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Sweden and coronavirus

Sweden don't look to be doing so great here, not that I think direct comparisons with the UK or other mainland European states are particularly valid - as discussed earlier in this thread.


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Sweden don't look to be doing so great here, not that I think direct comparisons with the UK or other mainland European states are particularly valid - as discussed earlier in this thread.


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Is anywhere going to avoid a big omicron wave? I suspect not, so it's just a case of where you are in your curve. Sweden did very well in the delta wave. I think we can say that now. It was bottom of the European list throughout autumn for cases and deaths. Will it avoid a big omicron wave? I see no reason why it would. See no reason why anywhere will.
 
Sweden don't look to be doing so great here, not that I think direct comparisons with the UK or other mainland European states are particularly valid .
As for this bit, why are they not valid? It's arbitrary only to compare Sweden to certain of its neighbours and nobody else. In fact, Tegnell argued early in the pandemic that, in terms of throughput of people from around the world, Sweden is more like The Netherlands than it is Norway.

Got to be really careful about cherry-picking stats here. For instance, there were plenty of people arguing that a comparison between Sweden and Germany showed how Sweden had got it badly wrong back when Germany's stats were better than Sweden's.
 
As for this bit, why are they not valid? It's arbitrary only to compare Sweden to certain of its neighbours and nobody else. In fact, Tegnell argued early in the pandemic that, in terms of throughput of people from around the world, Sweden is more like The Netherlands than it is Norway.

Got to be really careful about cherry-picking stats here. For instance, there were plenty of people arguing that a comparison between Sweden and Germany showed how Sweden had got it badly wrong back when Germany's stats were better than Sweden's.
It was already discussed at some length some time ago so you'll have to go back through this thread.
 
Also, i caught it in Sweden, so im basing opinion on feelings born from this been the 7th day of isolation. Sweden as a concept can fuck off.
 
The stats don't back that up, though. Excess death numbers show that covid-19 as a public health emergency ended in Sweden around March last year. In fact, while Denmark has done better overall than Sweden since the start of the pandemic - 44 vs 117 excess deaths per 100k - Sweden has done better than Denmark in the last ten months.

Right at the start of the pandemic, Anders Tegnell said to wait on passing judgement over Sweden's approach until March 2021. He got some things wrong, including underestimating the power of mutation to cause future waves, and he got that date wrong, probably by about a year. March 2022 is likely to be roughly the time when we can meaningfully carry out covid audits. He also specifically referenced Denmark, asking how they would be protected over the winter of 2020-21. Again, he got that wrong as Denmark wasn't that badly affected, and was less badly affected than Sweden over that winter. However, if he'd referenced a whole bunch of countries in Eastern Europe that dodged the first wave and then were smacked so badly by the second wave that their overall deaths surged past those of countries badly hit by the first wave, he'd have been spot on.

Meanwhile, mask mandates, etc, aren't making the blind bit of difference to the spread of omicron. It's hit Denmark first and no doubt Sweden will get its share very soon.

Everyone has got something wrong when dealing with this pandemic. The Swedes have been better than most in admitting that, admitting very early on that they failed to protect care home residents. But from what I see in the stats, Sweden's approach only looks better the further on in the pandemic we get. I certainly don't think it's tenable to hold up Sweden as an example of folly, even when comparing it to the rest of Scandinavia only (which is a bit of an arbitrary choice) - for instance, Finland's excess deaths are now standing at 73 and have been steadily catching up with Sweden over the last year. But in any case, the whole of Scandinavia, including Sweden, is well below the European average. Countries once held up as the examples to follow, such as Germany, have now overtaken Sweden, and many, many countries have done far worse.

Tracking covid-19 excess deaths across countries
Excess death rates aren’t a bad measure of how countries are weathering the pandemic, but neither can they be used to judge the success or otherwise of any country’s Covid strategy, IMHO.

The reason being that excess death rates, by definition, are counting deaths from all causes, and that’s influenced by many other factors than just how successfully a country has mitigated COVID deaths. One of the biggest influences is going to be how resilient / well resourced the healthcare system is and to what extent other, non-COVID related health appointments have been able to proceed as normal.

I know, having been living in Sweden during this period and having had a regrettably huge number of doctor and hospital appointments in the past year that the healthcare system has held up fantastically well and at times I’ve been able to get urgent consultant appointments within three days. The tales of woe I read on these boards about the difficulty accessing overloaded NHS services are probably occurring in very many countries to even greater degrees and having a compounding effect on overall death rates.

