As a Swede that did not agree with the strategy at the time (it was hugely risky), given what we know now, I'm starting to think it was the right decisions (for the wrong reasons). The reason the economy is in trouble has more to do with that the rest of the word shut down, it being a highly export dependent economy. Sweden did not shut down, practically nobody wears a mask (still), social distancing is minimal (crammed subways, buses and beaches), schools have remained open, yet there has not been a single death in the worst hit area of Stockholm for the past 5 days. Again, I think given the uncertainty and lack of evidence in March, not shutting down was an extremely stupid risk, and Tegnell and crew have shown to been wrong at practically every turn, but at this point you have to look at the evidence and reassess. It would seem Stockholm has reached the point of significant herd immunity, which is probably true for other hard hit areas like NYC. Less hit areas will probably have second waves, and unless a vaccine is here soon, my guess is most of the world will go through the same thing eventually.
This would indicate that the swedish response is among the worst. Several countries with comparable health systems have a death rate which is many times lower, for example Germany. This saved many thousands of lives.
If the pandemic is expected to continue for many months, isn't it a bit premature to talk about current death rates as a metric for success? Given Sweden's 'herd immunity' plan, higher death rates at the beginning would seem to be a given. They didn't flatten their curve. But as they approach something like herd immunity, the number of possible carriers should plummet permanently (assuming immunity is a thing with COVID), and infections and deaths would permanently decline.
Nations which have held down infection numbers with shutdowns have, of course, flattened their curves. But they may well suffer from second/third waves which will hike up their total numbers.
They did flatten the curve[0], they kept their cases within hospital capacity (by banning gatherings over 50, reducing restaurant capacity, having people work from home, etc)
What they never did was crush the curve, which is the strategy most other countries switched to once they realized it was feasible
Herd immunity is certainly possible--we could hold a parade, and spray it with cultured virus. Obviously no one is doing that, because no one actually wants natural herd immunity. Sweden just thinks the cost to control the epidemic to the point that it doesn't end in that way is unacceptably high. If a treatment is discovered next month that cuts the IFR by a factor of ten, then Sweden was wrong. If no safe and effective vaccine is ever developed and treatment never improves, then Sweden was right. Reality will fall somewhere between those two unlikely extremes, and we don't know where.
Fewer infected is always good news[1], in Sweden or anywhere else--it means fewer dead now, more infections pushed until later when treatment will probably be better, etc. It's weird to see low infection rates twisted around as if they were bad, "evidence that herd immunity may not be possible". This is particularly true when the prevalence is compared to herd immunity from a model assuming a well-mixed, homogeneous population, which we know overestimates the herd immunity threshold (though not by how much, since estimates of the heterogeneity of the coronavirus are even more uncertain than those of R0).
Finally, herd immunity is a gradual process. Even in a crude homogeneous SIR model, you may approach it asymptotically but never get there. This is good--the only case where a disease "burns itself out" abruptly is when there's big overshoot, which implies many avoidable deaths. Perhaps that kind of overshoot could be desirable in a population of young people, if the small excess mortality in the young people were more than offset by their decreased ability to spread it later; but that's a narrow needle to thread.
For the avoidance of doubt, I believe Sweden did a bad job protecting elder care facilities (though many places that locked down did too), and I disagree with their position on masks. Their response otherwise seems reasonable to me, not obviously better than stricter approaches but also not obviously worse.
1. Unless you know the death count and you're looking for the denominator for your IFR, since more infected then means lower IFR. That was true early in the epidemic, before the first high-quality serosurveys, but not anymore.
Indefinite lockdowns, vaccines haven't been "proven possible" either. At some point you have to make a plan with the best information you have.
The fact that spread in New York has slowed down compared to other states that weren't initially hit hard implies that there's some immunity effect going on.
Simple: it's not over yet, but it might be for some hard hit areas of Sweden. We'll see. Then there is another question whether it was worth it to shut down the world economy over a 0.05% death rate, or a few years worth of flu at once. I'd say probably no. We didn't know this back in Feb/March, which is why I was very much for a quarantine then, but not now. I don't think the powers that be would have done a complete shutdown if they'd known what they know now.
