Sweden and coronavirus

[ska invita]

10 mins -
Q: UK curve is flattening because of lockdown and hospital capacity increasing - surely it is demonstrably working
Sweidsh expert A: No its because of growing Immunity and that the cohort of old vulnerable people has thinned down already.

No evidence for either of those two things. Not that many people have died form the cohort yet, and theres zero proof of immunity existing. For someone who started off by saying We Will Only Follow Evidence this seems massively hypocritical to me

???

 

[littlebabyjesus]

10 mins -
Q: UK curve is flattening because of lockdown and hospital capacity increasing - surely it is demonstrably working
Sweidsh expert A: No its because of growing Immunity and that the cohort of old vulnerable people has thinned down already.

No evidence for either of those two things. Not that many people have died form the cohort yet, and theres zero proof of immunity existing. For someone who started off by saying We Will Only Follow Evidence this seems massively hypocritical to me

???

Seems to me that, like everyone, he's only reaching the conclusions his starting assumptions lead him to. So the most important starting assumption here is that c19 has a mortality rate of 0.1–0.2 per cent, ie very similar to a nasty flu.

Following that assumption, you will get his 'thinning out' happening, I think - not all old and sick people will be vulnerable to it, but those that are will die first, particularly within the initial wave of deaths due to infections from before any social distancing measures (such as no visitors to care homes). And, of course, the big untested bit of the assumption - if he's right then he's also right that a big percentage of the population has had it already and we'd be peaking already even without lockdown.

I think what he's essentially saying is that protecting the old and sick is the important bit of lockdown and everything else is marginal or even counterproductive. And he also admits that Sweden failed in this. (Strange dig at immigrant workers in that bit.)

If he is right in his assumptions, then a full-on 'do nothing except protecting old people for a bit' strategy would kill perhaps 50-100k people in the UK. His contention is that with lockdowns, it still kills that many people, just spread out over a longer period. (That assumes no progress in treatment over the coming months, mind you - if an effective treatment is discovered in, let's say, the next three months, then Germany's death figures will never approach those of Sweden.)

The one thing his modelling has in common with the Imperial modelling is that both models indicate the crucial importance of testing. Test test test is still the way out of this, even for 'herd immunity' advocates, which is essentially what this is - protect the old, let everyone else get it.

 

[Reno]

10 mins -
Q: UK curve is flattening because of lockdown and hospital capacity increasing - surely it is demonstrably working
Sweidsh expert A: No its because of growing Immunity and that the cohort of old vulnerable people has thinned down already.

No evidence for either of those two things. Not that many people have died form the cohort yet, and theres zero proof of immunity existing. For someone who started off by saying We Will Only Follow Evidence this seems massively hypocritical to me

???

It's not like there is zero evidence. It is very likely that people who have recovered will have immunity, at least for a while. That's because it's not like we don't know anything about viruses and coronaviruses in particular, they've been with us for a while. The reports of people reinfecting in South Korea have shown to probably have been misinterpreted. People still test positive for the virus for a long time after they've recovered. Sometimes people were thought the have recovered, when the had not and there also were false negative test results do to poor testing. Even if there is such a thing as reinfection sooner than has been estimated, it is thought that there are enough antibodies present for the disease to be less severe a second time round. In most cases its already not severe.

What to Know About Coronavirus Immunity and Chances of Reinfection

Some COVID-19 patients are testing positive after recovering in Asia, but experts say the presence of antibodies should guarantee short-term immunity

time.com

He is doubtful about an exit strategy which the politicians of most countries talk about and he says that the more vulnerable people who die now in Sweden, will die at a later point in other countries, once they relax their lockdown, which strikes me as logical. So far he is confident that the Swedish health system is coping and that's what Sweden is basing its measures on.

The 12 to 18 months for a vaccine is pure guesswork, this could be with us for years. Till then, a safe exist which politicians are talking of now, is an illusion. The main argument for a lockdown is flattening the curve and that is dependent on how well any health system can cope. It is not the aim of stopping more people from dying because in all likelyhood we are in for at least a year, possibly years and we can't stay in lockdown that long. If we stayed in lockdown till there is a vaccine, then the collapsing economy, mental health concerns, etc will claim many more victims than the virus itself. In theory that would also mean locking in all those who are more vulnerable for years. I have health issues which put me in a higher risk group (tottering towards my 60s, male, high blood pressure, allergy based asthma) but I'd rather take my chances than going into lockdown for years. Even most of those in higher risk groups, won't die from this.

