Thank you for this. At the time, Sweden's more relaxed approach presented a fascinating test case and it's good to see a rigorous analysis of the possible effects of this approach.
This paragraph raises a technical question in my mind:
"Partly, the catch-up in excess mortality (which is not seen in official Covid death count) may be an illustration of the reality that if you prevent a 90-year-old from dying of Covid in March 2020 — well, many such people are going to die by September 2022, even if kept safe from Covid. So part of the catch-up is because some of the “lives saved” unfortunately couldn’t be saved for very long."
In the operational definition of "excess mortality" that you've used, is the figure cumulative for the entire period, or a month-by-month calculation based on expected death rates for those alive in each period?
In other words, in expressing the excess death rate for the period of January 2020 through July 2022 for the age group 85-90 (for example), does that reflect the aggregate deaths versus the expected deaths (based on the earlier comparison period) for the time period viewed as a unitary whole or does it represent the sum of each month's excess death rate based on the number of people alive at the beginning of that month?
To me, it seems that the latter measure (if feasible) would tend to avoid the "catch-up" effect that you point out. In the cumulative model, the mere fact that the countries that avoided early deaths would mean that there are just numerically more old people left alive who can die. But if that larger group of old people are dying in July 2022 at *rates* no higher than they died in the comparable earlier period, there should be no "catch-up" effect.
I'm no statistician, so I readily concede that what I'm saying here might not make much sense at all.
Agreed, it should be possible to mostly exclude the "catch-up" effect by graphing the non-cumulative *rate* of death by age group over time.
I say mostly, because the lives saved are likely to be disproportionately sicker, even for their age group. To take an example, if we imagine that Norway prevented all Covid deaths, and Sweden didn't: First, there be more old people in Norway post-Covid, but that is solved by just taking their *rate* of death, like you suggest. However, it's also likely that the frailest old people in Sweden would be the ones that were killed; so, post-pandemic, Swedish old people will be healthier than Norwegians, even after adjusting for age, because the sicker ones were killed. As a result, you'd still see some "catch up" for Norway (compared to Sweden.)
To totally eliminate "catch up," you'd have do the rate for both old people and also, somehow, adjust for health level.
That said, nothing is perfect, so the simple age rate graph you suggest could still be interesting to make, and could give some sense of how much of the increase in a place like Norway is due to catch-up, vs representing an actually-higher rate of death.
One big difference against at least Norway (I don't know about Denmark and Finland) is how medical and elderly care is organized.
In Norway this is centrally organized while in Sweden there are 21 (I think) regions with little to non coordination in between.
Elderly care in organized on a municipality level, so 290 different organizations there.
This led to that some regions did okay and some were sub par. It also made it slow to impossible for the government to to take adequate actions regarding health and elderly care.
I don't know where you got the information: "Less quantifiably, nordic people are known to be “colder” — to associate more with very close friends, and less with strangers and acquaintances — and to want more personal space. " but I think it is mistaken w. r. t. the associations. Most Swedes are members of at least one sports club, and at least one social/hobby club, and often many more. The people you know there are acquaintances and not close friends, and you see them all the time (often weekly). People who move to Sweden and aren't aware that this is where all the casual socialising happens often get the idea that it doesn't happen at all, because they never get invited to things.
Many of these activities was canceled during the peaks of covid though. Either by the restrictions on how many people that were allowed to gather on the same spot or actually by the club/society itself taking it's responsibility to not contribute to the spread.
Outside that context you really don't approach or talk to people you don't know while that it much more common in other countries.
Something else which may be significant is that the variant that was prevelant in Sweden in the first wave was not the same one that was prevalent in Denmark, Norway and Finland.
They mostly were sick with 'EU1' and 'EU2'. Sweden was sick with S:1122L . We have no clue if this was something that a traveller from a country that wasn't identifying variants brought home to Sweden, or if it first emerged locally, but the fact that only Latvia also had this variant in large numbers tends to support the idea that it originated here. Was it more or less transmissible than EU1 and EU2 which we also had but which lost out to S1122L here? And was the illness it produced more severe? We have no clue, and no way to find out now.
> Out of 22 non-Nordic EU countries, Sweden did better than all but two of them (Ireland and Switzerland.)
Switzerland is not a member of the EU.
I know that, but obviously slipped though. Thanks!
The statement is still not true:
> Out of 22 non-Nordic EU countries, Sweden did better than all but Ireland.
Luxembourg did better than Sweden. It's non-Nordic, but a EU member.
