Sweden and coronavirus

[BristolEcho]

I never thought I'd be saying this, but the FT has provided bloody excellent coverage of the coronavirus crisis

Sweden’s death toll unnerves its Nordic neighbours | Free to read

Denmark, Finland and Norway look at maintaining travel restrictions even as they prepare to open up to others

www.ft.com

I wish other papers would follow suit:

Not sure how surprising it is. They know that mass deaths and instability are a threat to the status quo. Mass deaths of people that have been "invested" in through education etc are a waste to them. They are cold hard economics make no mistake.

 

[MrCurry]

and bbcs maddy savage happened to interview

The “BBC’s Maddy Savage” is editor of thelocal.se and has a very long history of putting out some very dubious “factual” coverage of all sorts of stories. In fact wherever there’s a marketing or campaign budget available to be spent on some advertorial dressed up as unbiased reporting, there springs up a story on thelocal assuring the world things are this way, or that way in sweden. The whole enterprise (Thelocal) seems to be a propaganda-for-hire outfit to me*, so it’s really no surprise to learn her story on the BBC site turns out to be “Whoops, a little bit wrong!”.

* At least the Sweden site, I don't read their other country output.

 

[co-op]

I've had a handful of FB friends (most now defriended/on ignore) who kept going on and on that Sweden had got it right and the UK was acting like a fascist state/overreacting etc etc. Our government were absolutely fucking useless but thank fuck we did a (criminally belated) U turn on 'let's go for herd immunity' policy.

I'm not sure how you can be so certain that Sweden's wrong and lockdown is right? (or your friends/ex-friends the other way round?).

Covid is highly infectious and there's no vaccine and no one with any credibility thinks there'll be one for years, even if that's 'only' two years. Are we to lockdown for 2 years? If not, we are almost bound to have selective exposure for the majority of the population. Since it also looks like the serious impacts of Covid are massively concentrated in the elderly/ill, that does seem to indicate that for young and healthy people it may well be best to get the disease and obtain (presumptive) immunity - or at any rate this theory is not in itself evidence of being crazy. The key to a herd immunity policy should be proper protection for the vulnerable.

On top of this there is the international dimension; sure there are countries which have managed to effectively snuff Covid out (including using means which are extremely authoritarian) - but unless literally every single state goes down this path - and obviously many literally can't, others are choosing not to, others are blundering around with a bit of both - then what happens in terms of trade and contact internationally? China may snuff covid out but unless it literally completely shuts its borders to every other country that hasn't then it'll be re-infected anyway so I'm not sure how the lockdown/snuff-out theory works anyway.

It'll need another year to have any real idea whether or not there will be a second wave (there surely will?) & how big this will be and whether there's any noticeable difference between Sweden and lockdown states after that. At the moment, to be certain which of these policies is right and which is wrong is completely misplaced - certainty is precisely what we don't - can't - have.

 

[frogwoman]

Sweden are also doing extremely limited testing and tracking though? Which doesn't help limit the spread to say the least

 

[elbows]

Since it also looks like the serious impacts of Covid are massively concentrated in the elderly/ill, that does seem to indicate that for young and healthy people it may well be best to get the disease and obtain (presumptive) immunity - or at any rate this theory is not in itself evidence of being crazy. The key to a herd immunity policy should be proper protection for the vulnerable.

Letting the 'young and healthy' get it is not compatible with shielding others. Because many of the people caring for the vulnerable would no doubt fall into your 'young and healthy' category.

 

[Spymaster]

Sweden are also doing extremely limited testing and tracking though? Which doesn't help limit the spread to say the least

He has a point though. The rules in place regarding social distancing/lockdown/testing are arbitrary at best, clearly demonstrated by the disparity of approach from country to country and even state to state in the US. This is going on, and on, and on, probably for at least another year before there's a vaccine. We're really not very far from the lockdown being more destructive, consequentially, than the virus. Some argue reasonably that we're there already. We can't do this for another year.

 

[co-op]

Letting the 'young and healthy' get it is not compatible with shielding others. Because many of the people caring for the vulnerable would no doubt fall into your 'young and healthy' category.

This is just a practical issue - it can be done. Obviously carers need to be extremely careful about hygiene etc. In Germany they have been treating covid patients at home using a de facto parallel medical system, literally down to separate, dedicated Covid GPs, using dedicated covid cars. The decision as to whether or not a person with covid is then transferred to hospital is made by the GP, rather than the chaotic UK method, ie you are somehow supposed to self-diagnose when you are seriously ill enough and then you just rock up at a hospital.

I just want to reiterate that I'm not actually saying that the let-it-happen/herd immunity approach is necessarily right, it's just that I can see the logic. But if you're going to do it, you have to plan for the vulnerable and be rigorous about that - it looks as if Sweden haven't been particularly - but then again many of the 'lockdown' countries are experiencing care home scandals - the UK and France being outstanding examples.