I've been listening to a couple of podcasts by two of the most high profile virologists in Germany. They support the German lockdown measures in regard to taking the pressure off the German health system. Just in terms of the science, they say the same as what this scientist is saying.

 

[elbows]

He’s saying basically he believes it’s mostly a very mild illness, and that the mortality rate is way over estimated, in other words many (perhaps most) have already had it without knowing. Also that the lockdowns in other countries are not based on any scientific evidence of effectiveness and will make little difference to the overall number of deaths and all countries will end up with similar death rates.

I wont watch the video, not enough time, and I dont want my blood pressure to go wrong. But thanks for sharing it anyway, and for the summary.

It is true that there are many unknowns and a series of assumptions have had to be used when countries decided what sort of lockdown to do, and when.

What I find unacceptable is that he can criticise the lack of scientific evidence behind lockdowns, but then trust his own beliefs that a large percentage of people have caught it already. Where is the evidence for that belief? So far there isnt any, and when countries try to find the answer, so far it has tended to come out on the low side, eg a range of perhaps 1%-15% of people infected in some places, not the much higher figure that would be required to support the assumptions used in the Oxford model and by the Swedish expert.

Now having said that, I was one of the people who didnt want to just take the initial WHO China team assertion in February that there werent many other cases showing up through antibody testing at face value. But evidence that contradicts the WHO China findings has been in short supply, so maybe they were right. But I am still content to deal in maybes rather than absolutes, of which there are few.

Or maybe there is something else going on that we dont understand yet. Like everyone else I've had to use some assumptions, but none of them are sacred to me, I will be happy to ditch any of them if the evidence points in a direction incompatible with them. And Sweden is certainly on the list of countries that I am watching for clues, and the picture there so far has been mixed. I dont have an exact theory about this, and its not like Sweden is a 'pure' example, they havent done a full lockdown but they did do some social distancing, and we dont know what other variables make a big difference to countries epidemics either. And their numbers are horrible compared to their neighbours.

I dont even know if what we are seeing in Sweden is even proof that 'something important is missing from our knowledge', let alone what that something might be. I suppose I expect several major revelations at some point, but I dont know what or when.

 

[littlebabyjesus]

I wont watch the video, not enough time, and I dont want my blood pressure to go wrong. But thanks for sharing it anyway, and for the summary.

It is true that there are many unknowns and a series of assumptions have had to be used when countries decided what sort of lockdown to do, and when.

What I find unacceptable is that he can criticise the lack of scientific evidence behind lockdowns, but then trust his own beliefs that a large percentage of people have caught it already. Where is the evidence for that belief? So far there isnt any, and when countries try to find the answer, so far it has tended to come out on the low side, eg a range of perhaps 1%-15% of people infected in some places, not the much higher figure that would be required to support the assumptions used in the Oxford model and by the Swedish expert.

Now having said that, I was one of the people who didnt want to just take the initial WHO China team assertion in February that there werent many other cases showing up through antibody testing at face value. But evidence that contradicts the WHO China findings has been in short supply, so maybe they were right. But I am still content to deal in maybes rather than absolutes, of which there are few.

Or maybe there is something else going on that we dont understand yet. Like everyone else I've had to use some assumptions, but none of them are sacred to me, I will be happy to ditch any of them if the evidence points in a direction incompatible with them. And Sweden is certainly on the list of countries that I am watching for clues, and the picture there so far has been mixed. I dont have an exact theory about this, and its not like Sweden is a 'pure' example, they havent done a full lockdown but they did do some social distancing, and we dont know what other variables make a big difference to countries epidemics either. And their numbers are horrible compared to their neighbours.

I dont even know if what we are seeing in Sweden is even proof that 'something important is missing from our knowledge', let alone what that something might be. I suppose I expect several major revelations at some point, but I dont know what or when.

