How Sweden Calculates COVID-19 Deaths


Martin Kulldorff, PhD, explains the standard Sweden uses to collect data on the country's seemingly high COVID-19 mortality.

After an initial spike of deaths somewhat concentrated in the city of Stockholm's long term care facilities, Sweden's negative indicators from coronavirus disease 2019 (COVID-19) have steadily trended downward even as several European countries face imminent second waves.

Sweden has been compared negatively to neighboring countries like Norway based on the "nordic" label, despite substantial population differences between them. Norway, for example, has half of the population of Sweden. But what else plays a role? How does Sweden calculate deaths from COVID-19?

Several countries with more generalized restrictions in Europe have also seen more dramatic COVID-19 fatality rates, pointing to there being no easy answer for what differentiates Sweden's outcomes from the rest of the world.

The United States, as well, is currently on a trajectory to outpace Sweden's deaths per million statistic unless the pandemic situation changes.

Martin Kulldorff, PhD, weighs in. Dr. Kulldorff also presents a balanced picture of where Sweden made mistakes in their response.

Kulldorff is a biostatistician in the Division of Pharmacoepidemiology and Pharmacoeconomics at the Brigham and Women’s Hospital + Harvard Medical School. He has long been working in infectious disease outbreaks, detection of new disease outbreaks, and developing novel epidemiological methods.

He has developed new sequential statistical methods for near real-time post-market drug and vaccine safety surveillance, where the purpose is to use weekly, monthly or other frequent data feeds to find potential safety problems as soon as possible.

As a biostatistician, Dr. Kulldorff also does collaborative and consulting work with epidemiologists and clinicians, using a wide variety of study designs and methods for many different types of diseases. Dr. Kulldorff received his bachelor’s degree in mathematical statistics from Umeå University in Sweden, and his doctorate in operations research from Cornell University.

[Bio courtesy of Harvard Medical School]

Evaluating Age-Based Coronavirus Strategies With Martin Kulldorff

Raj Bhopal: Herd or Human Immunity?

Zugzwang is a German word for “a position in chess where every move is disadvantageous where we must examine every plan, however unpalatable.”

Raj Bhopal, CBE DSc, BSc MD, MPH, MBChB, FRCP, FFPHM, is professor emeritus of public health at the University of Edinburgh, Scotland. He held the chair of Public Health in the university until his retirement in 2018. Bhopal is also the author of Concepts of Epidemiology: Integrating the Ideas, Theories, Principles, and Methods of Epidemiology.

Bhopal’s recent article, COVID-19 zugzwang: Potential public health moves towards population immunity, was published in Public Health in Practice. Public Health in Practice is an official journal of the Royal Society for Public Health and a sister journal of Public Health.

The article offers that scientific inquiry around various SARS-CoV-2 interventions has been frustrated by an unappealing mix of competing ethical priorities societies face, alongside political battles and terms like “herd immunity.”

Full interview.

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