • 6 years ago

84 103 6 years ago

bloomberg.com

twelvechairs• 6 years ago

"The greatest of faults is to be conscious of none" - Thomas Carlyle

alpanka• 6 years ago

To be fair, they didn't have the resources to do it any other way.

For example, lack of gloves etc led to spread of covid in elderly care homes. That happened because countries like Germany stopped export of gloves and mask from their factories (and hijacked some shipments passing their borders).

toyg4• 6 years ago

Maybe ask their neighbouring countries, who managed to do it?

logicchains3• 6 years ago

Apparently Sweden had a few large nursing homes, whereas Denmark had lots of smaller nursing homes, so it was easier to manage the spread.

wukerplank• 6 years ago

Fair point about Germany, but locking down like the rest of Europe is not a question of gloves or medical equipment. There must have been different reasons for that decision.

jacobwal• 6 years ago

Swedish and biased here, but as far as I understand a large share of the deaths come from nursing homes. The tactics to limit the spread in those homes failed. However, that is largely a separate question of policies for the broader population, which is what most news outlets have been reporting as controversial.

torb-xyz• 6 years ago

AFAIK they didn't have very different resources from Norway, but Norway decided to be much more careful and lockdown more and earlier.

Norway: 237 deaths

Sweden: 4468 deaths

(Yes there are more people in Sweden than Norway, but not that much more).

My (personal, subjective, I'm not a doctor, etc…) impression is that Sweden authorities where afraid of overreacting and the economic fallout of that. The Norwegian government (despite currently being right-wing) still decided to be careful and eat the economic cost.

Sources: https://en.wikipedia.org/wiki/COVID-19_pandemic_in_Norway https://en.wikipedia.org/wiki/COVID-19_pandemic_in_Sweden

timkam2• 6 years ago

There are additional relevant aspects:

1. A main aspect of the response, i.e., the issuing of "recommendations" instead the implementation of outright restrictions seem to have been caused by legal concerns, which means this is probably not something that Tegnell and his team decided.

2. Norway can rely on its natural resources and on the resulting "oil fund" to mitigate an economic crisis, Sweden lacks such resources, at least to the Norwegian extent.

3. The Norwegian government is "right-wing" from a Scandinavian perspective. Many of its policies would be considered socialist in the US.

4. Most deaths in Sweden are related to elderly care and the lack of preemptive efforts to prevent covid-19 spread in elderly care homes, which was certainly a big mistake, but somewhat unrelated to many of the measures that Sweden is scrutinized for.

timc32• 6 years ago

I see no evidence to support that claim.

They could have imposed much stricter measures to limit public gatherings and do it faster, even more public messaging, clearer guidelines, working to make sure that everyone was inline with the guidelines.

Yes it would have helped with massive amount of testing, which they said wasn't possible, and tracing and more effective quarantine.

alkonaut5• 6 years ago

The PPE is only part of the problem. A couple of decades of budget cuts meant elderly care has been suffering lately. Staff is stretched extremely thin and lots of temporary staff means you can have some staff that works in 4-5 elderly homes in a short period of time. No resources to isolate those returning from hospital after having the disease. So they basically end up back in the same home, where they are cared for by that staff that works with uninfected patients and in several other homes.

The messaging from the authorities was clear: don't do that. Protect the elderly. The mistake was believing that saying it would magically make it happen, when there is no money, no training, no equipment.

ardy42• 6 years ago

To be fair, they didn't have the resources to do it any other way.... For example, lack of gloves etc led to spread of covid in elderly care homes.

That doesn't make sense. Social distancing (which includes lockdowns) is a mitigation for the lack of other means of infection control (like PPE and treatments). If you don't have PPE, then you have to social distance more strictly to reduce transmission.

toyg4• 6 years ago

On one hand, it's good that he's intellectually honest enough to finally admit that "mistakes were made". It's a sign that he's still a scientist and not a full-on politician, who would never do that.

On the other, I wonder how one can sleep at night with the knowledge one was directly responsible for thousands of deaths. Or how can one's career recover from something like this.

diggan2• 6 years ago

I'm Swedish but I live in Spain.

I feels like it's way too early to say which country did good here and which country did bad. In Spain we're mostly still in quarantine, and will continue to be. There are so many factors in this world events that it's hard to say who handled it best. Think it'll take years before we can come to any conclusions. On the surface, it seems Spain handled it much better than Sweden, as we used to have lots of cases, but now we have less. Sweden instead have remained with the same rate since end of March. So looks better, but all the falloff from this event has yet to been measured so again, too early to tell, at least for me.

chess_buster• 6 years ago

Meanwhile the other nordic countries are covid free.

logicchains3• 6 years ago

On the other, I wonder how one can sleep at night with the knowledge one was directly responsible for thousands of deaths.

