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Another update on the Swedish model for COVID response

With cases of Omicron and now BA.2 rising in Europe, it occurred to me that this might be a good time check in again on Sweden. Here it is:

Back in the middle of last year, Sweden was officially a disaster area. Their light touch on COVID regulation had backfired, producing higher case counts than any other big country in Western Europe.

But the fat lady hadn't sung and the COVID pandemic wasn't over. Today, the cumulative Swedish case rate is among the lowest, below both Denmark and Norway. At the same time, its cumulative death rate is right in the middle (though above both Denmark and Norway).

There are caveats to this, including questions about how accurate case counts are these days and whether Sweden significantly changed its approach later in 2021. Still, over the long run it's no longer clear that the Swedish model is a huge failure. It's possible—only possible, mind you—that the lesson from all this is that for a virus like COVID the best response is to flood the zone with countermeasures for the elderly but keep countermeasures fairly light for everyone else.

Of course, the pandemic still isn't over. A year from now it's possible that things will look different once again. Don't take any of this as the final word.

65 thoughts on “Another update on the Swedish model for COVID response

  1. antiscience

    Well and also, have national health insurance, generous sick leave, and everybody decently housed. So anybody who does get sick can, y'know, get medical care and meanwhile stay isolated.

    1. Salamander

      Plus, I think (anecdotally, that is) that Swedes don't tend to be morbidly overweight like us Americans, with all the co-morbidities that produces. Had the US done the Swedish thing, which under that former guy, we nearly did, it would have been even more of a bloodbath.

  2. Jasper_in_Boston

    Today, the cumulative Swedish case rate is among the lowest, below both Denmark and Norway. At the same time, its cumulative death rate is right in the middle (though above both Denmark and Norway). There are caveats to this, including questions about how accurate case counts are these days...

    I just don't see the efficacy in looking at case rates. This statistic is entirely dependent on frequency of testing. There are also definitional issues (China, for instance, apparently doesn't record asymptomatic cases). Far better to look at deaths, which, while not a perfect datapoint, should give us a vastly more accurate picture of the damage done by the disease.

    Using that method. Sweden isn't a UK/US/Italy-style disaster. But that's setting the bar pretty low. Its performance has been middling/poor by the standards of high income countries, especially next to its closest comparables (the Nordics), and is very far indeed behind Australia and New Zealand.

    Maybe the price has been worth paying because of some degree of markedly superior economic performance, but I've seen zero evidence of this.

      1. sturestahle

        I could write a sarcastic comment on how the old and disabled are treated in the United States of America but it’s of topic.
        Your comment is to stupid to care about

    1. MindGame

      Yeah, case rates are totally dependent upon testing, which in itself is going to vary greatly between countries. Death rates, particularly excess mortality, are a much more determinative indicator. Sure don't need a test for it.

      1. sturestahle

        It ended up in a “world cup” in Covid deaths in media, comparing statistics reported to worldometer and John Hopkins on all nations not caring over the fact that not two countries reported in the same way .
        Stupid!
        Mr Drum was into it 100%
        We will need another year, or two or three, before it’s possible to evaluate the effects of the pandemic , before it’s possible to start guessing what kind of measures that was effective and which ones that wasn’t.
        We also has to evaluate what effect different measures has had on society as a whole

    2. Pittsburgh Mike

      Agreed. Death rates are the only meaningful thing to look at, considering differences in testing rates, home testing and the like.

  3. jdubs

    Those caveats are of course pretty significant to the conclusion. Hard to draw any conclusions about an approach if we aren't sure if or when the approach was changed.

      1. Traveller

        I saw this coming and it still made me laugh...thanks for the smile in these miserable times. Best Wishes, Traveller

  4. skeptonomist

    It's clear by now that most of the countries listed did not do enough to really keep the contagion down. Of course the idea from the beginning was simply to "flatten the curve", that is spread the infection out over time so that health facilities were not overwhelmed. Well, the facilities were at least severely strained in most countries, and actually overwhelmed in nursing homes and some other specific areas. Exactly which measures and strategies are most effective has never been clear and may never be in these countries. But yes, much more should be done in nursing homes.

