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COVID19: The performance of the Swedish strategy

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Christos Papahristodoulou May 29, 2020

The three Nordic countries together, Denmark, Norway and Finland had in May 28, almost 200 deaths per million inhabitants from the COVID-19. Sweden, with approximately 60% of the population of the other three countries, had 419 deaths per million. Obviously the COVID-19 pandemic hit Sweden much harder. Today it was announced that the other three Nordic countries will enforce quarantine to travellers from Sweden during the summer. In addition, two Mediterranean countries, Greece and Cyprus, just announced that they do not allow tourists from Sweden this summer.

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It will be interesting to see results of large-scale antibody tests. Sweden might actually be well ahead of the curve, going forward.

POSTED BY: Daniel Lichtblau

Thanks Daniel! I hope I am wrong, but things are not very well in Sweden. One should expect from a welfare state with so high taxes a better performance.

Sweden opted to take on more cases, and this may have lead to a greater percentage of infections in the most vulnerable populations, hence perhaps a high mortality. It is not clear (to me) that the Swedish health care system failed to hold up, although certainly if vulnerable populations were hard-hit that would indicate some policy failures.

It is also not entirely clear that the mortality is as high as claimed, as we do not really know what percentage of the Swedish population has been infected. I expect this will clarify in the next several weeks, as more antibody testing is performed.

As to whether the greater exposure leads to an improved herd immunity effect (as compared to other countries), we likely will not know until the end of 2020 (unless we learn sooner than that that immunity simply does not last very long, but this seems unlikely based on evidence thus far). Similarly, we will not have a clear indication of overall relative mortalities before that time.

There is the obvious counter-balance that Sweden's economy has almost certainly taken less of a hit than the economies of most other countries. But so far as the virus impact goes, I really would not draw any hard conclusions until more data is in. It might turn out to be a disasterous strategy, or it might turn out well, or it might be somewhere in between, as is often the case, when all options carry serious drawbacks.

POSTED BY: Daniel Lichtblau

Update June 14. IHME (https://covid19.healthdata.org/sweden) forecasts 8534 fatalities by August 4th. In contrast, our model forecasts 6012. It will be a good model check. I will post updated picture just before I go on a break in July along with additional comments. The end result will depend on whether the distancing in Sweden is breaking (and producing more cases) or not (in which case all the extra new cases are due to increased testing)

Update June 11. I have updated the pictures, and added a fatalities curve and forecast which has proven to be the most stable of all the models I have worked with so far. It is obtained my fitting the R curve of a SIR model to the fatality cumulatives, as in the picture of the fatalities per million (I owe you all an explanation of why this works), and taking the derivative of that curve to obtain the forecast in the new picture. According to the state epidemiologist, the increased number of cases is due to increased testing, although not entirely. This does not affect the model for fatalities. But a new model needs to be derived for the infection cases when more data is available and the trend stops rising and stabilizes. The forecasts are made originally on 4 May.

Dear Daniel,

Four things:

1) Serological tests indicate that the levels of infection are comparable to that of other countries (7%), so no, they do not seem to be gaining in terms of acquiring herd immunity.

2) Sweden's economic crunch is just as bad as that of its neighboring countries. I am based in Finland. From the point of view of unemployment, it is actually worse.

3) Fatality per million rate. Sweden is fifth worst in the world, and various models (including mine) forecast that it will end up being second or third worst by the autumn.

4) The state epidemiologist now accepts fault to some degree. Not so the government. There is a huge debate in Sweden. Nevertheless, it is unlikely they will change their strategy at this point, that is, unless things get much worse. This week, the number of cases reported has increased dramatically. I have the pictures of a very neat true SIR model posted elsewhere in community which illustrate this. I attach them here along with the fatality PM forecasts. The pictures show in alpha order (

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Enrique, I am afraid you are right. I update my post and will be clear soon, with new data. Preliminary, the number of deaths in Sweden will be more than 6,200 by the end of July, where it seems to be the time when the pandemic is over. In addition, compared to all other 25 European countries, the ratio of total infected/total number of tests is the highest in Europe (almost 15%). The Italian ratio is about 6%, in Spain and the UK is less than 10% and in Holland is almost 13%. If you regress it with the lockdown index you find a very strong negative relationship!

I believe you are right. However, both the economical impact or the total mortality are things that we are far away from having an answer to yet. As far as I know there is no reliable data yet on number of infected in Sweden (or any of the Nordic countries), and as long as we don't have that it is very hard to to a realistic comparison. A couple of weeks ago Denmark and Sweden reported figures from small samples they taken. These indicated that Denmark had much fewer infected, but at the same time a higher fatality rate (especially among elderly). Both were very small studies, and both with obvious flaws, so drawing conclusions from these should be done carefully.

If we assume that the figure were right, then even if things like unemployment rate have followed similar patterns, it is quite likely that Denmark will have to keep harder measures for longer and therefore get bigger problems over time. On the other hand if they are wrong then it might be Sweden having bigger problems ahead. We just don't know.

For me one interesting thought is, if we we say that countries like Norway, which are below there average death rate, are doing the right thing, then why are they not doing this every year? If you are able to go below your average in the middle of a pandemic, and claim that you are doing the right thing, shouldn't the consequence be that you should do the same during every single influenza? Probably not, because you have to think long-term too: What's the long-term consequence if you have a, let's say, 2 week influenza lock-down every year? Or, what is the long-term consequence if we do a 3 months or months lock-down during pandemic years?

That's not straight-forward at all to answer.

(Btw, the last few days Sweden's death rate counted per 10 million inhabitants look like it will be very close, perhaps even below, average. )

POSTED BY: Jan Brugard

Your post has been selected for our editorial column Staff Picks http://wolfr.am/StaffPicks and Your Profile is now distinguished by a Featured Contributor Badge and is displayed on the Featured Contributor Board. Thank you!

This post has been listed in the main resource-hub COVID-19 thread: https://wolfr.am/coronavirus in the section Computational Publications. Please feel free to add your own comment on that discussion pointing to this post ( https://community.wolfram.com/groups/-/m/t/1990972 ) so many more interested readers will become aware of your excellent work. Thank you for your contribution!

POSTED BY: Moderation Team

I found these graphs to be quite interesting, and thought that others reading Christos' post might find it too. They show mortality rates (non-Covid specific) in several European countries (and regions) over time and by age groups. No analysis included, just data, but quite interesting.

POSTED BY: Jan Brugard

Hi everyone, I have now updated the Swedish and European Infection and mortality estimate and done a few more estimates. Things are still bad in Sweden... I will continue with updates at least once per month and hope the Swedish COVID-19 performance will improve!

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