Sweden

Why Are Sweden and India Not Seeing a Covid Surge?

Why are some countries surging this autumn but others aren’t, at least not yet? Much of Europe is now seeing sharp rises in reported infections. In some it appears to be a delayed Delta surge, but in others like France, Netherlands, Norway and Finland it comes after an earlier summer Delta ripple that looked like it had gone away. Yet India, which had (quite literally) the mother of Delta surges, has not seen any new rise despite only 29% of its population being double-vaccinated, and despite the festivals of Diwali and Durga Puja, widely warned about as a transmission risk, taking place in the autumn.

Sweden, meanwhile, has somehow so far managed to avoid Delta surges altogether, after being hit relatively hard in spring 2020 and winter 2020-21. The country famously imposed only light restrictions (no stay-at-home orders, school or business closures or mask mandates at any point). Similarly, few restrictions were imposed in India in 2021, and there is also doubt about how far Indian citizens have followed any restrictions that were brought in; in any case, high population antibody rates were subsequently reported. Are India and Sweden benefitting from a more robust immunity owing to greater exposure prior to this autumn? What happens this winter will help to clarify this question.

The U.K. meanwhile is experiencing a strangely drawn-out Delta epidemic. Beginning in June, it has now been simmering away at around about the same level for five months, neither exploding as the models predicted, nor dropping off again back to low levels, as earlier waves have done.

Sweden Has Had *Negative* Excess Mortality Since the Start of 2020

We all remember what happened last year when Sweden’s unflappable state epidemiologist Anders Tegnell announced there wouldn’t be a lockdown. His “trust-based” approach was roundly denounced – not only in the media, but also by some ‘experts’.

As Johan Anderberg notes, Sweden’s pandemic strategy was variously described as “deadly folly” (Guardian), “a disaster” (Time magazine) and “the world’s cautionary tale” (New York Times).

Since the end of the first wave, however, Sweden has been gradually creeping down the list of countries by official Covid death rate. As of 16th October, it was ranked 52nd – well below the European average.

Yet this actually understates how well Sweden has done. As I and others have consistently argued, number of Covid deaths per million is not the best measure of the pandemic’s impact on mortality. Far better is age-adjusted excess mortality.

Thanks to an ONS report published on Thursday, we now have age-adjusted excess mortality numbers for most of the countries in Europe, covering the entire period from January 2020 to June 2021.

As an aside, the report clearly states: “The best way of comparing the mortality impact of the coronavirus (COVID-19) pandemic internationally is by looking at all-cause mortality compared with the five-year average.”

So what do the new numbers show? Sweden has had negative excess mortality. In other words, the level of mortality between January 2020 and June 2021 was lower than the five-year average. If this isn’t a vindication of Anders Tegnell’s approach, I don’t know what is.

The table below (taken from the ONS report) shows age-adjusted excess mortality from 3rd January 2020 to 18th June 2021. As you can see, Sweden is 8th from bottom, with a value of –2.3%.

Interestingly, the bottom six are all small, geographically peripheral countries (three islands, plus Denmark, Norway and Finland). This suggests that geography and border controls were key, and that lockdowns – in the absence of effective border controls – didn’t make much difference.

The top seven are all in Eastern Europe, which again suggests that some geographic factor is at work. What may account for high excess mortality in these countries is the fact that all of them missed the first wave, and hence had even bigger epidemics in the winter. Official Covid death rates are shown below:

If true, this would constitute strong evidence against the House of Commons’ report, which concluded that Britain should have tried to suppress the first wave. As I’ve noted before, this approach always carried the risk of creating an even bigger epidemic in the winter.  

In any event, Anders Tegnell can give himself a well-deserved pat on the back. His country kept civil liberties largely intact, and ended up with one of Europe’s lowest death tolls. Well done, professor.

