Faced with mounting evidence that lockdowns did not substantially reduce COVID-19 deaths in most of the countries where they were implemented, lockdown proponents have fallen back on what Paul Yowell calls the “neighbour argument” – i.e., the argument that comparing Sweden to its neighbours shows that lockdowns really do work.
On May 10th, a tweet plotting cumulative COVID-19 deaths per million in Sweden, Norway and Finland – which referred to the “Nordic natural experiment” – garnered over 6,000 likes.
However, this argument isn’t convincing for a whole number of reasons, as I’ve outlined in two previous posts. For example: the other Nordics had a head start on Sweden; border controls – not lockdowns – made the difference in the first wave; and once you include the Baltics, Sweden no longer stands out.
However, suppose we just look at the mortality figures. Do they show that Sweden had an exceptionally bad year? Far from it. As I’ve noted before, the country saw age-adjusted excess mortality up to week 51 of just 1.7% – below the European average.
Now, it’s true that all three other Nordics saw negative excess mortality (of up to –5% in Norway’s case). Because mortality rates declined gradually from 2015 to 2019, no change from 2019 to 2020 yields a negative value for excess mortality. In addition, there may have been fewer flu deaths and car accidents, thanks to social distancing.
However, one reason why Sweden’s excess mortality figure isn’t lower is that the country saw particularly low mortality in 2019 (which brings down the average of the last five years). In that year, Sweden had the lowest mortality of all four Nordics – its rate was 4% lower even than Norway’s.
As several commentators have pointed out, this meant that there were more frail elderly people alive at the beginning of 2020 than there otherwise would have been. So even in the absence of a pandemic, you’d have expected to see a slight rise in mortality – owing to the “dry tinder” effect.
If we take the average of 2019 and 2020, then Sweden’s age-standardised mortality rate was 15.8 per 100,000, Denmark’s was 17.6, Finland’s was 16.4 and Norway’s was 15.5. In other words, Sweden’s was lower than both Denmark’s and Finland’s, and was only slightly higher than Norway’s.
Of course, the average of the last two years isn’t a measure of the impact of the pandemic (and other relevant events). For that, we can need to compute the excess mortality for 2019–20, by comparing the average mortality rate in those two years to the average over the preceding four years. When we do that, the numbers come out as follows: –3.3% in Sweden, –4.4% in Demark, –4.8% in Finland and –4.9% in Norway.
Although Sweden still saw the least favourable change (i.e., the smallest decline in mortality), the disparity with respect to its neighbours is much reduced.
This exercise is not meant to obscure the fact that Sweden saw a moderate rise in mortality last year, unlike the other Nordics. It’s simply meant to put that rise in mortality into perspective. After all, having a sense of perspective is very important when trying to evaluate the measures that were taken during the pandemic.
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nice article
as is often pointed out. all cause mortality is the best metric but it suffers from 2 issues
1 – it doesn’t separate covid from lockdown deaths
2 – you can’t look at them without considering dry tinder effect
so well done for addressing (2). it is simply mad not to consider how many old people you have when looking at how many old people die
this is an issue for covid specifically because 95% of ‘covid’ deaths are actually just old age – maybe brought forward a little
And co-morbidities. That is probably a huge factor in deaths seen in USA and UK, with obesity, diabetes and other respiratory ailments too.
“. it is simply mad not to consider how many old people you have when looking at how many old people die” Unless your aim is not that of reflecting the truth, or the actual risk, but instead to exaggerate, frighten, obfuscate, deceive, bully.
You are, of course, absolutely right about separating out ‘Covid’ deaths.
But there’s no way round this other than rough estimates from aggregated research.
So – we end up with all-cause mortality by default. What we can say is that any really significant fatal epidemic will show up.
I think the best metric is all cause mortality, age and population adjusted
like this for the UK
https://www.ons.gov.uk/aboutus/transparencyandgovernance/freedomofinformationfoi/deathsintheukfrom1990to2020
if there is a tinder effect you can pick it out by eye
it would be good to have the above graphed for every country
ie
True, but it isn’t going to persuade the fanatics.