I was hoping it was "obvious" that I'm not counting micro- countries. Since it's not, I've revised to:
>> Out of 22 EU countries (putting other nordic and tiny countries aside,) Sweden did better than all but Ireland.
Thanks.
Thank you for this. At the time, Sweden's more relaxed approach presented a fascinating test case and it's good to see a rigorous analysis of the possible effects of this approach.
This paragraph raises a technical question in my mind:
"Partly, the catch-up in excess mortality (which is not seen in official Covid death count) may be an illustration of the reality that if you prevent a 90-year-old from dying of Covid in March 2020 — well, many such people are going to die by September 2022, even if kept safe from Covid. So part of the catch-up is because some of the “lives saved” unfortunately couldn’t be saved for very long."
In the operational definition of "excess mortality" that you've used, is the figure cumulative for the entire period, or a month-by-month calculation based on expected death rates for those alive in each period?
In other words, in expressing the excess death rate for the period of January 2020 through July 2022 for the age group 85-90 (for example), does that reflect the aggregate deaths versus the expected deaths (based on the earlier comparison period) for the time period viewed as a unitary whole or does it represent the sum of each month's excess death rate based on the number of people alive at the beginning of that month?
To me, it seems that the latter measure (if feasible) would tend to avoid the "catch-up" effect that you point out. In the cumulative model, the mere fact that the countries that avoided early deaths would mean that there are just numerically more old people left alive who can die. But if that larger group of old people are dying in July 2022 at *rates* no higher than they died in the comparable earlier period, there should be no "catch-up" effect.
I'm no statistician, so I readily concede that what I'm saying here might not make much sense at all.
Thank you!
Agreed, it should be possible to mostly exclude the "catch-up" effect by graphing the non-cumulative *rate* of death by age group over time.
I say mostly, because the lives saved are likely to be disproportionately sicker, even for their age group. To take an example, if we imagine that Norway prevented all Covid deaths, and Sweden didn't: First, there be more old people in Norway post-Covid, but that is solved by just taking their *rate* of death, like you suggest. However, it's also likely that the frailest old people in Sweden would be the ones that were killed; so, post-pandemic, Swedish old people will be healthier than Norwegians, even after adjusting for age, because the sicker ones were killed. As a result, you'd still see some "catch up" for Norway (compared to Sweden.)
To totally eliminate "catch up," you'd have do the rate for both old people and also, somehow, adjust for health level.
That said, nothing is perfect, so the simple age rate graph you suggest could still be interesting to make, and could give some sense of how much of the increase in a place like Norway is due to catch-up, vs representing an actually-higher rate of death.
Great, glad to hear you didn't think I was completely off-base here.
One big difference against at least Norway (I don't know about Denmark and Finland) is how medical and elderly care is organized.
In Norway this is centrally organized while in Sweden there are 21 (I think) regions with little to non coordination in between.
Elderly care in organized on a municipality level, so 290 different organizations there.
This led to that some regions did okay and some were sub par. It also made it slow to impossible for the government to to take adequate actions regarding health and elderly care.
I don't know where you got the information: "Less quantifiably, nordic people are known to be “colder” — to associate more with very close friends, and less with strangers and acquaintances — and to want more personal space. " but I think it is mistaken w. r. t. the associations. Most Swedes are members of at least one sports club, and at least one social/hobby club, and often many more. The people you know there are acquaintances and not close friends, and you see them all the time (often weekly). People who move to Sweden and aren't aware that this is where all the casual socialising happens often get the idea that it doesn't happen at all, because they never get invited to things.
Many of these activities was canceled during the peaks of covid though. Either by the restrictions on how many people that were allowed to gather on the same spot or actually by the club/society itself taking it's responsibility to not contribute to the spread.
Outside that context you really don't approach or talk to people you don't know while that it much more common in other countries.
Something else which may be significant is that the variant that was prevelant in Sweden in the first wave was not the same one that was prevalent in Denmark, Norway and Finland.
They mostly were sick with 'EU1' and 'EU2'. Sweden was sick with S:1122L . We have no clue if this was something that a traveller from a country that wasn't identifying variants brought home to Sweden, or if it first emerged locally, but the fact that only Latvia also had this variant in large numbers tends to support the idea that it originated here. Was it more or less transmissible than EU1 and EU2 which we also had but which lost out to S1122L here? And was the illness it produced more severe? We have no clue, and no way to find out now.
https://covariants.org/per-country?country=Denmark&country=Sweden&country=Norway&country=Finland&country=Latvia&country=Estonia&country=Iceland