The epidemiologist behind Sweden’s controversial coronavirus strategy | Hacker News Reader

The epidemiologist behind Sweden’s controversial coronavirus strategy

nature.com

196 pointsvanilla-almond498 comments

One thing is missing from this discussion that needs to be understood: the Swedish government and related agencies generally do not do things based on common sense.

This may sound ridiculous, but in most cases, it's not. Common sense is wrong so often. The view of the Swedish government is that they are not more intelligent than the citizens. Unless things can be scientifically proved, the individual rights of citizens should not be restricted.

This permeates a lot of public policy in Sweden; I recently had reason to investigate to what extent maternal/neonatal care followed the best of our scientific knowledge and it was extremely close. If you think that's a given, think again. Many countries base their maternal/neonatal care on common sense and old wives' tales instead.

Both approaches are valid, but they are different. With policy based on common sense, you accept that you occasionally (often?) force something wrong on the public, potentially against their better knowledge. With policy based on strong evidence, you are more rarely wrong, but you also get way fewer opportunities to force things on the public, simply because there are so few things we truly know to be true. Doubly so during a novel pandemic.

There is a dark side to this. Scientific consensus follows certain rituals and heuristics. Even if you can assume that the scientific consensus is the closest to truth you can get (this is debatable), the approach will fail in some situations.

In particular, in war-like situations where there is little published science, data is scarce, data changes fast and there are policy considerations to be made across a multitude of disparate fields - fields that can not all be quickly evaluated with the scientific method.

IMHO, as I've been saying throughout this crisis, many institutions that do well in peace-time are in a terribly dangerous situation when they follow their normal heuristics and routines today. Strong top leadership (political or otherwise) can mitigate this danger.

Yet most strong top leaders I can name have (a) gained power during some sort of crisis, and (b) turned out to be on the wrong side of history.

Given that Scientific consensus has limitations, what do you propose is better in situations where data is scarce?

How does a strong leader mitigate this danger? Is the leader making choices by following their intuition? Does the leader make choices based on public sentiment?

One possible mechanism by which strong leadership could be more effective is that inaction and uncoordinated action can be less effective than any coordinated decision, regardless of whether that decision happened to be optimal.

I don't know how often this happens in a pandemic or in a political setting, but as an example from software engineering bikeshedding seems somewhat common -- it probably doesn't matter whether curly braces get a new line, but there's probably a benefit to only doing it one way in a codebase. Not that strong leadership is the only path to resolution either, even accepting that some cohesive decision needs to be made, but it does solve that class of problems.

Strong leadership and science are orthogonal dimensions. You can have strong leadership that makes decisions based on evidence and scientific arguments, or not. I would argue the first is always better than the second.

Again in the current crisis the decisions based on scientific evidence (pandemic models developed previously) was to act early and quickly with lots of testing. Most countries did not follow this, but I would say this had nothing to do with what the "scientific approach" was.

Somehow people here conflate scientific with need to wait/establish all information.

However in the end science is a method to establish truth/knowledge about the world around us. It can guide our decisions, but it's not a decision making method.

Let me clarify. You can follow a scientific approach, and you can follow Science the ritual. When uncertainty goes up and time is of the essence, the latter is to a large degree subjected to the limitations and blind spots I highlighted. The former might not, if you adapt it to the current limitations.

I am a scientist, by the way.

What I mean by strong leadership is an intelligent leader that can quickly review evidence from multiple disparate fields and experts (scientists among them) and choose a good approach that takes all available constraints and uncertainties into account. The way a skilled military commander would do.

In particular, such a leader does not focus exclusively on a single metric or concern, unless this is warranted by the situation. But that would be an exceptional circumstance in an exceptional situation.

You may think that the focus on reducing death rates is focusing on a single metric to the exclusion of everything else, but this is not the case. There are plenty of exceptions to this rule being made in every country with a lockdown. Critical infrastructure, economics, mental health, healthcare that's unrelated to Covid19 and so on.

> the approach will fail in some situations.

Well... yes. Everything does. Treating this as a non-starter could be used in literally anything.

> In particular, in war-like situations where there is little published science, data is scarce,

This is actually probably one of the most well researched fields in existence. I'm a little confused about this statement. What do you think they do at places like Annapolis?

I presume marvin is talking about a particular war when in progress, not the phenomenon of war in general.

One interpretation of that as a strategy is "in a crisis with imperfect information we should centralise all power to popular people".

If someone working to evidence (ie, science) can't make good decisions how on earth will strong leadership help? We've seen crisises that led to actual war time situations (pretty much all the wars in the Middle East, particularly when recently the 'strong leadership' in the US when they speculated wrongly that Saddam Hussein had WMDs) where with benefit of hindsight the entire planet would probably have been better off with weaker leaders, more evidence and people just sticking to their normal routines.

Centralising power without a proven strategy is going to lead to more misses than hits. Even now, we don't know what the endgame here is. The lockdowns could still conceivably be failures if they turn out to have delayed all the deaths by 12 months instead of preventing them. We don't know. It is too early to say what did or didn't work.

>evidence (ie, science)

An abrupt leap.

I would move away from a passing vehicle without peer-reviewing its existence. If international and inter-city travel had been shut down in early February some nations would have remained fully functional today. Not to say I agree with current quarantines, but you have to admit there are thresholds for action.

I'd like to know your stance on climate change, btw.

Science generalizes into engineering etc, so not everything needs to be peer reviewed.

Without the germ model of disease aka science, we would be thinking about Coronavirus very differently. Thousands of years of human history and massive epidemics show how bad following common wisdom based on incorrect models can be.

>>evidence (ie, science)

>An abrupt leap.

Not at all, it seems more that you have a wrong conception what science means. Science is all about evidence, the scientific method is to make observations, then inductive hypotheses that are then tested. All this relies on using evidence. Peer review is one process how evidence can be evaluated, but definitely not the only one. Science is much older than peer review.

We agree on what science means, and my point stands. Swift decisions needed to be made in February.

cycomanic says it better than I; science is not much more than the systematic creation and review of evidence. It isn't easy but it isn't usually very exciting. There would be a scientific consensus that you should get out of the way of a passing vehicle without any need for peer review.

> I'd like to know your stance on climate change, btw.

* Never seen an explanation that convinced me I, my descendants or anyone I know could be at risk from climate change. Particularly after calibrating expectations on the huge amount of background risk over 100 years. Climate change is less threatening than other alternatives over the century (eg, WWIII US/China for economic reasons, peak oil/returning to a pre-fossil-fuel standard of living, maybe it turns out some sort of 1:100 year solar storm takes out the communications grid, plain overpopulation).

* Society could have gone nuclear at any point from around 1970 and solved the coal part of the fossil fuel problem. I've never seen a push for that in a climate demonstration. I don't think the activists are serious about solving problems; they are more interested in making people respect their opinions. It doesn't look to me like they really perceive a threat - they havn't seen anything that scares them enough to try working with their opponents to find compromise solutions. Fukushima vs. the more far out predictions on the climate front are not even remotely comparable levels of risk.

* We're much more likely to be able to solve problems if we embrace cheap energy than trying to preemptively guess at and mitigate uncertain threats.

I just mentioned peer-review as an absurd example. I never equated it to science in general, and it amazes me that it comes across that way. I still stand by my saying that equating evidence to science is an abrupt leap.

Strong leadership "can" mitigate this danger. An interesting question is how likely it is that it'll mitigate it rather than exacerbate the problems. I suspect the type of strong leaders humans usually elect are not the ones that will maximize the chances of mitigating.

I'm unsure what you mean about strong leadership and also why you believe scientific approach means to strife for scientific consensus.

However regarding strong leadership I think the current crisis shows that the autocratic states are typically do worse, look at Russia for example, or even China if they would have reacted better early on we would not have this crisis.

[Am Swedish and not a fan of the current policy]

This evidence-driven decision making process (which is indeed the default here) works remarkably well when things are moving slowly. It kills bullshit beautifully. This is normally something I'm quite proud about.

However, it breaks down so badly when you're suddenly facing a one in a hundred years pandemic and you can't act decisively 3-4 months into the pandemic because there's no evidence yet.

Sweden is "peace-damaged". We haven't really had to deal with any national-level crises the since the spanish flu about 100 years ago. The last war was in 1814. 500 soldiers died.

Note that the above mostly applies to national governance - this is the stuff that really gets set into code and culture over time.

At a local e.g. hospital/research unit/private company level, there's fantastic innovation happening on a daily basis, just as in the rest of the world.

This whole thing is kind of like driving a car, except that when you turn the steering wheel, nothing happens, and then two weeks later the wheels start to turn.

They admit thus in the article, when they say there’s no point closing the schools. The time when doing that would have made a difference was a month ago and they didn’t do it, so the damage was done.

> it breaks down when you're suddenly facing a one in a hundred years pandemic

What if you're not actually facing such a thing and you only think you are because the initial non-scientific estimates from government "scientists" are 2 orders of magnitude off the mark, just like the last few times? https://mobile.twitter.com/amasad/status/1252824592453742598...

Most countries are seeing excess mortality compared to previous years, much larger than could be explained by a bad flu year, which means that covid-19 is absolutely a real threat, we haven't seen anything like this in a hundred years, and countries should absolutely take measures to protect the population.

The peak mortality in the UK from this might still beat the 1989 flu epidemic, and it'd probably have done so already if it wasn't for all the lockdowns, but it hasn't officially achieved even that much yet. And our lockdown was relatively late and lax compared to a lot of other countries, so much so that it's probably still a little early to see much effect on the total mortality figures.

(If you're wondering "what 1989 flu epidemic", it probably wasn't well known outside or even inside the UK except amongst people who lived through it.)

I agree.

The 1957 Asian Flu pandemic is widely considered to be the worst pandemic since the 1918 Spanish Flu pandemic. Most figures I see for UK deaths from the Asian Flu in 1957 range from 3500 (for just England and Wales) to 30,000 (which looks at just excess death in the entire UK).

Most estimates I see for 1989 flu epidemic in the UK are around 30,000.

COVID-19 death toll in the UK will almost certainly exceed the both of those death tolls. You're at 18,000 already, and you're likely not even at the peak of the curve yet. And almost certainly, we'll see a second wave come late fall and winter (sadly).

> Most countries are seeing excess mortality compared to previous years

Incorrect.

Some countries are, or more accurately, a few countries.

Sorry, yes you are technically correct. What I meant is that most countries seeing significant numbers of people infected with coronavirus are also seeing excess mortality.

Can you point to some sources?

https://www.nytimes.com/interactive/2020/04/21/world/coronav...

https://euromomo.eu/

New York’s hospitals being overwhelmed, and a massive spike in excess mortality in the city isn’t an estimate. Those are real people sick and dying right now. The same with Spain and northern Italy.

Those regions got hit hard too soon for lockdowns to prevent disaster. Fortunately those disasters gave us a wake up call to lock down early enough elsewhere. If we hadn’t it’s pretty clear every city or region would eventually look like them.

Have you read the Ferguson paper? From the re-tweet you posted, I doubt it. The 1.2 million figure was the absolute highest estimate in the whole paper, and was mentioned off-hand as a worst case scenario if no preventive measures were taken.

In fact, if you read his paper and look at his estimated deaths under various different interventions and time period, and the current death toll, he actually may have underestimated the death toll.

Here, read the paper: https://www.imperial.ac.uk/media/imperial-college/medicine/s...

> Sweden is "peace-damaged". The last sort of national crisis we had besides the spanish flu was the Swedish–Norwegian War of 1814.

The second World War was definitely a national crisis. Huge military mobilisation, disruption to the iron and shipping industries including thousands of sailors dead, rationing, accidental bombings...even though Sweden was neutral that was a far bigger deal for her than the coronavirus has been.

Besides the deaths of those sailors it was a big meh.

[Am living in Sweden but not Swedish] I disagree with you that this is about a "slow evidence based decision process" (paraphrasing). That is actually the most infuriating about the policy. I have encountered this quite often here, it's a "we know better than everyone else" attitude.

The thing is the story they give is "we are evidence based, rational...,have the best methods", but completely ignore scientific evidence from outside Sweden. Example 1.: asymptomatic spread, despite several countries having evidence to the contrary the story here is, it's not important (in fact they slightly changed the tune is used to be negligible or nonexistent) Example 2: the chief epidemiologist has repeatedly said he "believes" the spread will go done in summer, without significant evidence. Example 3: sometimes the statements even contradict themselves. Example masks, the story (and there is actually a lot of propaganda around this) is still they don't help, because non95 masks are not completely closed. On the other hand the recommendation from the public health agency, (same who gives advice about the masks) for health workers treating covid19 patients is either goggles +mask (often there are no Googles) or visor without mask. How can a surgical mask which is not 100% tight not help, but at the same time a visor which is open to the sides is sufficient.

However, dealing with the novel corona virus isn't necessarily a scientific problem, but more of an engineering problem (as opposed to a problem to be solved with common sense).

Science tries to remove inprecise assumptions. Engineering accepts inprecise assumptions and works around them, e.g. building in a safety factor; using masks when there is some evidence they lower R0.

So no requirement for parachutes in planes, then? They’ve never been proven in a double blind study.

They don't block 100% of the air, so they can't possibly be effective.

Proven in a double blind study is not the only method of proof. You can also use model organisms. So you throw goats out of airplanes with and without automatically opening parachute ave see what happens. Or you can have an extremely good grasp on the mechanism of action of what you’re doing. Somewhere on Earth today a complicated piece of machinery is being fabricated and assembled that has never existed before and is going to be 90% as good as the final production version.

Multiple methods of proof of varying reliabilities exist.

Epidemics are something for which the mechanism of action is fairly well understood. The exact response of R to various measures is not known beforehand, but we can make decent guesses about what will reduce transmission.

The details of the epidemic matter, though. For example, closing schools is a fairly obvious intervention in flu epidemics - kids are really likely to get it and bring it home to their families, especially since they don't have the immunity that some adults might. It may actually be completely useless in this epidemic. Whilst kids can be infected, they generally seem to have very mild cases and there's some evidence they're no good at passing the infection on to others.

> there's some evidence they're no good at passing the infection on to others

May I ask: What evidence of this did you find convincing?

From my own digging it seemed like this was a claim from China, which merely indicated that it was rare that, in a family, the child got it first and gave it others.

However, when the epidemic really started taking off, it was the middle of CNY and kids weren't in school, which could completely account for why they didn't observe child->adult transmission.

I'd love to be wrong about this, though.

The China evidence was fairly compelling (they did contact tracing and were unable to find a single case where the child was the transmitter).

Schools didn't close in Australia (although many parents kept their children at home). There have been zero cases traced to child transmission, even in a few cases where a teacher or worker at a school got it from another place and brought it to school and those individual schools had to be closed.

There was a single cluster based around a school in Sydney but it was found to be parent-to-parent transmission.

Singapore didn't close schools during their early phase (until 2 weeks ago) and contact traced every single case. Zero were attributable to child-to-child contact.

It's possible this is all luck though.

Schools in Australia are closed now, not reopening since Easter break.

Kinders (preschool child daycare centers) remain open, and are now free - 100% paid for by the government.

It's the school holidays in many states (I'm Australian).

All schools will open for term 2, with Victoria and the ACT saying parents should prefer to keep children at home when possible while the other states are advising there will be more face-to-face[1].

[1] https://www.theguardian.com/australia-news/2020/apr/13/are-s...

In Vic children are held home, except for those of essential workers and if vulnerable; school started last week. Source: I'm managing son in grade 4. They just started using Cisco WebEx to connect with AV.

https://www.thelancet.com/journals/lanchi/article/PIIS2352-4...

Here's an article from a microbiologist here in NZ who's been one of the public faces of decoding the current scientific understanding of COVID for the general population: https://thespinoff.co.nz/society/23-04-2020/siouxsie-wiles-w...

I keep coming back to since we don't know the details very well right now and risk of catastrophe is high then executing the laundry list of interventions is the most prudent option until we have better data.

Maybe we figure out that children and teenagers basically don't get it or spread it. Then we can guardedly reopen schools. But not before we aren't certain it isn't going to blow up in our faces.

Unemployment directly leads to suicide over the long run, and that’s not even mentioning the extra suicide and overdose-related deaths from the unique conditions of isolation and constant fear mongering we are all collectively being exposed to.

It’s not clear that our interventions are going to help, given that the economic damage is going to introduce mortality (dud to the aforementioned suicide/overdose) in individuals who never would have been harmed by covid.

Meanwhile, it’s still a reality that majority of the globe will be exposed to this, so the lockdown is not avoiding death but instead just _postponing_ it. We need to hunker down insofar as we are close to exceeding medical capacity, but when we are not on the brink of medical collapse we need to be opening up.

Unfortunately the public policy has been built around irrational fear rather than “straight talk”. Thus why people are scared shitless that their teenage children, or elementary school children, will did if they return to school (rather than merely being a vector to infect their parents).

I’m on mobile but I have citations for the link between unemployment vs suicide that I’ll try to edit and stick in here in an hour or so. Last thing is that people should understand that the serological data, while not entirely reliable, is indicating from multiple sources that true IFR is .2-.8%, and furthermore that relative risk varies massively as a function of age/obesity/etc. So this seems to be one of the worst diseases to be practicing national lockdown for. (Avoiding hospital overrun was a great goal but the goalposts have now moved over time).

Also the IMHE model is so laughably bad that I actually am shocked that the authors are considered “experts”. It predicts 0 deaths after some point in June (I forget the day, I think june 6) because it naively assumed a .3 R_0 based off of the wuhan data, which they apparently assumed would hold for the US. In other words my understanding is the model is pretending that we’re going to contain covid. And they actually were crazy enough to lower the estimated deaths to 60,000 which we can already see is ridiculous.

I really wish I was in Sweden right now...

I forgot you can't edit comments on HN later.

Here's a study linking unemployment and suicide: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1732539/pdf/v05...

Note that they call it "causal" but it's still using statistical magic, but I think the idea that unemployment leads to suicide is one of those that seems like a sane default assumption, so as much as I distrust these kinds of analyses in general, I think it's relevant here.

I have question. If you don't care about one out of 20 of your friends, family and neighbors drying, people you know. Why do you pretend to care about some out of work schmuck you don't know offing himself?

Seems like your argument is trying to abuse the fact that I care.

Where are you getting that 5% mortality rate? That is an order of magnitude higher than what the data currently indicates, and is exactly what I meant about widespread fear mongering.

BTW the rhetorical technique you are using seems to basically be concern trolling. It’s the debate equivalent of a thought terminating cliche. It will never lead to a useful discussion.

