Why did Sweden have more covid deaths than its neighbors?

One of the arguments that has been used in support of strict lockdown is that Sweden has had significantly more covid deaths than its nordic neighbours. On the 19th of November, Sweden had registered 637 covid deaths per million people. For comparison, Denmark had registered 140, Norway had registered 57, and Finland had registered 69.

But, as I wrote about recently, the studies that have been done have not been able to find any correlation between severity of lockdown and the number of covid deaths. Which must logically mean that Sweden’s higher death rate was not due to the fact that it didn’t institute a severe lockdown. So, if that is the case, why did Sweden have more covid deaths than its closest neighbors?

A paper written by three economists at the end of August sought to answer that question. The research didn’t receive any specific funding, and the authors reported no conflicts of interest. The authors provided 15 different factors that could potentially explain the difference. I’m going to focus on the few that I think are likely the most important.

The first hypothesis is that Sweden, and in particular Stockholm, imported many more cases of covid-19 from abroad before measures were put in place to stop the spread between countries. The main reason for this is that Stockholm has a half-term holiday (“sportlovet”) in late February, when many people go skiing in the alps. The other nordic countries have similar holidays, but they have them earlier. So any Norwegians, Danes, or Finns who went skiing in the alps, would have gone there before the pandemic exploded in that region, while the people from Stockholm were there when infections were spreading at their worst.

The two other large-ish cities in Sweden, Malmö and Gothenburg, provide a useful control for this hypothesis. Both cities have their half-term holiday a week or two before Stockholm, and both were hit far less severely than Stockholm in the first wave. Stockholm experienced 40% of Swedish covid deaths, despite having only 24% of Sweden’s population.

Apart from this, Swedes travel internationally far more than their nordic neighbors (80% more per million people), which would have resulted in significantly more cases of covid being brought in to the country at the beginning of the pandemic.

The second hypothesis concerns the fact that Sweden has a much bigger population of immigrants than its nordic neighbors. 19% of Sweden’s population is foreign born, as opposed to 14% for Denmark and Norway, and only 8% for Finland. What this means in practice is that Sweden has a bigger population of people with darker skin, and it has been clear since early in the pandemic that darker skinned people in western countries are much more likely to develop severe covid than lighter skinned people.

As an aside, Much of the media debate around this phenomenon has centred around the idea that darker skinned people generally have lower status, higher rates of poverty, worse access to health care and so on – basically, that the difference is due to institutional racism.

But there is one big problem with that idea. It doesn’t fit all the facts. An article in the Washington Post on May 20th reported that 27 of 29 doctors who had died of covid in the UK up to that point belonged to ethnic minorities. In other words, 93% of doctors who had died at that point came from ethnic minorities, even though they only constitute 44% of all doctors in the country. Why is this important? Because doctors with darker skin are still doctors, which means that they are members of a high status, well paid, well-off segment of society.

Note, I’m not saying that institutional racism doesn’t exist. I’m just saying that it can’t explain why darker skinned people in western countries are hit much harder by covid than lighter skinned people.

Vitamin D deficiency could though. Darker skinned people in northern Europe are more likely to be vitamin D deficient for the simple reason that their skin isn’t as good at producing vitamin D from the feeble sunlight we get in this part of the world. A number of observational studies have shown that people with low vitamin D levels do worse when infected with covid, and there is even a randomized trial in which patients treated with high dose vitamin D did much better than the control group, which I’ve written about in a separate article (funnily enough, that study gained pretty much zero media attention, while remdesivir, a highly expensive drug that is almost completely useless against covid, has been talked about endlessly).

Anyway, what the authors are saying is that Sweden has a larger ethnic minority population than its nordic neighbours, and people from ethnic minorities do worse when they get covid.

The third hypothesis, and from my perspective the most important, concerns the fact that Sweden had a much larger vulnerable population at the beginning of 2020 than its nordic neighbours. This can be seen in multiple different ways in the statistics.

The first is that Sweden has a large nursing home population. Relative to population size, Sweden’s nursing home population is 50% larger than Denmark’s. And as I’ve mentioned previously, in Sweden, people don’t go to nursing homes until they are near the end of life.

The second way this can be seen in the statistics is by looking at overall mortality for the immediately preceding year, 2019. If unusually few people die in one year, then unusually many will die in the following year, since there is a carry forward effect (due to the fact that humans are not immortal). 2019 was an unusually un-deadly year in Sweden, and the early part of 2020 (pre-covid), was also unusually un-deadly, which means that there was an unusually large number of very frail old people in the country when covid struck. This same effect was not seen in Sweden’s nordic neighbours – for them 2019 was normal in terms of overall mortality.

To clarify exactly how big this difference is, let’s look at the numbers. In Sweden, overall mortality in 2019 was 2,5% lower than the average for the preceding five years. In Norway, mortality was exactly in line with the average. Denmark and Finland both had mortality rates that were 1% above the average. Denmark, Finland, and Norway were in a much better position in relation to covid from the start. Sweden was always going to have more deaths, regardless of the actions it took.

As I think this article shows, there were a number of big differences between Sweden and its nordic neighbors at the beginning of the pandemic, which are altogether certainly sufficient to explain the big difference in covid mortality.

