Lessons from the COVID-19 Pandemic

“State Public Health Laboratory in Exton Tests for COVID-19” by Governor Tom Wolfe // CC

The pandemic continues, but the first data-based analyses are starting to emerge – and some conclusions may now be drawn. The most important indicator in assessing the response to the pandemic is the excess mortality – i.e. how many more people died in comparison to the average rate in previous years.

The discussion on how to determine this average is interesting from the methodological point of view (how many years to look back at, how to take into account the aging of the population), but the adopted method does not have a significant impact on the results (most often, the average from five years before the year 2020 is analyzed).

Excess deaths generally consist of two groups:

  • people who died due to the COVID-19 (although, of course, not all of them – some would die in 2020, even if there was no pandemic – one shall remember that the most vulnerable are the elderly, but for the sake of simplicity it can be assumed that all those who died from COVID-19 are excess deaths; and,

  • people who died due to the pandemic indirectly – mainly due to lack of access to healthcare resulting from overcrowded hospitals and overworked doctors.

As it turns out, the scale of both these parts largely depended on the policies adopted. A number of states – mostly Scandinavian countries – had excess deaths of 0 or even below (Norway -3.6%, Denmark -4.3%, Iceland -4.1%, Latvia -2.2%, Estonia 0), which shows that it was possible to go through the pandemic in 2020 with a dry foot in this regard.

At the other end, there are countries that fared badly in this respect, including Poland (14.4%), as well as Bulgaria (12%), Belgium (12.2%), England (10.5%), Slovenia (12 %), and Spain (12.9%).

Of course, reducing the number of excess deaths is a policy objective – but the question arises, at what cost (and how) this result was achieved? Because it cannot be denied that limiting the spread of the virus is expensive. So it makes sense to argue that there may be an optimal level of restriction and the level of deaths that does not ruin the economy at the same time.

Here, the most frequently cited example is Sweden, where restrictions were abandoned in spring – and the excess mortality is at the level of only 1.2%, which is one of the lowest in Europe. So maybe the lockdowns are unnecessary?

The Swedish case is an interesting one on several levels, and it is worth digging into it by examining the arguments against lockdowns.

First, it should be determined whether 1.2% of excess deaths is low or high. When compared to Europe, it seems that this is not a lot. However, the proper background for assessing Sweden is not the whole of Europe – but only the Scandinavian countries. If we look from this perspective, excess deaths in Sweden are by about 5 percentage points higher than in the case of their neighbors. And this is quite a significant difference.

Secondly, it shall be estimated how much Sweden has saved in the economic sense thanks to its policy – in other words, how much faster it has developed thanks to the absence of lockdowns. The decline in GDP in Sweden for 2020 amounted to 2.8% – how did the Scandinavian countries deal with greater restrictions (and thus excess deaths lower by 5 percentage points)?

Norway decreased in this respect by 0.8%, Denmark by 2.7%, and Finland by 2.8%. It seems these states have done better economically – or at least not worse. Thus, the argument that the greater the restrictions aimed at limiting the spread of the virus, the worse it is for the economy seems incorrect – whereas, in fact, it is quite the contrary, as it seems.

Another element in this analysis concerns the improvement of data resolution. The figure of 1.2% applies to the entire year. Meanwhile, the epidemic appeared only in March, the Swedish experiment lasted whole the spring, in the summer the pandemic wave subsided everywhere, and in the autumn, the Swedes radically changed their approach (including King Charles VI Gustav apologizing to his subjects for the shortcomings of the spring policy) and began to introduce restrictions.

Thus, the number 1.2% relates to a fairly long period of time. It is worth looking at how this has changed over time – for comparison, let us look at Poland and Brazil.

The conclusions are quite obvious. The key part of these 5 percentage points lower in comparison with their neighbors come from April and May, when the Swedish experiment was carried out. At the same time, our government locked us in our homes and there were no excess deaths (it was also the argument of Polish coronasceptics: “how can there be a pandemic if there are no deaths”).

