How bad is covid really? (A Swedish doctor’s perspective)

Ok, I want to preface this article by stating that it is entirely anecdotal and based on my experience working as a doctor in the emergency room of one of the big hospitals in Stockholm, Sweden, and of living as a citizen in Sweden. As many people know, Sweden is perhaps the country that has taken the most relaxed attitude of any towards the covid pandemic. Unlike other countries, Sweden never went in to complete lockdown. Non-essential businesses have remained open, people have continued to go to cafés and restaurants, children have remained in school, and very few people have bothered with face masks in public.

Covid hit Stockholm like a storm in mid-March. One day I was seeing people with appendicitis and kidney stones, the usual things you see in the emergency room. The next day all those patients were gone and the only thing coming in to the hospital was covid. Practically everyone who was tested had covid, regardless of what the presenting symtom was. People came in with a nose bleed and they had covid. They came in with stomach pain and they had covid.

Then, after a few months, all the covid patients disappeared. It is now four months since the start of the pandemic, and I haven’t seen a single covid patient in over a month. When I do test someone because they have a cough or a fever, the test invariably comes back negative. At the peak three months back, a hundred people were dying a day of covid in Sweden, a country with a population of ten million. We are now down to around five people dying per day in the whole country, and that number continues to drop. Since people generally die around three weeks after infection, that means virtually no-one is getting infected any more. If we assume around 0.5 percent of those infected die (which I think is very generous, more on that later), then that means that three weeks back 1,000 people were getting infected per day in the whole country, which works out to a daily risk per person of getting infected of 1 in 10,000, which is miniscule. And remember, the risk of dying is at the very most 1 in 200 if you actually do get infected. And that was three weeks ago. Basically, covid is in all practical senses over and done with in Sweden. After four months.

In total covid has killed under 6,000 people in a country of ten million. A country with an annual death rate of around 100,000 people. Considering that 70% of those who have died of covid are over 80 years old, quite a few of those 6,000 would have died this year anyway. That makes covid a mere blip in terms of its effect on mortality.

That is why it is nonsensical to compare covid to other major pandemics, like the 1918 pandemic that killed tens of millions of people. Covid will never even come close to those numbers. And yet many countries have shut down their entire economies, stopped children going to school, and made large portions of their population unemployed in order to deal with this disease.

The media have been proclaiming that only a small percentage of the population have antibodies, and therefore it is impossible that herd immunity has developed. Well, if herd immunity hasn’t developed, where are all the sick people? Why has the rate of infection dropped so precipitously? Considering that most people in Sweden are leading their lives normally now, not socially distancing, not wearing masks, there should still be high rates of infection.

The reason we test for antibodies is because it is easy and cheap. Antibodies are in fact not the body’s main defence against virus infections. T-cells are. But T-cells are harder to measure than antibodies, so we don’t really do it clinically. It is quite possible to have T-cells that are specific for covid and thereby make you immune to the disease, without having any antibodies. Personally, I think this is what has happened. Everybody who works in the emergency room where I work has had the antibody test. Very few actually have antibodies. This is in spite of being exposed to huge numbers of infected people, including at the beginning of the pandemic, before we realized how widespread covid was, when no-one was wearing protective equipment.

I am not denying that covid is awful for the people who do get really sick or for the families of the people who die, just as it is awful for the families of people who die of cancer, or influenza, or an opioid overdose. But the size of the response in most of the world (not including Sweden) has been totally disproportionate to the size of the threat.

Sweden ripped the metaphorical band-aid off quickly and got the epidemic over and done with in a short amount of time, while the rest of the world has chosen to try to peel the band-aid off slowly. At present that means Sweden has one of the highest total death rates in the world. But covid is over in Sweden. People have gone back to their normal lives and barely anyone is getting infected any more. I am willing to bet that the countries that have shut down completely will see rates spike when they open up. If that is the case, then there won’t have been any point in shutting down in the first place, because all those countries are going to end up with the same number of dead at the end of the day anyway. Shutting down completely in order to decrease the total number of deaths only makes sense if you are willing to stay shut down until a vaccine is available. That could take years. No country is willing to wait that long.

