Finland

“We Have to Compare Sweden to Its Neighbours” Isn’t a Convincing Argument

In a recent post on Lockdown Sceptics, I argued that the case for lockdown basically collapsed in May of 2020, when Sweden’s epidemic began to retreat. Sweden was the only major Western country that didn’t lockdown in 2020, yet it saw age-adjusted excess mortality up to week 51 of just 1.7% – below the European average.

A common reply is that, although Sweden did better than the European average, it did worse than its neighbours. Here its neighbours are taken to be the other Nordic countries: Denmark, Norway, Finland and Iceland. Looking at age-adjusted excess mortality, it’s true that the other Nordics did better than Sweden. All four saw negative excess mortality up to week 51.

Does this mean lockdown sceptics are wrong to cite Sweden as evidence that the benefits of lockdowns are vastly overstated? No, I don’t believe it does.

First, the economist Daniel Klein and his colleagues have identified 15 different factors that may account for the higher death toll in Sweden as compared to the other Nordics. These include the greater number of frail elderly people alive at the start of 2020 (the ‘dry tinder’ effect); the larger immigrant population; and the lack of adequate protection for care home residents in the early weeks of the pandemic. 

Second, as the researcher Philippe Lemoine has pointed out, the epidemic was already more advanced in Sweden by the time most European countries introduced lockdowns and social distancing. The other Nordic countries therefore had a head start in responding to the deadly first wave. This is particularly important because, when the first wave struck, the best ways of treating COVID-19 were not yet well understood.

I would add that, with the exception of Denmark (which saw a moderate second wave), the other Nordics are small, geographically peripheral countries for which a containment strategy was actually workable. As I’ve noted in Quillette, all the Western countries that have managed to keep their COVID-19 death rates low (Norway, Cyprus, Australia, etc.) benefited from pre-existing geographical advantages. And all imposed strict border controls at the start (something the UK Government’s scientific advisers cautioned against).

Third, as the legal scholar Paul Yowell has argued, the Baltics (Estonia, Latvia and Lithuania) are similar to the Nordics in terms of climate and population density, and once you include them in the comparison, Sweden no longer stands out. Lithuania actually had higher age-adjusted excess mortality than Sweden last year, despite imposing a strict winter lockdown.

Finally, as Yowell also points out, the ratio of Sweden’s COVID-19 death rate to Denmark’s isn’t that much higher than the ratio of Denmark’s to Finland’s. And this is despite the fact that Denmark has taken a more restrictive approach than Finland. One could therefore take the comparison between those two countries as evidence against the efficacy of lockdowns.

What’s more, this exercise could be repeated with other pairs or trios. For example, despite taking a slightly less restrictive approach than Spain and Italy, France has reported fewer deaths from COVID-19 (as well as lower excess mortality). Of course, these kinds of comparisons don’t tell us very much. But that’s the point. We shouldn’t only compare a country to its immediate neighbours.

And when researchers have analysed European countries and US states in a systematic way, they haven’t found evidence that lockdowns substantially reduce deaths from COVID-19.

Sweden Had Lower Excess Mortality Last Year Than Most of Europe

According to new excess mortality data compiled by Eurostat and Reuters, Sweden emerged from 2020 with a smaller increase in its overall mortality rate than most European countries in spite of eschewing the lockdown policy. Reuters has more.

Preliminary data from EU statistics agency Eurostat compiled by Reuters showed Sweden had 7.7% more deaths in 2020 than its average for the preceding four years. Countries that opted for several periods of strict lockdowns, such as Spain and Belgium, had so-called excess mortality of 18.1% and 16.2% respectively.

Twenty-one of the 30 countries with available statistics had higher excess mortality than Sweden. However, Sweden did much worse than its Nordic neighbours, with Denmark registering just 1.5% excess mortality and Finland 1.0%. Norway had no excess mortality at all in 2020.

Sweden’s excess mortality also came out at the low end of the spectrum in a separate tally of Eurostat and other data released by the UK’s Office for National Statistics last week.

That analysis, which included an adjustment to account for differences in both the age structures and seasonal mortality patterns of countries analysed, placed Sweden 18th in a ranking of 26. Poland, Spain and Belgium were at the top.

Lockdown enthusiasts often point to the lower excess mortality in the other Nordic countries, implying that had Sweden locked down it would have had even lower excess mortality. Against this, two things can be said. The first is the point made by Dr Paul Yowell which is that if you include the Baltic states among Sweden’s neighbours – and there is no non-arbitrary reason for not doing so – Sweden’s excess mortality begins to look less atypical for the region. The second is the argument made by Dr Oliver Robinson which is that Finland itself didn’t lock down, so pointing to Finland’s lower excess mortality than Sweden’s is not an argument in favour of lockdown.

The Reuters piece is worth reading in full.

