Over the past several months, a conventional wisdom has been solidifying in certain centrist and liberal quarters that the controls imposed during the COVID-19 pandemic Went Too Far. This idea has crystallized in a book by two Princeton political scientists, Frances Lee and Stephen Macedo—notably not epidemiologists, or virologists, or public-health experts—called In COVID’s Wake: How Our Politics Failed Us. The authors have gotten a respectable hearing from PBS, Jake Tapper, and, of course, The Daily podcast from The New York Times.
The podcast If Books Could Kill recently did a deep-dive debunking of this book, but I want to focus on its treatment of Sweden because of how it’s become a synecdoche for the whole argument. In the Financial Times, the normally level-headed Ed Luce recently cited the Swedish example: “Everyone could agree back then that otherwise liberal Sweden was foolish to take the herd immunity route. That Sweden ended up with one of the lowest mortality rates in Europe has not been similarly highlighted.” The book “should be compulsory reading across the spectrum. That it has not been reviewed by most major newspapers is troubling,” he added.
OK, let’s discuss Sweden.
As an initial matter, Sweden, like the other Nordics, was much less vulnerable than most countries to a respiratory pandemic that hit the elderly the hardest, because of its household structure. According to the OECD, 40 percent of Swedish over-65s live by themselves—one of the highest rates in the world—while only about 5 percent live in households with non-seniors. That made it relatively more difficult for outbreaks at schools or workplaces to spread to the most vulnerable population.
The Swedish experience cannot be generalized to countries like Greece, where about 40 percent of seniors live with non-seniors, and just over 20 percent live alone—let alone poor countries where multigenerational cohabitation is the norm. Also unlike most of the world, Sweden has a world-class public health care system, high state capacity, and a relatively high-trust population willing to follow government instructions.
That last factor matters in particular because while Sweden did not follow the rest of Europe in implementing full-scale lockdowns, it did reverse course and implement some fairly strict control measures later in 2020. Public events were limited to eight people in November, upper secondary schools were closed, and nursing homes were closed to visitors—alas, too late to save many of their residents.
A lot of Sweden’s mortality drop in 2021 almost certainly was just moving deaths around.
On the mortality question, while it is true (and I’ll admit, surprising) that Sweden’s overall rate of excess mortality was among the lowest in Europe, Lee and Macedo play fast and loose with statistics. The money quote: “This book is not a mystery novel, so, at the risk of ‘spoiling’ the surprise, at the end of June 2021 … Sweden’s excess morbidity for the period from January 2020 to the end of June 2021 was negative 2.3 percent,” they write. The citation on this goes to another anti-lockdown book by Johan Anderberg, who in turn cites the U.K. Office for National Statistics, which does indeed have that figure.
But including half of 2021 is misleading. Vaccines started rolling out in Sweden in January 2021, and were widely available in the following months. By that time, most of Europe had abandoned lockdowns as a policy. What matters is 2020, because that is the period when Sweden differed from the rest of Northern Europe, and especially the first half of the year. Sweden had a terrible 2020—two monster waves of COVID deaths, the first one even worse than the United States, then and now governed by President Donald “Inject Disinfectant” Trump. The same U.K. office had Sweden’s excess death rate at 2.3 percent in the first half of 2020, the eighth-highest in Europe, and 1.7 percent in the second half.
That murderous first wave was why so many countries turned to lockdowns in a panic. Doctors and nurses had not even had time to figure out treatment rules of thumb like “proning” patients, and many were themselves quickly struck down by COVID, which drove up the death rate. Health care systems, almost all of which were not nearly so well resourced as Sweden’s, were overwhelmed. I can’t be the only one who remembers the refrigerated morgue trucks in New York City where seniors struck down by then-Gov. Andrew Cuomo’s cruel ineptitude were stacked up like cordwood.
Relatedly, it would not have been possible to fully skip the negative effects of lockdowns, because much of the public, fearing infection from a strange new virus, would choose to stay home anyway—creating similar economic disruptions as a lockdown but without the sufficient stringency to halt community transmission, as Australia, New Zealand, and Taiwan managed for some years. Sweden indeed suffered an economic hit almost as bad as the other Nordics.
What’s more, the U.K. figures are provisional, and actual studies have very different numbers. A study in The Lancet by Pizzato et al. found that Sweden’s excess mortality rate was 7.2 percent in 2020—worse than Germany or Greece—and only -0.2 percent in 2021.
Whatever the correct figure is, a lot of Sweden’s mortality drop in 2021 almost certainly was just moving deaths around. For instance, dementia deaths dropped by a lot in 2021-2022, and as a study in the European Journal of Epidemiology notes, “This might reflect that many frail individuals with dementia died prematurely in 2020, hence reducing the population of individuals with dementia who would be at risk of dying in 2021 and 2022.” Seeing a drop in dementia deaths because those individuals were already dead from the government letting COVID run wild in nursing homes is not anything to celebrate.
The lockdown-focused story about mortality is also misleading when it comes to 2022. Prior to that year, the other Nordics were doing far better than Sweden—but they got hammered by the omicron variant, while Sweden did not, which is why it ended up with the best overall mortality rate through 2023, per the Lancet study. Why? It wasn’t immunity from prior infections, as a study in Frontiers in Immunology argues persuasively, but rather that Sweden did its rollout of booster shots far faster than the other Nordics. Ironically, it was swift action by the Swedish public-health bureaucracy, not failing to lock down two years previously, that saved lives. It is simply not true that “interventions seemed to do little if any good beyond delaying the inevitable” or that “the stringency of pandemic restrictions made little evident difference for countries’ overall Covid mortality,” as the authors argue. If Sweden had locked down in the critical early months of the pandemic as its neighbors did, a great many of those 2020 deaths could have been avoided through vaccination and not crushing the hospitals.
Taking all this together: This implied notion that Sweden’s experience proves lockdowns were pointless, we could have largely ignored the pandemic, and overall deaths would have gone down is certainly provocative, but it’s utter nonsense. Aside from the above, we already know what happened when COVID was allowed to run wild in a country without any of Sweden’s advantages. That was what unfolded in Peru, a weak state with a rickety hospital system that was unable to implement its attempted lockdown. It was a charnel house, with about 220,000 official COVID deaths—almost three times the rate of Sweden, or more than seven times that of New Zealand—and that is almost certainly a large underestimate.
Again, this Swedish example is only the tip of the garbage iceberg with this book. The authors argue that nonpharmaceutical interventions do not work; as Adam Kucharski demonstrates, this is flagrantly incorrect. For the full treatment, see the podcast mentioned above.
It is disturbing how appealing this ridiculous book is to elite figures. Certainly, many mistakes were made in the pit of a once-in-a-century pandemic; as I’ve argued previously, Zero COVID policies went on far too long in places like China. But that is very different from arguing that lockdowns weren’t effective, particularly in the pandemic’s early stages. It doesn’t bode well for next time.
UPDATE: After press time, Macedo and Lee wrote to contend that they are not saying that nonpharmaceutical interventions do not work; they are merely saying that, while there is some evidence that NPIs reduced transmission, there is an absence of evidence proving that NPIs reduced COVID mortality. While several studies do in fact claim to provide this evidence, we add this clarification for the sake of transparency, and invite readers seeking more information to read the authors’ response to Adam Kucharski.