They want to believe. They need to believe.
Noah – this is good work. But do stop farting around in the fog of ‘excess mortality’ – a concept that is imprecise and variable. It’s always bollocks.
Just establish a credibly long baseline, and compare the year in question to deviation from it. Forget the habit of 3-5 years timescale ; anything under about 15 years is useless for comparative purposes, in a situation where comparisons between countries are, in any case, fraught with an impossible matrix of confounding variables (My general condemnation of the Johnson government doesn’t go so far as to lay the apparently higher mortality than most just at its door).
But the ‘dry tinder’ issue is vital. Do an analysis over 2- rather than 1-year periods, and the outcome is significant.
Differences in overall all cause mortality between Sweden and Denmark in 2020 are largely explained by differing approaches to care for the elderly. Denmark and, indeed, Greece (which also had a good common cold coronavirus epidemic outcome) care for large numbers of their elderly in their own homes. ‘Danish policy calls for allowing the elderly to remain in their own homes for as long as possible. There where they have lived with their families, friends and neighbors, and where they feel at home. If they fall ill or lose any of their functional abilities, they can be provided with home help and home nursing. Such care is provided free as part of the Danish welfare model, and is based on qualified social and health care personnel visiting the elderly at home, and helping with anything they find hard to do themselves.’ https://www.sosufvh.dk/international/the-danish-care-model ‘Due to the crisis and economic hardship, families opt to look after the elderly at home as pension benefits are a major source of income particularly among households with unemployed members.’ eurocarers.org/greece Both countries have consequently largely avoided the nosocomial infection disasters in care homes elsewhere. Not so in Sweden. ‘Sweden experienced disproportionate incidence among the very elderly and nearly… Read more »
Absolutely, the most important analysis is nosocomial vs community mortality. Only the former can reasonably be managed, but even then you have to balance quality of life in a care home vs infection control.
In the UK the Government has made life grim for residents, but at least they’ll be dying of depression and loneliness rather than covid. If it saves just one career….
Yes. We kicked our elderly and infirm out of hospital; Sweden wouldn’t let them into hospital: ‘From March 2020 there was urgent pressure to free up 15,000 NHS beds for the anticipated wave of COVID-19 admissions. Hospitals, in effect, closed to all but urgent and emergency care. The government guidance applicable at that time directed rapid discharge of everyone clinically ready. Transfer off wards should be within one hour of a discharge decision to a designated discharge area, and then discharge from hospital as soon as possible, normally within two hours.’ https://www.scie.org.uk/care-providers/coronavirus-covid-19/commissioning/hospital-discharge-admissions ‘…increasing numbers of workers are also coming forward to criticise regional healthcare authorities for protocols which they say discourage care home workers from sending residents into hospital, and prevent care home and nursing staff from administering oxygen without a doctor’s approval, either as part of acute or palliative (end-of-life) services. ‘”They told us that we shouldn’t send anyone to the hospital, even if they may be 65 and have many years to live. We were told not to send them in,” says Latifa Löfvenberg, a nurse who worked in several care homes around Gävle, north of Stockholm, at the beginning of the pandemic. “Some can have a lot of… Read more »
i.e. died of old age and cancer.
Ivor Cummins highlighted the “dry tinder effect” related to Sweden around the middle of 2020.
Dry tinder- an AIER article from the summer 2020.
But facts never mattered and won’t ever matter here.
Whilst I agree that Sweden has not suffered excessive deaths and is a good example to show lockdowns and measures do not work, we need to take care with how we express this. Border closures have always been known to not work – viruses mutate and we cannot say that masks and social distancing are useless and then claim that perhaps they are the reasons why flu has not been as prominent. The biggest reason Sweden saw slightly more deaths than its neighbours was having had 2 light flu seasons in the prior years whereas their neighbours did not. Lets remain clear and ensure clarity in our arguments. We rightly pick up on the zealots for being contradictory, lets not start doing the same ourselves
Dry Tinder has to be the most relevant factor. Populations with a high number of immune compromised citizens [frail elderly] are bound to do the worst.