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Post Sweden's Coronavirus Policies *Are* Different from Rest of Europe
Created by John Eipper on 04/13/20 3:54 AM

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Sweden's Coronavirus Policies *Are* Different from Rest of Europe (Sam Abrams, USA, 04/13/20 3:54 am)

Cameron Sawyer's response to my post about Sweden conflicts with what Christina Anderson and Henrik Pyser Libell reported in their March 28th New York Times article I cited.

https://www.nytimes.com/2020/03/28/world/europe/sweden-coronavirus.html

That article, entitled "In the Coronavirus Fight in Scandinavia, Sweden Stands Apart," opened with this assessment:

"When the coronavirus swept into the Scandinavian countries, Norway and Denmark scrambled to place extensive restrictions on their borders to stem the outbreak. Sweden, their neighbor, took a decidedly different path.

"While Denmark and Norway closed their borders, restaurants and ski slopes and told all students to stay home this month, Sweden shut only its high schools and colleges, kept its preschools, grade schools, pubs, restaurants and borders open--and put no limits on the slopes."

Anderson and Libell continued:

"Finland closed the borders of its most populous region--which has 1.7 million people and includes the capital, Helsinki--for three weeks to fight the outbreak there.

"Norway limited groups outdoors to no more than five people, and those indoors must keep a distance of more than six feet (except relatives). Denmark closed its borders, sent public workers home with pay and encouraged all other employees to work from home. It shut nightclubs, bars, restaurants, cafes and shopping centers, and banned gatherings of more than 10 people outdoors....

"Some Swedes have suggested that their country is deviating from most other nations' response to hasten herd immunity, risking lives unnecessarily.

"The public health agency denies this.

"In the meantime, the infection curve in Sweden has started to rise sharply, and on Friday the government tightened the limit on crowds to no more than 50 people [after initially limiting crowds to no more than 500]."

Regarding schools, in particular, the difference is stark: Denmark, Finland, and Norway closed all schools. As Anderson and Libell reported, Sweden closed only high schools and universities and kept preschools and primary schools open.

Alex Ward provided more detail in his April 9th Vox article that I cited. That article is entitled "Sweden's Government Has Tried a Risky Coronavirus Strategy. It Could Backfire." I encourage WAIS members to read this article, as well.

https://www.vox.com/2020/4/9/21213472/coronavirus-sweden-herd-immunity-cases-death

As for fatality rates, the difference between 88 deaths per million inhabitants in Sweden, on the one hand, and, on the other, 9 per million in Finland, 21 per million in Norway, and 45 per million in Denmark speaks for itself.

The fatality rate in Sweden indeed pales by comparison to rates in Belgium and France, as Cameron noted, but the point of my post was to compare countries as similar as possible yet distinct in strategy. After all, the fatality rate in New York City, where my family lives, is now nearly 800 per million inhabitants, or 9 times the rate of Sweden. But the population density of New York City makes comparison to Sweden or any other country irrelevant.

Again, given the difference in strategy employed by Sweden in combating the coronavirus, the country indeed represents a compelling epidemiological test case. In time, scientists should be able to discern important lessons.

JE comments:  We've seen several references to "herd immunity."  I'd like to learn more about the harsh logic of the concept.

On a related topic, population density does not seem to predict infection or death rates.  Our own Detroit is one of the least dense major cities in the US, yet its population-adjusted infection rate is higher than NYC:

https://www.metrotimes.com/news-hits/archives/2020/04/07/detroit-has-a-higher-coronavirus-death-rate-than-new-york-city


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  • More on Coronavirus Policies in the Nordic Countries (Cameron Sawyer, Russia 04/14/20 1:26 PM)
    In response to Sam Abrams (April 13th), there are plenty of articles critical of Sweden's pandemic response. It is an understandable if ugly human impulse to want to disbelieve, when everyone is suffering such cost and damage from lockdowns, that some other country may get away with less cost and damage.

