Sweden Stayed Open. A Deadly Month Shows the Risks. - The New York Times

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Where deaths increased

There has been no clear

sign of increased mortality

in Norway this year.

Sweden has seen 27% more deaths than normal during the outbreak.

United

Kingdom

Netherlands

Deaths in Britain are 67%

higher than normal, the largest

increase in Western Europe.

Switzerland

Where deaths increased

There has been no clear

sign of increased mortality

in Norway this year.

Sweden has seen 27% more

deaths than normal during the

outbreak.

Deaths in Britain are 67%

higher than normal, the largest

increase in Western Europe.

United

Kingdom

Netherlands

Switzerland

Where deaths increased

Sweden has seen

27% more deaths

than normal during

the outbreak.

United

Kingdom

Deaths in

Britain are

67% higher

than normal.

Source: New York Times analysis of mortality data in March and April.

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 American 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,” Senator Rand Paul of Kentucky, a Republican, said at a hearing on Tuesday.

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

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 American cities like Boston and Chicago, and approaches the increase seen in Paris.

Across Sweden, almost 30 percent 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. While 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 the University of California at Irvine. “There’s no reason Sweden should be doing worse than Norway, Denmark and Finland.”

How Sweden compares to Europe

More than Sweden

Less than Sweden

COUNTRY	PCT ABOVENORMAL	EXCESSDEATHS	TIME PERIOD
United Kingdom	+67%	53,300	Mar. 14 - May 1
	+60%	31,500	Mar. 16 - May 3
	+50%	5,300	Mar. 16 - Apr. 19
Netherlands	+50%	8,700	Mar. 16 - Apr. 26
	+49%	24,600	March
	+44%	28,500	Mar. 16 - Apr. 26
	+27%	3,300	Mar. 16 - May 3
Switzerland	+24%	2,000	Mar. 16 - May 3
	+15%	1,300	Mar. 16 - Apr. 12
	+11%	1,000	Mar. 16 - Apr. 26
	+6%	4,100	Mar. 16 - Apr. 12
	+5%	300	Mar. 16 - May 3
	+0%	100	Mar. 16 - Apr. 26
	+0%	100	Mar. 16 - Apr. 26

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 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.

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

Swedish public health officials have defended their strategy, while acknowledging that the country has failed to protect the elderly. The goal is to limit the spread of the infection without having to lock everything down, they said.

“Once you get into a lockdown, it’s difficult to get out of it,” Sweden’s state epidemiologist, Anders Tegnell, said. “How do you reopen? When?”

Instead of imposing strict lockdowns, public health officials said that Swedes could be relied on to go out less and follow sanitation guidelines. That proved to be true: As a whole, Swedes visited restaurants, retail shops and other recreation spots almost as little as residents of neighboring countries, according to Google mobility figures.

Mobility trends for retail and recreation

But there is reason to believe that Sweden’s approach may not work as well elsewhere.

Sweden’s low density overall and high share of single-person households — factors it shares with its Scandinavian neighbors — set it apart from other Western European countries. In Italy, the virus tore through multigenerational households, where it easily spread from young people to their older relatives.

And although Sweden is not a particularly young country in comparison with its Western European peers, it has a high life expectancy and low levels of chronic diseases, like diabetes and obesity, that make the virus more lethal.

Source: OECD (age and obesity), Eurostat (density and household size), World Health Organization (diabetes), U.S. Census Bureau

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 G.D.P. will contract by 7 to 10 percent this year, an estimate on par with the rest of Europe. (The European Commission projects the E.U. economy will contract by 7.5 percent.)

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

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

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