    If there is any chance of really suppressing another pandemic, the strategy would have to come from those countries which really did keep the rate of infection down, not the ones that Kevin shows. The low-infection countries are mostly in Asia. Some other isolated countries kept the rate down for the obvious reason that they basically cut themselves off.

    mRNA vaccines seemed to offer hope of really preventing pandemics, but so far they are not as effective as they seemed to be at first. And there has been nowhere near an adequate world-wide distributions system, and apparently little hope of having one in the future.

  5. illilillili

    The swedes had a high case rate pre-vaccine. Post vaccine and with rapidly spreading but less deadly variants, their case rate heads toward the middle.

    1. jvoe

      Exactly. Sweden's approach was stupid before the vaccines and before the disease was even well understood. After vaccines were available, I would give it a 'wait and see'.

      But one thing the Swedes got right is that a population of young people in a free country are not going to change their lives indefinitely for a 0.25% chance of dying. A large fraction of a population don't really care about others but they do care about being inconvenienced.

        1. Joel

          What was the Swedish approach?

          "While most countries endured harsh lockdowns during March 2020, Swedes went on with their lives largely as before, indulging in nightlife, visiting elderly relatives, and so on. Government officials hoped that a large enough portion of the Swedish population would gain immunity to COVID-19, making the diseases’ spread less consequential. At the time, many were curious about Sweden’s unconventional approach."

          https://chicagopolicyreview.org/2021/12/14/swedens-unconventional-approach-to-covid-19-what-went-wrong/

          1. sturestahle

            Your article is copied from some other source, I have read similar ones primarily in British and American media but also in German media (although my German is not that good)
            Biggest lie is that Sweden was going for herd immunity, that’s only a truth in International media . I never heard a Swedish official saying so in one of the daily news briefings they held
            Next lie is that Sweden never had any restrictions whatsoever and that’s also a lie but restrictions was implemented the Swedish way not by Police officers armed as if it was a war
            American right wing extremists are just loving a nonexistent Swedish model and mainstream media over at your place are bashing the same nonexistent model
            Problem is that it’s fake news .Information in foreign media has rarely been coming from official sources or Swedish mainstream media.
            Apparently was a closed Swedish Facebook group more popular as source of information instead.
            That group is consisting of roughly 200 persons critical to our approach . Originally was a handful of them renowned scientists with a critical opinion on our handling of the virus.
            It’s important to have such people.
            One of them was Björn Olsson , in foreign media described as being silenced by the authorities
            Ridiculous!
            He has been frequently seen in Swedish media sometimes critical sometimes not.Highly regarded.
            The group was soon taken over by people of little expertise on the subject of virus and was instead spreading distorted information
            The group has been checked up by Swedish public service media (NOT the serfs of the government, Sweden is rated in third position worldwide on freedom of press by Reporters Without Borders)
            Public service handed over the material to James Pamment, PhD specialists on strategic communications at the University of Lund to assess. He compared it to disinformation commonly used by hostile nations.
            Especially Time (UK) and Washington Post was mentioned . Both are mportant media that has been copied by many other
            (It’s also a little weird to hear a reporter from Times ask a question to a Swedish representative on a press conference in Swedish TV and the day after read something completely different in his paper)
            Reading comments in a publication like Washington Post is a little amusing but also scary. Even the most advanced brains wants to teem up with the crowd , wants approval, wants “likes” , lies are spreading fast.
            It’s no wonder people like Putin still is able to control the opinions of people
            The situation in Sweden was totally different to the situation in other Nordic countries at the onset but that’s another story.
            Now when it’s starting to be possible to evaluate the outcome (we will need another two or three years before we can start to summarize it) does data show that we managed better than most other European countries but it’s clear that it’s a narrative most Americans don’t want to listen to
            Have a nice day my Friend.
            I will leave this thread now