Covid has at present killed less than 6000 in Sweden. It is very unlikely that the number of dead will go above 7,000. An average influenza year in Sweden, 700 people die of influenza. Does that mean covid is ten times worse than influenza? No, because influenza has been around for centuries while covid is completely new. In an average influenza year most people already have some level of immunity because they’ve been infected with a similar strain previously, or because they’re vaccinated. So it is quite possible, in fact likely, that the case fatality rate for covid is the same as for influenza, or only slightly higher, and the entire difference we have seen is due to the complete lack of any immunity in the population at the start of this pandemic.

This conclusion makes sense of the Swedish fatality numbers – if we’ve reached a point where there is hardly any active infection going on any more in Sweden in spite of the fact that there is barely any social distancing happening then that means at least 50% of the population has been infected already and have developed immunity, which is five million people. This number is perfectly reasonable if we assume a reproductive number for the virus of two: If each person infects two new, with a five day period between being infected and infecting others, and you start out with just one infected person in the country, then you will reach a point where several million are infected in just four months. If only 6000 are dead out of five million infected, that works out to a case fatality rate of 0.12 percent, roughly the same as regular old influenza, which no-one is the least bit frightened of, and which we don’t shut down our societies for.

If you want to read more of my writings on the covid pandemic, then you might be interested in my article on the role of T-cells in figuring out how many people have developed immunity, or my article on the use of hydroxychloroquine as a treatment for covid-19. You might also be interested in watching the TV-interview I did with Sky News.

I am rolling out a ton of new science-backed content over the coming months, including:

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Author: Sebastian Rushworth, M.D.

I am a practicing physician in Stockholm, Sweden. I studied medicine at Karolinska Institutet (home of the Nobel prize in medicine). My main interests are evidence based medicine, medical ethics, and medical history. Every day I get asked questions by my patients about health, diet, exercise, supplements, and medications. The purpose of this blog is to try to understand what the science says and to translate the science in to a format that non-scientists can understand.

40 thoughts on “How bad is covid really? (A Swedish doctor’s perspective)”

  1. Tack så mycket for writing this. Now all we have to do is get this information to the masses around the globe who have been terrified into hiding in their houses by the mainstream media and Governments who bring in policies to justify their previous policy, rather than any regard as to what is actually happening.

    It’s not that I’m pessimistic about this happening in the UK, but I started learning Swedish at the start of lockdown. I may see you soon!

    Sköldpaddan har på sig en gul hatt (I have a way to go!!!)

    1. “Now all we have to do is get this information to the masses around the globe who have been terrified into hiding in their houses by the mainstream media and Governments…”

      Logical, but most unlikely. Because the broad masses (as I have taken to calling them) are actually far more frightened of losing their unconditional trust in “mother” and “father” (the government and the media) than they are of the virus. Just like real mothers and fathers, government and media can lie, steal, cheat, and even kill – without losing the trust of their children.

      Of course the broad masses are no longer children, but shhhh! Government and media haven’t told them.

      1. You are spreading misinformation. I take it there is no Hippocratic Oath in Sweden.

  2. Thank you for your front line review if the situation in Sweden. The more light that can be shone on this subject from practicing doctors the sooner life can get back to normal in more countries.

  3. I read your blog on Dr. Kendrick’s site. I wanted to say a big thank you for being brave enough to share your experience. We really need more people like to you around the world to tell the truth about Covid. I know for some people this has been a very sad time. However the daily death tolls provided by sensationalist media are never given in context. The only driver has been fear. Thank you again.

  4. Thank you for posting this. I am another who got a link to your blog through Dr. Kendrick’s website.
    Another Dr. is Vernon Coleman. His ‘Old man in a chair’ videos are fifteen minute gems of commonsense.