Correlation is not causation. Many people have chosen to see a causative relationship between Sweden’s lack of severe lockdown and relatively high number of deaths, because it supports their prior beliefs about the effectiveness of lockdowns. Those beliefs are, however, not supported by the evidence.

You might also be interested in my article about how deadly covid really is, or my article about how effective lockdowns are.

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76 thoughts on “Why did Sweden have more covid deaths than its neighbors?”

  1. This seems to be the case in the uk as well, but over a longer time span. There is a regularly repeated fact about UK mortality for this year: That it is the highest since 2009.

    The age standardised mortality rates for each year from 1st Jan to 31st October were published in the most recent Monthly Mortality Analysis report by the UK Office of National Statistics. This data shows a gradual linear reduction in mortality each year since the records began in 2001 to about 2010, dropping from approx 1250 to 1000 per 100k in that period. It then plateaued at around 1000 per 100k until this year, when it significantly jumped to 1050.

    There other way to look at this of course is that the mortality this year in the UK is lower than 2001, 2002, 2003, 2004, 2005, 2006, 2007, and 2008. I wonder why this comparison is never mentioned?

    A rough back of an envelope calculation suggests that the total UK covid death toll would have to increase 3 fold in the next month (from around 60k to 240k) for this year’s mortality rate to exceed that of 2001. Odd how I don’t recall the ne ar decade of 2001-2009 being marked by mass panic, removal of civil liberties, and crippling destruction.

    The reports seem to be quite well written, to the layman atleast, and can be found by googling for “Monthly mortality analysis ons” plus the month required. The report for a given month is usually published around the 18th of the following month.

  2. Thanks for the right to the point article.
    I will refer to your post every time a troll will point to the fact that Sweden’s death toll is higher than its Nordic neighbours.

  3. Sebastian,
    Many thanks for this information which will will help me in my ongoing discussions about this topic.
    Franz

  4. Months ago, I did a little bit of research myself and this is what I found out. Winter is the main sports season in Norway with the result that Norway has the most Winter Olympic medals of any Nation. Norwegians boost their immune systems by getting out and about on ski walkes and races. They keep fit in weather conditions when other nations stay indoors.
    Ski walking and racing is also big in Finland as is the common and regular use of saunas. Also a number of decades ago the Finnish government promoted a campaign of healthier eating which included high vitamin D foods such as fatty fish.
    I could not identify exceptional reasons for Denmark except for the consumption of high vitamin D foods such as pork and fatty fish.
    Ivor Cummings identified that in 2018/19 Sweden had had less ( pro rata) Flu deaths than its neighbours and that left more vunerable souls to be taken in 2019/20.

  5. I am a visitor from Dr Kendrick’s blog.

    I enjoyed your analysis, but I would just like to make two points.

    The justification for all the COVID restrictions is that without them, we would see a disaster. Even with your slightly higher death rate, there has clearly been no disaster in Sweden!

    It doesn’t make much sense to look only at deaths from COVID – in the UK people’s access to medical care has been greatly reduced – to the extent that some people have had urgent cancer operations/chemo delayed until it is too late. The despair and stress from the lockdowns is also likely to cause more deaths in the UK. Maybe comparisons of the total numbers of deaths in Sweden vs other nordic countries would be more appropriate.

    I do hope Sweden will resist pressure to enter a lockdown this winter.

  6. The fact that “27 of 29 doctors who had died of covid in the UK up to that point belonged to ethnic minorities” does not negate the proposition that lower status etc. leads to worse outcomes. Why should this idea have to ‘fit the fact’ of the UK doctor victims being mostly of ethnic minorities? Among the inferences to be drawn from this revelation are that healthcare professionals are more at risk of catching diseaes; doctors from ethnic minorities outnumber the home-grown variety by a factor of c.13.5 in the UK; and that having a darker skin indeed makes you more vulnerable. It says nothing at all about outcomes among poorer classes of people among whom the dark-skinned are disproportionately represented. Of course poverty and access to healthcare are factors. As is diet and fitness, also class-related.

  7. Sebastian, above about 33 degrees latitude, no one can make any vitamin D no matter how light their skin is, due to UVB not penetrating the atmosphere due to the sun’s angle to the ground.

    It is very difficult to get enough vitamin D from food to remain immunologically competent. So whatever you accumulate in the liver in the Summer, you have to use that supply throughout the winter, and people invariably run out, leaving them most vulnerable during late winter/early spring — UNLESS you supplement.

    Might be worth looking at the rates of vitamin D supplementation in the different countries if such information is available.

  8. Forgot to mention that it is above 33 degrees from mid-Fall to mid-Spring that Vitamin D production is not possible.

  9. So glad I subscribed to Dr Rushworth’s posts–we need every voice of sanity we can find..

    Here is the US, the collateral damage of the lockdowns is becoming known–and it’s not good.. Fortunately, I live in an area of the US (Alaska) not connected to the ‘Lower 48’, or the ‘Outside’ as we call it. Each state’s governors and their staffs make individual decisions on countermeasures and luckily, ours have been mandates that are really suggestions and basically up to the individuals to use their commonsense. Also–being that we are a high latitude area and have many people here connected to northern latitude countries (in my case, Sweden), most of us take vitamin D-3 supplements and enjoy outdoor winter activities. Our covid death rate is at this point is194 per million–very low! And the number that have succumbed to covid that had no underlying condition is, of course, significantly lower.

