16 ms·

Evaluation of science advice during the Covid-19 pandemic in Sweden

67 points by areoform 5y ago

msandford 5y ago
20k deaths for a population of 10M in Sweden is 0.2% right? USA has had just under 1M deaths for 330M people or closer to 0.3%. I'm not saying that Sweden did the totally right 100% perfect thing. But it seems to have done much less catastrophically horrible than many predicted at least as far as I can see.
- ianbooker 5y ago
  It would be a better benchmark to compare Sweden with Denmark, since societies and health care capabilities are more alike.
  - ZeroGravitas 5y ago
    Since I looked it up out of curiousity: https://www.statista.com/statistics/1104709/coronavirus-deaths-worldwide-per-million-inhabitants/ https://www.statista.com/statistics/1104709/coronavirus-deat... deaths per million inhabitants: Sweden: 1,755.2 Denmark: 924.97 Finland: 521.89 Norway: 405.58
    - throwaway4good 5y ago
      Maybe add Netherlands and Germany ... And in DK we are now doing 20-50 corona dead pr. day - leaving us at 365*20-50 / 5.5 at 1,327 - 3.318 added for this year.
    - sampo 5y ago
      There's a recent large study in The Lancet, where they estimate 2020-2021 excess mortality, and compare these to reported Covid19 deaths. The study covers a large number of countries, but here I only look at your four. excess excess/reported excess/(1 million) Denmark: 10 400 308% 1784 Finland: 8780 503% 1587 Norway: 742 57% 138 Sweden: 18 100 118% 1719 Either the study methodology to estimate excess mortality has some problems with Denmark and Finland. Or, if the study is correct, the official numbers from Finland and Denmark are bad in estimating their own Covid19 deaths: Denmark underestimating by 3x, Finland underestimating by 5x. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02796-3/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6... Direct link to results table: https://www.thelancet.com/action/showFullTableHTML?isHtml=true&tableId=tbl1&pii=S0140-6736%2821%2902796-3 https://www.thelancet.com/action/showFullTableHTML?isHtml=tr...
      - deleted 5y ago
        [deleted]
      - Lewton 5y ago
        Denmark tested way more than any other country in the world. They most likely have the most accurate picture of how many people actually died with covid I'd strongly question their method of calculating excess mortality, look at denmark on https://www.euromomo.eu/graphs-and-maps https://www.euromomo.eu/graphs-and-maps and compare it to other countries
      - specialist 5y ago
        Agree on using excess deaths data. Also, it'll be years before knockoff effects can be more fully assessed.
      - jltsiren 5y ago
        I would assume methodological flaws. Just by looking at the number of authors and the publication date, the authors simply did not have enough time to control for area-specific factors for 191 countries and 252 subnational units. Finland reported 53949 deaths from all causes in 2019, 55488 deaths in 2020, and 57343 deaths in 2021. (The figure for 2021 is preliminary.) The total increase from the 2019 level in 2020-2021 is ~5000 deaths, and a large part of that is explained by aging population.
  - timr 5y ago
    "Better" in the sense that it makes them look worse, and some people prefer this version of events? Perhaps. But if you compare across all of Europe by deaths per capita, they're near the best performers on the list (#13; #12 in continental Europe), and the only reason those specific countries look better is because they're the top three in continental Europe (they're also smaller countries; see below): https://www.statista.com/statistics/1111779/coronavirus-death-rate-europe-by-country/ https://www.statista.com/statistics/1111779/coronavirus-deat... In particular, the UK, France, Spain, Belgium, Italy and Portugal all did worse, despite far more significant impositions on society. It's also important to know that worldwide, there's a clear dependence of per-capita deaths on population (greater population -> greater deaths per capita): https://coronavirus.jhu.edu/data/mortality https://coronavirus.jhu.edu/data/mortality (second plot; deaths per 100k population tab) And that Denmark has a population of ~5.8M, Norway 5.4M, and Sweden 10.4M. This alone should make you question any simple narrative involving interventions and outcome.
  - alkonaut 5y ago
    Societies and health care aren’t as similar as one might think in the Nordics. Sweden is surprisingly diverse, unequal, urbanized etc. It’s more “continental” than its neighbors in a lot of ways.
- melling 5y ago
  I like what you’re doing here. Take a country like the United States with a horrible outcome and use them for comparison. More people died after vaccines than before in the United States. How does that happen? One thing is absolutely clear: 1 million Americans never needed to die from coronavirus.
  - throwaway111023 5y ago
  - pmorici 5y ago
    It's not clear to me the total deaths number is accurate in the US because the government was reimbursing hospitals for COVID treatment and paying for people's funerals who "died of covid". It incentivized people to list the cause of death as COVID even when covid didn't play a role in the death or was at best incidental to it. Anecdotally this happened with the father of a friend of mine. He had cancer since before the pandemic and it became terminal after exhausting treatment options last year. As his condition deteriorated, they planned to move him to hospice, did a routine covid test and found he was positive. He died a few days later. He was going to die of cancer in days no matter what. He is counted among the million US covid deaths and the US government paid for a portion of the cost of the funeral. What percentage of that million are cases like this? I don't know, but it is pretty clear it wasn't uncommon and in the context of your original comment I wouldn't call cases like this preventable deaths.
    - jmull 5y ago
      Look up excess deaths
      - refurb 5y ago
        You act like excess deaths is an easy analysis, but deaths vary significantly year or year. What you baseline are makes a big difference. And considering we’re not even through the epidemic it seems like it’s a bit early to call winners and losers.
- lament76 5y ago
  The US has like 5 times the obesity rate and obesity is a relatively strong predictor of adverse outcomes with C19.
ZeroGravitas 5y ago
> Roger Pielke’s Honest Broker framework(Pielke, 2007) That was useful. Just as I got to that stage in the paper I was thinking, "well yeah but in a pandemic/emergency there's some value of people just being clear and not muddying the water" and that framework was useful to think about how to get the best result.
