In a recent post, I pointed out that Washington State had much lower Covid fatality rates than California, which were in turn much lower than Arizona. I argued that the difference was probably cultural.
An alternative hypothesis is that the difference is due to tighter regulations in Washington State.
To get at this issue, consider the death rate from Covid in Washington and Idaho:
Washington 1060/million Covid deaths
Idaho 1744/million Covid deaths
Now consider the death rates in King county (Seattle area) and Spokane County, which is way over along the Idaho border:
King County: 846/million
Spokane County 1745/million
Some of this may be vaccination rates, but probably not all. I recall that even a year ago (i.e. before vaccines), the Covid death rate in the Bay Area of California was far lower than in Southern California. The exact same state, but different cultural attitudes toward risk. It’s not about state mandates; it’s about culture.
The example of Sweden might seem to point in the opposite direction, as its Covid death rate is far higher than in Norway or Finland. In my view, however, the biggest problem in Sweden was not the lack of mandates; it was (misguided) government recommendations that people not wear masks. The Swedes are more likely to follow government recommendations than most other cultures. In America, you do not see differences in Covid death rates between similar states that are anywhere near as large as the nine-fold difference between Sweden and Norway. Sweden really is an outlier.
BTW, I’m not suggesting that being more cautious is always best; I believe that roughly 1/3 of the country is too cautious and 1/3 are not cautious enough. Of course I’m in the rational middle group. 🙂
READER COMMENTS
Dylan
Oct 10 2021 at 1:53pm
I’m inclined to believe that culture is largely responsible for the differences, but I think it is pretty difficult to show. Spokane County is also quite a bit older than King County, and I wouldn’t be surprised if King County or Seattle had stronger regulation than Spokane did (although if they did, the extent that regulation was driven by local culture is up for debate)
On the culture side, the Seattle area was mostly settled by Nordic people, and that culture still permeates. As someone who lived there for a long time, I now find the cultural conformity stifling, and if I had to do it over again, I wouldn’t have spent my 20s there (as you suggested in your earlier post). But, I imagine that culture is also really good about building cultural norms around mask wearing and general social distancing, more so than in other places (even liberal cities like New York). For anecdotal point of reference, the majority of my friends that live in Seattle and have been vaccinated for months, still won’t even consider eating in an indoor restaurant.
Scott Sumner
Oct 10 2021 at 6:01pm
I am confident that any differences in average age couldn’t even come close to explaining the hugely different fatality rates.
Nicholas D
Oct 10 2021 at 2:20pm
Should we test geographically adjacent populations, after adjusting for age, say in bordering counties? So, the difference between Pullman and Moscow, pretty much. We could do that analysis over the entire country. Has that already been done though?
Phil H
Oct 10 2021 at 5:05pm
Hang on: the variation in death rates that makes Washington safer than other states definitely isn’t due to the government; but the variation that made Sweden more dangerous definitely is due to the government? I’m not sure there’s consistency in this argument.
Scott Sumner
Oct 10 2021 at 6:00pm
Phil, I’m saying it isn’t due to government mandates. I do think that the very bad advice the Swedish government gave its population was quite harmful.
Max More
Oct 11 2021 at 9:41am
I think the point is that Swedish people are far more deferential to the government. (My friend from Sweden yesterday agreed with this, although he is an exception.) When the Swedish govt. tells the people not to bother with masks (which was consistent with the USA’s CDC report in 2019), the people don’t bother with masks. In Washington, it matters much less what the government says because people trust it much less.
Lizard Man
Oct 10 2021 at 7:05pm
A lot of caution may seem excessive relative to health risks, but isn’t excessive relative to career and income risks. For example, if you are a physical therapist with your own practice, if you get a cold, you may well need to reschedule a whole day or two of appointments, some of which you will never be able to ultimately reschedule.
Of if your kid gets a cough, they are sent home from preschool, and then you have to get them a COVID test and a doctors note, and the cough needs to be noticeably better before they can go back to the preschool. That can easily be three days of missed work or more. Or your kid sits next to another kid at lunch who tests positive for COVID and then they miss at least 5 days of school due to their exposure to another child with the virus.
Granted that those are schools being overly cautious and forcing huge costs on parents for incommensurately small health benefits.
Mark Brophy
Oct 10 2021 at 9:39pm
Sweden isn’t an outlier, it’s a typical European country. It’s the other countries in Scandinavia that are outliers.
Todd Kreider
Oct 11 2021 at 2:15pm
There are many factors including Sweden had an unusually mild flu season prior to Covid so there were many more vulnerable elderly. Sweden has much larger and not as well care homes relative to neighboring countries and Swedish vacationers brought back much more coronavirus from Italy in March 2020 because its student holiday week was earlier than in Finland and Norway, which didn’t have people leaving.
