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FACT CHECK: Did Sweden have lower pandemic mortality than Denmark and Norway?

A graphic published by the Svenska Dagbladet newspaper last week claimed that Sweden had the lowest excess mortality of all EU and Nordic counties between the start of 2020 and the end of 2022. We looked into whether this extraordinary claim is true (and it is, sort of).

FACT CHECK: Did Sweden have lower pandemic mortality than Denmark and Norway?
Sweden's former state epidemiologist Anders Tegnell photographed at the headquarters of the Swedish Public Health Agency in March. Photo: Stina Stjernkvist/SvD/TT

At one point in May 2020, Sweden had the highest Covid-19 death rate in the world, spurring newspapers like the New York Times and Time Magazine to present the country as a cautionary tale, a warning of how much more Covid-19 could ravage populations if strict enough measures were not applied. 

“Per million people, Sweden has suffered 40 percent more deaths than the United States, 12 times more than Norway, seven times more than Finland and six times more than Denmark,” the New York Times reported in July 2020

An article in Time in October 2020 declared Sweden’s Covid response “a disaster”, citing figures from Johns Hopkins University ranking Sweden’s per capita death rate as the 12th highest in the world.

So there was undisguised glee among lockdown sceptics when Svenska Dagbladet published data last week showing that in the pandemic years 2020, 2021 and 2022 Sweden’s excess mortality was the lowest, not only in the European Union, but also of all the Nordic countries, beating even global Covid-19 success stories, such as Norway, Denmark and Finland. 

Versions of the graph or links to the story were tweeted out by international anti-lockdown figures such as Bjørn Lomborg, a Danish sceptic of climate action, and Fraser Nelson, editor of Britain’s Spectator Magazine, while in Sweden columnists like Dagens Nyheter’s Alex Schulman and Svenska Dagbladet’s opinion editor Peter Wennblad showed that Anders Tegnell, the state epidemiologist who led Sweden’s strategy, had been “right all along”. 

Excess mortality — the number of people who die in a year compared to the number expected to die based on previous years — is seen by some statisticians as a better measure for comparing countries’ Covid-19 responses, as it is less vulnerable to differences in how Covid-19 deaths are reported. 

But are these figures legitimate, where do they come from, and do they show what they purport to show?

Here are the numbers used by SvD in its chart: 

Where do the numbers come from? 

Örjan Hemström, a statistician specialising in births and deaths at Sweden’s state statistics agency Statistics Sweden (SCB), put together the figures at the request of Svenska Dagbladet. 

He told The Local that the numbers published in the newspaper came from him and had not been doctored in any way by the journalists.

He did, however, point out that he had produced an alternative set of figures for the Nordic countries, which the newspaper chose not to use, in which Sweden had exactly the same excess mortality as Denmark and Norway. 

“I think they also could have published the computation I did for the Nordic countries of what was expected from the population predictions,” he said of the way SvD had used his numbers. “It takes into consideration trends in mortality by age and sex. The excess deaths were more similar for Denmark, Sweden, and Norway. Almost the same.” 

Here are Hemström’s alternative numbers: 

There are two basic ways of measuring excess mortality. The simplest, and the one used by SvD/SCB, is to simply compare the death rates in the relevant period with the mean of previous years, normally five years. 

More sophisticated measures attempt to estimate the expected number of deaths by extending mortality trends seen in a certain country, adjusting for the age of the population and other factors. But this can lead to results to vary significantly depending on how mortality trends and expected mortality are calculated. 

The issue with the analysis in the SvD graph is that compares deaths in the pandemic years to deaths over just three years, a mean of 2017-2019, and does not properly take into account Sweden’s longstanding declining mortality trend, or the gently rising mortality trend in some other countries where mortality is creeping upwards due to an ageing population, such as Finland. 

“It’s very difficult to compare countries and the longer the pandemic goes on for the harder it is, because you need a proper baseline, and that baseline depends on what happened before,” Karin Modig, an epidemiologist at Sweden’s Karolinska Institute whose research focuses on ageing populations, told The Local.

