Chapter Five - *That* letter to the editor
During my own personal Twitter pandemic there were a few turning points, or perhaps "points of no return" would be a better description. The first one occurred on April 14, 2020. On this day, Dagens Nyheter published a letter to the editor with the caption "Folkhälsomyndigheten har misslyckats - nu måste politikerna gripa in" (The Public Health Agency have failed - now the politicians need to take the reins - https://www.dn.se/debatt/folkhalsomyndigheten-har-misslyckats-nu-maste-politikerna-gripa-in/), written by 22 Swedish scientists, academics and physicians. As the title suggests it was a full frontal attack on the Swedish strategy, the public health agency and its staff, the latter of whom were referred to as "civil servants without talent", a phrase which would take on a life of its own, but to avoid committing the same fallacy as Tegnell's critics (see last chapter), I will provide the entire context: "Med tjänstemän utan talang att förutspå eller begränsa epidemin måste de folkvalda gripa in med snabba och radikala åtgärder." - "With civil servants without talent to predict or limit the pandemic, our elected politicians need to step in with fast and radical measures", the implication being of course that the 22 signatories knew much better than the experts at the public health agency. The problem was that they didn't have a fucking leg to stand on.
On the 27th of March one of the signatories, Cecilia Naucler Söderberg, had published a document on Twitter (I believe) in which she discussed the modelled need for intensive care. In the first paragraph she states: "Man skulle sluta att testa misstänkta fall. Jag sa till min man att 'de släpper viruset fritt, will take the hit, och kommer att köra folk i ättestupa'" ("They were going to stop testing suspected cases. I told my husband that 'they're letting the virus free, will take the hit and they will drive people over the precipice' ("ättestupa" is an old Swedish word referring to the myth that elderly and weak people in prehistoric times would have thrown themselves or would have been pushed off a cliff into their deaths in order not to be a burden to their families). There are (at least) two issues here. Firstly, "they" did not stop testing suspected cases. When signs of community spread in the Stockholm and Gothenburg regions were identified around the 10th of March, the Public Health Agency recommended that testing be limited to people in need of hospital care and health care staff. Since the first Swedish case was confirmed more than a month earlier on January 31, efforts were made to test, trace and isolate all identified cases, now this was no longer possible due to the increasing number of cases, but testing still continued at an unabated rate and in fact increased every week. The perceived lack of testing capacity would become a running saga, but we'll get back to that. Secondly, "letting the virus free" is a very simplistic view - let's keep in mind that on the 11th of March the WHO declared covid-19 a pandemic, the virus was very much "free" already.
Although Naucler's description of the situation was questionable, the main issue with the document she shared on Twitter is its conclusions. Naucler and others (including Joacim Rocklöv) had used "advanced models" and reached the conclusion that in Stockholm alone, in the most optimistic scenario (!), over 1,000 people would be in need of an ICU bed by April 12, i.e. two days before the notorious letter in which she, Rocklöv et al. called the public health agency "civil servants without talent to predict or limit the pandemic" was published. And then this number would keep doubling every third day - there is no mention of when she/they think the wave would peak:
The below article from SVT is a less than scientific source, but it is good enough in this context to prove the point that the need for ICU beds in Stockholm peaked around April 20 at around 230, i.e. 5 times less than Naucler's most optimistic figures for April 12.
Yet she had the temerity to come out guns blazing accusing the public health agency of lacking talent to predict the...pandemic! I couldn't believe my eyes. Here's my reaction summed up in a tweet from the 18th of April:
On the 20th of April, I uploaded the document to my Google drive and posted a link to it, with the comment "Probably best to put this here, so it doesn't disappear". By then Naucler had deleted her Twitter account, maybe realising that her media blitz had been an unmitigated disaster.
