How did Sweden Fail the Pandemic?

Abstract

Sweden has since the start of the pandemic a COVID-19 mortality rate that is 4 to 10 times higher than in the other Nordic countries. Also, measured as age-standardized all-cause excess mortality in the first half of 2020 compared to previous years Sweden failed in comparison with the other Nordic countries, but only among the elderly. Sweden has large socioeconomic and ethnic inequalities in COVID-19 mortality. Geographical, ethnic, and socioeconomic inequalities in mortality can be due to differential exposure to the virus, differential immunity, and differential survival. Most of the country differences are due to differential exposure, but the socioeconomic disparities are mainly driven by differential survival due to an unequal burden of comorbidity. Sweden suffered from an unfortunate timing of tourists returning from virus hotspots in the Alps and Sweden's government response came later and was much more limited than elsewhere. The government had an explicit priority to protect the elderly in nursing and care homes but failed to do so. The staff in elderly care are less qualified and have harder working conditions in Sweden, and they lacked adequate care for the clients. Sweden has in recent years diverged from the Scandinavian welfare model by strong commercialization of primary care and elderly care.

Excess deaths associated with covid-19 pandemic in 2020: age and sex disaggregated time series analysis in 29 high income countries

“…New Zealand was reported to have deaths at or below expected levels, which is consistent with our findings 2140. Our estimates show that Sweden had the highest excess deaths among the Nordic countries, which is also consistent with a previous report 41. Our estimated number of excess deaths in South Korea is lower than those reported by Statistics Korea 4243.…”

“… 21 40 Our estimates show that Sweden had the highest excess deaths among the Nordic countries, which is also consistent with a previous report. 41 Our estimated number of excess deaths in South Korea is lower than those reported by Statistics Korea. 42 43 This is because these reports compared the mortality in 2020 with that in 2019, whereas our model examined the difference in 2020 compared with the expected mortality based on 2016-19 data.…”

Inequitable impact of infection: social gradients in severe COVID-19 outcomes among all confirmed SARS-CoV-2 cases during the first pandemic wave in Sweden

“… 33 34 These are possibly explained by disparities in health literacy, healthcare-seeking behaviour and healthcare access, which could result in disadvantaged populations reaching healthcare with more advanced COVID-19 disease. Such inequalities would be expected to be cumulative to any inequities in exposure and immunity 19 as well as in testing. As inequalities at admission seemed to be decreasing with more severe outcomes, this could signify more equitable management of patients once admitted.…”

“… 16 These studies were however unable to further detail the potential underpinnings of the mortality inequalities: differential exposure to the virus, differential immunity and/or differential consequences once infected—including severe COVID-19 disease and survival. 19 The present study seeks to explore the lattermost possibility.…”

Intermarriage and COVID-19 mortality among immigrants. A population-based cohort study from Sweden

“…[14][15][16][17] Among these groups, excess mortality has been suggested to be the result of differential exposure (eg, high-risk occupations or overcrowded accommodation), susceptibility (eg, pre-existing conditions) and language barriers and access to healthcare. [18][19][20] Recent studies, however, suggest that immigrants and minorities maintain an excess mortality even after controlling for socioeconomic status and housing conditions. 3 21 Yet there is paucity of evidence on the role of language barriers and institutional awareness in explaining the COVID-19 excess mortality experienced by immigrants.…”