Lockdown Advocates Were Wrong to Mock Sweden's COVID Policy Strategy

When the pandemic began, multiple countries reacted in panic with lockdowns, school closures, mask mandates, and travel bans. There was one country that tried a light-touch, more laissez-faire approach: Sweden. Sweden had mask recommendations starting in June 2020, but never a mandate. Sweden never locked down or imposed curfews, although there were bans on crowds over five-hundred people, and later fifty people. Restaurants and bars in Sweden had more restrictions, but businesses by and large stayed open. There were moments where secondary schools went to remote learning, but primary schools and preschools stayed open. Sweden did not have a complete travel ban, but did ban those outside of the European Union, a policy that has since been rescinded. 

It is not as if Sweden did nothing to slow the spread. Sweden still had COVID-related restrictions in place, but that did not stop Sweden from getting walloped with criticism. Fortune called Sweden a failure. The New York Times referred to Sweden as "the world's cautionary tale." Foreign Policy thought Sweden's approach was botched. The Guardian believed it was a catastrophe. The fear ramped up to the point where being strict, regardless of outcome, was optimal. Anything else was seen as selfish, careless, and bordering on sociopathic. It turns out that the lockdown advocates were wrong to mock Sweden. Here are five reasons as to why:

1. Sweden's economy held up without lockdowns. There were those who thought that there was no tradeoff between lockdowns and the economy. Some prominent economists thought that we needed more aggressive lockdowns at the beginning because earlier control of the virus would have meant a smoother return to a pre-pandemic level of economic productivity. If short-term pain in the form of lockdowns were the solution, Sweden's economy should have performed terribly since they never had a lockdown. However, that was not the case. The Economist ranked 23 wealthy countries on their economic performance during the pandemic using multiple factors, including GDP, household per income, share prices, investment, and public debt to GDP. Sweden ended up ranking third on this list. Sweden's performance helped to disprove the hypothesis that the lockdowns were needed for longer-term economic performance. 

2. Number of total COVID deaths in Sweden have been way fewer than predicted. The Imperial College model, which was the model that scared the United Kingdom into locking down in 2020, predicted that in early 2020, as many as 40 million people would die if we did not take drastic measures (e.g., lockdowns). The Imperial College model inspired a similar study in Sweden (Gardner et al., 2020). This study's modeling predicted that without lockdowns, Sweden would have experienced a median 96,000 COVID deaths by the end of July 2020. That sounds scary, doesn't it? That would have been terrible for Sweden. Where did Sweden actually end up by the end of July 2020? According to the Swedish Health Minister's data from Folkhälsomyndigheten, at 5,723 deaths. The scary modeling exaggerated the threat by a factor of almost seventeen. This is May 2022. Where is Sweden at now? As of May 22, 2022, Sweden has had 18,941 COVID deaths, which is still about a fifth of the deaths that the scary modeling predicted. 

3. Sweden's COVID death rate in comparison to other countries is relatively low. Mortality data from Johns Hopkins University show Sweden has one of the lowest COVID death rates per 100,000 people in Europe. As of May 22, 2022, Sweden has 187.55 deaths per 100,000 people. Sweden has fared better than about 50 countries that had more heavy-handed COVID regulations, including Peru (646), the United States (304), Chile (302), Argentina (285), Greece (284), Belgium (276), Italy (274), the United Kingdom (273), France (228), and Spain (226).

4. Sweden's mortality rate did not spike due to COVID. If Sweden's policy were really that careless, we would have seen a huge surge of death in Sweden. However, the historical mortality rate data from the Swedish government's Statistiska Centralbyrån show that COVID did not cause major spikes in Sweden's death rate. The 2010-2019 average morality rate for Sweden was 9.27 deaths per 1,000. In 2020, that figure was 9.48 deaths, which was a 2.3 percent increase. In 2021, the mortality rate dropped to 8.83 deaths per 1,000, which is a 6.9 decrease from the previous year. When comparing Sweden to past years within its own history, its COVID response does not suggest a calamity befell Sweden. 

