Learning COVID lessons – Sweden and comparison tables revisited

I’ve seen two types of article about Sweden’s pandemic response over the past few weeks (as indeed I have throughout the pandemic). On the one hand, there are those who continue to argue that the Swedish approach demonstrates that we were wrong to bring in tough measures such as social distancing, face masks and lockdowns. To those authors, Sweden is a success story. On the other hand, some articles have suggested that all is not well in Sweden.

Of course this has implications for the United Kingdom. There continues to be a strong dividing line between those who insist that we have seen one of the worst COVID responses, that in comparison to other countries we have faired badly and that we should have imposed stricter measures longer and earlier. Meanwhile there are others insisting that we should have followed the Swedish route, that our response in fact made little difference.

So it’s worth having a look at the data. Here’s a table of COVID mortality percentages from a sample of countries.

Sample of countries from around the world

What you will see from the chart is that Sweden sits pretty much in the middle of this chart. However, there are outliers at both ends of the chart. On the one hand, Peru appears to have faired particularly badly with 0.6% of the population dying from or with COVID. At the other end of the chart are a cluster of outlying countries that appear to have faired significantly better than other nations. New Zealand, Taiwan, Australia, South Korea, Singapore and Iceland all have seen less than 0.01% deaths. If we remove them, then the chart looks even better for Sweden.

You will also see that when you exclude the outliers that the UK appears to be fairly central on the chart. So does this now suggest that Sweden has something to teach us?

There is a risk with drawing up league tables like this. The risk is that we can end up making faulty comparisons. The old proverb reminds us that we should compare apples with apples and oranges with oranges. Can we be sure that we are comparing like with like.

It’s worth noting that there appear to be some particlar blocks on this chart. There’s a block of mainly Scandinavian countries, a block of Western European Countries and a block of South American countries and yes, the do seem to cluster. It might be worth pulling out those groups and looking at them individually

Western Europe
Scandinavia

South America
East Asia

What you will notice is that in general terms, South America appears to have been hit the worst, East Asia has faired best overall, then Western Europe sits pretty much in the middle, along with with the US with Scandinavia fairing better than Western Europe. It’s not quite uniform, Mexican figures look closer to the US and to Western Europe whilst New Zealand fairs significantly better than East Asia.

We could also add in another little cluster of Island nations. Indeed, these appear to have faired the best of all and you can really see at this point how much New Zealand appears to stand out.

Now generally speaking with the exception of New Zealand and Peru as the main outliers, once you look at a regional grouping, the data does appear to cluster fairly closely together. The difference in Western Europe between the Netherlands and Belgium is just 0.12%, it’s about 0.13% between Sweden and Iceland whilst between Brazil and Mexico it’s about 0.06% and the difference between the selected East Asian countries is just 0.005%.

Now from this, I would suggest that it would be difficult to argue that the differences are down to significant differences in policy within the control of countries. What I mean by this is that as well as policy differences, we can observe differences in terms of geography, climate, demographics and population density all of which may have had a significant impact on outcomes.

It is true that the East Asian countries along with New Zealand went for stricter measures including tougher lockdowns and stricter border controls and that is perhaps something we need to pay attention to. As has been observed before, though:

  • East Asian countries tend to have more compliant and uniform cultures when responding to situations like this.
  • There may well have been greater readiness due to prior experience of SARS.

The “island” factor cannot be completely ignored either. This will have made border control easier to enforce.

So, it has been my view throughout the pandemic that it is difficult to suggest that this or that country has faired worse and that this or that country has done better. This is not to give a free pass to governments or to say that outcomes couldn’t have been better. It remains my view too that better management of the Care Home system and swifter/clearer rules on border control would have made a significant difference in the UK. We also have to consider the implications of seeing 11k reported deaths from people who contracted COVID-19 whilst in hospital for other conditions.

However, I don’t think that the lessons are going to be learnt from drawing up league tables.

Returning to the Swedish experience though, I’d like you to have another look at that graph. You will notice that whilst Sweden may on the one hand appear to have faired well along with the other Scandinavian countries in comparison to Western Europe, South America and the US, when you look at the Scandinavian data in isolation, Sweden appears to stand out as a bit of an outlier from the rest of the region. It’s not perhaps a huge difference but at the same time the experience there does look different to Finland, Norway and Denmark. Comparing like for like certainly doesn’t give the COVID sceptics permission to crow and declare Sweden a success.

My argument throughout the pandemic is that league tables comparing different nations are unhelpful. This remains my view.

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