He's not directly responsible for thousands of deaths. Not doing something that could have saved lives is different from actively doing something to hurt people. Otherwise we'd all be responsible for hundreds of thousands of deaths because we didn't spend a bit of money to donate more mosquito nets to Africa, where a huge number of people die every year from preventable malaria.

smt88• 6 years ago

Not doing something that could have saved lives is different from actively doing something to hurt people.

What if your job is to do something to save lives?

To take your analogy to its logical conclusion, you're also saying a firefighter isn't responsible for a building burning to the ground, even when he's standing in front of the building with a hose in his hand.

toyg4• 6 years ago

Otherwise we'd all be responsible for hundreds of thousands of deaths [in] Africa

I'd argue that we are (and not just for mosquito nets), we just rationalize it away and forget it. Distance helps a lot, in that sense. But this guy is likely to meet or talk to people who were directly affected by his decision, basically every day for the rest of his life.

noetic_techy2• 6 years ago

I wonder how one can sleep at night with the knowledge one was directly responsible for thousands of deaths.

I have to disagree, this is not how public policy works and there are more than just loss of life to consider such as economic impacts and cascading effects. You cant consider this from a "all lives are sacred and must be preserved" perspective. Believe it or not public policy DOES put a price on life and for good reason: you cant mitigate away ALL risk of death. Think of speed limits or even the normal flu death rate. You can't have a functioning society if everyone lives in bubbles and drives 5mph because all life must be preserved. Even the US CDC acknowledges this, and they themselves calculate on average the economic loss of a human life is 10 million USD over their lifetime. When the mitigation cost (including cascading effects) exceeds this, then its not considered reasonable to implement at a public policy level. Sure he is an epidemiologist but he has been designated to make a public policy decision so I don't think its fair to place the blame on him. Flatten the Curve focused on hospital capacity and the avoidance of overwhelm and triage death, not necessarily covid related death and not preserving all life. The area under the curve is the same, we will all be infected at some point. I highly doubt any vaccine will be effective since they were failures for SARS or MERS. My money is on better treatments.

2rsf2• 6 years ago

The word "he" appears only once in the article and in a different context, Tegnel speaks about mistakes but not of all them are his. He leads a group of experts and an organization, he did not make the decisions himself.

timc32• 6 years ago

Someone at some point has to take responsibility. That should be the head of the organisation or whoever is tasked with making the decisions. Whether it's a CEO, President, Prime Minister or the head of a public health authority.

AlbertoGP• 6 years ago

Yes, Jocko Willink explains very well in this video

“At what level up the chain does extreme ownership stop?” https://www.youtube.com/watch?v=WsMScRfjVC0

“When something goes wrong, where does it stop? [...] Ramadi, friendly fire incident... and I took ownership of it. Now you got to remember also [that] people below me in the chain of command said «no it’s my fault», «no it’s my fault» [...] I said «No, it wasn’t your fault, it was my fault. Now you could say... you could look at my boss and go «why wouldn’t it be your boss’ fault?», «why wouldn’t it be his boss’ fault?» [...] why wouldn’t you take it all the way up the chain of command to the president of the US, since the senior person in the US military is the president, why wouldn’t he say «hey, Jocko’s unit had a blue-on-blue and it’s my fault», right? Theoretically, that’s what Extreme Ownership is. Here is the deal: the goal of Extreme Ownership isn’t just to take ownership. The goal of E.O. is to actually solve the problem.”

For anyone to whom that sounds interesting, I recommend listening to that whole segment, 18 minutes, where he explains in detail how someone taking responsability at the right level gets the problem solved.

2rsf2• 6 years ago

Absolutely, and as far as I have heard he is not avoiding responsibility to his organization's actions and decisions, so far he is not talking about resigning but definitely about learning from mistakes.

But many of the mistakes were made above or parallel to him, some are not directly related to Corona or health, for example privatization of elderly care homes or the number of immigrants living in crowded conditions.

puranjay2• 6 years ago

Can this virus even be controlled? Or rather, beyond a point, does it even make sense to try - without dismantling our current economic structures completely?

As soon as you open international borders and ease lockdowns, regions and countries with few cases will see cases rise. We got to our current situation with just a handful of imported cases. Now that there are millions of carriers, you can't possibly hope to contain it with people traveling everywhere for work and leisure. Quarantining incoming travelers isn't feasible, at least not without sacrificing international business and leisure travel completely (a huge chunk of the GDP).

This is a siege where the castle only has food for two months. Unless you expect reinforcements (i.e. a vaccine or cure), extending the siege mostly means starving to death.

a-saleh• 6 years ago

I think the point is to find a point.

I.e. I was watching with some degree of unease how some of our official in Czech Republic seem to have had a bit of a power trip with closing the borders, e.t.c.

Fortunately that seems to be over, with restrictions on travel to bordering countries being slowly lifted.

