Sweden

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!

Sweden Avoided a ‘Pingdemic’. Why Couldn’t We?

A reader, who wishes to remain anonymous, has sent the following post, comparing Britain’s enthusiastic embrace of a contact-tracing app with Sweden’s more considered approach.

As the U.K.’s ‘pingdemic’ spreads ever wider, wreaking havoc on hospitals, care homes, schools, supermarkets, and the economy, one person at least might afford himself a wry smile.

In the early months of the pandemic, many Swedish epidemiologists, virologists and other medical specialists implored their Prime Minister Stefan Löfven and Health Minister Lena Hallengren to build a contact-tracing app. Tech companies fell over themselves to claim they had the necessary expertise to do just that. Development actually got underway, but once state epidemiologist Dr Anders Tegnell and his team had evaluated the viability of such an app and come to the view it would cause excessive fear and large-scale disruption, Löfven was talked out of it and all work ceased.

In an interview on Swedish Television in May of last year, Tegnell said he didn’t think the idea of an app had been “properly thought through'” (He could have said the same of a great deal else of U.K. pandemic decision-making and implementation). He foresaw large numbers of ‘pings’ being generated and vast resources being expended on staffing and testing. Many people would be worried for no good reason and hospitals and care homes would come under more pressure as staff would have to self-isolate. He also questioned whether a distance as great as two metres for a period as short as 15 minutes were appropriate parameters.

Tellingly, when asked: “Wouldn’t it be worthwhile at least in controlling the spread of infections?”, he replied: “Few of the contacts (of a person with a positive test result) would be infected. For every person ill with Covid, I would reckon about 30 healthy people would be urged to self-isolate unnecessarily.”

Is there any evidence that the U.K. Government’s much-vaunted contact-tracing NHS COVID-19 App, run by NHS Test and Trace, has nevertheless been successful? According to politicians of all parties and medics of many disciplines, the answer is a resounding no.

Referring to the current £37 billion projected cost of Dido Harding’s test and trace operation, Lord Macpherson, who was Permanent Secretary at the Treasury from 2005 to 2016 and worked on 33 Budgets and 20 Spending Reviews, went so far as to say: “This wins the prize for the most wasteful and inept public spending programme of all time.”

To paraphrase Tegnell’s famous commentary on Sweden rejecting a large-scale lockdown of society: “It was as if the world had gone mad about contact-tracing apps, and everything we needed to consider was forgotten. The cases became too many and the political pressure got too strong. And then Sweden stood there rather alone.”

New Paper Claims Lockdowns Do Not Cause More Health Harms Than They Prevent, but It Misses the Big Picture

A new paper in BMJ Global Health purports to debunk lockdown sceptics’ claim that “the cure is worse than the disease”. However, it misses the big picture; in fact, it hasn’t shifted my priors one jot.

The paper contains no new data or analysis. Rather, it comprises a review of the existing literature. The authors focus on the claim that “lockdowns cause more health harms than COVID-19 by examining their impacts on mortality, routine health services, global health programmes and suicide and mental health”.

In other words, they attempt to show that lockdowns do not cause more health harms than they prevent. Notice: this is not the same as showing that lockdowns pass an overall cost-benefit test. Even if lockdowns were a net positive for public health, they could still be a massive net negative for society (taking into account their effects on the economy, education and civil liberties).

The strongest argument the authors make (with which I was already familiar) is that excess mortality in countries like Australia and New Zealand – which managed to contain the virus – was zero or negative last year. Since these countries did not experience an epidemic of COVID-19, but did see weeks or even months of lockdown, the lack of excess mortality suggests that lockdowns themselves do not cause many deaths.  

However, some lockdown sceptics would argue that – even if lockdowns don’t cause many deaths in the short-term – they do cause more deaths in the long-term, via missed cancer screenings, drug overdoses etc. And here the authors are much less persuasive.

They concede that “the connection between lockdowns and missed contact with health systems is very well established”. However, they claim this association “may be related to lack of capacity of healthcare services or impacts of the pandemic itself rather than measures taken by governments”.

There is “no doubt”, the authors admit, “that global health programmes have been disrupted”. But they argue such disruptions were caused by “multiple complex direct and indirect consequences of COVID-19, not just stay-at-home orders”.

So they acknowledge that lockdowns do have harmful long-term effects. And given that those long-term effects are yet to be quantified, the authors have little basis for concluding that lockdowns are “unlikely to be causing harms more extreme than the pandemic itself”.

COVID-19 Mortality Rate Among Children Is Even Lower Than Previously Thought

We’ve known since the early weeks of the pandemic that age is the single best predictor of COVID-19 mortality, and that the risk of death for young people is vanishingly small.