Because 5% morality is what you get when the healthcare system breaks down. Which would be a direct result of letting the pandemic rip.

It's easy, take the 0.7-1% measured fatality rate. Double that to account for under counting. Then triple it to account for complete breakdown of the healthcare system

There 5%.

Advice: None of this is hard to sort out and you are flailing at it.

Your 0.7-1% fatality rate is not in line with current figures, which peg it closer to 0.35%. I've been rounding up to 0.5% for the US to account for the poor state of health here.

The rest of your napkin math is completely absurd and is just you progressively multiplying an arbitrary number until you magically hit that 5% number that you started out with. Funny how that works.

You should understand that even the 5% mortality when hospitals are overran is likely to be a huge overestimate for the same reason that we have been overestimated CFR all along. The vast majority of cases are not a big deal and don't need medical care whatsoever. But particularly for those over 70, you get covid and you have like a 1/8 chance of dying. It's that population that does get crushed when hospitals are overwhelmed, but when you run the hospitalization numbers, it's not clear that we would overrun the hospitals.

Which is a moot point btw since my actual position is end the lockdown but reinstate policies briefly if we are at the edge of the precipice.

Looking at https://old.reddit.com/r/COVID19/comments/g4tqvk/dutch_antib... you can see that for every 500 20-29 year olds who get infected, we have one hospitalization. Even 60 year olds only have a 3.4% hospitalization rate, which while high does not support your assertion without a much, much more rigorous analysis.

Thanks for the discussion. I'll keep following along.

>Your 0.7-1% fatality rate is not in line with current figures, which peg it closer to 0.35%. I've been rounding up to 0.5% for the US to account for the poor state of health here.

My 0.7-1% fatality rate? What you talking about my? I'm not pulling that out of my keister.

From here.

https://twitter.com/Bob_Wachter/status/1253538428114870277

>11/ Why? 142K confirmed NYC cases, so 21% of city (8.4M) -> 1.76M, or 12.5x confirmed case count, more in sync with other studies. If right, then true mortality rate (~15K deaths in NYC) about 0.8%, which also seems credible. There’ll be lots more of these serology studies soon.

Since you don't know who Robert Watcher is

https://profiles.ucsf.edu/robert.wachter

So your argument is that suicide rates might be higher in the future because of unemployment and that those deaths might outweigh the deaths from COVID19. Now this might be true, however the reduction in traffic deaths will outweigh them both. Just to show that number of deaths by itself is a poor measure.

These interventions aren't harm-free, though, even putting aside the obvious effect on children's education. Nurses, doctors and other key workers have children and shutting down all the schools is going to be very disruptive to them. A surprising number of countries rely on schools to make sure some children are actually fed. There's also the problem of policing what those children do when they're out of school. And on a darker note, schools are a very important early warning system for domestic violence and abuse against kids, and there are some frankly very worrying claims that murders of kids have spiked dramatically in at least some parts of the US. It's likely that there are children who are dead now that wouldn't be if countries hadn't taken the "prudent option" of imposing a probably-ineffective intervention, quite possibly a substantial number.

It's important to try to better understand the effect of various measures on R. In the present situation in the US and Europe, though, what matters most is quickly reducing R. There will be time for more experimentation with different measures (e.g., different regions trying slightly different interventions) later, but right now, plausibility is the best guide.

Well, yes. But there's not enough time right now to do that goat study, and that's what we're advocating if we want to follow science to the exclusion of common sense.

There’s both inductive and deductive reasoning. A fact can be proven be mere logical reasoning.

I don’t need a double blind study in that case because gravity has been proven before and there’s no reason to assume it doesn’t apply to everybody (or rather every body) alike.

There has been a randomized controlled trial to test if parachutes reduce injuries when jumping out of planes.

However, it found that parachutes do not reduce injuries: https://www.bmj.com/content/363/bmj.k5094

It's not really true vs false, it's a matter of deciding what level of evidence is convincing. One point is that we already know the approximate effectiveness of social distancing from many 1918 data points and its epidemic with similar contagiousness. Some places in 1918 did it and some did not, like San Francisco vs Philadelphia where the difference was stark.

Maybe the effect will be less this time for some inexplicable reason but I would not want to run the experiment in my country.

Deferring decision making from experts to the common people is exactly what "common sense" is.

And it's a pretty bad idea to use common sense to solve a problem that zero people alive today have ever encountered. None of have endured an unvaccinatable pandemic.

> Unless things can be scientifically proved, the individual rights of citizens should not be restricted.

Sorry, but this doesn't make, err, common sense. If you have a huge fire, would you put off evacuation order until it is scientifically proven that an area will burn down? By the time you are sure, it's usually too late.

It is not logical either - numerous exceptions can be found, including in this pandemic.

We already have a lot of scientific knowledge about how fires burn that we can apply to firefighting, so this is a non problem.

But it’s exactly the kind of country I want to live in. It’s my life, my right to do what I want within reason. Within reason should err on freedom.

You need more than scientific knowledge in order to make policy, you also need a quality metric against which to measure the desirability of outcomes. Science can tell you what is likely to happen if you pursue a certain policy, but it cannot tell you if that outcome is good or bad, or more to the point, whether the tradeoffs inherent in any complex policy decisions are worthwhile.

This has little to do with common sense vs Science. You can easily make the scientific case towards controlling the borders and isolating, it simply hasn't been done in Sweden's case. Handwaving away the necessity for scientifically vetting the idea of closing the borders, behind the idea that every country in Europe is already infected isn't good enough to claim a meritious victory for science over common sense.

The four debates Jordan Peterson did with Sam Harris about the reduction of information down to science and the necessity for building value structures and behavioural interpretations of facts proves to me that Science can't tell you how to behave. It can show you what facts will prevent death and what won't, but we never have enough resources to sciencetifically test every single decision tree outcome, there are an infinite number of objective facts. We make best guesses about which idea to follow based on value structure and gathered information we build over time.

Sweden's version of common sense is to follow what the scientific signallers are telling them, their reaction to the virus is an expression of culture and law that has little to do with the facts. They can't lockdown even if it was better.

Australia locked down and followed the norms for great success with double the population to Sweden, despite having similar issues with aged care facilities. Finland is performing well.

I don't see the evidence to support the Swedish solution, nor it as virtous example of science over common sense.

>I don't see the evidence to support the Swedish solution, nor it as virtous example of science over common sense.

The strong point of Sweden's response is that the Swedish economy is going to suffer much less. Other countries will have to piece their economies together after their lockdowns end. Furthermore, Sweden can keep things going as they are for a long time. How long do you think Australia could keep its lockdown going?

If there's going to be evidence to show that Sweden was right then it'll likely take a few years before we can measure the economic impact and all that brings with it. I'm not saying they are right, I'm just saying it's too early to tell that they're wrong.

I'm all good with Sweden doing what it wants, it's nice to see a country stand up for it's own values and culture and laws in the face of a deadly virus and find an outcome that works.

Pushing a weak argument about the virtues of science as a reasoning for doing so seems a bit much.

Australia will go as long as necessary, it is taking this opportunity to do the largest economic reform in 30 years. Australia relies on reform to stop itself from becoming the 'poor white trash in asia' (Lee Kuan Yew). Reductions in corporation tax, strengthening of unions and many more changes. Retail had been slowing down pre-covid and the mining is out of it's boom cycle. There has been rumblings for change coming for a while and all this lockdown is a great way to rejig the setup. We are setting up our agriculture to boom in the 30s so in the long term we should be okay.

The IMF predicts that Sweden's GDP is going to shrink 6.8% this year. Denmark, Norway and Finland are predicted to shrink only 6.5%, 6.3% and 6.0% respectively, despite locking down more aggressively than Sweden.

https://www.imf.org/en/Countries/SWE

https://www.imf.org/en/Countries/DNK

https://www.imf.org/en/Countries/NOR

https://www.imf.org/en/Countries/FIN

Australia is talking about being to reduce the lockdown in 4 weeks.

The Australian lockdown isn't complete - shops are still open, can go to offices if required, schools will open next term except in one state (it's holidays at the moment).

The economic cost is high, but unclear how much more than Sweden. Unemployment in Sweden hit 8% in the most recent quarter[1], while Australia's is forecast to reach 10%.

The IMF is forecasting -6.8% growth in Sweden[3], vs -6.7 in Australia[4]

[1] https://www.nytimes.com/reuters/2020/04/20/world/europe/20re...

[2] https://www.abc.net.au/news/2020-04-13/coronavirus-unemploym...

[3] https://www.imf.org/en/Countries/SWE

[4] https://www.imf.org/en/Countries/AUS

I dont understand the point you are making. Australia’s lockdown has been progressing and alleviating at the same rate as the rest of the world. Most countries are having a reprieve. Japan is going into lockdown lite and Australia’s economy was slowing pre covid anyway.

That was in response to "Furthermore, Sweden can keep things going as they are for a long time. How long do you think Australia could keep its lockdown going?"

I was giving evidence to show the impact on the Australian economy isn't obviously higher than the impact on Sweden, but with 1/10th of the number of deaths.

That's an attractive thought, but I'm less than convinced it's true. For example, I doubt there's much scientific evidence behind Sweden's zero-tolerance drug policy that literally equates heroin with cannabis [1], or their policy of criminalizing all sex work [2], with the admittedly unusual twist of making buying, not selling, illegal.

[1] https://en.wikipedia.org/wiki/Drug_policy_of_Sweden

[2] https://en.wikipedia.org/wiki/Prostitution_in_Sweden#Current...

> with the admittedly unusual twist of making buying, not selling, illegal.

The twist is probably based on the supposition that for selling to be illegal would mean endangering the the lives of sex workers, who (I assume, as the reasoning goes) are likely to be financially vulnerable. When selling is illegal, there is more risk for the person rendering the services.

When buying is illegal, it still imposes risks on sex workers. First, it hurts their income, meaning fewer sex workers are available, meaning it’s more likely victims will be coerced. Those who participate willingly can be put at risk from their customers when those customers are prosecuted.

A concern for the lives or welfare of sex workers may be among the points used to sell the Nordic model but based on the Norwegian experience they don’t actually care about them.

https://www.amnesty.org/en/latest/news/2016/05/amnesty-inter...

> “If a customer is bad you need to manage it yourself to the end. You only call the police if you think you are going to die. If you call the police, you lose everything.”

> --Sex worker in Norway

> Amnesty International heard how some sex workers who have reported violence to the police in Norway have been evicted from their homes or deported as a result of engaging with the police.

> Under Norway’s laws, sex workers are at risk of forced evictions as their landlords can be prosecuted for renting property to them if they sell sex there.

> A representative of a Norwegian sex workers’ rights organization explained: “If landlords don’t evict, the police will launch a criminal case against them...The police are encouraging landlords to take the law into their own hands and enforce it themselves.”

> People who do sex work are also unable to work together for safety, or hire third party support like security, as this would likely qualify as ‘promotion of prostitution’ under the law.

Just because a legal system places two different things in the same category doesn't mean they're saying they are equal.

For instance, in many states, it is both a felony to steal something worth $300 and commit murder. No one on the planet would say they are equal. In the same way, I doubt there are any legislators in Sweden who say that cannibis and heroin are scientifically equal. They're just classified the same for legal purposes.

But unless I'm reading this wrong, the penalties are equal for dealing either drug.

That doesn't match your analogy, where the two crimes - while both classified as felonies - have radically sentencing guidelines.

You're not reading it wrong, however what they're saying is incorrect.

>For instance, in many states, it is both a felony to steal something worth $300 and commit murder. No one on the planet would say they are equal.

Nobody is. It's like saying stealing and murder shouldn't both be considered crimes because they're so different. Felonies are just crimes that are considered more serious than lower crimes (misdemeanors)--there are loads of grade and classifications within that spectrum. Felonies tied to monetary values are generally written when $X monetary value is a large amount. $300 could've easily been a full month's rent a few decades back, so it was written as a serious offense.

The problem is the law is incredibly slow to update with the times.

As far as scheduling goes that basically mirrors the US and UN. Those categories aren't "levels of danger", but whether something has accepted medical use.

That will always vary country to country - in the UK diacetylmorphine is medicine, despite being highest schedule. And poppy straw is class A just as fentanyl. Does that make it correct to say they are "literally equated"? That's absurd.

(Not saying there aren't very dumb things about the national anti-harm reduction approach, but the scheduling isn't exactly unique internationally, nor really an aspect of what makes the system a massive mess).

Sex work is not criminalized, as you yourself point out.

There are exceptions to that general approach, of course. Even Swedish politicians need to be elected by popular vote, and this requires some amount of people-pleasing, along with the terrible consequences of that.

I think the term you're looking for is conventional wisdom vs common sense.

Agreed that conventional wisdom is often wrong.

> If you think that's a given, think again. Many countries base their maternal/neonatal care on common sense and old wives' tales instead.

Not a general attack on what you write, just a warning against taking this too far.

As both a father of small children, and as someone born in the early eighties I recently found reason to take a closer look at SIDS which peaked around here around the time when I was born:

Turns out it was explained by doctors and nurses telling people to let their infants sleep upside down instead of on their backs which is what has always been done. And they had good reasons for what they did as well, at least thats what they said:

- sleeping upside down was supposed to strengthen the kids neck and improve early development

- another argument was that it would protect them from being choked if they vomited

Once people went back to allowing their kids to sleep on their backs, SIDS almost vanished over night.

Turns out Chestertons fence is there for a reason.

Same goes for a number of other BS ideas that doctors has pushed even around here like the idea that mothers should use wipe their breasts with antibac before allowing infants to drink milk.

I wonder what the long-term effects of the "put them to sleep on their back" advice will be, though.

Our son hated (and continues to hate) sleeping on his back. We put him down that way because that's what medical advice recommends today, and if he died of SIDS because we didn't we'd feel terrible. But as soon as he learned to roll over, the first thing he did was start sleeping with his butt up in the air. I'm told this is very common, and most infants don't like to sleep on their back, and will avoid it if possible.

Are we going to find out in 20 years that we've raised a generation of kids with lower cognitive abilities and poorer emotional control because they didn't sleep well when they were newborns? That they have asthma and sinus problems from mucus dripping down their throat while asleep? That there's some other unknown risk factor we're not accounting for? That's certainly the case with a lot of common parenting wisdom from the 80s.

Oftentimes both sides of Chesterton's fence suck, but they suck for different reasons. And humans have a bias toward fixing problems they see, not being grateful for problems that were silently averted. That's why we perpetually tear down fences and generate new stocks of problems.

"Turns out Chestertons fence is there for a reason."

The bummer is when there's no followup research to validate the new policies.

For example, Atul Gawanda attributes some of the reasonability for the opioid epidemic to updated standards of care for managing pain but then those advocates failing to do any followup studies to assess the outcomes.

Except that the article gives evidence to the contrary.

There is nothing very 'scientifically more accurate' about Sweden's approach to COVID.

This is the 'Swedish Model' narrative which borders on propaganda, promulgating an exceptional view of the Swedish government.

More often than not, bureaucrats take decisions they think are right, but which can just as easily be base on the arrogance or myopic view of the local institution.

Every response in this COVID article illustrates that:

- 'Closing borders' has been imminently successful in slowing the spread of Covid in almost every case - either giving more time for officials to prepare, aggressively suppressing it (Korea), or - locking out the disease almost completely (Taiwan).

- The 'trust-based' Swedish approach is irrational - because the issue is not 'trust'. The issue is literally physical distance. If Swedes are 'going to restaurants and school' and 'restaurants are a serious vector' - then COVID will spread, it's that simple.

- "What evidence was this approach based on? It is difficult to talk about the scientific basis of a strategy with these types of disease, because we do not know much about it and we are learning as we are doing, day by day. Closedown, lockdown, closing borders — nothing has a historical scientific basis, in my view. "

This is not true! We have historical data from pandemics, particularly from America which demonstrate cities that went on lockdown were able to recover more quickly from the Spanish flue. Moreover - the issue is risk. The more 'unknowns' there are, the more likely we err on the side of caution, not risk.

- "We do not need to close down everything completely because it would be counterproductive" we're 100% certain that lock-downs prevent spread - the issue then becomes one of value vs. cost, but it's not fair to them to indicate it's 'counter-productive'.

Even his testimony about 'asymptomatic spread' is strongly challenged by some evidence. Yes, we don't know for sure, but to assume the negative, given the consequences, does not fit this 'we use science not common sense' pragmatism. It's just plain risky.

"I recently had reason to investigate to what extent maternal/neonatal care followed the best of our scientific knowledge and it was extremely close. If you think that's a given, think again. Many countries base their maternal/neonatal care on common sense and old wives' tales instead."

This is only anecdotal and it's not substantiated.

...

The media perspective is mind-blowing: everyone seems to give 'Noble Sweden' the benefit of the doubt with respect to their measures, talking about the supposed effectiveness of it ... but if a Republican Governor were to suggest literally the same measures, they'd be mocked mercilessly on CNN.

This is happening literally, today on CNN: governors/mayors wishing to make limited openings of their states, remaining still more closed than Sweden, and wherein they have fewer cases than Sweden, are getting the harsh treatment.

I do think they all need to get hard questions from the press, but let's not pretend there's anything more magical going on here with respect to the policy or behaviuor, and treat these groups more 'in kind'.

That's one way of looking at it. But the one that decides seems quite sure of the opposite of what is considered common sense.

https://tegnellcitat.se/

He's not a humble man.

I can imagine a wild in which the US pursues science based policy, but it swiftly results in the corruption of science to provide evidence that fits certain conclusions. I think this already happens to a degree in certain fields, and especially among think tanks.

This isn’t a reason to avoid science based policies, but just a potential snare along the way.

It's notable as well when evaluating Sweden's number is that they are far more trustworthy than most countries. One interesting metric is excess mortality. Some places have wild unexplained excess mortality from the statistical expectation, that isn't fully explained by reported Covid-19 deaths. This suggests that Sweden is reporting deaths far more accurately than other countries, so when we evaluate the relative success of their strategy, we should keep that in mind.

A chart published by the NYT:

    Location | % extra | excess death# | official C19 d# | unexplained difference
    Spain    |  66%    | 19,700        | 12,401          | ~ 7,300
    England  |  33%    | 16,700        | 10,335          | ~ 6,300
    NYC      | 298%    | 17,200        | 13,240          | ~ 4,000
    France   |  21%    | 10,500        |  8,059          | ~ 2,500
    Holland  |  33%    |  4,000        |  2,116          | ~ 1,900
    Istambul |  29%    |  2,100        |  1,006          | ~ 1,100
    Jakarta  |  36%    |  1,000        |     84          | ~   900
    Belgium  |  25%    |  2,300        |  1,632          | ~   700
    Switzer. |  21%    |  1,000        |    712          | ~   300
    Sweden   |  12%    |  1,100        |  1,160          | ~   -50

This table is missing Norway, Denmark, and Finland which would be the most interesting to compare Sweden to.