In the end, though, Sweden ranks about #30 in Covid deaths per million and has about the same age adjusted excess fatalities as Finland, Norway, Iceland and Denmark.
Vaccination did almost nothing in Sweden as 99% of Covid deaths had already occurred by the time 2% were fully vaccinated.
Scott Sumner
Oct 11 2021 at 2:59pm
No, Sweden is not at all a typical European country. It’s a Scandinavian country with European type death rates. That’s really odd.
Todd Kreider
Oct 11 2021 at 11:43pm
Sweden’s Covid deaths rate is among the lowest in Europe. Sweden has had 20% more Covid deaths than German and the Netherlands (no spring 2020 lockdown and no masks until late 2020) yet Germany had and unusually bad flu year before Covid and Sweden had an unusually mild year.
For some reason, apart from a couple of exceptions like Don Bordeaux, blogging economists simply can’t figure this type of variation out. To them, all countries are the same at the onset and only policy differences like completely ineffective lockdowns and ineffective mask mandates are responsible for different outcomes.
Knut P. Heen
Oct 11 2021 at 6:08am
Culture? Scandinavians practice social distancing even in normal times. A Norwegian newspaper reported today that 40 percent of the hospitalizations due to Covid in Norway was foreign born. There is less than 20 percent immigrants in Norway (counting foreign born and their children). Sweden has a larger immigrant population than both Denmark and Norway. The main problem in Sweden was that they let Covid into the nursing homes to a greater extent than Norway and Denmark did. My impression is that many immigrants find work as assistants in nursing homes.
Max More
Oct 11 2021 at 9:45am
I agree with you, Knut. Another Swedish friend who stayed with us just before Covid said “We Swedes don’t like people”. She wasn’t entirely seriously but we were discussing cultural differences and how Swedes aren’t big huggers.
robc
Oct 11 2021 at 9:35am
I thought there was two big differences between Sweden and Norway.
Sweden has large senior centers while Norway’s are smaller and dispersed. So Sweden had large outbreaks early on among the elderly, as acknowledged as a mistake by their leadership in failing to protect them (unlike, say, the leadership in NY).
Sweden had a mild 2019 flu season while Norway had a bad one. So more “dry tinder” in Sweden.
That probably doesn’t explain the entire difference, but I think its the biggest part of it.
Max More
Oct 11 2021 at 9:47am
robc: Yes, I think these are important differences. I find it frustrating that death counts typically reported without any attempt to allow for screw ups in nursing homes and similar (NY being an exception). The same omission exists for previous flu seasons. I’ve seen this point made for the comparison of Sweden to other countries but rarely. Glad you made it here.
DennisS
Oct 11 2021 at 1:41pm
These differences seem more likely to be bigger factors than the view (expressed in the article) that the recommendation to not wear masks was the biggest factor. Most studies seem indicate there is not much difference in community spread with different mask-wearing regimes.
Bruce Ramsey
Oct 11 2021 at 2:45pm
The “cultural” difference between Seattle and Spokane is real. Part of it is political. Consider the vote in 2020 for president:
King County (Seattle) Biden 74.95%, Trump 22.24%
Spokane County Biden 45.96%, Trump 50.29%
The figures for Seattle proper are skewed even more to Biden. There are almost no Republicans in Seattle.
Todd Kreider
Oct 11 2021 at 2:50pm
Covid deaths per capita:
British Columbia 0.0004
Canada 0.0007
Washington 0.0016
California 0.0018
Arizona 0.0028
Why does Washington have 4 times as many Covid deaths’ as Washington? Culture?
Sumner: ” In my view, however, the biggest problem in Sweden was not the lack of mandates; it was (misguided) government recommendations that people not wear masks. ”
There was even less mask wearing in Norway and Finland at under 10%, just like Sweden until late fall when Sweden climbed to 20% and peaked at 30% last winter. Danes started using masks from fall of 2020 due to a government mandate but use was still lower than most of Europe. Many European health departments correctly pointed out masks don’t slow infection but those clever politicians with their history and law degrees overruled the scientists.
steve
Oct 11 2021 at 7:27pm
No, the scientists advocated for masks. The science showed they help.
Steve
Todd Kreider
Oct 11 2021 at 11:33pm
This simply isn’t true, and you have clearly not read anything out of Europe. In the Netherlands, there was a public battle between the scientists and the politicians in the summer of 2020.
Todd Kreider
Oct 11 2021 at 2:51pm
Oops… that should be:
Why does Washington have 4 times as many Covid deaths’ as British Columbia? Culture?
Scott Sumner
Oct 11 2021 at 3:02pm
I see lots of people trying to deny the obvious. To suggest that Sweden has 9 times more deaths than Norway due to bigger nursing homes seems beyond far fetched.
robc
Oct 11 2021 at 3:13pm
It is more obvious than mask wearing. Which, as pointed out, Norway may have done less of than Sweden.