The long-term success of Sweden's approach appears to hinge on this question. What evidence is there which supports that their hardest hit locales have achieved herd immunity?
My own observeration from Stockholm is: beaches crowded during heatwave, public transit is crowded as usual. Lots of movement of people, travel within Sweden etc. Practically nobody is wearing a mask. People are still generally careful, washing hands, keeping the distance in lines etc, but I don't think this can explain the cases going down. In March-April, I think people were the most careful, when hundreds were dying every day. Since then people have gradually become more relaxed, but the numbers keep going down.
Of course, it could be that these rather small measures have pushed r0 a bit under 1 ever since March. But there have also been reports that for each person tested with antibodies, two more are actually immune, which would put the immunity at maybe 30% two weeks ago. At least it's in the right ball-park, as some have proposed that herd immunity could be reached at much lower percentages than previously thought.
Sweden's total per-capita death rate is 50% higher than the Netherlands, 500% higher than Germany and Denmark, and 900+% higher than Finland, Norway, and Poland. All those deaths have not made you safer--your daily per-capita death rate is still several times that of those countries. Source: https://ourworldindata.org/coronavirus-data
The current death rate, 10-15 people a day, is insignificant compared to other causes of death. It is not reasonable to talk about percentage differences when we're talking 15 vs 3 deaths a day.
Do note that there's easily a 15-day delay when it comes to Sweden reporting somewhat correct number of deaths, so let's not focus on the "current" death rate too much. And I expect the reporting delay to actually be worse right now as we're in the middle of vacation time.
No one shut down economy for exteneded period of time in Norway or Finland, they did just intermittently and now they have exactly same economic situation Sweden. Not worse, not better, but much less death. So 5000 people are dead for nothing. Even more importantly, explicit denying medical care to everyone after, say, 75 y.o. will save lots of money which can be redirected to fun stuff (lowering taxes etc.), and your death rate will barely go up; no one does that though, because that would be considered completely inhumane.
Dont fall for the numbers game. The numbers in Sweden are reported on with an expected delay of 7 - 10 days for some deaths. The other game is the break-point in time 1400 - each day when public health agency ( state run ) report their numbers. They reported no new dead in Stockholm and then later on tuesday afternoon Smittskydd Stockholm ( regionally run ) reported 7 new deaths in Stockholm since monday...
Not really: I would much rather get the coronavirus today than three months ago. And would much rather get it 6 months or a year from now than today. Survival rates are measurably improving due to both improved procedures (proning) and better protocols on steroid use, as well as emerging therapies like remdesivir and monoclonal antibodies (in addition to convalescent plasma). Not to mention that many vaccines are barreling into phase 3 trials soon. I suspect history will not be kind to Sweden's approach.
Sweden did the right thing. Covid-19 is not worse than the flu. Norway recently also admitted the lockdown there was not neccesary according to the data they have now. In March they thought differently.
Norway: ‘Lockdown was not necessary to tame Covid-19’
According to Camilla Stoltenberg, the Director-General of the Norwegian Institute of Public Health (Folkehelseinstituttet), similar results would have been achieved in her country without a lockdown. She bases that statement on a study by her institution.
The study collected data on confirmed cases of coronavirus registered in Norway, the number of hospital admissions, the reproduction rate, etc. At the beginning of March it was feared that one person infected with the virus would infect four others. Only strict lockdown rules could bring that figure down. This hypothesis came from the Imperial College in London and gave forecasts for a number of European countries, including Norway.
Virus never spread as fast as was feared
In their report, the Norwegian Institute of Public Health now comes to a completely different conclusion: the virus never spread as quickly as was feared and was already on its way back when the lockdown was announced.
‘Our conclusion now is that we could have achieved a similar effect without lockdown. By staying open and taking a series of precautions to prevent the spread. It’s important that we admit that. Because should the number of infections rise again in winter or should there be a second wave, we have to be honest in our analysis whether such a lockdown has proven to be effective’.