    But the articles which Sam cites are demonstrably wrong about different things. First of all, Sweden does not indeed stand so much apart from other Nordic countries. Which Swedish policy, exactly, is being objected to? There is no unitary concept called "lockdown" which is the same everywhere--there are rather an array of different policies which can be combined in different ways, to wit:


    1. Close borders to non-essential international travel.

    2. Stay at home orders: people not allowed to leave their homes except for narrowly specified reasons.

    3. Closing public spaces

    4. Curfews and/or blanket bans on "non-essential travel"

    5. Closing schools

    6. Banning large gatherings

    7. Banning social contacts outside of one's own household.

    8. Closing restaurants and bars

    9. Closing factories and companies in "non-essential" industries

    10. Closing shopping centers and/or "non-essential" shops


    Most of Europe has taken all or nearly all of these measures. But not the Nordic countries. In Denmark, where I am now, only 1, 5, 6 and 8 were done, and starting on Wednesday, schools will be reopened so 5 will be off. So three out of 9 categories of measures, and without ever having had any of the most intrusive ones, which are stay-at-home orders, restrictions on internal travel, closing businesses, and closing public spaces. As to 8, restaurants in Denmark are actually open, but you are not allowed to dine inside.  Two people at a time are allowed inside to pick up orders.


    Just about the same thing is true in Finland and Norway, where there are likewise no stay-at-home orders, no closing of public spaces, no curfews, no bans on small gatherings or visiting. Finland has a short-term ban on non-essential travel into and out of the capital region--intended to slow down the spread of the virus from Helsinki into the countryside. This will be lifted at the end of this week. Norway has a short-term ban on people going to their country houses, which will also be lifted soon.


    Sweden has banned large gatherings like the other Nordic countries, has banned visiting nursing homes, and has closed high schools and universities. Sweden is alone among the Nordics in leaving borders open, but this is not a very important fact since international travel has just about stopped anyway, and Schengen as a whole, including Sweden, is closed to travel into and out of the Schengen zone, including from the UK. From Wednesday, the only difference between Denmark's policies and Sweden's will be that you can sit inside restaurants in Sweden, rather than going inside two at a time, and that Sweden's borders are theoretically, of not practically, open. That's it. Both Denmark and Sweden rely principally on people following non-mandatory recommendations about social distancing, which has profoundly changed behavior in both countries, and which has resulted in a significant flattening of infection rate curves.


    So all the Nordic countries differ radically from the tight lockdowns imposed in other European countries, and are more like each other, than to anywhere else, and that includes Sweden. Life in the Nordic countries goes on in a way much closer to normal life than elsewhere--people are out sailing and travelling by RV, the parks are full of people having picnics and going for walks, people visit their friends, children, and grandchildren (albeit selectively and carefully), people go to shops of all kinds, everyone who has not been laid off is working. People are not cowering in their homes and hoarding toilet paper like elsewhere.


    As to the "infection curve rising sharply" in Sweden, this is objectively false. The curve in Sweden has on the contrary steadily flattened, like elsewhere in Europe. As of April 13th, there are 10,483 cumulative cases. On 2 April, there were 5,568 cases, so in 11 days, the number of cases has not doubled. See: https://www.worldometers.info/coronavirus/country/sweden/ . This compares favorably to Denmark, with 6,174 cases, which has just about doubled since 3,107 cases on 1 April, so roughly the same rate of doubling as Sweden. Although not as good as Norway, with 6,525 cases which has taken more than two weeks to double. But better than France and UK, and similar to countries with the outbreak well under control like Germany. Note that the rates of doubling in Europe have very recently been 6, 5 even 4 days. The dynamic of spreading of the disease has dramatically slowed all over Europe, not excluding Sweden. The rate of doubling is indeed the critical metric--because the whole purpose of the economically devastating lockdowns is not to reduce the ultimate extent of the infections, but to "flatten the curve" of new infections sufficiently that critical cases are spread out over enough time that health care systems are not overwhelmed as happened in Italy.