emj 5y ago
As a Swede I do not agree with a lot of what was said in this paper, much seems to be more of an opion than fact. This is a clear poltical subject, as you often see when this is discussed on American forums, it's very hard to talk about these ideas without getting into us vs. them. The hardest part of all this pandemic was that it was so easy to say the wrong thing and getting judged unless you were among people that actually cared about what you were saying. EDIT removed opinions that still can not be discussed in a sane manner.
- deng 5y ago
  Well, this is a peer reviewed paper, arguing quite coherently that the handling of the pandemic in Sweden did not follow scientific methods, and they have a ton of references to back up that opinion. If you are aware of similar papers arguing against this opinion, please provide links.
  - bjeds 5y ago
    Expect that this Hacker News thread will be overrun by Swedish patriots who will, with tooth and nail, argue for Swedish exceptionalism and downvote all criticism. War is Peace and all that. I am ashamed how my country handled this pandemic and I'm ashamed that my fellow citizens are more interested in managing the public image of Sweden rather than learning from obvious mistakes. I am therefore thankful that Nature published this. It has been debated since early 2020, but the narrative of Swedish exceptionalism is so strong, especially on the Internet, that I wouldn't be surprised if this will tried to be burried. I have lost friends due to this, not because people have died of Covid but because foreign nationals, who moved to Sweden to work on some of the famous tech companies, have realized how poorly Sweden handled the pandemic. They have now moved to other countries instead.
    - Tade0 5y ago
      > the narrative of Swedish exceptionalism is so strong, especially on the Internet, that I wouldn't be surprised if this will tried to be burried. I always thought this was an American thing, but turns out just about every nation has this to some extent.
deng 5y ago
"The decision to provide end-of-life care to many older adults is highly questionable; very few elderly have been hospitalised for COVID-19. Appropriate (potentially life-saving) treatment was withheld without medical examination, and without informing the patient or his/her family or asking permission. [...] there was only limited public outcry in Sweden when this came out, the common narrative being that those in care homes are expected to die soon anyway. [...] Many elderly people were administered morphine instead of oxygen despite available supplies, effectively ending their lives." This is quite shocking. I didn't think this would be possible in a country like Sweden.
- marginalia_nu 5y ago
  I think this slipped by mostly unnoticed because the heavily polarized debate climate didn't really permit admitting fault or mistakes, it had turned into a trench war mostly about on whose side you are on. Really toxic dynamic.
- tored 5y ago
  In the early stages of the COVID-19 pandemic 9 out 10 deaths in Sweden was on persons over 70 years of age and half of them lived in a nursing home. I'm not sure what the current statistics says but probably within the same ballpark. This is why Sweden has had a such a high death toll, because of bad care given to the elderly. One big problem is that nursing homes in Sweden is often run by the kommun (city) whereas the hospital is run by the landsting (region), kommuns lacks the medical expertise on nursing homes to handle that kind of sickness, no oxygen or iv therapy. And there has apparently been a reluctance to send patience from the nursing homes to the hospitals instead treating them at place, which increased the risk of dying. Many elderly suffers from malnutrition in these nursing homes, malnutrition increases the risk of early death drastically. I would also argue that it culturally exists ageism in Sweden, Swedish core belief is state sponsored individualism, you don't have any responsibility on others because your maximal individual freedom is guaranteed by the state, thus you basically dump the elderly on a nursing home never to be seen again, it is not your responsibility, it is the state. Much of the Swedish society is very youth centric, it is not uncommon to find arguments a long the line, "it is good if the elderly dies off because they are holding us back". This also explains why Sweden is so eager to jump on every new trend there is, progressivism in a nutshell.
tored 5y ago
Here is a good article on the subject of lack of care for the elderly. in Swedish date 2020-05-18, Läkartidningen is a newspaper published by Sveriges läkarförbund, a union for doctors. https://lakartidningen.se/aktuellt/nyheter/2020/05/geriatrikprofessor-manga-aldre-dor-i-onodan-utan-korrekt-bedomning/ https://lakartidningen.se/aktuellt/nyheter/2020/05/geriatrik...
paul_f 5y ago
I imagine the motivation behind this paper was, it is embarrassing to the rest of the world that Sweden got it right about lockdowns and masks, so we mush punish them. Let's write a paper claiming they did something else unrelated wrong. That paper could easily have been written about at least one COVID policy in every country on earth, but Sweden was singled out.
- ninjin 5y ago
  If you have a look at the background and affiliation of the authors, there is a perfectly reasonable explanation as to why the country of study is Sweden without having to resort to mildly conspiratorial thinking. Not saying that there is no political nonsense going on related to the subject at hand. But this is (to a scientist in a different field) a well-authored article in a respectable journal. Thus I think it is a fair addition to a very complex debate that will likely continue among scientists long after the pandemic settles. Edit: I may be wrong about the journal. Springer has a rather elaborate network of journals using their “brands” and it looks to me like this one is far from receiving the same level of editorial scrutiny that one would expect [1]. The hint may be “communications” in the name, possibly indicating that this is a more to be treated like a scientific opinion piece (still, far better than an op-ed) than anything else. It also appears to be in the area of humanities and social sciences rather than “pure” medicine for some reason; with a majority of the editorial board lacking relevant expertise [2]. Anyone more familiar with publishing in medicine, medical policy, etc. is more than welcome to chime in. [1]: https://doaj.org/toc/2662-9992 https://doaj.org/toc/2662-9992 [2]: https://www.nature.com/palcomms/editorialboard https://www.nature.com/palcomms/editorialboard
