The Real Lesson of Sweden’s Laissez-Faire COVID-19 Response

Numerical analysis indicates the failure of a hands-off approach to the pandemic

4 min read
Swedish flag and COVID-19 symbols
Illustration: Peter Zelei/Getty Images

This is a guest post. The views expressed here are solely those of the author and do not represent positions of IEEE Spectrum or the IEEE.

The COVID-19 pandemic, now in its second year, has prompted a great deal of debate and reflection on the tension between personal civil liberties and the collective good. A surprising amount of this soul searching has offered up Sweden as either a shining example or a cautionary tale, depending on the viewpoint of the onlooker.

In Europe, America, and elsewhere, politicians ostensibly arguing for individual liberty and economic growth have weighed in against mandates on business restrictions and the wearing of masks. Some scientists have also joined the fray. For example, Scott Atlas (former advisor on the White House Coronavirus Task Force) and Sunetra Gupta (co-author of the Great Barrington Declaration) favor looser measures in order to preserve civil liberties and to attain herd immunity as a byproduct.

Sweden figures in all this because of its largely voluntary approach to quarantining and social distancing. Indeed, for much of 2020, Sweden's strategy was spearheaded not by politicians but by a health official, Anders Tegnell, the state epidemiologist at the Public Health Agency of Sweden. In advocating for a light-touch approach, Tegnell noted in September 2020 that controlled spread of the virus over the population should provide Sweden with greater protection in the second wave vis-à-vis its Nordic neighbors, who opted for conventional strategies. Thus, the cost of a high death rate in the first wave would be more than offset by the benefit of a low death rate in the second wave.

So, has this hypothesis been upheld? Were the voices championing individual liberties correct all along?

No. If they had been correct, then during the second half of 2020, excess mortality in Sweden—from all causes and not just COVID-19—should have ticked lower in comparison to that of the other Nordic countries. In fact, no such thing happened.

During weeks 46 to 52 of 2020, Sweden's standardized excess mortality rates were persistently above the “normal range" (Figure 1, above). By contrast, all of Sweden's Nordic neighbors combined had just three instances of excess mortality outside the “normal range" during weeks 36 to 52. In terms of actual COVID-19 deaths per million inhabitants, Sweden has done no better than the U.K. and the U.S. for much of the so-called second wave (Figure 2, below). Hence, the data for the final few months of 2020 contradict the individualists' case.

Daily COVID-19 Deaths per Million Inhabitants (Source: https://www.covid19insweden.com/deaths.html) Figure 2 – Daily COVID-19 deaths per million inhabitants Source: https://www.covid19insweden.com/deaths.html

Faced with such sobering statistics, champions of a hands-off approach should respond with humility. Yet, instead of adapting their hypothesis to fit the facts, they twist the numbers in order to suit their beliefs.

For example, Tegnell claimed in December 2020 that Sweden's immigrants have been “driving" its higher death rate. However, on a national TV appearance, Tegnell provided no evidence to back up this statement. Others, too, have misleadingly cited Sweden's relatively high percentage of foreign-born residents to make a case that Sweden did not fare too badly if you take into account the fact that the country has a higher proportion of more-vulnerable people than its immediate neighbors. In making this argument, though, some cited figures as high as 25 percent for Sweden's foreign-born population. But, this 25 percent estimate includes not only the foreign born but also people born in Sweden to two foreign-born parents. In fact, just 13.9 percent of the Swedish population is born outside the EU, EEA, and U.K., according to Eurostat. This is a critical distinction because only immigrants from low-and-medium-income countries tend to have the kinds of jobs and lifestyles that make them more vulnerable to infection.

Furthermore, consider the Norrland region in northern Sweden. Immigrants from outside the EU/EEA/U.K. constitute 8.2 percent of its population, not far off the 6.6 percent share seen in the neighboring Nordic countries. Yet as of 29 November, Norrland had a COVID-19 death rate that was 4.8 times higher than the average in those Nordic countries. During the so-called second wave (weeks 45 to 48), the discrepancy was starker still: Norrland's COVID-19 death rate then was over six times as high as the neighboring Nordic countries' average. All of which suggests that policy—not demographics—explains the outcome.

Some on the right have long trotted out Sweden as a job-killing, high-tax nanny state. Although there was scant empirical evidence for such a caricature, it conveniently suited a particular worldview. Now, during the COVID-19 pandemic, some civil libertarians and others have serendipitously found Sweden's laissez-faire public-health strategy amenable to their ideology and rushed to embrace it while again brushing aside other facts.

If these people insist on using Sweden as an exemplar when debating governance, then may I suggest that they take a look at the country's environmental policy? At €110 per metric ton of CO2 emitted, Sweden's carbon tax is the highest in the world. More important, there is empirical evidence that the carbon tax has, indeed, reduced CO2 emissions from transportation. In this domain, Swedish authorities have long acknowledged the obvious: that laws and regulations do affect human behavior. They further recognize that polite entreaties to firms and households to curb CO2 emissions would not work. The reason for this ineffectiveness is that the cost that an individual consumer incurs for using fossil fuel is lower than the cost that society bears.

If you want people to behave in a way that reflects the full cost of their actions to society, then you must change incentives. This is true whether you are dealing with environmental policy or with a public-health crisis. In a world where data are widely available, evidence-based best practices and not ideology should inform public policy. Framing the discourse in any other way is disingenuous at best and a willful obfuscation at worst.

This article was edited on 1 March, 2021, to more clearly describe Swedish immigration statistics and competing theories about their effect on COVID-19 infection rates.

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This CAD Program Can Design New Organisms

Genetic engineers have a powerful new tool to write and edit DNA code

11 min read
A photo showing machinery in a lab

Foundries such as the Edinburgh Genome Foundry assemble fragments of synthetic DNA and send them to labs for testing in cells.

Edinburgh Genome Foundry, University of Edinburgh

In the next decade, medical science may finally advance cures for some of the most complex diseases that plague humanity. Many diseases are caused by mutations in the human genome, which can either be inherited from our parents (such as in cystic fibrosis), or acquired during life, such as most types of cancer. For some of these conditions, medical researchers have identified the exact mutations that lead to disease; but in many more, they're still seeking answers. And without understanding the cause of a problem, it's pretty tough to find a cure.

We believe that a key enabling technology in this quest is a computer-aided design (CAD) program for genome editing, which our organization is launching this week at the Genome Project-write (GP-write) conference.

With this CAD program, medical researchers will be able to quickly design hundreds of different genomes with any combination of mutations and send the genetic code to a company that manufactures strings of DNA. Those fragments of synthesized DNA can then be sent to a foundry for assembly, and finally to a lab where the designed genomes can be tested in cells. Based on how the cells grow, researchers can use the CAD program to iterate with a new batch of redesigned genomes, sharing data for collaborative efforts. Enabling fast redesign of thousands of variants can only be achieved through automation; at that scale, researchers just might identify the combinations of mutations that are causing genetic diseases. This is the first critical R&D step toward finding cures.

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