Ps it’s going to sound like nitpicking but FYI Finland is not a Scandinavian country. The right term is Nordic countries
 
Is anywhere going to avoid a big omicron wave? I suspect not, so it's just a case of where you are in your curve. Sweden did very well in the delta wave. I think we can say that now. It was bottom of the European list throughout autumn for cases and deaths. Will it avoid a big omicron wave? I see no reason why it would. See no reason why anywhere will.
Nowhere looks likely to avoid a big wave, but they still take steps to reduce the ultimate size and impact of the wave.

These days Sweden seems less keen on Swedens original approach than you do! Why do you think they have felt the need to impose a range of measures on several occasions in the last month or so? Their current measures go further than the UKs in a number of areas, including limits to the size of private gatherings.
 
There's no correlation between mask mandates and spread of omicron. France is a decent example - widespread mask mandate and just about the biggest surge of any country.
You can't isolate out the mask mandate from all the other variables though. So I don't see how anyone can say there is or isn't a correlation.
 
Nowhere looks likely to avoid a big wave, but they still take steps to reduce the ultimate size and impact of the wave.

These days Sweden seems less keen on Swedens original approach than you do! Why do you think they have felt the need to impose a range of measures on several occasions in the last month or so? Their current measures go further than the UKs in a number of areas, including limits to the size of private gatherings.
I believe they gained a new prime minister at the end of last year. Not sure if this is relevant to the change in approach.
 
We can also look at comments in recent months from Tegnell, the face of their original approach, who often continued to defend that approach.

Mid November:


“If we have the continued low pressure from the virus which we have just now, then maybe proof of vaccination (for larger public gatherings) would be enough,” Anders Tegnell, the architect of Sweden’s no-lockdown approach to the pandemic, told a press briefing in the Swedish capital Stockholm.

“But experiences from many other European countries — the Netherlands, Belgium, Austria — suggest that if the spread of virus increases, then it is not enough.”

Mid December:


Prof Tegnell said masks are an effective way to stop transmission, particularly in crowded spaces, and that health officials should work to change attitudes to promote their use.

“We can’t get away from the fact that we have been sceptical towards face masks, and people have understandably picked up on that, and have it in the back of their mind. And then it’s hard to change that attitude,” he told newspaper Dagens Nyheter.

There are also various reports that we could look into. Some are mentioned in the following article:


The government’s measures were sharply criticised in an 800 page report (the second of this sort) published in October 2021 by the Swedish Corona Commission3—the government commissioned inquiry into the pandemic response—which it noted were both late and insufficient, and called preparedness “non-existing.”

This was followed in November 2021 by a report from the Royal Swedish Academy of Sciences,4 proposing the establishment of an independent expert unit for future pandemics, stating that authorities were “inadequately prepared” in terms of knowledge as well as equipment such as face masks, and that high mortality during the first two waves of the pandemic was because of “mild and tardy” measures to prevent the initial spread of infection.

Sweden’s King Carl XVI Gustaf labelled Sweden’s handling of the pandemic a “failure” in his end of 2020 TV speech. Then prime minister Stefan Lofven agreed. “The fact that so many have died can’t be considered as anything other than a failure,” he said.

Anders Vahlne, a professor of virology at the Karolinska Institute and one of the scientists critical of the Swedish response, told The BMJ that it was shameful that the whole pandemic had been in the hands of a few civil servants who acted and reacted slowly, lacking flexibility and still not clearly acknowledging that the virus was airborne.

littlebabyjesus has complained that I mischaracterise his pandemic stance, but his recent comments demonstrate quite how far out on a limb he remains, having not seized any opportunities to modify his stance. Even Tegnell moved further than him. Especially his ridiculous attitude towards masks which persists to this day despite being a disgraceful embarrassment that goes far beyond any false accusations I could possibly manage to invent. Perhaps I can be partially blamed for now allowing him sufficient room to 'save face', but on recent evidence I doubt thats the story really.
 
In a nutshell, initial stupid establishment attitudes towards masks in various countries were heavily sponsored by concerns about the supply of masks, and desperate attempts to save them for some narrow purposes rather than encourage widespread public use of masks. The tune changed when denials about airborne transmission could not possibly hold, and when supplies were less constrained. Even then the switch was often somewhat gradual, with the term 'face coverings' preferred to start with. Those who still stick to the original attitude are cranks, people with strange cultural and ideological objections which make them a disgraceful threat to public health.

Of course none of that means that masks are enough on their own, they are only one of a large range of non-pharmaceutical measures that have been required in this pandemic in order to hope to cope.
 
A view that I see stated amongst those who complain about mask mandates, is that the UK recommendation to wear a "face covering" is stupid and pointless, because according to them, cloth masks or even basic surgical masks are entirely useless, and it's only properly fitted FFP2 or better masks that are going to make any difference.

Those same people don't seem to be in a hurry to go out and wear FFP2 masks themselves. Instead their view seems to be that if you want to protect yourself, wear a high grade mask, don't expect them to wear one for the protection of others.

