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Post Sweden's Covid Policies are Misunderstood
Created by John Eipper on 12/23/20 3:40 AM

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Sweden's Covid Policies are Misunderstood (Cameron Sawyer, Russia, 12/23/20 3:40 am)

JE wrote on December 22nd: "The lone male-led Scandinavian country (Sweden) has famously gone its own way on Covid, with a lax attitude towards lockdowns and quarantines."

I have written about this before. There is considerable politically inspired mythology concerning Sweden's pandemic response. In fact, the pandemic measures in Sweden come from the exact same menu as in all the Nordic countries, none of which implemented any lockdown (defined as stay at home orders and mass closing of businesses).

The Swedish/Nordic approach to the pandemic is to rely principally on extensive voluntary measures with very few legally binding measures. There have been no stay at home orders, no wholesale closing of shops or workplaces, no mandatory restrictions of movement (with very limited exceptions). The reason for this different approach, as stated by Tegnell in Sweden, Salminen in Finland, and other Nordic health chiefs, is that the pandemic measures (a) should consider public health as a whole, and not only the Coronavirus pandemic; and (b) should be sustainable so that they can be kept up in the long term. Another important reason why there have not been lockdowns anywhere in the Nordic countries is because Nordic constitutions have extensive guarantees of personal freedoms including freedom of movement--in Sweden and Finland it is considered constitutionally impossible to order people to stay in their homes in peacetime.

"Considering public health as a whole" explicitly considers protecting the economic health of the country.  The PM of Finland famously stated that public health depends on the economy, so if we fail to protect the economy, we will fail public health as well--in explaining why the measures in Finland are much less strict than in other parts of Europe. Mass unemployment also has extremely negative effects on public health, even with a comprehensive welfare state as in Finland. Keeping children out of school harms the children directly, harms the parents and interferes with their ability to work, and harms the economy in future. All of these considerations require nuance and wisdom in choosing the appropriate set of pandemic measures and not just "throwing the kitchen sink at it," as many countries have done. And as a result, schools have managed to stay open in all of the Nordic countries throughout most of pandemic so far, at least elementary schools which were closed only briefly in the spring (Sweden, Finland, and Denmark have closed high schools and universities at various times), shops have not been closed (except hairdresser salons, gyms, yoga studios etc. in some countries and for relatively brief periods), construction sites have been unaffected, and the Nordic countries have suffered much less economic damage than other European countries, consistently -3% to -4% of GDP according to the latest figures.

These are not "lax" approaches; they are nuanced and multifaceted. Thus for example the quarantines are mostly voluntary--when you enter Finland, for example, which as the least infected country in Europe has a great concern with international travel, you are advised to isolate at home for 10 days except for necessary trips to shops and essential business meetings. There is no legal obligation and no one checks--there is huge social trust in the Nordic countries, and the authorities rely on good faith of the people. Compare that to the quarantine in Australia where travelers, including Australian citizens, are virtually imprisoned for two weeks at great expense in supervised facilities--they are not even allowed to quarantine at home.

The Swedish implementation of these measures does not materially differ from those in other Nordic countries. Specifically, Sweden closed only high schools and universities in the spring; the other Nordic countries briefly closed all schools. Now in the grips of the second wave, none of the Nordic countries are closing elementary schools. Rather than closing restaurants altogether, as briefly happened in the spring in other Nordic countries, Sweden enforced minimum distance between tables and forbid food being served other than with table service, and placed limits on hours of serving alcohol. Now during the second wave, the other Nordic countries are doing it the way Sweden did it.

So why has Sweden gotten so much attention with its allegedly "own way"? Because some right-wing nuts in the US held up Sweden as an example of how a country can just do nothing about the pandemic, and get away with it--as an argument against the pandemic measures at home. Whereupon the other camp in our polarized political landscape went on the attack, doing everything to show how awful things are in Sweden, as a way to defend against the idea that you don't need to do anything. The problem is that neither camp has any understanding of what is really happening in Sweden. The right-wing view of the Swedish measures is totally wrong--Sweden is no example at all of a country which "just did nothing." On the contrary, Sweden, like the other Nordic countries, has a highly detailed pandemic plan worked out years in advance, which it is following to the letter. This plan relies on mostly voluntary measures, but those voluntary measures are highly effective--the level of compliance with them is similar to the level of compliance with mandatory measures in countries with lockdown. And these measures evidently work--the Nordic region as a whole has had far less death on a per capita basis than other regions of Europe. Sweden (and now Denmark) has been more affected than other parts of the Nordic region, but the cumulative death rate (today 806 per million) is within 20% of the European average, and is far less than that of the UK (994) or France (932), not to mention Italy (1146), Spain (1053), or Belgium (1610). See: https://ourworldindata.org/coronavirus

