Lessons We Can Learn About Covid
Dec. 12, 2020
Sweden is in trouble with Covid-19 again. After a successful summer and early fall, they are having another bad round of infections. They made another mistake.
Their success from early July to mid-October led them to complacency, to think they had overcome the pandemic. They relaxed too much. As colder weather came they returned to an almost completely normal way of life — restaurants and bars were packed, gyms and other sports and health venues returned to full operation, and they opened their numerous ski resorts, where people congregated in lines, on ski lifts, and especially at after-ski events.
Now they are paying the price. The number of cases is up significantly and an increased death rate will follow. As winter settles in they clearly need to take several actions, such as reinstating physical distancing and perhaps closing some bars, restaurants, gyms, ski resorts, and other non-essential businesses that bring people into very close contact.
Since the Swedes have not asked for my advice, however, I bring this up only to discover what we in the United States might learn. Just as my earlier posts have said we can learn from Swedish successes, we can also learn from their mistakes. But there is only one primary, on-going lesson: balance.
It is easy to develop policy if one limits thinking to one main goal, such as: 1) prevent immediate deaths in my region; or 2) keep the national economy functioning; or 3) save jobs; or 4) prevent deaths over the longer term caused by the breakdown of societal systems; or 5) prevent massive deaths in poor areas and countries; or 6) prevent the disruption of peoples’ lives as much as possible; or 7) prevent the loneliness, anxiety, and depression caused by lockdowns and other restrictive measures; or 8) maintain the freedom of individuals to live their own lives as they choose — and so on.
Finding a course of action that balances all these desired ends while taking into account human nature — the tendency of people over time to rebel against strict rules and find ways around severe restrictions — is a herculean task. But it is the only way to a wise and healthy outcome to many problems, and certainly to this pandemic.
In trying to envision the best responses we in the U.S. might make, I have often used Sweden as an example because they seemed to be searching for balance. They made two big mistakes early on: in the first months of the pandemic they did not focus on preventing the spread of Covid-19 in their numerous nursing homes, and in the first months they also failed to roll out a major testing program. But they corrected those mistakes and then had several months of very low infection numbers and a very low death rate. And they did this while choosing to live much more normal lives than most of the rest of the world.
Now, however, they have made a third mistake. Because things were going so well, they lowered their guard, relaxing their voluntary physical distancing measures and other safety precautions. It was too much, too fast. The lesson, however, is not an all-or-nothing one — this is the mistake much of the world has made. The lesson is to constantly seek the right balance, constantly try to speak to all of the above goals, not just one or two at a time.
Is there a perfect path? No.
What is the right mix of rules and restrictions? That is the dilemma each and every government in the world has been facing since February. Sweden, since they have done things differently from most other countries, is helpful in understanding both what works and what doesn’t. We can learn much from them, both good and bad. Those who vilify them would do better if they included some perspective in their reporting. Sweden is not some outlier in the harm suffered by Covid-19. They have ended up with about average results, compared with most western countries, while maintaining their economy and their way of life better than most.
Let’s look at the actual numbers: As of Dec. 15, 2020, here are some rankings of total cases since the pandemic began, per 100,000 people: (All data from the New York Times coverage of the pandemic)
Cases per 100,000 people
Here are the numbers from some U.S. states:
Cases per 100,000 people
New York 4,110
As you can see, Sweden has done better than many European countries that have had far more restrictions, and much better than many U.S. states — even those like Connecticut that have had severe restrictions for months. Of course, the number of cases is significantly affected by how many tests have been given, so another important number is how many deaths have been attributed to Covid-19 in each place. Here are the latest numbers:
Deaths from Covid per 100,000 people
Numbers from some U.S. states.
Deaths from Covid per 100,000 people
New York 182
Once again, you can see Sweden has done much better than some countries, and worse than some. It has done better than most U.S. states.
However, another factor must be considered: In some countries death is more likely to be attributed to Covid than in others. Further, there have been many deaths in some countries that have been caused by the measures taken to prevent Covid, whereas in others there have been few. This means that another number, that of “excess deaths,” is an important indicator for deciding which countries provide the best model for action.
In looking at this number, in the United States this year there have been about 350,000 excess deaths; that is, about 350,000 more people have died so far than would have been expected by the average of the last 5 years. (If 2020 had been a normal year we could have expected about 2,860,000 deaths, so by the end of this year we will instead have about 3,240,000.) About 2/3 of those excess deaths have been attributed to Covid infection. The rest are either unrecognized Covid deaths or deaths caused by our response to Covid. In Europe, there have been about the same number of excess deaths, around 350,000.
Now, let’s look at the countries in Europe with the most excess deaths:
Those with very high excess deaths:
Italy, Austria, Switzerland
Next, with high excess deaths:
Belgium and Greece
Those with moderate excess deaths have been:
Spain, Portugal, France, England
Those with some excess deaths, but not very many:
Netherlands. Hesse state in Germany
And here are the countries with little or no excess death:
Sweden, Denmark, Norway, Germany (except for the state of Hesse)
And here are the percentages of excess deaths in some U.S. states and New York City:
New York City 72%
(Source: https://www.nytimes.com/interactive/2020/us/covid-death-toll-us.html )
Compare those numbers to the fact that, as of the end of November, Sweden, Denmark, Norway, and Germany had a percentage of about zero excess deaths. (In the broadest picture, taking all these numbers in account, Germany has had the best response of all large western countries.)
Unlike the other countries above with no excess deaths, however, Sweden had a significant number deaths in the spring. How, then, can they have no excess deaths now? Because their excess deaths since June have fallen below the average. This is either because many of those who died in the spring were close to death already, and would have died this year in any case, or because Sweden has reduced, much more than many other countries, the number of deaths caused by measures taken to limit the pandemic.
One of the lesson we can learn from Sweden, then, is that we must not rush to return to “normal life” as the pandemic subsides. Much of the world has several long, painful, dark winter months ahead. We must each do our part in trying to encourage and support each other as best we can during this time, try to protect others, share what we are learning, and together find the best path forward through this ordeal. And we must not let our guard down too soon.
We will come out on the other side of this trial. As I suggested in my last email, by July of 2020 a combination of the immunity that as many as 150 million will have from having been infected, plus the immunity many more millions will have from the vaccines, will break the back of this pandemic in the U.S. Life will emerge into the post-pandemic world.
What will that world look like? It will be different from before. Let’s work together to make it a better place. Here are some ways to think about that possibility:
May you have a peaceful and joyous holiday season,