It's a bit hard to argue about masks, partly because some people have become absolutely adament that they are a waste of time, and partly because it's true that there's not a lot of very definitive evidence of their efficacy at a population type level (although I'd like to see some if I'm wrong about that).
 
Its the usual problem, the really strong population level evidence would be enabled by having a parallel universe where we could see the same population with the same variant, same levels of vaccination, demographics, other behaviours etc etc, with and without people wearing masks. We dont get to see that, so the evidence on that level ends up much weaker. We have to resort to theory and small scale experiments instead, or comparisons that can be picked apart due to other differences between the different groups being studied.

Common sense and the repetition of simple public health messages have been enough to convince plenty that there is merit to these things. That obviously isnt going to satisfy those who have other reasons to oppose masks, and so here we find ourselves. I do find Tegnell and Sweden somewhat useful in this regard these days though, they offer a glimpse into how authorities which had a bad track record have tried to adjust their stance to bring themselves closer to the updated orthodox approach and obvious reality. People that continue to oppose both strong restrictions and all the other, easier stuff that can make a difference in combination are infuriating because they compound the failures that their approach brings, they end up unwittingly inviting even stronger restrictions because they undermine the simpler stuff. And they seem to want to deal in absolutes, are not so interested in the idea that you reduce risk a bit here and there, chip away at infection opportunities and that these things add up.
 
Something for the Tegnell fans (not me, I think he’s a pillock). In my local burger joint yesterday we were greeted with this:

B75E0D2E-3CCC-4218-A912-52DE38D699A6.jpeg
 
sounds like a trump quote
Yes, it’s delusional madness. And folkhälsomyndigheten is the public health agency of Sweden, the people who are meant to prevent the spread of infectious diseases. For them to say it’s fine for infected people to go mix with others but not ok for them to be tested is so fucked up, it makes it clear the only strategy in play now is herd immunity. I wonder how many people will die.
 
A new study paints a damning picture of Sweden's COVID response:

"The Swedish response to this pandemic,” the researchers report, “was unique and characterized by a morally, ethically, and scientifically questionable laissez-faire approach.”

The details of Swedish policies as described by Brusselaers and her co-authors are horrifying. The Swedish government, they report, deliberately tried to use children to spread COVID-19 and denied care to seniors and those suffering from other conditions.

“Many elderly people were administered morphine instead of oxygen despite available supplies, effectively ending their lives,” the researchers wrote. “Potentially life-saving treatment was withheld without medical examination, and without informing the patient or his/her family or asking permission.”

In densely populated Stockholm, triage rules stated that patients with co-morbidities were not to be admitted to intensive care units, on grounds that they were “unlikely to recover,” the researchers wrote, citing Swedish health strategy documents and statistics from research studies indicating that ICU admissions were biased against older patients.



 
There will have been a UK version of that too but I dont know how much of it will get a proper airing. The really obvious stuff like certain attempts to misuse do not resuscitate orders will come up in the inquiry, but theres plenty of other stuff too and they might keep the angles really narrow in order to avoid even beginning to explore uncomfortable truths properly.
 
A new study paints a damning picture of Sweden's COVID response:

"The Swedish response to this pandemic,” the researchers report, “was unique and characterized by a morally, ethically, and scientifically questionable laissez-faire approach.”

The details of Swedish policies as described by Brusselaers and her co-authors are horrifying. The Swedish government, they report, deliberately tried to use children to spread COVID-19 and denied care to seniors and those suffering from other conditions.

“Many elderly people were administered morphine instead of oxygen despite available supplies, effectively ending their lives,” the researchers wrote. “Potentially life-saving treatment was withheld without medical examination, and without informing the patient or his/her family or asking permission.”

In densely populated Stockholm, triage rules stated that patients with co-morbidities were not to be admitted to intensive care units, on grounds that they were “unlikely to recover,” the researchers wrote, citing Swedish health strategy documents and statistics from research studies indicating that ICU admissions were biased against older patients.




I don't think a damning picture can be painted by simply looking at COVID outcomes. Without factoring in e.g. mental health, healthcare for non-COVID conditions, or any of the other factors that might have been beneficial in the Swedish response, that article just reads like a diatribe befitting of a newspaper editorial. I'd be interested to read some actual research on the pandemic in that country.
 
Excess death numbers are probably the best way to factor in both direct and indirect effects of the pandemic. By that measure, Sweden's a bit worse than Finland, about twice as bad as Denmark and about three times as bad as Norway. If you class Estonia as a Nordic country, Sweden is way better than Estonia. Economist does a tracker:

Tracking covid-19 excess deaths across countries

Sweden's still well under the European average, mind you, and nowhere near the catastrophic numbers of Eastern Europe.

