Shutdown or no shutdown: Which country addressed Covid-19 the best?

Did Sweden take the better approach? The worse approach?

In the United States the Coronavirus pandemic has of course been politicized like everything else. Each political tribe knee-jerks into proclaiming its ideology as the one true ideology to dictate approaching the Coronavirus. The deregulate-it-all far-right advocates doing virtually nothing because doing anything would make us all literal slaves, and the virus is a made-up conspiracy by Democrats just to hurt Trump’s re-election prospects anyway. What is their evidence doing nothing works? Well look at Sweden, they didn’t shutdown or wear masks en masse and they are doing fantastic! Or so the Right says while insisting that such an approach is appropriate for virtually every country.

The far-left, as I am told by those on the Right, says Sweden is the worst ever and that people are dying left and right. So, who is right? Is Sweden the one country that got it right and everyone should emulate it, or did they get it terribly wrong, with dire consequences?

Well as far as its case-fatality rate (CFR) from Covid-19, it didn’t fare better. It has the highest rate of the Nordic countries: 7.06% (RCP Coronavirus Tracker, 2020). Its neighbors Norway, Finland, and Denmark had rates of 2.73%, 4.41%, and 4.34% respectively. Iceland is at .52%, but that is less comparable since it is an island and has much lower population density. Sweden has had about 5,700 deaths, while Norway has had 265. Of course, Sweden has a population about twice Norway, so you’d expect at least twice the deaths from Covid-19. What we see is far more than twice the deaths.

Probably the single most important statistic with which to evaluate how hard a country has been hit by Covid-19, and by proxy how well it has preformed in addressing it, is total cumulative Covid-19 deaths as a proportion of the country’s total population. This is an indication of a country’s status throughout the pandemic since it has begun. In this metric Sweden has done better than countries like Belgium and the UK. It is slightly better than Spain, almost identical to Italy, and worse than the US, France, Mexico, Canada, Switzerland, Russia, Germany, Austria, Finland, Australia, South Korea, China, and quite a few other countries whose greyed-out lines I didn’t single-out to highlight in the picture.

Sweden didn’t shutdown relative to its neighbors, and few people wore masks. Though, few people in any Nordic countries wore face masks (Farr, 2020; Klein, 2020). Sweden, however, did more than nothing. They prohibited gatherings larger than 50 people, and high schools and colleges were closed. It did keep its borders open in addition to its preschools, grade schools, bars, restaurants, shops, and such. Norway, conversely, shut down virtually the whole country, including kindergartens, child care facilities, schools, universities, professional and amateur, hairdressers, massage clinics, gyms, tattoo parlors, etc. It also restricted travel into the country.

One of the best metrics to know how a country has been getting along during the pandemic recently is new confirmed Covid-19 deaths per million (or any other fixed ratio of the population, as opposed to raw numbers which don’t account for population differences). Sweden is currently doing better than the US and Mexico, but worse than the European average, and much worse than countries like Switzerland, Norway, South Korea, and China. In Sweden, the US, Mexico, and countries doing similarly, the pandemic is far from over.

Focusing on deaths is a good approach because many Covid-19 cases may go unrecorded due to lack of testing and the fact only about 60% of cases are particularly symptomatic. Deaths, however, are much more likely to be recorded and much more likely to be correct. Moreover, deaths are truly what matters the most. If a lot of people got infected but virtually nobody died then it wouldn’t be considered as bad by most people’s standards.

In most ways, Sweden had and has an exceedingly laissez-faire approach to Covid-19, even compared to its Nordic neighbors which in general have similarly—if not more laissez-faire—approaches to life and economics in general. Indeed, the Fraser Institute (2017), a close affiliate of fellow libertarian think-tank Cato Institute, ranks Sweden’s economic freedom 35th, with Norway at 32nd, Finland at 21st, and Denmark at 13th. For further reference, New Zealand, the US, Switzerland, Australia, Canada, and Germany were ranked 3rd, 5th, 4th, 9th, 8th, and 20th respectively. In general prosperity, Denmark, Norway, Sweden, and Finland all populate the upper ranks of the Legatum Prosperity Index at rank 1, 2, 4, and 5 respectively (Legatum Institute, 2019). Suffice it to say, given their similarity, it is fair to compare Sweden to its Nordic comrades, particularly Norway and Finland.

Did Sweden’s economics fare better as a result of its Covid-19 approach?

Sweden didn’t buy a better economy than its neighbors with its lukewarm Covid-19 approach. Sweden’s economy is still expected by them to contract by 4.5% this year (Goodman, 2020). Norway estimates its economy will contract by only 3.9% this year. In Q2 its GDP shrunk slightly less than the US and Germany, but significantly more than China or South Korea. So, Sweden didn’t seem to earn much benefit from those extra deaths.

Deaths and economics in other countries

It is hard to compare countries because there are so many variables. But some information can be gleaned.

China, an extremely population-dense country, and where the first outbreak occurred, had an extremely aggressive (though belated) lock-down, and more than 95% of the people there report wearing masks in public. Their CFR is now around 5.48%, they have had about 4,700 deaths total (RCP Coronavirus Tracker, 2020). In other words, a country of about 1.4 billion people has fewer deaths than Sweden, a country of around 10 million. Even if you assume China is under-reporting their numbers by multiples of two or three, that still looks very bad for Sweden as a proportion of population.