  6. cld

    Covid-19 increases risk of heart conditions for everyone regardless of severity, pre-existing conditions or co-morbidities,

    https://publichealth.jhu.edu/2022/covid-and-the-heart-it-spares-no-one

    . . . .
    The major finding was that people with COVID-19 have a higher risk of all sorts of heart problems at one year. That included arrhythmias (irregular heart beats or the heart beating too fast or too slow) and atrial fibrillation (a fast heart rhythm in a particular pattern). We found evidence of an increased risk of stroke, of blood clots in the legs and the lungs, and of heart failure and heart attacks. The increased risk of a broad spectrum of heart problems was evident.
    I went into it thinking that [the risk] was going to be most pronounced and evident in people who smoked a lot or had diabetes, heart disease, kidney disease, or some [other] risk factors. What we found is that even in people who did not have any heart problems start with, were athletic, did not have a high BMI, were not obese, did not smoke, did not have kidney disease or diabetes—even in people who were previously healthy and had no risk factors or problems with the heart—COVID-19 affected them in such a way that manifested the higher risk of heart problems than people who did not get COVID-19.
    . . . .

      1. cld

        Which number is nowhere in that article, as you know as you didn't read it.

        What it does say is,

        . . . .
        I think that's why talking about it is very important. We think long COVID can affect anywhere between 4% and 7% of people. That seems really small, but it’s not if you multiply that number by the huge number of people infected with COVID in the U.S., more than 80 million people and counting. We think that will translate into millions of people with long COVID in need of care, and broadly speaking, our health systems need to be prepared. People running health systems or clinics need to start preparing for the tide of patients that are going to hit our doors with heart problems and other long COVID problems.
        . . . .

  7. Spadesofgrey

    You mean a disease that effects older people, disabled the worst and is to contagious for useless restrictions???

  8. Rattus Norvegicus

    This doesn't really account for the response of the population. I have a few American friends who married Swedes and moved there. Their families were fairly worried and basically did what you were supposed to do despite the lack of strictures. Basically, what your chart shows is that things were pretty grim until vaccine uptake got to a fairly high level. It took them a long time to get up to the 60% range, which happened in early to mid-September 2021.

    Then omicron fucked everything.

    1. sturestahle

      “I know someone who lives in Sweden “ doesn’t make you an expert on us
      I wouldn’t call my Sweden a success but one needs to cherry-pick facts to call us a failure since we managed better than most European countries especially if one check the more accurate statistics of “excessive deaths “ instead of the official statistics since no countries reported in the same way 
      We got caught in others domestic arguments, especially in USA .
      Right wingers advocated a “Swedish model “ that didn’t exist and mainstream media condemned the same nonexistent model.
      Reading comments in a publication like Washington Post was a little amusing but also scary. Even the most advanced brains wants to teem up with the crowd , wants approval, wants “likes” and the most ridiculous lies are spreading …fast.
      USA is the home of most conspiracy theories one can find out there and so far has right wing extremists been responsible for 100% of them but such theories can apparently originate from other groups as well.. as you are the proof of 
      … it was kind of weird.
      International media was over and over reporting the same three facts: 
       Sweden was aiming for herd immunity… and that’s fake news 
      Sweden did hardly have any restrictions whatsoever…. and that’s also fake news 
      Statistics on deaths are disastrous compared to other Nordic countries… ..true but irrelevant since the the situation is completely different if one compare urbanization, crowded living conditions and demography and most important, our schools had winter holidays when the virus reached Europe . Roughly 1m of us was out and about, many visiting after ski bars in the Alps the worst centers for infection in Europe.
      We had twice as many infected as the Danes, 5x as many as the Norwegians and 15x as many as the Finns at the onset of the pandemic Our situation was more like the one they had in Belgium
      We are in the bottom 25% in the developed world if one is checking excessive deaths
      Next year’s statistics will prove to be even more “positive” for us since we have succeeded well with vaccines
      Amazing how difficult it is to read a table when born in the US. Or is it perhaps the difficulty in absorbing facts that don't fit your narrative?
      …. And your claim that vaccinating was slow in Sweden is pure fantasy
      https://www.cebm.net/covid-19/excess-mortality-across-countries-in-2020/

