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FACT CHECK: Did Sweden have lower pandemic mortality than Denmark and Norway?

A graphic published by the Svenska Dagbladet newspaper last week claimed that Sweden had the lowest excess mortality of all EU and Nordic counties between the start of 2020 and the end of 2022. We looked into whether this extraordinary claim is true (and it is, sort of).

FACT CHECK: Did Sweden have lower pandemic mortality than Denmark and Norway?
Sweden's former state epidemiologist Anders Tegnell photographed at the headquarters of the Swedish Public Health Agency in March. Photo: Stina Stjernkvist/SvD/TT

At one point in May 2020, Sweden had the highest Covid-19 death rate in the world, spurring newspapers like the New York Times and Time Magazine to present the country as a cautionary tale, a warning of how much more Covid-19 could ravage populations if strict enough measures were not applied. 

“Per million people, Sweden has suffered 40 percent more deaths than the United States, 12 times more than Norway, seven times more than Finland and six times more than Denmark,” the New York Times reported in July 2020

An article in Time in October 2020 declared Sweden’s Covid response “a disaster”, citing figures from Johns Hopkins University ranking Sweden’s per capita death rate as the 12th highest in the world.

So there was undisguised glee among lockdown sceptics when Svenska Dagbladet published data last week showing that in the pandemic years 2020, 2021 and 2022 Sweden’s excess mortality was the lowest, not only in the European Union, but also of all the Nordic countries, beating even global Covid-19 success stories, such as Norway, Denmark and Finland. 

Versions of the graph or links to the story were tweeted out by international anti-lockdown figures such as Bjørn Lomborg, a Danish sceptic of climate action, and Fraser Nelson, editor of Britain’s Spectator Magazine, while in Sweden columnists like Dagens Nyheter’s Alex Schulman and Svenska Dagbladet’s opinion editor Peter Wennblad showed that Anders Tegnell, the state epidemiologist who led Sweden’s strategy, had been “right all along”. 

Excess mortality — the number of people who die in a year compared to the number expected to die based on previous years — is seen by some statisticians as a better measure for comparing countries’ Covid-19 responses, as it is less vulnerable to differences in how Covid-19 deaths are reported. 

But are these figures legitimate, where do they come from, and do they show what they purport to show?

Here are the numbers used by SvD in its chart: 

Where do the numbers come from? 

Örjan Hemström, a statistician specialising in births and deaths at Sweden’s state statistics agency Statistics Sweden (SCB), put together the figures at the request of Svenska Dagbladet. 

He told The Local that the numbers published in the newspaper came from him and had not been doctored in any way by the journalists.

He did, however, point out that he had produced an alternative set of figures for the Nordic countries, which the newspaper chose not to use, in which Sweden had exactly the same excess mortality as Denmark and Norway. 

“I think they also could have published the computation I did for the Nordic countries of what was expected from the population predictions,” he said of the way SvD had used his numbers. “It takes into consideration trends in mortality by age and sex. The excess deaths were more similar for Denmark, Sweden, and Norway. Almost the same.” 

Here are Hemström’s alternative numbers: 

There are two basic ways of measuring excess mortality. The simplest, and the one used by SvD/SCB, is to simply compare the death rates in the relevant period with the mean of previous years, normally five years. 

More sophisticated measures attempt to estimate the expected number of deaths by extending mortality trends seen in a certain country, adjusting for the age of the population and other factors. But this can lead to results to vary significantly depending on how mortality trends and expected mortality are calculated. 

The issue with the analysis in the SvD graph is that compares deaths in the pandemic years to deaths over just three years, a mean of 2017-2019, and does not properly take into account Sweden’s longstanding declining mortality trend, or the gently rising mortality trend in some other countries where mortality is creeping upwards due to an ageing population, such as Finland. 

“It’s very difficult to compare countries and the longer the pandemic goes on for the harder it is, because you need a proper baseline, and that baseline depends on what happened before,” Karin Modig, an epidemiologist at Sweden’s Karolinska Institute whose research focuses on ageing populations, told The Local.

“As soon as you compare between countries, it’s more difficult because countries have different trends of mortality, they have different age structures, and in the pandemic they might have had different seasonal variations.” 

She described analyses such as Hemström’s as “quite crude”. 

In an interview with SvD to accompany the graph, Tegnell also pushed back against giving the numbers too much weight. 