“As soon as you compare between countries, it’s more difficult because countries have different trends of mortality, they have different age structures, and in the pandemic they might have had different seasonal variations.” 

She described analyses such as Hemström’s as “quite crude”. 

In an interview with SvD to accompany the graph, Tegnell also pushed back against giving the numbers too much weight. 

“Mortality doesn’t tell the whole story about what effect a pandemic has had on different countries,” he said. “The excess mortality measure has its weaknesses and depends a lot on the demographic structures of countries, but anyway, when it comes to that measure, it looks like Sweden managed to do quite well.”

Do the numbers match those provided by other international experts and media? 

Sweden’s excess mortality over the three years of the pandemic is certainly below average worldwide, but in most other analyses it remains higher than those of Norway and Denmark. 

A ranking of excess mortality put together by Our World in Data for the same period as the SvD/SCB table estimates Sweden’s excess mortality between the start of 2020 and the end of 2022 at 5.62 percent, considerably more than the 4.4 percent SvD claims, and above that of Norway on 5.08 percent and Denmark on 2.52 percent. 

The Economist newspaper also put together an estimate, using their own method based on projected deaths. In this estimate, Sweden also has a higher rate of excess deaths than Denmark and Norway (but not than Finland).   

Our World in Data uses the estimate produced by Ariel Karlinsky and Dmitry Kobak, who manage the World Mortality Dataset (WMD). To produce the estimate, they fit a regression model for each region using historical deaths data from 2015–2019, so a time period of five years rather than the three used by SCB.

What’s clear, is that, whatever method you use, Sweden and the other Nordic countries are among the countries with the lowest excess mortality over the pandemic. 

“Most methods seem to put Sweden and the other Nordic countries among the countries in Europe with the lowest cumulative excess deaths for 2020-2022,” Preben Aavitsland, the Director for Surveillance and the Norwegian Institute of Public Health, told The Local.

So if Sweden had similar excess mortality to those of the other Nordics over the period, does that mean it had a similar Covid-19 death rate?

No. Sweden’s per capita death rate from Covid-19 over the period covered by the SvD/SCB figures, at 2,249 per million people, is still more than double Norway’s 959 per million, 60 percent more than the 1,409 per million who died in Denmark, and more than 50 percent more than the 1,612 per million who died in Finland. 

Sweden’s death rate is now much closer to those of the other Nordic countries than it was at the end of 2020, however, something Aavitsland put down to the higher number of Covid-19 deaths seen in his country in the later years of the pandemic. 

“The most striking difference between Sweden and the other Nordic countries is that only Sweden had large excess mortality in 2020 and the winter of 2020-21,” Aavitsland explained. “In 2022, the field levelled out as the other countries also had excess mortality when most of the population was infected by the omicron variant after all measures had been lifted.”

So why, if the Covid-19 death rates are still so different, are the excess mortality rates so similar?

This largely reflects the fact that many of those who died in Sweden in the first year of the pandemic were elderly people in care homes who would have died anyway by the end of 2022. 

About 90 percent of Covid-19 deaths were in people above 70, Aavitsland pointed out, adding that this is the same age group where you find around 80 percent of all deaths, regardless of cause, in a Scandinavian country. 

“My interpretation is that in the first year of the pandemic, say March 2020 – February 2021, Sweden had several thousand excess deaths among the elderly, including nursing home residents,” he said. “Most of this was caused by Covid-19. In the other [Nordic] countries, more people like these survived, but they died in 2022. The other countries managed to delay some deaths, but now, three years after, we end up at around the same place.” 

So does that mean Sweden’s state epidemiologist Anders Tegnell was right all along? 

It depends on how you view the years lost by the several thousand elderly people who caught Covid-19 and died in Sweden in the first wave because Sweden did not follow the example of Denmark, Norway, and Finland and bring in a short three-week lockdown in March and April 2020. Were those two years worth the greater restrictions imposed in Sweden’s neighbours? 

Tegnell himself probably said it best in the SvD interview. 