Norway Study Finds ZERO Vaccine Effectiveness Against Death for Covid Hospital Patients

A new pre-print study from Norway looking at differences in outcomes between vaccinated and unvaccinated hospital patients has found that being vaccinated makes zero difference to the risk of dying once hospitalised for COVID-19.

“There was no difference in the adjusted odds of in-hospital death between vaccinated and unvaccinated patients in any age group,” the researchers write. They also observed no difference between vaccinated and unvaccinated in the length of hospital stay for patients not admitted to ICU. These findings are adjusted for age and other risk factors so are not simply due to the vaccinated being older or at higher risk (though, as always, the validity of the adjustments may be questioned). The findings also only include patients admitted primarily due to Covid, so aren’t confounded by patients admitted for other reasons who also tested positive at some point.

The researchers did however find that vaccinated patients aged 18-79 had “43% lower odds of ICU admission” and an estimated 26% shorter hospital stay than unvaccinated patients.

It is curious that vaccinated patients were 43% less likely to need ICU but no less likely to die. Did the antibodies from the vaccines just mean that those who were going to fight it off did so a bit more quickly and easily, but the vaccine antibodies weren’t actually able to save anyone who wasn’t going to survive anyway? That appears to be the researchers’ conclusion:

Our results suggest that once hospitalised the risk of death among vaccinated and unvaccinated patients in Norway is similar. However, for survivors the disease trajectory is milder in vaccinated patients, with reduced need for hospital care and organ support.

Despite a Tsunami of Condemnation, Sweden’s Approach to Covid Hasn’t Ended In Disaster

When major Western nations committed themselves to top-down draconian lockdown measures, Sweden was largely alone in allowing life to continue as it had been before. This did not stop journalists or academics, both at home and abroad, from accusing the Nordic nation of performing a dangerous and deadly experiment. But Sweden has fared much better than Western nations which repeatedly shut their societies down for months on end (a fact largely ignored by the mainstream media). Johan Anderberg, writing in UnHerd, has more.

Until recently, prohibition remained the largest experiment in social engineering a democracy had ever undertaken. And then, in early 2020, a new virus began to spread from China. Faced with this threat, the world’s governments responded by closing schools, banning people from meeting, forcing entrepreneurs to shut their businesses and making ordinary people wear face masks. Like prohibition, this experiment provoked a debate. In all the democracies of the world, freedom was weighed against what was perceived as security; individual rights versus what was considered best for public health.

Few now remember that for most of 2020, the word ‘experiment’ had negative connotations. That was what Swedes were accused of conducting when we, unlike the rest of the world, maintained some semblance of normality. The citizens of this country generally didn’t have to wear face masks; young children continued going to school; leisure activities were largely allowed to continue unhindered…

During the year that followed, the virus continued to ravage the world and, one by one, the death tolls in countries that had locked down began to surpass Sweden’s. Britain, the United States, France, Poland, Portugal, the Czech Republic, Hungary, Spain, Argentina, Belgium, all countries that had variously shut down playgrounds, forced their children to wear facemasks, closed schools, fined citizens for hanging out on the beach and guarded parks with drones, have all been hit worse than Sweden. At the time of writing, more than 50 countries have a higher death rate. If you measure excess mortality for the whole of 2020, Sweden (according to Eurostat) will end up in 21st place out of 31 European countries. If Sweden was a part of the U.S., its death rate would rank number 43 of the 50 states.

This fact is shockingly underreported. Consider the sheer number of articles and TV segments devoted to Sweden’s foolishly liberal attitude to the pandemic last year, as well as the daily reference to figures that are forgotten today. Suddenly, it is as if Sweden doesn’t exist. When the Wall Street Journal recently published a report from Portugal, it described how the country “offered a glimpse” of what it would be like to live with the virus. This new normal involved, among other things, vaccine passports and face masks at large events like football matches. Nowhere in the report was it mentioned that in Sweden you can go to football matches without wearing a facemask, or that Sweden, with a smaller proportion of Covid deaths over the course of the pandemic, had ended virtually all restrictions. Sweden has been living with the virus for some time.