I am definitely saying it might yet prove to be the better approach but no one can say for sure yet and I'm depressed by the way that 'if Johnson wanted it, it must be wrong' has become an heuristic for many people. Even an idiot like Johnson could get this right - although U-turning half way is probably the worst of all choices.

 

[co-op]

Sweden are also doing extremely limited testing and tracking though? Which doesn't help limit the spread to say the least

As I understand they're not really trying to limit the spread although - as with everyone? - it doesn't seem totally coherent, eg they've banned large gatherings but allow everything else which doesn't to me look like a way of flattening the curve much, but maybe they have some evidence on that?

I'm not sure how track and trace complements the herd immunity approach - and this is back to my original post really; it seems to me likely that the choice for us as individuals is either pretty extreme isolation for an indefinite period, or accept that we are most of us going to get this at some point. And obviously for quite a few people option 1 isn't on the table.

 

[editor]

I'm not sure how you can be so certain that Sweden's wrong and lockdown is right? (or your friends/ex-friends the other way round?).

I would have thought that the death rate is evidence that it's not the wonder solution some seemed to think it was.

As of Wednesday, 3,831 people had died from Covid-19 in Sweden, a country with a population of 10m. Denmark, Finland and Norway — which each have about 5m inhabitants — have recorded death tolls of 551, 301 and 233, respectively.

The FT tracker shows that Sweden had 6.4 deaths per million people 61 days after its death rate first climbed above 0.1 deaths per million. That contrasts with the UK’s 6.2 deaths per million at the same stage, Italy’s 5.5, and Spain’s 4.

 

[co-op]

I would have thought that the death rate is evidence that it's not the wonder solution some seemed to think it was.

I don't think anyone's argued it's a "wonder solution" but - of course it might yet turn out that overall death rates are lower if we get second and third waves - this is literally unknowable so anyone claiming that the Swedish method is wrong are just as foolish as anyone claiming it's right. There is a clear logic to it though, which is not obviously wrong.

And the question of what damage is created by lockdown vs what damage is created by the virus is a perfectly ok one to ask - especially when the damage done by the virus is so hugely concentrated amongst certain groups. Why can't low-risk groups operate as normal if they want?

 

[frogwoman]

Problem is once lockdown is over and international travel picks up countries with the herd immunity approach will end up seeding new outbreaks to countries (and even places in the same country) MUCH less able to cope. See the story of how covid ended up in Brazil for instance

 

[editor]

I don't think anyone's argued it's a "wonder solution"....

Except some of the people on FB were arguing just that.

 

[co-op]

Except some of the people on FB were arguing just that.

OK that is obviously daft!

 

[elbows]

This is just a practical issue - it can be done.

The practicalities of chosen strategies are key. Countries and people that engage in the 'just protect the vulnerable' stuff are dangerous idiots if there is no way to actually obtain that level of shielding and infection control at scale, with the staff and resources that are actually available.

We catch a glimpse of what level of care is actually required to guarantee shielding when we see what the approach was with the Queen in the UK.

‘HMS Bubble’: memo reveals how Queen and Prince Philip rely on 22 employees | FR24 News English

www.fr24news.com

I am definitely saying it might yet prove to be the better approach but no one can say for sure yet and I'm depressed by the way that 'if Johnson wanted it, it must be wrong' has become an heuristic for many people. Even an idiot like Johnson could get this right - although U-turning half way is probably the worst of all choices.

U-turn as the worst of all choices? What the fuck! You'd rather they had stuck to plan a than have a lockdown at all?

Although the track record and rhetoric of Johnson did contribute to peoples misgivings about the original plan, I dont think it was the main driver of the plan-changing public and media sentiment. That stuff was overwhelmingly caused by the disparity between the UK plan/timing and what people saw was being done in other countries.

The other thing that disgusts me about some of the logic involved with herd immunity is that the idea that only those in the groups we class as vulnerable will die from this virus is simply not true. The scale of death is much smaller in other groups, but its still there, and the whole shielding the vulnerable plan therefore implicitly condemns some younger people to death.

 

[frogwoman]

Also 'the vulnerable' is a hell of a lot of people.

 

[elbows]

As for the longer term, yes there are a range of possibilities and current unknowns, more reasons I refuse to do anything than take things one week at a time. So I'm not rejecting absolutely everything you are saying. None of the available options were great and there may be further unintended consequences. But whatever happens in future, I think its very unlikely that, when looking at the curves of hospital admissions and deaths, that I would conclude we were wrong to slam the breaks on to deal with that stuff - doing it late was bad enough, not doing it at all would have been extra hideous.

 

[Spymaster]

The scale of death is much smaller in other groups, but its still there, and the whole shielding the vulnerable plan therefore implicitly condemns some younger people to death.