  10. Thank you for your articles, they are always interesting.
    I hope that, when eventually assessed dispassionately, Sweden’s approach proves to have been the most sensible. It is important to avoid confirmation bias though, so I must question whether the valid points raised here in relation to the first wave can be reasonably applied to the second ripple,
    I assume for instance that care homes are now safer environments, and that most people are aware of the importance of vitamin D.
    One factor which may have a bearing is exactly how each country actually labels a death “covid”. I have no idea if there are significant differences, but I don’t see how valid comparisons can be made in the absence of this information.

  11. But Stockholm was hit again in the second wave, in spite of having higher count of antibodies. Doesn’t that refute the “sportlov” hypothesis?

    And the dark skinned part of the Swedish population are generally younger than average. Wouldn’t that fact make the hypothesis about dark skinned people beeing more vulnerable less important in the Swedish case?

    1. Hi Håkan,
      Not necessarily – covid was firmly entrenched in Stockholm in spring, went dormant in summer due to the seasonal effect, and all it took was therefore the colder weather for cases to race up again. In other places, like Norway say, where they never got much infection in the country before the advent of summer, that would mean they started the autumn with much less covid already in the county.

      I’m not sure what the average age of darker skinned people living in Sweden is, and how big the proportion is that is 70+. But if there are more darker skinned people in general in Sweden than other Nordic countries, that also likely means there are more elderly darker skinned people.

  12. Thank you Sebastian. More common sense and sanity from you. I appreciate it. fyi, here in USA: On the one hand, it is already accepted that there are racial/ethnic disparities re. serum vitamin D (see CDC infographic in link). On the other hand, there seems to be a very strong (somewhat-unbelievable) refusal to attribute covid-19’s unequal death rates to physiological differences such as vitamin d status. 🙁 https://www.cdc.gov/nutritionreport/pdf/Second%20Nutrition%20Report%20Vitamin%20D%20Factsheet.pdf

  13. Dear Sebastian!
    I do like your scientific style, and i am just as you working as a medical doctor in Sweden, as an anaesthesiologist-intensivist in the countrie’s southernmost part.
    I tried to confirm your first hypothesis by looking at the incidence data (in relation to the population sizes) for the Nordic countries for the first few weeks of the pandemic. The Danish and Swedish incidences were almost identical till the 15th of april, the Norwegian ones somewhat higher and the Finnish ones somewhat lower. The Swedish ones then start taking off much in excess of those of the other three countries.
    Would not your hypothesis predict an early rise in the Swedish numbers, in excess of those in the other countries? Doesn’t this disprove your first hypothesis?
    I can provide the raw data and a graphical representation – the numbers are all in the public domain.
    Rainer

    1. Hi Rainer,
      Thanks for the nice feedback. Are you talking about incidence of PCR positivity? I’m under the impression that Sweden lagged quite a bit behind its Nordic neighbors in PCR testing capacity, which would tend to make Sweden appear to have fewer cases than it really did in the early part of the pandemic.

  14. Mark: Thank you for that clarification, an important one. Also, it is possible to produce vitamin D in the skin at altitude for a longer period during the year since the thinner atmosphere impedes UVB penetration less.

  15. “Sebastian, above about 33 degrees latitude, no one can make any vitamin D no matter how light their skin is, due to UVB not penetrating the atmosphere due to the sun’s angle to the ground.”

    Why does the UK official advice only recommend vitamin D supplements during the winter then?

  16. Thank you Sebastian.

    Vitamin D benefits and Covid’s seasonality are probably two most important and most ignored aspects.
    Australian Victoria had the most draconian lockdown rules in the world and the new cases and clusters were still popping out until late spring and summer when it all disappeared (Australian summer starts on the 1st of December). The government claimed their virus eradication strategy a great success.
    Despite the government’s rush to get the vaccine rolled as soon as possible it will not be rolled out to enough people to provide herd immunity before Australian fall and winter when “the third wave” will struck with the media fearmongering how dangerous and relentless the virus is (it may be called Covid-20 by then) and the government reinstating lockdowns and even stronger vaccination laws.

