SWPRS | 11 May 2022
Does Sweden have the lowest excess mortality in Europe? Does Germany have a higher excess mortality than Britain? Not really, but apparently even the WHO seems to think so.
Last week the WHO published its updated study on global excess mortality during the coronavirus pandemic (see BBC article). Some of the results have caused quite a stir.
Germany: Higher excess mortality than Britain?
The British were pleased to hear it, but German politicians were truly horrified: according to the WHO, excess mortality in Germany – one of the most repressive countries during the coronavirus pandemic – was higher than in Britain, the land that pioneered the “freedom day”.
But, alas, the WHO got it wrong. Indeed, the WHO strongly overestimated German excess mortality by not taking into account the natural increase in German mortality (see chart below), which is due in part to the German baby boom of the 1930s (i.e. 80 to 90 years ago). The WHO estimate for Britain is more or less correct.
If calculated correctly, excess mortality in Germany is only about half the British value (110 vs. 200 per 100,000). Why is this? German politicians will tell you it’s because of iron German discipline. But German scientists have already acknowledged that neither German lockdowns nor German school closures had an impact on the infection rate. Furthermore, mask mandates and even FFP2/N95 mask mandates in some German states had no measurable effect, either.
Instead, two things stand out: first, Germany mostly missed the fierce first wave in the spring of 2020 (as did most of Eastern Europe); second, Germany had one of the lowest covid death rates in care homes (3% in Germany vs. 12% in England), which account for 25% to 50% of all covid deaths in most Western countries. If Germany had had the same excess mortality as Britain, this would have resulted in an additional 80,000 deaths.
Why did Britain have a rather high excess mortality compared to other countries in Western Europe? Besides the rather high share of care home deaths, Britain also has the highest obesity rate in Europe (28%), one of the highest population weighted densities (similar to Italy and Spain, and almost three times higher than Germany); and a high share of people from Arab and South Asian countries, who are known to have a higher covid fatality risk in Western countries, regardless of economic status (perhaps due to lower vitamin D levels). Indeed, even in Germany, a full 90% of intubated covid ICU patients were (mostly Arab) immigrants, a major taboo topic.
Figure: German mortality trend and incorrect WHO prediction
Sweden: Lowest excess mortality in Europe?
Lockdown skeptics everywhere rejoiced: according to the WHO, Sweden had one of the lowest excess death rates in Europe. Fewer restrictions, fewer deaths, after all?
Alas, the WHO got it wrong again. In the case of Sweden, the WHO made the classic mistake and did not adjust for the strongly decreasing mortality trend, which has been “hiding” true covid excess deaths (see chart below). The decreasing mortality trend in Sweden is mainly due to very low birth rates between 1920 and 1940 (i.e. 80 to 100 years ago).
If calculated correctly, Sweden has a covid and excess mortality rate similar to demographically comparable countries, such as Switzerland and Germany. Britain and Belgium as well as Eastern Europe and Southern Europe are higher, whereas other Nordic countries (i.e. Denmark, Finland and Norway) are lower, likely because of a combination of early border controls and, in the case of Finland and Norway, a much lower population weighted density (three to four times lower than in Sweden).
In terms of economic performance, Sweden has indeed achieved one of the best results among OECD countries. Thus, Sweden has shown that for most countries, a calm, low-intervention and patient-focused approach to the pandemic has really been best.
Ironically, many lockdown proponents don’t dare question the WHO results (they either don’t understand the mistakes or they don’t want to embarrass the WHO), while many lockdown skeptics don’t mind amplifying the false WHO analysis.
Figure: Swedish mortality trend and excess mortality in 2020
15 million global excess deaths?
The WHO estimates that there were about 15 million excess deaths from the beginning of 2020 to the end of 2021. This estimate is more or less consistent with other estimates, such as Kobak&Karlinsky (hard data only) and The Economist (data & modeling).
In particular, the United States and Russia have a confirmed excess mortality of about 1.2 million deaths each; Brazil stands at 750,000; Mexico at 600,000; Iran, Egypt, Turkey and South Africa at 250,000 to 300,000; Ukraine, Poland and Italy at 180,000, and the UK at 140,000.
For India, despite denials by the government, most serious estimates found between 3 and 5 million excess deaths (mostly caused by the massive delta wave in 2021). Estimates for Pakistan, Indonesia and Bangladesh range from 500,000 to 750,000 each.
15 million additional deaths translate into a global excess mortality of about 15% (based on 60 million annual global deaths) and a global pandemic mortality of about 0.2% (based on a global population of about 8 billion people). Some major Asian countries, such as China, Japan and South Korea, are only now beginning to see covid-related excess mortality.
Most, but not all of these excess deaths were caused by the coronavirus, as a temporal analysis of infections and deaths shows. Nevertheless, countries like the US have also seen a record increase in drug overdose deaths (reaching 110,000 in 2021), and according to the World Bank, lockdowns have destroyed about 100 million livelihoods globally (see below).
Figure: Excess mortality per country (Economist)
Median age of covid deaths?
In most countries, the median age of covid deaths was at or above life expectancy (78 in the US, above 80 in most of Western Europe), and prior to vaccination, about 50% of covid deaths in Western countries occurred in nursing homes, which comprise less than 1% of the population.
Because of this, large parts of the population may have had the impression that there really was “no pandemic”, although the full impact of “long covid” health sequelae remains to be determined. If covid had been a 1918-flu-like pandemic, some of the young folks who have been posting funny memes on Twitter might have run for the basement and prayed to Bill Gates instead.
Figure: US flu/covid mortality by age in pandemic years (Glezen/SPR)
What about “covid measures”?
If compared region by region, global mortality data confirms the failure of most “covid measures”, including lockdowns, face masks, school closures, mass testing, contact tracing and “covid passports” (see e.g. Brazil in Latin America; Sweden in Western Europe; Belarus in Eastern Europe; Florida vs. California in the US; or the horrific lockdown failures in India, the Philippines, Peru, Uganda, Nigeria and other ‘developing countries’).
The only measures that made a real and substantial difference were early and strict border controls – successful in some remote countries and islands – and timely vaccination of risk groups.
A measure that might have made a difference, but that wasn’t used widely, is early outpatient treatment of high risk groups, targeting immune-relevant nutrient and vitamin deficiencies and the covid-related risk of hyper-inflammation and coagulation (blood clots).
In contrast, the World Bank estimates that lockdowns have pushed an historically unprecedented 100 million people into poverty and have disrupted global supply chains, while prolonged school closures have caused unprecedented havoc in education.
Figure: Germany vs. Sweden, covid deaths during second wave (IanMSC)
What about China?
Today, the last country in the world to still pursue a hopeless “zero covid” policy is China, whose Communist government is imposing extreme lockdowns on megacities such as Shenzhen, Shanghai and maybe soon Beijing. The Twitter video channel of “Songpinganq” continues to show the shocking and almost surreal reality of Chinese “zero covid” policy.
It is true that until 2021, China could more or less contain covid, but this is also true for Japan, which had a much more relaxed approach. It is possible that some Asian countries benefited from genetic or immunological characteristics or from record low obesity rates. Only delta and especially omicron managed to overwhelm these Asian countries.
Figure: Beijing in June 2020 (Xinhua)
A) Population weighted density in Western Europe (2015)
B) Covid mortality in European countries
Eastern Europe is highest; Norway, Finland and Denmark lowest.
C) Sweden: Deaths per month per million people
D) Coronavirus in Sweden: Predictions vs. Reality