5. Sweden's excess death rate is one of the lowest among developed nations. A more superior metric is the excess death rate. As the Left-leaning Washington Monthly illustrates, excess mortality includes all deaths, whether from COVID, deaths caused by COVID policy (e.g., lockdowns, delayed non-COVID healthcare, mental health caused by social isolation), or another cause. It removes underlying differences between regions and countries. Another point I would like to make is that excess deaths are a better metric in the sense that you do not need to get into the debate of "death with COVID" (i.e., incidental death) versus "death because COVID" versus "COVID was not the primary cause, but was a contributing factor."

Using this metric of excess death rate, Sweden fared even better than it did on COVID-specific death rates. A Kaiser Family Foundation found that Sweden was the only wealthy country that did not have any excess mortality for those under 75 years old (Amin and Cox, 2021). Earlier this month, the World Health Organization released global data on excess death rates in 2020 and 2021. It turns out that in 2020 and 2021, Sweden had one of the lowest excess death rates in Europe (see below).  

This does not surprise me in the least. When I took the time in June 2021 to analyze the available literature on lockdowns, I came across a study from scholars at Rand Corporation and the University of South California (Agrawal et al., 2021). The study analyzed 43 countries and all 50 states in the United States, and found that lockdowns actually increased excess death rates. 

Side Note About Comparing Other Nordic Countries to Sweden

There are some that like to lambast Sweden because their death rates are higher than their Nordic counterparts of Denmark, Finland, and Norway. While the the WHO shows that was indeed the case, I have pointed out in response that for much of the pandemic, Oxford's COVID-19 Stringency Index showed that Sweden was more stringent than the other Nordic countries for much of the pandemic. There is also the "dry tinder" hypothesis, which states that Sweden had higher deaths in 2020 and 2021 because they had fewer flulike deaths in previous years (e.g., Klein et al, 2020). There was also the issue with the Swedish strategy shielding the elderly (Rizzi et al., 2022), a point I made in August 2020. The "dry tinder" likely exacerbated the nursing home policy in Sweden. Since this was likely the major driver in Sweden's COVID deaths, it still has no bearing on the discussion of whether lockdowns, mask mandates, or school closures were necessary. 

Conclusion

Pointing out the Swedish case study does not by itself refute the pro-mandate side. A single case study can be suggestive, but you need more evidence than a single case study to prove something true or false. Conversely, if keeping business shut down or having mask mandates were that vital to public health, Swedish health metrics should have been a disaster relative to countries. Yet that was far from being the case. The "Swedish experiment" adds to the evidence base that lockdowns are harmful, mask mandates are ineffective, and school closures were by and large unnecessary. I'm not here to say that Sweden got everything right. The main flaw is that at the beginning of the pandemic, Sweden did not handle its nursing home pandemic policy in a fashion that would have adequately protected its most vulnerable. Even so, as this report from a Swedish government commission concludes, Sweden's light-touch approach to the pandemic was "broadly correct."

The facts mentioned above help explain why the "better safe than sorry" crowd cannot stand the Swedish example. It means that argument of "If we didn't have lockdowns, it would have been much worse" does not withstand scrutiny. It means that the lockdowns were not needed to avoid disaster and mask mandates (or masks generally) were not statistically significant in helping quell COVID transmission. It means that the lockdowns did come with considerable costs. 

I do not think the doubling down of lockdown advocates is simply a matter of ego or an incapability of admitting one was wrong. If these advocates were to accept that Sweden was successful in its overall approach, it would mean that delaying children's education, denying people freedom, disrupting (or in so many cases, causing the loss of) employment of millions, or exacerbating physical and mental health issues were undergone for no reason whatsoever. It is difficult to be on the side that took a sledgehammer to multiple institutions and to our way of life. The takeaway from the Sweden example should not simply be that the overly and unnecessarily stringent approach was the improper approach. It should be that we learn from this painful lesson so that we do not make the same mistake of panicking and ignoring best practices when the next pandemic happens.