We need summer dollars,” Amity’s mayor said to his police chief after a woman’s chewed-up body washed ashore. He went on, “You yell ‘shark’ and we’ve got a panic on our hands on the 4th of July.”(1) This scene early in the movie Jaws established a path for municipal denial of the obvious. The mayor finally changed his mind when the massive shark’s gustatory choices became more apparent.
Considering their response to the COVID-19 pandemic, it appears that Sweden’s leadership never fully absorbed the unfavorable consequences of filmmaker Steven Spielberg’s lesson in government disavowal. For as the viral pandemic swept across Europe, Sweden’s officials re-enacted early scenes from Jaws on the world stage.
Throughout the pandemic, Sweden’s prime minister, emphasizing personal responsibility, took measures to ensure that elementary schools, restaurants, bars, and other public gathering places would remain open during the crisis.(2) He explained, “The goal of the work of the government is to limit contagion so that not many people at once become seriously ill and to secure resources for health care as well as in these difficult times alleviate the consequences to you, the worker, and to our businesses” [emphasis added].(3)
Although the government initially limited the number of individuals in any location to 500, this number was later reduced to 50. Sweden’s Public Health Agency recommended that high schools, colleges, and universities switch to online teaching and that restaurants remain open but only serve at tables, eliminating popular buffets. Swedes were urged not to travel, although traveling was not forbidden.(2) Recognizing the COVID-19 risk posed for elderly individuals, the Public Health Agency advised people aged 70 and older to limit their social contacts.(2)
The public initially supported their prime minister’s decisions.(4) Opponents of the government’s strategy were few and far between. In a Dagen Nyheter newspaper editorial published on April 14, 2020, 22 researchers accused civil servants of not properly dealing with the crisis.(5)
COMPARING AND CONTRASTING
Sweden and the United States were the only countries with high overall mortality rates that failed to rapidly reduce those numbers as the pandemic progressed.(6) Because important healthcare disparities exist among the 50 American states, comparison of COVID-19 mortality rates in the United States proves difficult. For the Scandinavian countries, however, differences between them prove inconsequential.
Norway, Sweden, Finland, and Denmark all have comprehensive healthcare systems based on a socialist model. These countries have small percentages of foreign-born residents, ranging from 8% in Denmark to 16% in Norway. Likewise, the Scandinavian countries have relatively small populations. Finland, Norway, and Denmark have between 5.5 million and 5.9 million residents; Sweden has almost twice as many people (10.6 million).(7)
Based on information about COVID-19 mortality tabulated by The Center for Systems Science and Engineering at Johns Hopkins University (which finally stopped acquiring data on March 10, 2023),(8) Norway, Finland, and Denmark, with similar populations, averaged 7,508 deaths from COVID-19. Therefore, Sweden, with a population 1.88 times larger than that of its Nordic neighbors, should have experienced 14,111 deaths caused by the pandemic — the actual number was 23,777.
Hence, 9,666 more people died from a SARS-CoV-2 infection because of the Swedish government’s policy. This is enough people to fill Håkons Hall in Lillehammer, Norway, where, during the 1994 Olympic Gold Medal ice hockey match, Sweden beat Canada in an endgame shootout.
With the COVID-19 pandemic, however, Sweden landed on the losing side.(9,10) Excess deaths lower a nation’s life expectancy, as happened in Sweden during the COVID-19 pandemic, an effect similar to what followed the influenza pandemic of 1919.(6)
UNDERSTANDING EXPONENTIAL GROWTH
Oftentimes, it’s difficult for the general public and their elected officials to wrap their minds around the notion of exponential growth. Physicians and healthcare administrators, on the other hand, should be familiar with the concept. Many infectious diseases and contagions can grow rapidly within a person or within a population.
A “flesh-eating” bacterial infection can begin as a pimple, spread slowly up a limb, and then suddenly engulf the patient, often with a fatal outcome.(11) The same thing happens with a gas gangrene infection after a puncture wound,(12) or peritonitis following a bowel rupture.(13)
Indeed, in the pre-antibiotic era (less than 100 years ago), rapidly multiplying transmissible microbes decimated the entire population. Pandemics of yesteryear (e.g., smallpox, plague) and of today (measles, mumps, whooping cough) can engulf at-risk populations.