A letter in the New England Journal of Medicine reported that zero Swedish children aged 1–16 died of COVID-19 up to the end of June 2020. And only 15 were admitted to the ICU, of whom four had a serious underlying health condition.

Of course, England is a much larger country than Sweden, and it’s been a whole other year since those Swedish data were collected. So how many English children have died of COVID-19?

In an unpublished study, Clare Smith and colleagues sought to identify the number of COVID-19 deaths among people aged under 18 between March 2020 and February 2021. They examined data from the National Child Mortality Database, which was linked to testing data from Public Health England and comorbidity data from national hospital admissions.

The structure of their dataset allowed the authors to distinguish deaths that were plausibly from COVID-19 and deaths that were merely with COVID-19.

3,105 under 18s died from all causes in England during the relevant time period. Sixty one of these involved people who had tested positive for the virus. However, the authors determined that only 25 were actually caused by COVID-19. And of the 25, 76% had a serious underlying health condition.

Given that an estimated 469,982 under-18s were infected with the virus up to February of 2021, the survival rate in this age-group (the inverse of the IFR) was 99.995%. What’s more, 99.2% of total deaths were caused by something other than COVID-19.

Smith and colleagues’ findings underline just how small a risk COVID-19 poses to young people, and hence – I would argue – why a focused protection strategy was preferable to blanket lockdowns.  

As early as 10th April 2020, Martin Kulldorff – co-author of the Great Barrington Declaration – published an article on LinkedIn titled ‘COVID-19 Counter Measures Should be Age Specific’.

Based on the data that were then available, he estimated one would need to stop 3.5 million children being exposed in order to prevent the same number of deaths as one could prevent by shielding 1,000 people in their 70s. He argued, therefore, that Covid counter-measures must vary by age.

A similar argument was made by George Davey Smith and David Spiegelhalter in a piece for The BMJ last May. These authors called for “stratified shielding”, while noting that this would “require a shift away from the notion that we are all seriously threatened by the disease”.

According to the medical researcher Russell Viner, who spoke to Nature, “There’s a general feeling among paediatricians that probably too many children were shielded during the first wave.” And the epidemiologist Elizabeth Whittaker said that efforts to shield children “have probably caused more stress and anxiety for families than benefit”.

In addition to “stress and anxiety”, there’s also the learning losses associated with months of online teaching. All this compared to the marginal impact closing schools had on the spread of COVID-19.

When we look back at the response to Covid, serious questions will have to be asked about the costs of lockdown, not only to society in general, but to young people in particular.

A Response to Scott Alexander on Lockdowns

The prolific blogger Scott Alexander has written a long post about lockdowns. It’s not too objectionable from a lockdown sceptic’s point of view. For example, he concedes that “lockdowns weren’t necessary to prevent uncontrolled spread” and says that it’s “harder to justify strict lockdowns in terms of the non-economic suffering produced”.

Nonetheless, I do disagree with him on several points, which I will highlight here.

First, he ignores most of the academic studies that have found little or no effect of lockdowns on mortality. For example, he doesn’t mention Simon Wood’s studies finding that infections were in decline before all three U.K. lockdowns. Nor does he mention the paper by Christopher Berry and colleagues which observed “no detectable health benefits” of shelter-in-place orders in the United States.

Despite ignoring these studies, he dedicates a whole section of his post to something called CoronaGame, which he oddly classifies as “Actual Evidence”.

Second, he compares the official COVID-19 death rate up to August 2020 in Sweden with various other countries, and claims that “Sweden comes out looking very bad, but not the literal worst”. He then claims that “it looks even worse when you compare Sweden to other Scandinavian/Nordic countries”.

However, if he had used age-adjusted excess mortality, and had extended his window of analysis up to the end of 2020, Sweden would not have come out “looking very bad”. As I’ve noted several times, Sweden saw age-adjusted excess mortality up to week 51 of just 1.7% – placing it 14 out of 22 European countries.

And there are several reasons why the “neighbour argument” – the argument that we have to compare Sweden to its immediate neighbours rather than the rest of Europe – isn’t very convincing. Sweden saw unusually low mortality in 2019; border controls (not lockdowns) made the difference in the first wave; and once you include the Baltics, Sweden no longer stands out.

Third, he claims the cost of lockdown “is measured in psychological suffering and economic decline”, noting that in order to do a cost-benefit analysis “we should figure out how much stricter lockdowns affected the economy”.

