A Look At Sweden’s Handling of Covid-19

Like the rest of the world, Sweden started seeing the Covid-19 virus hit home in late February and early March of 2020. As the world began to panic, each country came up with its own idea of how to handle the inevitable wave of death and destruction. Most countries elected to entirely lockdown their society, and quarantine to mitigate the devastation and save lives. But Sweden didn’t.

They elected to take a milder approach than others. Most of the world thought they were absolutely crazy!

The Backlash Against Sweden’s Approach

Many international leaders used Sweden as warning to defend their own lockdown initiatives. Early in the pandemic, President Donald Trump compared the high relative fatalities in Sweden to other nearby countries. He said that “Sweden is paying heavily for its decision not to lockdown.”

China called Sweden a “Black Hole,” and called on the world to condemn their response.

A BBC article went so far as to imply that Sweden was actively helping the senior citizens of the country die.

Media and politicians from all over the world accused them of being radical, extreme, and playing a game of Russian roulette.

Even within Sweden there was great debate. Many in academia sent letters of protest over this approach, warning of “chaos in the healthcare system,” and while most of the government fell in line with the plan, their right wing populists argued for shutdowns.

What Sweden Did

First it is important to understand that the Swedish Constitution legally protects freedom of movement for the people. It does not allow a government-mandated lockdown in peace time. Please note as you read this, that The United States Constitution also does not allow for it.

Instead, The Public Health Agency of Sweden is allowed to provide advice, and the politicians needed to fall in line. As such, the state epidemiologist, Anders Tegnell, led their Coronavirus response. Some of their approach was “advice” and some was “law,” depending on the legality of the restrictions that would be put into place.

Here is a basic rundown of what they did:

• Public gatherings of more than 50 people were prohibited, with the exception of schools, workplaces, public transportation, grocery stores, shopping malls, health clubs, or private events.
• Visits to nursing homes were banned.
• Social distancing was advised.
• Preschools and elementary schools remained open.
• Secondary Schools and Universities were to use distance learning.
• Anyone over 70 was urged to limit close contact with others, and avoid crowded places. They were also urged to go outside for walks, following the recommendations.
• Relatives of elderly were urged to avoid unnecessary visits to hospitals and nursing homes.
• They recommended that employers urge their employees work from home.
• They recommended against travel within the country, between cities or abroad.
• Bars and restaurants were required to provide table service only, and increase space between tables.
• Businesses were not asked to close.
• Sweden recommended against wearing masks.

How Did It Work?

Until early April, most politicians and media were heavily criticizing Sweden’s approach, as they were seeing more cases than neighboring European countries. They did have more deaths per capita than their neighbors. By April 30th, 2.8 out of 10,000 residents had died from Covid-19. In neighboring Norway that did lockdown, it was 0.63 per 10,000. But by July 30th, the number in Sweden rose to roughly 5 out of 10,000 people, or a total of 5,500 people. To give another comparison, New York had roughly 16.5 fatalities per 10,000 people by July 30th (330% more than Sweden), and Florida was at 2.3 per 10,000 people, almost half of Sweden’s rate.

Sweden’s Curve

Most of the world saw skyrocketing cases, followed by a wave of deaths in early to mid April. They flattened their curve of cases, and then it started to go down, as the deaths went down with the cases. Not Sweden. Sweden hit their relative peak on April 6th, but it just stayed flat in terms of cases per day all the way through the end of May. Their ICU hospitalizations actually peaked on April 1st, and started a downward trajectory. Although there were roughly the same number of new cases every day, fewer and fewer were getting very sick. The same thing happened with their fatalities, which peaked on April the 8th, and have been on a solid downward trend ever since.

During this time, the media stopped talking about Sweden. It was as though the news was gone, but the numbers kept rolling in. Steady cases, fewer sick people and fewer deaths… getting less and less by the day. Why didn’t we explore this?

Sweden’s 2nd Spike

All of the sudden, in early June Sweden started to see a spike in cases. It just kept going up and up, seemingly breaking new records every day, until June 24, when Sweden hit its absolute peak of 1,806 cases. During this spike, Sweden was back in the media again. CBS reported “Sweden becomes an example of how not to handle COVID-19,” CNN reported “Sweden pays human and economic price for not locking down,” The New York Times reported “Sweden Has Become the World’s Cautionary Tale”. This new spike had everyone chiming in.

But they missed some pretty important information. It is the part of the story they neglected to tell us that gives a full picture.

