Sweden, Tegnell and coronavirus: Separating lies from stupidity. Is it possible?

The Swedish state epidimiologist Tengell is the face of the coronavirus pandemic in Sweden. He appears calm and confident. However, his statements are misleading at best, and bare-faced lies at worst. He cherry picks data and anecdotes, and makes statements without any evidence or models. Unfortunately, journalists never seem to challenge him, and the state media is operating in what appears to be a propaganda mode. Now, as Sweden has become one of the countries with the highest deaths per capita in the last few weeks, it is time for a thorough debunking of Tegnell's dangerous nonsense. The picture that emerges is either of an utterly incompetent government, or one that has performed a cynical calculation and decided that letting a few thousand people die preventable deaths is good if it will let them stay in power. So far the strategy seems to have worked, as voters have been supportive of the government.

Tegnell said "Closedown, lockdown, closing borders — nothing has a historical scientific basis, in my view."

There is a great scientific basis for lockdowns in periods of epidemics. A simple example is the 1918/19 influenza pandemic and response. A range of measures were tried, and the comparison between Philadelphia and Seattle is interesting. As Philly did nothing to prepared, the system was overwhelmed and Philadelphia was devastated. Seattle instead started quarantining cases and shutting things down, to great success.

Though there can be no stratified randomised double blind trial of measures, historical data does tell us what strategies have a good chance of working. This is a similar situation to economics, where we must rely mainly on modelling and natural experiments. Thankfully, the data from the US at the time do provide us with a great natural experiment.

Closing borders, or screening does make sense when there is no endemic transmission. Since transmission in Sweden is uncontrolled it makes no sense to shut borders down. Denmark's shutting down borders was probably unncessary given the high incidence in that country at te time, but Norway was probably right to close borders (especially with Sweden) as it had (and still has) few cases.

See also 'Nonpharmaceutical Interventions Implemented by US Cities During the 1918-1919 Influenza Pandemic' 

To say that there is no scientific basis for shutdowns is utter nonsense and deliberate misinformation.

Tegnell claimed that "In Sweden we are following the tradition that we have in Sweden and working very much with voluntary measures, very much with informing the public about the right things to do. That has worked reasonably well so far."

However, it is interesting to contrast Sweden with Norway, similar countries with different strategies. Firstly, Norway has had 43 deaths / million, while Sweden 384, an order of magnitude more. In fact, Sweden had the highest death rate / million in the world in the week 13-20 of May.

Tegnell dismissed the figures on Tuesday night, arguing that it was misleading to focus on the death toll over a single week.

In fact, Sweden has consistently been in the top 10 of deaths per million for multiple weeks, and is right now 8th in overall deaths since the beginning of the pandemic. Consequently, this is no statistical fluke, but a direct consequence of Sweden's failed response.

In terms of the public following the advice, it is also interesting to compare with Norway and Greece in terms of mobility changes.

	Recreation	Grocery	Parks	Transit	Work	Home
Sweden	-16	-1	146	-17	-5	2
Norway	-18	5	84	-22	-11	3
Greece	-54	4	45	-34	-25	9

Coronavirus resulted in a mass exodus of Swedes in the parks. Nobody stayed at home, and almost everybody continued going to work, since most schools did not close. The government had claimed that they cannot shut down schools because of the need for health workers, but they could have only allowed the children of essential workers to go to school. So, that sounds like an excuse.

We are somewhere around 20 percent [of infected individuals] plus in Stockholm now, Tegnell claimed after results were published showing around 7 percent of individuals had been infected three weeks ago.

Tegnell pulls this number directly out of his arse. If the disease really spread at that rate, this implies a tripling of cases every three weeks. Does the model they use really say something like that? Indeed, if we look at a statement by a colleague of his, Tom Britton, a maths professor who helped develop its forecasting model:

“It means either the calculations made by the agency and myself are quite wrong, which is possible, but if that’s the case it’s surprising they are so wrong,” he told the newspaper Dagens Nyheter. “Or more people have been infected than developed antibodies.” [Source: the Guardian, see also original article]

This is mind-blowing. His model has been falsified by the data to the extent that it is "surprising that they are so wrong". He refuses to believe that it is wrong, and suggest that the data is wrong. It is also interesting that Tegnell says the number is " a bit lower than we’d thought", which directly contradicts the previous statement about the calculations being "so wrong".

Later Tegnell continued to doubt the data saying that "In Sweden, anybody who has the diagnosis of COVID-19 and dies within 30 days after that is called a COVID-19 case, irrespective of the actual cause of death. And we know that in many other countries there are other ways of counting that are used".

However, excess deaths are in line with these calculations.

"We calculated on more people being sick, but the death toll really came as a surprise to us," Tegnell said. "We really thought our elderly homes would be much better at keeping this disease outside of them then they have actually been.

There are reports that the state utterly failed to protect the elderly population. They were slow in forbidding visitors to elderly homes (they only forbid it on March 30th!), they did not provide protective equipment to healthcare workers, and they discouraged to bring elderly people to hospitals if they were infected. (In fact, ICUs are mainly full of young rather than old patients, who just seem to die alone in care homes). At the moment of writing, Tegnell blamed the care homes for not following basic hygiene rules, rather than the government and his agency for not making sure they are able to do so by providing protective equipment.

June 3 Update: Tegnell defended strategy while admitting too many people have died

In fact he said “Other countries started with a lot of measures all at once. The problem with that is that you don’t really know which of the measures you have taken is most effective,” he said, adding that conclusions would have to be drawn about “what else, besides what we did, you could do without imposing a total shutdown.”.  Closing schools would have been a start. Why not go the other way around, and start with a total lockdown, slowly relaxing some measure to see what is crucial? It makes no sense to start easy given the uncertainty.

July 28 Update: Tegnell bizarrely talks about "evidence of more public spread than home spread"

In particular, after doubting ECDC evidence that masks seem to help limit the spread of the disease, he said "If there is more indications that the disease spreads more in public places rather than at home, the authority will of course consider a mask recommendation". This is puzzling because the spread of the disease happens by default outside the home: If everybody stayed at home the disease would stop spreading, and after two weeks it'd be nearly eliminated.

But after all, the ex-welder and metal-unionist prime minister, who is utterly out of his depth, like most of the useless government cabinet, did say in his first video address about the crisis "be prepared to lose your loved ones"