    An intelligent perspective from India:

  5. So there are no long lasting complications for those who survive the virus?
    That is not what has been reported.

    1. The vast majority recover without complications. If you become really sick and you spend weeks in the ICU on a ventilator then there are a whole host of complications you can experience, mostly related to the fact that you are immobilized (muscle loss, pneumonia, and pulmonary embolism for example) and to the fact that air is actively being pushed In to your lungs instead of passively dragged in. These are the same complications everyone who spend a lot of time intubated risks experiencing. Apart from that, there have been reports of vascular complications, like Kawasaki disease in children and stroke in adults, but these are all very uncommon.

      1. Thanks for this article trusting the experience of quick societal herd immunity. Am interested in reading about your experience with aggressive treatment at symptom onset when viral replication can be halted, well before intubation would be needed.

        I have a person-number and had my foot stitched from a floor hockey mishap. ( I know how to say inabaundy, though not spell it! ) Am seriously considering moving back to the rockholm of Stockholm.

      2. Statistics for the long term complications is not yet available – due to low time elapsed since the recovery and no data from the long term follow up available

      3. Being a member of a fb group for what is termed “Covid19 long-haulers” I can vouch that there are indeed many who seem to experience a post-viral condition for months (so far) with many different symptoms (dizziness, sob, myocarditis, sudden onset epilepsy, high levels of inflammation, fatigue, Migraine headaches etc etc). This is after they now test negative for Covid19. No idea about numbers of “recovered” that experience this. Regardless though avoiding Covid19 in the long term if it is now endemic in communities is unlikely so Sweden’s experience and policies seems very sane to me.

    2. I personally think that many of the so-called “long term covid” symptoms are actually caused by anxiety and stress. At least that’s how it was for me. I got a nasty bug in mid-February that turned into pneumonia. I was convinced months after recovery that I was experiencing lingering effects from it. Turns out I was actually suffering from my own anxiety. Once I got that straightened out I was back to normal in about a month.

  6. Quebec ER Doctor here. My experience in a medium-large ED in Montreal mirrors yours. I am referring to the ED here. However, our ICU was full with COVID patients, and we had several floors devoted strictly to COVID patients.

    As of today my province of Quebec, Canada had 5685 deaths for a population of 8.18 million.
    This is after complete lockdown including schools. In a time of uncertainty and when Italy, France and Spain were overwhelmed, being overly cautious can be justified. But after the first wave, our government should be taking a dispassionate look at the data coming out of Sweden.

    For now, suggesting anything other than near complete shutdown if a second wave occurs, is frowned upon. Mentioning that Sweden had better numbers, will only raise eyebrows and get you dismissive responses… best.

    Cheers! I sure hope you are right…

    1. Arruda said it’s very unlikely there will be another shutdown. I don’t know a single person who wants another shutdown. I find it concerning that as a Doctor you’re either misinformed or spreading misinformation. And the top article on Le Devoir (a left-wing newspaper) is an article about Sweden doing better than Quebec.

  7. Like many others, I suspect, I read this post on Dr. Kendrick’s blog. Dr Kendrick has a big following here in the UK. How refreshing to read something in line with what I have believed from the start. This virus SARS-COV-2 is a virus, a bad one, but still a virus. As such it will run its course and another virus, or another strain will come along. We have had viruses before, we will have them again. But this is the first time the world has been shut down because of one, and everyone has been made to look ridiculous wearing masks – which are more likely to cause problems with continual use. Thank you so much.

  8. Hello – I am yet another visitor from Britain, courtesy of Dr Kendrick!

    I am grateful that you and Dr Kendrick take the time to run these blogs, because otherwise all we would hear is the frenzied output from our media!

    I wonder if you have any thoughts about those PCR tests which are panicking Britain back into a partial local lockdowns as they are applied with ever greater frequency?