    All of the Scandinavian countries, including Sweden, have managed to flatten their infection rate curves early in the game, with infection rates lower than the rest of Europe, namely: Norway 1,204, Denmark 1,066, Sweden 1,038. Finland is even much better than this, but all the Nordic countries have the lowest infection rates in Western and Northern Europe. Finland is the only country in Northern or Western Europe with a lower infection rate than Sweden. See: https://www.worldometers.info/coronavirus/#countries . So the number of daily new cases in Sweden has stayed in the range of a few hundred cases a day, 332 yesterday, or 33 per million of population. This is rather sustainable compared to thousands of cases a day in other countries, for example, more than 5,000 cases yesterday in the UK, and recently near 10,000 in a single day. This is 83 - 160 cases per million per day.


    As to death rates, Sweden's is notably higher than other Nordic countries, but at 89 per million of population, is still low by European standards, below the average of Western and Northern Europe. On two days only have there been more than 100 deaths per day. The worst day was 114 deaths. Yesterday there were 12. This is 11 and 1.2 per million respectively. In France, there have been five days with more than 1,000 deaths, 1417 on one day last week. That is 23 per million, and cumulatively 221. We won't talk about Italy or Spain, or certainly not New York State, where more than 9,000 people have died just in the last 3 weeks, for a population only twice that of Sweden, for cumulative deaths of 469 per million, in less than a month since the first death. To paint the situation in Sweden as alarming in any way, compared to the rest of the world, you have to severely torture the data.


    As to the underlying demographic, economic and climatic differences between the Nordic countries and the rest of Europe--why should that be taken into account in the way that Sam suggests? So Sweden shouldn't accept a cumulative death rate of 89 per million, which is 2 ½ times less than France, although Sweden is at a later stage in the epidemic? Why? On the contrary, logically, the Nordic countries should be exploiting their natural advantages to disrupt life and disrupt their economies less, and to implement measures which are sustainable over a longer term than the kind of measures implemented elsewhere. And that is exactly what all the Nordic countries are doing, and not just Sweden, with much milder measures than the rest of Europe. The kind of lockdown being done in France and the UK cannot be sustained for long without total collapse of society and economy (and it is not clear that total collapse is avoidable even now), and could probably not be repeated. But the Nordic countries have taken measures which can be sustained for a longer periods of time, or which can be relaxed and reimposed as necessary as successive waves of the virus come through.


    Note also that it is not necessarily desirable to reduce the rate of infections too low. The idea that the epidemic should be allowed to spread uncontrolled so that "herd immunity" can come into play to stop further spread, has been generally discredited. But that doesn't mean that we don't care about herd immunity--on the contrary, it is desirable that people develop immunity, and countries whose citizens have been infected and have recovered, but not so fast that health care systems were overwhelmed, will be able to return to normal life sooner. Finland, for example, with one of the lowest infection rates in Europe, may be more vulnerable to the second wave, than other countries. There will be at least three waves of this before we have any decent chance of having a vaccine. So it may well be that Finland, even with its very light lockdown, has overdone it, at the cost of the biggest recession in a century--we won't really know for at least another year.


    As I wrote--whether Sweden or indeed any other country in the world has gotten the policy mix right, no one can say at this stage. It is still early days. If "flattening the curve" is indeed the right goal to be pursuing--and I'm not sure that we know even this for sure--then objectively, according to the data, Sweden has succeeded better than most, and indeed has succeeded in doing so at an early stage of the epidemic, while the total number of infections is still relatively small. Maybe Sweden's policies are not optimal, but you can't say that at all today, based on the data.


    JE comments:  Cameron Sawyer raises a new question on our extensive coronavirus discussion:  Will the nations that took extreme (even draconian?) measures against the virus be more vulnerable to the (inevitable?) second wave?  Finland vs. Sweden, perhaps, will provide the competing test cases.

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