Sweden or the world: which was a cautionary tale?

In the spring of 2020 the world was shaken by a new impending threat, or so we were informed. We were told that a new virus is about to cause 100% excess mortality within a few months — unless we obey new social rules: lock-down, mask-up, and keep distance from each other.

The domino effect and herd mentality played their well-known roles in history. One country after another followed unprecedented counter-pandemic measures for which there was no scientific basis. The wise leaders of the tribes belittled their few opponents and aggressively silenced dissenting voices.

And most of us trusted them.

We “sheltered in place”, shut down businesses and schools, lost jobs, avoided emergency rooms, and missed medical appointments — to name some of the immediate effects. In the following months countless people slid into poverty all over the world. Hunger rose in Africa due to disrupted chains of food supply. Panic-related deaths have accumulated, adding excess mortality in the US and elsewhere.

There was one notable early exception among Western countries: Sweden. Public health authorities in Sweden did not shut down the country, kept most of the schools open, did not mandate masks, and refrained from fearmongering. They said they were following pre-pandemic plans and years of research on viral transmission and epidemics.

Which was true.

The headlines called Sweden a cautionary tale and journalists told their readership that Sweden was performing a deadly experiment on its population. Famous (or infamous) modelers predicted doubling of the annual mortality in Sweden within a few months — 100% excess mortality.

And they were wrong.

The pandemic ended about two years later, and it is time for the final account. It is time to decide who was performing population-wide experiments: Sweden or much of the world? Which was a cautionary tale: Sweden or panic-stricken countries?

Sweden mortality statistics delivered the verdict. Here it is — in numbers — thoroughly explained.

TLDR.

Nowhere below will you find 100% excess annual mortality. Not even 10. Not even 5.

Keep reading, or skip to the last section.

All-cause mortality trends are usually computed according to the Gregorian calendar. That’s a matter of convenience, not a rationalized choice. Scientific reasoning tells us that the unit of observation should not combine a late part of one winter with an early part of another winter because not all winters are alike; some are associates with higher mortality than others. Furthermore, the winter mortality waves do not form the same distribution on the calendar every year.

From the perspective of science, a Gregorian year is an arbitrary slice of time.

A logical time unit should include a full winter and a full summer (there are heat-related mortality waves). In the northern hemisphere, a “flu year” meets this requirement (beginning on week 40 of the Gregorian calendar), roughly October through September.

There are numerous ways to compute the expected (“normal”) mortality, from which we estimate excess mortality or “mortality deficit”. One size does not fit all. In particular, we should take into account mortality trends, if observed.

This was the case in Sweden. There was a long-term trend.

Source: SCB.SE, accessed November 10, 2022

The graph shows the annual mortality in Sweden per million people in the past 24 flu years, where each flu year is labeled according to the calendar year in which it ends. For example, the first data point (1999) is mortality between October 1998 and September 1999. The last data point (2022) denotes October 2021 through September 2022. The scale is magnified.

A downward trend is visible through flu year 2018–19. Almost all of the observations deviate from the downgoing line by no more than 1.5% until 2017–2018. That’s an excellent fit of a line to the data (explained variation: 0.96).

No one knows if that trend would have continued “normally” — trends might change — but a continued decline along the same line is a logical prediction. It is difficult to justify any other trajectory.

The line was fit by a statistical method called linear regression, using the observations until 2017–18. If we continue this line, we see that the pre-pandemic flu year in Sweden (2018–19) was exceptional, showing significant “mortality deficit” (-3.5%). Such a “deficit” typically implies temporary survival gain of frail elderly, which necessarily would be added to future mortality, mostly in the following year.

Source: SCB.SE, accessed November 10, 2022

The first pandemic flu year (2019–2020) was also exceptional — 4.0% excess mortality — but at least part of the excess was due to the “deficit” in the previous year. In other words, that part would have been observed even if there were no pandemic.

We cannot tell how much of the excess mortality in 2019–20 (4.0%) is explained by “balancing” the deficit in 2018–19 (-3.5%), and how much is the pandemic toll. Nonetheless, we can compute a range for the latter: 0.5% (if complete “balance” is assumed) to 4.0% (if absurdly assuming that the exceptional low mortality in 2018–19 played no role in the following year). Realistically, the pandemic toll in Sweden in the first year (2019–20) was probably somewhere in between — perhaps 1–2% excess mortality — comparable, for example, to 1.5% excess mortality in 2017–2018, which contained a severe flu season.

