Published: May 2023
What Sweden really tells us about pandemic reality.
The recent SPR analysis showing that there was no Swedish “mortality miracle” has aroused many fiery reactions from all sides of the pandemic debate. And it is clear why: the battle over Swedish mortality is a battle over the interpretation of the pandemic, lockdowns, face masks, and vaccines. And although the global picture is already clear enough, Sweden has played a unique role.
For instance, a German professor with 100,000 followers on Twitter insisted that Sweden was not a “high vaccination country” at all. But statistics show that Sweden has one of the highest vaccination and booster rates in the world – in Europe, only Denmark and Portugal administered more vaccine doses. Only Swedish children and young adults had somewhat lower vaccination rates.
A Dutch pandemic modeler and covid skeptic insisted that “giving each country a different baseline at a different level is absolutely wrong.” In reality, this is exactly what has to be done and why excess mortality calculations are so complex, as even the WHO had to find out.
A Croatian pandemic modeler and covid skeptic insisted that “almost everything in this assessment is wrong”. The Croatian analyst is convinced that excess deaths cannot be compared to reported covid deaths, but mortality statistics and autopsy studies show there is 90% agreement.
Furthermore, some skeptics thought SPR claimed the Swedish model was a “failure”. In reality, SPR has always emphasized that the Swedish model was a great success, but that Sweden couldn’t prevent age-adjusted excess mortality comparable to other Western European countries.
At the end of the day, only an appropriate mortality analysis is consistent with all the available data, including covid infection rates, covid fatality rates, reported covid deaths, vaccination rates, vaccine protection and vaccine deaths, omicron properties, and cross-country comparisons. All other analyses have to distort or deny much of this data and then hide countless contradictions.
Figure: Reported covid deaths per country
Germany vs. Sweden
For many countries, the standard linear 5-year model works just fine, but for some other countries, this “one size fits all” model is simply not appropriate. Sweden and Germany are two of the best such examples: in Sweden, the standard model strongly underestimates excess mortality, while in Germany, the standard model strongly overestimates excess mortality.
By comparing Germany to Sweden, as many covid skeptics in Germany and elsewhere have done, the error is compounded. In both countries, the mortality trend is driven by historical demographics: in the 1930s, i.e. 90 years ago, Sweden saw a strong decline in births while Germany had a baby boom.
Figure: Long-term decline in Swedish mortality (red) vs. 5-year linear trend (blue).
The following chart once again shows mortality rates for Sweden and Germany. This time, unadjusted mortality rates are used to highlight the demographic effects even better.
Everything is clearly visible: how Germany missed the first covid wave in the spring of 2020; how Sweden reached a 5% infection rate after the first wave, while Germany reached it only at the end of the year; how vaccination stabilized or even reduced covid mortality in 2021 despite three more covid waves; and how the milder omicron variant escaped vaccine protection in 2022.
The chart also clearly shows how the declining mortality trend in Sweden “swallows” excess mortality caused by 10% covid, which is what has confused so many skeptics and modelers.
It is obvious that in 2020, excess mortality was higher in Sweden than in Germany; this was when many politicians and journalists claimed that Sweden had “failed”. In 2021, excess mortality was about the same in both countries, but decreased more in Sweden, due to higher vaccination rates among senior citizens and some compensation of previous excess mortality. However, since the emergence of omicron in 2022, excess mortality has been higher in Germany than in Sweden.
Why is excess mortality since omicron higher in Germany than in Sweden?
For three reasons: first, lower vaccination rates among senior citizens in Germany; second, the “catch-up effect” (Sweden had more pre-omicron infections); and third and most importantly: the German population is much older (median age 48 vs. 41). Because covid lethality is strongly age-dependent, this difference in median age of seven years means that at the same infection rate, excess mortality in Germany will be about twice as high as in Sweden, all else being equal.