Sweden has a higher rate. The theory is that the bulge in death rate is bigger up front vs a prolonged one that continues for months. It will be interesting to see long term results. Sweden also seems to have the same problem with long term care homes that many other nations (France, Canada, etc) are having.

I don’t think the up front deaths are in any way intentional. It’s very hard to compare strategies since there’s many other factors that control the outcome. Like Sweden had school holidays ending with a lot of people coming home from skiing in Italy just when the situation there exploded. And as you mentioned, the virus got into a lot of the nursing homes.

Just for reference, Norway's epidemic also started with a large influx of cases from Italy and Austria. But the countries have used different strategies from that point on.

Sad to say, I'm completely unsurprised that countries with rampant Covid19 spread have a lot of deaths in their retirement homes. It's practically deterministic.

People are contagious in the pre-symptomatic or asymptomatic case. So all that's needed is that one employee of the retirement home gets sick and goes to work before they know, and the game is up. Dead patients everywhere.

I'm sure this is discussed and considered on the highest levels of policy in the jurisdictions that have been the most proactive in getting a handle on the epidemic early, and missed in most others.

I'm sure a strict face mask policy could have helped slow things down, but that's sadly been a hotly contested topic.

Many retirement homes here in Czech Republic have had the care takers voluntarily locking themselves up together with the people living there. Some have been there like this for many weeks, only taking in supplies in a safe way & communicating electronically.

Thats some serious dedication & very prudent one, give all the tragic cases elsewhere.

This is one of the things I wondered when I saw the "flatten the curve" charts and simulations a few weeks ago.

Is there a valid statistical model for letting COVID-19 spread quickly, and "getting it over with", compared to flattening the curve and letting it create fewer mortalities over a longer time?

I suppose even if the total number of mortalities is projected over time, there's real hope that we could find more effective treatments over time.

The problem is that depending on your medical capacity, "getting it over with" overloads your medical system causing even MORE deaths. So the total number of deaths goes way, way up. Because in addition to the deaths from COVID-19, you get extra deaths from hospitals not having beds or able to handle other common injuries/sickness/accidents that are still happening every day but wouldn't normally lead to death because they could get full attention and care.

Now, if we had infinite medical capacity, then actually "getting it over with" could, from a number of deaths perspective, be advantageous. No lockdowns! No economic distress! However, you also overshoot a little. You would have deaths due to more of the population being exposed than required for herd immunity.

Of course, if you're a no lives lost at any cost, you'd still want to reduce deaths by slowing the spread until something like herd immunity or a vaccine. But most don't seem to have that sort of political or economic calculus.

There will be an economic crisis if 2-3% of people lose their lives in a span of a few weeks.

Absolutely there would be.

On the other hand, the results from the recent antibody testing in California[1] (if they're accurate) would suggest a much lower death rate - around 0.1% - 0.2%.

I fully agree that social distancing is the right move with the current data, but I wonder if that will continue to be the case as we come to understand the virus and its actual infection-fatality-rate more.

[1] https://www.nature.com/articles/d41586-020-01095-0

0.1% is the current mortality of flu, this has killed twice the yearly number of flu victims in a month. Could be explained by the huge infection rate possibly but it’s definitely more deadly by a wide margin.

I agree totally. I haven't seemed much informed discussion along these lines, but the only two possabilities I see are:

1) The antibody studies are incorrect, and over-counting the infection rate.

2) COVID-19 spreads much more easily than influenza, and so a large percentage of the population has become infected much quicker than typical influenza spread patterns.

Neither option is great, though to me of the two, #2 seems more hopeful, since assumedly we'd get herd immunity relatively quickly.

The problem with not getting it over with is that the next wave is at extreme risk of colliding with the peak of the next flu season, which is a really great way of overloading your medical system and causing a bunch of deaths. This is something that's getting a bit of attention in the US now, but (of course) the UK government spotted it fairly early on and was pressured into ignoring it by our idiot press who think that paying attention to anything other countries aren't is a delusion of "British exceptionalism" that needs to be squashed.

Where can I read more about early identification of this risk by the UK govt?

I don't think it's a given that there'll be a next flu season. In my jurisdiction, I calculated that we've reduced the incidence of cold/flu symptoms by about an order of magnitude with social distancing measures. (Based on normal incidence of cold/flu symptoms, and rate of covid-19 testing which is open to anyone with cold/flu symptoms.)

Note also that the herculean effort to reduce all other cold/flu viruses by an order of magnitude only reduced R of covid-19 to around 1.

Not to mention effectively killing your mostly ireplecable medical personell - either directly by massive exposure to the virus, due to overworking or due to psychological issues caused by watching people die every day for weeks on end.

Sweden: 1,937 deaths. 50 fewer seasonal deaths than expected.

Norway: 187 deaths. No increase in seasonal deaths.

Denmark: 384 deaths. Seasonal deaths unknown to me.

Finand: 149 deaths. Seasonal deaths unknown to me.

Sweden has approximately twice the population of the other Nordic countries, so per capita they have between ~2.5x and ~6x the Covid19 mortality of their neighbors, who have stricter preventive measures.

Honestly, I can't see how Anders Tegnell and his colleagues can sleep at night with the uncertainties they are powering through. By rights they should be terrified that they've gotten one of their assumptions wrong.

Denmark has ~2.5x the per-capita covid-19 mortality of Finland, should Danish authorities be terrified that they've gotten their assumptions wrong?

The UK has ~2x the per-capita covid-19 mortality of Sweden, should English authorities be terrified that they've gotten their assumptions wrong?

You are cherry-picking like crazy!

There is clearly no evidence that stricter measures have any effect. If that was true, then there should at least be a linear correlation between strictness of measures vs. excess deaths, and that's simply not the case. You're extrapolating a linear correlation using a couple of data-points that happen to support your theory, i.e. Sweden vs other Nordic countries. Sweden vs. all of Europe paints a completely different picture, so you're not looking at that, because you're cherry-picking.

There are so many uncertainties around this whole situation, and I think the only thing we can say with certainty is that if a country has no or a low rate of excess deaths, that country is doing "ok". Not doing great, not doing shit, just doing ok.

> There is clearly no evidence that stricter measures have any effect

Working for us in NZ, although I think the timing of our national lockdown is strongly significant to our success, we managed to do so before it was widespread in the community.

Our new case rate is literally bottom of the FT Covid graph: https://www.ft.com/coronavirus-latest

And we have 50% the population of Sweden, and 0.72% the deaths. If we were to be per-capita equivalent with Sweden, we'd need about another 964 people to die.

Look, I agree with you that stricter measures probably have an effect. All countries have some forms of restrictions, all countries have flattened their curves, no-one is really seeing crazy exponential growth, common sense dictates that it's working.

But a lot of people in this thread are arguing that Sweden should have enforced stricter measures because that should have decreased the deaths further. And that position is unsupported, because there are comparable countries with stricter measures than Sweden that have a higher per-capita death count, for example the UK or Belgium. Looking at excess mortality the picture is similar. Sweden is absolutely not doing great, but it's not doing bad either.

If stricter measures always resulted in less deaths, as you argue, why are so many countries doing worse than Sweden? Why are more people dying in those countries? Is their population stupider? Unluckier? More defiant towards government? Clearly there are multiple other unknown factors at work here, which is why there's no evidence that stricter measures in Sweden would have an effect.

> for example the UK or Belgium

It depends when each country locked down relative to the number of cases and deaths at the time.

The UK is widely acknowledged (here anyway) to have acted too late in its lockdown as the were trying to pursue herd immunity.

Every country was widely acknowledged to be too late in its lockdown. In the ones that have seen disasters the accusation stuck, while in the ones that haven't it's been quietly forgotten.

I perhaps didn't emphasise this enough in my original post, but I believe it answers your questions.

> I think the timing of our national lock down is strongly significant to our success, we managed to do so before it was widespread in the community.

> Why are more people dying in those countries?

Timing is a very significant factor, I believe - I couch that as a belief, because I haven't had the time to compare all lockdowns, but you'll note that on this FT graph[1], NZ's lockdown began near immediately by the metric being used, whereas the UK's took a full two weeks.

We know that the UK government dithered, initially focused on herd immunity (and worth noting that Johnson and his advisor Dominic Cummings who was hugely influential in pushing for it both went on to contract the illness), hired social media bots(?!)[2] to spin the party line, and only after all that, then went into lockdown. A veritable case of closing the barn door after the infectious horse has bolted.

Of course there's a bunch of other factors in death rates - the comparative proportion of your population which is especially vulnerable, medical care capacity, but it seems obvious to me that the largest factor will always be the number of infections in the first instance.

[1]: https://www.ft.com/__origami/service/image/v2/images/raw/htt...

[2]: https://www.thecanary.co/trending/2020/04/21/fake-nurses-pro...

> Timing is a very significant factor, I believe - I couch that as a belief, because I haven't had the time to compare all lockdowns

Fair enough, and I agree. It's clear that countries who clamped down super early have fared much better than everyone else.

But going by that FT graph, Spain went into lockdown a week before the UK, and still did worse? Germany later than the UK, and is doing better? There's a crazy amount of uncertainty about what good lockdowns are once you've passed a certain point of community spread.

Sweden obviously missed the point in time where lockdowns would have worked very well, while NZ, Australia, Norway didn't.

The UK obviously missed it as well, but while they were debating herd immunity, it might have been too late anyway? We might never know.

And with all that uncertainty, I think it's wrong for people to argue that Sweden "obviously" would have saved lives by going into a hard lockdown earlier. Maybe, probably, perhaps. Would a stricter lockdown now do anything in Sweden? Unlikely.

> Spain went into lockdown a week before the UK, and still did worse? Germany later than the UK, and is doing better?

Not relative to number of cases: Germany locked down later than UK, but a week earlier on the exponential growth curve.

I'll post this link again, because it's the best articulation of this point that I've found: https://medium.com/@tomaspueyo/coronavirus-act-today-or-peop...

Timing, with respect to where a country/region is on the exponential growth curve, is critical. In almost every place you see the same outcome, it's crazy.

> Not relative to number of cases: Germany locked down later than UK, but a week earlier on the exponential growth curve.

Not according to the Financial Times graph in the post I was commenting on. Germany went into lockdown at 3000 cases per day, while the UK went into lockdown at 700 cases per day, and Spain at 600 cases per day, according to that.

Is the FT graph wrong? Do you have a better data source that proves your point?

You're missing an implicit assumption - that each country's testing regimes and levels and criteria were comparable - for an example from the top of my head, some countries only test if you show symptoms.

So if you'll allow me to rephrase:

> Germany went into lockdown at 3000 known cases per day, while the UK went into lockdown at 700 known cases per day, and Spain at 600 known cases per day.

As you said earlier, so many damn factors in this.

To add more data, Germany locked down on Mar 17 at 24 known deaths. The UK locked down on Mar 23 at 336 known deaths. Germany reached 342 known deaths on Mar 27. That's 10 days of lead time on the deaths metric.

Germany's new deaths per day (smoothed) stopped increasing at 215 per day on Apr 9 (2.5 weeks later). The UK's death rate stopped increasing at 850 on Apr 15 (2.5 weeks later).

https://91-divoc.com/pages/covid-visualization/?chart=countr...

Deaths tend to be more accurate than just confirmed cases.

One way to account for testing rates is to look at the test positive rate, and use that as a proxy. If the test positive rate is 50% (as it was in Spain at some point), you can be pretty sure you’re missing a lot of cases.

So if Spain has “600 cases” but only did 1200 tests, they probably have way more real cases than Germany’s “3000 cases” out of 30,000 tests.

FWIW, Germany had 9 deaths on March 17, while UK had 10 deaths on March 14. By that metric, the UK led Germany by 3 days. There’s more to it than just the one national lockdown date — in particular, Germany is federal and I think different states went into lockdown at different times, as in the US.

But meanwhile, South Korea and Taiwan have avoided lockdowns entirely, so it’s clearly not only about lockdown timing — availability of testing, as in Germany, helps a lot with keeping the sick isolated.

Counterpoint: Santa Clara county locked down 3 days earlier than Los Angeles, but a week later on the epidemic curve. LA right now has had nearly twice the death rate per capita, and unlike Santa Clara which is almost at the end of the curve, may not even have peaked.

Lockdowns aren't everything..

Santa Clara has less population density and air pollution.

Santa Clara’s official lockdown, and the tech world’s “work from home” mandates were separated by about a week, which could account for some of this.

> and worth noting that Johnson and his advisor Dominic Cummings who was hugely influential in pushing for it both went on to contract the illness

Not really worth noting. It's an interesting anecdote, and I'm sure those who take the pro-lockdown position revel in the schadenfreude… but it has no relevance to the debate.

I does when Boris was going around boasting that he was "shaking hands with everyone" (in regards to a hospital visit). Then ends up in intensive care himself using up stretched resources.

I will give leaders who's job it is to meet lots of people to run a country a break, IF they take a reasonable position. Boris flaunting the risks to build up his public persona and then getting egg on his face is absolutely relevant. If you care in any way how a country is run.

Dominic is not so much in the public eye, but I bet he had a lot to do with Boris's early bravado.

It shows how widely it spread in the UK before they went into lockdown, which underlies my point that the efficacy of a lockdown is strongly tied to the timing thereof.

> If stricter measures always resulted in less deaths, as you argue, why are so many countries doing worse than Sweden?

The UK acted too late. Compare Sweden to Australia. Australia has 2.5 times the population of Sweden (25.6 million versus 10.3 million). Sweden has had 1,937 COVID-19 deaths and Australia has had 74. Sweden's deaths per million population is 192 and Australia's deaths per million population is 3. Sweden's rate of testing is 9,357 tests per million population and Australia's is 17,743:

https://www.worldometers.info/coronavirus/

https://coronavirus.jhu.edu/map.html

Australia's had fewer cases, fewer deaths, and is doing more testing than Sweden.

> we have 50% the population of Sweden, and 0.72% the deaths

After google, the percentage of elder in Swedden is like 20% and in New Zealand like 12%. If you have half of population, you would have half of elder with the same percentage, but is minor. You should have like 6 elder people by each 20 elder in Swedden.

Even if the covid would perform exactly the same in all countries and the measures taken would be exactly the same, the deathcount by million of people would be different.

Okay, so, to tweak it based on that, our most vulnerable populaton is 30% the size of Sweden's most vulnerable population, and we have 0.72% the deaths.

Other difference can be that you have passed the problem in summer-fall so far, whereas europe passed it in winter-spring. This means, for example, that water droplets in the air will dry much faster in your case

You are about to enter in flu season and the next months can be complicated, so take care for yourself and your family. This is not over.

Sweden unfortunately got a rather large injection of cases from tourists visiting northern italy in just the wrong week. NZ doesn't have the same close traffic with any early covid hotspot.

I'm not sure where you got that impression about the NZ cases.

A bit over half of New Zealand's early confirmed cases were directly linked to recent overseas travel. Although the data [1] is a bit awkward to analyze, in weeks #12-14 (15 March .. 4 April) 451 cases out of the 883 total (51%) were classified as "overseas travel".

The data only includes the country of origin of the final leg of their international flight. Since there aren't any direct Europe-NZ flights, some of the cases with origins in Australia/USA/Asia could be due to passengers returning from Europe via an intermediate airport.

[1] https://www.health.govt.nz/our-work/diseases-and-conditions/...

The number of Swedes traveling in general and especially traveling to virus hotspots like Italy is far higher than the number of Kiwis doing it.

You know, maybe, just maybe, being a remote island so far away from the rest of the world it's often forgotten on world maps helps with reducing transmission vectors in pandemics.

The specific assertion was that "NZ doesn't have the same close traffic with any early covid hotspot", but that's demonstrably false.

Perhaps there were more Swedes traveling in general, but that is neither here nor there. [There were an average of 16,300 people arriving in NZ each day in early March.] NZ did in fact have plenty of overseas arrivals returning from various early hotspots (such as New York and Italy) and this is reflected in the confirmed case data showing that a whopping 39% of all of our cases were infected during their overseas travel.

Furthermore, every single significant cluster of cases was kickstarted by an index case that had recently returned from overseas.

It wasn't distance or being an island that protected NZ from experiencing an epidemic outbreak, but rather the rapid action from our government: travel restrictions, isolation/quarantine of arrivals, and strict lockdown of the entire country.

New York was not a particularly early hotspot, it was much later than Italy.

We shut down flights from China in February for that reason, and China is a masssive source of tourism for us - we also had the plague ship Royal Princess dock here and spawn a cluster, all of our largest clusters came from overseas contact - either from tourists or returning Kiwis.

Ummm...

> There is clearly no evidence that stricter measures have any effect. If that was true, then there should at least be a linear correlation between strictness of measures vs. excess deaths, and that's simply not the case.

What? No, timing of measures is critical here. [0] The same exact strictness of measures, implemented a week later, can cause 4x more deaths (total, and thus per capita too) merely because of the delay.

Yes, English and Danish authorities should absolutely be terrified that they waited to long to act, just as the Swedish authorities should be.

[0] https://medium.com/@tomaspueyo/coronavirus-act-today-or-peop...

> Denmark has ~2.5x the per-capita covid-19 mortality of Finland

...and ~35% the per capita mortality of Sweden. Denmark is pretty much in the middle of the pack. That's clearly less reason for panic than if they were already in the top third and rising fast. And you accuse others of cherry-picking?

> Sweden vs. all of Europe paints a completely different picture

No, it really doesn't. Thanks for proving that this kind of jingoism isn't limited to the US.

It's not just that Sweden has a higher death rate but that Sweden's death shows a sharp exponential rise still. This effectively in the last few days, a week ago Sweden could be pointed to as a "miracle".

The other countries that have seen these exponential indeed effectively panic and impose any measure they can - social distancing and lock since that's all they have.

As people point out, there's no absolute evidence that quarantines, lock-downs or parachutes save lives yet common sense still dictates they do more than nothing and when a disaster is approaching, do you really want to say you failed to do that could have averted mass deaths?

Moreover, the Sweden versus the other Nordic countries does seem like a better comparison because these countries arguably have similar levels of relative isolation from the world, similar health care systems and similar cultures.

> is that if a country has no or a low rate of excess deaths, that country is doing "ok".

Where are you getting figure for all cause mortality for Sweden please?

