Anders Tegnell in an interview about covid-19 and the death toll in Sweden

Covid-19 is a disease that clearly affects the elderly. 91 percent of those who have died in Sweden are over 70 years old. 1 percent are under 50 years old. And men suffer more than women; in Sweden, 54 percent of men die compared to 46 percent of women, a relationship that has persisted throughout the pandemic.

Why the virus strikes so differently is a question for which state epidemiologist Anders Tegnell has yet to see an answer:

– I have spoken with several colleagues and we cannot think of any other disease in which age is so dominant as a risk factor. It is very rare when it comes to infectious diseases. And I still haven’t seen an answer to why more men than women die, says Anders Tegnell.

Why is it so difficult to protect the elderly? Are they often in confined spaces that need to be protected?

– I do not know. That is why the government has appointed new research to improve work in nursing homes and try to understand how the infection entered. This is in response to criticism from the Crown Commission. And given the problems that have been pointed out for many years in report after report.

– In the spring, it was obvious that there was a lot of potential for improvement, and it has improved, but a large part of those who now die live in nursing homes. Now it is a group that had risked death even if it did not live there. But the virus still gets in there and why it is so extremely difficult to keep it completely away, it may be because they are dealing with people who need a lot of contact with other people. We have seen the same development in countries that we think have done very well this spring, Germany is perhaps the clearest example that has now had a fairly large spread in its nursing homes.

Now sweden has passed 10,000 deaths from covid-19 and an excess mortality of between 6,000 and 7,000 compared to the last five years. And in 2020, a period will stand out when it comes to excess mortality in Sweden, according to statistics produced by The Economist. From April 1 to May 19, and especially the week of April 8 to 14, 2,563 people died compared to the 1,679 expected, a death rate of 53 percent. Other countries have had significantly higher peaks than Sweden, such as Belgium, Spain, the United Kingdom, Ecuador, and Peru, to name a few, all of which had between 100 and just over 200 percent excess mortality in the spring. 2020. Our neighboring countries Norway and Denmark also showed excess mortality during April but significantly lower than Sweden.

If you look at Statistics Sweden statistics from 1975 to 2019 inclusive, the number of deaths varies very little and, despite the population increasing by just over two million during the period, almost exactly as many died 45 years ago as in 2019: 88,208 people in 1975 and 88,766 years. 2019. During the 45 years, there will be an average of 92,000 deaths per year, compared to the last five years, the average will be 91,000. In 2020, the number of deaths appears to be between 97,000 and 98,000. It is true that a high number, but not unique during the period in which 97,008 people died in 1993.

The fact that the figures on how many people die in Sweden during a year are so stable even though the population is increasing is because life expectancy is also increasing and matching the figures.

How do you see a country like this? Russia reports a mortality rate in excess of just over 240,000 between the beginning of April and the end of November, but officially only around 60,000 deaths from covid-19 throughout the year?

– Sweden stands out when it comes to how we inform those who have died. Here, the figures on the number of deaths in covid-19 agree well with the excess mortality reported. There was not much excess mortality that we did not detect last year. Many other countries and regions have a big difference. New York, for example, has 50 percent more deaths than recorded. Excess mortality is a better and more objective value that doesn’t depend on how much you show or how you make the diagnoses, says Anders Tegnell.

So 60,000 dead in Russia, do you think that sounds a bit given the large excess mortality?

– Yes, it is certainly an adequate underreporting. But it is a classic health problem when it comes to people with various diseases, what do you really die of? Is it cardiovascular disease that someone has had for several years that they die from, or is it the covid-19 infection that causes them to tip over?

Different countries count differently. Sweden has a very broad definition. All people who have a covid-19 infection, and also others who are considered to have it and then die within 30 days, are counted as dead in covid-19. “Probably many people have died with covid-19 and not with covid-19, especially elderly and frail people,” declared the director general of the Public Health Agency, Johan Carlson, in an interview with DN in June last year. Furthermore, many countries count only those who die in hospitals.

And a lot changes when it’s about the coronavirus, says Anders Tegnell. Awareness is increasing and the opportunity to save lives has increased since last spring.

– We know much more about which groups are affected, health knows much more about how to treat the sick, which means that fewer people need intensive care than in spring. It has also become clearer that homes and workplaces are the places where most people are infected. However, there are still big questions about whether company closings are really important or not. There are studies that show both. Possibly due to the virus’s slightly random tendency to spread, Tegnell says.

Other questions still await answers, such as how much a person can spread without signs of illness. Cases called asymptomatic. Already on January 28, the president of the United States, Donald Trump, was informed during a security briefing that the new virus could be as dangerous as the Spanish flu in 1918, but also that the infection spread asymptomatically in China; that half of those infected had no symptoms. The position of the Public Health Agency has long been that this group is not so easily infected.

How do you see it today when there are many indications that it was total infection in society that increased the death toll among the elderly?

– Many of the measures we have are to keep our distance, not to create new contacts. And then it doesn’t matter if those who are infected are asymptomatic or have symptoms. So many studies show that asymptomatic infections are not as common as we think. When we tested people who have no symptoms to see if they carry the virus, we found that those who were shown to carry it almost all had symptoms when we talked to them later. The problem is that the symptoms are so vague at first that one does not think of them as an individual.

– Does that mean we should have other measures? No, the same basic measures that we already have in place work here. Work from home as much as possible, keep your distance in all possible situations, stay home if you have symptoms. And it is not about getting rid of all those who may be infected, it is about getting rid of so many that we go down to an R value below 1. That is, one person infects less than another.

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