The difference in the death rate between Sweden and the other Nordic countries cannot be attributed to the minor differences in implementation of pandemic measures. It is well known by now to science that the course of the pandemic in specific regions is greatly affected by superspreader events; thus Italy was hit badly and early because of a stream of businessmen traveling from Wuhan. Sweden was also affected by a terrible superspreader event--thousands of skiers returning from spring break to Stockholm and Gothenburg from Bergamo and Lombardy the first week of March, just after the infections exploded in those places and just before measures started to be taken anywhere--terrible timing. Proof of the significance of this event is the fact that the spring outbreak in Sweden was mostly centered around Stockholm and Gothenburg, while the third largest city of Sweden, Malmo, in Skane, where spring break like in Denmark was one week later, so that the authorities were able to keep people from traveling from the affected areas of Italy, was almost unaffected, with infection rates similar to Copenhagen across the Sound, although the pandemic measures were exactly the same as in Sweden's other cities.

Despite these terrible circumstances, the pandemic measures in Sweden have worked well, keeping the level of infection and death within reasonable levels compared to the rest of Europe, and certainly with much less effect than was suffered in Italy.

It is true, however, that Sweden badly bungled its protection of nursing homes, where the virus spread early and aggressively, killing thousands of old people. This has been the subject of intense internal discussion and harsh criticism, culminating in an official report released recently condemning the measures for protection of nursing homes, which inspired an unheard of public statement by the King. But similar things happened in Ireland and many other countries--nursing homes and their residents are particularly vulnerable for a host of reasons.

But in general, Sweden does not deserve all the attention. The country is having a more or less average outcome compared to other European countries, despite the awful early superspreader event, and far better than the outcome in the US. Measured by excess mortality for the year, rather than reported COVID deaths, an arguably better measure of the real effect of the pandemic, Sweden is doing even better than that--cumulative excess mortality for 2020 is only around 400 per million, half of the official COVID death rate, and within a fairly normal range of fluctuation for total mortality these last few decades (see: https://emanuelkarlsten.se/number-of-deaths-in-sweden-during-the-pandemic-compared-to-previous-years-mortality/ ). Compare to about 1200 per million in the US, three times the rate of Sweden, and higher than the official COVID death rate. The principle reasons for this are (a) differences in methods of counting COVID deaths; and (b) disproportionate number of the deaths in Sweden, were deaths of people who would have died this year anyway--therefore they show up as excess deaths in one month and then are subtracted from deaths in some future month.

All this being said, the pandemic, unfortunately, is far from over, and we can draw final conclusions only later. The Nordic region is now being hit very hard with a second wave which lagged the second wave in the rest of Europe. Sweden is again badly affected, and Denmark has had a huge rate of increase in daily infection rates and will overtake Sweden next week at this rate. Although the infection rates continue to be very low in Finland and Norway, there is a feeling in those countries that luck will run out soon. God help us all.

JE comments:  Nicely done, Cameron.  This summer and fall, there were frequent news items about Danes ferrying over to Malmo to drink in the still-open Swedish bars, but these reports were probably oversimplifications.  The crucial matter here may be the Nordic sense of social responsibility, which is famously absent elsewhere.  But one should also avoid oversimplification on the "social responsibility" front:  in Mexico, not noted for its civic cooperation, we observed a far higher compliance with masking in the streets and the ubiquitous taking of temperatures than in the US.

Now that we're back in Michigan, I'm preparing a report on Mexico in the Covid Era.  The US may indeed be the laxest nation of all.  And we are paying the price.

Can someone (Martin Storey?) explain to us how the draconian quarantine system works in Australia?  Where do the "internments" take place?


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  • Sweden's Coronavirus Policies ARE Different (Francisco Ramirez, USA 12/24/20 4:24 AM)
    For an alternative perspective to Cameron Sawyer's (December 23rd) on Sweden and its response to Covid, please read this study by Staffan Andersson and Nicholas Aylott:

    https://www.mdpi.com/2076-0760/9/12/232/htm


    The paper does not make causal claims linking different strategies to different outcomes. But it does contend that Sweden differed from its neighbors and that this was not a trivial difference.


    As the Director of the Scandinavian Consortium for Organization Research at the Graduate School of Education at Stanford, I am in constant communication with Scandinavian scholars. Three cohorts of Visiting Scholars have had to defer their visits to Stanford. This coming Winter will bring our third consecutive semester of weekly seminars via Zoom. Thus, not surprisingly, Covid is in our minds.