Insect-borne infections — malaria, yellow fever, Zika, West Nile — are no different. Mosquito abatement, typically requiring area-wide insecticide spraying, often meets strong resistance from the local public. Considering that a disease-spreading female mosquito (the only gender requiring a blood meal) can lay up to 200 eggs in a bottlecap full of water,(14) the insect’s potential for population explosion haunts the nightmares of healthcare leaders around the world.
The following fable best illustrates the mathematics of exponential growth:
A single bacterium, capable of doubling its numbers every minute, is placed in a jar of nutrient broth. After 26 minutes, a young bacterium, alarmed by the increasing crowd within the jar, conveys his concern to one of his elders. “Don’t worry, Sonny,” the old-timer says, “our family has been in this jar for 24 generations and we’ve consumed only 3.125% of the nutrients.” Because of the power of exponential growth, as Gramps speaks these reassuring words, he and his relatives are five minutes from total annihilation.
When faced with invasion by dangerous organisms — whether sharks, mosquitoes, parasites, bacteria, or viruses — elected and appointed officials must heed the warnings of experts, even when such advice is widely unpopular. The downside consequences of delay and denial often prove calamitous.
References
Spielberg S, dir. Jaws. 1975; Universal Pictures.
Petridou E. Politics and Administration in Times of Crisis: Explaining the Swedish Response to the COVID-19 Crisis. Eur Policy Anal. 2020;6(2):147–158. https://doi.org/10.1002/epa2.1095
Prime Minister Stefan Löfven’s Address to the Nation. The Local Sweden. March 22, 2020. https://www.thelocal.se/20200322/in-english-prime-minister-stefan-lfvens-address-to-the-nation?gaa_at=eafs&gaa_n=ASWzDAgUOuNy_8EY0zCbG9V1fRbKGLwBINau0vVmpqDFk6cNiYXUIwn-KONkorXXYk4%3D&gaa_ts=68a8660c&gaa_sig=1AZu6tdAsTxOkSWZLiTesFQDMWQfSK7X7dm_Eijj_fuJzKj1aDegcgxBOdgMGmjN6pOjhweGcyLgPhLgNiweTw%3D%3D .
Rosén H. Increased Trust to Löfven During the Corona Crisis. Dagens Nyheter. May 3, 2020. https://www.dn.se/nyheter/sverige/dnipsos-starkt-fortroende-for-lofven-under-coronakrisen/
Carlsson M, Einhorn L, Einhorn S, Elgh F, et al. The Public Health Agency of Sweden Has Failed—Now The Politicians Must Intervene. Dagens Nyheter. Updated April 24, 2020. https://www.dn.se/debatt/folkhalsomyndigheten-har-misslyckats-nu-maste-politikerna-gripa-in/
Bilinski A, Emanuel EJ. COVID-19 and Excess All-Cause Mortality in the US and 18 Comparison Countries. JAMA. 2020; 324(20):2100-2102. https://doi.org/10.1001/jama.2020.20717
World Population Review. Scandinavian Countries. https://worldpopulationreview.com/country-rankings/scandinavian-countries .
Johns Hopkins University Medicine. Coronavirus Resource Center. https://coronavirus.jhu.edu/map.html .
Diderichsen F. How Did Sweden Fail the Pandemic? Int J Health Serv. 2021;51(4):417–422. https://doi.org/10.1177/0020731421994848
Orlowski EJW and Goldsmith DJA. Four Months into the COVID-19 Pandemic, Sweden’s Prized Herd Immunity Is Nowhere in Sight. J R Soc Med. 2020;113(8):292–298. https://doi.org/10.1177/0141076820945282
Chen LL, Fasolka B, Treacy C. Necrotizing Fasciitis: A Comprehensive Review. Nursing. 2020;50(9):34–40. https://doi.org/10.1097/01.NURSE.0000694752.85118.62
Patzakis MJ. Clostridial Myonecrosis. Instr Course Lect. 1990;39:491-493. PMID: 2186141.
Hau T, Ahrenholz DH, Simmons RL. Secondary Bacterial Peritonitis: The Biologic Basis of Treatment. Curr Probl Surg. 1979;16(10):1–65. https://doi.org/10.1016/S0011-3840(79)80011-8
Connelly CR, Borchert J. Mosquito Control Emergency Preparedness and Response to Natural Disasters. J Am Mosq Control Assoc. 2020;36(2 Suppl):2–4. https://doi.org/10.2987/8756-971X-36.2S.2