Now it seems, that just wearing masks in shops and public transport should be enough? Accompanied with remoting where possible? I.e. there are no more spikes, and we have had preschools and pubs open for two weeks already.

puranjay2• 6 years ago

Are the borders open? That's the litmus test - can the cases be controlled with no travel restrictions?

battery423• 6 years ago

Yes it does.

We are still flattening the curve and we (at least i do) wait for a vaccine.

Trying also means, for me, that all people able to do home office, do home office as long as possible to reduce the amount of people in public transport. It also means being more hygienic (we are pigs...), it also means staying away from elder people.

chimprich• 6 years ago

Quarantining incoming travelers isn't feasible, at least not without sacrificing international business and leisure travel completely

You're not necessarily sacrificing international business and leisure travel, because there isn't going to be any if you've got a raging epidemic in your country.

Once you have the virus under control you can stop quarantining people coming from other countries with a similar or lower prevalence of the virus.

Unless you expect reinforcements (i.e. a vaccine or cure)

But we do expect those. A vaccine is not guaranteed, but likely. A cure might be possible, but it's extremely likely that we'll get some effective treatments over the coming months. We already have some positive results.

Mediterraneo10• 6 years ago

You're not necessarily sacrificing international business and leisure travel, because there isn't going to be any if you've got a raging epidemic in your country.

On some outdoors forums I participate in, people have expressed envy of those Swedish members who have been free to trek or cycle all these months. Now some of those foreigners are chomping at the bit to visit Sweden when borders reopen, because they want to experience that nature for themselves. There are enough younger people who are reasonably unconcerned with coronavirus to kickstart a tourism-based economy.

FWIW, I stayed at a hostel in a different city in my own country last weekend. It was already fully booked: as soon as the borders opened, young backpackers from the neighboring countries immediately started traveling again.

Whether an epidemic is considered "raging" or not comes down to media depictions. In countries where the media accurately portrays this illness as killing almost entirely people over the age of 70 with multiple comorbidities, younger travelers are going to move around.

deminature• 6 years ago

Can this virus even be controlled?

Absolutely, Taiwan, Singapore, South Korea, Australia, New Zealand, Czech Republic have all succeeded in nearly wiping out the virus entirely. It absolutely is possible and giving up on wiping the virus out is disappointing, because it's been demonstrated to be possible.

argonaut• 6 years ago

Sweden's GDP grew by 0.1% in Q1 2020 (0.4% annualized). Germany's GDP fell. https://www.cnbc.com/2020/05/29/coronavirus-swedens-gdp-actu.... The UK's GDP fell as well. Sweden's economy has not actually contracted by 7%. That is merely a forecast for 2020 and GDP forecasts are not particularly reliable.

They probably will be down for the year, but right now there really isn't any evidence their economy has suffered the same fate as the rest of Europe.

diggan2• 6 years ago

A bit irrelevant in this particular case. Not sure if it's mentioned in the Bloomberg version of the interview, but the Swedish interview focuses on the regret over the high death count, not the economic falloff (as Tegnell is a epidemiologist, not economist).

logicchains3• 6 years ago

It's relevant because the article mentioned a 7% contraction.

alkonaut5• 6 years ago

His position in the public health authority means his goal is maximizing the long term public health, e.g. minimizing all cause death (and of course other bad outcomes).

That means he has to consider deaths 10 years from now due to lower healthcare spending from a recession created by the pandemic. He has to consider mental health effects of mitigations, and so on. So while he isn't an economist, he can never ignore the economy.

This holistic view I think has been missing from the discussion in other countries to some degree.

cm21872• 6 years ago

It is very relevant to the millions of people which lives haven't been wrecked by losing their livelihood as a result of a lockdown.

noetic_techy2• 6 years ago

It is absolutely relevant to public policy discussion. Believe it or not public policy DOES put a price on life and for good reason: you cant mitigate away ALL risk of death. Think of speed limits or even the normal flu death rate. You can't have a functioning society if everyone lives in bubbles and drives 5mph because all life must be preserved. Even the CDC acknowledges this, and they themselves calculate on average the economic loss of a human life is 10 million USD over their lifetime. When the mitigation cost (including cascading effects) exceeds this, then its not considered reasonable at a public policy level. You absolutely have to acknowledge the economic impact of lock-down for a virus that has a 0.26% mortality rate overall.

marcell2• 6 years ago

While this is certainly a classic example of appeal to authority, I don't think the data backs it up. As of May 29, there have been 44k deaths in Sweden from all causes. If you extrapolate that out for the year, you get 105k. That's about 15% more than a typical year in that country [1]. Obviously bad, but all countries are experiencing increased mortality. It's not clear how much lockdown would have reduced that.

Additionally, there may be some death harvesting going on, where future deaths are pulled forward due to Covid. We are seeing this in the US [2], so possibly their incremental deaths will be lower than 15%.

Finally, if we are doing appeals to authority, the Prime Minister of neighboring Norway says she closed schools "out of fear" and seems to regret that action [3].