  - rsfern 5y ago
    The “communications” branding has more to do with the prestige level and expectation of faster-paced short research notes. Usually opinion pieces are explicitly filed under a “perspective” track (vs review and original research track). The hierarchy usually goes Nature, Nature Communications, Nature [field name] communications, then field specific nature-owned journals (which sometimes have higher status than the field specific communications journals)
xyproto 5y ago
What's true is that Sweden generally aims for the safe middle point, for something "lagom".
- tored 5y ago
  If feel that most of the time "lagom" is just a myth Swedes has created to hide their extremism behind.
ynfnehf 5y ago
I recognize most of the names of the authors. Thus I am not very surprised about their conclusions. Nothing is actually new in this article. It is mostly incoherent writing, with some conspiracy theories thrown in. The usual stuff that has been coming from these authors since the beginning of the pandemic. And for those confused: this is not published in nature, but in an open access journal owned by nature: "Humanities and Social Sciences Communications". This is not a subsection of Nature, and is rather obscure. I find it unclear what kind of peer-review has been done, but it has certainly not been done well. This is not some kind of scientific proof of the "Swedish strategy" being crime against humanity. Merely a oddly placed opinion piece.
- gjm11 5y ago
  A person's opinion can be predictable in advance (1) because they are closed-minded and not responsive to evidence or (2) because they are responsive to evidence and the evidence is clear. Presumably you're saying #1 rather than #2 is going on with these authors; could you be a bit more specific about why you think that? I had a quick look at the paper and it didn't seem obviously "incoherent writing" to me. Could you be a bit more specific about what you found incoherent?
  - geysersam 5y ago
    In the abstract the authors refer to professors being dismissed from the national health authority. But the also say this happened in 2014 and that the professors were rehired at the very prestigious medical university hospital Karolinska Institutet. That kind of references to seemingly incriminating facts without actually explaining how they affected the policies recommend by the public health authority is not a serious way of making a scientific argument. I have a hard time believing the dismissed professors had dissenting opinions on the validity of lockdowns or facemasks already in 2014.
    - gjm11 5y ago
      It seems like you're suggesting that the authors of this paper are trying to imply that those professors were dismissed because they might give unwanted advice about Covid-19, or to hide the fact that they were re-hired at the Karolinska Institute. But the 2014 date, and the rehiring, are right there in the abstract in the same sentence as the one that says they were dismissed: "In 2014, the Public Health Agency merged with the Institute for Infectious Disease Control; the first decision by its new head (Johan Carlson) was to dismiss and move the authority’s six professors to Karolinska Institute." I'm not sure how these facts are any more "seemingly incriminating" than "actually incriminating", since the things you say (and I agree) make them less worrying are given plenty of prominence right up front. It looks to me as if the argument the authors are trying to make is something like this: "The government moved the national health authority's actual experts out of the way several years ago, with the intention of making the health authority less an impartial scientific body and more a political tool. That meant that when the pandemic came along, politicians were able to persuade this body to make recommendations that were politically convenient even though they were scientifically unsound." It may well be that that argument is a load of bullshit; I don't know. But, right or wrong or Not Even Wrong, it doesn't depend on hiding the 2014 date or the fact that the professors were given new jobs, and it doesn't need the people involved to have had the clairvoyance to predict what specific inconvenient scientific advice the professors might have insisted on giving.
juanani 5y ago
geysersam 5y ago
Sweden did not have a good response to the COVID pandemic. More people died than in many comparable countries, we can agree on these facts. But that the response was poor because authorities did not "listen to scientists" is a difficult claim to swallow. Before 2020 the concept "national lockdown in response to a virus outbreak" simply did not exist. There were no consensus in the scientific world that a lockdown would be an effective measure to improve peoples health, all things considered. If anything I think the Swedish weak response was an effect of listening too much to expert opinions and politicians not taking initiatives and making their own judgements. Early in the pandemic there were many predictions made on number of deaths etc by some scientists. These models often overestimated the number of deaths/cases. Science is important but it's messy and it takes time.
- logifail 5y ago
  > Sweden did not have a good response to the COVID pandemic Austria (with several complete lockdowns) overtook Sweden in Covid deaths per capita in December 2021[0] Aren't Sweden's excess mortality figures since the start of Covid actually pretty good compared with the rest of Europe? [1] [0] https://www.kleinezeitung.at/international/6078837/Relativ-zur-Bevoelkerung_Erstmals-mehr-CovidTote-in-Oesterreich https://www.kleinezeitung.at/international/6078837/Relativ-z... [1] https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Excess_mortality_-_statistics#Excess_mortality_in_the_European_Union_between_January_2020_and_January_2022 https://ec.europa.eu/eurostat/statistics-explained/index.php...
  - geysersam 5y ago
    Yeah but I do think there is merit in comparing Sweden to neighboring countries such as Denmark. However, luck is also a factor that shouldn't be disregarded. If anything was learnt from the attempts of modeling the development of the pandemic it should be that the virus does not diffuse through the population in some idealized fashion. It's extremely messy and depends on local circumstances and sheer chance. This can easily be confirmed by comparing different regions of countries. Despite similar regulations the variation is enormous.
  - 5y ago
catears 5y ago
