Why is Denmark’s coronavirus lockdown so much tougher than Sweden’s?

To outsiders, Denmark and Sweden seem alike, but in their responses to coronavirus, they are at opposite ends of the spectrum. Why the difference and who, if either, is right?

Why is Denmark's coronavirus lockdown so much tougher than Sweden's?
Søren Brostrøm, Director General of the Danish Health Agency has described somme of Denmark's actions as 'political'. Photo:
The differences are quite extreme. Denmark was one of the first countries in Europe to close its borders, and has closed all schools, kindergartens, restaurants, and cafés and banned all gatherings of more than ten people.
In Sweden kindergartens, elementary schools, bars and cafés are still open as normal. 
Christian Wejse, an epidemiologist at Aarhus University, told The Local that he supported Denmark's rapid action to slow the development of the pandemic. 
“I'm a fan. I think we have a brave government and they've been ready to respond very quickly and in a very dramatic manner, even though the consequences are grave in terms of the economy,” he told The Local. “I think what applies here is the old saying, 'if you think preventing disease is expensive: try disease'.”  
In Sweden, state epidemiologist Anders Tegnell has come under fire from both scientists and from the public for not pushing for a tougher lockdown. 
“How many lives are they willing to sacrifice to avoid closing down and risking major consequences for the country's economy,” Joachim Rocklöv, a professor of epidemiology and public health sciences at Umeå University, said in an email conversation obtained by Swedish public broadcaster SVT
But even Søren Brostrøm, Director General of the Danish Health Authority, described Friday's decision to close Denmark's borders as “political”. 
“Border closure was not in our catalogue [of actions]. This is partly because there is fairly modest evidence that it is effective,” he said a press conference on Saturday, adding that it had was not part of the recommendations of the World Health Organisation either. 
Sweden's state epidemiologist Anders Tegnell, who has been the leading force behind Sweden's more gradualist approach, explained to DR why Sweden had taken a more slowly-slowly approach.  
“In Sweden, our assessment is that its not relevant any more to close borders because the infection has already spread so much in every country in Europe, that inhibiting travel wouldn't have an effect,” he said.
The same cost-benefit analysis was behind its decision to not yet close elementary schools and kindergartens. 
“Closing schools is very significant, very complex measure, and we have discussed it a lot,” he said. “We know that we will see a lot of very negative effects from closing schools: you lose workforce in healthcare to an extent which is totally unacceptable to Sweden
“Children will also come out of school and meet a lot of other people, so it increases the risk of spreading the infection to others, and also the risk of spreading it to the elderly, who we think it is very important to protect.” 
On Monday, Denmark's Health Minister Magnus Heunicke was clear that some of his government's actions had no medical or scientific evidence to back them up. 
“We have no evidence that everything we are doing works,” he said. “But we would rather take a step too far today than find in three weeks that we have done too little.” 
“If we have to wait for full evidence to fight the corona, then it is my clear conviction that we will be too late,” Prime Minister Mette Frederiksen said at the same press conference. 

Tegnell put the difference in the two countries' responses down in part to the high level of independence enjoyed by Swedish government agencies such as his employer, the Public Health Agency of Sweden. 
“In Sweden, government agencies are extremely independent, even if it's the government that has the final decision, and we have a long tradition for that,” he said. 
On the one hand, this means decisions are less likely to be made to appeal to public emotions. But on the other, it means Swedish politicians feel less able to bulldoze cautious bureaucrats.  
There are also demographic differences which could have an impact: Sweden has a population density of 25 per square kilometre, whereas Denmark has a population of 137 per square kilometre (although much of Sweden's population is concentrated in the big cities). 
But Tegnell argued that the coronavirus crisis had revealed deeper cultural differences between the two countries than expected. 
“There’s a bigger difference between Sweden and Denmark in many ways than we thought,” he said. “We speak nearly the same language, we share a lot of history and culture — but we have different social systems, and there are differences in the way the population reacts.” 
He said it was difficult to judge at present, but that his feeling was that Denmark's government had acted too rapidly and  heavy handedly.
“From a Swedish perspective, it looks like you are reacting a  little too quickly,” he told DR.  “We will see, after all this has finished, who comes out best.”

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FACT CHECK: Did Sweden have lower pandemic mortality than Denmark and Norway?

A graphic published by the Svenska Dagbladet newspaper last week claimed that Sweden had the lowest excess mortality of all EU and Nordic counties between the start of 2020 and the end of 2022. We looked into whether this extraordinary claim is true.

FACT CHECK: Did Sweden have lower pandemic mortality than Denmark and Norway?

At one point in May 2020, Sweden had the highest Covid-19 death rate in the world, spurring newspapers like the New York Times and Time Magazine to present the country as a cautionary tale, a warning of how much more Covid-19 could ravage populations if strict enough measures were not applied. 

“Per million people, Sweden has suffered 40 percent more deaths than the United States, 12 times more than Norway, seven times more than Finland and six times more than Denmark,” the New York Times reported in July 2020

An article in Time in October 2020 declared Sweden’s Covid response “a disaster”, citing figures from Johns Hopkins University ranking Sweden’s per capita death rate as the 12th highest in the world.

So there was undisguised glee among lockdown sceptics when Svenska Dagbladet published its data last week showing that in the pandemic years 2020, 2021 and 2022 Sweden’s excess mortality was the lowest, not only in the European Union, but of all the Nordic countries, beating even global Covid-19 success stories, such as Norway, Denmark and Finland. 

Versions of the graph or links to the story were tweeted out by international anti-lockdown figures such as Bjørn Lomborg, a Danish sceptic of climate action, and Fraser Nelson, editor of Britain’s Spectator Magazine, while in Sweden columnists like Dagens Nyheter’s Alex Schulman and Svenska Dagbladet’s opinion editor Peter Wennblad showed that Anders Tegnell, the state epidemiologist who led Sweden’s strategy had been “right all along”. 