I'm a parent, and the last point is personal for me. There is enormous cost to lockdowns that close schools, especially for working parents, especially if both parents work, especially if your home is cramped or small, and so on.

[1] https://www.statista.com/statistics/525353/sweden-number-of-...

[2] https://i.imgur.com/2HsNN54.png from https://www.reddit.com/r/LockdownSkepticism/comments/gvfep9/..., see also https://imgur.com/RQiEIku from the same thread

[3] https://www.dailymail.co.uk/news/article-8373857/Norways-PM-...

Lewton8• 6 years ago

Obviously bad, but all countries are experiencing increased mortality.

Not even remotely true. https://www.euromomo.eu/graphs-and-maps There's at least half a dozen of European countries that imposed measures early that are seeing no increase in mortality, (seemingly seeing slight decreases, even)

marcell2• 6 years ago

It seems like a bit of a crapshoot. Some countries had huge spikes in deaths (Spain, Italy obviously, France, Belgium, Netherlands), and some did not (Norway, Hungary, Greece). Sweden's spike is a bit longer and bit flatter than other countries.

I'm not denying that Covid is a real disease that is causing excess death. I'm mainly challenging the narrative that lockdown is the only way to address the problem, that it's to correct approach, or that Sweden's approach is causing some sort of doomsday scenario of mass deaths.

INTPenis2• 6 years ago

I'm glad you brought that up because if you look at cases /1M pops on worldometers Sweden is actually below at least two european countries (Italy, Spain) who enforced a strict quarantine and travel ban.

Yet Sweden are seeing a pretty high mortality compared to those countries.

So my conclusion is that quarantine has done no difference to spread but the state of health care is affecting mortality.

And not only Norway is making mistakes in this new experience. The fact that Denmark closes down tourist areas, and the border, but allow their citizens to cross the bridge to Sweden and enjoy all the tourist areas there, and then come back to Denmark, that's just silly.

Lewton8• 6 years ago

The fact that Denmark closes down tourist areas, and the border, but allow their citizens to cross the bridge to Sweden and enjoy all the tourist areas there, and then come back to Denmark, that's just silly.

This is politically impossible to stop. Sweden has not closed its borders, so there's no one to stop danes from entering. And Denmark can't close it's borders to danish nationals, so they can't be stopped from returning home.

The Danish Government has made clear statements saying that they strongly urge people to not go to Sweden

CaptainZapp• 6 years ago

Sweden had ample warning and time to prepare.

Italy, and to a lesser extent Spain, did not.

mcv• 6 years ago

Note that number of cases is never the total number of cases, only the number of cases that have been tested and tested positive. This number depends very strongly on how much a country tests. Some countries test everybody, others test only severe cases.

Number of deaths is more reliable, though even those numbers can be hidden. For example, in Florida the number of COVID-19 deaths is fairly low, but the number of pneumonia deaths is more than 6 times higher than normal all of a sudden.

rumanator2• 6 years ago

at least two european countries (Italy, Spain) who enforced a strict quarantine and travel ban.

Both Italy and Spain imposed strict quarantine measures in a time where the epidemic was already rampant and killing hundreds of patients a day.

Thanks to that, now they are experiencing zero deaths a day.

EdwardDiego2• 6 years ago

It's about the timing of the lockdown - once the virus was already widespread, you're closing the barn door after the horse bolted.

NZ locked down while spread was limited, and has had no new cases for 12 days, and only one remaining active case, as a result - but again, it was the timing of the lockdown - if it had happened 2 weeks later, who knows how it'd be doing.

philjohn• 6 years ago

Problem is you can't just extrapolate Sweden to other countries ... UK for example has higher levels of obesity and Type II diabetes, which are both known prognostic indicators for a worse outcome.

They also have a better-funded health system than the UK and lower population density.

collyw• 6 years ago

Overall they have lower population density but how does that translate to reality when 1/3 of their population lives in cities?

belorn3• 6 years ago

The article missed the details of what he said in the interview, located here: https://sverigesradio.se/sida/artikel.aspx?programid=83&arti...

In the last paragraph in a very academic tone, what Sweden did was to add more and more restrictions as they were shown to be needed, while most other country shut down everything to open up later. In order to figure out which restrictions works and which didn't, the approach to shutdown everything and sort things out later may be a better strategy in the future.

The bloomberg article also goes a bit beyond the interview in its commentary. It mention specific restrictions like "visit restaurants, go shopping, attend gyms and send children under 16 to school". The interview does not, and there are good reasons. Doing comparison between nations like Sweden and Denmark gives one type of numbers, but doing regional comparisons gives an other. If we compare Copenhagen and the city on the Swedish side of the bridge called Malmö, we find that Malmö has less cases and deaths while not having any of those specific restrictions. Why? We don't know for sure, but the main suspect are the number of elderly people living in care homes. When it come to Sweden more than half of all death comes from elderly care in the area around Stockholm, and Malmö does not have as many as Copenhagen and much fewer than Stockholm.