I very much understand that Sweden could have done better in response to the pandemic, but I feel that there are a lot of points where the paper is disingenuous. > During 2020, however, Sweden had ten times higher COVID-19 death rates compared with neighbouring Norway. As I understand it, the public health ministry avoided lockdowns partly because it argued it is a short-term strategy and partly because they did not find that it was lawful. To me, it does not seem fair to compare a strategy where one aims to reach goals in the long run, to a strategy that focuses on the short-term (and is deemed unlawful). Especially not since the paper only focuses on 2020. Good on Norway for having a strategy that worked well for them. > In 2014, the Public Health Agency merged with the Institute for Infectious Disease Control; the first decision by its new head (Johan Carlson) was to dismiss and move the authority’s six professors to Karolinska Institute. With this setup, the authority lacked expertise and could disregard scientific facts. I don't understand why the paper says "lacked expertise and could disregard scientific facts". That it fired six professors and therefore "could disregard scientific facts" does not seem to rhyme with that they have laboratories specifically for analyzing infectious disease? (Source, could only find Swedish version, sorry: https://www.folkhalsomyndigheten.se/om-folkhalsomyndigheten/organisation/avdelningar-och-enheter/mikrobiologi/ https://www.folkhalsomyndigheten.se/om-folkhalsomyndigheten/...). During the pandemic they hired experts as consultants, as I understand it. So were those six professors paramount to the agency having scientific expertise? > The Swedish pandemic strategy seemed targeted towards “natural” herd-immunity and avoiding a societal shutdown. This claim seems hotly debated. I tried following the sources in the paper for this but only found paywalls or papers that only talked about herd immunity in general terms. Lucky for me, one of the better Swedish journalists, Emmanuel Karlsten, wrote a long post about it (Source, Swedish: https://emanuelkarlsten.se/tegnell-mejlen-sa-fick-flockimmuniteten-faste-hos-folkhalsomyndigheten/ https://emanuelkarlsten.se/tegnell-mejlen-sa-fick-flockimmun...). I read it as that the agency definitely had herd immunity under discussion but it is unclear how much they based their strategy on it. Openly they repeatedly mentioned that they were trying to save as many lives as possible, not (necessarily) achieve herd immunity. Some of the more radical claims in the paper seem to come from Sörensen (who is also a co-author of the paper). > Both the Prime Minister and Minister of Health and Social Affairs publicly declared they had no competence considering pandemics or medical issues. In effect the democratic institutions ceased to function (Sörensen 2020) Mainly from: https://www.semanticscholar.org/paper/Terror-in-utopia%3A-Crisis-(mis-)-management-during-Stilhoff/6f94bcd98211eab6fcc4a8171b026c3bb2b61bf9?sort=relevance&citedPapersSort=relevance&citedPapersLimit=10&citedPapersOffset=0 https://www.semanticscholar.org/paper/Terror-in-utopia%3A-Cr... (finally a source in English!) It's certainly ...interesting... to read. It's published in a Russian journal of social sciences (https://scindeks.ceon.rs/JournalDetails.aspx?issn=0085-6320 https://scindeks.ceon.rs/JournalDetails.aspx?issn=0085-6320) which I can't find that much information on since I don't speak Russian. Interesting headlines in the paper include "The Sovietization of the Swedish state" and "Totalitarian Democracy". Reading it I don't really feel like including a source like that helps the credibility of the paper published in nature. From the closing parts of the abstract > If Sweden wants to do better in future pandemics, the scientific method must be re-established, not least within the Public Health Agency. I don't feel convinced by the paper that such a conclusion can be reached.
CryptoPunk 5y ago
Sweden's COVID response was excellent. First of all, the comparison to other Nordic countries is inappropriate. Its population-weighted density is closer to the UK, and closest to Austria: https://swprs.org/judgment-day-sweden-vindicated/ https://swprs.org/judgment-day-sweden-vindicated/ This Nordic cross-comparison is lazy and agenda-driven. Secondly, Sweden had 20 times fewer deaths than initially projected without a lockdown: https://medrxiv.org/content/10.1101/2020.04.11.20062133v1.full.pdf https://medrxiv.org/content/10.1101/2020.04.11.20062133v1.fu... The initial calls to lockdown were justified with these projections, not with how many COVID deaths Sweden would have relative to neighboring countries. Thirdly, not instituting a lockdown meant Sweden had far fewer limitations of civil liberties, and fewer adverse lockdown-related health and socioeconomic damage. For example, forcing a million young people to forego in-person schooling for a year would have done enormous damage to education: https://www.mckinsey.com/featured-insights/coronavirus-leading-through-the-crisis/charting-the-path-to-the-next-normal/30-to-40-percent-of-minority-and-low-income-students-werent-learning-during-lockdowns https://www.mckinsey.com/featured-insights/coronavirus-leadi... Not to mention the harm to development from foregoing summer jobs, in-person social interaction, etc for one or two years. The claim that lockdowns were appropriate doesn't even begin to contend with the harm from lockdowns. It focuses on COVID deaths single-mindedly, when it's a policy that affects every facet of society and daily life.
- deleted 5y ago
  [deleted]
- emn13 5y ago
  Whether the article is accurate or at least reasonable I don't know, however this criticism smells fishy - the kind of damages you're ascribing to the lockdown Sweden did suffer from, and not dramatically less so than nearby countries AFAIK. For economic indicators at least the data is available, and IMHO clearly shows Sweden was not unusual, e.g. https://www.statista.com/statistics/1274468/gdp-per-capita-nordic-countries/ https://www.statista.com/statistics/1274468/gdp-per-capita-n... Suppressed human interaction and stress causes harms, I'll postulate to that - but clearly even without any government intervention at all the pandemic will see to that. Whether formal social-distancing measures make that worse is not obvious; they could even conceivably make it better (if coordination helps pick those that work best and reduces their overall length, for instance); and surely the details of the measures, including timing and duration, matter. Ascribing pandemic related damages to lockdowns is wrong. Now, that doesn't mean lockdowns are always harmless, nor that this article is sane; but let's not delude ourselves that it's obvious "lockdowns" in general are terribly harmful, by comparing them to a false baseline of pre-pandemic normality.