You're absolutely right that Sweden is very far from 'pure'. They've closed higher schools and unis, a huge number of people are working from home, restaurants and bars now have minimum table distances, large gatherings are banned, and they have stopped care home visits. One aspect of that interested me, though - he, in common with a lot of Swedes, very clearly has high confidence in Swedes generally choosing to do sensible things off their own backs.

He does address the differences with neighbours. Compared to Finland, he makes the point that Finland locked down very early in its curve. Compared to Norway, he largely blames Sweden's failure to keep it out of care homes and points to the relative sizes of care homes - fewer, bigger ones in Sweden vs lots of smaller ones in Norway. He doesn't really proffer a reason for Denmark being significantly better, in fact he seems to be claiming that it isn't really that different; I'd suggest the numbers for Denmark are in the order of three times better than Sweden's numbers.

But anyway, his major contention is that they're not avoiding Sweden's level of deaths, merely postponing them. He is upfront about that - his contention is that all lockdown does is add a few months to the lives of people who were about to die anyway. He's not so different from Dominic Cummings in that regard.

That claim at least will be measurable in the longer run.

 

[MrCurry]

I understand and would have to say I agree elbows. I think there are plenty of reasons for me to doubt the Swedish approach and to worry about how this will all turn out. It seems to me that declaring they will only follow measures “with proven scientific effect” rules out all sorts of sensible precautions which may well not have been scientifically studied and proven in this context, but then how often does a global pandemic come along to allow for representative study and comparison of the effectiveness of alternative approaches?

I agree littlebabyjesus that his assertions will be proven or disproven in time, I just wonder whether people in this kind of influential role will ever be held to account if it can later be proven that their decisions were harmful to many in the population? It seems like he and others in similar roles will fall back on their early agreement with the govt that only measures with demonstrable scientific basis will be taken. That’s the “get out of jail free” card.

 

[elbows]

I use this article, which is updated every day and is not behind their paywall, to keep somewhat up to date with Sweden in this pandemic:

https://www.thelocal.se/20200310/timeline-how-the-coronavirus-has-developed-in-sweden

And here is a rather interesting graph which shows deaths there by actual day of death, and is colour-coded so that the date those deaths were reported is also shown.

Reported Covid-19 deaths in Sweden

This page contains graphs and statistics related to the Covid-19 outbreak in Sweden.

adamaltmejd.se

 

[smokedout]

Now having said that, I was one of the people who didnt want to just take the initial WHO China team assertion in February that there werent many other cases showing up through antibody testing at face value. But evidence that contradicts the WHO China findings has been in short supply, so maybe they were right. But I am still content to deal in maybes rather than absolutes, of which there are few.

Unpublished study using antibody tests reported in The Guardian today found cases were 50 to 80 times higher in Santa Clara County than recorded, however this still only put the infection rate at around 3%. California seems quite a bit behind the curve compared to badly affected European countries, so it may be hovering up to 10/15% in some regions but the idea that half of people have had it seems pretty far fetched. We do have data, messy as it is, around 25% of UK tests seem to have come back positive and that's largely amongst those with serious symptoms or health care workers, so you would expect the virus to be massively over represented in those groups.

 

[littlebabyjesus]

I use this article, which is updated every day and is not behind their paywall, to keep somewhat up to date with Sweden in this pandemic:

https://www.thelocal.se/20200310/timeline-how-the-coronavirus-has-developed-in-sweden

And here is a rather interesting graph which shows deaths there by actual day of death, and is colour-coded so that the date those deaths were reported is also shown.

Reported Covid-19 deaths in Sweden

This page contains graphs and statistics related to the Covid-19 outbreak in Sweden.

adamaltmejd.se

Looks remarkably similar in shape to the one you've been keeping for England, I must say. Possibly because the effects of the UK's lockdown are still yet to properly show up. But I'll be very interested to see how that comparison progresses.

 

[littlebabyjesus]

Unpublished study using antibody tests reported in The Guardian today found cases were 50 to 80 times higher in Santa Clara County than recorded, however this still only put the infection rate at around 3%. California seems quite a bit behind the curve compared to badly affected European countries, so it may be hovering up to 10/15% in some regions but the idea that half of people have had it seems pretty far fetched. We do have data, messy as it is, around 25% of UK tests seem to have come back positive and that's largely amongst those with serious symptoms or health care workers, so you would expect the virus to be massively over represented in those groups.