In the conclusion Nauclear writes "Vem som har rätt; -vi som kommer fram till en dyster prognos för Sverige som är samstämmig med internationella beräkningar, eller FHM:s positivare prognos, det får framtidens analyser utvisa. Det jag och mina kollegor har efterlyst är transparens i data och en vetenskaplig diskussion om olika scenarion. Allt för Sveriges bästa." [Future analyses will show who is right - we who arrive at a sombre forecast for Sweden in line with international estimates, or the public health agency's more positive forecast. What I and my colleagues have called for is data transparency and a scientific discussion regarding different scenarios. Always with what's best for Sweden in mind.] Apparently Naucler et al. felt no need to wait for "future analyses" any longer than April 14. As to who was right about the need for ICU beds, I think the record speaks for itself...
And it wouldn't stop there: When the figures began to diverge significantly from her predictions, she tried to blame the statistics, using a dubious Twitter profile as a source (which makes my "unscientific" SVT article above come across as worthy of a peer-reviewed paper in a prestigious journal):
The tweet from Naucler's deleted profile was dug up with some detective work by David Olsson in late 2022. Mattias Lindberg's Twitter handle is @lindbergpolemik and his 162,000+ (!) tweets are mainly focused on railing against immigration and left of centre politics. The "Tino" he refers to is Tino Sanandaji, an economist and the founder of the controversial and decidedly right of centre online newspaper "Bulletin" which was founded in late 2020 and declared bankrupt in early 2022. When some guy (or gal) on Twitter, like my Austrian "friend" (see chapter three) casts doubts on the Swedish stats it's hardly worth discussing - people are free to spout whatever bollocks they want on Twitter (and they do, all day every day!), but when a professor does it, using dubious sources, it is highly problematic. As Niclas Sjöström pointed out to Naucler in April 2020: "Can't you see what you're doing?". I added my two flippant cents:
As we will see later, Nele Brusselaers would also go on to do the same thing: Rather than questioning her analysis, she assumed that the stats were incorrect. Finally, note that apparently it was perfectly fine to use excess mortality as a parameter here...(yet another topic we will return to, probably more than once).
It gets even worse: On April 15, the day after the notorious letter to the editor, when the spread of the virus had already peaked (as the need for ICU capacity peaked around April 20, it suggests that the spread of the virus had started declining approximately two weeks earlier), Naucler spoke to a reporter at Aftonbladet and stated that Stockholm should be locked down: https://www.aftonbladet.se/nyheter/a/4qeKx6/professor-vill-se-nedstangning-av-stockholm. She also called for Anders Tegnell to resign. So much for a "calm debate focused on facts"...I was sure she also made a much criticised appearance on Russia Today, but when I look for it now, I can't find any references to it, maybe because RT is blocked in the EU? This is what I wrote in January 2022:
I'd like to think I didn't make it up, but maybe she just shared an article from RT, which, although far from great, is still much better that actually appearing on Putin's propaganda channel.
Naucler et al. were of course not the only ones critical of the public health agency. Here's another letter to the editor, this time to Dagens Samhälle, written by Petra Östergren, a PhD student of social anthropology, https://www.dagenssamhalle.se/opinion/debatt/resonemanget-ratt-insats-vid-ratt-tidpunkt-haller-inte/. It contains the nugget "Man behöver som sagt inte vara forskare själv för att fatta att resonemanget bakom 'rätt insats vid rätt tidpunkt' inte håller." (As mentioned earlier, you don't need to be a scientist to figure out that the reasoning behind "the right measure at the right time doesn't hold up.) Marcus Åhlin, a doctor working in the Stockholm Health Care Services wrote a very good reply (https://www.dagenssamhalle.se/opinion/debatt/anders-tegnell-ar-ingen-envaldsharskare/) in which he refutes Östergren's main arguments. It ends with the pithy sentence "Sammantaget är det beklämmande att Folkhälsomyndigheten gång på gång svartmålas när de kritiska rösterna inte ens bemödat sig med att sätta sig in i myndighetens arbete." (In conclusion, it's deplorable that the Public Health Agency is denigrated time and again when the critics haven't even made the effort to understand the agency's work.) That criticism from people like Östergren would be wide of the mark is understandable to a certain extent. Naucler et al. on the other hand should have known how the agency works and that calling for Tegnell to resign and calling the agency staff "civil servants without talent to predict or limit the pandemic" was extremely misguided. I still don't understand how they could show such a lack of judgement.