67 points by areoform 5y ago

20k deaths for a population of 10M in Sweden is 0.2% right? USA has had just under 1M deaths for 330M people or closer to 0.3%. I'm not saying that Sweden did the totally right 100% perfect thing. But it seems to have done much less catastrophically horrible than many predicted at least as far as I can see.

ianbooker 5y ago
It would be a better benchmark to compare Sweden with Denmark, since societies and health care capabilities are more alike.
- ZeroGravitas 5y ago
  Since I looked it up out of curiousity: https://www.statista.com/statistics/1104709/coronavirus-deaths-worldwide-per-million-inhabitants/ https://www.statista.com/statistics/1104709/coronavirus-deat... deaths per million inhabitants: Sweden: 1,755.2 Denmark: 924.97 Finland: 521.89 Norway: 405.58
  - throwaway4good 5y ago
    Maybe add Netherlands and Germany ... And in DK we are now doing 20-50 corona dead pr. day - leaving us at 365*20-50 / 5.5 at 1,327 - 3.318 added for this year.
  - sampo 5y ago
    There's a recent large study in The Lancet, where they estimate 2020-2021 excess mortality, and compare these to reported Covid19 deaths. The study covers a large number of countries, but here I only look at your four. excess excess/reported excess/(1 million) Denmark: 10 400 308% 1784 Finland: 8780 503% 1587 Norway: 742 57% 138 Sweden: 18 100 118% 1719 Either the study methodology to estimate excess mortality has some problems with Denmark and Finland. Or, if the study is correct, the official numbers from Finland and Denmark are bad in estimating their own Covid19 deaths: Denmark underestimating by 3x, Finland underestimating by 5x. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02796-3/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6... Direct link to results table: https://www.thelancet.com/action/showFullTableHTML?isHtml=true&tableId=tbl1&pii=S0140-6736%2821%2902796-3 https://www.thelancet.com/action/showFullTableHTML?isHtml=tr...
    - deleted 5y ago
      [deleted]
    - Lewton 5y ago
      Denmark tested way more than any other country in the world. They most likely have the most accurate picture of how many people actually died with covid I'd strongly question their method of calculating excess mortality, look at denmark on https://www.euromomo.eu/graphs-and-maps https://www.euromomo.eu/graphs-and-maps and compare it to other countries
    - specialist 5y ago
      Agree on using excess deaths data. Also, it'll be years before knockoff effects can be more fully assessed.
    - jltsiren 5y ago
      I would assume methodological flaws. Just by looking at the number of authors and the publication date, the authors simply did not have enough time to control for area-specific factors for 191 countries and 252 subnational units. Finland reported 53949 deaths from all causes in 2019, 55488 deaths in 2020, and 57343 deaths in 2021. (The figure for 2021 is preliminary.) The total increase from the 2019 level in 2020-2021 is ~5000 deaths, and a large part of that is explained by aging population.
- timr 5y ago
  "Better" in the sense that it makes them look worse, and some people prefer this version of events? Perhaps. But if you compare across all of Europe by deaths per capita, they're near the best performers on the list (#13; #12 in continental Europe), and the only reason those specific countries look better is because they're the top three in continental Europe (they're also smaller countries; see below): https://www.statista.com/statistics/1111779/coronavirus-death-rate-europe-by-country/ https://www.statista.com/statistics/1111779/coronavirus-deat... In particular, the UK, France, Spain, Belgium, Italy and Portugal all did worse, despite far more significant impositions on society. It's also important to know that worldwide, there's a clear dependence of per-capita deaths on population (greater population -> greater deaths per capita): https://coronavirus.jhu.edu/data/mortality https://coronavirus.jhu.edu/data/mortality (second plot; deaths per 100k population tab) And that Denmark has a population of ~5.8M, Norway 5.4M, and Sweden 10.4M. This alone should make you question any simple narrative involving interventions and outcome.
- alkonaut 5y ago
  Societies and health care aren’t as similar as one might think in the Nordics. Sweden is surprisingly diverse, unequal, urbanized etc. It’s more “continental” than its neighbors in a lot of ways.
melling 5y ago
I like what you’re doing here. Take a country like the United States with a horrible outcome and use them for comparison. More people died after vaccines than before in the United States. How does that happen? One thing is absolutely clear: 1 million Americans never needed to die from coronavirus.
- throwaway111023 5y ago
- pmorici 5y ago
  It's not clear to me the total deaths number is accurate in the US because the government was reimbursing hospitals for COVID treatment and paying for people's funerals who "died of covid". It incentivized people to list the cause of death as COVID even when covid didn't play a role in the death or was at best incidental to it. Anecdotally this happened with the father of a friend of mine. He had cancer since before the pandemic and it became terminal after exhausting treatment options last year. As his condition deteriorated, they planned to move him to hospice, did a routine covid test and found he was positive. He died a few days later. He was going to die of cancer in days no matter what. He is counted among the million US covid deaths and the US government paid for a portion of the cost of the funeral. What percentage of that million are cases like this? I don't know, but it is pretty clear it wasn't uncommon and in the context of your original comment I wouldn't call cases like this preventable deaths.
  - jmull 5y ago
    Look up excess deaths
    - refurb 5y ago
      You act like excess deaths is an easy analysis, but deaths vary significantly year or year. What you baseline are makes a big difference. And considering we’re not even through the epidemic it seems like it’s a bit early to call winners and losers.
lament76 5y ago
The US has like 5 times the obesity rate and obesity is a relatively strong predictor of adverse outcomes with C19.