    Below is a graphic to keep in mind:


    https://www.statista.com/statistics/1043366/novel-coronavirus-2019ncov-cases-worldwide-by-country/



    JE comments:  According to the graph immediately above (click on "expand statistic"), Sweden, with twice the population of Denmark, has 2 and 1/2 times more Covid cases.  This is a meaningful difference, but not an earth-shattering one.  I'd like to hear more of Cameron Sawyer's views on the Libertarian "approach" or ideal on how to deal with a public-health catastrophe.  Coercion is not in the Libertarian playbook, but how do you balance the public good with individual freedoms?


    Earlier today, A. J. Cave cited a Bloomberg assertion that authoritarian countries have a better track record with Covid than the liberal democracies.  I cannot readily grasp a correlation from the chart above--although five of the six most-affected nations (excluding Russia) are democracies.  Where's China, I wonder?  I would wager my 401k that the Chinese are underreporting their cases.  Eighty-six thousand?  Bah.

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    • Scandinavia's Covid Policies, Revisited (Cameron Sawyer, Russia 12/26/20 3:54 AM)

      The article cited by Francisco Ramírez (https://www.mdpi.com/2076-0760/9/12/232/htm ) is very interesting, but does not indeed show that Sweden's pandemic strategy is different from that in the other Nordic countries. This is merely assumed to be true without analysis.


      This article is not about the measures themselves, but about the sociology of public policy--about the administrative and sociological reasons of why this should be so. And these arguments are somewhat valid, concerning differences between Sweden and Non-Nordic Europe, but not as to Sweden and the other Nordic countries. This is a fact inconvenient to the thesis--which is that the outcome in Sweden is fairly average for Europe but significantly worse than the other Nordic countries.


      The facts are rather not what the authors, like so many others, merely assume, without information. The facts are like what I described in my previous WAIS post on the subject. People focus on the fact that Sweden's strategy is different from that of the rest of Europe. It is. But it is not that different from the other Nordic countries. That is merely assumed, and this assumption is incorrect. It would be easy to make this assumption, since the outcome in Sweden has been much worse than in the other Nordic countries. But beware of confirmation bias. The outcome was different, so one would expect to find an explanation in different measures. But It is not actually true that the approach or the measures are significantly different. There are many different factors which influence outcomes, besides the government response, some of them random.


      Much is made in Francisco's article of the voluntary nature of most of the pandemic measures in Sweden, whereas other countries supposedly implemented mostly mandatory measures. But as I wrote, the pandemic approach in all of the Nordic countries has been overwhelmingly based on voluntary measures. Even the quarantine in Finland, for people crossing the Finnish borders from highly infected countries, is an honor-system quarantine.  It is explicitly recommended. Just like in Sweden, and different from Non-Nordic Europe where it is a punishable offense to break quarantine. No Nordic country at any point ever imposed stay-at-home orders, any mandatory restriction of movements, closed workplaces, closed construction sites, or did any mass closing of shops and businesses. The social distancing measures in all of the Nordic countries were based on extensive recommendations backed up with huge campaigns of public information and education. These are the facts, and I know not just from reading about them--I have spent the whole pandemic in the Nordic region; I was in Denmark during most of the spring and early summer and mostly Finland and Sweden since then.


      Much is made in the article about the institutional approach to the pandemic--the striking lack of involvement of politics in the management of the pandemic in Sweden. Again, this is not unique to Sweden.  This is the same technocratic approach which is a hallmark of all Nordic societies, where public agencies have a certain degree of formal and legal independence from the political branches, which as I wrote, is somewhat anti-democratic, but that's the way they do everything, and not just health. The article made much of Tegnell's daily press conferences --but it was the same with Salminen in Finland and in the other Nordic countries.  The pandemic was explicitly and visibly managed by scientists everywhere in the region; the politicians kept their hands off it. In fact there was even a scandal in Denmark when primary schools were briefly closed by the government, overruling the decision of the public health agency not to close them. All the Nordic countries closed schools briefly; in Sweden and Norway they never closed the primary schools. Closing primary schools was considered to be a mistake (and this is now the view all over Europe); and the Danish PM was criticized for overruling the health authorities and suppressing information about the initial decision of the health authorities--putting politics above science.