Recall: the models that shut down the world predicted 100% excess mortality in Sweden by the summer of 2020, in the absence of “drastic measures of mitigation”. Do you realize the magnitude of the mistake that was made by public health officials and policy makers all over the world? Politicians rarely admit their mistakes, but have you read any confession in main stream media? Any headline like the followings?

We were wrong about Sweden: The apocalyptic prediction was false!

Public health officials have made a colossal mistake: Our country was shut down in vain!

No, there were no such headlines. Likewise, will you see this article among “Staff Picks” on Medium? Unlikely. People don’t like to find out that they have been fooled.

The pandemic did not end in September 2020. SARS-Cov-2 continued to suppress other respiratory viruses and flu did not return in the winter of 2020–21. The “twindemic” scare did not realize. It was another false prediction.

What happened in Sweden?

Source: SCB.SE, accessed November 10, 2022

Mortality in the second pandemic year (October 2020-September 2021) was not apocalyptic either, not even close. In fact, the mortality rate was lower than three years earlier (October 2017-September 2018), when Sweden experienced a severe flu season: 9,049 per million versus 9,184 per million. Excess mortality was higher, 3% in 2020–21 versus 1.5% in 2017–18, but that was not unique to Sweden. Data from about 25 European countries (combined, including Sweden) shows exactly the same magnitude: the second pandemic year was twice as severe as the 2017–18 flu year.

Source: EuroMOMO (euromomo.eu) 2022; accessed, September 13, 2022

The rate continued to decline in 2021–22, the last flu year, but there was still excess mortality in Sweden (2.7%) and elsewhere, attributable to multiple causes: Covid, the flu, a heat wave, and Covid vaccines.

Again, the same pattern was seen in many European countries. Sweden was not an exception.

Source: EuroMOMO (euromomo.eu) 2022; accessed, September 13, 2022

A scholar once said that history is the consequences of evil and stupidity. That’s only partly true. History is also the consequences of advances in science and technology through discoveries of previously unknown truths, or at least of what is considered to be truth at any time point.

But who has made those discoveries? Who is credited with new truths? The majority? Group-think? The leadership?

Never.

It is always the minority. It is often one person. It is almost always those few who deviated from the consensus, only to be embraced by a new consensus, sooner or later.

A quote attributed to Arthur Schopenhauer summarizes it nicely:

“All truth passes through three stages: First, it is ridiculed; second, it is violently opposed; and third, it is accepted as self-evident.”

Are you still surprised that the consensus on Sweden turned out to be false? That a few dissenting voices about the merit of “counter-pandemic interventions” were right?

Shutting down countries erroneously is no small mistake that can be ignored as if it never happened. The horrifying effects of reckless, panic-triggered actions cannot be erased by changing the agenda to the count of Covid deaths, or to personal Covid stories. Countless lives have been lost and countless livelihoods have been destroyed — in vain. The world-wide death toll would have been lower, not higher, if all countries behaved like Sweden! Record-high inflation and a looming recession would have been avoided. Human rights, achieved over decades of slow progress, would not have been sacrificed in the blink of an eye. Children would not have been deprived of precious years of education.

The greater good would have been served if normal life continued, undisrupted, throughout the pandemic.

History will not forget the wrongdoings of the Covid era. The foolishness and destructiveness of “non-pharmacological interventions” will be highlighted in history books. The fools who were responsible will not. There are too many of them to name.

Are you wondering now what will be written in history books about the evolving saga of Covid mRNA vaccines? Will this be another story of a failed consensus about safety and effectiveness?

Place your bet.

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Professor Emeritus of Public Health (University of Arizona); MD (Tel-Aviv University, Israel); MPH, Epidemiology (University of Minnesota)

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Eyal Shahar

Professor Emeritus of Public Health (University of Arizona); MD (Tel-Aviv University, Israel); MPH, Epidemiology (University of Minnesota)