From there we can speculate all day long on what kind of restrictions do help. Maybe keeping children under 16 at home forces the typical demographic that are employed at elderly care to also stay home. Maybe Sweden, or Stockholm, use a different strategy in handling elderly care than other countries/regions and that is the culprit. Maybe other countries did more to prevent the virus from getting a hold in the elderly care system by providing employees more equipment and more time. When more nations are lifting restrictions, maybe the answer will be known.

Lewton8• 6 years ago

If we compare Copenhagen and the city on the Swedish side of the bridge called Malmö, we find that Malmö has less cases and deaths while not having any of those specific restrictions. Why? We don't know for sure

We might not "know for sure", but population density is clearly the biggest factor in any of this. Comparing Malmö to similar sized Danish cities again show clear effects from the differences in measures taken

belorn3• 6 years ago

Could you give specific examples?

If we look at the heat maps on wikipedia, it is clear that regions difference exist in Sweden. https://en.wikipedia.org/wiki/COVID-19_pandemic_in_Sweden#/m...

Population density is also not a major difference between Malmö and Copenhagen. 4,049/km2 vs 4,400/km2. Stockholm however does have 5,200/km2.

In absolute numbers, Copenhagen is almost twice the total size than Malmö, but the only other city we can then compare to is Aarhus that is 2/3 of the size of malmö and a drastic lower density of 2,874/km2. At best we can make an argument that you can not compare Malmö to any city in Denmark since no city in Denmark is close to the same size and population density.

mywacaday• 6 years ago

A good plan violently executed now is better than a perfect plan executed next week. -George S. Patton

fxtentacle• 6 years ago

Space Force is amazingly funny :)

dijit3• 6 years ago

I’ve been outspokenly critical of Sweden’s approach on more than one occasion. I live in Malmö in the southern region of Sweden- where COVID-19 deaths were 3 weeks behind Stockholm.

The situation here was, for lack of a better term, inconsistent.

There are people locking down, and some restaurants are closing early. There Are people wearing masks- but in far greater numbers there are huge congregations of people. Masses of people, herding together in bars at night shoulder-to-shoulder[0].

People aren’t taking it seriously, because “the rest of the world is overreacting and as long as we follow the rules we’ll be safe” but people fall right back to not following the rules.

It seems like it only takes a few people to not follow the rules and then everyone around them forgets. Forgets about distancing. Forgets about not touching the face. Forget that there’s even a pandemic at all.

Anders arrogantly believed that swedes follow the rules and that it would save us. And frankly we’re fairing better than the UK- though the population density is far lower, and there’s more single-person households than anywhere else in Europe.

I just don’t think there’s a workable argument for why it was a good idea. Except for that we were unable and wanted to make it look like it was part of the plan.

[0]: Sorry for the quality. https://i.imgur.com/LVspmHs.jpg

yaris4• 6 years ago

Well, I live in Stockholm and here is what I see: during the first few weeks (maybe a month) people really followed the rules. There were significantly fewer cars on roads, some parts of the city looked as if completely abandoned etc. But then the weather's become better, people have got tired of restrictions - and now it is back to usual (I don't dare say "normal"). But people are still much more careful than they were before COVID. What makes me feel good about Tegnell is that schools were not forcefully closed, otherwise economic hit would be much bigger.

dijit3• 6 years ago

That could be because Stockholm was hit so much harder than the Skane region in its entirety. People here might have thought it was "far off" and put it out of mind.

I don't mean to imply there has been no change, lots of businesses are requiring people to work from home, some restaurants wont let you sit indoors. There are stickers on the floor in ICA indicating where you can queue, and plexiglass around the cashiers.

However, it's very surface level in a lot of cases, people are still going to tightly packed bars, massing in large numbers in the parks, going for walks through crowded shopping streets. Gyms are open and I'm not sure that's the best idea in the world (COVID being transmitted easiest in a still air enclosed environment with lots of people exhaling forcefully).

But, I digress. I think when Swedes talk to me about Sweden's response to COVID they talk from a stockholmers mindset. But I am derided by Swedish friends in Malmo for avoiding contact as much as humanly possible.. Many of whom keep requesting that I join them in the Gym. Which seems like a really stupid idea to me.

WildParser• 6 years ago

Michael Levitt has already shown the world a long time ago that COVID-19 is sub-exponential. Any competent mathematician can do that, just look at f'/f in a logchart (death per day / death total) look at the data of Germany - use 7 day averages to be surprised)

So going for herd immunity is most likely mistake. For something that destroys itself in the long term anyway (R0~0,7) something like "duck and cover" would have been the right strategy.

alkonaut5• 6 years ago

The weirdest thing in all this is the comparison to neighboring nordic countries and the conclusion that if Sweden had acted like Norway, the outcome would be similar.The south part of Sweden had a similar outcome to neighboring Denmark.