The dangers of, and justifications for, cherrypicking comparisons come into play here. During the first wave, Sweden compares pretty badly with many places. Since the first wave, Sweden compares well with the rest of Europe, and doesn't compare badly with other Nordic countries. Since the second wave, Sweden compares very well with anywhere in the world. I would argue that the above article is doing a fair bit of cherrypicking when it picks out the stat saying that Sweden was 10 times worse than Norway in the first wave. True, but not the whole story.

Speaking to a few Swedes recently, I was slightly surprised to hear how much activity did actually stop. A fair few Swedes effectively placed themselves into a voluntary lockdown, closing clubs, ending socialising, etc.
 
Many of those other "non covid" effects either won't show up in excess deaths (eg things that reduce quality of life without actually killing you) or may only show up in excess deaths a couple of years down the line (eg late diagnosis of cancers).
 
Yes. An example of that would be my mum's cataracts. Should have been operated on two years ago and she's still waiting. Not life-threatening but certainly life-affecting.

Another example I've spoken about before is the way that many social services in the UK, such as moving people out of (and so into) emergency housing, came to a complete standstill for about five months in 2020. A hell of a lot of people suffered due to that.

I don't know how Sweden compares by those measures, but I agree that it's relevant to the discussion.
 
Excess death rates are strongly influenced by other factors, so won’t simply be a reflection of the success or otherwise of the covid strategy. For example the amount of excess capacity and overall fitness for purpose of the healthcare system has a very direct bearing on how many excess deaths from non-covid causes occur when covid cases put high loads on the system.

When comparing a country with a well organised and well funded healthcare system which adopted a shitty covid strategy with one whose healthcare system is thinly spread at the best of times but did a better job of their covid response, one might see a similar or even higher excess death rate in the second country, but it‘s not safe to use that as a metric solely of the covid strategy.
 
There are no infallible metrics, but if you have to choose just one by which to make comparisons across countries, excess deaths is the one to go for.
 
Speaking to a few Swedes recently, I was slightly surprised to hear how much activity did actually stop. A fair few Swedes effectively placed themselves into a voluntary lockdown, closing clubs, ending socialising, etc.
Heres a few thoughts on it not being all that surprising when we think about it:

We should have expected to see even greater divergence in Covid wave data between countries that in non-pandemic times had roughly comparable patterns of life and age population pyramids, if these behavioural changes had not been a meaningful part of the picture at any stage at all. Shit would have kept getting worse, with even later and higher peaks, if informal brakes had not been applied at all. As I was probably discussing with you a few weeks ago, Swedens wave 1 shape wasnt all that dissimilar to 'late lockdown' countries such as the UK, and that offers some clues about behavioural changes there over time.

Nor should we be surprised that concerns about a new virus, gloomy mood music and concern about hospital capacity being used up led to behavioural changes, even in the absence of certain formal rules being imposed. The phenomenon still exists even in the vaccine era, but obviously to a much lesser extent unless fresh concerns cause worsening mood music and the impression that some of the gains in protection from severe disease have been lost.

This sort of stuff is also relevant when considering a couple of different versions of 'against lockdowns and other measures' political stances. There are several versions of that too:

There is an extreme version which tries to get everyone to carry on as if nothing is happening, and sees various things in binary terms, with all behavioural changes and reductions in economic activity being attributed to the imposition of formal rules. Including the idea that there was actually a viable option to expect people to completely ignore the virus and carry on as normal, an idea I consider absurd and divorced from reality, something thats never going to happen, something that at most would just have delayed the inevitable for some additional deadly weeks.

There is a version where its proponents are allergic to the imposition of formal rules, but do recognise the role of behavioural changes in influencing the scale and timing of a wave.

I ranted about them both. But I have more sympathy with the second one because its at least possible to imagine it being compatible with how humans will actually end up behaving when faced with a threatening virus. I still could not back it in the first waves in the pre-vaccine era, because it still amounted to leaving too much uncertainty in peoples minds, and too many people doing too little, too late, sticking to the standard pressures in terms of what people think is expected of them socially and economically, and I thought time was of the essence. Plus as we saw if the timing and strength of braking was all messed up, then it made it more likely that the system would be pushed to the point that we'd still end up with heavy formal rules in the end, and that they would end up being imposed for longer. The way the UK establishment flip-flopped on the formal rules and messed up their timing, then feeling the need to slam the brakes on real hard, made us a text book example of that. Whereas Swedens situation was somewhat more nuanced and leaves us still unpicking and decoding what happened there. I think I already mentioned in a previous post my impression that this may be because Sweden had a number of initial systemic advantages compared to the UK, stuff that affected the initial seeding of disease and the pace and scale of the exponential explosion of cases, but then used up those advantages by not u-turning and formally braking as hard as we did.
 
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