Sweden has not only the highest rate of fatalities per capita, but also the total death toll is higher than that of all the other Nordic countries put together. As of April 10, Sweden has 86 Covid-19 fatalities per one million of population, while Finland has nine, Norway 20, and Denmark 43. (The U.S. has 47, and Russia 0.5 Covid-19 fatalities per one million, respectively).
The elderly and the poor
The authorities have been repeating for weeks that the paramount aim of their strategy is to protect the elderly. But 40 percent of all victims were infected in homes housing them. And while no testing has been provided to the personnel taking care of these elderly, the virus has reached one third of Stockholm nursing homes. The vast majority of Covid-19 deaths in Sweden corresponds to people aged over 70.
Furthermore, areas in the Stockholm region inhabited mainly by immigrants with lower socioeconomic status are overrepresented among those infected by the virus. It is the worst in Rinkeby-Kista (the suburb referred to by Trump in his renowned quote “Look what happened last night in Sweden”) which exhibits the highest rate per capita (48 per 10,000). In social-privileged areas, e.g. Kungsholmen, it is only nine cases per 10,000. On March 16, an independent organization of Somali physicians revealed that at least six out of 15 fatalities that occurred in Stockholm were of Somali origin.
Further measures detrimental to the elderly’s odds partly consist in new instructions to doctors as to how to prioritize the selection of patients to be treated in intensive care units. Clearly, patients of a biological age 8o or over should not be prioritized. The same regarding people 70-80 years old who have a significant disease in more than one organ system. Neither should people aged 60-70 who have similar failure in more than two organ systems be eligible for intensive care.
The above rules are to be applied in situations where there are not enough critical beds. But even if the authorities have now made efforts to increase bed availability, Sweden was, according to EU statistics, the country in Europe with the lowest number of curative care beds in hospitals. Local mainstream media reported that during the 90s Sweden dismantled most parts of their field hospitals which had been kept in case of major catastrophes. Other measures affecting the elderly is that all planned operations (e.g. cancer, etc.) have been canceled. The number of operations decreased by five thousand during the previous week alone.
Swedes are not inherently special
As declared by the government and public health authorities, a key component in the Swedish strategy would be some national idiosyncratic factor making Swedes abide by the authorities’ leadership, i.e., “authorities only need to recommend, people follow.” Sweden’s Foreign Minister Ann Linde explained on March 30 that Swedes have “a lot of trust” in each other and in the authorities and politicians, and that the public follows the decisions and takes personal responsibility. She repeated on April 9:
We trust that people take responsibility.
Put aside Swedish author Elisabeth Asbrink’s explanation that the often echoed “trust” could instead be “naivety, or passivity, or laziness, or even despise for the elderly,” what Minister Linde said is empirically questionable in the context of this epidemic.
Newspaper DN published the results of a survey carried out on April 9 among the Swedish people which focused on the attitudes of the public regarding “social distancing”–a cornerstone in the authorities’ recommendations. The survey results show that–paradoxically–despite the authorities’ calls for “social distancing” having successively sharpened, less and less of the people interviewed over a number of days were in favor of abiding with the recommendations.
The study then names the age-groups which “to a greater extent break the recommendations of the Public Health Agency.” It also concludes that such,
national behavior (riksbeteende) indicates that–with great probability–the infection shall increase in the coming days.
To assess the injury-epidemiological consequences of the Swedish strategy is also difficult due to unreliable statistics. On the one hand, the reported “infected cases” is solely based on tested cases, chiefly done only at hospitals; the real number of Swedish cases remains unknown. On the other hand, the death toll reported on a daily basis does not represent the real number of fatalities of that day, as the Public Health Agency claims they receive scores of death reports days after deaths occurred.
In addition, according to a Swedish associate professor in anaesthesiology and intensive care, Dr Mats Eriksson, “Numerous patients released from hospitals then die at home, untested, and get the diagnosis of unspecified pneumonia.” He also noted,
There is an instruction in Stockholm that suspicious deaths caused by Covid-19 shall not be further tested and therefore not included in the statistics. Yet, they should be put in a death-bag marked ‘Infected.’
The Swedish experiment is flawed. Either it’s not emphatically true that Swedes are so voluntarily obedient or the recommendations from the authorities are considerably insufficient–besides being non-coercive. The drastic increasing death toll in comparison to neighbouring countries speaks volumes..
Marcello Ferrada de Noli, Swedish professor emeritus of public health sciences, esp. epidemiology, and former research fellow at Harvard Medical School.