The WSJ is far from alone in its selective reporting. The New York TimesGuardian, BBCThe Times, all cheerleaders for lockdowns, can’t fathom casting doubt on their efficacy.

Worth reading in full.

New Lancet Study From Sweden Shows Vaccine Effectiveness Against Infection Dropping to Zero and Sharp Decline Against Severe Disease As Well

To judge from recent scientific and media output, there appear to be two parallel realities currently existing side-by-side in Covid world. In one, the vaccines are highly effective at preventing infection and transmission, and any data that suggests otherwise is being misrepresented or is biased or contains some kind of basic error. In the other – the one that bears a much closer resemblance to the one we actually live in – vaccine effectiveness against infection has been declining significantly and after six months is basically zero. At some point, one of these realities is going to have to give way because they can’t both be true. I know which one my money’s on.

An example of the first appeared in New Scientist this week, headlined: “How much less likely are you to spread COVID-19 if you’re vaccinated?” The answer: at least 63%, according to a new population-based pre-print study from the Netherlands.

A recent study found that vaccinated people infected with the Delta variant are 63% less likely to infect people who are unvaccinated.

This is only slightly lower than with the Alpha variant, says Brechje de Gier at the National Institute for Public Health and the Environment in the Netherlands, who led the study. Her team had previously found that vaccinated people infected with Alpha were 73% less likely to infect unvaccinated people.

What is important to realise, de Gier says, is that the full effect of vaccines on reducing transmission is even higher than 63%, because most vaccinated people don’t become infected in the first place.

De Gier and her team used data from the Netherlands’ contact tracing system to work out the so-called secondary attack rate – the proportion of contacts infected by positive cases. They then worked out how much this was reduced by vaccination, adjusting for factors such as age.

The data comes from August and September 2021, when Delta was dominant in the Netherlands. The key table, breaking the figures down by whether the index case and contacts were vaccinated, is below.

Sweden Suspends Use of Moderna Covid Vaccine in Under-30s Due to Concerns about Side Effects

Swedish health authorities have suspended the use of the Moderna Covid vaccine in people aged 30 and under due to concerns about side effects, including inflammation of the heart muscle. The Independent has the story.

The reason for the pausing is “signals of an increased risk of side effects such as inflammation of the heart muscle or the pericardium” – the double-walled sac containing the heart and the roots of the main vessels, Sweden’s Public Health Agency said in a statement. “The risk of being affected is very small.” 

Anders Tegnell, Sweden’s Chief Epidemiologist, said they “follow the situation closely and act quickly to ensure that vaccinations against Covid are always as safe as possible and at the same time provide effective protection” against the disease.

In July, the European Medicines Agency recommended authorising Moderna’s Covid vaccine for children ages 12 to 17, the first time the shot has been authorised for people under 18.

Moderna’s vaccine was given the green light for use in anyone 18 and over across the 27-nation European Union in January. It has also been licensed in countries including Britain, Canada and the U.S., but so far its use hasn’t been extended to children. To date, the Pfizer vaccine is the only one approved for children under 18 in Europe and North America.

Hundreds of millions of Moderna doses already have been administered to adults. In a study of more than 3,700 children ages 12 to 17, the vaccine triggered the same signs of immune protection, and no Covid diagnoses arose in the vaccinated group compared with four cases among those given dummy shots.

Sore arms, headache and fatigue were the most common side effects in the young vaccine recipients, the same ones as for adults.

U.S. and European regulators caution, however, that both the Moderna and Pfizer vaccines appear linked to a rare reaction in teenagers and young adults — chest pain and heart inflammation.

The Swedish health authorities said that the heart symptoms “usually go away on their own,” but they must be assessed by a doctor. The conditions are most common among young men, in connection with, for example, viral infections such as Covid. In 2019, approximately 300 people under the age of 30 were treated in hospital with myocarditis.