As of June, China’s economy is predicted to grow by 1% by the end of the year, versus Sweden’s 4.5% shrink (International Monetary Fund, 2020). The US is expected to shrink by 6% overall by the end of the year.

Of course, a China-level lock-down is not necessary for most countries, especially if they act early. China notably tried to cover it up and ignore it at first rather than address it. Germany, on the other hand, handled things differently. Other than Russia, Germany is Europe’s most populous country. Around 95% of its people wear face-masks there, they had a shutdown (though less draconian than China), they banned large events, they vigorously contact traced, and they acted very early. Also contrary to the US, Germany has universal healthcare, one of the world’s best systems. Germany has a CFR of 4.33%, and despite having around 8 times the population of Sweden, it has only about 2 times the deaths.

It’s economy, as of July 31st, had contracted about (non-annualized) 10% compared to Sweden’s 8% (BBC News, 2020b, 2020a). It seems that the 2% more of a contraction was drastically more than offset by the lives saved. The US, of course, acted late, haphazardly, and is still floundering. It has a decent CFR of 3.26% (likely aided by lower population density and thus slower spread and fewer overwhelmed hospitals), and an economy that shrank 9.5% in Q2. Abysmally, the US has over 162,000 deaths (as of Aug. 6th), meaning the virus has infected a much larger portion of its population than China despite having a lower CFR.

Importance of population density

Despite Sweden having worse numbers than its neighbors, none of the Nordic countries were particularly swamped by Covide-19. One may ask why? Well, it is likely extremely related to their population density. Sweden has a population density of about 35 people per square kilometer (The World Bank, 2020). Finland, Norway, and Denmark are 18, 15, and 138 persons per square kilometer respectively. Denmark is a bit of an outlier on population density, but its vigorous shutdown likely is what prevented its numbers from exploding.

Germany, despite having a much more densely populated country than any of the Nordic countries, has managed to keep its total deaths as a proportion of its populations comparable to its sparsely populated friends across it Baltic.

It is no accident the places within the US hit most hard and earliest were also the most populous areas. In densely packed areas of people disease spreads much more quickly and stands a much better chance of acutely overwhelming local resources. New York City, LA, Houston, Miami, and other large cities—whether in Democrat or Republican states—have been the most ravaged (Muro et al., 2020).

Conclusions

The reasonable conclusion to all of this information is that whether or not Sweden’s approach is appropriate depends on your situation and the background factors at play. One of the most important factors is population density. In America’s more dense cities a serious shutdown (like New York saw early on) is almost certainly a requisite to avoid disaster. The sooner you act, the less severe the shutdown and other mitigating responses will need to be. In rural areas where your next-door neighbor is a half mile away you essentially already live life as permanently social distanced, so you would likely never need a shutdown. Consider New York City and rural country-dwellers as to ends of the spectrum, with pandemic mitigating responses needing to be more intense the closer you get to NYC.

Tourism is likely another important factor. France and Spain are the world’s 1st and 2nd most traveled-to countries by tourists (Wright, 2020). Italy is the 5th. Those countries are extremely densely populated, and thus it should be no surprise those were the first major region outside of East Asia that got hit, and among the ones that got hit the hardest.

Think of it like a wildfire. If an arsonist starts only one fire at the side of the road the fire will take longer to become a disaster, but will in fact become a disaster if ignored. A single fire gives the local fire department a chance to catch it while smaller and stomp it out before necessitating more resources and allowing more overall destruction. However, if the arsonist started several small fires at multiple points along the road the fire will grow much faster into a disaster before authorities even know what hit them, necessitating more resources, like it or not, and only so much destruction will be able to be prevented even with those resources.

Another point to make, all countries have different levels of strength in their healthcare infrastructure. If your country has fewer hospitals and fewer hospital beds, you may want to consider being more rigorous when it comes to shutting down or wearing face-masks. Lack of access to healthcare likely feeds the disproportionate number of African Americans dying from Covid-19. A country’s CFR is probably the best indicator of how well its healthcare infrastructure is handling the pandemic within its borders. In best conditions Covid-19 may kill only .6% of those infected, but due to high infection rates and lack of population immunity, the best conditions almost never seem to be met by most countries currently.

Sweden has shown us that not shutting down won’t have apocalyptic consequences if you have low population density and lower tourism, while its neighbors show that if you have those advantages and you still do shutdown you will have better consequences. France, Spain, Italy, and the UK have shown us that places with high population densities are extremely susceptible to being caught off guard and not acting until it’s too late, leading to serious shutdowns being unavoidable if you want to save lives. Germany has shown us that an organized, consistent, and early effort in a densely populated country will still require a shutdown, but that shutdown will not have to be as draconian or as economically crippling.

To sum things up, if you are densely populated and had a large amount of tourism and international travel, you should absolutely have to (or should have) shutdown. Not doing so would have been abysmally irresponsible, cost lives, and negatively impacted the economy. How early you acted, how organized, and how completely the population complies with the shutdown will determine how severe and complete the shutdown needs to be, and how long it will need to last.

Lastly, of course no methodologies are perfect, and stats may be over or underestimated. However, at this point we have a pretty good idea of what happened and what is continuing to happen. So to dismiss all of the data mentioned here because it may fall short of perfection would be asinine. Doing such a thing would be more likely motivated by confirmation bias and motivated reasoning rather then genuine good-faith issues with the data.

References

Categories Covid-19

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