According to Stoltenberg, who is herself a doctor and the sister of former Norwegian Prime Minister and current NATO Secretary-General Jens Stoltenberg, such draconian measures should only be announced in the future if there is an academic basis for them. And that was missing now, according to Stoltenberg.
Angelo Borrelli, the head of Civil Protection, who announces the latest figures every day at 6 p.m., said Saturday night that the 793 new deaths have been caused “by and with” the coronavirus. “We count all the dead, we make no distinction between with and by the coronavirus.” However, one wonders whether these daily figures reflect the situation correctly. The dead are said to have almost all had one or more other diseases, which leaves a question mark as to exactly how deadly the coronavirus is. At the same time, it has become clear that a large number of people who die at home (which is often a retirement home) do not undergo a coronavirus test."
"On Friday, April 24, 2020, Vittorio Sgarbi, a member of the Italian Chamber of Deputies, denounced what he claims are false coronavirus death statistics. Sgarbi feels that fake statistics are being propagated by the government and the media to terrorize the citizens of Italy and establish a dictatorship.
The member of the Forza Italia party slammed the closure of 60% of Italian businesses for 25,000 Chinese-Coronavirus deaths from the floor of the legislature. “It’s not true,” he said. “Don’t use the deaths for rhetoric and terrorism.” According to the National Institute of Health, 96.3% did not die of coronavirus, but of other pathologies stated Sgarbi – which means that only 925 have died from the virus and 24,075 have died of other things claimed Sgarbi, “….the virus was little more than an influenza. Don’t lie! Tell the truth!”"
For US data, I like how this table compares deaths from covid, flu, and pneumonia against the total deaths for all causes each week. I especially like that they show the ratio of current deaths vs the average of the 3 years prior for the same week.
The downside is how the data is slowly updated as each state trickles in data, so the most recent 4-8 weeks look lower now than if you check back later.
Still if you look back to April, flu deaths each week were in the hundreds, while covid deaths 9-15k. Saying it is 10x or more worse, doesn't seem unreasonable to me.
What really grabbed me is that the total US deaths in April from all causes was +40% compared to prior 3 year average.
Unfortunately covid deaths are highly unreliable as there is lots of evidence worldwide that people dying with covid are also counted with those dying of covid. Also lots of cases of dead people being counted while not being tested or positively tested for covid.
That's exactly why I like the link I posted. It tries to provide context on how many people die with covid, flu, pneumonia, or some combination of the 3.
Then more importantly, it looks at the overall death rate. Because even if you completely ignore the covid count, the fact that there are so many more people dying than normal should grab people's attention.
How do you think flu deaths are counted? Because that numbers shows also estimated death people - people who were never even tested on flu. Like, percentage of pneumonia deaths. And they contain also people also having other health issues and not just flu.
Flu deaths are counted as the number of people who die because of the flu - that is, they represent people who wouldn't have died if they didn't catch the flu. This is of course an estimate, and there are some pretty fundamental reasons why it has to be such as the fact that flu causes heart attacks and strokes but also just happens to be present in patients who have one for unrelated reasons, but it should be a pretty robust one because flu is an old and well researched disease and we have a vey good idea of how it behaves at a population level.
“Under these conditions, there does not seem to be a significant difference between the mortality rate of SARS-CoV-2 in OECD countries and that of common coronaviruses (χ2 test, P=0.11). Of course, the major flaw in this study is that the percentage of deaths attributable to the virus is not determined, but this is the case for all studies reporting respiratory virus infections, including SARS-CoV-2.”
“Under these conditions, and all other things being equal, SARS-CoV-2 infection cannot be described as being statistically more severe than infection with other coronaviruses in common circulation.”
“Finally, in OECD countries, SARS-CoV-2 does not seem to be deadlier than other circulating viruses.”
This is not the first time you've been called out on HN for quoting that outdated paper. The last time was 70 days ago (it was outdated 2+ months ago).
