The debate about whether we should move towards Sweden’s strategy increasingly seems like a debate about nothing since we have no choice but to move towards their strategy eventually. Lockdowns can’t last forever. Even Andrew Cuomo has begun talking about a game plan to reopen for business. Sweden may become more relevant after we reopen and some state or city somewhere begins to experience a second wave. Then we’ll have a bitter argument about whether it’s smarter to lock down again to douse the epidemic before it burns out of control or whether to do what the Swedes did and let it burn in the hope and expectation that it won’t do as much damage as we fear.
But that’s later. We’re going to reopen soon-ish because there’s no alternative.
The other quirk of the great Sweden debate is how caricatured the two sides’ positions have become. The American position, supposedly: Lockdowns forever. The Swedish position, supposedly: Business as usual. But it’s not business as usual there. Sweden is practicing social distancing too, just with fewer formal restrictions than the U.S. Gatherings of more than 50 people are banned. Universities are closed down. No sports. Older citizens are expected to self-quarantine, and visits to nursing homes are now banned. The economy has taken a big hit, partly because of the global economic downturn and partly because many Swedes have the good sense not to patronize crowded businesses even though they’re open.
Once the U.S. reopens, which has already begun in states like Georgia and Colorado, the chief distinction between the Swedish and American approaches will be the fate of elementary schools. They’re open in Sweden, they’re closed here. Does the Swedish experiment suggest that we can safely reopen those too?
It depends on what data you look at and what your personal risk tolerance is. Unquestionably Sweden has fared worse than the countries that are most similar to it in terms of ethnicity, geography, and culture:
Sweden — 18,926 cases and 2,274 deaths among 10.3 million people
Denmark — 9,049 cases and 427 deaths among 5.8 million people
Norway — 7,599 cases and 206 deaths among 5.4 million people
Finland — 4,695 cases and 193 deaths among 5.5 million people
Sweden’s fatality rate is higher than the fatality rate in the United States (although not in New York City). But they’re not a catastrophe by global standards. As the Times noted yesterday, Sweden and Ireland have had practically the same number of deaths per million residents. Belgium, Spain, Italy, and Great Britain are far ahead of both. Many of the deaths in Sweden have come in nursing homes, which the government admits it needs to a better job of protecting — but so do many other western countries, as assisted-living facilities have been hot spots in one nation after another. Nor have Sweden’s hospitals been overrun by the volume of patients:
2) However, it also increasingly seems that their numbers are leveling off, especially in Stockholm, which is what you would expect if 30% of the population has had it there (as their ambassador claims) providing some herd immunity. Here is their ICU data:https://t.co/I6cNalVUYL
— Nate Silver (@NateSilver538) April 29, 2020
The ambassador projected that Stockholm could reach herd immunity as soon as next month. If that’s true, the number of cases, hospitalizations, and ICU admissions should all be in decline in Stockholm sometime in June. We’ll keep an eye on it.
The point of the comments by the WHO official in the clip below (watch four minutes or so for the full flavor) is that we shouldn’t misunderstand Sweden as a case of people carrying on as normal. They’re not. What they’re doing in the absence of formal lockdown orders is trusting people to maintain social distancing practices voluntary, exactly what the United States will soon be asking its citizens to do. (Again, elementary schools may remain subject to formal closure.) Can we expect a result as comparatively good as the Swedes have had, though? They’re a “high trust” society, it’s said: When their leaders request compliance on something, they’re apt to get it. Trust in the U.S. isn’t so high. Does that mean Americans won’t take social distancing as seriously once the lockdowns lift as the Swedes do?
Eh, maybe not. Lyman Stone is a proponent of social distancing but a critic of lockdowns. His reasoning is simple: When you look at the data, it seems like most lockdown orders are a case of the government following the people, not vice versa. It turns out many Americans were actually beginning to practice social distancing en masse in March, based on the frightening information they were receiving about COVID-19, even before stay-at-home orders were issued. Information, not regulation, is what’s flattened the curve. If that’s true then reopening the country and shifting towards a Sweden-style system (with the exception of elementary schools) in which people are free to go about their business but discouraged from doing so may not be much more dangerous than what we’re doing now — but may not look wildly different in practice from what we’re doing now either. Stone:
Americans began to practice social distancing not because they were ordered to do so, but because, belatedly, our political and cultural leaders woke up to the risks of COVID and sounded the alarm around March 8–13. Having received credible information about the risks of COVID, Americans responded with remarkable solidarity, adopting stringent social distancing measures even in states without stay-at-home orders. These social distancing measures have almost certainly saved tens of thousands, perhaps even hundreds of thousands, of lives. But policymakers (outside of Washington State and some county officials in California) cannot take credit for this achievement: it was a grassroots campaign by Americans of all stripes working together to protect each other.
There’s more to it than that. Whenever people tell you that Americans need lockdowns because before lockdowns they were refusing to socially distance, they’re not just smearing Americans, they’re also wrong on the facts. Americans, like people in almost every country, were quicker to understand the risks than most of the people who govern us. Alas, had our leaders taken the threat seriously a month earlier, and communicated the risks to Americans more explicitly, COVID could have been a flash in the pan. Instead, many thousands of Americans are going to die unnecessary deaths.
If Stone’s right then maybe we won’t have a big debate over the Swedish model if reopening for business leads to a second spike after all. That problem will be self-correcting, no lockdown orders needed. Residents of the city or state where the spike is happening will hear about it, absorb the information, cancel any plans involving retail or restaurants, and begin self-isolating again to protect themselves. The infection rate will gradually begin to fall again, as will the local economy. The point is, there’s no sustained “business as usual” outcome. Certainly not in the U.S., especially if most states are still far away from herd immunity.