“Mortality doesn’t tell the whole story about what effect a pandemic has had on different countries,” he said. “The excess mortality measure has its weaknesses and depends a lot on the demographic structures of countries, but anyway, when it comes to that measure, it looks like Sweden managed to do quite well.”

Do the numbers match those provided by other international experts and media? 

Sweden’s excess mortality over the three years of the pandemic is certainly below average worldwide, but in most other analyses it remains higher than those of Norway and Denmark. 

A ranking of excess mortality put together by Our World in Data for the same period as the SvD/SCB table estimates Sweden’s excess mortality between the start of 2020 and the end of 2022 at 5.62 percent, considerably more than the 4.4 percent SvD claims, and above that of Norway on 5.08 percent and Denmark on 2.52 percent. 

The Economist newspaper also put together an estimate, using their own method based on projected deaths. In this estimate, Sweden also has a higher rate of excess deaths than Denmark and Norway (but not than Finland).   

Our World in Data uses the estimate produced by Ariel Karlinsky and Dmitry Kobak, who manage the World Mortality Dataset (WMD). To produce the estimate, they fit a regression model for each region using historical deaths data from 2015–2019, so a time period of five years rather than the three used by SCB.

What’s clear, is that, whatever method you use, Sweden and the other Nordic countries are among the countries with the lowest excess mortality over the pandemic. 

“Most methods seem to put Sweden and the other Nordic countries among the countries in Europe with the lowest cumulative excess deaths for 2020-2022,” Preben Aavitsland, the Director for Surveillance and the Norwegian Institute of Public Health, told The Local.

So if Sweden had similar excess mortality to those of the other Nordics over the period, does that mean it had a similar Covid-19 death rate?

No. Sweden’s per capita death rate from Covid-19 over the period covered by the SvD/SCB figures, at 2,249 per million people, is still more than double Norway’s 959 per million, 60 percent more than the 1,409 per million who died in Denmark, and more than 50 percent more than the 1,612 per million who died in Finland. 

Sweden’s death rate is now much closer to those of the other Nordic countries than it was at the end of 2020, however, something Aavitsland put down to the higher number of Covid-19 deaths seen in his country in the later years of the pandemic. 

“The most striking difference between Sweden and the other Nordic countries is that only Sweden had large excess mortality in 2020 and the winter of 2020-21,” Aavitsland explained. “In 2022, the field levelled out as the other countries also had excess mortality when most of the population was infected by the omicron variant after all measures had been lifted.”

So why, if the Covid-19 death rates are still so different, are the excess mortality rates so similar?

This largely reflects the fact that many of those who died in Sweden in the first year of the pandemic were elderly people in care homes who would have died anyway by the end of 2022. 

About 90 percent of Covid-19 deaths were in people above 70, Aavitsland pointed out, adding that this is the same age group where you find around 80 percent of all deaths, regardless of cause, in a Scandinavian country. 

“My interpretation is that in the first year of the pandemic, say March 2020 – February 2021, Sweden had several thousand excess deaths among the elderly, including nursing home residents,” he said. “Most of this was caused by Covid-19. In the other [Nordic] countries, more people like these survived, but they died in 2022. The other countries managed to delay some deaths, but now, three years after, we end up at around the same place.” 

So does that mean Sweden’s state epidemiologist Anders Tegnell was right all along? 

It depends on how you view the years lost by the several thousand elderly people who caught Covid-19 and died in Sweden in the first wave because Sweden did not follow the example of Denmark, Norway, and Finland and bring in a short three-week lockdown in March and April 2020. Were those two years worth the greater restrictions imposed in Sweden’s neighbours? 

Tegnell himself probably said it best in the SvD interview. 

“You’ve got to remember that a lot of people died in the pandemic, which is of course terrible in many ways, not least for their many loved ones who were affected, so you need to be a bit humble when presented with these kinds of figures.”

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‘Running out of options’: Husband’s fight to return paralysed wife to Sweden

A British man has told The Local he will continue the fight to move his paralysed Swedish wife home to Sweden, despite red tape blocking her access to Swedish healthcare.

'Running out of options': Husband's fight to return paralysed wife to Sweden

The woman, who is a Swedish citizen but has lived in the UK for 25 years, has spent the past year in hospital after a bike accident left her paralysed with a serious brain injury.

Her British husband has tried to return her to Sweden so the couple and their 12-year-old son can be closer to his wife’s mother and siblings. But because she is no longer listed in Sweden’s population register, bureaucracy has so far left them unable to move her back home.