      1. Jasper_in_Boston

        Shorter Sture: the fact that my country saw an increase in mortality in 2020 when our neighbors actually managed a decrease in deaths has nothing to do with our "let it rip strategy." No, it's because we Swedes like to take vacations!

  9. Solar

    "At the same time, its cumulative death rate is right in the middle (though above both Denmark and Norway)."

    I don't know about you but putting aside that death counts is much more accurate number than case count, I think any rational person would rather have a sky high case rate as long as the deaths stay low, rather than a lower case count but higher death rate.

    1. Jasper_in_Boston

      It's very similar to "crime rates" vs. "homicide rates." The former (just like covid "cases") is a very noisy source of data.

  10. cephalopod

    Sweden was one among several places that had very poor outcomes for people in nursing homes. I think it is worth looking specifically at how to make nursing homes safer - even a less transmissible version, like SARS, can be quite dangerous in that population. General lockdowns are not a great tool for limiting deaths in nursing homes, because patients and workers move between facilities so frequently.

    There was so much early obsession with lockdowns, but there are many different responses and outcomes that should be studied. Japan, for example, had a lighter tough that worked pretty well. Specific at-risk populations may need different safety measures than the ones we chose: don't push the homeless into crowded shelters, fans instead of plexiglass barriers in stores, etc. Tracking cases like South Korea could also be a boon; it stopped outbreaks and they learned a lot about transmission.

    1. Jasper_in_Boston

      Japan, for example, had a lighter tough that worked pretty well.

      In other words the Japanese largely self locked-down. And it did work well. I doubt many Western countries could have emulated their results without rules and coercion, though.

  11. Traveller

    I wore a mask today here in Los Angeles...I felt positively Asian in my intelligence. And since I am moderately sure this is voluntary now, it, (a KF94), didn't seem difficult to breath though at all. Sometimes when mandatory, they did seem a little more restrictive than today....I kind of marveled at my perception of this difference.

    But then of course, it was a beautiful day in SoCal today...so this kind of helps everyone's mood I think...still, I am not sure when I will de-mask in crowded places now.

    Best Wishes, Traveller

  12. Vog46

    Traveller
    I'm with you on the masks.
    Not just for COVID. I haven't had the flu in two years and a cold in 18 months.
    I am vaccinated and boosted although the protection offered is diminishing. People then say "but Vog your T-cells are still protecting you". Sorry but that protection varies from person to person and in the elderly that protection is severely limited.
    If we ever get to the point where COVID is an annual thing rather than a next wave thing then we can say it's endemic. We aren't there yet and too many variants have circulated this past 12 months alone to say it has slowed down.
    Let this sink in for a minute
    At this time last year we were on the tail end of Beta, then along came Delta in May/June, then Omicron in November, now BA2.2.
    We had more people die in the last 12 months than we had births!!! We had more people leave the work force due to fear of catching a disease than we had entering the workforce. Now birthrates have nothing to do with COVID as it has been declining for decades
    The old paradigms are changing. COVID is not your grandmothers flu anymore.

  13. Traveller

    Dear Mr Intelligent Vog46:

    I was a little startled to see that Mr. Obama has recently contracted COVID, a mild case to be sure...but he is triple vaxed, and yet there he is. Likewise Ms Clinton, Jen Paski and Canada’s Prime Minister Justin Trudeau had to cancel WH meeting.

    These are all smart people, all vax 'ed, all infected this young year, and yet...so should be less cautious?