      As to the "libertarian approach" to the pandemic in the Nordic countries--this is of a piece with the particular style of the, let us say, communitarian-libertarian society of the Nordic countries, which seems paradoxical to Americans, it seems like a combination of irreconcilable opposites. But the Nordic countries do in fact combine a high degree of social solidarity, including comprehensive welfare states (in Finland they even experimented with a Basic Minimum Income), with, at the same time, a very high degree of personal freedom. This high degree of personal freedom includes some freedoms which we do not have, including for example freedom of movement which cannot be abrogated by the state in peacetime, which was one of the reasons why there were no lockdowns in any of the Nordic countries. I was in a business meeting in Helsinki recently when an English person asked a Finnish person why there was no lockdown, when everyone was so worried about the second wave, and the reaction of the Finnish person was visceral--"Why they can't do that! Maybe only if there is a war!" As if the very idea was shocking.


      Here's an illustration of "lockdown," Nordic-style:





      JE comments:  This may be the gentlest Covid leaflet I've seen anywhere.  Note the urgency of protecting not only loved ones, but "other people," too.  A perfect example of the Nordic communitarian spirit.


      Cameron, when time permits, could you send some reflections on Finland's experiment with the Basic Minimum Income?  Over here BMI means Body Mass Index--perhaps because we exceptional Americans are fatter but less concerned about our neediest neighbors.

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      • Finland's Experiment with Basic Minimum Income (Cameron Sawyer, Russia 12/27/20 4:31 AM)
        JE described the leaflet "Recommendations for Passengers Arriving in Finland" thus:

        "This may be the gentlest Covid leaflet I've seen anywhere. Note the urgency of protecting not only loved ones, but ‘other people,' too. A perfect example of the Nordic communitarian spirit...When time permits, could you send some reflections on Finland's experiment with the Basic Minimum Income?"


        Note also how the leaflet, strikingly, assumes that people take compliance with the voluntary measures very seriously. For example, it explains exactly what you need to do in order to end the quarantine early. That is perhaps the most striking difference to what we might see in other countries. In the US, if the quarantine would be voluntary, then no one would care what steps you would have to go through, to be freed of the "recommendation." We would presume that a person would simply leave off doing it, in case of need.


        And so we see that in the Nordic countries, the effect of the voluntary measures has been similar to the effect of legally mandatory measures in other countries. This gives the lie to the idea of some right-wing people in the US that Sweden just "did nothing"--in fact, social distancing took place at more or less than same extent as in locked-down countries, with especially striking effects on use of public transport (down more than 90% in Stockholm during some weeks in the spring) and internal travel.


        What concerns Finland's Basic Minimum Income, the results of the experiment are inconclusive. Explained better here, than I could: https://www.weforum.org/agenda/2019/02/the-results-finlands-universal-basic-income-experiment-are-in-is-it-working/ .


        The Basic Minimum Income is another example of the, to us, paradoxical Nordic combination of libertarianism and communitarianism. This is similar to the proposals of some conservative theorists of the Reagan era--that to support poor people, it is much better to give them money with no strings attached, than to create perverse incentives by giving them money only on the condition they are not working. I agree with this, by the way. Another example of harmful perverse incentives was the way AFDC (remember that?) worked--giving financial support only to single mothers of small children, creating an incentive for the fathers to disappear, which had disastrous effects on the culture in some parts of US society in the 1960s and '70s.


        The experiment in Finland was attempting to show that if the support was not conditioned on the people not working, that they would find work more often. It did not demonstrate this, but I still think it's a good idea. I don't think this small experiment actually proved that it doesn't work, either--merely failed to demonstrate clearly so far. And note that people receiving this kind of assistance did show clear improvement of health and well-being.


        The Nordic countries are a century ahead of us, in designing the welfare state in a way that it does not manipulate people, that it preserves as much individual freedom and choice as possible. Nordic society is surprisingly congenial to the instincts and values of people who put a high value on individual freedom, individual choice, and entrepreneurship. The Nordic system has almost nothing to do with what Bernie Sanders, who mentions it so often, thinks it means. I have written before in these pages:  Even the tax system is congenial to conservative-libertarian people.  It is far less progressive than ours is, and it pays back to everyone richly, for what you put into it, which puts the rates into a completely different perspective. The system does not in any way punish anyone for being wealthy. There are no wealth or inheritance taxes. Corporate tax rates are about half of ours, even after the Trump reform. 20% in Finland.


        JE comments:  Finland's two-year experiment with Basic Minimum Income provided €560 monthly.  The surprising, "experimenty" part was that a control group apparently received nothing.  Don't know how they chose between the Gets and the Get-Nots.  Perhaps this is the perfect example of Nordic "exceptionalism"--that the control group quietly accepted being poorer and more stressed in the interest of social research.