> should English authorities be terrified that they've gotten their assumptions wrong?

There is wide-spread condemnation about the UK approach - too little, too late.

Compare countries of similar population:

pop 10.7e6 https://covid.observer/gr/#daily

pop 10.7e6 https://covid.observer/cz/#daily

pop 10.3e6 https://covid.observer/se/#daily

pop 10.3e6 https://covid.observer/pt/#daily

pop 9.8e6 https://covid.observer/hu/#daily

pop 8.9e6 https://covid.observer/at/#daily

pop 8.6e6 https://covid.observer/ch/#daily

I want to point out the high absolute numbers of deaths, the deficient recovery, and that the curve shows no decline in Sweden.

I would be completely unsurprised that when this is over, an angry mob captures Tegnell and tears him limb from limb while alive.

And Germany is another outlier

It looks like Germany put lockdown measures in place about a week earlier than France, Belgium or the Netherlands, if you compare the number of deaths at the time the mesures were enforced.

Getting a lockdown in place a week earlier mathematically translates in a 4x reduction in deaths a few weeks later, which is more or less what we see when comparing France and Germany.

Likewise the UK enforced the lockdown a few days later than France (proportionally to the state of the pendemic at the time of the measures), more or less like Spain. Looks like they are both heading towards 30k or 40k deaths until the pendemic gets under control. A few days really matter when you're fighting a pendemic that double in size every 3 days.

Even before the lockdons went into effect the difference between Germany and France was puzzling.

> A chart published by the NYT:

Do you have a link to the source?

https://www.nytimes.com/interactive/2020/04/21/world/coronav...

That chart is really hard to read. Am I supposed to take away that Sweden only has about 50 or 60 more COVID deaths than the official count? This seems hard to believe. These types of numbers don't tend to have that level of quality at this stage of a disaster. I guess time will tell.

No it's even weirder; the gap implies that there are 50-60 fewer non-COVID deaths in Sweden than there would be otherwise since the pandemic began.

I would chalk that up to people acting a little more conservatively because of COVID-19, even if there isn't a lockdown.

Which isn't weird at all - if you trust that people avoiding crowds also lead to fewer having the accidents which would otherwise have gotten them dead.

Or prevents them from contracting any other disease that would have otherwise killed them. In fact even these numbers are undercounts of the "true" death total due to the pandemic, as we'd obviously expect baseline deaths to have dropped significantly over the short term. How much is for the next generation of epidemiologists to argue about.

But FWIW: Sweden is absolutely an outlier here, and given the choice between "Swedish reporting is fundamentally better" and "Swedish death counts are wrong in some banal way", I'll choose the latter.

Say it with me everyone: we don't make risk analysis decisions on the basis of outlier data.

Mortality data and excess mortality data goes back decades, it's not like we suddenly started counting these things yesterday because of the coronavirus.

For Sweden's death count to be wrong now, they would also have to have been wrong going back decades, without anyone noticing. Or, the total all-cause death count would have to start being wrong about now because of unspecified reasons.

That doesn't make sense.

Doesn't the logic go the other way around though? For Sweden's numbers to be unimpeachible now, they would have had to have never been wrong going back decades. But in fact public numbers get reported incorrectly all the time, they just get corrected.

This is happening everywhere right now, watch all the various numbers on Worldometer jump around like crazy.

What you're doing is pointing to this one, single number, as collated by the New York Times in one story, which doesn't match any other numbers in the same data set. And you'redemanding that we treat it as proof of your particular policy views on this one country.

And I'm saying: well, OK, that could be true. But it's probably just a mistake.

There's a huge difference between all-cause mortality numbers being wrong, and covid-19-attributed deaths being wrong.

The only way the all-cause mortality numbers can be significantly wrong is if you suddenly find piles of corpses and skeletons around, and that they belong to people who magically weren't being missed or noticed by friends, family, neighbours, etc. And the only way for governments to hide these numbers would be by digging mass graves, shoveling them full of dead bodies, and hoping no-one notices. This simply does not happen, modern countries do not get this number wrong. If there's any public statistic you can count on going back centuries, it would be the number of births and the number of deaths.

Excess mortality is simply graphing the number of deaths backwards through time, to find trend curves and spikes in the trend curves. Those numbers are as correct as the underlying numbers.

In comparison, correctly attributing a death to covid-19 is very difficult right now. Tests are in short supply, so a lot of countries aren't testing already dead people, because those tests can be better used elsewhere, to save lives. There might be political pressure to downplay the severity of covid-19, so cause of death gets fudged here and there. Cause of death is also not always straight-forward, a lot of people are dying with covid-19, not from covid-19, how should they be counted? Different countries have different rules here.

The NYTimes article is saying that a bunch of countries have unexplained excess mortality, quite a lot of it actually. And since the most likely cause of those deaths are in fact covid-19, it means that those countries are under-reporting, i.e. their numbers are garbage. In comparison to those countries, Sweden's covid-19 deaths align pretty well with Sweden's excess deaths. The official number is still probably wrong, but there's absolutely no way that Sweden's covid-19 numbers are more garbage than those other countries, and there's absolutely no way that Sweden is under-reporting to the same extent.

> The only way the all-cause mortality numbers can be significantly wrong is if you suddenly find piles of corpses and skeletons around

Or if someone types a number incorrectly; or the reporting deadline changes for a month causing a few offices miss it and get counted in the wrong month; or if the Times writers didn't understand the specific categories being reported and missed some data...

Again, I'm not saying you're wrong. I'm saying you're hanging your entire argument on one outlier number. And, statistically (see what I did there?) that doesn't tend to work out for you.

Hospitals have seen a dramatic drop in visits that aren't coronavirus-related. You can bet that automobile accident deaths and injuries have dropped like a rock in the past month, for example.

Well spotted. I bet that work accidents also sinked

And probably people are getting lost on mountains less and less flu deaths too...

A likely explanation is that some of the people who died of Covid-19 would have died anyway.

For flu deaths, perhaps people are so cautious/being sanitary that they are dropping, I know Japan has seen record drops in Flu diagnosis due to extreme caution from the populace due to covid.

The opposite. Sweden has counted 50 or 60 extra cases as COVID than can be accounted for simply by excess mortality. That sounds impossible, but the difference can come from a few places:

1) Excess mortality is only an estimate. There could be other reasons why non-covid mortality is lower/higher than previous years (e.g. less serious flu season)

2) The tests can have some false positives.

3) If the way you count deaths is "anyone who died and tested positive for Covid", it's possible that the people you're counting didn't die from Covid but happened to have the virus in their system (or would've died even if they didn't catch Covid).

All this is saying is: in past years, X people died in Sweden during this period on average. This year, Y people died. (Y - X) are the "extra deaths", so to speak, and so this is comparing extra deaths to reported Covid-19 deaths.

I think Covid is causing other causes of deaths to be reduced (less car accidents, flu etc. than usual), so the -50 on the chart implies that (1) all Covid deaths are being accurately counted) and (2) non-Covid mortality is slightly down.

The excess mortality problem isn't about trust. No one has alleged that existing studied covid death numbers in Lombardy or New York or wherever are due to people lying.

It's just that some people, in every health care system, end up dying without a test being done. It's certainly plausible that Sweden has been far more conscientious about testing unknown deaths (or testing at-risk people before symptoms, etc...). That doesn't say anything about their trustworthyness.

FWIW, my money is on a bunch of these cases being discovered in Sweden too, they just didn't show up in the check the Times did. Epidemiology is just hard, and there are no magic tricks to play with the science.

Pretty hard to hide excess death. That's precisely the point of this chart. You can miscount Covid deaths, but it's pretty hard to miscount deaths overall unless there's a fraudulent cover-up. Deaths are all recorded and tracked. Bodies don't just disappear.

It would probably help to state the unexplained difference as a percentage of official C19 death count (and narrow the columns). I took the liberty:

             |   %   | excess  | official| unexplained
    Location | extra | death#  | C19 d#  | difference%
    --------------------------------------------------
    Spain    |  66%  | 19,700  | 12,401  |   59
    England  |  33%  | 16,700  | 10,335  |   61
    NYC      | 298%  | 17,200  | 13,240  |   30
    France   |  21%  | 10,500  |  8,059  |   31
    Holland  |  33%  |  4,000  |  2,116  |   90
    Istambul |  29%  |  2,100  |  1,006  |   109
    Jakarta  |  36%  |  1,000  |     84  |   1071
    Belgium  |  25%  |  2,300  |  1,632  |   43
    Switzer. |  21%  |  1,000  |    712  |   42
    Sweden   |  12%  |  1,100  |  1,160  |   -4

Couldn't you in fact make the opposite case?

Sweden as the outlier is not reporting accurately and others are?

The UK has seen huge excess mortality above the average which is being attributed to large numbers of undiagnosed deaths in care homes and in the community.

Its far too early to make any claims as to superior accuracy when almost every country is struggling with accurate testing across their entire population.

In which case you'd expect Swedens numbers to get revised strongly upwards.

Sweden also has no conclusive sign of flattening yet.

The total number of people that have died on a certain date is not going to be revised, why would it be?

The excess is that number minus a historical average which will also not be revised.

Because of the huge amount of excess deaths that get assigned as probable covid cases. This is happening right now in the UK.

> Sweden as the outlier is not reporting accurately and others are?

Huh?

If a country is in lockdown, and still experiences excess mortality, but the official covid-19 deaths aren't enough to cover that excess, then.... what the hell did people die of?

The expectation is that because of lockdown, the excess mortality from non-covid-19 causes should be lower than previous years, and therefore all the actual excess, and probably more, is attributable to covid-19. Which means that countries where the official covid-19 number is lower than excess mortality, like the UK, are underreporting, while countries where the excess mortality matches the official covid-19 number, like Sweden, are not underreporting.

I don't think you can assume that non-covid-19 causes should be lower than previous years. For example, the main cause of deaths in normal years is cardiac problems. If Covid-19 is discouraging people from seeking help, and especially from going to the emergency room when they they think something might just possibly be wrong, then you can get a big increase in cardiac deaths.

> I don't think you can assume that non-covid-19 causes should be lower than previous years.

Sure, I agree that it's very uncertain.

However, if that's the case, then that just furthers my point, because it means that Sweden is overreporting covid-19 cases, and is actually doing even better than official stats say they are.

Your underlying assumption is a) Sweden is reporting correctly and b) won't in future find excess deaths in the community - as other countries have:

https://www.independent.co.uk/news/health/coronavirus-care-h...

UK coronavirus deaths more than double official figure, according to FT study:

https://www.ft.com/content/67e6a4ee-3d05-43bc-ba03-e239799fa...

> Your underlying assumption is a) Sweden is reporting correctly and b) won't in future find excess deaths in the community

Yes.

> The expectation is that because of lockdown, the excess mortality from non-covid-19 causes should be lower than previous years

It is hard to say whether this is true. There are two reasons why there could be excess mortality caused only indirectly by covid-19 (so not part of covid-19 mortality):

1) Overwhelmed hospitals cannot offer proper healthcare to some patients with non-covid-19 illnesses. This might happen in Italy or Spain.

2) People are too frightened by covid-19 to visit doctor even in acute cases of other illnesses (e.g. minor stroke) and sometimes visit them too late. This was reported by doctors in Czechia.

There's a very definite possibility that what people died of is lockdown and fear. More specifically, there have been some really worrying alarm bells going off in multiple countries about people not seeking medical attention for really serious conditions, or not receiving it when they did.

A close relative of mine had cancer surgery delayed by 1.5 months because the treating hospital refused to host the surgery. After they realized their hospital had been empty for many weeks, they called him and asked, "do you want to get your surgery three days from now?". He is recovering, but for him it would have been better to have had his surgery when it was originally scheduled.

The excess UK deaths linked to coronavirus are likely to be currently around 43,100.

For an explanation see: https://www.ft.com/content/67e6a4ee-3d05-43bc-ba03-e239799fa...

For today's latest numbers see: https://twitter.com/ChrisGiles_/status/1252983884284821505

The spanish case is interesting. Must be noticed that the virus hit particularly hard in the retirement homes that contribute to 12.000 of the 20.000 deaths. Some elder in retirement homes weren't hospitalised. Some people say that their parents were "rejected" by hospitals (non belonging to a prioritary group). We breath a dense fake news atmosphere in any case, so this part can be wrong. Not all people that died in retirement homes this weeks died by coronavirus necessarily.

Retirement homes can not and are not designed to provide real medical care. This part has failed clearly. Some of this people could have been saved in normal circumstances. Specially if the retirement homes were more transparent about numbers and the people would had a clear protocol to follow.

Another special circumstance of Spain is that we are one of the countries with more life expectancy. We have lots of elder people, therefore much more people by million falling in a high-risk category. I don't see anybody explaining that in the news, but surely must have some statistical effect. Maybe we should start adding to the charts a category of people killed by million of people over 65yo.

This mean also than some countries in Africa (or Brazil) could go through this problem "relatively unscathed", just because they have lots of children and young adults. Same with poor US states that could behave different than rich states in this sense. Only time will tell us.

Reddit user /u/Anaemix made a nice graph of the Swedish stats [1]. Döda per dag translates to deaths per day.

[1] https://i.imgur.com/oXyrncm.png

Could reduced deaths from driving etc. also be significant in this analysis?

Do you have a link to this?

Super interesting, thanks. Do you know if anyone has graphed the excess mortality on a month by month basis? That data would be invaluable in understand the timelines of actual spikes in excess mortality, irrespective of covid-19 testing and diagnosis. For example, did it spike up in March in NYC compared to Jan or Feb?

The New York Times article mentioned has more complete data, including the graphs you want.

https://www.nytimes.com/interactive/2020/04/21/world/coronav...

There is a lengthier interview by UnHeard with Professor Johan Giesecke (another experienced epidemiologist) of Sweden on YouTube [0]. It’s worthwhile listening to their perspective.

One of the comments he made was that no lockdown would work in democratic countries and the real test will be fatality rates between Sweden and others in 1 year. He believed it’ll be very little difference between those countries that have implement the lockdown and those that haven’t

I had watched the simulation of covid19 infection by 1blue3brown[1] and some of his modeling appeared to me (maybe I misunderstood them) to confirm Swede’s point of view.

Ultimately the same number of people got infected albeit in a “flatter” rate. However one counter point by Johan Giesecke was that these flattening the curve is motivated by the assumption of a static capacity of ER rooms to deal with this pandemic and he pointed out they have increased capacity. Overall I found listening to his side very informative, at least it gave me a different view of looking at from their view.

[0] https://youtu.be/bfN2JWifLCY

[1] https://youtu.be/gxAaO2rsdIs

well when I look at Sweden https://www.worldometers.info/coronavirus/#countries it has 16,004 total cases, 13,517 active cases, 550 total recovered, 515 serious/critical, total deaths 1,937

and Denmark has 7,912 total cases, 2,441 active cases, 5,087 recovered, 80 serious critical, total death 384

So what does that tell me?

1. They have slightly over 12% death rate currently and Denmark has slightly over 4%.

2. They have very many active cases and no recovered cases yet so this makes me think like all these people that have it right have just barely gotten it. So it is a little bit early to talk about how successful it is (otherwise it is time to talk about why is it taking so long to recover in Sweden if they have had it a long time)

If indeed my supposition that they have just barely gotten all these cases and have not had the time to let anyone recover so that means they don't know how many of the people they have right now will actually recover or how many will get critical and have life long complications or die and they are already at a 12% death rate with another 3.2% currently critical === HOLY HELL WTF!!

on edit: of course percentage death rate only for symptomatic cases we know have it, there should be much larger portion of population that has it.

>They have very many active cases and no recovered cases yet so this makes me think like all these people that have it right have just barely gotten it. So it is a little bit early to talk about how successful it is (otherwise it is time to talk about why is it taking so long to recover in Sweden if they have had it a long time)

I'm struggling to find a good source on this, ([1] is the best I could find, though it's in Swedish) but Sweden doesn't track recovered cases so that number is meaningless.

[1] https://www.mabra.com/halsa/friskforklarad-fran-coronavirus/

Ok, then less holy hell wtf. Although I think though most of the cases they have are still relatively recent because I could swear I remember Sweden having less numbers of people than Denmark with it about a month ago.

When I look at this chart of death rates they had 451 dead on April 2 https://www.statista.com/statistics/1105753/cumulative-coron...

which argues a much lower number of cases back then (haven't been able to find how many active cases they had then though, so I may be wrong)

I think this article is right on target

https://www.project-syndicate.org/commentary/swedish-coronav...

on edit: added "then Denmark"

Perhaps the icu stats provides some insights https://www.icuregswe.org/data--resultat/covid-19-i-svensk-i...

> So what does that tell me?

That you look at very unreliable data that is even more difficult to compare across countries?

No it tells me I was looking to get a really smart HN comment by somebody more competent than I in the relevant subject that would explain to me patiently why I was wrong - don't worry though - I shall continue to look.

on edit: I see some other people have replied with more cogent explanations as to why my worries are probably wrong.

A highly relevant XKCD: https://xkcd.com/2295/

Comparing death rates across countries is highly misguided because is depends directly on the testing strategy. The sickness is not different in Sweden than in Denmark and neither country's health care system is overburdened (even in Stockholm, worst hit region of Sweden) which would otherwise be a strong contributing factor to a higher death rate. So there is little reasons to believe that there should be a difference, let alone such a stark one.

Total case count isn't very interesting on its own because it depends highly on testing and policies related to testing. This is one reason why the reported death rates are total crap and why there is such interest in anti-body testing. What is less affected by testing policy and availability is the number of hospitalizations. The number of people currently in hospital presents a pretty good idea of the progress of the disease (it lags a bit.. typically 10 days).

Just growing the infection denominator alone should not change policy very much though without also considering how infectious COVID-19 appears to be. NYC, Italy, etc... have clearly had a lot of deaths from the virus regardless of the final death rate ends up being when this all over.

Where antibody testing does come into play (and assuming antibodies at levels those are tested for do give some immunity) is when things can start to go back to normal.

> 1. They have slightly over 12% death rate currently and Denmark has slightly over 4%.

This site isn't a great way to compare death rates. There's some baked in assumptions. If we compare statistical results we need 1 to 1 comparisons, or an understanding of the limitations of the comparisons.

The lion's share of testing is going to those that are sick. We've already established that <20% of covid cases go to the hospital. It is frequently recommended that one does not go to the hospital unless one is seriously sick. We also know that covid is highly asymptomatic. These people aren't ever going to be tested unless they are in a study specifically that is looking at random but representative samples of the population. Additionally, these countries have different median ages.This is important when we're talking about a disease that affects people dramatically differently by age. (e.g. Italy would be expected to be hit hard because it has an old population that frequently smokes). Also, countries are not uniform in their travel structure, i.e. how dense the country is and strength of nodal connections between dense areas. Finally, strategies were applied at different times in their curves.