  17. Very good post as usual. But I suspect that the answer is much simpler. To preface I’m not a doctor but a professor of public policy, so I’m just looking at this from a statistical perspective. Let’s compare Denmark and Sweden because for all the reasons you mention above, Norway and Finland are just too different. Denmark, on the other hand, is well connected, Danes travel as much as Swedes, and Denmark has seen considerable immigration.
    First, we should note that seen over the whole year of 2020, Sweden has not had any excess all-cause mortality – and neither has Denmark. In both countries, about 0.935% of the population have passed away every year during the past ten years. In fact, neither Denmark nor Sweden has seen any excess mortality at all during any week of 2020 in those under 65 years of age.
    Second, there was significant excess mortality in Sweden between March and May among those over 65 and in particular among those over 85, compared to the same months during the previous ten years. These 5500 or so excess deaths were mostly due to Covid-19. But this excess mortality among the old was followed by several months (June-October) of below-average mortality in the same age group. Meanwhile in Denmark, there were neither any peaks nor valleys in all-cause mortality.
    Third, notwithstanding this variation, both countries are approaching a nearly identical all-cause mortality of around 0.935% for 2020. This data is available from the statistical agencies of both countries (https://www.scb.se/ and https://www.statbank.dk/).
    Given the by now well-known age profile of Covid-19 deaths, this only leaves one possible interpretation: Yes, Sweden had far more Covid-19 deaths than Denmark, but the same demographic group – the very old and the very ill – in Denmark died of other causes during the year. The difference is that a few thousand deaths were ‘brought forward’ by a few months in Sweden by Covid-19. This is simply an effect of the slightly more rapid spread of the virus in Sweden compared to Denmark and – possibly – of some problems in care homes in Sweden. But be that as it may, over the year, the all-cause mortality is the same in both countries. Only if for some odd reason were to think that a death at age 85+ from Covid-19-related complications is somehow worse than a death at the same age from e.g. a cardiovascular problem or any of the many other ailments many people have at the time is Sweden ‘worse off.’
    Of course, each individual death is tragic, but making public health decisions with a view to reducing deaths from one cause in order to see the same number of people in the same age group die of a different cause would be wholly irrational.

  18. we could also summarize it this way: in the countries that had low or normal mortality in 2020, the old and frail people died before 2020 (but over a longer period of time, so it was not noticed)

  19. All of this could explain higher deaths in the spring. But the deaths are much more frequent in the fall as well. Since the summer about 1500 swedes have died of covid, while in Norway about 100. About 7 times as much per capita. Both in Norway and Sweden covid was almost gone in august. Sweden had at that point a much more immune population. The more strict rules in Norway must be the reason.

  20. I wonder what the normal Vitamin C and D deficiency rates are for all people across Europe?

    I’m aware from our own care homes that such defficiencies exist and it’s a national disgrace, if not grounds for legal challenges on negligence charges. I wouldn’t surprise me if it is worse within our prison population and mental institutes.

    As for minorities, I expect they are even more likely to suffer from Vitamin C/D deficiencies during the winter months.

  21. MIchael, regarding how death cause is labelled it is very similar between the Nordic countries (see (in Swedish) https://emanuelkarlsten.se/sa-raknar-norge-danmark-finland-och-sverige-dodsfall-med-corona/).
    Timing is of essence to hinder an epidemic. Sweden and Denmark had their first cases before Norway and Finland. I would say health authorities reacted with “force” about a week earlier in Denmark than in Sweden during crucial early March. The most important messages about holding distance/staying home at slightest symptom/work from home was not quickly enough communicated in Swe to hinder community spread in, primarily, Stockholm region.

  22. Above 33 degrees latitude, one cannot make any vitamin D from mid-Fall to mid-Spring — not that you are exposing much skin at those times anyway.

    Without supplementation, you live off your liver stores and slowly deplete until you are able to make vitamin D again as the earth tilts back and the sun is once again high in the sky. You reach your vitamin D serum nadir during flu season…. coincidence?

    The latitude factor is due to the failure of UVB to penetrate the atmosphere at such a low angle, since the northern hemisphere is tilted away from the sun at these times. This has been shown experimentally by Michael Holick, MD PhD who has devoted his career to vitamin D research. He discovered the active form of vitamin D decades ago and probably knows more about it than anyone.

  23. Thank you, Dr. Rushworth, for your excellent blog. I have a suggestion for something you might comment on. Here in the States, stories are starting to appear about the ongoing disaster in Sweden and how the Swedish government has finally seen the light and admitted how misguided their policies have been. I suspect exaggeration and selective reporting. Perhaps you could update us as to the current situation in Sweden.

  24. The greatest number of passings is actually people coming from Finland. This can easily be checked at SCB.se.
    One can speculate in the reason for this. After the WW2 many Finns emigrated to Sweden for jobs since Finland was in a really bad state after the war.
    Now they are old and many living in elderly care and this shows the Swedish failure. The elderly were not protected.
    The skin color does thereby not have any effect. It is other underlying causes.

  25. Dr Rushworth

    What is a dormant virus? Is it hypernating in your body for months just to turn active when the weather changes?

    Regarding dark skinned people in Sweden, SCB has statistics on number of deaths split into geograpical origin. The number of excess deaths in 2020 as compared to 2015-19 average up to week 48 is 785 regarding people born in Africa, Asia and South America. Since we are above 7000 covid deaths in total the contributrion from dark skinned immigrants is still marginal.

    1. That is a good question, and I don’t think anyone really understands why respiratory viruses seem to “disappear” in summer. Of course, they don’t disappear, they’re still there, but for some unclear reason they don’t cause symptoms to anywhere near the same extent.

      You’re right. None of these hypotheses explain everything. I think this is a puzzle with many different pieces.

  26. Thank you for all the effort you put into writing your blog. I refresh your home page once a day to see if there is some new interesting papers that you have looked at.
    As a response to some of the comments of this blog post it might be in it’s place to also point out that we are also dealing with a spread that may have a big chunk of randomness depending on where and which group that gets infected. This could be another part of an explanation of the different spreads we have seen in different countries. I found this rather enlightening simulation in the beginning of the pandemic and the more the time is passing, the more of these simple simulations seems to be applicable to more and more countries.
    “Simulating an epidemic” https://youtu.be/gxAaO2rsdIs
    Especially the simulations of physical distancing shows similar patterns as we see in a number of countries now with a lot of restrictions but no total lock-down. This simple model indicates that a look-down does only work if it is total which is also in line with one of your earlier blog post.