Keeping the lockdown in place, as is, is also condemning people to death. We already have sufferers of other illnesses going untreated because of hospital restrictions, and the government isn't going to keep paying 80% of 8 million people's salaries indefinitely. That's going to stop pretty soon. Businesses will fold left right and centre and the mass poverty will kill countless more people. Either way, people are going to die.

 

[elbows]

Also 'the vulnerable' is a hell of a lot of people.

And the UK provided a fine demostration about how easily it is to construct 'shield the vulnerable' rhetoric when actually the long0standing plan involved extra risk for those very groups. NHS Englands 'reverse triage' plan was the very opposite of shielding the vulnerable, it was placing them in harms way for the sake of avoiding pictures of overwhelmed hospitals.

 

[frogwoman]

People are dying from other illnesses in much greater numbers in places like Brazil though. Even if there is no lockdown you're not going to go to hospital if you can avoid it.

 

[frogwoman]

Sweden itself has cancelled 44,000 routine operations to make way for covid patients.

 

[Spymaster]

Sweden itself has cancelled 44,000 routine operations to make way for covid patients.

So the question has to be, for how long does covid get priority over absolutely everything else?

 

[frogwoman]

Not really a question of priority. If vast numbers of severely ill highly infectious people are turning up at hospital there is not much choice is there.

 

[maomao]

We already have sufferers of other illnesses going untreated because of hospital restrictions

How would lifting lockdown change this?

 

[maomao]

So the question has to be, for how long does covid get priority over absolutely everything else?

Are you suggesting hospitals should turn covid patients away? Emergencies always take priority. A large proportion of medical emergencies are people who can't breathe for one reason or another.

 

[elbows]

Keeping the lockdown in place, as is, is also condemning people to death. We already have sufferers of other illnesses going untreated because of hospital restrictions, and the government isn't going to keep paying 80% of 8 million people's salaries indefinitely. That's going to stop pretty soon. Businesses wil fold left right and centre and the mass poverty will kill countless more people. Either way, people are going to die.

A lot of people were not condemned by lockdown in general, they were condemned by poor decisions over many years, poor priorities for healthcare funding over decades, poor infection control in hospitals.

Disgusting right-wing idiots who justified spending cuts and appalling priorities over decades, who think they are now in a position to lecture on the other sorts of deaths will hopefully get to see their ideologies relegated to the margins in the years ahead. Because the options available to particular countries in this pandemic were largely dictated by all that came before, all those terrible decisions over many years. The pandemic shone a light on all that, and there should be no going back to the way things were. Especially as there is such a strong link between deprivation and risk in this pandemic.

There are things we could do in the years ahead that end up saving more lives than this pandemic and the lockdown and other related things kills.

 

[frogwoman]

And indeed part of the reason for the extremely high death rate in the uk is that people were told to avoid hospital unless they were literally about to die. Meanwhile deaths from normal illnesses also went up because people were scared of burdening the NHS and getting infected themselves. So not really a question of prioritising covid at all.

 

[elbows]

Something I read from Sweden some time ago gave me a tip that I need to follow up on. It sounds like their healthcare capacity was cut once the cold war ended, probably because that threat of war was something establishments found easy to pay attention to and plan for, with resulting effects on spending priorities and capacity in various areas including hospital capacity. Once that threat diminished, priorities changed, rather than finding all the other reasons why you should have a high healthcare capacity. Apparently Germany was an example of a country that did not cut its hospital capacity in the same way just because the cold war was over.

 

[Spymaster]

Are you suggesting hospitals should turn covid patients away?

Of course not, but there are hospitals cancelling people's procedures not because of the lack of capacity due to treating covid patients, but because of perceived fears of bringing the virus into the establishments or patients contracting C19 whilst in there. Some people are dying because of that. At some point the consequences of lockdown and other restrictions has to be weighed against the damage caused by the virus.

 

[frogwoman]

That's not just because of the lockdown though is it. That is something that has actually happened?

 

[elbows]

Of course not, but there are hospitals cancelling people's procedures not because of the lack of capacity due to treating covid patients, but because of perceived fears of bringing the virus into the establishments or patients contracting C19 whilst in there. Some people are dying because of that. At some point the consequences of lockdown and other restrictions has to be weighed against the damage caused by the virus.

Such concerns were entirely appropriate.

Fifth of patients with Covid-19 may have caught it in hospital, study finds

PHE research chimes with concerns that asymptomatic healthcare workers may have played role in spread

www.theguardian.com

If we had decent capacity, PPE and infection control in normal times then things could have been quite different. We didnt, and many people quite correctly cottoned on to the risk of hospital acquired infection. Even if the establishment tried to ignore some of these aspects, the public became aware of the risk and took matters into their own hands.

Now it is largely a question of how the hell confidence can be restored. It will probably be a long struggle, just like with schools, and the number of new infections in particular locations is likely to be a major driver of attitudes going forwards. There are other things that could improve confidence too but since the government is making a mess of it the going is slow.