Data point to an increased incidence also in connection with vaccination against Covid, mainly in adolescents and young adults and mainly in boys and men.

Worth reading in full.

No, Minister, Vaccine Passports Are Not Necessary to End the Pandemic

Vaccines Minister Nadhim Zahawi has insisted to MPs in the Commons that vaccine passports are necessary to end the pandemic. The evidence, however, suggests otherwise.

While the U.K. has seen a spike in reported ‘cases’ in recent days, much of it is driven by the increase in testing as schools have returned. The positive rate, by contrast, shows a gentle decline.

There’s no sign here of vaccine passports being needed to prevent unmanageable spread.

What about elsewhere? Israel is a highly vaccinated country which got in there early with vaccines, so that upwards of 55% of the population has been double vaccinated since early April, and it has made extensive use of vaccine passports.

India, by contrast, is a low vaccination country which only recently broke through 10% double vaccinated.

How are they faring? Israel is currently experiencing a big surge in Delta infections, at a time when over 62% of the population is double vaccinated.

When Will Neil Ferguson Admit He Got it Wrong?

We’re publishing another critique today, this one by Glen Bishop, of the new paper in Nature by Neil Ferguson and others claiming that a lockdown in Sweden would have resulted in a two- to four- fold reduction in mortality. Hard to credit they’re still banging this drum, given that Ferguson’s team originally predicted the absence of a lockdown in Sweden would have resulted in up to 90,000 deaths by July 2020. The real number was 5370. When will Ferguson admit he simply got it wrong?

In the latest episode of the Imperial modelling saga, Imperial have dusted off old modelling techniques and cherry picked the time scale and countries in a study to try to disparage the Swedish success, the Achilles heel of the lockdown lobby. In the paper published in Nature, Imperial propose a counterfactual model, whereby the Danish, Swedish and British responses to coronavirus are transposed to the other two countries respectively, to compare the effectiveness of each approach in reducing covid mortality when accounting for the heterogeneities between the countries.

Imperial’s team models the respective change in R value through the first months of the pandemic using the death data from each country. Interestingly, it implies that the R0 value of the virus in March 2020 in the U.K. was around 4.5, far higher than previous estimates of 2.5 to 3. These changes in the R-value are then applied to the other countries. The problem is that the Imperial team then retrospectively model the pandemic for each hypothetical scenario using the same flawed modelling techniques which have consistently been wildly inaccurate. Despite Professor Ferguson misleading Matt Ridley at a select committee hearing to suggest Imperial had not produced estimates for Sweden, his Imperial team had in fact predicted between 30,000 and 42,000 deaths in Sweden with social distancing lockdowns and up to 90,000 deaths by July 2020 if the pandemic was left unmitigated. By July 2020 the actual figure was 5370, an order of magnitude below Imperial’s predictions.

Should We Be Surprised That Case Numbers Have Been Falling?

“Scientists are scratching their heads over the precipitous decline in daily COVID-19 infections”, says a recent article in the journal Nature. “A sharp fall in the number of people testing positive has surprised scientists”, says a piece in the FT. According to the epidemiologist John Edmunds, “Nobody really knows what’s going on.”

Should scientists really be surprised by the fall in case numbers? Yes, some remaining restrictions were lifted on July 19th – the U.K.’s supposed ‘Freedom Day’. But cases have fallen in the absence of restrictions many times before. It’s therefore hardly surprising they would do so again.

To identify previous examples where infections fell in the absence of restrictions, I utilised the Oxford Blavatnik School’s COVID-19 Government Response Tracker. Specifically, I looked for examples where cases fell from a peak at a time when there were no mandatory business closures in place, and there was no mandatory stay-at-home order.

I was able to identify nine examples. (And note: one’s ability to identify examples is limited by the fact that almost all countries have had either mandatory business closures or a mandatory stay-at-home order in place during each successive wave of the virus.)