  27. I was expecting Sweden to experience milder fall in terms of covid hospitalizations and deaths. After all, many frail people succumbed allready in Spring, and the virus could spread (better than elsewhere) and potentially create herd immunity. This “milder” is mostly the case in comparison to european countries (Sweden doing good), but not within Scandinavia. Sweden added more covid deaths in sep-nov than finland, norway and denmark put together over whole season (so far)! This is a surprice? Less immunity and more spread of the virus, still finding vulnerable people?

    BTW, Sweden and U.S. do not differ that much if the numbers are scaled to “per million”. This was unexpected, thought U.S. was doing much worse. Guess it is the hospitals capacity…
    JR

    1. I think the explanation to that is that Sweden already had much more covid in the country at the start of autumn than Norway, Denmark, and Finland, so those countries are at an earlier stage of the pandemic. If that is the case, then Sweden will peak soon (I think it probably already has – here in Stockholm hospital admissions for covid have been stable for the last two weeks), while the other three countries will continue to see an increase for several more weeks. And while Sweden’s autumn peak with probably end up being around half of what the spring peak was (in terms of deaths per day), similar to the UK, which Sweden seems to be tracking quite closely, the other three nordic countries will likely peak at much higher levels than they did in spring. That’s my guess as to what will happen.

  28. Dr Rushworth

    Why do you claim ”of course they don’t disappear, they’re still there”? Isn’t it a more plausable explenation that they do disappear in the conditions brougth by the summer season, at least to a great extent? And then the small amount of surviving viruses start to multiply when conditions change back in the fall. The number of positive test went down in the summer so it’s hard to believe ”they’re still there” but ”they don’t cause symptoms”.

    1. Sorry, I expressed myself poorly, I meant that they don’t cause visible problems to the same extent. What I mean is that, once they’re widespread in a population, they’re not going to go away, although they may diminish in summer. But the moment the colder weather returns, they return. That is different from if they’ve never been effectively seeded in a population in the first place.

      Considering how late in the season covid came to northern Europe in spring, I can imagine that even just a few weeks could have made a big difference in the effect seen in Sweden compared to, say, Norway, which would mean that at the beginning of autumn, Norway would be starting from a situation with very little covid in the country, while Sweden would have much more already in the country, and would therefore see a more rapid resurgence.

  29. There is a new article in German defending Sweden’s numbers.
    https://www.nachdenkseiten.de/?p=67735
    Also, Lockdownsceptics had a rebuttal of the sceptical DM article today.
    My questions to Sebastian are: why is Sweden still testing like mad, opening itself up to those flawed relative comps thereby?
    What ct number do Swedish PCR tests use?
    Or do you use lateral flow tests now as well, like the UK?
    What are the case/death numbers for the Skane region alone, compared to maybe Stockholm and Copenhagen regions?
    They alone, in conjunction with your Ski holiday explanation, would, if low, vindicate Sweden’s approach completely (it’s vindicated anyway, if all collateral damage was included, of course)?

    1. Hi George,
      I think Sweden is testing like mad because the Swedish government has decided that we should test like mad. I think the CT in Sweden is usually 40. No, we’re not using lateral flow tests as far as I’m aware. While Stockholm was hit harder in spring, Skåne wasn’t hit very hard in spring, and is being hit harder now.

  30. markmanger and David Evans have raised Sweden’s overall mortality for 2020, and it can be seen here in a graph comparing with years from 2010: https://www.statista.com/statistics/525353/sweden-number-of-deaths/

    We’re in December now, and there will be more deaths to add before the end of the year, but so far it looks unlikely 2020 will be hugely different to other years.

    Similarly EUROMOMO doesn’t look too grim for Sweden: https://www.euromomo.eu/graphs-and-maps/#z-scores-by-country

    So why is the Swedish Prime Minister Stefan Lofven, and others, beating up the danger now? See for example: Swedish PM Makes Covid Plea in Historic National Address. Bloomberg, 23 November 2020.

    1. Hi,
      Very good question. I’m writing an article about what’s been happening in Sweden in the last few months, that I’ll put out in the next week or two, that contains my hypothesis as to what is currently going on with the Swedish government

  31. Dear Sebastian, it seems that the death rates are shooting-up again in Sweden, the shape of the deaths curve is similar to that of April. Please can you give us your opinion about it? Does it mean that Sweden has not had herd-immunity? Does it mean that Sweden’s strategy of minimal lockdown was wrong?

  32. Also look at these statistics: Number of coronavirus (COVID-19) deaths in Sweden in 2020, by age groups (as of December 8, 2020): https://www.statista.com/statistics/1107913/number-of-coronavirus-deaths-in-sweden-by-age-groups/

    9 years and younger – 3
    10-19 years – 1
    20-29 years – 12
    30-39 years – 22
    40-49 years – 53
    50-59 years – 179
    60-69 years – 470
    70-79 years – 1,528
    80-90 years – 3,058
    90 years and older – 1,970

    Out of a total of 7,296 deaths attributed to COVID-19 in Sweden over the past 10 months, 5,028 deaths were in people aged over 80 years. 6,556 deaths were in people aged over 70 years. 470 deaths in the age group 60-69 years. 270 deaths in 0-59 years.