So we've established that the critics were very unhappy with the Swedish strategy and that people with very little or no qualifications in the field (as well as some with plenty of qualifications, it should be added) claimed that it didn't hold water. But what was it that they wanted? Let's look at another letter to the editor, this one published in SvD, on April 13 (https://www.svd.se/a/0nyqA2/bortse-inte-fran-de-basta-forskarnas-modeller), the day before the notorious letter to the editor of DN. In it Naucler and four others, including Björn Olsen and Nele Brusselars, deplore the fact that Sweden is ignoring "de bästa forskarna, som i princip hela resten av världen låter sig informeras av" (the best scientists, whom basically the entire rest of the world are looking to for guidance). They refer to the much publicised study from Imperial College (which we'll also come back to), written by Neil Ferguson et al. and they say "Sverige är alltså enligt rapporten sämst på att stoppa smittspridningen. Vi är också det enda landet av de elva som inte har infört full lockdown och skolstängningar." (Sweden is thus according to the report ranking last when it comes to preventing transmission. We're also the only country of the eleven [in the study] which hasn't introduced a full lockdown and closed schools".) (my emphasis), i.e. they believed that unless Sweden introduced much harsher measures immediately ("Tiden för att ändra strategi rinner ut nu, dödsfall och nya infekterade ökar kraftigt varje dag." - The time to change strategy is now running out, deaths and new infections are increasing substantially every day) the health care sector would not be able to handle the influx of patients needing (intensive) care - in short, Sweden should follow the rest of Europe into lockdown.
Around the same time (time stamp for the Youtube clip is April 16) at a press conference Angela Merkel discussed "why deciding when to lift a lockdown is such a complex issue", which gained a lot of media coverage, here with the somewhat sycophantic title "Angela Merkel uses science background in coronavirus explainer" from the Guardian:
In the synopsis the Guardian writes: "Merkel, who has a doctorate in quantum chemistry, said that physical distancing measures had brought a 'fragile intermediate success' and helped 'flatten the curve', but added that these rules would remain in place until at least 3 May but some shops could reopen next week." Merkel's focus here is solely on flattening the curve and making sure the health system is not overwhelmed. I want to hammer home this point because of how the focus of the criticism of Tegnell and the public health agency kept changing throughout the pandemic. Already in that notorious interview on April 15, Naucler shifts the focus of the criticism, from health care capacity to high death rates. At this stage it was slowly becoming obvious that the Swedish health system was not in danger of being overwhelmed and that Naucler's advanced models didn't hold water. However, it should still be pointed out that the situation in the ICU units, in particular in the Stockholm region, was serious. The hospitals had managed to increase the total number of ICU beds in the entire country from around 500 (the lowest capacity per capita in Europe, if I remember correctly) to more than 1,000 within a matter of weeks and hospital staff worked extremely hard to manage the crisis. There were also some reports that triage criteria were applied too strictly in the Stockholm region. (https://www.expressen.se/nyheter/coronaviruset/hardare-prioritering-trots-lediga-iva-platser/). This article, initially published on April 10, mentions that 79 out of a total of around 300 beds are still available and that in light of this the harsher triage criteria provided by the National Board of Health and Welfare should not be applied. An investigation by the Health and Social Care Inspectorate later showed that one of the six emergency hospitals in the region, Karolinska, may have been guilty of this (https://www.dn.se/sthlm/karolinska-kritiseras-for-brister-vid-prioritering-inom-covid-iva/). In summary, however you look at it, Sweden had, obviously not without hardship, but without lockdowns and closed schools, managed to "flatten the curve". Not that this pleased the critics, far from it...
(There's obviously a discussion to be had here about whether the "Swedish solution" would have worked in other countries, and it might be a valid argument, but as far as I'm aware it wasn't made at the time. It was only after Sweden had "proven" that the pandemic could be handled without lockdowns that these discussions appeared on Twitter - "It would never work in [insert name of country] because we/they don't listen to the authorities." However, data from Miami, which was the US state with the loosest restrictions, seems to suggest that lockdowns didn't do much to reduce the number of deaths and hospitalisations, but this is another issue we'll come back to at a later stage.)