The nine examples are as follows: Sweden in the spring of 2020; Japan in the spring, the summer and the winter of 2020; North Dakota in the winter of 2020; South Dakota in the winter of 2020; Wyoming in the winter of 2020; Utah in the winter of 2020; and Iowa in the winter of 2020.

In all nine cases, infections fell in the complete absence of either mandatory business closures or a mandatory stay-at-home order. (Though in some of the cases, there were restrictions on large gatherings, or other less intrusive measures in place.)

It should be noted that all these locations other than Japan have relatively low population densities – which presumably equates to lower transmission, all else being equal. (And Japan’s “success” in dealing with the virus may be due to some cultural or biological factor that is common to every country in South East Asia.) Nonetheless, differences in population density are of degree not of kind.

So what explains the declines – did people just change their behaviour voluntarily? Not necessarily, as I’ve noted before. In South Dakota, cases began falling rapidly in mid November, despite almost no government restrictions and little change in people’s overall mobility. How could this happen?

One possible explanation is super-spreaders. We know there is substantial variation in transmissibility across individuals. Most people don’t transmit the virus to anyone; but a few people spread it to many others. Perhaps cases start declining once enough of these super-spreaders have been infected.

Whatever the true explanation, lockdowns are not necessary for infections to start falling (even if they may cause this to happen slightly earlier or slightly faster than otherwise). Why, then, are the scientists so puzzled?

One reason, as Philippe Lemoine noted in our recent interview, is that some epidemiological models simply assume that only lockdowns can have a large effect on transmission. Not particularly scientific, you might say, but that’s modelling for you.

The fact that infections have been falling in the U.K. is actually even less surprising than I’ve suggested so far. That’s because over 93% of Britons now have Covid antibodies – acquired from either vaccines or natural infection (whereas in the examples listed above, the numbers were far lower).

In summary, a decline in case numbers is only surprising if you’re reasoning from a flawed model.

Is Christopher Snowdon an Anti-Vaxxer?

Christopher Snowdon is plainly an anti-vaxxer, however well he tries to hide it. “Existing Covid vaccines are simply not good enough at preventing transmission and infection,” he writes. Hasn’t he read the trial results, showing 95% efficacy against infection for the Pfizer vaccine and 74% for the AstraZeneca vaccine? Or the large population study from Israel showing Pfizer’s 92% efficacy? Or the study from Public Health England showing 67% and 88% vaccine efficacy against the Delta variant for AstraZeneca and Pfizer vaccines respectively?

On what does he base his bald assertion that they are “not good enough at preventing transmission and infection”? Clearly not the science. He doesn’t appear to feel it necessary to give a single scientific reference for a claim that flies in the face of all these respectable studies, leaving the baffled reader assuming he must have picked it up in some article he read on an obscure website somewhere, presumably by a pseudo-scientific sceptic in denial.

This, of course, is not the way to go about intelligently criticising someone’s viewpoint. Which is precisely my point. As it happens, I agree with Christopher that the current vaccines are not very good at preventing infection or transmission, particularly now the Delta variant is in town. But I’m also aware that that is not the current mainstream scientific position (though it is based on recent official data and reports). Rather, it is currently a claim being circulated among the very networks that Christopher pillories in his recent piece in Quillette, naming and shaming the “coronavirus cranks”.

It seems, then, that Christopher is not averse to a spot of ‘crankery’ himself. But how helpful really is all this name-calling, mudslinging and smear by association? Science does not advance by consensus, by everyone agreeing, or by closing down dissenters. Christopher himself is evidently sceptical of one of the key mainstream vaccine claims – that they are highly effective against infection and transmission – so inadvertently places himself within the ambit of his own polemic. Indeed, at one point he fires a shot at the ‘smileys’, as he calls sceptics, for being sceptical of the vaccines, arguing the jabs “have been tested in clinical trials and have demonstrated their safety and effectiveness beyond reasonable doubt in recent months”. Yet he himself goes on to doubt their effectiveness!