So the issues are:

- We don't have 100% testing coverage and this data isn't a representative sample.

- Countries aren't uniform in their age or habits or pollution

- Countries aren't uniform in density and nodal connections.

- Countries applied different strategies at different times.

You should also be aware that the way Sweden is counting deaths by CoViD-19 is by attributing ALL deaths which tested positive for the virus to the disease.

This is very different from other countries statistics and one of the reasons why Sweden statistics are showing that there is very little undercounting of unexplained excess deaths when seasonally adjusted.

actually that seems to be the default method of counting deaths. I find it questionable to attribute (100% of) a death to covid when 4 other conditions existed and contributed to the fatality but there you have it. The undercounting issue has been a result of deaths of untested patients, e.g people found dead at home in NY.

Belgium on the other hand reports all deaths that could plausibly be covid related.

With such an enormously high r0 as currently predicted, completely stopping the virus once firmly established is an impossibility, but many examples e.g. Finland and Korea have shown that you can seriously reduce infections and deaths. There's no reason a lockdown followed by extensive testing shouldn't work, and indeed it _has_ worked in countries such as Korea and Taiwan. In fact, it worked in Hong Kong and Canada during the original SARS epidemic.

There has to be a willingness to act early and responsibly, closing your borders, attempting to isolate highly infected areas, and slowing the spread of the disease as you dramatically ramp up testing. It seems as if the Western world has complete amnesia of previous events like SARS and is throwing caution to the wind as they assert that nothing could have been done to prevent this.

It's a policy choice to allow all of the reaction to work through the private sector instead of just deploying a national response strategy. In the U.S., the CDC tried to take the lead on testing (good) and essentially banned any other testing infrastructure (bad) and fell on its face with contamination issues (very bad), and pivoting to opening the testing infrastructure was a good policy choice. But the real answer has always been: DO BOTH. The CDC could be doing a million tests a day right now. Why don't they? It's madness.

Reminds me of "Contact". Why build one, when you can build two for twice the price? :)

The reason the CDC aren't doing a million tests a day right now is because there is a massive global shortage of every single consumable needed to do this and no easy way to expand manufacturing. Even Germany, which has pretty much the best testing capacity for coronavirus of any country out there in per-capita terms, has been stalled at about 50,000 tests per day for a few weeks and it's not for any lack of desire to expand that. Trusted American media institutions like the New York Times and their Editorial Board have been giving people wildly overblown ideas about what would be possible if it wasn't for the hated Trump and his incompetence for stupid, partisan reasons.

There is no doubt that there are shortages of some consumables; namely the swab. But every single? That is utter nonsense. The lysis reagents, extraction reagents, nucleotides, enzymes, primers probes etc. are available today by the metric tonne. The swab shortage could be designed around, but they don't. No one wants to go out on a limb and glue a Q-tip to the end of a thin flexible coffee stirrer, but i bet you it would work. Something thinner in all dimensions and one-piece would be better. Are we really ready to believe that this marvel of swab technology can't be produced at scale in a minimal amount of time from scratch? That we really are screwed because they are largely made in Northern Italy?

Hong Kong had 300 deaths from SARS, they had over 600 suicides above the average during the same period.

This time around they are keeping businesses open

Two points: - Your numbers don't indicate the number of lives saved by shutting down. It could well have been more than 600. - It seems likely that it is possible to reduce the number of suicides in such an event with better planning and support for vulnerable people.

their experts conclude they overacted with how they dealt with SARS

Okay, so mathematically proven that for every life lost to a respiratory disease two more will commit suicide. Impeccable math of yours.

China is the most prominent example of how dramatic an effect quarantines and social distancing can have. There was a massive outbreak in Wuhan, with tens of thousands sick. Two months later, there were almost no new cases.

Extensive testing and contact tracing currently seems to be keeping case numbers under control. We'll see if they eventually have to go back into lockdown mode, but for the moment, it looks like the measures taken turned things around.

In Wuhan, the army was called in. Roads out of the city were not only blocked off but actually torn up in some places. People were strictly limited to their housing blocks and had to await food deliveries. The Chinese state was able to rely on the fact that each apartment block already had its appointed minor Communist Party official who could ensure discipline. The population already had a single government-controlled app for communications, and this could easily be upgraded to show the three-colour health code before citizens were allowed to move anywhere in public.

A lockdown so strict simply would not work in most Western countries. The legislation is simply not there for that, even with the emergency powers that some authorities have, and enacting such legislation would require time and debate. Also, China was deeply concerned with protecting its elderly people due to such ingrained cultural respect for the elderly, but in other countries citizens may well feel that, if the army has to be called in, better that the army help with triaging and disposing of the mainly elderly victims than enforcing a crackdown on the population at large.

> lockdown followed by extensive testing shouldn't work, and indeed it _has_ worked in countries such as Korea and Taiwan

Korea and Taiwan had no "lockdown", they had contact tracing and targeted quarantine. They never closed non-essential businesses, and Korea didn't even ban flights.

You don't have to assume static ER capacity and the like to be logically in favor of flattening the curve. You can assume a 100% increase in COVID treatment capacity or even 300% and still note that without any flattening you are going to have series logistical issues with disposing with all the bodies that drop day after day after day. I agree that roughly the same number of people are going to get it over a year, but the goal is for them to get it over a year instead of 1 to 2 months. That's a huge difference in capacity constraints.

It is also why this approach would be foolish in countries with less developed treatment capacity. Capacity, for example, that is already at it's limit even with social distancing.

So, did Sweden have logistical problems? If not, how is their way wrong?

Inability to dispose with bodies is a reason to put 16 million Americans out of work and cancel school?

That was a good interview, and obviously he's very experienced, but I'm still concerned with a lot of things he said.

First of all, he claimed that the death rate was going to turn out to be 0.1%; but he didn't even give a hand-wavy answer for why he thinks that. Now obviously, he's a professional who's been studying epidemiology for decades, so his "gut feel" is actually worth something; but I'd feel a lot better about that if he at least gave some other evidence that corresponds to that.

Later in the show, when the interviewer asks him how many deaths he thinks the UK might have in total, he says "12,000"; and the interviewer says, "We've already had 13,000". I mean... dude, your model is obviously off by at least a factor of 2 or 3; what if it's a factor of 10?

He claimed that Korea was backtracking because they couldn't contain it; but looking at the numbers just today, they're still above 10,000, which is what they've been at for weeks now. (I think he may have gotten Korea confused with Japan, who do seem to be having hundreds of new cases on a regular basis.)

But, I mean -- he does have a point: suppose you get to the place where Korea and Taiwan are. Are you really going to keep the country hermetically sealed for the next 18 months while we wait for a vaccine? Are you really going to keep people under lockdown that long?

If you don't have a coherent plan to prevent sickness, but only to delay it, then this "controlled burn" approach -- where you try to let your country become infected as fast as your health capacity will safely allow -- is going to lead to exactly the same number of deaths in the end, but will reduce the economic and societal impact greatly.

>but I'd feel a lot better about that if he at least gave some other evidence that corresponds to that.

I can't speak for the man himself but recent evidence from California, the Netherlands and Germany (Heinsberg) suggests that the true number of infections may be underestimated by a factor of 20x-100x, which would drastically push down the fatality rate.

I read a blog analyzing the numbers out of California, which said that they'd made some pretty critical errors; namely, it wasn't clear what the false-positive rate of their test was, and that even a fairly small false-positive rate would put "0" within their error bars.

Germany is running nearly half a million tests per week now against a population of 83 million. I can believe that their true infection number is 2 or maybe even 3 times the official number, but I have a pretty hard time believing 20x.

BTW, here's a link to the blog I mentioned:

https://statmodeling.stat.columbia.edu/2020/04/19/fatal-flaw...

People are grasping at straws. It's so horrendous to believe that the world will be struggling with the pandemic for 18-24 months that any plausible-sounding indication otherwise is taken as truth.

Been seeing it for three or four weeks already, ever since Elon Musk first quoted the hopeful-sounding but incorrect study stating that most of the UK had already had the disease.

20x-100x underestimation seems like fairy-tale land. Even 3x underestimation is hard for me to believe, but 100x ??? That would mean 84M Americans have it, and that is _very_ hard to believe.

why is that hard to believe? It's clear that many (most) experience no symptoms, and if the size of the infected population doubles every ~3 days, well, you do the math...

Well, we'll know in two weeks. Bet you it's wrong.

The Heinsberg study specifically said they shouldn't extrapolate to the entire country since the epidemic there had some unique characteristics. E.g: they had an event which boosted spread a lot.

Anything above a factor 20x is wishful thinking. Limiting it to the studies that have been done in europe show 10-20x which is much more realistic

The whole thing is clearly an attempt at a graceful exit.

The original strategy was herd immunity. The argument being made was that Sweden was gonna get infected anyways, so better to get it out of the way sooner rather than later, while protecting the at risk. And this would reduce economic harm as well.

However, the Swedish decision makers seemed completely unaware of asymptomatic carriers, which led to the at risk (largely old people) being heavily exposed anyways due to the asymptomatic younger workers around them infecting them.

Further, the Swedish people, reflecting normal human behavior, shut down economic activity anyways.

The result was a slight linear short term economic benefit but an exponential, potentially long term, downwards public health situation whose economic effects itself will likely dwarf the direct economic benefit anyways.

So now that their plan has failed both in concept and execution they are changing their story saying that it was a Swedish cultural thing, where they trusted individual Swedes to take personal responsibility, because of the exceptional Swedish character.

This is pretty much the opposite of what's happening. The herd immunity strategy is working, antibody testing shows around 30% of Stockholm is already immune, with their mortality rate comparable to many other countries and lower than a few too.

The media that wants to paint this strategy as terrible and ineffective (despite all evidence to the contrary) is now scrambling to come up with an alternative explanation that allows them to say "but it wouldn't have worked here". A special culture is the perfect explanation.

>The herd immunity strategy is working, antibody testing shows around 30% of Stockholm is already immune

This isn't true (or, at least, isn't supported by studies). There was indeed a report [1] published that claimed that 30% of Stockholm has been infected, but it was a mathematical model and not antibody testing.

A study was recently published that showed that 11% of people in Stockholm had antibodies, but that was retracted [2] (only have Swedish sources for this, sorry) because the researchers didn't think that it was good enough.

[1] https://www.medrxiv.org/content/10.1101/2020.04.15.20066050v... [2] https://www.svt.se/nyheter/inrikes/nya-antikroppstestet-base...

It was 11 out of 100 people, using an antibody test that's known to have some false positives. So the error bars are huge. (The fact that this result has metastasized into obvious nonsense is exactly why people should be careful publishing incomplete scientific results.)

This new test from Karolinska Institute cannot have false positives, only false negatives. However, the way the test was conducted was indeed incorrect (they accidentally included people who gave blood because they were infected so it was not random). They will conduct a new test so let's see what that says.

There is no such thing as test without false positives so that's your clue. Especially antibody tests typically have 4% false positive, just a day ago there was news that revealed 4% false positive for a test claimed to have 0.5%.

My clue for what? I'm not the one who is saying this, it's Karolinska Institute saying their new antibody test has no false positives: https://www.svt.se/nyheter/inrikes/11-procent-av-stockholmar...

> The fact that this result has metastasized into obvious nonsense is exactly why people should be careful publishing incomplete scientific results.

On top of that, the situation is fluid and changing almost daily. I saw a meme a couple of days ago about covid-19 being no big deal with tons of people agreeing, and the data was from 4/1. It's not a surprise, but it concerns how few people are a) critical of what they see and b) refuse to change their mind when new information arises.

I wouldn't put as much faith in current antibody tests, especially where "In a low prevalence area for previous Covid-19 infection, which is most of the country, a positive antibody result could be a true positive or a false negative."[1]

[1] - Michael Osterholm https://www.cnn.com/2020/04/21/opinions/bergen-osterholm-int...

This is a new test from Karolinska Institute that can only have false negatives, not false positives.

With that said they had to retract the test results but that was due to other reason (accidentally including people who gave blood due to being infected).

Is that even possible to have a serological test that can't give false positives? Field contamination etc would seem to be something that can't be prevented.

No idea but that's what they say: https://www.svt.se/nyheter/inrikes/11-procent-av-stockholmar...

Google Translate:

> Karolinska University Hospital and Karolinska Institutet have collaborated to produce a new antibody test in the fight against covid-19.

> - We are happy to have a test that we know is okay. It is not 100 percent sensitive, it has sensitivity of 70-80 percent. Some will test negative even though they have had it. But no one will test false positively. Those we have tested that should be negative have been, says Jan Albert.

(Google Translate translates chief physician to consultant for some reason but other than that the translation seems fine)

I would be surprised if the antibody test had a 100% specificity. The sensitivity also seems to be problematic as well.

The specificity of a test is a property of the test itself, not of the circumstances in which it is applied.

If a test has a 100% specificity, and you give it a sample that has been contaminated with the virus, the fact that it registers a positive result is not an error.

People who downvote this, please explain. Is it incorrect?

Let’s see the research and judge by then. I’ve seen published study from Uppsala that tested and confirmed antibody tests with high degree of accuracy 99%+, but had 1 false positive related to cross reaction to another corona virus but they had no details on the sample input or the kind of corona virus is cross reacted with, and hence no way of knowing the accuracy. Lots of bad science being performed these days so I’ll be skeptical until I read the results myself.

Coming from the US, it wouldn't have worked here.

Can you cite that 30% number? That doesn't seem correct at all given the actual case count. It would correspond to a asymptommatic undercount of a factor of two hundred, which isn't supported anywhere. Even the Stanford study only guessed up to 60x or whatever.

Note that if Sweden were really approaching herd immunity new infection rates would be dropping, and in fact Sweden's outbreak is still growing. This at a time when it's objective size is very significantly larger than its neighbors' (who are dropping).

> The media that wants to paint this strategy as terrible

Are you sure it's the media's desires that are coloring interpretation? I mean, objectively Sweden's outbreak is the worst in northern Europe, and it's growing faster than pretty much anyone else on the continent. That's not consistent with "herd immunity".

My bet is that both Denmark and Sweden and other places that got these high numbers used tests that were both giving false positives eg by cross reaction to common cold corona viruses. We have seen this with early tests and as much as 20% of the population might have had just one of these 4 common ones. A Swedish study noticed this but didn’t get into the details and was essentially a bad study as it still concluded tests were 99%+ accurate. WHO was asked the other day if they had comments on these studies but all they had to say was diplomatic that they could help with input to make sure studies were performed correctly.

That's in Stockholm, so the question is still, what about the rest of the country, they don't have the built up immunity. What's the exit from here?

I think you've been misinformed here. Their strategy is still herd immunity. Some officials have said that's a bad way to characterize it - that their strategy consists of the things they do to mitigate harm, not the epidemiological fact that will eventually bring the outbreak to an end. (And I think that's fair - nobody calls the strategies that were applied during the Spanish Flu "herd immunity".) But they don't have any plan for ending the outbreak other than lots of people catching it and becoming immune.

Trying to suppress transmission until a vaccine is available is another option - one which potentially saves a lot of lives.

Swedish officials, rightly or wrongly, don't believe that can be done.

Yet transmission has been suppressed in several countries in Asia.

It can be physically done yes but it cannot be done because of political and cultural issues.

A critical mass of people will continue thinking it's less serious than the flu (these retracted studies not helping it) until it gets so bad that it becomes impossible (e.g. everyone knows someone they really care about who died). That's when proper lockdowns are politically possible.

It has, but nobody really knows why they've been successful. The people who say it's just testing and contact tracing are misleading. Sweden was testing and contact tracing, like most countries were, but it failed to contain the virus.

And we should be cautious about even the idea that they've been successful; people used to believe Japan and Signapore had contained it too.

> nobody really knows why they've been successful

It's not much of a mystery. The lockdown was much more complete, and was accompanied by additional measures to separate and quarantine sick people. There message wasn't, "Stay home if you're sick (and infect your families, and maybe your neighbors too)." Sick people quarantined apart from their families. People went door to door to measure temperatures. Food was delivered to neighborhoods, so that people didn't have to go out at all. That's how they brought the number of active cases to a low, manageable number.

Now, they have extensive testing, and they use cell phone data to assist contact tracing.

Basically, what's needed is a capacity for organization and discipline that seems lacking in many countries that are struggling.

and australia, eastern europe etc

Do you believe this lockdown can last for a year?

It doesn't have to. Suppress transmission with lockdowns and quarantines until the number of cases is low. Then open up partially, with social distancing measures, mask requirements, etc. Do contact tracing with extensive testing and contact tracing to keep the virus at a low level. Use random testing to keep an eye on the level of the virus in each community. Impose stricter measures locally if you detect R > 1.

If you have 800 000 active cases you need to reduce R very close to 0 to get rid of it in a reasonable time, just having sub 1 is not enough.

In China, it was suppressed to somewhere around 0.3. They went from nearly 4000 new confirmed cases per day in early February to about 100 new confirmed cases per day (at a much higher rate of testing) a month later. New cases are low enough now that contact tracing appears to be holding the epidemic in check.

Once you reach a low overall case count, you can ease measures to target R ~ 1.

The alternative, letting the epidemic burn through the population, means sacrificing ~0.5% of the population.

Given the steady pace of ~30k new confirmed cases per day in the US, R has not been suppressed enough. Yet governors are talking about easing restrictions...

As someone who is opposed to his plan I feel the other way round. The more data we get the more it seems to have worked. And Tegnell has increased in popularity.

Was his plan the best one? I am skeptical, but it is far from as stupid as I originally thought.

It would be a more convincing strategy if they actually effectively isolated vulnerable populations, which by his own admission they didn't do. You can't have it both ways. Either lockdown applies to everyone or you lock down vulnerable populations even more rigidly than a general lockdown would require (since those populations are far more exposed to infection than they would be under a general lockdown).

He is not a general to order that by decree. He can only urge actors to act appropriately.

There are a number of options:

* lockdown until there is a vaccine or treatment

* slow down the spread

* do nothing

A vaccine or treatment is at least half a year away so unless your country is exceptionally rich the first option is not feasible.

Slowing down the spread can help making sure the demands to healthcare are met. This is not an issue in Sweden. It can help because treatment right now is better than treatment a month ago. And in theory at a certain moment there might be herd immunity. Or there may not be. Ultimately either a large amount of people or everyone will get ill anyway and then they will get better and immune or die.