    This is in a country which has annual deaths of around 90 odd thousand, in a population of around 10.4 million. So deaths attributed to COVID-19 in 2020 have to be seen in that context.

  33. And another major thing to consider is the reliability of the COVID-19 diagnosis, given PCR testing is so questionable.

    Really, if there is a similar pattern of deaths across ages in other countries, how on earth has the idea of mass vaccination for this virus gotten off the ground?!?!? It’s ridiculous!!!

    We desperately need independent and thorough analysis of all the ‘cases’ and deaths attributed to COVID-19 around the world.

  34. Hmmm, it’s the Swedish Prime Minister Stefan Lofven who is beating up the fear, with Anders Tegnell maybe being sidelined?

    Lofven is falling into line with other European ‘leaders’, I guess they couldn’t bear Sweden being a ‘control’ group? Fascinating though that Sweden was out there on its own for a while.

    However, do the following grim headlines really stand up with the statistics?

    – How Sweden is being forced to abandon its failing Covid-19 strategy. NewStatesmen, 14 December 2020
    – Sweden nears all-time high of COVID-19 cases in hospital. Reuters, 15 December 2020
    – Sweden has recorded its deadliest November since the Spanish Flu outbreak in 1918. SBS News, 15 December 2020

    1. Hi Elizabeth,
      -No, Sweden hasn’t abandonded its strategy – in some senses the recommendations are stricter than in spring, but there is still no legally enforced lockdown of the kind seen in other countries. And unless the Swedish constitution is changed, there never will be.
      -This is true, at the moment the same number of people are in hospital as in spring. Partly this is due to the fact that covid has now reached parts of Sweden that were barely touched in spring, like Skåne. Partly this is due to the fact that we are admitting people who we wouldn’t have admitted in spring, when it wasn’t clear how bad things were going to get and we thought we might run out of beds. That’s probably a big part of the explanation why there are as many people in hospital as in spring, but the number dying is much lower.
      -This is just ridiculous, and is based on looking at absolute number of deaths, rather than deaths per million population. The last time Sweden had a deadlier November was 2012.

  35. Mark, the 33 degrees latitude thing is ridiculous — please check your facts. I’m glad you’re not my MD.

  36. Thanks for your response Sebastian.

    An article in The Times seems determined to make Sweden look bad, i.e.:

    “Cases soar. The country now faces a significant rise in cases and fatalities. Its statistical agency recorded a total of 8088 deaths from all causes last month, the highest mortality in any November in Sweden since the first year of the Spanish flu pandemic in 1918, when 16,600 people died. Since Friday 153 people have died from COVID-19 related causes, bringing the total to 7,667. There have been 320,000 confirmed cases. The coronavirus death toll in the past month stands at about 1,400 compared with about 100 in Norway and 80 in Finland, each of which have about half its population of nine million. Sweden’s death rate per capita, while several times higher than that of its neighbours, is lower than some European countries that chose tough lockdowns.” *

    What do you think about those statements Sebastian? Re the comparisons with Norway and Finland, are they comparing apples with apples? Are all these countries using the same criteria to define covid ‘cases’/deaths?

    I guess in the end we need to compare annual death figures for 2020 across these countries, including examining excess deaths.

    I’m very suspicious of the antagonism towards Sweden, because of course there are many who do not want this country to be a success if it threatens the main game, i.e. mass vaccination…

    * Coronavirus: Medical chiefs failed us with light touch, says Swedish leader. The Times, 16 December 2020.

    1. Yes, I think the different nordic countries are defining cases and deaths largely the same way, but comparing Sweden with Norway and Finland is not comparing apples with apples. Sweden is in several important ways much more similar to more connected countries in continental Europe, like the UK and the Netherlands, so that is a much fairer comparison. And the “highest death toll in November since 1918” is ludicrous, because it is not adjusting for population size. Like I wrote before, the last time Sweden had a deadlier November was 2012.

      Yes, at the end of the day we should be looking at overall mortality, not disease specific mortality. I think the world is going to be in for a shock when it sees what overall mortality in 2020 (the year of “the deadliest pandemic in a hundred years”) ends up being.

  37. Sebastian, another interesting thing to consider is Anders Tegnell’s CV, see this link: https://www.ecdc.europa.eu/sites/default/files/media/en/aboutus/governance/af/Documents/Curriculum%20vitae%20-%20Anders%20Tegnell.pdf

    Tegnell seems to be a very rare bird indeed, it looks like he’s actually a specialist in monitoring disease and associated matters. Importantly, it doesn’t appear he has worked on vaccine clinical trials, i.e. is not conflicted by associations with industry… (Although he was employed by the WHO earlier in his career – in my view the WHO is seriously tainted now, it’s a front for industry.)

