Kevin Kavanagh, MD, reviews a book examining the results of Sweden's controversial decisions made during the early COVID-19 pandemic.
Currently, the United States’ rates of COVID-19 hospitalizations are increasing, and its response is muted, even paralyzed, with a lack of public consensus. Much of the public’s confusion can be traced back to Sweden’s “experience,” one which is shrouded in misinformation and the “massaging of data.”
The Swedish experience weighed heavily during the May 12, 2020, United States’ Senate Health Education, Labor, and Pensions (HELP) Committee, where Senator Paul Rand stated:
“But, basically, I do not think anybody is arguing that what happened in Sweden is an unacceptable result. I think people are intrigued by it, and we should be.”
Now with the soon-to-be-published book entitled Sweden’s Pandemic Experiment (edited by Sigurd Bergmann and Martin Lindstrom) one can no longer make this statement. Many in the scientific community are disturbed by the representations of the Sweden pandemic experience.
As pointed out in the prologue by Peter Baldwin, PhD, Sweden ignored asymptomatic spread, children as vectors, aerosolization of the virus, the efficacy of masks in mitigating community spread, and ignored the threat posed by children which allowed authorities to keep schools and daycare centers open.
Although “herd immunity” was never stated as an implicit goal, the measuring and reporting of antibody levels in the community, along with favorable statements about its obtainment implied that herd immunity was being sought.
It should be noted that in the United States some mandates were not well accepted, while in Sweden voluntary restrictions of movements and working from home were accepted in many parts of the country. Overall, the global view of the United States’ effective pandemic responses in the developed world is one of the lowest with only Japan, Germany, and Italy lower. The current pandemic results from Sweden are described as dismal, but it depends upon the country one compares the performance to. As stated by Senator Rand at the May 2020 U.S. Senate HELP committee:
“We need to observe with an open mind what went on in Sweden where the kids kept going to school. The mortality per capita in Sweden is actually less than France, less than Italy, less than Spain, less than Belgium, less than the Netherlands. About the same as Switzerland. “
However, Sweden is a very large country with a low-density population. The total population is just over 10 million. Better comparators are other Nordic Nations, and when this comparison is done, the Swedish experience is very poor. Excess deaths in 2020 to 2021 were twice that of Denmark and Finland. At the time of the book’s writing, Sweden has had greater COVID-19 mortality than Austria, Switzerland, Germany, and Netherlands, and far worse than its Nordic neighbors. It was estimated that 13,000 of the 18,000 Swedes who died would be alive “had the Norwegians run Sweden’s public health system.”
Many of the chapters in the book deal with data integrity, misinformation, herd immunity, comparisons to other nations, and political influences on the Swedish Public Health System. Of particular interest was the chapter dealing with “Children at the front line of the Covid-19 pandemic” by Johanna Hoog.
This chapter delved into the push to keep schools open. The policy appeared to be based upon a misinterpretation of a World Health Organization study where a lack of analysis (“not possible to determine”) was reported by the lay press as strong evidence that children do not spread disease. In addition, there was inadequate testing and reporting of cases which masked the outbreaks that did occur. And finally, questions arose regarding how data was presented, data which appeared to mitigate the impact of SARS-CoV-2 on children.
The authors do not solely argue to close schools but to also keep schools open by enacting mitigation strategies such as testing, masking, case tracking, and increasing room ventilation. Because the Public Health Agency of Sweden “denie(d) asymptomatic and airborne spread” as major modes of transmission, adoption of mitigation strategies in schools were severely hampered. Thus, almost all children were required to go to school, even if there was a high-risk family member or a family member sick with COVID-19, and in parts of Sweden, families were NOT notified of outbreaks in schools because of municipality rules. The guidance was that “Children very rarely get seriously ill, and they do not spread the disease.”
There was also what appeared to be conflicting messaging by, until 2022, the Swedish state epidemiologist Anders Tegnell, MD, who is reported to have stated that “The risk of transmission in school is extremely small; that is not where the virus is.” Then later wrote in an email (March 14, 2020) where he suggests: “One point would be to keep the schools open to reach herd immunity faster.”
Because of “almost non-existent testing during the first wave,” outbreaks in schools were presumably not detected by officials, but a voluntary organization documented 30 school outbreaks in March and April 2020. After the first wave, testing improved but children continued to have difficulties with access.
The risks to children also appeared to be mitigated with not adequately taking into consideration long COVID-19 and hyperinflammation syndromes (multisystem inflammatory syndrome in children).
There was also concern that Sweden’s excess mortality data in children, as reported in the New England Journal of Medicine (NEJM), was biased. Data reported in the main article indicated that during a 4-month pre-pandemic window, the number of deaths in children was 65 and during the pandemic was 69. The data did not compare the same months and did not control for being present in school. An email sent by the NEJM author to Tegnell indicated that when the months of comparison were kept constant there was an observed 68% increase in excess mortality in children during the pandemic. The NEJM article’s appendix data were updated and currently show an increase in childhood mortality during the pandemic.
The Sweden’s Pandemic Experiment authors also asserted that pregnant women were not at higher risk for COVID-19, but this was comparing outcomes to the general population, not younger age-matched controls.
The above are only a small fraction of the book’s valuable contents. It is a must-read. It contains highly referenced and detailed descriptions of public health strategies and misrepresentations in Sweden. A very different narrative is told than the one which is being used to shape much of our pandemic policy.
The book Sweden’s Pandemic Experiment will be available in paperback in mid-December and for download on Kindle, on January 9, 2023. Free open access is currently available through Routledge/Taylor & Francis’ open access section.