ZeroGravitas 5y ago

> Roger Pielke’s Honest Broker framework(Pielke, 2007) That was useful. Just as I got to that stage in the paper I was thinking, "well yeah but in a pandemic/emergency there's some value of people just being clear and not muddying the water" and that framework was useful to think about how to get the best result.

emj 5y ago

As a Swede I do not agree with a lot of what was said in this paper, much seems to be more of an opion than fact. This is a clear poltical subject, as you often see when this is discussed on American forums, it's very hard to talk about these ideas without getting into us vs. them. The hardest part of all this pandemic was that it was so easy to say the wrong thing and getting judged unless you were among people that actually cared about what you were saying. EDIT removed opinions that still can not be discussed in a sane manner.

deng 5y ago
Well, this is a peer reviewed paper, arguing quite coherently that the handling of the pandemic in Sweden did not follow scientific methods, and they have a ton of references to back up that opinion. If you are aware of similar papers arguing against this opinion, please provide links.
- bjeds 5y ago
  Expect that this Hacker News thread will be overrun by Swedish patriots who will, with tooth and nail, argue for Swedish exceptionalism and downvote all criticism. War is Peace and all that. I am ashamed how my country handled this pandemic and I'm ashamed that my fellow citizens are more interested in managing the public image of Sweden rather than learning from obvious mistakes. I am therefore thankful that Nature published this. It has been debated since early 2020, but the narrative of Swedish exceptionalism is so strong, especially on the Internet, that I wouldn't be surprised if this will tried to be burried. I have lost friends due to this, not because people have died of Covid but because foreign nationals, who moved to Sweden to work on some of the famous tech companies, have realized how poorly Sweden handled the pandemic. They have now moved to other countries instead.
  - Tade0 5y ago
    > the narrative of Swedish exceptionalism is so strong, especially on the Internet, that I wouldn't be surprised if this will tried to be burried. I always thought this was an American thing, but turns out just about every nation has this to some extent.

deng 5y ago

"The decision to provide end-of-life care to many older adults is highly questionable; very few elderly have been hospitalised for COVID-19. Appropriate (potentially life-saving) treatment was withheld without medical examination, and without informing the patient or his/her family or asking permission. [...] there was only limited public outcry in Sweden when this came out, the common narrative being that those in care homes are expected to die soon anyway. [...] Many elderly people were administered morphine instead of oxygen despite available supplies, effectively ending their lives." This is quite shocking. I didn't think this would be possible in a country like Sweden.

marginalia_nu 5y ago
I think this slipped by mostly unnoticed because the heavily polarized debate climate didn't really permit admitting fault or mistakes, it had turned into a trench war mostly about on whose side you are on. Really toxic dynamic.
tored 5y ago
In the early stages of the COVID-19 pandemic 9 out 10 deaths in Sweden was on persons over 70 years of age and half of them lived in a nursing home. I'm not sure what the current statistics says but probably within the same ballpark. This is why Sweden has had a such a high death toll, because of bad care given to the elderly. One big problem is that nursing homes in Sweden is often run by the kommun (city) whereas the hospital is run by the landsting (region), kommuns lacks the medical expertise on nursing homes to handle that kind of sickness, no oxygen or iv therapy. And there has apparently been a reluctance to send patience from the nursing homes to the hospitals instead treating them at place, which increased the risk of dying. Many elderly suffers from malnutrition in these nursing homes, malnutrition increases the risk of early death drastically. I would also argue that it culturally exists ageism in Sweden, Swedish core belief is state sponsored individualism, you don't have any responsibility on others because your maximal individual freedom is guaranteed by the state, thus you basically dump the elderly on a nursing home never to be seen again, it is not your responsibility, it is the state. Much of the Swedish society is very youth centric, it is not uncommon to find arguments a long the line, "it is good if the elderly dies off because they are holding us back". This also explains why Sweden is so eager to jump on every new trend there is, progressivism in a nutshell.

tored 5y ago

Here is a good article on the subject of lack of care for the elderly. in Swedish date 2020-05-18, Läkartidningen is a newspaper published by Sveriges läkarförbund, a union for doctors. https://lakartidningen.se/aktuellt/nyheter/2020/05/geriatrikprofessor-manga-aldre-dor-i-onodan-utan-korrekt-bedomning/ https://lakartidningen.se/aktuellt/nyheter/2020/05/geriatrik...

paul_f 5y ago

I imagine the motivation behind this paper was, it is embarrassing to the rest of the world that Sweden got it right about lockdowns and masks, so we mush punish them. Let's write a paper claiming they did something else unrelated wrong. That paper could easily have been written about at least one COVID policy in every country on earth, but Sweden was singled out.

ninjin 5y ago
If you have a look at the background and affiliation of the authors, there is a perfectly reasonable explanation as to why the country of study is Sweden without having to resort to mildly conspiratorial thinking. Not saying that there is no political nonsense going on related to the subject at hand. But this is (to a scientist in a different field) a well-authored article in a respectable journal. Thus I think it is a fair addition to a very complex debate that will likely continue among scientists long after the pandemic settles. Edit: I may be wrong about the journal. Springer has a rather elaborate network of journals using their “brands” and it looks to me like this one is far from receiving the same level of editorial scrutiny that one would expect [1]. The hint may be “communications” in the name, possibly indicating that this is a more to be treated like a scientific opinion piece (still, far better than an op-ed) than anything else. It also appears to be in the area of humanities and social sciences rather than “pure” medicine for some reason; with a majority of the editorial board lacking relevant expertise [2]. Anyone more familiar with publishing in medicine, medical policy, etc. is more than welcome to chime in. [1]: https://doaj.org/toc/2662-9992 https://doaj.org/toc/2662-9992 [2]: https://www.nature.com/palcomms/editorialboard https://www.nature.com/palcomms/editorialboard
- rsfern 5y ago
  The “communications” branding has more to do with the prestige level and expectation of faster-paced short research notes. Usually opinion pieces are explicitly filed under a “perspective” track (vs review and original research track). The hierarchy usually goes Nature, Nature Communications, Nature [field name] communications, then field specific nature-owned journals (which sometimes have higher status than the field specific communications journals)

xyproto 5y ago

What's true is that Sweden generally aims for the safe middle point, for something "lagom".