Another quote (from the abstract):
"It is concluded that the problem of SARS-CoV-2 is probably being overestimated, as 2.6 million people die of respiratory infections each year compared with less than 4000 deaths for SARS-CoV-2 at the time of writing. "
As of the Mar 19th 2020 issue of the Journal of Antimicrobial Agents.
Even without reading the paper, I can tell you that if this analysis were to be repeated, we would get different results, given that we are now (four months later) at 540,000 (confirmed, which is definitely an underestimate) deaths, rather than 4000.
"A report on the coronavirus by the German Ministry of the Interior was leaked on May 9th 2020 by officer Stephan Kohn to the magazine Tichys Einblick, one of the most popular alternative media in Germany. The report, on which a dozen or so doctors and professors from various universities in Germany have worked, states that “the state has failed in the coronavirus crisis in an almost grotesque way.” In a press release, the scientists concerned stated that “the observable effects and consequences of COVID-19 do not provide sufficient evidence that it is more than a false alarm in terms of health effects on society as a whole. The new virus has probably never posed a risk to the population in excess of normal levels […]. The people dying from corona are mainly those who are statistically dying this year because they have reached the end of their lives and their weakened bodies are no longer able to withstand random daily exposure (including to the approximately 150 viruses currently in circulation). The danger of COVID-19 has been overestimated. (No more than 250,000 deaths from COVID-19 worldwide within a quarter of a year, compared to 1.5 million deaths during the flu wave in 2017/18). Of course, the risk is no greater than that of many other viruses. In all likelihood, we are dealing with a global false alarm that has gone unnoticed for a long time.”
They also didn’t have anything positive to say about the ‘protective’ measures of the German criminal government. “The collateral damage [because of the measures] is now enormous and far greater than any observable benefit. […] Just a comparison of previous deaths due to the virus with deaths due to the protective measures prescribed by the State […] supports this finding. Much of this damage will continue to manifest itself even in the near and distant future. This can no longer be prevented but can only be minimized. […] The shortcomings and failures in crisis management have consequently led to the dissemination of unsubstantiated information, and thus disinformation, to the public. […] The State turned out to be one of the biggest fake-news producers in the coronacrisis.”"
Just to be clear: that is a "report on the coronavirus by the German Ministry of the Interior" in the sense that the "leaker" works there, wrote that report on his own (he wasn't part of the groups working on COVID specifically) based on at least cherry-picked data and then sent out on the official letterhead without permission.
From the provided link here is a list of some of the people who worked on the report and signed the press release:
Prof. Dr. Sucharit Bhakdi, University Professor for Medical Microbiology (retired) University of Mainz
Dr. med. Gunter Frank, general practitioner, member of the permanent guidelines commission of the German Society for Family Medicine and General Medicine (DEGAM), Heidelberg
Prof. Dr. phil. Dr. rer. pol. Dipl.-Soz. Dr. Gunnar Heinsohn, Emeritus of Social Sciences at the University of Bremen
Prof. Dr. Stefan W. Hockertz, tpi consult GmbH, former director of the Institute for Experimental Pharmacology and Toxicology at the University Hospital Eppendorf
Prof. Dr. Dr. rer. nat. (USA) Andreas S. Lübbe, Medical Director of the MZG-Westphalia, Head Physician Cecilien-Klinik
Prof. Dr. Karina Reiß, Department of Dermatology and Allergology University Hospital Schleswig-Holstein
Prof. Dr. Peter Schirmacher, Professor of Pathology, Heidelberg, Member of the National Academy of Sciences Leopoldina
Prof. Dr. Andreas Sönnichsen, Deputy Curriculum Director of the Medical University of Vienna, Department of General and Family Medicine.
Dr. med. Til Uebel, General Practitioner, Specialist in General Medicine, Diabetology, Emergency Medicine, Teaching at the Institute of General Medicine at the University of Würzburg, academic teaching practice at the University of Heidelberg
Prof. Dr. Dr. phil. Harald Walach, Prof. Med. University of Poznan, Dept. of Paediatric Gastroenterology, Visiting Professor University of Witten-Herdecke, Dept. of Psychology 4