What should have happened was that Sweden's major outbreak (Stockholm) should probably have been given a stricter and earlier containment. But that's easy to say in hindsight. The corresponding initial outbreaks in Helsinki, Oslo, Copenhagen most likely simply weren't as large as the one in Stockholm. Stockholm had school holidays that coincided with the worst outbreak in the Italian alps. Other parts of Sweden didn't, and didn't get the same size initial oubreak. A good comparison is Belgium where the whole country had school holidays and traveled a lot the same week as Stockholm (The week of feb 24th). They had a similar development.

Lewton8• 6 years ago

Sweden allowed for gatherings of up to 500 people 10+ days after Norway and Denmark had set the limit to less than 50 trying to explain it with "just bad luck" is ridiculously revisionist history

edit: sources

https://www.thelocal.dk/20200317/denmark-shuts-down-restaura... 17. of march, Denmark banning gatherings above 10 people

https://www.dw.com/en/coronavirus-sweden-still-skiing-despit... 25. of march, sweden still having parties of 499 people

alkonaut5• 6 years ago

trying to explain it with "just bad luck"

I didn't. No one is. It's a combination of 1) poor protection of elderly homes 2) a larger seed outbreak most likely in the Stockholm area 3) less mitigations. I think 1+2 makes the majority of the difference while 3 makes less of a difference, because people changed behavior similar to other countries (and obviously other countries just like Sweden changed behavior before regulations were put in place).

Obviosly the decision to keep business and schools open weren't taken assuming it would make no difference to the outcome. There is an element of calculated risk here. No one is denying that. But very few as far as we know have been infected by school children so that risk seems like the correct one, for example.

The limits of 500 and later 50 people for gatherings was laws for public gatherings i.e. these were laws on businesses. You couldn't arrange concerts larger than that, and so on.

The recommendations towards individuals was always to keep social distancing, not socialize in large groups, not travel unnecessarily and so on.

I think in some countries there were bans even for private gatherings, e.g. laws restricting the size of private gatherings. That was never in place in Sweden (unsure if it would have required some constitutional change or similar, but it was said to be impossible).

So even when the restriction is 50 people, I can still arrange a private wedding for 1500 people. But obviously, no one is going to do that so it's hypothetical.

The question is what happened, not so much what was allowed. Most places with lockdowns saw the majority of the effect predate the lockdowns, because people change behavior. I doubt there were many cases of large gatherings any time after mid March. There will always be idiots obviously (such as the weekend afterskiers that week in march in Åre), but such things occurred elsewhere too with "corona parties" etc. The difference is that they could take place in a few places in the open in Sweden.

cm21872• 6 years ago

The article spins it as an absolute failure:

At 43 deaths per 100,000, Sweden’s death rate is among the highest globally and far exceeds that of neighboring Denmark and Norway, which imposed much tougher lockdowns at the outset of the pandemic.

However:

1) that is much less than many other european countries (Belgium, Spain, UK, Italy, France) which all implemented a full lockdown. You would logically expect more death if you spare a lockdown to your population. Having less deaths than many countries who implemented a lockdown is not, I think, a disastrous outcome. It is rather a success.

2) the justification for the lockdown was to avoid overwhelming the healthcare system (flattening the curve to under the hospital capacity, which everyone seems to have forgotten now). As far as I know the Swedish healthcare system wasn't overwhelmed.

KingOfCoders2• 6 years ago

Other countries like Italy and Spain were hit much earlier with no time to prepare.

DanBC• 6 years ago

UK implemented a full lockdown really late, a long time after covid-19 was fully established in the community.

There's a bunch of other stuff going on with the UK that has increased the number of deaths:

10 years of austerity has cut budgets to local authorities, and they're responsible for public health (so things like track and trace). LAs are also responsible for care homes, and the lack of budget means care home workers are on minimum wage zero hour contracts, so they feel they have to work and they often work in more than one place. This means they're more likely to spread covid-19 to vulnerable residents.

the justification for the lockdown was to avoid overwhelming the healthcare system (flattening the curve to under the hospital capacity, which everyone seems to have forgotten now)

There are ways to avoid overwhelming the hospitals. One way (which is what the UK did) is to just let people die in the care homes and never admit them to hospital. That's not great.

The problem with ending lockdown is that in many places it's not being done with any care. There's a rush to end lockdown without any measures being put in place around what to do if the number of infections starts to rise again.

FranzFerdiNaN• 6 years ago

As far as I know the Swedish healthcare system wasn't overwhelmed.

They werent because their official position was to not send old people to the hospital and to just let them die. 50% of all people who died lived in care homes, despite the intention being to protect exactly those people.