    Best Wishes, Traveller

  14. Salamander

    I've started wearing an N95 (a Draeger) around the house, since the Spousal Unit has started hacking and coughing non-stop. Probably won't save me from catching it, but it's worth a try. (He took a Covid test and it came back negative).

    Lots of folks in Albuquerque are still wearing the mask. Haven't heard any heckling, though.

  15. Joseph Harbin

    Why would you draw conclusions based on recent case counts? Look at deaths:

    Country / Cume Deaths / Deaths per 1M Pop

    Sweden / 18,155 / 1,779
    Norway / 2,339 / 426
    Finland / 2,985 / 537
    Denmark / 5,542 / 951

    US / 1,003,198 / 3,000
    World / 6,143,211 / 788

    Suddenly, if you look at a different -- and more important -- metric, every broad assumption you're making about Sweden turns out to be not just wrong but completely backwards. If the whole world had emulated Sweden's great "success," another 7.7 million people would be dead. Sheesh.

    (If you wanted to do a true comparison, you might look at other factors to see if the country enjoyed some extraordinary benefit for its subpar performance in keeping people healthy and alive. I haven't looked in a long while, but I remember seeing Sweden's Scandinavian neighbors doing about as well or better in economic performance during the pandemic.)

    1. sturestahle

      It ended up i as a “world cup” in Covid deaths in media, comparing statistics reported to worldometer or John Hopkins on all nations not caring over the fact that not two countries reported in the same way .
      Stupid!
      Mr Drum was into it 100%
      To clarify my statement compare , as an example, Belgium and the Netherlands.
      Belgium had much tougher restrictions but still had a much worse outcome than their neighbors to the north. One major difference was that In the Netherlands didn’t they report untested victims who died at “nursing homes” even if they showed clinical symptoms of Covid but the Belgians did. It’s impossible to compare statistics if the data has this kind of differences.
      Bad data gives shitty statistics
      If one instead compare “excessive deaths” isn’t the difference between the two countries as pronounced. Excessive deaths is what epidemiologist are using out of tradition even if that one also comes with some problems
      Sweden is doing well if one are using excessive deaths
      Sweden had an extremely tough way to report Covid deaths in order not to lose any cases
      Americans are usually regarding the Scandinavian countries as more or less one country when in fact it’s huge differences in diversity of population, urbanization and culture. Sweden is the country that differs most on things that has proved to be of importance during the pandemic
      It’s also difficult to compare economies. Denmark’s export is big on bacon and butter, Norway’s is big on (long term contracts) of oil while Sweden mostly is dependent on selling vehicles (not just cars but more important big ones) something that isn’t on demand in a lock down
      “I remember seeing Sweden's Scandinavian neighbors doing about as well or better in economic performance during the pandemic” (your quote) isn’t much of an analysis
      We will need another year, or two or three, before it’s possible to evaluate the effects of the pandemic , before it’s possible to start guessing what kind of measures that was effective and which ones that wasn’t.
      One factor that is of utmost importance but is totally disregarded by amateurs on the Internet is the situation at the onset, when the world woke up one morning and discovered a new virus was on the lose. Sweden had already 2x as many cases as Denmark that morning, 5x as many as in Norway and 15x as many as in Finland
      This was simply because Swedish schools had winter vacations at this particular time in history and 1 million of us was all around Europe, especially in the after ski bars in the Alps that was the super spreader events over here .
      You are basing your analysis on bad data and you are being influenced by media reporting on a Swedish approach that didn’t exist my friend
      Here is a reliable report on excessive deaths concerning 2020. Sweden will do even better when we get results for 2021 and 2022

      https://www.cebm.net/covid-19/excess-mortality-across-countries-in-2020/

      Have a nice day my friend

      1. Joseph Harbin

        @sturestahle

        It's true that caveats apply to all data. That's true whenever comparing numbers across different countries, states, etc. Still, it's what we have to use, and it applies to excess-death data too.