Doing nothing means a lot of people get ill and then get better and immune or die and the country keeps running.

Sweden chose the last option because the first option is not realistic and the advantages of the second option are, in their opinion, not worth it.

In my opinion this is at least a defensible position to take. If a country does not have enough healthcare capacity the second option has to be chosen for as long as necessary. The first option, barring exceptional circumstances (your country is a self sustaining island that can handle losing all tourism and trade) is not viable.

I’m not sure what you mean by a downwards public health situation whose economic effects will dwarf the direct benefits. It’s terrible if a lot of old people die but realistically the economy will get over it rather quickly.

> There are a number of options:

>* lockdown until there is a vaccine or treatment

>* slow down the spread

>* do nothing

> Sweden chose the last option

No, Sweden did not choose that option.

So what did they do? Note that with doing I don’t mean issuing advisories etcetera.

Sweden chose (and is still choosing) option number 2.

Universities are closed, high schools are closed, elementary schools are half-empty, people that can work from home do so, a lot of employees have been furloughed, restaurants have switched to mostly take-out, bars are closed, large events are cancelled, grocery stores reserve hours in the morning for senior citizens, elder care homes don't accept visitors, travel is way down, and people generally self-isolate and self-quarantine. Field hospitals have been constructed, recently retired healthcare workers have been asked to come back to work, vodka producers have shifted to making hand sanitizer, and other companies have shifted to making PPEs, etc.

Yes, Sweden is one of the least locked down countries de jure, but it's de facto locked down pretty well. The actual difference between Sweden and other European countries is much smaller than you think.

I think it is not well locked down because their death rates are close to Italy (per capita, not per infected which are also similar but depend on testing protocol).

If you investigate the graphs then you may notice that it is a general rule that when when number of daily infected tops, it takes some time for the number of daily deaths to top.

I have not run statistical analysis yet but from eying it I would say that it is about a week or more.

From this point on the number of deaths will double or grow even higher.

For Sweden it will mean that even when the growth of daily infected stops today, the number of daily deaths will top when it is the number of deaths is around 3000 from what follows that the total number of dead will be around 6000 (assuming that the growth of daily infected stops).

It is more per capita then in Italy.

> However, the Swedish decision makers seemed completely unaware of asymptomatic carriers, which led to the at risk (largely old people) being heavily exposed anyways due to the asymptomatic younger workers around them infecting them.

Not unaware, but actively denying that asymptomatic carriers exist and trying to discredit reports saying that asymptomatic carriers play a role in the spread of covid-19.

https://www.svt.se/nyheter/vetenskap/tegnell-domer-ut-italie...

https://www.svd.se/oklart-om-viruset-smittar-aven-utan-sympt...

Disingenuous. A belief that asymptomatic carriers aren't the primary drivers of the epidemic may well be incorrect, but in no way is it equivalent to "actively denying [they] exist", or saying they don't at all contribute to the spread.

It's important to stick to the facts in the material when linking. Doubly so when sources are behind paywall and/or in a language understood by very few.

> Further, the Swedish people, reflecting normal human behavior, shut down economic activity anyways.

If people are shutting down the economy and avoiding contact anyways, doesn't it mean that an imposed lockdown is unnecessary?

I'm an American, so the usual caveats apply, but I think more should be made of this statement from the interview:

"The Swedish laws on communicable diseases are mostly based on voluntary measures — on individual responsibility. It clearly states that the citizen has the responsibility not to spread a disease. This is the core we started from, because there is not much legal possibility to close down cities in Sweden using the present laws. Quarantine can be contemplated for people or small areas, such as a school or a hotel. But [legally] we cannot lock down a geographical area."

If we take that as a given then the approach used in, say, Italy isn't doable. Why not put that out there and let there be a public debate about the issue? Is there a sense that this isn't the time?

Maybe there is a debate. I'm not exactly in touch with Swedish politics, so if someone knows, I'd love to hear about it.

Isn't this whole process of debate and individual responsibility basically irrevocably tainted in the age of mass misinformation? I don't know where we get if we walk down this train of thought, probably nowhere good, but when a not inconsiderable portion of the population has been directly targeted to cause them to believe the whole thing is just Bill Gates fault, who magically caused the Coronavirus and is holding back a cure, does debate have value?

This might be a good time when a representative democracy, composed of people who are willing to listen to experts and make the hard, unpopular, decisions, would be the best choice.

> Isn't this whole process of debate and individual responsibility basically irrevocably tainted in the age of mass misinformation?

maybe so, but if you assume this to be true, it's guaranteed.

You right, that may be too far. But I don't know if we assume that direct democracy works well in the face of extremely important, time critical, issues requiring a lot of specialized information. I still have faith in democracy finding decent leaders, but I don't know if the populace has the required ability to consider all the nuance of this pandemic we're facing and then making an educated, forward thinking, and in all probability incredibly painful decision. It's been clear from a lot of the arguments I've heard people neither have a good grasp on exponential growth and it's consequences in terms of containment, nor on the timeline or steps required to get this all under control.

to be clear, I don't think america should have a national vote on quarantine or just let people do whatever they want. the current situation has degraded too far for that.

what I refuse to accept is that the notion of individual responsibility and reasoned debate is over forever. maybe this is naive, but I do believe that it's more effective to convince people they should work towards a goal than to impose rules by force. I will concede that the US is missing many of the prerequisites to make this realistic. people not being able to reason about exponential growth is a failure of the education system, not an intrinsic limitation of the human mind. people distrust information/directions from the government because it has repeatedly shown itself to be untrustworthy. people are unwilling to sacrifice months of income because they were barely getting by before.

> people not being able to reason about exponential growth is a failure of the education system

I think it is a cultural failure, not an educational failure. Education is available, but people, both children and adults, make excuses like "when will I ever need mathematics in real life?"... [Answer: when your life depends on it]

There is, or has been, a general lack of respect and inherent laziness toward intellectual pursuits. This is especially apparent when viewing the antagonism between science and politics.

The supposed "age of mass misinformation" isn't as big of a problem in Sweden as it is in the US.

For one, test scores and reading levels indicate the average Swede is far better educated than the average American.

Second, Sweden's media industry doesn't have competing private 24 hour cable news conglomerates fighting over eyeballs. In Europe, government financed media is more common, and thus there is not the same private incentives to drive fear and anger.

Does Sweden has issues with misinformation? Of course (mostly around fear of immigrants). But they don't have anywhere near the problem we have in the US with misinformation.

Misinformation is nothing new and just as the amount of misinformation has increased, the amount of information has increased too. I would bet that the average citizen is better informed overall today than say 50 years ago.

Possibly. But there's been a huge signal boost for the extreme views. 50 years ago you couldn't find out about the corona protests and half an hour later be reading website after website after website about how 5G causes a virus.

You couldn't read a website, so you'd go down to the cult's headquarters to learn about it in person. It was a huge social problem in the 70s!

Which, ironically, would have probably kept a large portion of the rural populace and the smaller urban centers without a HQ immune to it.

That's still a much larger barrier to entry though. Getting someone to click a link is much easier than getting them to visit you in person at a particular place and time.

The misinformed weren't winning elections 50 years ago.

Richard J. Hofstadter would like a word.

Citation needed.

Probably, but the core issue (at least in the US) is that a large fraction of informed citizens have moved to coastal cities, leaving the less informed citizens with more voting power. This means that misinformed citizens are gaining more influence over time, not less.

> but the core issue (at least in the US) is that a large fraction of informed citizens have moved to coastal cities, leaving the less informed citizens with more voting power

Every person imagines they are better informed than those they disagree with, especially when it comes to politics.

There are exceptions to this rule. For example, I am better informed than those who disagree with me.

> the core issue (at least in the US) is that a large fraction of informed citizens have moved to coastal cities

No, a large fraction of citizens who think they are better informed have moved to coastal cities. Most of them are mistaken. If they are so well informed, why are the coastal cities they live in the places with the highest per capita crime rates and the highest cost of living?

> This might be a good time when a representative democracy, composed of people who are willing to listen to experts and make the hard, unpopular, decisions, would be the best choice.

So basically, you want a return to some form of Aristocracy?

No. A representative democracy, like most nations whose citizens don't directly vote on everything have, have right now.

As opposed to the aristocracy we have now?

How many Senators and Congresspeople (and MPs in the UK) aren't multi-millionaires?

Your comment reminds me of the that Swedish "If crisis or war comes" pamphlet sent to all Swedish households in 2018. Right on the second page is a warning about "false information":

https://www.dinsakerhet.se/siteassets/dinsakerhet.se/broschy...

Maybe a "mental herd immunity" against viral propaganda is a necessary first step to develop a biological herd immunity ;)

Many would argue that the pamphlet is in itself untrustworthy state propaganda, so I can't even begin to guess at a good solution.

Well, surely it's not working at the present time. A politician interviewed who went out to get the virus and then attended meetings was completely unconcerned about spreading it to his peers.

Interviewer: "But can you understand his concern [about his risk due to his health conditions]?"

Persson: "No, I do not. He's 50 years old. There is no risk to him. He doesn't get sick of this."

Interviewer: "But do you know that even younger people get sick and die of corona?"

Persson: "There is no reason to be worried. It's a hysteria. It is the same as with the climate. It is not possible to change. We cannot influence it politically."

https://www.svt.se/nyheter/lokalt/varmland/storforspolitiker...

And yet, somewhat bizarrely, Sweden has been latched onto as the model for a sane response to the virus amongst many conservative circles. I will hold my breath as they fail to take action against a disease with 10 times the IFR of the flu and many fold the transmissibility, with the CDC now reporting an r0 of 3.8–8.9 in a 95% CI.

That interviewed person is from a local party in a small municipality. Very fringe.

Of course the US right tries to score points from the lack of a hard lockdown here. But I wonder how well that would have worked without universal healthcare and salaries partly (80%?) paid by government for the time being.

The key bit is "not inconsiderable portion of the population".

That is a very human perception failure and one that all politics and tribal psychology use. "Others are more dangerous than they are because they are other.and we say they are" not because they have an actual threat.

The reality is that these are incredibly small numbers but the hype about them is real.

Based upon this survey, more than a quarter of people don't want the United States shut down. That's a considerable proportion. That's the amount of people who vote in a president.

https://thehill.com/homenews/state-watch/494028-poll-more-th...

We needn't go to the margins of Bill Gates somehow creating corona virus. Here's some of the blatant lies and misinformation that came straight out of the supposedly legitimate leadership.

* Masks don't work, and you're too stupid to wear one anyways (WHO and US Surgeon General)

* There is no human to human transmission (WHO)

* The fact that there is a biolab in the exact area where the virus started spreading from is just a wild coincidence you racist (media Cathedral)

I have a hard time blaming people for going down conspiracy theory rabbit holes about Gates when all the people who should be setting us straight have no credibility.

To be fair at least one of those three you posted is still a conspiracy theory, unless you have a source about the virus being man made - I don't think there's any evidence outside of coincidence.

I would highly recommend parsing the statements by Chinese media and WHO very carefully. They're using explicitly non-scientific squishy language to describe the whole thing. One example:

>All available evidence suggests the virus has an animal origin and is not manipulated or constructed in a lab or somewhere else,” WHO spokeswoman Fadela Chaib told a Geneva news briefing. “It is probable, likely, that the virus is of animal origin.

What the heck does that mean, exactly? It sounds like MAYBE it suggests the virus' genome was not explicitly manipulated with CRISPR. Okay. Was the lab growing virus in human cadaver tissue? Was the lab putting selective pressure on the virus in bats? Was the lab even studying the virus which had been discovered totally as-is in the wild?

Make no mistake. There has been no blanket denial of the lab's involvement with the virus. Only carefully worded PR responses and calling you racist for asking questions.

You're still not providing evidence for. There is evidence against:

https://www.sciencenews.org/article/coronavirus-covid-19-not... https://www.sciencedaily.com/releases/2020/03/200317175442.h...

You do understand that the scientific method is couched entirely in current best understanding, right? We assume the theory of gravity is how gravity works up and can assume it's probably true until a better theory comes up. You'll notice they didn't mention the animal - can we then safely assume it's a moose flu? That's even better supported as they did confirm in the affirmative it was an animal.

And the other lies you posted were said with 100% certainty - how is the use of probable more evidence of a lie?

I'm explicitly not making claims about the origin of the virus. The only "conspiracy" is that you're racist for demanding answers.

Neither of your articles provides a blanket denial that the lab was involved in research that included the virus. It only makes some very narrow denials in non-scientific language.

Well in that case that seems entirely philosophical, and entirely out of place with the other two claims, which can actually have results.

But you do seem to be arguing for the theory as well.

I ask you about A.

You respond with B, a tiny subset of A.

I ask you for the rest of A.

Rather than saying something even as innocuous as "I don't know" you call me a racist.

In the most technical sense you might not be lying about B. But you're definitely being dishonest with the presumptive accusation of racism. And you're definitely using deceptive language to avoid answering the question. And you've definitely destroyed your credibility on a scale equal to "Masks don't work."

When outlined like that, it's totally fair to doubt, assuming that's the only or primary defense. Do you have some links to mainstream media outlets directly correlating questioning origin as being racist?

On the contrary, this is exactly how scientific communication works. Nothing is in absolutes. If you want absolute language look to religion.

Nice trick to slip an actual conspiracy in with two things that are not.

Totalitarian China hasn't made any efforts to close its wet markets, which are the claimed source. They also have not blanketly denied the lab's involvement with the virus. They've only hinted in non-scientific language that they didn't directly manipulate the genome (with CRISPR or something).

The conspiracy is by the media Cathedral for suggesting racism is the source of the demand for answers. I have no idea where the virus came from. But we're definitely not getting accurate info in this area.

Not getting accurate info is no reason to spread inaccurate info.

I think I see our disconnect.

You are focused on people questioning the origin of the virus as a conspiracy. I'm focused on the lies/credibility of the people in charge.

It doesn't matter where the virus came from. The supposedly credible people haven't been answering honestly. First they gave very narrow responses, then they accused people of being racist for calling them out on the narrow, useless response.

You don't attribute any of those comments to the WHO trying to get a handle on an evolving situation, and instead to deliberate lies, even though they have changed their recommendations as time passed?

And you're grouping all these groups mistakes together when that's not really fair to the different groups.

https://twitter.com/Surgeon_General/status/12337257852839321...

The Surgeon General makes two claims in this single tweet. The first is that masks won't protect YOU from catching the virus. The second is that it will protect healthcare workers.

Reading that first claim as anything but a lie intended to manage your behavior is generous beyond credulity. He told you it was a lie in his second claim. He couldn't even separate these claims into two tweets, much less some period of time when new scientific information might have been discovered.

To be fair the way the average person wears a mask it won't protect them.

Literally anything that increases the friction between you and the virus protects you. Even a snorkel, with no filter at all, which forces the water droplets carrying virus to travel farther and around a few corners will likely provide you with some tiny bit of protection. It will do so because the extra turns increases the odds that the droplet will hit a surface or something and get stuck before entering your airway.

It's very reasonable to suggest that a trained professional with years of experience in dealing with contamination will have better results from PPE than an average person. But that's a wildly different claim than masks do not offer the general public any protection.

It takes very few viral particles to catch covid.

Any protection greater than zero is still some protection. Reducing odds of getting it by 0.01% is a huge number of people at scale when you're estimating over a million people dying and 100+ million getting it.

I agree. I wear a mask and wish others would.

I'm watching the coronavirus task force press release right now and the Surgeon General just doubled down and said masks don't protect you from getting the virus, and that medical professionals need them because it protects medical professionals. So he's still lying to you.

My belief is they are deliberately lying because they are managing you rather than informing you. The lie is to encourage compliance on turning over masks to the medical professionals. But even if I'm as generous as possible about their intent, it still has destroyed their credibility.

American public messaging is trying to draw a distinction between proper masks (surgical and N95, needed for medical professionals, no reason for you or I to get them) and coverings (just any piece of cloth in front of our face holes). It seems convoluted but I think it's no longer dishonest.

The part where they claim a proper mask, like N95, wouldn't provide you any protection is dishonest.

> Isn't this whole process of debate and individual responsibility basically irrevocably tainted in the age of mass misinformation?

Wasn't there an article here yesterday about the San Francisco anti-mask league [0] from 1918? I don't think misinformation and people acting incorrectly is something new.

0: https://en.wikipedia.org/wiki/Anti-Mask_League_of_San_Franci...

Totally true. Really shows it's a longstanding flaw in the idea that we can use direct democracy for topics like this.

> Isn't this whole process of debate and individual responsibility basically irrevocably tainted in the age of mass misinformation?

The problem is not misinformation. The problem is whether a country is really willing to enforce a law that says every citizen has a positive responsibility to not infect others.

If you really enforce that law, then anyone who gets COVID-19 because they didn't take reasonable precautions, and then infects someone else, is legally liable for damages. They could be sued for all of the health care costs of anyone they infect. They could be sued for wrongful death if someone they infect dies. Depending on the circumstances and the details of the statute, they could be liable to criminal charges.

That's what "individual responsibility" means--holding individuals responsible, legally, when they harm others. And in a legal environment like that, misinformation isn't a problem, because people who act on misinformation end up harming others and being held responsible, and since nobody wants to be in that position, everyone learns, in their own self-interest, to not act on misinformation. Which in turn means that information sources that continually propagate misinformation die because nobody listens to them. And information sources that can reliably report accurate information thrive, and have an incentive to continue reporting accurate information.

> This might be a good time when a representative democracy, composed of people who are willing to listen to experts and make the hard, unpopular, decisions, would be the best choice.

Representative democracy will only be composed of such people if people have a strong incentive to act on accurate information and to not act on misinformation. Which, as you yourself point out, does not describe societies today.

>This might be a good time when a representative democracy, composed of people who are willing to listen to experts and make the hard, unpopular, decisions, would be the best choice.

There's always the next election. It's hard to do unpopular things if you don't expect them eventually to become popular. E.g. lockdowns may be unpopular now, but if crisis can be avoided, it wouldn't hurt your election results. There is an exception though; if countries like Sweden don't have strict measures and still thrive, a lot of people will see that as a failure of your government.

The balance, nuance, respect for law-- this is absent from the public discussion in the U.S.

That may be, but I'm wondering what the reasoning is in Sweden, not the US.

Swede here - I get the feeling we trust our citizen and government response enough to not generally call for a hard lockdown. Some wanted elementary schools closed. Almost nobody is happy about how the elderly care works - but almost everyone were unhappy about the elderly care in general even BEFORE this.