The other variable here is how many of us are actually susceptible to infection in the first place. These smaller studies published in The Spectator of all places (yeah, I know, but the studies are correctly reported) are consistent with the idea that many or even most of us may have some kind of resistance to infection.

More data needed. Desperately. Every country round the world needs to set aside a proportion of its testing capability for this kind of study, I think, then collating the results from everywhere.

 

[elbows]

The other variable here is how many of us are actually susceptible to infection in the first place. These smaller studies published in The Spectator of all places (yeah, I know, but the studies are correctly reported) are consistent with the idea that many or even most of us may have some kind of resistance to infection.

I havent researched this topic properly at all yet, but the basic idea is certainly one of the things I was vaguely pondering when I mentioned the 'something else going on that we dont understand yet'. Thanks for the link, I am supposed to be giving myself a break this weekend but its tempting to read up on that stuff now. Hopefully I can resist then posting about it continually over the weekend, I should let it sink in and see what else I can augment it with before commenting further, cheers.

 

[littlebabyjesus]

I agree littlebabyjesus that his assertions will be proven or disproven in time, I just wonder whether people in this kind of influential role will ever be held to account if it can later be proven that their decisions were harmful to many in the population? It seems like he and others in similar roles will fall back on their early agreement with the govt that only measures with demonstrable scientific basis will be taken. That’s the “get out of jail free” card.

I liked that interviewer. I thought he asked all the right questions to allow his subject to fully explain his position. However, I would also be very interested in a set-up that pitched this guy up against another epidemiologist who fully supports lockdown. That would bring out the areas in which the disagree, but also the areas in which they agree. They will presumably agree about a fair few basic science things to do with viruses and epidemics.

I suspect that a major point of argument would centre around mortality rates, because it does seem to me that the Swedish approach only works with the low mortality rate suggested here. Once it rises higher than that, then we're not just finishing off the oldest and illest, we're getting into a big chunk of the previously healthy, and we're diverging sharply from any comparison with the flu. He is basically saying that this is no worse than a bad flu, after all, and all his arguments rest on that being true.

 

[Boris Sprinkler]

It works here ( in Sweden currently) in that Swedes will adhere unquestionably to Government advice. It doesn’t matter that 20 miles away the advice is much different.
This is how it is. And when I go back I have to pass a immigration control in Denmark. With the army and everything. Quite what they are stopping I am not sure. I prove I live in Denmark and I am allowed to pass. I am not asked if I am ill. It is, nothing more than illusions. To show they are in control of things and that it is serious.
still, this was produced recently and sent to every household in Sweden.
“When crisis or war comes” but I guess that particular paranoia comes from the weapons they make to arm the world.

 

[littlebabyjesus]

Regarding the different outcomes in Scandinavia, allowing for all the problems inherent in reporting deaths, comparing different testing regimes, etc, if you were to compare the numbers for new cases and new deaths of the four countries and asked "One of these didn't lock down, which do you think it is?" most/nearly all people would choose Sweden.

But if you were to do the same thing with, say, Sweden, Belgium and the UK, Sweden wouldn't stand out. I think most people would probably plump for Belgium out of those three.

Sweden's progress hasn't quite been the car crash many assumed it would be. So far...

 

[Reno]

Regarding the different outcomes in Scandinavia, allowing for all the problems inherent in reporting deaths, comparing different testing regimes, etc, if you were to compare the numbers for new cases and new deaths of the four countries and asked "One of these didn't lock down, which do you think it is?" most/nearly all people would choose Sweden.

But if you were to do the same thing with, say, Sweden, Belgium and the UK, Sweden wouldn't stand out. I think most people would probably plump for Belgium out of those three.

Sweden's progress hasn't quite been the car crash many assumed it would be. So far...

I’ve been thinking that too, it lies somewhere in the middle. What could happen is that if we don’t find a vaccine any time soon, we’ll be forced into something like controlled herd immunity. That means easing restrictions with an eye on the health system and if serious cases climb beyond what hospitals can cope with, putting restrictions back in action. That would mean that we’ll have severe cases and deaths for longer than Sweden, but eventually the numbers will be similar.