Importantly, in many Western countries about 90% of all covid infections have been omicron infections. The large omicron waves are no longer visible in PCR data, as expensive PCR mass testing has been discontinued in most countries, but they are visible in the much more reliable wastewater data. Excess mortality in senior citizens continues to run in parallel to these omicron waves.
Figure: Omicron waves in Berlin – PCR data (red) and wastewater data (blue):
If calculated correctly, German excess mortality since 2020 is only about 70k instead of 200k, as the following chart by German professor of Medical Data Science, Stefan Kraus, shows. Professor Kraus notes that the popular “5-year models often lead to massively distorted results”. Ironically, excess mortality was exaggerated first by covid alarmists and then by covid skeptics and vaccine skeptics.
Overall, covid mortality in Western Europe was rather low compared to the United States and Eastern Europe: the United States lost over one million people to covid, while some Eastern European countries lost one percent of their entire population to covid (e.g. Serbia and Bulgaria). The main causes were poorer health, higher pre-omicron infection rates, and lower vaccination rates.
The British mortality mystery
In Great Britain and especially in England & Wales, there has been a great deal of discussion about the true level of excess mortality, especially since the beginning of mass vaccination.
It is clear that British mortality has been increasing since 2010 and that a “five-year average” baseline, as initially provided by the British ONS, greatly overestimates true excess mortality:
However, it is a matter of debate just how steep the increase in British mortality has been in recent years. If one applies the steepest pre-pandemic trend, there has been very little excess mortality since 2022, even though mortality has been very high in absolute terms (see next chart). If one applies other pre-pandemic baselines, excess mortality declined in 2021 but increased again in 2022. The truth is that British excess mortality is almost impossible to estimate at the moment.
Moreover, England is one of the few Western countries that has seen substantial covid excess mortality in the 40-to-60 age group, both before and after vaccination. It is possible that this is due to higher obesity rates or citizens of South Asian ethnicity, both of which are known covid risk factors. Wastewater data shows that the omicron variant continues to circulate at high levels in Britain.
During initial vaccinations Britain relied much more heavily on the AstraZeneca “clot shot” vaccine than most other Western countries (60% vs. 0% to 10%). However, the hypothesis that mortality is driven by the AstraZeneca vaccine seems to be contradicted by more positive Scottish data.
Conclusions
Excess mortality statistics have received a great deal of attention and have caused a lot of confusion during the pandemic. A “one size fits all” linear 5-year model has worked for some countries but not for others. If calculated correctly, pandemic excess mortality both in Sweden and in Germany perfectly matches all other data on demographics, infections, and vaccinations.
Without lockdowns, school closures and face masks, Sweden has achieved excellent social and economic results and good Western European mortality results, but not zero excess mortality. Social media platforms such as Twitter have enabled outstanding independent pandemic analysis and discussion, but they have also amplified a lot of alarmist and questionable information.
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Sweden: The Battle over Pandemic Reality.
An analysis by Swiss Policy Research.
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Annex
1) Switzerland vs. Sweden
Switzerland has an even lower but slightly increasing mortality baseline compared to Sweden. Switzerland had a mild first wave in the spring of 2020, but a rather strong winter wave prior to vaccination. Vaccination reduced mortality in 2021 but omicron increased it again in 2022. The Swiss population is somewhat older than the Swedish population (median age 43 vs. 41).
2) The Netherlands vs. Sweden
The Netherlands has a somewhat older population than Sweden (median age 43 vs. 41) and has had a flat mortality baseline since 2014. Using the correct mortality baselines, one can see that the overall pandemic excess mortality in the Netherlands and in Sweden was quite similar.
3) Austria vs. Sweden
Austria largely missed the first wave in the spring of 2020 (see the very small mortality bump) but suffered a pretty strong winter wave prior to vaccination. Vaccination rates among senior citizens were lower than in Sweden but vaccination still stabilized mortality rates in 2021.
The Austrian median age is 44.5, almost four years higher than in Sweden (41). Thus, at the same infection rate, Austrian covid mortality will be about 50% higher than in Sweden.