Well, that's not an excuse, laws can and should change as needed.

There may be a constitutional or-- as it's often put in Europe-- a basic law issue. But, I'm wondering why it is that we haven't heard about a debate to change these laws.

The simplest reason is probably because that type of internal political debate is unlikely to be reported by foreign media, assuming you aren't consuming any Swedish news.

That's not to say that too much discussion of these types of laws have been brought up, but a law was recently (quarantine throws off my sense of time, but I think last week) passed which gave the government significantly more power in terms of ability to close down businesses, airports, harbors, and more without needing to seek parliamentary approval first. This was after a bit of debate regarding the unprecedented nature of such a law and some modifications which were mostly aimed at not giving the government too much power.

They might not even be changeable. For Germany for instance:

"Article 79 states the Basic Law may be amended by an absolute two-thirds majority of both the Bundestag and the Bundesrat. Such a vote may not remove any of the principles underlying articles 1 and 20 as defined by the eternity clause, or remove or otherwise affect the essence of, any of the fundamental rights originally specified in articles 1 to 19; [32] but may clarify, extend or refine those original principles and fundamental rights. " (https://en.wikipedia.org/wiki/Basic_Law_for_the_Federal_Repu...)

So any coronavirus-fighting law that could be seen as "removing" one of those fundamental rights simply could not be made. Making these laws hard to change is deliberate, as allowing for changes in "emergencies" allows potential dictators to use emergencies as an excuse for broadening their own power, as Hitler did (and Hungary is doing now, under pretense of fighting the virus).

The legal argument is weak, and the disingenuous way he discusses it makes me question the veracity of his other points. The national government could 'strongly suggest' a lockdown and most people would comply willingly.

The reason for not doing that has been stated time and again earlier - they worry about endurance. We will have to keep up with modified behaviour for a long time, and overdoing it may compromise endurance.

The statement omits the fact that mandatory measures can be imposed when it comes to diseases classified as dangerous for the public, which covid-19 is. So while it's the citizen's responsibility not to spread diseases, the law also provides for mandatory isolation of people who are unable or unwilling to follow precautions.

The outbreak has absolutely dominated the news and public discourse for nearly two months now. There's lots of coverage of Sweden's strategy, including opposition to it, and its coverage in foreign press. Politics has been likewise dominated by the government's response and he opposition's reaction to it. I really don't get the feeling that there's a lack of debate on anything covid-related, although the nature of the event means that the usual Swedish process of taking decisions by slowly building up to a consensus cannot apply.

This is helpful to know, thanks!

> I'm an American, so the usual caveats apply

What do you mean with usual caveats?

Just that since I don't live there and know the society/culture I may be asking a dumb question. I probably should have said something like "I don't know much about Sweden, so I'm asking from a position of genuine ignorance."

Ah thanks, I assumed it was an HN inside joke and I was a bit lost

Cheers

That quote stood out to me, too.

It's hard to lock down an area in the U.S., too, but some states and cities have enacted nonessential business, school, and transportation closures that have been quite effective at flattening the curve without a geographic quarantine.

Maybe another question to ask: Can Sweden enact emergency facility and public transportation closures for other reasons? For instance, for a flood or some other disaster?

> The Swedish laws on communicable diseases are mostly based on voluntary measures — on individual responsibility.

I don't know much about Sweden, but this would have a hard time working in the US. There is a large percentage of the population that would do nothing because the government suggested it. I think it's pretty clear that many states are opening too fast too early, but instead there are protests about people wanting to be free.

> I think it's pretty clear that many states are opening too fast too early

Not at all.. I think it's clear we locked down way too fast (and I was supportive of the initial lockdowns). At the time, we thought that -- even with the lockdown -- we would overwhelm the hospital systems in many parts of the country. Guess what... that didn't really happen. We didn't run out of ventilators at all. That means we over reacted. Now it's time to lower the restrictions with the new constants in mind, so that any subsequent peak more completely uses excess capacity, and more people can get back to work.

I'm a little confused. You think because the system was not overwhelmed, the US locked down too early? The point of the lockdown was to prevent getting overwhelmed, which appears to have mostly worked.

I guess I'm having hard time understanding the logic where since the system wasn't overwhelmed with a lockdown in place, there was no need for a lockdown.

I agree the point of lockdown was to prevent getting overwhelmed and without it we would have had some regions with overwhelmed systems.

However, we more than met that. Not only were hospitals not overwhelmed, many hospitals had such little work that they ceased operations.

That means we clearly overreacted, at least in those areas. Now, it's time to loosen up, and let all those hospitals that literally had so few patients they were closing down to have a reason to exist.

For example, California locked down early -- good for them! But their ICUs were not anywhere near capacity. They've now had a month to expand capacity, which they've done. That means they can handle more sick people. California should think about opening up a little, and then, as some get sick with COVID and need ICU care, we can be assured there will be ICU space. We have better numbers now and can run a model that ensures ICUs run at or near capacity so that more people can be at work while everyone can be assured there is an ICU bed should they need it.

What I don't understand is your perspective. It is clear we had excess ICU capacity during the lockdown. Doesn't that mean we wasted resources in getting to herd immunity. The point of a lockdown is to 'flatten the curve', not make the virus go extinct (which is all but a pipe dream at this point). We cannot get herd immunity unless more people get it. The danger in letting everyone get it at once is that we run out of ICU beds. The danger in locking down too hard is that we have excess ICU beds that could have been used to get us to herd immunity faster. We had a lot of excess ICU beds in the country. That means we wasted time. That's okay -- we had information at the time we now know was not 100% correct. Let's adjust the models and continue on.

The government actually did give themself increased authority to enact short term measures as needed. Parliament only demanded that any such measures are passed through parliament for approval within two days of execution, and I think maximum extent of such measure are three months.

But wrt to debate I think the general sentiment is that current measures are working fine. People are getting a bit restless with the spring coming, but besides that most internal debates right now is why there is not more action taken against restaurant owners and such. The municipal authorities are allowed to close down any such business that don’t take suitable measures to limit infection. And a apparently there’s some places that people aren’t too happy with.

go here and scroll down to Cases by Country, normalized by country population then highlight Sweden. Across the different metrics Sweden seems to be doing about average.

http://91-divoc.com/pages/covid-visualization/

here's projections for Sweden but given how wildly these projections have fluctuated i'm not sure how valuable it is

https://covid19.healthdata.org/sweden

Cases are a poor metric because they're a function of per-capita testing, which is variable across nations. You have to go by deaths. In that case you can see that they're much worse than their neighbors Norway and Finland, and that they're closer to regions with catastrophic death rates like Switzerland.

The earlier lockdown measures are imposed, the greater the impact, hence the comparatively excellent numbers from Finland. Sweden has long held denial of asymptomatic transmission (especially by Tegnell, even in this article), which we've learned is categorically wrong. The IHME model has been considered notoriously optimistic, as the US number of deaths has been rising but the US peak is reported as 1 week ago. The IHME model assumes a full lockdown in the US until August, which has already been violated by a number of US states this week.

To back this up with some data, this article has information about tests per capita: https://www.thelocal.se/20200414/understanding-swedens-figur...

If Sweeden had been testing at the rate of Norway or Germany, they would not be in the middle of that cases per capita graph. This is despite Sweeden's infection growth being ~15 days behind Italy's, e.g. enough time for a lockdown to have almost entirely prevented it.

So it seems clear that Sweeden's policies have made infections worse. The questions that remain are: 1) Will their peak infection rate go over hospital capacity? 2) Will they have economic benefits from having population immunity faster?

As Tegnell points out, the relevant comparison is death rates after the epidemic has run its course, say after a year or so. Lockdown just delays some of the infections to buy time for additional mitigations which will hopefully decrease the total number of deaths. The virus will still eventually spread through the population until herd immunity is reached.

This ignores hospital capacity, which is the most important consideration when projecting out fatality rates. Lockdowns are not just about buying time for additional mitigations.

And the ICU load has hovered around 80% the last couple of weeks. Which was the goal of the chosen strategy. Current goal is to keep things below that while things develop

One of those mitigations is increasing hospital surge capacity.

> Will their peak infection rate go over hospital capacity?

https://www.icuregswe.org/data--resultat/covid-19-i-svensk-i...

First bar graph is total number of patients with covid-19 in ICU care in Sweden. Blue is yesterday's numbers, orange is today's numbers, including backdating of cases.

So probably not, is the answer to your question.

Sweden's death counts are the most statistical precise ones so far, exactly because every death from someone tested positive for SARS-CoV-2 is counted as a death from CoViD-19. No other country is doing this, you can check that by following metrics such as "excess deaths" after seasonally adjusting deaths by country and adding their official death tolls [0].

[0] https://news.ycombinator.com/item?id=22945974

>>> Sweden's death counts are the most statistical precise ones so far, exactly because every death from someone tested positive for SARS-CoV-2 is counted as a death from CoViD-19.

So if the 95 years old who already withstood 3 heart attacks dies from the 4th one, and he tests positive for SARS-CoV-2 you then blame his death on CoVID-19, and not on his weak heart? Doesn't make much sense to me.

It makes sense when you think that this removes the individual variation per hospital/doctor writing a death certificate, you don't rely on professional opinion, you count all of them as it is easier to later clean this statistic with models based on historical data than the opposite (to figure out the missing data for deaths from CoViD-19 after the fact).

You need to be aware that Sweden has a long history of keeping demographical statistics [0] so there is a method to the apparent madness of counting.

[0] https://www.scb.se/en/About-us/main-activity/history-of-stat...

Why would you normalize by population in the early stages of an epidemic? If you assume a large and small country both have similar growth rate and number of initial cases, then their absolute case growth will be similar in the early stages. But the large country will appear "better" once you normalize for population. This is exactly the pattern I see when you compare Sweden to its smaller neighbors.

is this still the early stages? A number of countries have passed their peak.

A number of countries have most of their populations under what is effectively house arrest

Meanwhile, the virus still permeates, those same populations' collective immunity has barely changed, and we're only marginally closer to a vaccine

The fundamentals won't have changed when we do get around to removing the lockdowns

Whether the virus is permeating is the point. If the virus has broadly spread across society, and it sounds like we're agreed that it has, then you have to normalize by population to get useful numbers.

Why would you assume a large and small country both have similar number of initial cases? I'm under the impression a lot of the nordic initial cases were travelers coming home from ski trips in Italy. That ought to scale pretty linearly with population.

Some countries in martial law some shut down a massive portion of their economy. The controversial approach is relying on individual citizen responsibility. Fascinating times

If it was something that affected only those individuals, noone would care. The problem is, that someone else can be irresponsible, and you die because of that.

Yes, we all get that, it's been rammed down our throats for months.

Why is that suddenly a problem? We always had it. Most people posing danger to others in one or the other way. Driving a car is the most obvious example but there are countless other

That's why we have drivers' licenses and manslaughter charges for negligent homicide. We don't just shrug our shoulders at the risks.

We take reasonable, targeted measures to mitigate the risks. What we don't do is embark on a grand social program to eradicate freeway crashes, because such a program would involve banning or heavily restricting cars and we feel cars are too important for that.

But we do just that.

Every car has to pass a bunch of certifications to be legal to drive on the road. It has to pass a (4-, 2- or 1-)yearly checkup, has to be registered, insurance has to be paid, road tax, etc. Also the driver has to pass a theoretical and a practical exam, has to be of certain age, not be under influence of any of many substances, has to obey a bunch of traffic laws, etc. And we also have check for all that, from police controls, to speed cameras, alco-testers, etc.

The car/cancer/heart-disease analogies are inherently flawed because they're not communicable. If my road rage started a chain reaction across the Interstate causing 45K people to die in a month, I think we'd stop driving until we figured out what was going on.

Eliminating traffic deaths isn’t a totally unrealistic goal.

https://www.independent.co.uk/news/world/europe/oslo-traffic...

Again going back to the cars example: if you did not "just shrug our shoulders at the risks" each car will be equipped with alcohol detecting interlock at the minimum. Of course the society "shrugs the shoulder" as soon as it inconveniences it a bit too much.

Why do you think speeding and drunk driving is illegal? There's a risk/benefit threshold and society has decided that regular driving is below that threshold but drunk and reckless driving is above it. When a pandemic is in effect some of the activities that would be acceptably low-risk in a normal context suddenly become unacceptably high risk.

"Why do you think speeding and drunk driving is illegal" - so far drunk driving is the leading cause of death for young drivers. I do not see electronic immobilizers installed in the cars by default to prevent those deaths. Care to guess why?

As for "suddenly become unacceptably high risk" - it seems that governments do not have much clue and nearly enough info on this particular subject ( COVID )

This has always been the case and is a risk of living in human society. Your life may end at any time due to someone else's irresponsible behavior.

To my knowledge, not a single country has declared martial law.

Sweden's approach is controversial because irresponsible individuals put responsible others at risk.

> The controversial approach is relying on individual citizen responsibility.

Practically speaking this approach is what we are relying on in the US, too.

It probably won't work very well in the US though since workers' rights are much weaker in the US than they are in Sweden.

Telling people to stay home if they have any symptoms only works if people are actually able to stay home from their jobs.

> It probably won't work very well in the US though since workers' rights are much weaker in the US than they are in Sweden.

The demographic patterns emerging from this pandemic are already showing a strong skew along lines of existing privilege or lack thereof. In the US, this revolves around the nexus of race, poverty, and lack of regular prior healthcare access which, to your point, also aligns with the kinds of workers who have fewer rights.

My money is within a month Sweden going into full lockdown, and regretting their decision.

If it weren't for the states closing down here, Australia's death toll could have been much worse given the Federal wanted to keep everything open.

People have been saying that about Sweden for a long time. My money is on all other countries doing something closer to the swedish model when the next wave hits in winter.

I mean. In all likelihood covid 19 will last at least 2 years(til successful vaccine)? Wouldn't it be likely that most countries populations cannot stay at home that long? Not even intermittently(like 2mths locked down every 6mths)? Whereas if the swedes dont overwhelm their hospitals they can go on like this for as long as they like?

> In all likelihood covid 19 will last at least 2 years(til successful vaccine)?

Why not hoping for some drug development to bring the disease to clinically manageable levels? There are far more drugs in trials than vaccines (even though I expect the majority to miss the mark, as is the case with drug development).

Hope for the best of course. But prepare for the worst.

If we can get a vaccine in under 6 years it would be unprecedented. 2 years would be astonishing. Most take 8-10 to go from lab work to peoples arms.

Waiting for a vaccine is not a good long term strategy. If a country can lock down long enough to kill its own spread it can re-open its economy safely so long as international borders remain closed.

> If a country can lock down long enough to kill its own spread it can re-open its economy safely so long as international borders remain closed.

I really feel you're understating how impossibly difficult this would be for a large country

There are multiple vaccines in first round human safety trials.

Like, they've injected people with them.

I think this is accurate. Fears of medical systems being overrun are generally overstated. The threat to doctors is already maximal, and by extending the length of the epidemic we're just extending the time they're at maximal risk. There's an argument towards buying time for more PPE availability but I think that's a bad bet. Lockdowns lifted before something like herd immunity is reached isn't going to help. If less than 10% of the population is immune, then you're in the same boat when the lockdown is lifted and you've achieved basically nothing but buying time. I don't think anybody would say we can endure a lockdown FOREVER. I think it's naive to think we can endure a lockdown for even one year without economic devastation causing far more harm than the virus, let alone the ambiguous timeline towards a vaccine.

A lot of people are going to die. More people will die if the lockdown is lifted, and many of those who would have died anyway will die sooner. But famine, crime, war, and authoritarianism will cost more. On a global scale I have no doubt that disease is less harmful than poverty in terms of happiness or lives lost. The same for any given country as a whole. For wealthy communities perhaps not.

It is frustrating to me that saying such things comes off as right wing or anti-science. I feel the calls to keep the lockdown going are a thing of entitlement from those who can afford to do so. There's a middleground where you lockdown those at risk, reduce travel, and encourage sanitation practices but open things up.

I live in a small Midwestern state. A friend's mother is going through oncology, and is having complications due to the treatment regimen. Yesterday she had to be put in ICU for a day because every other bed in the facility was being used for COVID-19.

This isn't in the local news, nor regional news. It's almost like it's a dirty secret.

You may not consider this "overrun" but I do. I sure hope I don't have appendicitis or a stroke because it'll be an issue...

That is an issue, but its a separate issue. The concern that COVID is going to drastically overrun hospitals to the point at which we simply cannot take in more people and cause even the young to die is mostly not an accurate depiction of how hospitals and their capacity works.

It's true, a prolonged lockdown could potentially keep hospital usage low enough that things like this aren't happening, but only temporarily, and not in a way that meaningfully diminishes the threat of the virus and similar hospital burdens occurring later. You can't slowly let everyone acquire immunity. The disease either exponentially spreads to a sufficient scale or it spreads too slowly to build up a community resistance that permits a lockdown to end without consequence.

I really do empathize with people who are suffering, but what do you do if 6 months from now the disease is still here, we don't have a vaccine, and the economic situation is worse? You either release it, and put us back at the beginning with these same woes we're encountering now, or we keep holding the lockdown for short term loss of life avoidance at significant economic cost.

The hospitals were overloaded in Lombardy, in exactly the way you're saying will not happen.

From everything I've read, the hospitals in Lombardy could have surged even higher. Hospitals, in general, can expand care to many more people than they're scoped to handle. It means that each person gets worse quality care, but for an untreatable disease, there's little you can do to treat it anyway. Ventilator mortality is extremely high. My sense is ballpark 80% mortality rate, and that's just an average. With ventilator + age + pre-existing conditions assessment there's a large number of people that have extremely low chances of survival. At the level of triage decisions being made, I'd expect very few additional lives to have been lost.

I get that this is tragic. I get that people are dying. I get that this is an enormous mental and emotional toll on doctors. I get that we should be cautious and avoid needless exposure, especially to vulnerable populations or with unnecessary large social gatherings. But the lockdown is not saving lives. It's delaying inevitable deaths, at an economic cost which could kill even more people!

Not an accurate depiction? Perhaps you should read up on how Lombardy's health care system fared for Italy. Or travel to Bellevue Nebraska, and ask why non-COVID patients are being kept in ER (hint: it's because all the non-ER beds are full of COVID patients).

Also, you're idea of how herd immunity functions is not accurate.

We'll have the virus here in 6 months; no doubt in my mind. We'll have it combined with the annual flu. We won't have a vaccine either, though perhaps some therapeutic treatment if we're lucky.

No, we won't reach herd immunity for at least a year at this rate. And the political pressure to "open up" the economy will become too great since we don't have a real welfare net in America.

