Sweden and Norway — a Contrast in Strategies and Outcomes

On March 14^th we noted how remarkably low the Scandinavian countries’ COVID-19 mortality rate appeared to be (although we cautioned that the statistics were weak and results could easily evolve).  Since that optimistic start Sweden has chosen a highly unusual strategy to deal with the Pandemic and as a consequence, has achieved very different results than Norway and Denmark.   

While Norway and Denmark closed their borders, restaurants and ski slopes and told all students to stay home in March, Sweden shut only its high schools and colleges, kept its preschools, grade schools, pubs, restaurants, and borders open and put no limits on ski slopes. In fact, Sweden and Brazil are the only two major countries in the world that have not imposed any lockdown of significance.  Sweden has chosen a strategy that Boris Johnson had intended to employ in the UK but quickly abandoned when the public got wind of the herd immunity theory backing his minimalist approach.  Sweden’s rationale for this approach is not herd immunity — at least in the public defense of their laissez-faire approach.  Their argument is that the Swedish have always complied with government recommendations so they feel that advising people to practice social distancing and not to travel should be sufficient to slow the virus so that their hospitals can handle all the sick patients appropriately.  Eventually, herd immunity will take over and stop the Pandemic.  This approach looks like it is heading over the cliff.

All three countries have experienced very high infection rates as most EU countries have due to their initial open border policies.  While Sweden has continued to maintain open borders, Norway banned non-residents from entering the country on March16^th after they had locked down most of the country’s institutions on March 12^th.  Their infection curve basically peaked broadly on March 29^th. Sweden’s infection curve has still yet to peak reaching 726 newly confirmed cases today, April 8^th.  

The table above shows that all 3 countries’ infections per million population are near 1000.  However, the death count per million is significantly higher for Sweden (68) than for Denmark (38) or Norway (19).  This is associated with the significantly higher mortality rate for Sweden — which we estimate to be a very high 12.5% — nearly as high as that for the tragedy in Spain, 13.2%.  There is nothing in the gross demographics that could explain this huge and statistically significant discrepancy between Norway and Sweden such as (1) median age: 39.8 vs 41.1, or (2) net migration: 28,000 vs 40,000 for Sweden, or (3) urban concentration, both near 83%.  However, Norway has done a much better job of testing its population with 21,009 tests per million citizens. Moreover, Norway also has a much smaller number of critical patients that could turn into deaths over the next week.

Sweden has not published its death statistics but we would bet that a significant portion of their dead is older and/or have comorbidities.  Older people were asked but not compelled to isolate themselves.  When everybody else is in the public square enjoying a nice day this past weekend in Stockholm, the elderly also joined the crowd.  This intermixing is deadly for the elderly but somehow the advice did not get through that they need to isolate and stay home.  This is the problem with an advisory vs a government-mandated shutdown.  Moreover, their advisory was only for those 70+, clearly not considering the Italian data that show people in the 60-69 band had a mortality of 7.1%.  Sweden needs to widen its testing immediately, to impose stringent travel restrictions to permit only essential businesses to operate, and to reduce the congregation maximum from 50 to 2. 

This has been a very expensive experiment by the Swedish government that will eventually cost over a thousand unnecessary Swedish deaths even if they corrected themselves tomorrow.  The longer they delay the higher the cost in terms of lives lost.