Aletho News

Update on the Swedish covid response

By Sebastian Rushworth M.D. | December 19, 2020

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.

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

– Analyses of the benefits and risks of all common supplements and medications
– The keys to a longer, healthier life (possibly quite different from what you may have heard)
– A long-term follow-up of the health consequences of the covid pandemic and global lockdown.

December 19, 2020 Posted by aletho | Science and Pseudo-Science | Covid-19, Sweden | Leave a comment

Why did Sweden have more covid deaths than its neighbors?

By Sebastian Rushworth, M.D. | December 6, 2020

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.

December 6, 2020 Posted by aletho | Science and Pseudo-Science | Covid-19, Sweden | 2 Comments

How deadly is covid-19?

By Sebastian Rushworth | October 24, 2020

September 2020 was the least deadly month in Swedish history, in terms of number of deaths per 100,000 population. Ever. And I don’t mean the least deadly September, I mean the least deadly month. Ever. To me, this is pretty clear evidence of two things. First, that covid is not a very deadly disease. And second, that Sweden has herd immunity.

When I posted this information on my twitter feed, the response from proponents of further lockdown was that the reason September was such an un-deadly month, was because everyone has already died earlier in the pandemic. To me, that seems like a pretty self-defeating argument. Why?

Because 6,000 people have died of covid in Sweden, a country with a population of 10,000,000 people. 6,000 people is 0,06% of the population. If it is enough for that tiny a fraction of a population to die of a pandemic for the pandemic to peter out so completely that a country can have its least deadly month ever, then the pandemic was never that deadly to begin with.

In August, I wrote an article where I proposed that the mortality for covid is only 0,12%, roughly the same as influenza. That number was based on a back-of-the-envelope calculation. I figured that, since the death rate had dropped continuously for months and was at very low levels, Sweden must have reached a point where it had herd immunity. And I figured that at least 50% of the population must have been infected for herd immunity to have been reached. 50% of Sweden’s population is five million people. 6,000 / 5,000,000 = 0,12%

At the beginning of October, one of the World Health Organisation’s executive directors, Mike Ryan, said that the WHO estimated that 750 million people had so far been infected with covid. At that point, one million people had died of the disease. That gives a death rate for covid of 0,13% . So the WHO said that the death rate is 0,13% . Not too far off my earlier back-of-envelope estimation. This of course begs the question why there are continued lockdowns for a disease that is no worse than the flu.

A short while later, the WHO released an analysis by professor John Ioannidis, with his estimate of the covid death rate. This analysis was based on seroprevalance data, i.e. data on how many people were shown to have antibodies to covid in their bloodstream at different times in different countries, which was correlated with the number of deaths in those countries. Through this analysis, professor Ioannidis reached the conclusion that covid has an overall mortality rate of around 0,23% (in other words, one in 434 infected people die of the disease). For people under the age of seventy, the mortality rate was estimated at 0,05% (in other words, one in 2,000 infected people under the age of 70 die of the disease).

As I’ve discussed before, I don’t think antibody data gives a very complete picture, since there are studies showing that a lot of people don’t produce measurable antibodies in their bloodstreams, but still have immunity, either thanks to a T-cell response, or thanks to local antibody production in the respiratory tract. So I think that the fatality rate is significantly lower than what the analysis by professor Ioannidis found, and more in line with what the WHO stated earlier in October.

But even if the antibody based number is the correct number, then covid still is not a very deadly disease. For comparison, the 1918 flu pandemic is thought to have had an infection fatality rate of 2,5%, i.e. one in forty infected people died. So the 1918 flu was 11 times more deadly than covid if you go by professor Ioannidis’ antibody based numbers, and 19 times more deadly than covid if you go by the fatality rate provided 12 days earlier by the WHO’s Mike Ryan.

And this is missing one big point about covid. The average person who dies from covid is over 80 years old and has multiple underlying health conditions. In other words, their life expectancy is very short. The average person who died in the 1918 pandemic was in their late 20’s. So each death in the 1918 pandemic actually meant around 50 years more of life lost per person than each death in the covid pandemic. Multiply that by the fact that it had a 19 times higher death rate, and the 1918 flu was in fact 950 times more deadly than covid, in terms its capacity to shorten people’s lives.

OK, I’ve discussed the fatality rate of the 1918 flu pandemic, and compared that to covid. But what about the fatality rate of the common cold viruses that are constantly circulating in society? How does covid compare to them?

Many people think that the common cold viruses are harmless. But in fact, among elderly people with underlying health conditions, they are frequently deadly. A study carried out in 2017 found that, among frail elderly people, rhinovirus is actually more deadly than regular influenza. In that study, the 30 day mortality for frail elderly people admitted to hospital due to a rhinovirus infection was 10%. For frail elderly people admitted to hospital due to influenza, 30 day mortality was 7% .

What is my point? If you are old and frail, and have underlying health conditions, then even that most harmless of all infections, the so called “common cold,” can be deadly. In fact, it often is. Covid-19 is not a unique disease, and does not appear to have a noticeably higher mortality rate than the so called “common cold.”

There is one final aspect to all this that needs to be discussed. And that is the effect of covid on overall mortality. If it turns out that covid has no effect on overall mortality, then that really brings in to question why we are locking down, since we’re not actually preventing any deaths. So, what is the effect of covid on overall mortality?

Let’s look at Sweden, since that is perhaps the country that has taken the most relaxed approach of any to preventing spread, and which should therefore also be reasonably be expected to have had the highest impact on its overall death rate. From January to September 2020, Sweden experienced 675 deaths per 100,000 population. That is less than both 2017 and 2018. In fact, 2020 is so far the third least deadly year in Swedish history.

What does this mean? It means that covid, a supposedly deadly viral pandemic, has not killed enough Swedes to have any noticeable impact on overall mortality.

How can this be explained, when we know that 6,000 Swedes have died of covid?

As I see it, there are two possible explanations. The first is that most people who died “of” covid actually died with covid. In other words, they had a positive covid test and were therefore characterized as covid deaths, when the actual cause of death was something else. The second is that most people who died of covid were so old, and so frail, and had so many underlying health conditions, that even without covid, they would have died by now. There are no other reasonable explanations.

I am not saying that covid is nothing, or that it doesn’t exist. I am saying that it is a virus with a marginal effect on longevity. And yet, public policy in most countries has been driven by doomsday scenarios based on completely unrealistic numbers. To put it simply, we’ve acted like we’re dealing with a global ebola outbreak, when covid is much more like the common cold.

You might also enjoy reading my article about why I think Sweden has herd immunity, or enjoy watching my conversation with Ivor Cummins of Fat Emperor about covid-19.

October 24, 2020 Posted by aletho | Science and Pseudo-Science | Covid-19, Sweden | 1 Comment