Update on the Swedish covid response

Since my article at the end of October detailing exactly what had been happening in Sweden in relation to covid up to that point, I’ve been getting a lot of requests for a new update, detailing events in November and December. Here it is.

I ended my previous article by stating that there had been a slow increase in hospitalizations and deaths in October, and that the slope of the curve suggested that the peak would end up being significantly lower than in spring. That slow increase continued through most of November, and appears to have stabilized at a level of around 70 deaths per day at the beginning of December (as a reminder, in spring deaths peaked at 115 deaths per day in mid-April).

This makes Sweden similar to the UK and the Netherlands, two countries that Sweden has been tracking closely throughout the pandemic, with a second peak in deaths per day that is a little over half what was seen in spring.

Here in Stockholm, the number of people being treated in hospital for covid has been stable since late November, with around 800 people being treated simultaneously for covid in hospitals (in spring around 1,100 people were simultaneously being treated for covid in Stockholm at the peak).

Since the total number of hospital beds in Stockholm is around 3,850, it should be plain to everyone that the healthcare system has never been close to being overwhelmed, in spite of claims to the contrary in media. And while it is true that hospitals are currently at 100% capacity, it is false to claim that that situation is in any way unusual. Sweden has among the lowest number of hospital beds per 100,000 population in Europe, and the hospitals are always running at 100% capacity this time of year.

My feeling (shared by multiple colleagues I’ve spoken with) is also that we’re being more generous with which covid patients we admit to the hospital than we were in spring, when we were more worried about the system being overwhelmed. In other words, if we had been as strict with admitting covid patients in autumn as we were in spring, the number of people in hospital in Stockholm with covid would not currently be 800, it would be quite a bit lower.

Other parts of Sweden, that were only hit lightly in spring, have however been hit harder the second time around. For example, Skåne, in the south, has been hit much harder in autumn than it was in spring. Parts of northern Sweden have also been hit harder.

One thing that I think is very interesting, that has received little mention in media, is that the proportion of people with antibodies has been rising by 2-3 percent every week. In Stockholm, 37% of those tested for antibodies in week 49 were positive (up from 20% six weeks earlier). That suggests that the level of immunity is rising very rapidly in the population, and makes it questionable whether the vaccine will arrive in time to have any meaningful impact on the course of covid-19 in Sweden, even if people start to get vaccinated shortly after Christmas, as is currently planned.

Overall, the situation is no more serious now than it was in spring, at least if you look at deaths, ICU-admissions, and hospitalizations. During the spring peak, 2,350 people were being treated simultaneously for covid in hospitals in Sweden as a whole. At present, 2,500 people are being treated in hospitals for covid, but, as mentioned, these 2,500 are on average less sick than the 2,350 being treated in spring, which is likely why deaths are lower even though hospitalizations are up a bit. Another data point in support of this is that at present, 290 people are being treated for covid in Intensive Care Units (where the very sickest people end up). In spring, that number was 550.

In the parts of Sweden that were hit hard in spring, like Stockholm, the situation is clearly less serious now than it was then. Of course, if you ignore hospitalizations, ICU-admissions, and deaths, and just look at cases, the situation looks a lot worse than in spring, but that is due to the fact that we’re now testing ten times as many people per week as we were at the end of April.

Apart from that, we know a lot more about covid now than we did in spring. We now know that the overall fatality rate is less than 0,2%, and that the risk to healthy people under 70 years of age is infinitesimal. But if you see reporting in media, and if you look at the actions of the Swedish government, you get a very different picture. What follows is an update on all recommendations and restrictions coming from the Swedish state during November and December.

As I mentioned earlier, a decision was made in October by the Public Health Authority to start imposing recommendations on a local rather than national basis. This was followed by a tightening of recommendations in multiple counties over the next couple of weeks, so that by November 3rd (when tightened recommendations were imposed in Örebro, Halland, and Jönköping) fully 7 out of 10 Swedes were living in counties with tightened recommendations. On that day, the government also announced that people would be forbidden from gathering in groups of more than eight at the same table in restaurants. And it was reiterated that employers should allow employees to work from home, if possible.

On the 11th of November, the government announced that restaurants and bars would be forbidden from serving alcohol after ten pm, and would need to close at 22.30 at the latest.

On the 16th of November, the government announced that the number of people allowed at all public events (plays, demonstrations, lectures, sports events etc) was being decreased to eight, significantly lower than the previous lowest limit of 50.

On the 19th of November, the government authorized the Public Health Authority to make decisions to stop visits to nursing homes on a county by county basis (during spring and summer, all nursing homes in Sweden were closed to visitors, but this restriction was lifted at the beginning of October). On the 4th of December the Public Health Authority decided to make use of this measure, closing nursing homes to outside visitors in 32 Swedish municipalities (out of a total of 290).

On the 3rd of December, the government announced that high school students (ages 16-19) would return to distance learning, as had been the case during a period in spring. Initially, the plan is that this will apply until January 6th (this has later been extended to January 24th).

And then, on the 18th of December, the government went even further, imposing the most severe restrictions yet. Restaurants and bars are now ordered to stop serving alcohol at 20.00, and groups in restaurants are not allowed to number more than four. Shopping centers and other public venues like supermarkets and gyms are ordered to set a max number of visitors, so that crowding can’t happen. All public venues that are run by the state, such as libraries, public swimming pools, and museums, are ordered to close, and stay closed at least until January 24th. The government has also recommended that people start wearing face masks in public transport during rush hour.

In total, this means that the restrictions and recommendations in place are now much more severe than the ones that were in place in spring. As I think is clear, the Swedish government has played a much more active role in autumn than it did in spring, when it was happy to let the Public Health Authority do most of the decision making.

The rhetoric from the Swedish government has also been more alarmist the second time around, with the Swedish Prime Minister, Stefan Löfven, delivering speeches that make it sound as if Sweden is going to war, for example telling people on November 16th to “do their duty”.

The Health Minister, Lena Hallengren, said in a speech on November 16th “don’t consider these measures voluntary”, about the voluntary recommendations that the government is asking people to follow. To me, that’s pretty clear evidence that the only reason Sweden hasn’t followed other countries in imposing severe legally enforced restrictions is that the Swedish constitution has prohibited it.

In conclusion, the Swedish government has officially lost its mind. In the name of protecting public health, the government is doing its utmost to destroy public health. In spite of the fact that some of the biggest risk factors for severe covid are obesity and lack of exercise, the government is seriously telling people to stop visiting swimming pools and gyms; in other words, to stop exercising.

Why the change in tone from the Swedish government during November and December?

If one were cynical, one might think it was due to the fact that the governing Social Democrats received a big boost to their opinion ratings in April and May, in the usual “rally around the flag” fashion seen when a nation faces some type of crisis, but since then they have been polling worse month on month. Maybe they saw their polling numbers, panicked, and hoped that they would get a boost in the polls if they could appear more assertive. Or maybe they’ve just capitulated to international pressure to “get in line”.

You might also be interested in my article about why Sweden had more covid deaths than neighboring countries, or my article about whether lockdown is effective.

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