 

[Reno]

I’ve been thinking that too, it lies somewhere in the middle. What could happen is that if we don’t find a vaccine any time soon, we’ll be forced into something like controlled herd immunity. That means easing restrictions with an eye on the health system and if serious cases climb beyond what hospitals can cope with, putting restrictions back in action. That would mean that we’ll have severe cases and deaths for longer than Sweden, but eventually the numbers will be similar.

OK, forget that. I looked into the maths of that and it's not going to work.

 

[editor]

Guardian update

Its advice to the care workers and nurses looking after older people such as Bondesson’s 69-year-old mother is that they should not wear protective masks or use other protective equipment unless they are dealing with a resident in the home they have reason to suspect is infected.

Anger in Sweden as elderly pay price for coronavirus strategy

Staff with no masks or sanitiser fear for residents as hundreds die in care homes

www.theguardian.com

 

[littlebabyjesus]

Guardian update

Anger in Sweden as elderly pay price for coronavirus strategy

Staff with no masks or sanitiser fear for residents as hundreds die in care homes

www.theguardian.com

Yeah that's mad. If you're not having a lockdown, use of good ppe becomes even more important. South Koreans know that well enough.

 

[littlebabyjesus]

OK, forget that. I looked into the maths of that and it's not going to work.

Thing is, especially wrt Germany, they have at the very least bought themselves a massive amount of time by the handling of things thus far.

I think some people are overly negative about the possibilities of much more effective treatments being discovered over the coming months. Labs around the world are on the case and we can't really know what might come out of that.

That's probably my biggest criticism of the Swedish approach - not only does it make certain assumptions about mortality rates, it also makes assumptions about the impossibility of improvement in knowledge over the medium term. It may be that we don't make much progress on treatment quickly enough for it to matter, but should we assume that we won't?

 

[Ahlan]

Regarding the different outcomes in Scandinavia, allowing for all the problems inherent in reporting deaths, comparing different testing regimes, etc, if you were to compare the numbers for new cases and new deaths of the four countries and asked "One of these didn't lock down, which do you think it is?" most/nearly all people would choose Sweden.

But if you were to do the same thing with, say, Sweden, Belgium and the UK, Sweden wouldn't stand out. I think most people would probably plump for Belgium out of those three.

Sweden's progress hasn't quite been the car crash many assumed it would be. So far...

Not if you compare Belgium's people / square mile population density of 991 to Sweden's of only 64.
Someone mentioned upthread - Sweden has a population similar to London and a land mass 4 times the size of the UK. It's almost isolation by default. So on those terms, they're having a shocker.

 

[littlebabyjesus]

Not if you compare Belgium's people / square mile population density of 991 to Sweden's of only 64.
Someone mentioned upthread - Sweden has a population similar to London and a land mass 4 times the size of the UK. It's almost isolation by default. So on those terms, they're having a shocker.

We need to be careful about that stuff, of course. But it's percentage of people living and/or working in cities and towns that really matters. How many fields or forests there are in between each town isn't such a factor. Like everywhere else in Europe, the vast majority of Swedes (85%) live in urban areas, and it's no surprise that the worst-hit bit is Stockholm, a city of more than 1 million people. The vast majority of Sweden's hectarage has virtually nobody living in it at all.

 

[Ahlan]

We need to be careful about that stuff, of course. But it's percentage of people living and/or working in cities and towns that really matters. How many fields or forests there are in between each town isn't such a factor. Like everywhere else in Europe, the vast majority of Swedes live in urban areas, and it's no surprise that the worst-hit bit is Stockholm, a city of more than 1 million people. The vast majority of Sweden's hectarage has virtually nobody living in it at all.

Well using that metric Brussels and Stockholm are also two compketely different beasts. Think of the transit numbers. Alone the commuters in and out of BeNeLux states going to and from numerous Eu institutions. Michael Barnier was even diagnosed.
Where Sweden has nothing of the sort. My experience of Sweden in deep winter is one of desolation. Little to no passers through.