    Tegnell’s experience puts him in a different category to people influential on infectious disease public health policy in countries such as the UK and Australia. For example, in the UK, there is the government Joint Committee on Vaccination and Immunisation which is chaired by Andrew Pollard, who is also the chief investigator on the AstraZeneca/Oxford vaccine trials. And he has been involved in other vaccine trials, e.g. the Bexsero meningococcal B vaccine, a vaccine product which was originally rejected by the JCVI for the taxpayer-funded schedule in the UK, and then added to the schedule after Pollard became Chair of the JCVI.

    Similarly in Australia, the Australian Technical Advisory Group on Immunisation is colonised by members who are also associated with the vaccine industry via their involvement with vaccine clinical trials and/or industry conferences etc.

    So you can see the conflict here… The UK and Australia have groups committed to promoting vaccine products, it seems vaccines are usually seen as the solution to disease outbreaks…but is this really ideal? In the case of SARS-CoV-2 for instance, a virus which doesn’t appear to be a serious problem for most people, it seems to me mass vaccination is not the right course of action…

  38. Dr Sebastian Rushworth,
    always in our lives, there are days that had been cursed (or we had been).
    This post is marked by your feeble phases of participation.

    No. 2 — The story of the “33 degrees latitude” is completely non-sense. See a map of the world and look for the land between 33 degrees latitude north and 33 degrees latitude south.

    greetings

  39. Ahhhhh… I get it now. Sweden is being pulled into line with the rest of the EU…to get those vaccines rolled out…

    The Local reports: Coronavirus: Sweden set to start vaccinations on December 27th: https://www.thelocal.se/20201217/coronavirus-sweden-set-to-start-vaccinations-on-december-27th

    “Sweden, like other EU states, is currently waiting for the European Medicines Agency to give the green light to the Pfizer-BioNTech vaccine, which is expected to come next week.
    The plan is for delivery to get under way on Christmas Eve, and for all member countries to start vaccinating on December 27th, although Sweden’s vaccine coordinator Richard Bergström told Swedish public radio broadcaster SR on Thursday that vaccinations in Sweden could start as early as Boxing Day, December 26th.”

  40. In regards to Sweden, also see this interview on UnHerd: Swedish Professor: we are headed for disaster: https://unherd.com/thepost/swedish-professor-we-are-headed-for-disaster/

    Freddie Sayers interviews Fredrik Elgh, a professor of virology at Umea University. He’s “been one of the most outspoken critics of the Swedish response to Covid-19, calling for more dramatic action as early as March 2nd…”

    Not a fan of Anders Tegnell or Johan Giesecke apparently…

  41. Thanks Sebastian for your sober fresh-air articles. There have been reports of severe mistreatment of elderly in Sweden during the spring. Apparently, many in nursing homes with ‘Covid-symptoms’ were put on palliative care with morphine instead of being given something that could actually heal them (oxygen, vitamins, hcq/zinc…). Lots of people were also put in respirators that potentially did more harm than good.

    Do you know how the statistics would look if people had been given adequate care?

    What treatment are ‘Covid-cases’ being given today in Sweden, and what is the prognosis for them?

    1. At the moment we’re only using three drugs specifically for covid, at least in the hospital where I work. Low molecular weight heparin, an anti-coagulant is given to everyone admitted with covid, due to some evidence that people with covid are more likely to get blood clots. Cortisone is given to pretty much everyone who has had symptoms for more than a week and requires oxygen supplementation. Remdesivir is still used occassionally, but seems to be on the way out now that increasing evidence shows that it is useless. I can’t say what the difference would be if we had been better at treating covid in spring, I haven’t seen any good data to answer that.

  42. Do you have any opinions / thoughts on prophylaxis (and EARLY… symptomatic treatment ) using either HCQ + zinc, or Quercetin + Zinc, and the AZT a’la Dr Zelenko. Actually, I’ve noticed more than one ‘front-line Doctor using various recipes of the above, some adding Ivermectin. All stress early intervention – if not earlier! – and claim these patients have had zero mortality.
    I use quercetin for cardiac benefit, so I may be inadverdantly protecting myself from SARS-2, and oysters are not off my menu !

    1. The trials of hydroxychloroquine haven’t shown benefit. Zinc can’t hurt and might help, I haven’t had time to look in to it yet. The evidence for vitamin D is pretty strong, so I recommend that everyone supplement with it. 4000 IU (100 mcg) per day should be a good dose for most people. I plan on writing an article about ivermectin in the next few weeks.

  43. Correct. 2012 was a Very Bad Year, – and for the UK. ‘The Guardian’ headlines from then –
    2012 “Hospitals ‘full to bursting’ as bed shortage hits danger level” So was :-
    2013, “Hospitals scramble to prevent crisis in NHS’s ‘toughest ever’ winter” Fast forward 2 years
    2015, “Hospital bed occupancy rates hit record high risking care”. another three –
    2018 “NHS intensive units sending patients elsewhere due to lack of beds” and
    2019 Hospital beds at record low in England and NHS struggles….”

