Additional Ideas on Sweden’s Pandemic Response

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Yves right here. This submit illustrates how arduous it’s to select aside the connection between public coverage approaches and Covid outcomes. And it’s now turning into inconceivable because of the failure to collect something remotely like ample knowledge, significantly with the CDC altering the way it counts extra deaths to help its “Covid is over” fabrications.

By Rajiv Sethi, Professor of Economics at Barnard School, Columbia College. Initially printed at his web site

In my final submit I checked out Sweden’s pandemic response and made two observations.

First, it seems that Sweden’s coverage selections in the course of the pandemic, which relied largely on voluntary compliance with public well being steering somewhat than mandates, don’t appear to have resulted in superior financial efficiency relative to its Nordic neighbors. Financial development in Norway, Denmark, and Sweden adopted very comparable trajectories over the 2020-2022 interval.

Second, there have been important variations throughout these international locations in extra demise charges early within the pandemic, with extra lack of life in Sweden, however cumulative extra demise charges seem to have converged. That’s, the Swedish polices affected the timing somewhat than eventual magnitude of extra mortality. Denmark and Norway had been in a position to postpone extra deaths (relative to Sweden) however not keep away from them solely.

How can these two observations be reconciled? One can clarify the financial trajectories by arguing that Swedes voluntarily did what their neighbors had been pressured or compelled to do. However this is able to not clarify the sample of extra deaths. It seems that the primary distinction between Sweden and its neighbors was the diploma to which probably the most susceptible populations (the aged and people with weakened immune methods or severe coronary heart and lung situations) had been protected. The state epidemiologist Anders Tegnell acknowledged this, whereas defending Sweden’s total technique of reliance on private duty and voluntary compliance.

However there have been many different elements at play, together with very excessive vaccination charges in Sweden (maybe within the shadow of the trauma attributable to early extra mortality). Following my earlier submit I acquired an extended and considerate message from Troy Tassier of Fordham College which discusses a few of these points. I’ve reproduced his message beneath with permission.

Hello Rajiv,

I hope that you’re doing nicely. I learn your weblog submit on Sweden with curiosity as we speak. I’ve been within the “catch-up” in extra deaths by the non-Sweden Nordic international locations for some time. It’s very perplexing to me and I haven’t finished a extremely deep dive however I had a number of feedback which may be of curiosity to you.