    It seems to me that if these positive tests mean anything important, there should be a rising number of COVID-19 cases being treated in hospitals – I understand this is not happening. I can’t help wondering if these tests throw up false positive results. Even a small percentage of false positives would show up in mass testing. Has there been any attempt to check them for false positive mistakes?

    1. Hi David!
      As I understand it from the literature, the tests have a high false negative rate (why we’ve been re-testing people with a negative test result but where we still think covid is likely) but a pretty low rate of false positives. However, I don’t put much stock in what the PCR tests show on a societal level, for two reasons. Firstly, people stay PCR positive for up to two months after being infected even though they are no longer infectious, so a positive PCR test is often a sign of an old infection that is over and done with. Secondly, how much covid you find depends on how much testing you do, and the rates of testing over the course of the pandemic have varied a lot both within and between countries. This is why it makes much more sense to look at the number of deaths than the number of infections, since that statistic doesn’t vary based on how much testing you’re doing and is much harder to manipulate.

      1. Thanks Sebastian,

        We hear that the death rate is also a rather compromised number. People get tested for COVID as they enter hospital, and then if they die – for whatever reason – they are recorded as dying of COVID. Also, in England Public Health England had an extraordinary policy of recording a COVID death even among those released from hospital as cured, who then died of something else! Bearing in mind the age profile of those falling ill, that policy raises the total considerably.

        It is almost as though everything possible has been done to confuse and corrupt the data.

  9. I understand why your perspective is a personal one since the government, if anything like the UK, will have a different slant. Sweden is not the only country in Europe who has gone for the herd immunity approach. Belarus has had even more outstanding results with less than 600 deaths. Their president, Alexandr Lukashenko, refused a World Bank loan to prevent a lockdown, social-distancing, curfews and the like. On Sunday he faces his toughest election ever. If not elected Belarus will go the way of most other European countries.

  10. That’s an interesting perspective you’ve got.

    We know from various pieces of research that Covid-19 infects up to 50%, and possibly more, of captive populations (various data from cruise ships, military ships, prisons, childrens’ camps – all reached these sort of levels and were continuing to rise at the point at which interventions took place).

    So for your idea to be correct, confirmed infectees would have to test negative to antibodies some time later – not just the odd one of them, but in large numbers. This would be amongst, not hospital admissons (doesn’t fit your theory), but asymptomatic infectees who have otherwise been identified and thus tested.

    Alternatively, in longitudinal serology studies, which several countries are now conducting for diseases surveillance purposes (maybe not Sweden who seem to have a “why bother?” attitude to science in this sphere), previously antibody positive subjects would become negative.

    There is a huge gap in the research “market” for a study demonstrating either of these phenomena and I do wonder why no-one has filled it yet.

    It would be great if you were correct. I understand that the profile of T-cell responses to CV-19 is the subject of much study at present.

  11. The first half of the year 2020 has seen fewer deaths per 100000 inhabitants (482,92) than the first half of the year 2015 (483,15). This at least according to the official numbers published by the SCB which they publish here (don’t forget to take Feb 29 out when you make the comparison, because 2015 didn’t have a Feb 29 either):

    Official population data can be found here (for 2015 I use the population at the end of 2014; for 2020 the population at the end of 2019):–the-whole-country/summary-of-population-statistics/

    It is also known that April 2020 has not been the worst month (in terms of mortality) of the last decades. In December 1993 slightly more than 126 people died per 100000 inhabitants. In January 2000 the same number was 110,8. In April 2020 Sweden recorded slightly more than 103 deaths per 100000 inhabitants (I have adjusted the numbers for the fact that April has 1 day less than Dec and Jan).

    So even though this infection is seemingly “a new one” it has caused less harm than previous influenza infection waves.

  12. I would humbly ask you to consider looking at all-cause mortality in Sweden in 2019 vs. 2018 and 2017. The excess mortality due to Covid in 2020 can nearly entirely be explained by the mild Winter of 2019 (and early 2020). In a sense, these deaths were not so much “accelerated” and “delayed”.