Here is the BBC reporting about it: https://www.bbc.com/news/world-europe-52704836

bagacrap• 6 years ago

in the US, that number is 42%. 20% of Swedes are over 65 and only 15% of Americans are. So it's reasonable to assume a third more Swedes (per capita) are in nursing homes. That only about 20% more of the deaths come from that population makes me think Sweden is doing better than the US.

bjoli3• 6 years ago

To moderate this a bit: the two people quoted in the article are politicians for the nationalist and more nationalist right wing parties. They both have things to gain by portraying the current policies in bad light.

Reports about withheld care have been hard to verify. Reports about lousy routines with regards to sanitation and disinfection have been more common. The debate about the quality of this kind of care has been going on for more than 2 decades, since even before Sweden's rather extreme laws about winnings in state-funded health care. The utter failure of these homes to not spread covid-19 is the real news. The numbers are atrocious, and stories about workers walking from sick elderly to healthy elderly without proper procedures have been rather common.

Sure, the angle BBC chose is juicier, but I have some serious doubts about the accounts published.

sumedh• 6 years ago

that is much less than many other european countries (Belgium, Spain, UK, Italy, France) which all implemented a full lockdown.

Dont they have a higher population density compared to Sweden?

kungtotte• 6 years ago

They've been working their asses off to make it work (immense kudos to all of our health care workers!) but we haven't once exceeded our capacity for intensive care patients, which is one of the critical aspects in flattening the curve.

Non-emergency procedures and so on have all been postponed, obviously, but everyone who actually had to go to the hospital were able to do so. So our strategy worked great as far as flattening the curve/keeping the hospitals afloat.

This is me being an armchair expert, but I think the one major thing that they should have done differently is stop visitation in hospitals and elderly care. It took a little bit too long before they did that which allowed the virus to hit the elderly care. Some specific elderly care homes have had a crazy high mortality rate for example.

Keeping the schools and daycare open was also part of the plan to not overtax the hospitals, since a non-trivial amount of nurses would've had to stay home to take care of their kids if they couldn't go to daycare/school.

roenxi• 6 years ago

It is impossible to say what worked and what didn't work yet. The pandemic isn't over. And the reported mortality stats aren't reliable; there needs to be a good 6 months to figure out what the aggregate numbers really are.

It is too early to say whether the strategy succeeded or failed.

jakeogh• 6 years ago

Typical values for the US: https://www.cdc.gov/nchs/data/health_policy/influenza-and-pn...

ReticentVole• 6 years ago

The public bought into the notion of 'Flatten the Curve'. It made sense to stop hospitals being overwhelmed and patients having to be triaged by age.

Sweden's approach of limited lockdown succeeded in flattening the curve. Existing medical facilities were sufficient.

In that way Sweden's approach should be seen as a massive success, and lockdowns all around the world should be ended. Additionally, we now have plenty of PPE, and understand how to better treat critical COVID patients. So the effective capacity of the healthcare system is even greater.

EdwardDiego2• 6 years ago

Sweden's approach should be seen as a massive success

Unless your loved one was one of the 4500 who have died so far. Or the 50 or so who are likely to die today.

onyva• 6 years ago

Yeah. Oops.

Maybe use the opportunity to apologize for scapegoating medical support workers who don’t speak “good enough Swedish” to follow instructions. Same workers from similar background all over Europe of course, where authorities did a much better job with less xenophobia.

imartin2k2• 6 years ago

There are at least 2 different perspectives to look at Sweden's strategy.

One is the long term view: Whether Sweden's approach will, when this pandemic is over, turn out to have produced a "better" outcome in regards to e.g. fatalities, severely sick, people who need rehab, economic performance and societal stability, in comparison to other countries. As is frequently being emphasized: It's too early for a verdict here. We'll know in hindsight.

But then there is another perspective: The one based on risk-reward, and based on what is the right thing to do in the moment for a democratic, humanist society that generally promotes values based on protecting lives, particularly of the weak.

Confronted with a new, evidently potentially very dangerous virus about which few things were known other than it created chaos in various places and led to many deaths, Sweden chose a gamble based on a rather bad risk-reward distribution. Let's say Sweden will turn out to be "right" in the long term (meaning other countries will eventually also end up with similar numbers of fatalities/infected per capita), then the reward will be at best moderate: A slightly better economy (as an export-nation, Sweden's economy suffers when other countries shut down regardless of Sweden's own strategy) and a bit more individual freedom for people to do what they wanted even during crisis times.

But if Sweden should turn out to be wrong (meaning that other countries manage to keep numbers of fatalities/severely sick much lower indefinitely, and economies will only do a bit worse, until we have a vaccine, or until the virus has mutated to become much weaker), then the downside is gigantic: Thousands of people whose life could have been saved, thousands more who had to fall severely sick who could have been spared this experience, a damaged global reputation (which is one of the most important things for Swedes: What others think of their country) as well as a moral identity crisis (because how to justify future signaling of moral superiority if one has just sacrificed thousands for an utilitarian ideal?!).