While the economic impact of lockdown certainly constitutes a major entry on the costs side of the ledger, Alexander neglects to mention another negative impact of lockdown, namely the switch to remote learning. As several studies have shown, this resulted in sizeable learning losses, which were concentrated among children from the most disadvantaged backgrounds.

Alexander’s post offers a decent overview of the debate, but he’s too charitable to the lockdown side, leading him to overstate the benefits of lockdown and understate the costs. Not his best piece of work, in other words.

Keeping Schools Open Had Only a Minor Impact on the Spread of COVID-19 in Sweden

Sweden was one of the few Western countries that kept schools open in the spring of 2020. Pre-schools, primary schools and lower-secondary schools (for those up to age 16) continued with in-person teaching, whereas upper-secondary schools switched to online instruction on March 18th.

Despite this, zero Swedish children died of COVID-19 up to the end of June. In fact, only 15 were admitted to the ICU, and four of these children had a serious underlying health condition. 

So keeping schools open didn’t cause any deaths among Swedish children. But did it increase the spread of COVID-19? Although evidence suggests that children are less infectious than adults, their level of infectiousness is not zero. In addition, teachers could transmit the virus to one another in the staff room, and parents could do so when picking their children up from school.

In a paper published in Proceedings of the National Academy of Sciences, researchers from Stockholm and Upsala University examined the impact of keeping schools open on the spread of COVID-19 in Sweden. Their analysis focused on the period from March 25th to June 30th. 

The authors used rigorous methods to estimate the causal impact of keeping schools open on COVID-19 outcomes among parents, and among teachers. Specifically, they compared parents whose youngest child was in the last year of lower-secondary school (Year 9) to those whose youngest child was in the first year of upper-secondary school (Year 10). 

This method ensured that the two groups of parents were as similar as possible with respect to other possible causes of COVID-19 outcomes. But to be safe, the authors controlled statistically for characteristics like the age, occupation and region of the parents.

They found that there was only one additional positive PCR test per 1,000 parents among those whose youngest child was in the last year of lower-secondary school. They also looked at the number of diagnosed cases of COVID-19, but found this did not differ significantly between the two groups of parents. 

When the authors compared teachers from lower-secondary schools with those from upper-secondary schools, the differences were somewhat larger. However, the overall impact of keeping schools open on the spread of COVID-19 was small. The authors estimate that keeping schools open resulted in 620 more cases in a country that saw more than 53,000 up to mid June. 

They conclude that closing schools “is a costly measure with potential long-run detrimental effects for students”. And their results are “are in line with theoretical work indicating that school closure is not an effective way to contain SARS-CoV-2”.

Sweden’s Mortality Rate Last Year Was Lower Than in 2015

As I’ve mentioned several times, when you calculate mortality the correct way – as the age-standardised mortality rate, or as life expectancy – the year 2020 in England doesn’t look that unusual. Last year’s rate was a fair bit higher than 2019’s, but that was a year of unusually low mortality. 

Plotting the age-standardised mortality rate over time (as the ONS has been doing each month since July of 2020) shows that mortality last year rose to a level last seen in 2008. So while the year-on-year change was large, the level wasn’t particularly high – at least by historical standards. 

Interestingly, this point even found its way into a BBC article last September. The author noted:

And if you look at the age-adjusted mortality rates, which take into account the size and age of the population, you can see that while 2020 has undoubtedly been a bad year compared to recent years, what has been seen in terms of people dying is not completely out of sync with recent history. It is actually comparable with what happened in the 2000s.

Given that 2008 – which, to repeat, saw a higher level of morality than last year – wasn’t that long ago, one might argue the pandemic’s lethality has been overhyped. Of course, others would contend that, if we hadn’t taken the drastic measures we did take, mortality would have risen to a far higher level.

But I’m not convinced the UK’s lockdowns did do much to curb mortality, over and above the effect of restrictions on large gatherings and voluntary social distancing. And I’d argue that we could have saved more lives with a well-executed focused protection strategy.

However, many people continue to insist that mortality would have been far higher in the absence of lockdowns. It’s therefore worth looking once again at Sweden – the only major European country that didn’t lock down.

We already know that Sweden’s age-adjusted excess mortality up to week 51 was only 1.7% – below the European average. But when was the last time its mortality rate was as high as last year?

Going up to the end of week 52, the rate for 2020 – based on the European Standard Population – comes out as 16.4 per 100,000 (which is actually lower than in Denmark). And the last time Sweden saw this level of morality was in 2015 – just five years ago.

So despite taking the least restrictive approach of any major Western country, Sweden’s mortality rate only returned to the level of 2015. This casts doubt on the claim that mortality in the UK would have been much higher in the absence of lockdowns.