  13. Australia to date has had only 266 deaths in total, and our population is almost 3x the size of Sweden. You were losing 100 people a day? That’s no blip!

  14. Sweden is not not alone – Japan also did not do lockdown, and they fare even better.

    Lockdown is not a black or white decision, it’s not always correct or wrong.
    It DEPENDS on the context.

    In Vietnam, it would be wrong NOT to lockdown – thanks to an effective lockdown, they have on 10 fatalities so far.

    But in Japan, it would be wrong to lockdown.

    Not all countries are the same – so, different medicines for different ailments indeed.

    1. Erm… it’s a joke? That’s a military gas mask not medical PPE… and it’s badly fitted – there are gaps showing around the sides

      Many thanks Dr Rushworth.

      From another visitor from Dr Kendrick’s site.

      1. Hi Mike,
        In many Swedish hospitals we’ve been using gas masks instead of N95 masks. The advantage of the gas mask is that it’s reusable, so instead of going through hundreds of N95 masks, I’ve had one gas mask that I’ve used throughout the pandemic. Also, the gas mask is many times better than the N95 at filtering out small particles like viruses. That photo was taken when I first got my gas mask, before I realized that I was supposed to take out the plastic fittings on the inside of it .

  15. I’m looking at the numbers for New York State, where Covid ‘took off’ with no initial shutdown. With a population of over 19 million New York State, is about twice the population of Sweden. As of early August there are 32,800 deaths, which is about 2 1/2 times as many per-capita as you are reporting for Sweden. Do you have any thoughts as to why these numbers are so different?

  16. Do you mind if I ask about the use of hydroxychloroquine? It has been politicized so much in the US, but I have read quite a bit on how it has been used successfully here and in other countries, especially when given early and with other things. Did Sweden develop a “standard” treatment or was each patient treated on a case-by-case basis?

  17. With respect, your article does miss a large reality.
    Putting a vaccine aside, within a short few months, the fatality rate for Covid has dropped in part because treatment methods have improved.
    By definition the a few months of shutdown have given medical practitioners around the world time to improve survival rates for patients.
    The changes the long term calculus for how many would have died due to Covid…

  18. “Since people generally die around three weeks after infection, that means virtually no-one is getting infected any more” – false, first does not results from the second. The demographics of the newly infected changed, with many older ppl voluntarily reducing the social interactions despite no government prohibitions and improved cleaning/hygiene practices at the seniors care homes. As a result, there are now more young ppl infected and they are basically not dying from Covid – no deaths does not mean no infections, the infection can circulate mostly with the low symptoms or asymptomatic in these age groups. Also it is already reported from other countries that there is an improvement in survival rate of the ppl hospitalized with Covid due to medical community actively sharing the best and most promising practices.

  19. Thank you for your insight. I have re-posted, if I may, to my blog that discusses clinical trials, clinical technologies, and now COVID hoax. Unfortunately, I am afraid, CORONA is a FLU but COVID is the AGENDA. They will not stop until completing their agenda and the real tread aka bioweapon can be released to do more damage than this virus. They tested the water and now they saw people’s reactions without questioning. I was skeptical from day 0. Distrust the government; avoid mass media; fight the lies.

  20. Great personal opinion on the current pandemic! However, it is rather unfair to compare the current pandemic to 1918 pandemic which happened one hundred years ago because it is very clear that medical field has improved significantly over the years, with invention of facial masks, PCR, and antivirals with innovation and researches, contributing to the longer life expectancy of humans. Especially now with the quarantine and lock down, the figures are just the proofs of whether the preventive measures are working rather than proving the covid is bad or not as bad.

    Besides, to confidently say that there is no complication from the infection is a daring move coming from a physician because there is no clear evidence and research on the long term complication or follow up of the infected population as this virus strain is new and still poorly understood.

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