Stop Press: MailOnline has summarised the Reuters story here.

The Other Sweden

We’ve heard a lot about Sweden over the past year, but according to Dr Oliver Robinson Sweden isn’t the only ‘control’ that invalidates the lockdown experiment. We’ve been neglecting Finland. In an original piece for Lockdown Sceptics, the Associate Professor of Psychology at the University of Greenwich points out that Finland has had the second lowest Covid death rate in Europe, yet, like Sweden, it avoided locking down.

So, what interventions did the Finnish Government make? From March to May 2020, schools were closed, public meetings were limited to 10 people, borders were shut and citizens returning from abroad were put into quarantine. Guidance was given to people with symptoms to stay at home, and over-70s were requested to avoid social contact unless essential (this last measure is notably similar to the Great Barrington Declaration’s proposed approach of ‘focused protection’). On June 1st, the number of people allowed to meet was increased to 50 and public indoor places were opened gradually. Since then, various selective international travel restrictions have been imposed.

According to the Blavatnik School of Government’s COVID-19 Response Tracker, Finland’s response to COVID-19 was marginally stricter than Sweden from March to early April 2020, then the same level of strictness from April to May, then less strict than Sweden, something which remains true to this day. You can check for yourself here.

Worth reading in full.

Stop Press: Dr Paul Yowell, an Associate Law Professor at Oxford, has written a fascinating blog post in which he points out that Sweden hasn’t fared badly compared to its neighbours – an argument often made by lockdown enthusiasts – provided you count Estonia, Latvia and Lithuania among those neighbours. “Once you include the Baltic countries (lying immediately south of Finland) in the geographic comparison, Sweden is no longer an outlier in mortality comparisons,” he writes.

Finland: The Covid Success Story No-One is Talking About

by Dr Oliver Robinson

Finland has not implemented a lockdown at any point during the COVID-19 pandemic. Yet, compared with its neighbour Sweden, which has been in the constant media spotlight for its lack of lockdowns, Finland’s avoidance of them has gone largely unacknowledged.

The measures that Finland has imposed have not come close to the OECD definition of a lockdown (i.e., stay at home order plus school closures of non-essential business/venue closures). Finland has never implemented a stay-at-home order, or a limit on household mixing or any restriction on travel within the country, just non-binding guidance. So, what interventions did the Finnish Government make? From March to May 2020, schools were closed, public meetings were limited to 10 people, borders were shut and citizens returning from abroad were put into quarantine. Guidance was given to people with symptoms to stay at home, and over-70s were requested to avoid social contact unless essential (this last measure is notably similar to the Great Barrington Declaration’s proposed approach of ‘focused protection’). On June 1st, the number of people allowed to meet was increased to 50 and public indoor places were opened gradually. Since then, various selective international travel restrictions have been imposed.

According to the Blavatnik School of Government’s COVID-19 Response Tracker, Finland’s response to COVID-19 was marginally stricter than Sweden from March to early April 2020, then the same level of strictness from April to May, then less strict than Sweden, something which remains true to this day. You can check for yourself here.

So how has Finland done in terms of health outcomes during the pandemic? Exceptionally well. In terms of mortality, Finland has the second lowest Covid deaths per million in the whole of Europe. Its excess deaths statistics have never increased above of the normal range, as you can see in the below graph, which covers the beginning of 2020 to February 2021. England is shown as a comparison.

(Euromomo)

What’s the explanation? Is it down to low population density? Unlikely. Finland may be a large country with a small population, but over 85% of its population lives in towns and cities, where opportunity for viral transmission is the same as in more urban areas. Furthermore, somewhat surprisingly, research shows no relationship between Covid mortality rates and population density.

How about obesity? Are Finns unusually thin? No. The obesity level is average for European countries at 22% (same as Belgium).

One factor that helped Finland may be the early border closures and border quarantine for the first few months, which research shows can be effective in the early stages of this pandemic. But this is a long way from the Zero Covid approach of New Zealand or Australia. Finland’s borders have been open to the majority of countries since May 2020.

Another factor could be Finland’s intensive focus on building public health into all aspects of Finnish life.For example, Vitamin D deficiency is a predictor of COVID-19 disease, and Finland has mandatory fortification of milk and margarine with Vitamin D. Or another more tenuous suggestion is that Finns are prolific users of saunas, and there’s some research evidence that saunas boost the immune function.

Whatever the reason, one thing is for sure: Finland is an important case study in showing that success in managing the COVID-19 pandemic is NOT a function of strict lockdowns. Finland shows that if you manage your borders properly, keep people healthy, active and social connected, and give them clear information not panic-inducing propaganda, a pandemic need not turn into a catastrophe.

Dr Oliver Robinson is an Associate Professor of Psychology at the University of Greenwich.