No Country for Old People

The COVID-19 death rate in Sweden has exposed worldwide bias against the elderly.

Sweden did not set out to kill thousands of its older citizens. Nor did any country as COVID-19 swept across the globe. But Sweden’s unique and closely watched approach to the pandemic has spotlighted the tragic toll the coronavirus has taken on the elderly. It has cast a harsh light on the value that societies have placed on the freedoms of some to the expense of others.

In March, when many European countries imposed strict lockdown, Sweden experimented with mostly voluntary measures. Gyms, shops, businesses, and restaurants remained open, though citizens were encouraged to stay four feet from one another. The country closed upper schools and universities, but not elementary schools and daycare centers. The government urged people 70 and older to try to avoid crowds and say home when possible. Masks were seldom worn in public. “Locking people up at home won’t work in the longer term,” Anders Tegnell, Sweden’s chief state epidemiologist, has said.

The results of the Swedish experiment to date are in. Sweden now has one of the highest death rates in the world: 39.5 per 100,000 people. That is seven times the rate of Finland, its neighbor to the east, and nine times more than its western neighbor, Norway. Eighty-eight percent of the deaths were people 70 and over—higher than the 70 percent observed in the United States and most other countries. According to Swedish health figures, almost half of the dead were residents in nursing homes. “We did not manage to protect the most vulnerable people, the most elderly, despite our best intentions,” Sweden Prime Minister Stefan Löfven admitted on BBC News.

Did Sweden’s lax social policy lead to the outsized impact on the elderly? George Rutherford, professor of epidemiology at the University of California, San Francisco, has looked extensively at health data from Sweden in his role as an advisor to the World Health Organization. “The elderly got hit hard, and there is no question it was because the virus was circulating so widely in other parts of the country,” Rutherford tells me.

On May 18, on his BBC show, HARDtalk, Stephen Sackur pressed Tegnell about Sweden’s policy and its toll on the elderly. “You probably would not have had that catastrophic spread of COVID-19 through your care homes, particularly around Stockholm, if you had run a more strict, less open policy for the general population,” Sackur said. Tegnell responded, “Yeah, I mean, these people meet a lot of people, even if you have a lockdown. You can’t isolate them. In that way a lockdown would not have stopped the spread into them.”

Johan Giesecke, former state epidemiologist of Sweden, and a professor emeritus at the Karolinska Institute, tells me criticisms of Sweden’s current rates of infection and death are premature. “Wait one year before you start counting deaths in different countries,” he says. “The countries that are opening up now will get their deaths with time.”

Sweden has a national health care system run by the federal government with an excellent track record of care for children and young adults. However, nearly 300 separate municipalities are responsible for care of the elderly and disabled. About 30 percent of all nursing home and home care are contracted to private companies. This arrangement has contributed to mixed priorities and policies. Latifa Löfvenberg, a nurse who worked in several care homes around Gävle, north of Stockholm, told the BBC that care-home management “told us that we shouldn’t send anyone to the hospital, even if they may be 65 and have many years to live. We were told not to send them in.” The Swedish government has promised to improve care homes. Last week it pledged to spend an additional $226 million for training to make nursing-home work more attractive.

To medical observers, the high death toll of Sweden’s elderly exposes a bias worn deep into cultures around the world. In Sweden, says Arthur Caplan, director of bioethics at NYU Langone Medical Center, who has observed the country’s health statistics, “The institutionalized elderly were just forgotten, as they were in the days of plague.” But Sweden is not alone. “The institutionalized elderly were abandoned in Sweden, Canada, the U.K., the U.S., and many other nations long before COVID,” Caplan says. “Letting them die when minimal protection would have helped is not a policy choice, it is not a matter of intergenerational priorities. It is lazy, culpable indifference.”

As more countries ease off pandemic lockdowns, older people will remain disproportionately at risk. Is it fair that the vulnerable should be put at risk for personal freedoms for the young and healthy? “There is no moral excuse for writing off the elderly,” Caplan says. “There are many situations in which a vulnerable group like children receive extra protection—for example, car seats. They restrict liberty in a small way, but permit great freedom.”

Rutherford of UCSF agrees. Ample evidence shows that places with lockdowns saw death decline, and that deaths are starting to creep up in many areas as lockdowns are lifted. “As long as the virus is out there,” he says, “it will infect and kill the most vulnerable.”

Robert Bazell is an adjunct professor of molecular, cellular, and developmental biology at Yale. For 38 years, he was chief science correspondent for NBC News.

Lead image: James Griffiths Photo / Shutterstock