        At the link you provided, Sweden is hardly a shining example for other countries to model. In comparison to its most immediate neighbors, the Nordic countries, Sweden hardly deserves a passing grade.

        Country / Excess Mortality per 100K / Excess Mortality %-age
        Denmark -44 / -4.3%
        Finland -29 / -3.1%
        Iceland -31 / -4.1%
        Norway -32 / -3.6%
        Sweden +13 / +1.5%

        Maybe Sweden will do better in later years but it has a lot of ground to make up.

        1. sturestahle

          Why are you comparing us to other Nordic countries
          Please give me a logical explanation?
          … don’t just come saying
          But …But… But.. you are neighbors.
          My guess is that you are not that well informed on us, try to check up on us first

          1. Joseph Harbin

            Why are you comparing us to other Nordic countries...

            Such a good question. Understand that I did consider a number of alternatives for comparisons with Sweden.

            (a) the Baltic states
            (b) the Balkans
            (c) Central American countries
            (d) French-speaking countries
            (e) OPEC countries
            (f) the Papal states
            (g) Countries of sub-Saharan Africa
            (h) Countries with capitals of more than 8 letters
            (i) Countries in the board game Axis & Allies
            (j) Nordic countries

            I went with (j) because it's my first initial. Maybe that was unwise. If you think (a) thru (i) would have made a better choice, tell me why. Please provide a logical explanation, footnotes, and an apology for inflicting ABBA on the rest of the world. Thank you, and I await your reply.

    2. Jasper_in_Boston

      If the whole world had emulated Sweden's great "success," another 7.7 million people would be dead

      Indeed.

      Sweden's performance hasn't been egregiously bad. Plenty of countries have suffered more covid death, or comparable amounts of covid death. But a number of high income countries have protected their citizens better, with equal or stronger economic performance. In other words, Sweden's overall pandemic response has been A) pretty unremarkable (worthy or neither scorn nor praise) but, B) weaker than its Nordic neighbors (which suggests the big body county it allowed via its early, "let 'er rip" strategy was misguided).

      1. sturestahle

        Why are you comparing us to other Nordic countries?
        What makes us comparable?
        We has been compared to our neighbors in all international media but no one has given it a second thought why .
        (please don’t come saying it’s because all Nordic countries are having very homogeneous “Lilly White” population, that’s the usual answer I get from the stupid ones)
        Also if you care to check the link on excessive deaths during 2020 , the worst yer. It’s a reliable source. We will further “improve” in the upcoming ones
        We made many mistakes, just as everyone else and it’s much we have to reconsider but given the situation Sweden was in in March 2020 I actually don’t believe we could have done much better

        1. roboto

          Nobody on the left will understand your comment.

          Sweden was hit hardest with coronavirus because many families went skiing in Italy and Austria during the school holiday in March, which was earlier than its neighbors were people didn't go to Italy.

          Norway has much smaller and better care homes for the elderly than Sweden's large care homes so coronavirus killed far fewer if it went through one in Norway.

          Sweden had more vulnerable elderly per capita at the start of 2020 than its neighbors and ultimately have had very similar excess deaths per capita in 2020 and 2021.

          1. Jasper_in_Boston

            Norway has much smaller and better care homes for the elderly than Sweden's large care homes so coronavirus killed far fewer if it went through one in Norway.?

            Norway also had much stricter covid protocols (ie, mandatory social distancing) than Sweden. So, too, did Finland and Denmark.

            I'll take your word for it that Sweden's care homes are inferior to those of Norway.

            1. Silver

              I can confirm that Swedish care homes are inferior to those in Norway. I am not sure about the exact numbers, but I think they have something like 10 times the number of nurses per resident. As an example.