Her story was first reported by The Guardian. The man – who wishes for him and his wife to remain anonymous – is now trying to contact more media organisations to try to raise awareness of his family’s situation.

“We’re a very private family. We would not have wanted to go contacting press organisations – I don’t want to have anything in the press about our personal information,” he told The Local.

“But we’re running out of options. I don’t want her to end up in a UK nursing home where she has no family, she has no support here. It’s just our immediate family, my son and myself here. There’s nobody else.”

His wife is unable to walk or talk, and must physically be in the country for her husband to re-register her as a Swedish resident at the Tax Agency.

Although those leaving Sweden retain their personal number for the rest of their lives, former residents are listed as emigrants and removed entirely from SPAR, the Swedish state’s personal address register, after three years spent abroad.

This means that, despite being a Swedish citizen, she must attend a Tax Agency office in Sweden in person to be re-registered in the system and for her personal number to be reactivated.

She is unable to walk or communicate, is paralysed from the neck down and is in a high-dependency unit in London requiring constant care due to her condition.

As a UK resident, she would be eligible for planned treatment in Sweden, but she would have to show a so-called S2 certificate approving healthcare in another country, a certificate showing her right to healthcare or medical insurance in Sweden, or a certificate showing that she lives in Sweden.

Without these documents, the family must pay the full cost of treatment themselves, unless they formally move to Sweden and are registered in the Swedish population register – something which can only be done upon arrival in Sweden.

The family has applied for an S2 certificate to fund her treatment in Sweden until she is re-registered as a resident, although her British hospital is unable to approve her travel unless they can confirm that she will be accepted for treatment at a hospital in Sweden. Swedish hospitals, however, can’t register her for treatment if she is not legally resident in Sweden, her husband told The Local.

She is therefore trapped in a situation where she cannot be transferred to a Swedish hospital directly from the UK without first arriving in Sweden to register residency – a process which can take weeks or even months.

“The problem is not funding, it’s about the bureaucratic tickbox, that she cannot be [registered as a resident] until she’s formally back on Swedish soil. She can’t be back on Swedish soil, because she’s completely disabled. And nobody will send her to Sweden because they need proof in advance that she’ll be cared for. So it’s an evil circle,” he said.

He has applied to become her Health and Welfare Deputy, which would enable him to make decisions on her behalf about her treatment and enable her British hospital to discharge her for travel to Sweden without having a Swedish hospital lined up in advance.

“But that may take another two to three years, the courts here are incredibly slow,” he told The Local.

“But if that ever does get resolved, then that would actually move things along. And then we could proceed with the S2 funding, take her to Sweden, once she’s in Sweden, then the problem goes away, then there’ll be new problems, different problems.”

“I mean, you know, none of this is going to be good. The outcome of her going to Sweden is, she’s still going to be 100% incapacitated and unable to communicate, our life is still going to be ruined, but at least, maybe, she’ll be in a prettier place where she has more family.”

The woman’s husband has been shocked by Sweden’s refusal to allow an exception to the rules and is worried that other Swedish citizens living abroad are unaware that this could happen to them.

“A lot of expatriate Swedes who are living abroad probably do not realise that they could get injured and if they’re not [registered in the personal register] anymore, they could potentially be barred from returning to Sweden.”

The family have visited Sweden many times, often spend their summers in the country and were making plans to retire to Sweden in the next year or so.

He told The Local that the situation has led to his view of Sweden changing.

“There’s the disabled rights aspect, Sweden’s usually cited as one of these enlightened countries that helps people and does the right thing. And it’s kind of shocking when you find out that this is not being enforced in this way.”

He has contacted 349 Swedish MPs, receiving only one response. He has also contacted the Discrimination Ombudsman and the Parliamentary Ombudsman, who didn’t take his case, he has contacted MEPs in Europe, the European Commission and the United Nations office of the High Commission for Human Rights who were all unable to help.

“There’s this deficit of democracy where you’re trying to contact people in Sweden, and everybody says, ‘Oh, I’m really sorry, but I can’t do anything’. There’s nobody you can appeal to. Here in the UK, I contacted my MP. And she’s been really helpful. But you can’t do that with your Riksdag member in Sweden. They can change laws, but they can’t help individuals.”

“That was kind of a big shock, especially when somebody is as sick as [she is] and really needs help now. You know, she can’t really afford to wait forever.”