Sweden stayed open; A deadly month shows the risks

By late March, nearly every country in Europe had closed schools and businesses, restricted travel and ordered citizens to stay home.

But one country stood out for its decision to stay open: Sweden.

The country’s moderated response to the coronavirus outbreak has drawn praise from some U.S. politicians, who see Sweden as a possible model for the United States as it begins to reopen.

“We need to observe with an open mind what went on in Sweden, where the kids kept going to school,” Sen. Rand Paul of Kentucky, a Republican, said at a hearing Tuesday.

But though Sweden has avoided the devastating tolls of outbreaks in Italy, Spain and Britain, it also has seen an extraordinary increase in deaths, mortality data shows.

In Stockholm, where the virus spread through migrant communities, more than twice the usual number of people died last month. That increase far surpasses the rise in deaths in U.S. cities like Boston and Chicago and approaches the increase seen in Paris.

Across Sweden, almost 30% more people died during the epidemic than is normal during this time of year, an increase similar to that of the United States and far higher than the small increases seen in its neighboring countries. Though Sweden is the largest country in Scandinavia, all have strong public health care systems and low health inequality across the population.

“It’s not a very flattering comparison for Sweden, which has such a great public health system,” said Andrew Noymer, a demographer at UC Irvine. “There’s no reason Sweden should be doing worse than Norway, Denmark and Finland.”

No two countries are exactly alike, making comparisons inexact. Luck, travel patterns and personal actions play a role, not just government policy.

Swedish officials chose not to implement a nationwide lockdown, trusting that people would do their part to stay safe. Schools, restaurants, gyms and bars remained open, with social distancing rules enforced, while gatherings were restricted to 50 people.

Two months later, it has not been the worst-case scenario that many envisioned. COVID-19 deaths have disproportionately hit the elderly and those in nursing homes, as is the case in most countries, but hospitals have not been overwhelmed.

As with the rest of the world, it will be months, or even years, before the full picture of mortality emerges.

“It is clear that mortality in Stockholm has been a lot higher than you would expect from a normal year,” said Martin Kolk, a demographer at Stockholm University. “But we will have to wait and see what happens. It’s a very big difference if we continue to see excess mortality for six more months, or if it will be back to normal levels in a few weeks.”

The New York Times measured the impact of the pandemic in Sweden by comparing the total number of people who have died in recent months against the average over the past several years. The totals include deaths from COVID-19, as well as those from other causes, including people who could not be treated or decided not to seek treatment.

Though no measure is perfect, the increase in deaths offers the most complete picture of the pandemic’s toll, demographers say.

Even without a full lockdown, Sweden’s economy has not been unscathed. Preliminary evidence shows Sweden has suffered similar economic effects as its neighbors: The Swedish Central Bank projects the country’s GDP will contract by 7 to 10% this year, an estimate on par with the rest of Europe. (The European Commission projects the EU economy will contract by 7.5%.)

That could change. But the country’s high death toll offers a warning, demographers say.

“Sweden will be judged at the finish line,” Noymer said. “But it’s a very highstakes risk, and the consequences are people’s lives.”

“Sweden will be judged at the finish line. But it’s a very highstakes risk, and the consequences are people’s lives.” — Andrew Neymar, demographer at UC Irvine