              I can also contribute with an observation regarding case counts: Sweden changed its testing routines in January, meaning that we don't catch as many cases as before. This should of course be combined with observing the positivity rate, but still, the fact that Swedish case rates are lower now is partly because of this. So, the situation is probably a bit worse case-wise than it looks.

              As for what else has been said in this commentary field about Sweden and the pandemic... I just don't have the energy to contribute today. Even though I am a Swedish native, live in Sweden, speak and read Swedish, follow the news rigorously, and can explain what is actually going on in Sweden, it seems that so many here are more willing to believe journalists from other countries that do not understand Swedish hence are not able to follow Swedish media or politics, publishing with an agenda to draw attention rather than make sure they are correct. I can't do much about that.

        2. Jasper_in_Boston

          Why are you comparing us to other Nordic countries?

          Because Sweden is a Nordic country characterized by comparable levels of income, wealth, urbanization, economic models, political systems etc. Nobody is claiming the Nordics are identical peas in a pod. (No two countries are identical). But yes, they are comparable.

          But sure, if we choose your preferred comps for Sweden (Poland? Nigeria? The US? Madagascar?) as usual it comes out as a shining city on a hill.

  16. azumbrunn

    I think it is pointless to compare over the entire pandemic. The arrival of vaccines changed the game so much that one has to compare years one and two separately.

    The Swedish model was clearly distinct in the first few months. But as time went on we got the De Santis model and other such models plus a general softening of discipline; we began looking more and more like Sweden. Finally everybody rescinded measures prematurely--after which even reimposing them had only limited success.

    1. sturestahle

      You are talking about a Swedish model that only exited in International Media, that model didn’t exist in Sweden
      (That nonexistent model was just loved by American Republicans)

      1. roboto

        Of course the Sweden model existed in Sweden. The WHO used the Ferguson model to tell the Swedish government in early April that unless they locked down there would be 90,000 Covid deaths by June. Sweden didn't lock down and there were 3,000 deaths by June 2020 and 18,000 Covid deaths after two years.

  17. arghasnarg

    "It's possible—only possible, mind you—that the lesson from all this is that for a virus like COVID the best response is to flood the zone with countermeasures for the elderly but keep countermeasures fairly light for everyone else."

    There is one big problem with this: when exactly do you "know" that a virus is COVID-like? For this approach to be useful, you must conclude this before the virus makes the choice for you.

    Early on, some of the critics of the Swedish Model were arguing risk of the unknown. That turned out to be wrong, but I don't think the fear was misplaced.

    A second big question is messier: mitigating the second-order effects of mobilizing a response, which now must include plans for dealing with the various different flavors of yahoos and insurgents.

    1. Jasper_in_Boston

      There is one big problem with this: when exactly do you "know" that a virus is COVID-like?

      By the time a virus that's killing people has been sequenced (or shortly thereafter), we'd likely have substantial evidence as to who the vulnerable populations are. Also, although 1918-1919 was a glaring exception, older people in general tend to be more vulnerable to many respiratory infections (the immune system weakens as we age) so, it seems to me public health policy would likely be on firm ground being extra protective of old people as a general precautionary principle. In other words, err on the side of caution in the early going.

  18. Leo1008

    As everyone here knows, there are so many caveats:

    “It’s possible—only possible, mind you—that the lesson from all this is that for a virus like COVID the best response is to flood the zone with countermeasures for the elderly but keep countermeasures fairly light for everyone else.”

    There are many good comments here about Sweden’s healthcare system: fine. But whenever I hear these comparisons to Europe I think of the size, population, and complexity of the USA. These factors seem obvious but they’re rarely mentioned.

    In fact, that’s one thing that always bothered me about Bernie sanders. He seems to mean well (though I was never a huge fan), but he kept asking the same question: if European countries can have generous national health care systems for all their citizens, why can’t we? One obvious answer that always came to my mind: a lot of those countries are small, they contain few people, and all of those people are white. That makes it a lot easier to make big decisions than in a huge country with a diverse population of almost 400 million. Then throw in our different system of government, and it’s just not surprising that things get done differently over here.