tored 5y ago
If feel that most of the time "lagom" is just a myth Swedes has created to hide their extremism behind.

ynfnehf 5y ago

I recognize most of the names of the authors. Thus I am not very surprised about their conclusions. Nothing is actually new in this article. It is mostly incoherent writing, with some conspiracy theories thrown in. The usual stuff that has been coming from these authors since the beginning of the pandemic. And for those confused: this is not published in nature, but in an open access journal owned by nature: "Humanities and Social Sciences Communications". This is not a subsection of Nature, and is rather obscure. I find it unclear what kind of peer-review has been done, but it has certainly not been done well. This is not some kind of scientific proof of the "Swedish strategy" being crime against humanity. Merely a oddly placed opinion piece.

gjm11 5y ago
A person's opinion can be predictable in advance (1) because they are closed-minded and not responsive to evidence or (2) because they are responsive to evidence and the evidence is clear. Presumably you're saying #1 rather than #2 is going on with these authors; could you be a bit more specific about why you think that? I had a quick look at the paper and it didn't seem obviously "incoherent writing" to me. Could you be a bit more specific about what you found incoherent?
- geysersam 5y ago
  In the abstract the authors refer to professors being dismissed from the national health authority. But the also say this happened in 2014 and that the professors were rehired at the very prestigious medical university hospital Karolinska Institutet. That kind of references to seemingly incriminating facts without actually explaining how they affected the policies recommend by the public health authority is not a serious way of making a scientific argument. I have a hard time believing the dismissed professors had dissenting opinions on the validity of lockdowns or facemasks already in 2014.
  - gjm11 5y ago
    It seems like you're suggesting that the authors of this paper are trying to imply that those professors were dismissed because they might give unwanted advice about Covid-19, or to hide the fact that they were re-hired at the Karolinska Institute. But the 2014 date, and the rehiring, are right there in the abstract in the same sentence as the one that says they were dismissed: "In 2014, the Public Health Agency merged with the Institute for Infectious Disease Control; the first decision by its new head (Johan Carlson) was to dismiss and move the authority’s six professors to Karolinska Institute." I'm not sure how these facts are any more "seemingly incriminating" than "actually incriminating", since the things you say (and I agree) make them less worrying are given plenty of prominence right up front. It looks to me as if the argument the authors are trying to make is something like this: "The government moved the national health authority's actual experts out of the way several years ago, with the intention of making the health authority less an impartial scientific body and more a political tool. That meant that when the pandemic came along, politicians were able to persuade this body to make recommendations that were politically convenient even though they were scientifically unsound." It may well be that that argument is a load of bullshit; I don't know. But, right or wrong or Not Even Wrong, it doesn't depend on hiding the 2014 date or the fact that the professors were given new jobs, and it doesn't need the people involved to have had the clairvoyance to predict what specific inconvenient scientific advice the professors might have insisted on giving.

juanani 5y ago

geysersam 5y ago

Sweden did not have a good response to the COVID pandemic. More people died than in many comparable countries, we can agree on these facts. But that the response was poor because authorities did not "listen to scientists" is a difficult claim to swallow. Before 2020 the concept "national lockdown in response to a virus outbreak" simply did not exist. There were no consensus in the scientific world that a lockdown would be an effective measure to improve peoples health, all things considered. If anything I think the Swedish weak response was an effect of listening too much to expert opinions and politicians not taking initiatives and making their own judgements. Early in the pandemic there were many predictions made on number of deaths etc by some scientists. These models often overestimated the number of deaths/cases. Science is important but it's messy and it takes time.

logifail 5y ago
> Sweden did not have a good response to the COVID pandemic Austria (with several complete lockdowns) overtook Sweden in Covid deaths per capita in December 2021[0] Aren't Sweden's excess mortality figures since the start of Covid actually pretty good compared with the rest of Europe? [1] [0] https://www.kleinezeitung.at/international/6078837/Relativ-zur-Bevoelkerung_Erstmals-mehr-CovidTote-in-Oesterreich https://www.kleinezeitung.at/international/6078837/Relativ-z... [1] https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Excess_mortality_-_statistics#Excess_mortality_in_the_European_Union_between_January_2020_and_January_2022 https://ec.europa.eu/eurostat/statistics-explained/index.php...
- geysersam 5y ago
  Yeah but I do think there is merit in comparing Sweden to neighboring countries such as Denmark. However, luck is also a factor that shouldn't be disregarded. If anything was learnt from the attempts of modeling the development of the pandemic it should be that the virus does not diffuse through the population in some idealized fashion. It's extremely messy and depends on local circumstances and sheer chance. This can easily be confirmed by comparing different regions of countries. Despite similar regulations the variation is enormous.
- 5y ago