Yes! It is true. Sweden was seeing a spike in new positive tests. But there are three other things that we should be looking at:

• From June 24th to July 13th, cases have been going significantly lower each day, with a few minor spikes. June 24th was 1806 cases, June 26 was 1,239, July 1st was 742. July 4 was 433, July 13th was 174.
• Throughout the second spike, ICU hospitalizations have plummeted. Back in April they had as many as 49 people admitted ICU. But during this much larger spike in June and July, it never got higher than 20. As of July 6, when many of the above articles were published, Sweden only has TWO admitted in ICU nationwide.
• Similarly, deaths per day peaked on April 7th with 115 deaths, but have been on a steady decline ever since. Even after the June spike in “cases,” the deaths have been continuing on a clear downward trend, with very few deaths per day in early July.

Remember, while death count is a lagging indicator, Sweden’s second spike in “cases” started on June 1st, and that was after staying at the same case level throughout April and May. But the deaths have continually gone down. To compare, their highest case count in the initial outbreak was between March 1 – April 6. This period is the same as when hospitalizations were at their highest, and their fatality peak was April 7th. So following the same logic of lagging indicators, the hospitalization and death rates should have been peaking weeks ago, but they have continued on a strong downward trajectory.

We MUST Stop Measuring By “Cases”

I am not saying we should stop testing, or even slow down. I am saying that measuring the effects of the pandemic by “cases” gives us an extremely inaccurate picture of what is going on. Even when we count test positivity rate, we are just learning how many people have it, not how many are being affected by it. This is extremely clear when you look at this chart that shows Sweden’s numbers over time:

This is a logarithmic chart, rather than linear. This allows us to look at data in relative terms when the numbers vary greatly. If we used a linear chart, since the highest number of daily cases is 2,000, you would not be able to see the trend in the ICU and deaths, because they would look like a flat line at the bottom. Just recognize that the bottom half of this chart represents the numbers 1 to 50, and the top half goes from 51 to 2,000. The higher you go, the larger the range is so that you can see trends.

Looking at the darker blue line, it is clear that in terms of cases, Sweden pretty much flattened their curve in early April. But then you see it start to rise in early June. It doesn’t look like much on this kind of chart, but on a linear chart, it is very noticeable. Those tiny June bumps you see represent when all the media was telling the world that Sweden was a failed experiment. Do you still trust your news sources after looking at this?

But look at the lighter blue line, and you see that in the initial outbreak, it rises in relation to the cases, and starts to go down after the peak. But during the second big peak, hospitalizations FOR COVID-19 continued to decrease. This is anecdotal evidence against any argument that would suggest the lowering death rate is due to the fact that the world now knows how to treat the virus more effectively. Because if that were the case, you would see the hospitalizations rise all the same, but the death rate go down.

The black line in the above chart is fatalities. As you can see, in the first outbreak, hospitalizations followed “cases” with about a two-week delay, and fatalities followed a trend about a week later, roughly 3 weeks on average after cases were reported. Still, as with hospitalizations, fatalities continue to decline, and remained on a downward trend, despite Sweden’t sudden spike in reported cases in June. If this does not prove that “cases” should not be a primary focus for us, I don’t know how to open your eyes.

Cases do not tell the story

Stop. Breathe for just a moment. Maybe you know someone that is laying in an ICU bed right now. Maybe you have friends and family that succumbed to this. My heart and prayers are with you, and all of their loved ones.

I am not trying to say that Covid-19 is not a serious threat. I am trying to say that the absolute best way we can protect our society is with logic and actual historical analysis to see how we need to move forward.

The media thrives on headlines that incite panic, and this is the sweetest of candy for any politician. We must keep our eye on the ball, and counting “cases” is an act of misdirection, plain and simple.

So breathe again, and try to take emotion and “what that news personality said,” or “what that expert said,” or “what that politician said” out of your mind. Let’s look at this with logic for a moment.

We Do Not Count Cases of Infections for Most Anything Else

When was the last time you heard a reporter talk about how many people caught the common cold? What if every day we announced how many people catch a cold? The count would be roughly 62 Million “cases ” per year. We don’t even count deaths related to common colds, but for many, a common cold leads to all sorts of other complications. This includes pneumonia, especially in those that are immunocompromised an/or elderly. In such cases, it can easily lead to death. But we usually attribute those deaths to pneumonia.

The CDC estimates that there were 45 Million cases of influenza in the 2017-2018 flu season. They estimate 810,000 people were hospitalized, and as many as 95,000 may have died from complications. Now, consider that flu season is roughly 6 months long. What if every day we had been bombarded by news reports of how many flu “cases” there were? We would be hearing on average 250,000 “cases” per day, 4,500 hospitalization per day on average during those six months, and 527 fatalities per day. Given that the flu season really peaks in February, we would be hearing about daily “cases” that passed the 1 Million mark at times, and daily deaths in the thousands.