 

[littlebabyjesus]

Well using that metric Brussels and Stockholm are also two compketely different beasts. Think of the transit numbers. Alone the commuters in and out of BeNeLux states going to and from numerous Eu institutions. Michael Barnier was even diagnosed.
Where Sweden has nothing of the sort. My experience of Sweden in deep winter is one of desolation. Little to no passers through.

Ah yes, the numbers passing through a place is almost certainly a factor in Belgium's problems, as it is with London. That's a different argument, though.

 

[MrCurry]

An exasperated Facebook post from police in Stockholm. The picture is taken shortly before sunrise, showing the number of people on a city street overnight from Sat to Sun.

The text summarises the weekend and isn’t so much about the number of people out and about. Some youths throwing cans to knock a police patrol off their segways on Fri night, the same officers picked them up the next evening. Arrests of people selling vodka from cars to the crowd in the street pictured below and further infringements of the occupancy limits for bars and restaurants in the whole area (presumably more than 49 punters in at a time?). Some chiding of people not following the rules and causing problems for everyone else.

It doesn’t seem to me that prof. Giesecke’s argument that people are obediently staying indoors voluntarily, without needing to be compelled by law, holds much water.

 

[frogwoman]

An exasperated Facebook post from police in Stockholm. The picture is taken shortly before sunrise, showing the number of people on a city street overnight from Sat to Sun.

The text summarises the weekend and isn’t so much about the number of people out and about. Some youths throwing cans to knock a police patrol off their segways on Fri night, the same officers picked them up the next evening. Arrests of people selling vodka from cars to the crowd in the street pictured below and further infringements of the occupancy limits for bars and restaurants in the whole area (presumably more than 49 punters in at a time?). Some chiding of people not following the rules and causing problems for everyone else.

It doesn’t seem to me that prof. Giesecke’s argument that people are obediently staying indoors voluntarily, without needing to be compelled by law, holds much water.

The comments on that post are interesting. I don't know how representative they are tho

 

[planetgeli]

An exasperated Facebook post from police in Stockholm. The picture is taken shortly before sunrise, showing the number of people on a city street overnight from Sat to Sun.

The text summarises the weekend and isn’t so much about the number of people out and about. Some youths throwing cans to knock a police patrol off their segways on Fri night, the same officers picked them up the next evening. Arrests of people selling vodka from cars to the crowd in the street pictured below and further infringements of the occupancy limits for bars and restaurants in the whole area (presumably more than 49 punters in at a time?). Some chiding of people not following the rules and causing problems for everyone else.

It doesn’t seem to me that prof. Giesecke’s argument that people are obediently staying indoors voluntarily, without needing to be compelled by law, holds much water.

I'm probably being dumb but what is the constant reference to 'hooks'? What are/is 'hooks'?

 

[littlebabyjesus]

An exasperated Facebook post from police in Stockholm. The picture is taken shortly before sunrise, showing the number of people on a city street overnight from Sat to Sun.

The text summarises the weekend and isn’t so much about the number of people out and about. Some youths throwing cans to knock a police patrol off their segways on Fri night, the same officers picked them up the next evening. Arrests of people selling vodka from cars to the crowd in the street pictured below and further infringements of the occupancy limits for bars and restaurants in the whole area (presumably more than 49 punters in at a time?). Some chiding of people not following the rules and causing problems for everyone else.

It doesn’t seem to me that prof. Giesecke’s argument that people are obediently staying indoors voluntarily, without needing to be compelled by law, holds much water.

If Swedish police are anything like the UK police, we shouldn't just take their word for this, though. UK police have been talking up problems and misrespresenting the stats. Wouldn't surprise me if Swedish coppers are doing the same.

 

[Idris2002]

Agree with all of this, except for the precautionary principle which is a load of bollocks. If we'd discovered and consistently applied it since the early days of humanity, we'd still be dodging sabre-toothed tigers and shivering in dark caves at night because starting fires is "tOo dAnGeRoUs".

We are the descendants of the ones who hid in the caves while Ogg of the High Valleys was eaten by the tiger.

 

[cupid_stunt]

Stockholm could achieve herd immunity by next month, health chief claims

The Swedish government has employed a controversial coronavirus strategy.

metro.co.uk

 

[frogwoman]

I'm probably being dumb but what is the constant reference to 'hooks'? What are/is 'hooks'?

Seems like a slang term for bars