  1. It appears that there’s a distinction between what I’ll name the “folklore” of Swedish coverage and the response of Swedish residents. Should you have a look at numerous mobility metrics (like Google’s mobility knowledge) it seems that the Swedish inhabitants didn’t behave all that in a different way than populations of neighboring international locations regardless of Sweden being much less aggressive by way of its official coverage response. Observe the 2 graphs beneath that are primarily based on Google knowledge gathered from OWiD, smoothed to a weekly common. (Comparisons to different Nordic international locations and comparisons utilizing different Google metrics like Time Spent at Residence are comparable.) Aside from the preliminary pandemic section in spring 2020 and the winter of 20/21 the Swedish inhabitants really had extra conservative conduct than Denmark. They in the reduction of on mobility greater than Denmark aside from these two intervals of time. As a result of the Swedish inhabitants didn’t reply strongly in spring 2020 I believe this goes a great distance in explaining why Sweden did so poorly by way of extra deaths. And, it could clarify part of the catch-up by different Nordics (as a result of the Swedish inhabitants was really extra cautious than the opposite Nordic populations in 22/23). However I don’t suppose it could possibly clarify all of it. I believe additionally it is attention-grabbing that after Sweden did so poorly in 2020 that the inhabitants reacted extra strongly in future months. A part of me wonders if there was a NYC kind impact the place issues had been so unhealthy that individuals acted strongly with a view to keep away from a repeat of 2020. So that they locked themselves down due to their threat notion from earlier expertise.
  2. I believe level 1 additionally provides clues as to why Sweden’s financial efficiency wasn’t appreciably higher than its neighbors. The Swedish inhabitants didn’t behave all that in a different way than its neighbors so its financial system suffered after which rebounded to the same diploma.
  3. The mobility level above additionally suggests what I’ll name robust company results of populations. Not surprisingly the mapping from coverage to conduct isn’t direct. And, just like the Sweden graph beneath, there’s proof that individuals act to keep away from (pandemic) threat with out being instructed to take action—no shock to an economist that individuals reply to perceived threat, proper?! For example, Austan Goolsbee and Chad Syverson counsel that solely a small % of the lower in financial conduct was on account of coverage selections/ legal guidelines early within the pandemic. And much like that paper, for those who look to issues like Google knowledge on time in public transit stations, time spent at dwelling, and so on., nearly all of the response in March 2020 occurred previous to particular “keep at dwelling” bulletins or faculties closures. I’ve a small bit on this regarding NYC and London in a e book I’ve popping out this February. So once more, Sweden’s official insurance policies (or lack of coverage response) doesn’t imply that Sweden’s inhabitants didn’t react. They did and over a big a part of the pandemic they responded extra strongly than their neighbors regardless of no coverage telling or suggesting that they accomplish that.
  4. All of this nonetheless doesn’t clarify why the Nordics ended up in the identical place as Sweden by way of extra deaths after 3+ years. I’ve seen a few potentialities steered (apart from the apparent—it was going to occur it doesn’t matter what coverage selection was made and the general public well being measures carried out in 2020 simply delayed the inevitable):
    1. I don’t have a superb cite off hand for this however I’ve been a part of conversations suggesting that Sweden did a a lot better job at getting vaccines to its aged and most susceptible populations. And so they did this extra shortly than their neighbors. This means that the catch-up in extra deaths might have been as a result of Sweden’s vaccine coverage was extra responsive than their neighbors. Which once more is a unique story than the one which dominates public notion (i.e., that Sweden did nothing). Sweden might have finished nicely just because that they had a extremely aggressive and swift vaccine coverage.
    2. I don’t know sufficient about this, however I’m considerably skeptical of the way in which that many extra demise calculations are estimated. Many don’t appear to account for adjustments in populations. Some are easy linear regressions of brief time period traits, like 3-5 years, generally adjusting for age composition and generally not. Virtually none take account of demographic elements like migration and altering demographics. I’d like to see a paper that basically pulls aside how these estimates are made. My fast studying of public well being commentary on this implies that there are initially unintuitive results of issues like immigration. For example despite the fact that latest immigrants are typically poorer on common, they are typically more healthy (in any other case they couldn’t migrate). Then there are substitute results throughout pandemics—if susceptible members of a inhabitants die early in a pandemic then anticipated deaths in future years ought to lower as a result of individuals who you might count on to die in 12 months three from some “pure trigger” die in 12 months one on account of an epidemic—so your anticipated deaths ought to be decrease in 12 months three than preliminary estimates counsel. However a linear estimate of pre-pandemic years goes to overlook this. There will probably be a form of pure imply reversion for those who don’t account for the underlying change within the inhabitants because the epidemic evolves. So, there appear to be a bunch of things that aren’t accounted for by numerous the surplus demise estimates that I’ve seen. Perhaps these are all small magnitude results that don’t actually matter. However Sweden v. different Nordics in late 2021 and 2022 actually puzzle me. In the long run it could merely be that there was nothing we may do besides delay the inevitable. The optimist in me hopes this isn’t true. However I’d love to know this higher.

Anyway, no actual cause or motion plan for sending this to you. Simply wished to throw out some unorganized ideas that I had after studying your submit a bit earlier as we speak.

Finest,

Troy

Troy has a Substack e-newsletter in case you’d prefer to subscribe.

One remaining thought. The concentrate on Sweden’s method is comprehensible, because it was such an outlier and acquired an excessive amount of contempt and scorn on the time. However the knowledge means that one ought additionally to look intently on the insurance policies instituted in Norway and (particularly) Denmark. On each financial and public well being grounds Denmark seems to have finished extraordinarily nicely relative to its neighbors, although at the price of some liberties that Swedes continued to take pleasure in.

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