For years, progressives have told us that the United States should adopt a health-care system similar to that of Sweden. At present, the most celebrated advocate of this approach is Sen. Bernie Sanders (I-Vt.). Oddly, he has been silent about the Swedish approach to the COVID-19 pandemic. Unlike most of their EU counterparts, Sweden’s government officials have refused to overreact. Other than closing high schools and colleges, they haven’t imposed the kind of draconian measures that most European countries have adopted. Sweden’s borders remain open, as do its preschools, grade schools, and restaurants. Even its ski slopes are still open. In other words, life in Sweden continues essentially unchanged.
Why hasn’t Sanders recommended that the United States emulate Sweden’s approach to the pandemic? There is a small but growing cadre of serious epidemiologists that might endorse that position. They aren’t in denial about the seriousness of the COVID-19 epidemic. Yet they are dubious about the assumptions upon which government officials, particularly at the state and local level, have based their extreme countermeasures. Our officials have, according to these “pandemic skeptics,” shut down schools, restaurants, and businesses based on woefully incomplete data. How incomplete? Stanford epidemiologist John Ioannidis answered that question in no uncertain terms two weeks ago:
The data collected so far on how many people are infected and how the epidemic is evolving are utterly unreliable. Given the limited testing to date, some deaths and probably the vast majority of infections due to [COVID-19] are being missed. We don’t know if we are failing to capture infections by a factor of three or 300. Three months after the outbreak emerged, most countries, including the U.S., lack the ability to test a large number of people and no countries have reliable data on the prevalence of the virus in a representative random sample of the general population.
The testing to which Ioannidis refers involves large-scale serological surveys. In order to accurately assess how widespread the infection really is, these tests must be carefully monitored and randomly administered. The latter feature is essential in order to ensure that the resultant data are truly representative of the population. Selection bias is so pervasive in the statistics now available that Ioannidis has correctly labeled them an “evidence fiasco.” He goes on thus: “Reported case fatality rates, like the official 3.4% rate from the World Health Organization, cause horror — and are meaningless.” Yet this is the information reported in the media and used by government officials to wreck our economy.
Sweden’s state epidemiologist, Anders Tegnell, seems to grasp the reality that Ioannidis is getting at — unlike most of his counterparts in neighboring countries. The fatality rate used by the World Health Organization is arrived at by dividing the number of deaths caused by COVID-19 by the number of confirmed cases. As of 6:15 p.m. Sunday, confirmed cases worldwide stood at 719,414 and deaths stood at 33,901. Dividing the latter by the former produces a 4.7 percent death rate. This death rate is, however, too high by many orders of magnitude because the denominator (719,414) only accounts for confirmed cases. Eran Bendavid and Jay Bhattacharya of Stanford’s Center for Population Health Sciences explain:
Fear of Covid-19 is based on its high estimated case fatality rate — 2% to 4% of people with confirmed Covid-19 have died, according to the World Health Organization and others. So if 100 million Americans ultimately get the disease, two million to four million could die. We believe that estimate is deeply flawed. The true fatality rate is the portion of those infected who die, not the deaths from identified positive cases.… If the number of actual infections is much larger than the number of cases — orders of magnitude larger — then the true fatality rate is much lower as well.
The only way to arrive at a reliable infection figure is by conducting the serological surveys noted above. The tests required to conduct these surveys will not merely need to detect active infections, however. They will have to detect antibodies remaining in the systems of people who have been infected in the past, perhaps without knowing it, and recovered. Deborah Birx, response coordinator for the White House Coronavirus Task Force, said last week that the Food and Drug Administration is already evaluating several serologic tests and hopes to approve at least one within a few weeks. Managing the logistics of conducting the surveys and ensuring that they are statistically valid will be a daunting task.
Meanwhile, Sweden is developing herd immunity by refusing to panic. Its population is about 10.2 million, and its first coronavirus case was confirmed on January 30. Since then, Sweden’s number of coronavirus deaths has totaled 110 of 3,700 confirmed cases. During the interim, due to its refusal to impose a lockdown, its actual COVID-19 infections have probably exceeded confirmed cases by several orders of magnitude. This does not, however, mean Sweden’s health officials have failed to encourage common-sense measures like hand washing, social distancing, etc. The New York Times quotes Tegnell as follows: “We are trying to slow the spread enough so that we can deal with the patients coming in.”
But where is Bernie Sanders? Why isn’t he praising the Swedish response to the COVID-19 pandemic? Perhaps it is because the country’s officials have approached the pandemic in a way that maximizes individual choice. As Tegnell puts it, “That’s the way we work in Sweden. Our whole system for communicable disease control is based on voluntary action.” And there’s the rub. Bernie Sanders is a statist. The Swedes have been there and done that. They prefer liberty. Maybe we should try that once again in the United States.