The Morning Jolt


Let’s Talk About the Swedish Approach

A man walks past the Royal Swedish Opera, amid the coronavirus outbreak in Stockholm, Sweden, April 27, 2020. (Fredrik Sandberg/Reuters)

It’s not easy to shop these days, but Sunday is Mother’s Day, so remember to go out and get her something — even if it’s just a card and flowers from the grocery store. I’ve got the best. Thank you for everything, Mom.

On the menu today: a long look at Sweden, a short look at Mexico, and the return of the pop-culture podcast.

The Swedish Approach Won’t Work in a Less-Healthy Nation

“We should do what Sweden did! Try to get to herd immunity as fast as we can!”

Within National Review, John Fund and Joel Hay are more or less advocates or enthusiasts for the Swedish approach, and Nick Frankovich and Ramesh Ponnuru are skeptics.

As of this writing, Sweden has 24,623 cases of coronavirus and 3,040 deaths. Sweden has 2,438 cases per million people and 301 deaths per million people. The United States has 3,906 cases per million people . . . but only 232 deaths per million people.

Sweden currently ranks tenth in the world in deaths per million people. It is worth noting that an outbreak in a tiny, densely populated country can rocket a country to the top of the list. At this moment, San Marino, a microstate entirely surrounded by Italy, ranks first. Andorra, a tiny country between Spain and France, ranks third. Sint Maarten, the Dutch-speaking half of an island in the Caribbean, ranks eighth. The United States ranks 13th, with the Isle of Man stuck between us and Sweden.

Perhaps the most important point in the discussion around Sweden is the recognition that different countries’ populations will have different preexisting health conditions; what works for one won’t necessarily generate the same results.

Begin with the question of scale. If you look at the top ten most populous countries in the world, many of them are authoritarian, dealing with significant poverty, or both: China, India, Indonesia, Pakistan, Nigeria, Brazil, Bangladesh, Russia, Mexico. (Read to the end of today’s newsletter for an important related point.)

Heading into a crisis like this, the United States has to ensure access to personal protective equipment, hospital beds, ICU units, tests, potential treatment drugs, for the potential treatment of 330 million people (although I suppose you could rule out the population under 18). That’s just a much more difficult task than securing what’s needed to prepare for a viral outbreak in Hong Kong (7 million people), Taiwan (23 million people), or South Korea (51 million people). All of those countries have handled the outbreak well, and significantly better than the U.S. — but we should keep the degree of difficulty in mind.

Sweden has about 10 million people. Much like the United States, Sweden is having serious outbreaks of the virus in nursing homes, and complaints about insufficient access to personal protective equipment. Much like the United States, their rate of testing is increasing much less quickly than their leaders wanted.

When you compare populations, other key differences become clearer. Sweden has about 4 million citizens over the age of 60; the United States has about 150 million. (UPDATE: Nationmaster puts this sum at 148.6 million, but the Population Reference Bureau and the Census Bureau put it at about 52 million. The point stands that the U.S. has many, many times more elderly to protect from the virus.) With 7.6 million people living in urban areas, Sweden ranks 57th in the world in that metric. We rank third with almost 240 million. Neither of our population densities is particularly high by world standards, but ours is a little higher.

A Goldman Sachs assessment noted that the Swedish approach wouldn’t work for many other European countries: “Its population density is about half that of Italy, and Sweden has a high proportion of single-occupancy households, and a relatively low proportion of multi-generational households.”

Perhaps most importantly, Sweden is literally the least-obese country in the world, just 12 percent. We rank 16th, with 33 percent of our population being obese. (Some put the percentage of obese Americans closer to 40 percent.)

A study of coronavirus patients admitted to the intensive care unit at university hospitals at Johns Hopkins, University of Cincinnati, New York University, University of Washington, Florida Health, and University of Pennsylvania found “an inverse correlation between age and body mass index” — meaning the younger a person was in the ICU, the more likely they were to be obese. (“Obese” means a body mass index over 30; for someone who is 5 feet, 9 inches tall, that would be 203 pounds or more.)

From this, it is not hard to imagine an attempt at “herd immunity” in the United States that would result in a much higher death rate, because we have more people who are obese. We can argue about why America has more obese people, but there’s little that can be done to change that fact now or in the near future. (If losing excess weight was easy, everyone would be doing it already.)