    – We get the picture. Winter consistantly wipes out the NHS. (2016 surgery cut – to free beds and 99% bed use in 2017)

  44. Can official deaths in Sweden be directly quickly compared to official Covid deaths in Norway? Because:

    https://www.news24.com/news24/world/news/covid-19-deaths-top-4-000-in-under-fire-sweden-20200525

    ” “In Sweden, anybody who has the diagnosis of COVID-19 and dies within 30 days after that is called a COVID-19 case, * IRRESPECTIVE OF THE ACTUAL CAUSE OF DEATH *. And we know that in many other countries there are other ways of counting that are used,” he told AFP. ”

    How can this method of counting deaths possibly reflect reality?! And why 30 days and why not 25, 28, or 31 days or 40? The way the Public health agency counts Official deaths will artificially inflate the total. So why are they counting deaths in this manner? It doesn’t make sense. What’s the explanation?

  45. I would imagine that “traditional Swedish” dietary and cultural choices would lend themselves to the prevention of winter vitamin D deficiency – especially relative to those of 1st and 2nd generation immigrants from sunnier climes who likely have not fully adopted Swedish culture as their own.

  46. On this page (details in the PDF document) it says Sweden uses two databases with different definitions:

    https://www.socialstyrelsen.se/en/statistics-and-data/statistics/statistics-on-covid-19/

    “The Public Health Agency only reports deceased with laboratory-confirmed COVID-19 who have died within 30 days.

    The National Board of Health and Welfare reports all cases where the underlying cause of death was COVID-19, regardless of whether the diagnosis was laboratory-confirmed or not.”

    There’s a flaw with the 2nd database (no PCR test required) but the major flaw with the 1st database (30 days – why?) means it shouldn’t be used at all.

  47. You’re missing what I feel is the most important part. We have a lot of nursing homes, as you said. The reason they got hit so hard, though, is likely not only that we have them, but also how they are managed. A lot of the nurses working at those places hold unstable employments, what we call “vikariat”. This means that they are employed by the hour with very unstable schedules where they are often called in on short notice and where they are not guaranteed to in fact get any work at all. This means that a lot of them have multiple jobs at multiple nurseries, to make sure they have an income. Since they do not have a set schedule, they do not get sick pay, which means that many of them have worked sick. They are also often part of the more susceptible minorities, since it’s low wage work. Canada had the same system, but introduced paid sick leave for hourly work early in the pandemic.

  48. Marcus: You are correct. So many of the early deaths of elders in nursing homes have been caused by poor care, abuse and neglect. While some nursing homes provide good care, a portion of them, in the U.S., the UK, and Europe, are owned and run by private equity, companies which exist solely to buy other companies, suck all the money out of them, then discard the carcass (Toy’s’R’Us is a good example of this). With nursing homes they don’t discard the carcass, as their money comes from the Medicare and Medicaid programs of our federal government, and there is a never-ending supply of that. Andrew Cockburn wrote an article about this in the September, 2020 Harper’s magazine. It is nothing short of murder what they have done.

  49. Marcus and Gary: This goes in line with what I wrote in my comment above. If Covid had been treated in a good way, we would have had much less “covid deaths” and “cases”. Still, the official statistics in Sweden show that the total number of deaths in 2020 is fairly normal. This illustrates that the Covid scare is not about health – it is about something else. We are seeing severe restrictions in freedom and free speech, and people seem to accept that. How much more oppression do we need before we either revolt or become totally “locked down”?

  50. Johan Krunholm: Yes. Up to the people of the world to put a stop to this. They’ve essentially captured the U.S. and the UK. China now has total control of their citizens’ lives, and the oligarchs would love to see this sort of social control everywhere. In the U.S. we are entering a dark period. 25,000 armed troops (in addition to the police) to protect the installation of their puppet. 2020 was a year of incompetence and perfidy by the “public health” bureaucracy and cowardice and perfidy by our political leaders. Despite what the press says, Trump is still immensely popular.

  51. So you propose that one of the factors in the higher death rate might be the fact that Sweden has a higher population of immigrants with dark skin.
    There´s 5% more foreign born people in Sweden compared to its neighbouring countries. Not all 5 % of these immigrants will have darker skin, because Sweden also has immigrants with white skin. So a lot less than 5 percent of these immigrants have darker skin.
    If people of colour are truly more susceptible to the virus, then they can only account for the much higher number of deaths if they actually died from the virus.
    Now I would like to see the numbers on that. How many of the covid deaths were actually people of colour?
    Or should we derive from this that it´s the people of colour who have been spreading the virus among the white people, who have then been spreading it to the older white people, who then died?
    That would be an incredibly racist thing to imply.
    That would basically be saying that the Swedish government did what they had to do (did they really?), but the higher death rate was caused by black people.
    So basically Sweden should get rid of its immigrants, so that the Sweden government can sit back and do nothing next time a pandemic arrives.
    I´m sure you had no intention of writing something racist, but I think it is very important that this is straightened out, even if you don´t believe this was the main cause of Sweden´s high numbers.

    I´m not saying that I´m totally in favour of a harsh lock down. I read your post “A Swedish care home doctor´s perspective”, and I very much agreed with what that letter says. I am writing this from Spain, so I know what a harsh lock down feels like, and I´ve been following the debate inside and out. We´ve all been taken by suprise by this and are now figuring out what is the best course of action to deal with it. But let´s be very careful that we do not put fuel on the fire of racism that´s been burning for centuries and lately seems to be flaring up.

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