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

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.

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

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 its 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 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: 

Another issue with the analysis is that the SvD graph 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 it is only in the SvD/SCB figures that it beats 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.  

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 is, along with the other Nordic countries, 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,” said Preben Aavitsland, the Director for Surveillance and the Norwegian Institute of Public Health.

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

Not at all. 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 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. 

While Sweden’s death rate is still far ahead of those of its Nordic neighbours, it is now much closer to theirs than it was at the end of 2020. 

“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 shortened lives of the close to ten 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. 

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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Pregnancy in Norway: What to expect in your first trimester

Whether you're a first-time parent or have experienced the process before, understanding the resources and services available in Norway in the first trimester of pregnancy can make this time more manageable and less stressful.

Pregnancy in Norway: What to expect in your first trimester

Expectant parents in Norway can rely on a comprehensive and supportive healthcare system.

Generally speaking, all pregnant women are entitled to free follow-ups with their midwife and/or GP.

Nine pregnancy consultations, including fetal diagnostics and ultrasounds, are offered during the pregnancy – but you may also be offered more consultations if your GP or midwife, together with you, decide that they are needed.

READ MORE: What benefits are you entitled to if you have children in Norway?

As you embark on this path, the initial trimester is a crucial period filled with significant developments and changes, both physical and emotional.

In this overview, we delve into what to expect from Norway’s healthcare system during your first trimester, guiding you through the vital aspects of prenatal care and assistance that ensure a healthy start to your pregnancy journey.

Contacting your health provider after finding out you’re pregnant

As soon as you confirm your pregnancy through a home test, don’t hesitate to contact your local health centre or general practitioner (GP) to arrange your initial consultation.

You can expect to secure an appointment within a week of contacting your healthcare provider.

Moreover, you can choose whether you prefer follow-up care from your GP or a midwife or even alternate between them (meaning that you can see both) as you see fit.

While there is a comprehensive offer of GPs and midwives in major cities, that does not mean the service will be offered in each neighbourhood or near your home.

Don’t be surprised if you must take public transport or drive for more than 20 or 30 minutes to reach your GP or health centre offering midwife consultations.

Initial consultation appointments (weeks 6-12)

Usually, your GP will ask you to bring a sample of your morning urine for routine urine tests. This step aids in monitoring your health and the progress of your pregnancy.

Your first antenatal (pre-birth) consultation is an important milestone. During this visit, your midwife or doctor will ask a series of questions to understand your specific needs and expectations for the upcoming months.

This early consultation focuses on several issues, and this is usually when you can get most of your questions answered. Your midwife or doctor will likely share advice on lifestyle and preparing for pregnancy, share thoughts and plan out your prenatal care, and go through the maternity services available in your area.

Additionally, you’ll receive an Antenatal Health Card (usually printed on a sheet of paper), which will be updated during subsequent consultations. This card is crucial, so remember to bring it to every appointment.

The questions and topics that will come up

The initial consultations in weeks 6-12 will cover a wide range of topics, from diet, exercise, and lifestyle choices to your overall health, medical history, and any medications you may be taking.

The GP or midwife will also ask you about previous pregnancies, childbirth experiences, maternity leave, breastfeeding, and any past abortions.

They will check whether you’re feeling okay and for your assessment of your own mental health and well-being.

Health checks in weeks 6-12

At each consultation, you’ll undergo essential health checks.

Usually, the first one will be a simple urine test to check for proteins. This will be followed by blood pressure measurement.

After that, you can expect blood tests to screen for hepatitis B, HIV, and syphilis, as well as assessments of haemoglobin and serum ferritin levels.

Your pre-pregnancy weight will also be recorded on your health card.

Depending on your specific circumstances, further tests may be recommended and discussed during your consultations.

In Norway, the first ultrasound examination usually doesn’t take place before week 11 or 12, and you can’t have it at your GP – you will generally need to be referred to a gynaecologist at your local hospital.

In any case, all pregnant women are offered an ultrasound examination before week 14. As HelseNorge, the official website for information about and access to health services for residents of Norway, points out, the examination is offered free of charge.

Most pregnant women will have the ultrasound scan at their local hospital (for a fee of roughly 200 kroner, you can get the ultrasound images printed out). You will receive more information about what your local hospital offers at your first doctor or midwife consultation.

However, you can always opt for a private ultrasound before week 11 – just know these are expensive. In 2023, an ultrasound checkup at Volvat cost around 2,200 kroner.

The NIPT test: Eligibility and cost

Non-Invasive Prenatal Testing (or NIPT) is used to see if your baby has an increased chance of a genetic health condition, such as Down syndrome and other chromosomal differences.

If you’re 35 years or older by your estimated due date or if you have specific risk factors, you will be offered the test.

The NIPT test is readily accessible through public health services and is free of charge.

For pregnant women who are younger than 35 at their due date and do not present specific risk factors, the public health services do not routinely offer NIPT.

However, if you fall into this category and desire to have the NIPT test, you have the option to reach out to authorised private clinics. At the time of writing, the cost of the test at Volvat was around 10,000 kroner.

READ MORE: The most important things to do after having a baby in Norway

As you progress through the first trimester, it’s important to remember that you should reach out to your healthcare provider with any questions or concerns about the changes occurring in your body (such as pains, bleeding, or similar).

Overall, your first trimester is a time of preparation and planning. Norway’s healthcare system is dedicated to ensuring a healthy and informed start to your pregnancy journey – though you might be surprised by how “hands off” everything feels (at least compared to some other European countries, which offer more ultrasound checkups in the first trimester).