If the media and politics gave the same kind of coverage to the cold and flu that we take for granted, we would all live in panic, especially if we were measuring by case count. It would seem as though the world was coming to an end. I wrote more on this in my post about The Coronavirus Catastrophe in the USA.

But we do not look at all of the daily numbers for other things. We look at them in hindsight. If we have a particularly bad flu season, we do talk about being more careful, but we don’t micro-analyze every measurable statistic or person that caught it or got sick, and focus only on the ones that sound the most horrifying. Most of all, we look at how many people are getting seriously ill and dying, not at “cases.”

This is not to say that Covid-19 is not significantly worse than the common cold or flu. Of course it is! But the reality is that the more asymptomatic carriers and people with mild symptoms we use in our numbers to determine how bad this is, the less we focus on the people that are actually suffering from this and/or dying as a result.

But this is not the flu!
Of course not. I am not saying it is. But since our method for determining what a “case” counts as is so flawed, we will never actually know what our fatality rate was from Covid-19. But we do know something from some other countries that had major outbreaks, and also were more rigorous in their testing protocols. That is, quite simply that the R0 of the virus is clearly very high, but the number of asymptomatic people is significantly higher than we ever could have imagined. Furthermore, countries that have had major outbreaks, and follow rigorous protocols, are seeing that fewer people relative to the number of infected are getting seriously ill. In other words, the virus isn’t nearly as deadly as it was months ago.

They are finding more and more people now get little more than symptoms similar to “Common Human Coronaviruses,” such as 229E, NL63, OC43, and HKU1. More popularly known as “The Common Cold.”

But look at how many cases we have!
It is a big, unthinkable number, and that is scary. But we actually don’t know how many cases we have that matter. When we build a system that labels anything that resembles a Covid-19 symptom as a Covid-19 “case,” we are taking our eye off the ball. When we count people in the hospital that happen to have Covid-19 alongside those that are there because of Covid-19, we do the world a disservice. It is great for creating fear, but terrible for tracking the lethality of a virus.

Countries like Italy and Sweden are now testing less than they were before, and you might think that this is a sign that they are not catching all of the cases, and why their numbers are getting so low. You would be correct to think that. But again, if fewer people are getting sick, fewer people are in the hospital because of Covid-19, and fewer people are dying because of it, why would you want to find more cases? Do we do this with any other illness? Did we do this with SARS, MERS or Ebola? No. We tracked for people with symptoms and direct contact only. Why is this any different?

Or look at it from another angle: If I were in the hospital with Covid complications, and the person in the bed next to me was there for hip surgery, but also happens to be Covid-Presumptive, I would be alarmed and furious that I might not be getting the focused care I should be getting.

We absolutely must do the following in order to know what we are actually dealing with:

1. Insist that our leadership gathers data from hospitals that tells us how many are in normal beds or ICU with Covid-19 complications, as well as the number of people that have Covid-19, but are not suffering from Covid-19 complications, plus the number of people that are Covid-Presumptive, and why. Finally, how many are not considered Covid-19 cases. Our covid-19 hospitalization reports should ONLY count people in ICU with Covid-19 complications and people in regular beds with Covid-19 complications.
2. Insist that our leadership gathers data from hospitals that tells us how the above numbers change on a daily basis, so that we can track it over time.
3. Insist that our leadership gathers data for the number of people in home isolation after testing positive.
4. Insist that our leadership gathers data for the number of people in home isolation do to possible contact, but not covid-confirmed.
5. Insist that our leadership follows up with all Covid-positive, and implements a strict protocol to remove them from the “case” count when they have tested negative two times consecutively.
6. Insist that our leadership gathers data from hospitals and coroners that counts covid-19 deaths only when Covid-19 is considered the actual cause of death, and not when it is presumed or not a primary contributing factor.
7. Insist that HHS maintains the same financial incentive for Covid-related cases as non Covid-related cases, even if it is higher during the pandemic. This would remove any financial incentive to mark a case as Covid-related.
8. Keep the case count of tests on symptomatic people separate from tests of asymptomatic people and contact tracing tests, and report accordingly.

Asymptomatic Cases Do Not Necessarily Lead to Higher Death Numbers or Hospitalizations

Without the above information, we cannot know. But we are seeing in many places in the world that more cases does not equal more sickness. The fact that we are seeing more hospitalizations in the U.S. is clouded by the fact that hospitals are playing catch-up with elective procedures, they are often marking cases as Covid-19 inaccurately, most of them are short on staff because of mass layoffs, and many are admitting asymptomatic or very mild cases unnecessarily for observation. While these circumstances exist, we have no way of actually knowing to what extent hospitalizations and fatalities are going up or down as a result of Covid-19. If we had better information, and learned that things are very bad, we would be able to take action with a complete understanding of what we are dealing with. But we might also find out that we may be overreacting. The point here is to say that we must insist on full data transparency to know the truth. Good or bad.