catears 5y ago

I very much understand that Sweden could have done better in response to the pandemic, but I feel that there are a lot of points where the paper is disingenuous. > During 2020, however, Sweden had ten times higher COVID-19 death rates compared with neighbouring Norway. As I understand it, the public health ministry avoided lockdowns partly because it argued it is a short-term strategy and partly because they did not find that it was lawful. To me, it does not seem fair to compare a strategy where one aims to reach goals in the long run, to a strategy that focuses on the short-term (and is deemed unlawful). Especially not since the paper only focuses on 2020. Good on Norway for having a strategy that worked well for them. > In 2014, the Public Health Agency merged with the Institute for Infectious Disease Control; the first decision by its new head (Johan Carlson) was to dismiss and move the authority’s six professors to Karolinska Institute. With this setup, the authority lacked expertise and could disregard scientific facts. I don't understand why the paper says "lacked expertise and could disregard scientific facts". That it fired six professors and therefore "could disregard scientific facts" does not seem to rhyme with that they have laboratories specifically for analyzing infectious disease? (Source, could only find Swedish version, sorry: https://www.folkhalsomyndigheten.se/om-folkhalsomyndigheten/organisation/avdelningar-och-enheter/mikrobiologi/ https://www.folkhalsomyndigheten.se/om-folkhalsomyndigheten/...). During the pandemic they hired experts as consultants, as I understand it. So were those six professors paramount to the agency having scientific expertise? > The Swedish pandemic strategy seemed targeted towards “natural” herd-immunity and avoiding a societal shutdown. This claim seems hotly debated. I tried following the sources in the paper for this but only found paywalls or papers that only talked about herd immunity in general terms. Lucky for me, one of the better Swedish journalists, Emmanuel Karlsten, wrote a long post about it (Source, Swedish: https://emanuelkarlsten.se/tegnell-mejlen-sa-fick-flockimmuniteten-faste-hos-folkhalsomyndigheten/ https://emanuelkarlsten.se/tegnell-mejlen-sa-fick-flockimmun...). I read it as that the agency definitely had herd immunity under discussion but it is unclear how much they based their strategy on it. Openly they repeatedly mentioned that they were trying to save as many lives as possible, not (necessarily) achieve herd immunity. Some of the more radical claims in the paper seem to come from Sörensen (who is also a co-author of the paper). > Both the Prime Minister and Minister of Health and Social Affairs publicly declared they had no competence considering pandemics or medical issues. In effect the democratic institutions ceased to function (Sörensen 2020) Mainly from: https://www.semanticscholar.org/paper/Terror-in-utopia%3A-Crisis-(mis-)-management-during-Stilhoff/6f94bcd98211eab6fcc4a8171b026c3bb2b61bf9?sort=relevance&citedPapersSort=relevance&citedPapersLimit=10&citedPapersOffset=0 https://www.semanticscholar.org/paper/Terror-in-utopia%3A-Cr... (finally a source in English!) It's certainly ...interesting... to read. It's published in a Russian journal of social sciences (https://scindeks.ceon.rs/JournalDetails.aspx?issn=0085-6320 https://scindeks.ceon.rs/JournalDetails.aspx?issn=0085-6320) which I can't find that much information on since I don't speak Russian. Interesting headlines in the paper include "The Sovietization of the Swedish state" and "Totalitarian Democracy". Reading it I don't really feel like including a source like that helps the credibility of the paper published in nature. From the closing parts of the abstract > If Sweden wants to do better in future pandemics, the scientific method must be re-established, not least within the Public Health Agency. I don't feel convinced by the paper that such a conclusion can be reached.

CryptoPunk 5y ago

Sweden's COVID response was excellent. First of all, the comparison to other Nordic countries is inappropriate. Its population-weighted density is closer to the UK, and closest to Austria: https://swprs.org/judgment-day-sweden-vindicated/ https://swprs.org/judgment-day-sweden-vindicated/ This Nordic cross-comparison is lazy and agenda-driven. Secondly, Sweden had 20 times fewer deaths than initially projected without a lockdown: https://medrxiv.org/content/10.1101/2020.04.11.20062133v1.full.pdf https://medrxiv.org/content/10.1101/2020.04.11.20062133v1.fu... The initial calls to lockdown were justified with these projections, not with how many COVID deaths Sweden would have relative to neighboring countries. Thirdly, not instituting a lockdown meant Sweden had far fewer limitations of civil liberties, and fewer adverse lockdown-related health and socioeconomic damage. For example, forcing a million young people to forego in-person schooling for a year would have done enormous damage to education: https://www.mckinsey.com/featured-insights/coronavirus-leading-through-the-crisis/charting-the-path-to-the-next-normal/30-to-40-percent-of-minority-and-low-income-students-werent-learning-during-lockdowns https://www.mckinsey.com/featured-insights/coronavirus-leadi... Not to mention the harm to development from foregoing summer jobs, in-person social interaction, etc for one or two years. The claim that lockdowns were appropriate doesn't even begin to contend with the harm from lockdowns. It focuses on COVID deaths single-mindedly, when it's a policy that affects every facet of society and daily life.

deleted 5y ago
[deleted]
emn13 5y ago
Whether the article is accurate or at least reasonable I don't know, however this criticism smells fishy - the kind of damages you're ascribing to the lockdown Sweden did suffer from, and not dramatically less so than nearby countries AFAIK. For economic indicators at least the data is available, and IMHO clearly shows Sweden was not unusual, e.g. https://www.statista.com/statistics/1274468/gdp-per-capita-nordic-countries/ https://www.statista.com/statistics/1274468/gdp-per-capita-n... Suppressed human interaction and stress causes harms, I'll postulate to that - but clearly even without any government intervention at all the pandemic will see to that. Whether formal social-distancing measures make that worse is not obvious; they could even conceivably make it better (if coordination helps pick those that work best and reduces their overall length, for instance); and surely the details of the measures, including timing and duration, matter. Ascribing pandemic related damages to lockdowns is wrong. Now, that doesn't mean lockdowns are always harmless, nor that this article is sane; but let's not delude ourselves that it's obvious "lockdowns" in general are terribly harmful, by comparing them to a false baseline of pre-pandemic normality.