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  • Quarantines and "Spreader Events" in Australia (Martin Storey, Australia 12/30/20 2:18 PM)
    John E asked on December 23rd:

    "Can someone (Martin Storey?) explain to us how the draconian quarantine system works in Australia? Where do the 'internments' take place?"


    Here just like in many other countries, it is difficult to know the truth, and when one happens to know some shreds of it, these are often shockingly different from the official narrative. Nevertheless, there is no doubt that beyond the ravaged economy and the virtual impossibility to travel overseas, life here in Western Australia is essentially "normal."


    Here is how I broadly understand how events have unfolded here:


    The first recorded case was in late January, of someone who had just returned from Wuhan, China. We followed the news but it was towards the end of March when people started really acting or reacting, in particular by purchasing prodigious numbers of toilet paper rolls. In mid-March (11th), the level of concern was still sufficiently low that I went to see a rock concert and stood for three hours in a sweaty "moshpit" with hundreds of people, in the nearby harbour town of Fremantle.


    Around that time, the federal government closed the international borders to non-residents/non-citizens for selected countries. People returning from overseas were required to quarantine, although details of requirements and implementation varied on a state-by-state basis (Australia is a federation with six states and 2 main "territories"--effectively 8 states).


    As the virus spread around the world, it arrived to Australia mainly by plane, a risk that can be controlled through a combination of government-imposed quarantine and airline flight cancellations, and by cruise ship, which has been controlled by refusing to let the ships berth or people disembark.


    At the small scale of the epidemic in this country, things went very wrong mainly twice:


    In mid-March, a cruise ship called the Ruby Princess was allowed to dock in Sydney, New South Wales, and discharge more than 2500 passengers, when it was known that there were confirmed cases of COVID-19 on board. The various authorities in the relevant chains of command all denied allowing this to happen. The virus spread into the community, including aged-care facilities and, for some reason, meat-processing plants, from that incident.


    From March to May, in Melbourne, Victoria, there were gross breaches of hotel quarantine and it appeared that security had been outsourced to people who were neither qualified nor trained for the work, and would allow guests to leave the hotel, or would socialise with them, possibly even overnight, it has been reported. This required the lockdown of more 300,000 people to control. Once again, no one fessed up to deciding on and awarding these contracts, all without due tender process of course.


    Apart from these two incidents which caused the numbers to flare up, most cases remain from returning people and are detected while they are in quarantine, thus preventing the virus from spreading in the community.


    Travel between states remains difficult and contingent on there not having been any community case in the state from where people want to come.


    Sometime during that period, we too here in Western Australia had to completely lock down for a few weeks, and home-school our children.


    In this state, we have not had a reported case of COVID-19 in the community in over 270 days, although we hear regularly of people who "test positive" while in hotel quarantine. As I type and according to https://www.worldometers.info/coronavirus/country/australia/ , there are currently 1,715 active cases in the country, of whom 0 (zero) are "serious or critical." Previously there have been nearly 26,000 cases recorded as recovered or discharged, and 909 deaths. 26,000 is just a little over 0.1% of the population of 25 million.


    Here in Western Australia, we all realise that we have been very "lucky," no doubt thanks to some of our state and federal governments' actions, but also through sheer luck. We all know that things could change very quickly indeed, as they did in Sydney and Melbourne following their respective incidents.


    In the past few days, large groups of people have been reported to socialise and "party" on New South Wales beaches just as cases are flaring up there. Could this be the third time when things go very wrong?


    In our circumstances, we are told that vaccination will start in March (2021).


    I am not sure whether this was instructive to outside readers. At the above URL, the figures from 220 countries can be seen in "real time" and Australia currently has the 99th most number of total cases. Pick a different criterion and Australia gets a different ranking, but there are many countries doing better, and not all of these are small. Take Taiwan, for instance, of approximately the same population: it has done much better than Australia by any criterion. Could it be that Australia gets more attention because it is English-speaking?


    Please stay safe.


    Warmest Season's Greetings from Perth, Western Australia (> 100 deg F today)


    JE comments:  Martin, I'd love for you to share some of that warmth!  And best wishes for the New Year.  The last time you explained Australia's relative success in containing Covid, we noted that Melbourne has been hit the hardest.  From what you write above, we now know why.


    Still, Australia is fortunate to be a continent accessible primarily by air.  Insular Taiwan has the same good fortune.


    You mention home schooling.  Although I presume it's now summer holiday, can you give us a sense of how this worked?  Due to its long history of "distance learning" for children in the Outback, Australia can probably give educators elsewhere a pointer or two.


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