    Same with the pandemic. The USA will never adopt a “Swedish model” because, for one thing, the USA as a whole is unlikely to adopt a uniform model of anything. There are of course a few exceptions: social security and Medicaid may be as close to uniformly national programs as we’re likely to get. But those exceptions are few. In this and future pandemics, our response will almost certainly continue to break down and diverge along countless fault lines: state legislatures, city governments, local law enforcement, individual school districts, etc….

    1. Jasper_in_Boston

      if European countries can have generous national health care systems for all their citizens, why can’t we? One obvious answer that always came to my mind: a lot of those countries are small,

      That's not obvious. In fact it's wrong. Small economies are sharply more vulnerable to exogenous shocks than large ones (google the effects of the USSR's collapse on Finland for the classic example, or look at Ireland circa 2008-2012). Also, many European states aren't issuers of sovereign currency. These factors make it more difficult, not less, to "have generous national health care systems."

      The US doesn't maintain a sufficiently strong safety net because of political and constitutional factors, pure and simple. If the US could get its political act together, the country would do perfectly well in taking care of her people. **

      Indeed one piece of evidence for this is that America's two existing large federal safety net programs, Social Security and Medicare—while not perfect—are remarkably effective, politically and financially stable, and do tremendous good for tens of millions.

      **Let's not forget the United States is wealthier than Sweden, Denmark, Finland, Germany, Austria, Canada, Britain, The Netherlands...

      1. Leo1008

        “If the US could get its political act together, the country would do perfectly well in taking care of her people.”

        This is a bit of an important condition to place on your assessment of the situation, and it relates back to everything I said in my original post.

        All of the factors I originally mentioned add to the political dysfunction you speak of. So, I feel a bit as if you have said that the USA should simply function better despite the massive and intrinsic elements preventing it from doing so. And, Yes, that does seem to resemble the Bernie approach that has always bothered me.

        Once this perspective is brought to the White House, it crumbles in the face of reality. Hence, our progress will always be slow and faltering, and there will always be people deeply frustrated by that fact. And that will be as true with pandemics as with everything else. Welcome to the USA.

  19. DonRolph

    Or maybe it suggests that the optimum strategy is to:

    - institute rigid controls very early in the pandemic to contain spread while it is still easy to contain: South Korea, Australia, Taiwan, China, and New Zealnd come to mind

    - accelerate development of vaccines and vaccinations: Britain's experience here may be instructive

    and, but without supporting evidence so far,

    - accelerate treatments

    If we can contain the case level to low levels then vaccinations can be much more effective at stopping new cases.

    If we have good treatments, then cases do not develop into deaths.

    This would argue that no one country got it right, but a synthesis of approaches from various countries might be optimal.

  20. Special Newb

    My understanding is that Sweden did in fact switch its policies to be more in line with its neighbors later on.

    However the leaked emails show that Tegnell is both a fool and a monster. So of course he got promoted into WHO.

  21. jdubs

    A bit late to this one, but here is a link to the always great Michael Hiltzik covering a recent study showing how truly disastrous the Swedish covid response was.

    https://www.latimes.com/business/story/2022-03-31/sweden-covid-policy-was-a-disaster

    While we aren't at the end of the Covid outbreak and stats can always change over time.....we should feel pretty comfortable calling out the initial Swedish strategy as a complete failure. Cumulative deaths in Sweden are high compared to neighbors and the rest of the advanced world and extremely high compared to geographic neighbors. Death rates in Sweden were not just high initially followed by a dramatic leveling off, instead they started high and have seen additional surges in winter 2020 and spring 2022. The economy did not perform any better for all of these human sacrifices.

    There is no argument to be made in favor of Sweden approach now that we can see the results. It feels extremely misleading to shrug and say that the current case counts are middling and maybe we just need to wait for more data before we cast judgement.

    Disaster.

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