The Sweden Curve Further Illustrates That We Cannot Rely On Cases

Here is a visualization of the hospitalization trend in Sweden since the outbreak:

As you look at this, consider that in the month of June, their “cases per day” more or less doubled all of the sudden. The world thought it was out of control in Sweden. But look at the hospitalizations! A tiny little bump for a couple days in June, and it just went back to its downward trajectory as “cases” continued to increase. Looking at this data, it looks like they got this well under control in mid April! How is this even possible given everything we are being told?

One answer is quite simple. As noted above. Sweden is not looking for “cases,” they are looking for people that are getting sick. As with what I have written about Italy, they are not radically increasing testing with a goal to find every possible carrier. They are focusing on public health overall. There are surely many “cases” that are not being found, but again, I have to ask… what it more important? Finding “cases” or finding “people that are sick?”

But Sweden Is Different Than Us!

They sure are. Many will say that Swedes are more likely to follow the rules than we are, so they didn’t need to take such extreme measures. For one thing, that is an assumption. Most countries paint a dark brush over their own society. The Swedes are so orderly and well-mannered. Well, yeah. That is what the Italians think of Americans… that we obey and follow all of the rules. As a generalization, it is true. Americans are big rule followers compared to Italians (despite the fact that we praise how well they handled Covid-19), and Swedes are, in general, more obedient than Americans. But hey, that picture right there is of rioting in Sweden, not New York.

But even if we go with the excuse that Swedes are better at following the “rules,” let’s not forget that they didn’t implement all of the rules that we are arguing over in the States. Businesses didn’t close. Schools for younger children that could not be left alone did not close. There is no mask rule, and thereby no mask shaming. And yet, look at those charts!

But Sweden has a small population.
True. Only about 10.3 million. So compare their charts agains that of Arizona with half the population. Stockholm has about the same population as Phoenix and Gothenburg is just a little bigger than Tulsa. Remember, it is the trends, not the numbers that count.

But Sweden has lower population density.
Sure, when you compare to high population density cities like Milan, Rome, Tokyo, or New York City. But how do cities in Sweden stack up against the current “hot spots” with the rising “cases?”

For reference, New York City is 38,242 and Milan is 7,700.

Then it must be pollution!
Maybe, but according to the World Air Quality Index project, while Sweden is absolutely a front-runner in the world clean air race, we need to look at Florida as well, which city by city has roughly the same, or even slightly better air quality than the larger cities in Sweden. So that may be an argument if you are comparing to New York City or Los Angeles, but not Miami or Orlando.

Did Sweden Mess Up Anywhere?

Yes. With almost six months of hindsight, The Public Health Agency of Sweden noted that they had failed to protect nursing homes and elderly living with in-home care as well as they could have. Despite the fact that visits were banned, more than half their deaths were in these categories, and they recognize that they.should have taken additional steps to protect them. However, they stated that these steps would have been additional care, testing, and tracking of those people, not lockdowns.

They have also since concluded that it may have been better to suggest people wear masks when they are unable to socially distance, in order to help protect people from still unknown carriers.

How Does Sweden Look Compared to Their Averages Over Time?

An important measurement to look at is to see what is actually normal. After all, people die. So I obtained a chart from The Public Health Agency of Sweden that shows the range of deaths from 2016 to now.

There is no doubt that Covid-19 hit hard and fast. While that is truly a shame, I think it is also important to note that with their softer touch at handling the situation, their decrease after the initial spike was as rapid as their increase, without shutting down the entire country, mass unemployment, and mass bankruptcies. Of course, none of us knew at the time what the best answer was, but now we have almost six months of hindsight to learn from, and I would argue that this needs to be studied heavily. Despite the spike they had in June, few people actually got sick and died, so it is barely a blip on this chart compared to the April spike. Above all, note that they are within striking distance of their “average window” of deaths for this period right now.

The way the United States is handling its data, we actually have no way of making an analysis like this that is anywhere near accurate, and that infuriates me.

What If The United States Had Done The Same As Sweden?

This is an impossible question to answer, because there are so many unknown variables. But we do know that so far without massive restrictions and closures, Sweden has so far reported roughly the same number of fatalities per capita from Covid-19 as The United States.

In Conclusion

Like most of what I write, my goal is to dig for facts that raise more questions than answers. I am not looking to further a political narrative, but to search for truth. Sweden is a very interesting case to look at, because almost all of the press they received has been negative. When they first announced their plans to go against what the rest of the world was doing, they were considered mad. When they had their minor spike in cases, the world media seized the opportunity to point fingers at them, without doing any responsible research. Why?

I look forward to your comments below!