“You’ve got to remember that a lot of people died in the pandemic, which is of course terrible in many ways, not least for their many loved ones who were affected, so you need to be a bit humble when presented with these kinds of figures.”

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For members


What’s the state of Sweden’s maternity wards this summer?

A difficult summer is on the cards for maternity wards across Sweden once again this year. Here's a rundown of the situation in each region in Sweden.

What's the state of Sweden's maternity wards this summer?

Sweden’s maternity wards have issues with midwife shortages all year round, with the situation worsening over the summer period as the staff are all entitled to four consecutive weeks of holiday during the summer under Swedish law.

More babies are usually born during summer, too, meaning that the busiest period on Swedish maternity wards is often the period where they have the least staff.

So, how is the situation in maternity wards across Sweden this summer? Newswire TT asked each of Sweden’s healthcare regions to fill in a questionnaire between May 10th and May 23rd, asking for information on the state of maternity care in the run-up to the summer months. Here are the results.


Situation: Same as last summer

Blekinge region described the situation this year as strained, adding that many shifts have still not been filled.

Staff on parental leave, one hired-in independent midwife, temporary staff on hourly contracts and managers are taking shifts to fill the gaps, and midwives are being offered 7,000 kronor to move a week of holiday.

The region added that there is a small risk that patients will have to give birth in another region, although this is uncommon, and that the biggest challenge is covering midwife shifts and possible absences.


Situation: Worse than last summer

In Dalarna, the region described the situation as “fragile” due to a very small number of staff and no stand-ins for sick cover.

Their greatest concern is that staff won’t be able to cope if they have to cover for each other, according to the survey.

However, it reports that there’s also a low number of births expected, so pressure is not that high. There are around four midwife positions left unfilled, and staffing issues are being resolved by hiring retirees and giving bonuses for extra shifts.


Situation: Better than last summer

Gotland has enough midwives to cover maternity wards over the summer, and some temporary staff have been hired to cover the summer months. The region has not had to hire in any independent midwives and is not offering bonuses for staff to move their holidays.


Situation: Worse in Hudiksvall hospital, same as last year in Gävle.

In Hudiksvall, the region is 3-4 midwives short of the level needed for summer cover. It is trying to cover this with overtime shifts and by offering bonuses of 20,000 kronor a week (up from 15,000) for moving weeks of holiday.

It has had difficulties in finding enough independent midwives to bring in for holiday cover in Hudiksvall, and in Gävle, some wards are running at a reduced capacity.


Situation: Worse than last year

In Halland, capacity has been reduced to around 75 percent of normal capacity, with around 15 midwife positions unfilled. The region is hiring in independent midwives, retirees, and offering bonuses for moving holidays and working overtime. The region says that this is the third year in a row with staffing issues and describes staff as “tired”. 

It says that the biggest challenge is in Halmstad, where the neonatal ward is located.

Jämtland Härjedalen

Situation: Better than last summer

Jämtland Härjedalen’s main challenge is ensuring there are enough senior midwives working when pressure on hospitals is at its highest. It has hired in three independent midwives in part-time positions, is hiring retirees and offering bonuses for moving holidays and extra shifts.

It adds that some staff have moved their holidays and received bonuses which are offered as a certain percent of their salary.


Situation: Differs depending on maternity clinic

Jönköping has 14 empty midwife positions, and is struggling to have enough experienced staff working over the summer. It has hired independent midwives and retired staff, is offering bonuses for moved holiday weeks, but adds that there is still a risk that some patients will have to give birth in a different region.


Situation: Same as last summer

Västervik hospital has a few empty midwife positions and the biggest challenges are staff needing to take sick leave and peaks in workload. Independent midwives and retired staff have been hired, as well as bonuses offered for moving holidays and taking extra shifts. Midwives in other areas (gynaecology, postnatal care) have been moved to maternity wards over summer.


Situation: Same as last summer

Tight situation, if any staff get sick there will be more pressure on others. Two rooms on Växjö maternity ward closed. Independent midwives have been hired in and bonus offered for moving holiday. There’s a risk some patients will have to give birth in other regions.