Excess mortality — the number of people who die in a year compared to the number expected to die based on previous years — is seen by some statisticians as a better measure for comparing countries’ Covid-19 responses, as it is less vulnerable to differences in how Covid-19 deaths are reported. 

But are these figures legitimate, where do they come from, and do they show what they purport to show?

Here are the numbers used by SvD in its chart: 

Where do the numbers come from? 

Örjan Hemström, a statistician specialising in births and deaths at Sweden’s state statistics agency Statistics Sweden (SCB), put together the figures at the request of Svenska Dagbladet. 

He told The Local that the numbers published in the newspaper came from him and had not been doctored in any way by the journalists.

He did, however, point out that he had produced an alternative set of figures for the Nordic countries, which the newspaper chose not to use, in which Sweden had exactly the same excess mortality as Denmark and Norway. 

“I think they also could have published the computation I did for the Nordic countries of what was expected from the population predictions,” he said of the way SvD had used his numbers. “It takes into consideration trends in mortality by age and sex. The excess deaths were more similar for Denmark, Sweden, and Norway. Almost the same.” 

Here are Hemström’s alternative numbers: 

Another issue with the analysis is that the SvD graph compares deaths in the pandemic years to deaths over just three years, a mean of 2017-2019, and does not properly take into account Sweden’s longstanding declining mortality trend, or the gently rising mortality trend in some other countries where mortality is creeping upwards due to an ageing population, such as Finland. 

“It’s very difficult to compare countries and the longer the pandemic goes on for the harder it is, because you need a proper baseline, and that baseline depends on what happened before,” Karin Modig, an epidemiologist at Sweden’s Karolinska Institute whose research focuses on ageing populations, told The Local.

“As soon as you compare between countries, it’s more difficult because countries have different trends of mortality, they have different age structures, and in the pandemic they might have had different seasonal variations.” 

She described analyses such as Hemström’s as “quite crude”. 

In an interview with SvD to accompany the graph, Tegnell also pushed back against giving the numbers too much weight. 

“Mortality doesn’t tell the whole story about what effect a pandemic has had on different countries,” he said. “The excess mortality measure has its weaknesses and depends a lot on the demographic structures of countries, but anyway, when it comes to that measure, it looks like Sweden managed to do quite well.”

Do the numbers match those provided by other international experts and media? 

Sweden’s excess mortality over the three years of the pandemic is certainly below average worldwide, but it is only in the SvD/SCB figures that it beats Norway and Denmark. 

A ranking of excess mortality put together by Our World in Data for the same period as the SvD/SCB table estimates Sweden’s excess mortality between the start of 2020 and the end of 2022 at 5.62 percent, considerably more than the 4.4 percent SvD claims and above that of Norway on 5.08 percent and Denmark on 2.52 percent. 

The Economist newspaper also put together an estimate, using their own method based on projected deaths.  

Our World in Data uses the estimate produced by Ariel Karlinsky and Dmitry Kobak, who manage the World Mortality Dataset (WMD). To produce the estimate, they fit a regression model for each region using historical deaths data from 2015–2019, so a time period of five years rather than the three used by SCB.

What’s clear, is that, whatever method you use, Sweden is, along with the other Nordic countries, among the countries with the lowest excess mortality over the pandemic. 

“Most methods seem to put Sweden and the other Nordic countries among the countries in Europe with the lowest cumulative excess deaths for 2020-2022,” said Preben Aavitsland, the Director for Surveillance and the Norwegian Institute of Public Health.

So if Sweden had similar excess mortality as the other Nordics over the period, does that mean it had a similar Covid-19 death rate?

Not at all. Sweden’s per capita death rate from Covid-19 over the period covered by the SvD/SCB figures, at 2,249 per million people, is more than double Norway’s 959 per million, 60 percent more than the 1,409 per million who died in Denmark, and more than 50 percent more than the 1,612 per million who died in Finland. 

While Sweden’s death rate is still far ahead of those of its Nordic neighbours, it is now much closer to theirs than it was at the end of 2020. 

“The most striking difference between Sweden and the other Nordic countries is that only Sweden had large excess mortality in 2020 and the winter of 2020-21,” Aavitsland explained. “In 2022, the field levelled out as the other countries also had excess mortality when most of the population was infected by the omicron variant after all measures had been lifted.”

So why, if the Covid-19 death rates are still so different, are the excess mortality rates so similar?

This largely reflects the fact that many of those who died in Sweden in the first year of the pandemic were elderly people in care homes who would have died anyway by the end of 2022. 

About 90 percent of Covid-19 deaths were in people above 70, Aavitsland pointed out, adding that this is the same age group where you find around 80 percent of all deaths, regardless of cause, in a Scandinavian country.

“My interpretation is that in the first year of the pandemic, say March 2020 – February 2021, Sweden had several thousand excess deaths among the elderly, including nursing home residents,” he said. “Most of this was caused by Covid-19. In the other [Nordic] countries, more people like these survived, but they died in 2022. The other countries managed to delay some deaths, but now, three years after, we end up at around the same place.” 

So does that mean Sweden’s state epidemiologist Anders Tegnell was right all along? 

It depends on how you view the shortened lives of the close to ten thousand elderly people who caught Covid-19 and died in Sweden in the first wave because Sweden did not follow the example of Denmark, Norway, and Finland and bring in a short three-week lockdown in March and April 2020. 

Tegnell himself probably said it best in the SvD interview. 

“You’ve got to remember that a lot of people died in the pandemic, which is of course terrible in many ways, not least for their many loved ones who were affected, so you need to be a bit humble when presented with these kinds of figures.”