Ethics and moral aside, choosing a strategy with such a bad distribution of reward and risk strikes me as highly dubious.

Furthermore, based on my own personal ethical/moral set of values, the damage is done. Even IF Sweden will look better once we'll be out of the pandemic, the whole strategy was inevitably based on an ethically questionable gamble, which could have gone either way, and which as I see it sets a rather concerning precedent.

If one crosses a highly trafficked street with closed eyes, even if one makes it to the other side unharmed, the worst outcome is if one concludes that this was smart and should be repeated again in the future.

As I see it, Sweden went on a dangerous path, historically taken by those who turned out to be on the wrong side of history. I moved from Germany to Sweden in 2006 but I’m not sure anymore if this is a great country for the future. And it’s emotionally very tough on me having to confront those thoughts.

yaris4• 6 years ago

Swedish authorities relied on their citizen to behave, follow rules and use common sense in general, plus some administrative measures that can be implemented only by organizations. To me this is much better than to force people into lockdown no matter what. This has shown (again) negative parts of the swedish mindset, but that is a different matter and possibly the current approach with COVID will help to improve (if not eliminate) those parts.

imartin2k2• 6 years ago

Let's hope you are right.

Edit: I clicked on your previous comments and saw one from some months ago where you wrote this: "Swedes tend not to think about "bad case", so if something does not go according to an optimistic plan - it sometimes comes as a great surprise for them"

This exactly in line with the current situation and my own assessment. So do you see a chance that this will be enough of a learning experience so in the future, Swedes (on a group level) will become better in factoring in the "bad case" in their decisions/thinking?

Lewton8• 6 years ago

Great post.

Couldn’t agree more. Defending Sweden’s strategy displays “results oriented thinking”, a derogatory term used in poker to describe someone who claims they did the right thing just because they got lucky and won a single hand, completely disregarding the long term viability of the choices they made. It’s the kind of player you’d love to have at your table as they’ll eventually lose everything.

mediascreen• 6 years ago

Here is a simple and pretty unbiased video (made by and american expat) of everyday life during the epidemic in Sweden: https://www.youtube.com/watch?v=PI7nrqH_YnE

qbaqbaqba• 6 years ago

Wonder how recent events will influence the pandemics.

downerending• 6 years ago

Whatever the ultimate merits, I find the admission of mistakes refreshing. Hard to imagine anyone in American or UK politics doing that.

mensetmanusman3• 6 years ago

Part of the blame lies with a (our) culture of putting all the old people in the same place to be (lonely) together.

These deaths would not have happened nearly as effectively if we had more intergenerational households.

goto11• 6 years ago

I thought intergenerational households were one of thee reasons for the large death toll in Italy?

bjoli3• 6 years ago

The nursing homes (as opposed to service homes) in Sweden are generally a "last resort", for elderly that are incapable.of taking care of themselves. Very fragile elderly with varying degree of confusion and dementia. For a Swedish nursing home the life expectancy after admission is something like 400 days.

The nursing homes has failed miserably at protecting their inhabitants in and around Stockholm. The debate about lacking funding and poor quality care has been going on for the past 2 decades. The recent stories has been about people walking from sick to healthy patients/inhabitants (I don't know the correct English term, sorry) without proper disinfection and sanitation, even though supplies have been available.

mensetmanusman3• 6 years ago

Other factors:

-lots of uncertainty and unchanged behavior -strain of COVID spreading -culture of hygiene -culture of physical closeness

moogly• 6 years ago

Tegnell has clarified what he meant, and thinks foreign media has misquoted him: https://www.dn.se/nyheter/sverige/anders-tegnell-there-are-t...

As a follow-up to the above article, he furthermore said that he "sometimes feels like a personal punching bag, but that's something I'll have to take".

Tegnell is one to rarely, if ever, admit to being at fault. In my view, he's always had this air about him of infallibility. He's almost never wrong, and he's criticized every other country's way of counting cases and casualties at every opportunity, without giving any reasoning. He's also come with very inconsistent, almost asinine statements. The last one cheering that Sweden only had 8 new reported deaths this past Monday, even though that reporting always lags behind directly after weekends. When I read that quote I thought "but it'll be back to 50-70 reported deaths in a day or two like it's been for a month now". And not to toot my own horn, but I was right.

From where I sit, almost everything he says has an angle to downplay risks. There are no guidelines to wear masks in Sweden because "the science is not clear" of its efficacy (true-ish), but in the next breath he parrots things like "these kinds of viruses don't like the summer heat, so we expect the upcoming summer to improve things" which, from what I've read, is even more scientifically unclear.

Nevertheless, he is the public face of the Covid-19 and has an enormous fan club in Sweden. I'm sure several people will rush to his defense here as well.

Man behind Sweden’s controversial virus strategy admits mistakes

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