Situation: Same as last summer

No expected staff shortages on maternity wards. Gaps in staffing have been covered by hourly workers, some new hires and staff hired through a summer recruitment initiative where the region offers to pay for travel and housing. Some staff have moved holiday weeks with a bonus of 25,000 kronor per week moved. Some staff are taking extra shifts, and independent midwives and retirees have been brought in for the summer.


Situation: Same as last summer

Difficult to get enough staff on the maternity ward at Skåne University Hospital as well as neo-natal ward as Helsingborg hospital. In Kristianstad, there are 5 empty midwife positions and they will need to scale down services over summer.

Independent midwives have been hired for the summer as well as retirees. Skåne is also offering bonuses for moving holiday weeks and taking extra shifts, and Kristianstad have brought in assistant nurses and service workers to help lessen the load.


Situation: Better than last summer

Around 50 empty midwife positions, although the region says the situation better than previous years. Two hospitals might need help with referrals. A new maternity ward at S:t Görans hospital as well as fewer expected births means the region believes it has planned well.

Stockholm has also hired in independent midwives and retirees, offering bonuses for moved holidays and for taking extra shifts. It is offering 15,000 kronor for moving one week of holiday or 25,000 kronor for moving two weeks, and adds that there is a risk that patients will have to give birth in other regions.


Situation: Same as last summer

Sörmland doesn’t have enough midwives to cover all of the region’s maternity wards, stating that it’s not possible to say how many midwives it’s missing. Like many other regions, the region has hired in independent midwives and retirees and is offering bonuses for moved holidays and for taking extra shifts.


Situation: Same as last summer

Uppsala also said it had a midwife shortage, but also a shortage of experienced assistance nurses. Around 10 midwife positions are empty this summer, and it is offering 12,000 kronor to midwives for each moved week of holiday. It adds that there is a risk of women giving birth in other regions and is combatting this by hiring in independent midwives and pensioners. It has cut the number of hospital spots available for patients just after giving birth, is offering extra pay for senior midwives during summer and is prioritising treatment that can’t wait.


Situation: Same as last summer

Värmland region said that its biggest problem is not enough experienced staff, as well as the logistics of making sure that there is a good balance of experienced staff working on each shift. It has hired independent midwives and retirees, and offering 20,000 kronor bonuses for moving holiday weeks, as well as bonuses for taking extra shifts. It is also working at minimum capacity.


Situation: Better than last summer

Despite the situation being better this year than last year, Västmanland region said that the situation was still fragile, as it has assistant nurses and midwives working during the summer who don’t work all year round.

Some midwives have been moved from other clinics to handle births, and independent midwives and retired midwives have been brought as extra cover over the summer. Midwives have been offered 15,000 kronor to move a week of holiday.


Situation: Better than last summer

Västerbotten described its biggest challenge as providing safe maternity care with extremely low staff. It has hired independent midwives, midwives working hourly rates, is offering bonuses for moving holidays and taking extra shifts and has also hired midwives from Finland.


Situation: Same as last summer

The region said that it had a shortage of around 12 midwives, which it is covering by hiring independent midwives and by asking employees to work overtime. It has also hired retired midwives, and is offering bonuses for moving holidays and taking extra shifts.

Västra Götaland

Situation: Better than last summer

Midwives, nurses and assistant nurses need to work extra shifts and move holiday weeks. Retired staff have been hired in, as well as staff working on hourly contracts. Midwives are being offered 10,000 kronor per moved week of holiday and bonuses for working overtime.


Situation: Better than last summer

Around 30 midwife positions will be unfilled over the summer, and midwives have been offered 20,000 kronor per moved week of holiday, as well as bonuses for working overtime. The biggest issue is staffing extra shifts. It writes that there is a risk of patients having to give birth in other regions.


Situation: Better than last summer

Östergötland’s biggest issue is covering sick leave or other absences. It has hired independent midwives and retired midwives and is offering bonuses for moving holidays and taking extra shifts. It adds that there is a risk of patients having to give birth in another region.