Especially when most of the deaths are among the elderly.
While Sweden gets discussed a bunch, I have never heard you attempt to explain Belgium. That is an even bigger mystery.
robc
Oct 11 2021 at 3:20pm
https://imgur.com/qgBGq3y
Here is Sweden vs Belgium vs the Netherlands.
Sweden and the Netherlands are similar, Sweden slightly worse, although I don’t know what is up with Netherlands monthly corrections for this year.
Belgium though? How are they that dramatically different than the Netherlands? As far as I know, Belgium did nothing dramatically unique.
Scott Sumner
Oct 12 2021 at 1:07pm
Belgium has a more inclusive definition of Covid deaths. If the actual rate is higher, then it’s likely they did something different. Even within Belgium, traffic fatality rates vary significantly between the south and the north. Culture matters.
Todd Kreider
Oct 11 2021 at 4:15pm
Nobody said the sole reason that Sweden had more Covid deaths was larger nursing homes. It also isn’t the sole reason that Sweden has 3 times as many Covid deaths as Denmark.
If the Norwegian department of health is to be believed, its lockdown did not work as the spread of coronavirus was already rapidly decreasing by the time the lockdown went into effect.
zeke5123
Oct 11 2021 at 5:58pm
Let’s start with some basic demographic facts.
Norway has a little more than 1/2 the population of Sweden.
Norway has a younger population compared to Sweden (e.g., Sweden elderly make up about 21% of the population; Norway it is about 17%.
In absolute numbers, Norway has about 1.3m less elderly people compared to Sweden.
Sweden has had about 14k more COVID deaths compared to Norway.
COVID has a massive difference in risk profile for the elderly v. the not elderly.
It is entirely reasonable given the differences in age and nursing home policy (which we know can be a massive killers) that the differences in death aren’t far fetched (i.e., difference is not so great once adjusted).
The numbers are a little less favorable comparing Sweden v. Finland (but they also didn’t start recommending masks until August). Likewise, the nursing home issues looms very large for a disease that massively disproportionately kills elderly (especially the kind of elderly in nursing homes).
Despite this (and claims by others that mask usage is similar — would love to get some citation for that, or that the elderly population in Sweden was meaningfully more ill compared to e.g. Finland), you say “bullocks, must be masks.”
I am not saying I am right and you are wrong, but I am saying your model for approaching this (at least publicly) needs work — especially before you insult people saying they deny the obvious yet you make no serious attempt to refute them.
The final thing I would add is that the claim isn’t just that masks might help a little — it is that masks explain a large difference.
Scott Sumner
Oct 12 2021 at 1:09pm
This is a good example of innumeracy. The trivial difference in the share of old people plays no significant role in the 9 to 1 death disparity. Why even mention it?
zeke5123
Oct 12 2021 at 4:50pm
If you ignore everyone under 65+ (which we shouldn’t if we are doing a full analysis but is fair for high level approx given how extreme the IFR shades) then in this category Sweden has about 2.27 for every 1 in Norway. That makes a not immaterial difference. That ratio of course doesn’t itself explain the differences in deaths.
But then you need to get into network effects which depend in part on absolute size. If Sweden had about 2.3x the size of the very vulnerable population in much more centralized networks AND had on an absolute sense a much larger size of the population, then it is entirely reasonable that within those networks R0 could be higher. Given the IFR for these kinds of population, then creating 14k extra deaths is entirely reasonable.
We are dealing with really tiny numbers for both Norway and Sweden (i.e., 1K and 15K for countries of 5.5m and 10m respectively). Having not in a relative sense but in an absolute sense a much larger vulnerable population increases the chances for a few localized breakouts that can skew the numbers when the overall deaths for both places are pretty small. That is, you can’t ignore both (i) the local nature of viruses and (ii) the exponential growth of viruses. So even if the IFR is the same for Norway and Sweden, it doesn’t necessarily follow that the R0 will be the same because local conditions matter and the ability for the virus to scale matters.
Scott Sumner
Oct 15 2021 at 1:31am
“If you ignore everyone under 65+ (which we shouldn’t if we are doing a full analysis but is fair for high level approx given how extreme the IFR shades) then in this category Sweden has about 2.27 for every 1 in Norway.”
More innumeracy. The difference in the absolute number of old people is of no relevance. Compare South Dakota to California, which has 50 times as many old people.
Thomas Lee Hutcheson
Oct 11 2021 at 10:07pm
Cautious or incautions about what? Becoming infected or infecting? The most important thing to have done early of to prevent infecting on was to have massive testing and self isolation. Was that a failure of caution of incaution?
Aaron
Oct 24 2021 at 11:43pm
I’ll need some actual facts on the culture between SF, LA, and Sacramento. (Sacramento was about between LA and SF in covid.)
Exactly what cultural difference and how did you measure it?
And did you consider climate? As in, SF doesn’t need air con
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