Then came summer, which temporarily stifled the virus. The Swedes, having learned from the experiences from the spring, began to introduce restrictions. Polish politicians were convinced by the supporters of the Swedish model and they removed the restrictions: the children went back to schools, restaurants and other facilities were opened.

As long as the summer lasted, the excess deaths were at a higher rate – but still low. After the children returned to school, a disaster occurred. In mid-November, Poland recorded over 100% of excess deaths (while Swedes observed 0%).

The rushed restrictions made it possible to contain this crisis by the end of the year. One political mistake, however, following arguments based on common sense, and a lame fantasy cost Poland 65,000 lives.

At the end of the year, the mortality rate jumped and the Swedes responded with further restrictions, and, at the moment, they have fallen back to negative surplus deaths – meanwhile, Poles are happy that the country experienced only 15% more than usual. After a trauma of an increase in this rate by 100%, it is no wonder that the Polish people may feel glad – but one has to remember that it is still a national tragedy.

To sum up, in the spring, the Swedes took a risk and lost. The summer saved them. They have learned from their mistakes – which makes the overall result look good – compared to the country’s neighbors. Poland took a risk in the fall, with the same result as Sweden. This proves that Poles are incapable of learning from other people’s mistakes. Only there was no summer that could save us, which translated into 65,000 excess deaths.

Why is Brazil included here? This is a country where President Bolsonaro initially did not recognize the existence of a pandemic and did not introduce any restrictions. This is the Swedish model par excellence. The result does not require a comment, except that it needs to be mentioned that the numbers we see are underestimated – the Brazilian statistics in this respect are far from perfect.

It is also worth looking at the strategies of the countries that have mastered dealing with the pandemic. Of course, they introduced permanent restrictions, as well as temporary lockdowns, but if we look at the timeline and severity of these measures, they are not the most radical. In other words, containing the pandemic and the length of lockdowns do not go hand in hand, which is another argument used by lockdown opponents. However, they do not see two elements.

First of all, these countries introduced lockdowns earlier – which has been absolutely crucial in the case of processes developing at an exponential rate.

The fact that people stayed locked at homes all autumn, winter, and spring was largely due to the fact that the government loosened the restrictions in August and September. When the number of COVID-19 cases explode, dealing with it is very costly and requires drastic measures. It is a bit like inflation – keeping it low does not take as much effort, but suffocation is painful and costly. This is a lesson we will learn soon, because, clearly, the 1991 inflation has already been forgotten.

Early introduction of restrictions is one of the elements of a successful strategy. Mass testing and isolation of infected and those arriving from abroad are another one.

Effective, mass screening is the key to extinguishing infection outbreaks. Sadly, the Polish government believes that breaking the thermometer will help get rid of the fever. We have been at the bottom of the testing ranking for a long time (on average, Poland tested 3 out of 10 people, and the leaders in this respect tested everyone twice), which is not due to low needs.

In Poland, half of the tests were positive, and at the moment around 25-30% of all tests come out positive. The WHO states that testing is sufficient and the epidemic under control when positive tests account for less than 5% of the total.

So what can we learn from the numbers we have observed so far?

1. Testing and early restrictions are the key to containing an outbreak.

  1. The Swedish model has not worked. Its application may lead to a tragedy. The summer saved the Swedes from experiencing all its consequences; meanwhile, Poland had a taste of the full scale of the related problems, because Polish politicians failed to learn from other people’s mistakes.

  2. Natural herd immunity (without vaccines) turned out to be impossible to achieve, and various mathematical models recommending the spread of the virus among the most active seem to be theoretically interesting but completely useless in practice. First, because natural immunity does not last long, isolating those at risk is logistically impractical, and the spread of the disease rapidly overloads the health care system.

  3. There is no dilemma between fighting the pandemic and protecting the economy. Excessive loosening of the restrictions to protect the economy leads to disease outbreaks and results in the need for longer and more severe lockdowns.

The article was originally published in Polish at: https://liberte.pl/pandemia-trwa/

Translated by Olga Łabendowicz