Now imagine Sweden’s minimalist approach in the U.S. and how that would effect not just obese Americans, but those with heart disease, high blood pressure, diabetes, asthma, smokers, those undergoing cancer treatment, bone marrow or organ transplants, HIV, kidney disease or undergoing dialysis, liver disease, lupus, any other potential immunocompromised condition, and those 65 and over. We have a lot of people who are “healthy enough” to function on a day to day basis, but who have at least one condition that would make a fight with coronavirus life-threatening. Your mileage may vary, but I look at the millions upon millions of Americans who could lose that fight with the virus and find the Swedish approach unworkable here — just too much risk to too many people.

Right now, the Sweden fans are arguing, “But they’re not going to have a second wave!” We will see. We’re still quite a long way from being finished with the first wave. There are good reasons to think that the second wave in the United States may not be as bad.

As for the notion that this approach spared the Swedish economy . . . the Wall Street Journal looks at the country and concludes that they’re going to have a slightly less bad economic recession — not that they will be spared:

Sweden’s decision not to impose a mandatory national lockdown has drawn global attention from policy makers eager to judge the strategy’s impact on public health and the economy. But it turns out the situation here is not as different as it might first appear.

Even without legal prohibitions, many Swedes are voluntarily following authorities’ social-distancing recommendations and limiting travel, pushing down domestic consumption. And the country can’t insulate itself from lockdowns among its trading partners. Exports are falling.

The result: Sweden’s economy is contracting, but not by as much as some others in Europe. Meanwhile, it is recording deaths per capita from the virus that are considerably higher than in neighboring countries — though below levels seen in France, Italy and the U.K.

Shops, restaurants and even nightclubs have been allowed to stay open in Sweden. There are no curbs on the manufacturing and services industries. But that doesn’t mean life is normal here.

Despite recent warm weather, streets are quieter and business is slower because many Swedes, like Ms. Sandblom, take government guidelines seriously and even go beyond them to avoid catching the highly contagious pathogen.

All of that is contributing to what Sweden’s government estimates will be a 6 percent contraction in domestic consumption this year. Combined with a forecast 10 percent drop in exports, Swedish authorities predict, the result will be a 7 percent decline in overall 2020 economic output.

Maybe that looks good in light of today’s utterly abysmal jobs numbers. But it seems to me that much of the discussion around Sweden is driven by a desire to believe that there is an easier path out there, that our leaders are just too dumb to see it, and that by yelling loudly about it enough, America will alter its course.

People hate the lockdowns — now wrapping up week eight — with good reason. Thankfully, most states are starting to loosen the rules here and there; as the weather improves, more people will want to spend more time outside and enforcement is going to start being impossible. Post-lockdown America will not mean post-coronavirus America.

Big Countries Are Either Hit Hard by the Virus or Lying about It

A few moments ago, I wrote: “If you look at the top ten most populous countries in the world, many of them are authoritarian, dealing with significant poverty, or both.” This means that the United States is arguably the only country in the world that has high population, considerable wealth compared to other countries, and can be trusted to count and report its coronavirus cases and deaths in a reasonably accurate manner. (Yes, yes, I hear you, I said “reasonably accurate,” and whatever the flaws in our data, our numbers are sure as hell more accurate than the ones coming out of Beijing or Moscow.)

And it appears the Mexican government isn’t being honest about their situation, either:

The Mexican government is not reporting hundreds, possibly thousands, of deaths from the coronavirus in Mexico City, dismissing anxious officials who have tallied more than three times as many fatalities in the capital than the government publicly acknowledges, according to officials and confidential data reviewed by The New York Times.

The tensions have come to a head in recent weeks, with Mexico City alerting the government to the deaths repeatedly, hoping it will come clean to the public about the true toll of the virus on the nation’s biggest city and, by extension, the country at large.

But that has not happened. Doctors in overwhelmed hospitals in Mexico City say the reality of the epidemic is being hidden from the country. In some hospitals, patients lie on the floor, splayed on mattresses. Elderly people are propped up on metal chairs because there are not enough beds, while patients are turned away to search for space in less-prepared hospitals. Many die while searching, several doctors said.

The End of Grading Presidents on Performance

An observation from Ramesh about the idea that most elections are referendums on the performance of the incumbent: “In retrospect, it appears that the referendum theory of presidential elections was an artifact of a less politically polarized time. When a lot of voters floated between the parties, presidents could win or lose landslides based on their perceived performance. Now we have two hardened and roughly evenly matched party coalitions with more uniformly antagonistic views, and almost all voters lean toward one or the other of them.”

ADDENDUM: As promised yesterday, a new, long, and uncensored edition of the Jim and Mickey Show, tackling lockdown life, those horrible commercials that begin “in this time of uncertainty . . .” ESPN’s The Last Dance, a bit about Tiger King, a lot about Counterpart, the outbreak of Karens, when or if we’ll ever go back to movie theaters, and more.


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