So my estimate at the end of the year is that we'll have about 40% of the population infected or recovered. We'll have roughly 19M hospitalized during the next 8 months, and 1.4M deaths. This will cripple our country, our economy, and our people. Yeah, I'm a pessimist. Everything I've seen about how this country is reacting confirms my priors.

How can we avoid this? Keep things shut down to a bare minimum of true essential services. Protect the employees doing essential services to the max. Implement a social safety net so workers don't lose everything. Do the same for businesses, since demand is drying up fast. Listen to scientists instead of firing them for disagreeing with the POTUS about hydrochloroquine. Develop reliable serological tests so that immune people can safely work.

Most importantly, be lucky. The US has been lucky for a long long time; for most of its history. Hopefully that will continue, and rub off on the rest of the world that is in far dire straits.

Commented on Lombardy elsewhere.

You cannot "just" provide a social safety net. That's not how the economy works. Somewhere between 10 and 20% of households with kids did not have enough to eat. Now more people, especially the poor, are out of work, and food prices have gone up because we're producing less food. Giving a handout to keep people afloat makes sense as a short term fix but it's not a viable long term solution.

You're saying we're going to see 1.4M deaths on the current track. Well what's the deaths on your track? There's NO WAY to open up the economy without the virus resuming its spread. You haven't lowered the deaths, you've just delayed it at great economic cost.

These are really two independent issues. The justification for current lockdowns is nominally 'flattening the curve' because we were ill-prepared to handle a flood of serious cases. We can hope that, in another nine months, many of the specific shortages will have been addressed.

One issue that I would like to have seen mentioned here is whether Sweden's resources for treating the very sick have the capacity to handle an increasing rate of infection, if claims that it is over the hump turn out to be premature.

Why do you think the next wave will be in the winter?

not OP but:

1) there won't be a vaccine - even if there will be, you won't be able to vaccinate everybody

2) the virus spreads fast but due to lockdowns not fast enough for herd immunity to prevent spread

3) lockdowns will be relaxed when new cases stop being found

4) all of it assuming immunity lasts for a few years, which it should, but it isn't a certainty

5) 3) will lead directly to asymptomatic cases causing flare-ups a few weeks after lockdowns are relaxed (see Singapore, Japan)

6) if 4) isn't true, we're toast

we don’t yet know if this novel virus will induce long-term immunity in those affected as other related viruses do not.

https://www.immunology.org/news/bsi-open-letter-government-s...

Short term, on this case means 6 months to 2 years. The GP is talking about something 4 to 7 months away.

Right I agree but that will happen in a few weeks already when measures are relaxed. There is no reason we know of that the virus will wait until winter. The next wave will already have started in places where lockdowns are being lifted.

That is a bet quite many people would take. There are very few indications of that Sweden will go full lockdown any time soon. Something would need to radically change first.

"My money is within a month Sweden going into full lockdown"

I'm willing to take the other side of this bet. Do you have a way of organising it?

I agree. It seems extraordinarily risky to let another disease spread among the world population.

- What if there are long term effects?

- What if it becomes a seasonal disease?

- What if the next mutation is more severe?

Each country should b a good global citizen, and put in its best effort to make sure the spread is as limited as possible.

The mortality rate has been stable for a while now so I doubt that that will happen any time soon [1]. If people in Stockholm don't follow the recommendations then they might set up some more restrictions though.

[1] https://i.imgur.com/xJ16VGd.png

It sounds exactly what the UK was going to do until Imperial released a report that said it wouldn’t work.

For now Sweden has slightly fewer deaths per capita than the UK, so their last minute change does not seem to have helped much. While I was and still am in favor of a harsher lockdown the Swedish strategy does not seem to perform that badly.

There are countries with harsh lockdown doing both doing way worse and way better, so other factors may matter more.

I think the reason for that is that British people are less trusting of the government and will generally ignore rules if it doesn’t make sense to them unless they’re mandatory. Even the prime ministers dad said he’d still go to the pub just before the lockdown.

And Anders "debunked" imperials study because it was not yet peer reviewed[0]. While continuing with his "Scientific" gut feeling.

(No, I'm not making any of what I said up or being hyperbolic[1])

The serious lack of testing and fact that many doctors are saying they cannot attach COVID-19 as a cause of death unless it is a direct cause and has been tested for, give me pause to the numbers Sweden is putting out.[2] Since if you arrive to the hospital already dead then they will not "waste a test" on you confirming cause of death. I would much rather look at the Swedish death rate comparative to last year instead[3]

[0]: https://www.theguardian.com/world/2020/mar/28/as-the-rest-of...

[1]: https://twitter.com/bjornsing/status/1252888065959436288

[2]: https://www.thelocal.se/20200414/understanding-swedens-figur...

[3]: https://www.scb.se/en/finding-statistics/statistics-by-subje...

I have no idea whether the paper is good or not, but an off-hand tangential comment in an interview is hardly a debunking.

Also note that if you have to react to an emergency you might not have the luxury to wait for the data and evaluate all possibilities.

Of course you should definitely reevaluate your decisions as data come in.

edit:

I can't see a direct comparison in your links, but FWIW euromomo [1] is showing a large spike in excess deaths for Sweden.

edit2:

as pointed elsethread, neighbouring Norway and Finland are seeing a very different scenario; the graphs show pretty much no excess mortality.

[1] https://www.euromomo.eu/outputs/zscore_country_total.html

Agree, excess deaths over a suitably long period is the only metric I trust at this point, and the only one that will be able to settle the debate over the effectiveness of lockdowns.

Although very early data (as it is everywhere) does it not look like the stats for excess deaths and the reported COVID-19 deaths for sweden line up pretty well?

https://www.nytimes.com/interactive/2020/04/21/world/coronav...

Although very early data (as it is everywhere) does it not look like the stats for excess deaths and the reported COVID-19 deaths for sweden line up pretty well?

https://www.nytimes.com/interactive/2020/04/21/world/coronav...

On the face of it, the numbers don't look too good for Sweden. Compared to the Los Angeles area (LA county and Orange County) we see 1937 deaths in Sweden vs 697 in the LA Area. The population is also about 18% higher in the LA area vs all of Sweden. We are assuming the numbers reported in the LA area are accurate, which they may not be.

I don’t think these kind of comparisons are meaningful until we are out of it. It all depends on exactly when the outbreaks started at the different places and what the long term infection rate will be.

These uncoordinated set of strategies by different countries seem to me like battles in RPGs; Sweden's probably opting to take less economic damage and instead take a x2 damage on health points.

The Netherlands is switching strategies, thinking that Sweden's strategy is cool, but they're dipping their toes first by sending in teachers and children to see if they take a great amount of damage.

> Sweden's probably opting to take less economic damage

In all the discussion so far, I haven't seen any documentation of just how much "economic damage" the various countries are taking. I suppose there is little such data at sufficiently fine granularity to compare internationally.

It's entirely plausible that Sweden's voluntary measures vs other countries' stricter approach don't make as much economic difference as many people seem to take for granted.

My impression is that they actually haven’t considered the economy much at all when they have decided the strategy. More important is that that the strategy is feasible in the long run. You can close everything for a few weeks, but this is going to continue for many months still, maybe even years.

Also, the social costs of isolation must also be taken into consideration. All the kids where the school is the only stable point in their life. Domestic abuse, alcohol and drug abuse are all going up a lot when people are isolated.

Yeah, I agree with you there. I'm going to guess that the LA area has early exposure to the virus due to our close ties to China here.

There's also a possibility (for now just a possibility) that the virus behaves differently in warmer climates.

The average daily temperature in March in Sweden was a bit on either side of freezing, while it regularly gets up to 70F in Los Angeles. Meaning that if the virus is affected by more summer'y weather, Los Angeles has a significant advantage compared to Sweden.

> We are in the middle of the epidemic and, in my view, the science shows that closing schools at this stage does not make sense. You have to shut down schools fairly early in the epidemic to get an effect.

Could anyone shed some light on why Sweden chooses not to close down schools fairly early?

I live in Stockholm, Sweden, so while I acknowledge my bias I'd bet my money on the fact that other countries will change their approach rather than Sweden starting to follow others.

While there are some undeniable social (think multiple generations in a household), geographical and cultural (swedes are notorious in keeping their distance from other swedes) differences at play here, other European countries have gone for a "people can't be trusted so we must restrict individual freedom". While there is certainly some good reasons to think that this will work the means used to implement this have some really sad consequences. Look at France, people are getting fined and in some cases brutalized; protests are sparking in places where strict measures have been implemented, not because they are unfair but because they affect people unfairly! Easy for well-off people to "leave early, far and for a long time" but far from everyone has that luxury (oh if you understand French, check out Twitter on the "lockdown diaries" parodies and compare that to how people in the suburbs of Paris are being treated!). This is without even starting to talk about how the economic impacts will be spread amongst social classes. To me Sweden has chosen the most socially (in this case as opposed to morally) fair route to handle this crisis.

That being said, it's morally very difficult to defend this strategy in the face of a higher death toll amongst seniors in care homes. I cannot come up with a single argument that I don't know will get shot down immediately and that is a good sign that it's probably not morally optimal. We live in a time of humanism and human life comes first, rightly so but even with that said, it shouldn't hide the picture and justify every consequence out there. The approaches in many countries are incredibly reactive and short sighted in that regard.

>That being said, it's morally very difficult to defend this strategy in the face of a higher death toll amongst seniors in care homes. I cannot come up with a single argument that I don't know will get shot down immediately and that is a good sign that it's probably not morally optimal.

It's easier if rather than "lives saved", you look at "life years saved". In this sense, somebody in their 80s who only has a couple of years left dying early is equivalent to the situation of a young adult being pushed into poverty by the lockdowns and never managing to recover a middle-class lifestyle, so they die a couple years earlier (I'm not sure about Sweden, but in English speaking countries poor people on average die a few years earlier). A 20-year-old commiting suicide due to sudden poverty, or depression from being locked inside, is equivalent to twelve 80-year-olds who have five years to live dying early.

If only life were so simple. Essentially you are saying:

if 12*(lifeexpectancy@80) > lifeexpectancy@20 and if (20 year old will commit suicide due to poverty or depression) then 12 oldies get to die.

That sort of reasoning is faulty in so many ways that it would be bothersome to work out all the various ways but let's start off with the assumption that those 12 people are not just as eager to live a few more years and that those last few years may be more precious to them and those around them than a 20 year old that may or may not commit suicide.

This sort of cold-hearted calculus is not going to solve anything at all, merely create rifts by polarizing what it means to be 'young', 'old', 'suicide prone', 'depressed' and 'suddenly poor'.

Being 'suddenly poor' is really hard in Sweden by the way.

I think the comments about suicide are a bit of a red herring.

There are many reasons why death rates increase with economic hardship and I do not think this is a significant one. More significant are changes to factors which are already leading causes of death (cancer and heart disease). In the short term, examples are how many treatable cancers are not being found or how many people are skipping other medical procedures. In the long term, how many life-years would have been saved with tax money which is lost. Even with socialized medicine, countries have budgets which need to balanced, and not every procedure is available to everyone who could benefit.

This study [1] estimated 260,000 extra deaths from treatable cancers from 2008 to 2010 in the OECD. One should ask how will this scale when additional diseases are considered and how the current economic impact will compare.

I'm not saying that I know what the correct choice is here, and perhaps we will never know, but it isn't as simple as saving lives vs suicide.

[1] https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

And then there are the factors on the other side of the ledger: fewer traffic deaths, ironically - fewer COPD related deaths because of significantly improved air quality. And many more. This is not a simple problem by any stretch of the imagination and trying to make it seems as though only one or two factors are suddenly dominant and should be given precedence without taking into account other effects of larger or equal magnitude and possibly with inverted sign makes it all about as useful as badly informed guesswork.

I wholeheartedly agree. My hope is that people can at least recognize that there is a complex risk benefit problem and encourage or at least permit our health experts to asses the problem.

Unfortunately, the pubic ( at least in the US) is dividing into camps which largely ignore this fundamental question. Either any action which which increases covid deaths is amoral, or the economy should be the primary concern. In reality, the real question of how to optimize quality adjusted life years has been squeezed out of the conversation.

Part of the reason is that the US tends to treat any major political issue as though it is a spectator sport rather than as something society will have to find a good solution for.

>This sort of cold-hearted calculus is not going to solve anything at all, merely create rifts by polarizing what it means to be 'young', 'old', 'suicide prone', 'depressed' and 'suddenly poor'.

However "cold" the reasoning is, it doesn't change the fact that there are people who'll die decades earlier now than they otherwise would have without the lockdown. I don't see how sixty years of a young person's life is worth any less than 60 years of multiple old people's lives; the only difference is that it's easier to see the direct consequences (old people dying now) than the consequences that take years to materialise. Ignoring and not measuring second-order consequences isn't warm, it's stupid.

Yes, but you are not capable of pointing out which people, and that is part of the problem here. If you could then you could take care of them on an individual basis. Which is one of the reasons most countries have some kind of social net to catch people in trouble. In an each-for-themselves-and-god-for-us-all setup those people will likely not make it. But that's no reason to address the superficial symptom, you'd do better to examine the root cause and fix that instead.

To be honest, I'd like somebody to explain to me how a lockdown would have prevented more deaths in elder care facilities in Sweden.

Preventing general spread in the population prevents the care home workers catching it.

But his point is that they are just experiencing these deaths now rather than in 2 or 6 months time, and that does seem likely given a vaccine is at least a year away.

Unless he has an accurate crystal ball I can't see how he can see the future.

Speaking of today's situation, that's straightforward. Fewer infections in the population in general, lower probability that an elder care worker in a given facility gets infected and goes to work contagious without their knowledge. Once that happens, game over.

This effect is evident just from different death rates per capita in countries that have similar demographic and housing situations, e.g. between the Scandinavian countries.

I'd expect that better working conditions would have been a much bigger help.

These workers would like to follow the general guidelines and stay home if they have any symptoms, but they generally work hours, not salary jobs, and can't miss too much work.

If they had the flexibility and leisure a lot of the swedish middle class experience at their office jobs, being able to call in sick, then more of the care workers could have obeyed the recommendation by the health authority.

But for now it's a low-wage, high pressure sector with less than ideal working conditions.

To add to that, the same patients meet very many different caregivers during a week due to the same working conditions, and this is also not good for preventing transmission.

I suspect that in the aftermath of this. There’s are the things that will have had the biggest impact on outcomes. The pre-conditions at the start. Not differences in response strategies.

I do like the reliance on the high trust society in Sweden, but I also feel like a wider circle of experts could be consulted for such a decision.

Even if it may not be a good model of human behavior, it's sometimes useful to consider "rational behavior" - if only to judge the resilience of certain mechanisms.

In this case, "social" behavior is in a sense very altruistic. If I am young and healthy, recent media reports (accurate or not) would suggest that limiting myself to staying inside, practicing more hygiene and such, is costly but doesn't significantly reduce my own risk. At the same time, isolating risk-groups may not be sufficient, and younger people may genuinely be at risk. So, it would be desirable if everyone practices social isolation.

If that is true, social behavior is a collective good: The more people stay inside, the easier it is for myself to go outside and, say, enjoy the sun in a park or have fun in a club. Thus, my incentives are not aligned with the goals of these recommendations. And if everyone thinks that way, social distancing will not be achieved in a "decentralized" fashion. Indeed if everyone is that rational, such a decentralized but workable "recommendation" does not exist.

Now, I stress that people do not fit this model, especially in Sweden. But in situations of anonymity, e.g. with many people involved, it has sometimes proven useful to check the robustness of one's decisions against the case where people act rationally. In that case, laws and regulation do make sense.

Is there a pronounced difference between coronavirus cases in Sweden vs neighboring countries? On a per population basis I'm seeing very similar numbers (links below). Anecdotal evidence is one thing, but these charts don't seem to tell that story. That being said, it's unclear to me the degree to which coronavirus statistics provided by different countries can be compared meaningfully, or if this is an apples and oranges situation (for any number of reasons).

https://www.worldometers.info/coronavirus/country/sweden/ https://www.worldometers.info/coronavirus/country/norway/ https://www.worldometers.info/coronavirus/country/finland/ https://www.worldometers.info/coronavirus/country/denmark/

Population numbers:

Sweden: 10.2 million

Norway: 5.4 million

Finland: 5.5 million

Denmark: 5.8 million

Cases are an unreliable metric because Sweden has done less testing per capita than Norway/Finland/Denmark. However, its deaths per capita is notably higher (and rising - from 14th global rank to 10th in the last couple weeks)

Sweden: 192 per million

Denmark: 66 per million

Norway: 34 per million

Finland: 27 per million

That does not look good for Sweden. I was just thinking that it would be interesting to compare total deaths per year for 2020 at years end to eliminate differences in methodology. It's a crude measurement, but if the coronavirus death toll becomes large enough compared to total population then it should give us a general idea considering how slowly death rates change in general. That could at least point us to who did things right, and hopefully some guidance for future policy.

Hold that thought. They probably have deaths by week already.

https://euromomo.eu/

https://www.nytimes.com/interactive/2020/04/21/world/coronav...

Only if COVID-related deaths are counted the same way by each and every country, which is not the case now.

Some only count if the person died in a hospital, for instance. Did not New York's rate take a major jump when they started to count also non-hospital deaths, e.g. ones at retirement homes?

I have been following Sweden vs my country (Portugal) for a while. Population number is about the same.

According to official data, Sweden has double the deaths of COVID per capita than Portugal (192 v 72 or something like that last time I checked). But latest data from my country has been suspicious since there has been a LOT of deaths above the average for March/April that aren't counted as COVID. I think at the time Portugal had 400 deaths of COVID, it had around 700 extra deaths about the average that weren't counted as anything.

NY times[1] and other studies have shown a big difference between average deaths in various countries and covid ones. Interestingly enough, Sweden is the one where the average extra deaths are all covid related, while most other countries have a big difference. (sorry for bad english, just woke up)

*edit: Just re-read the article and they added Belgium to the list. Belgium has the more deaths per capita in europe (world?), and they are also along with Sweden the only ones that don't have 'missing' deaths.

[1] https://www.nytimes.com/interactive/2020/04/21/world/coronav...

Low official case numbers in Sweden are meaningless. They made a strategic decision not to track untested cases which would be presumed COVID-19 cases in most countries and they perform an almost negligible number of tests in Sweden which are officially restricted to be used for certain specific at-risk demographics.

The number of deaths per capita will give a clearer picture of the underlying situation comparing against the rest of Scandinavia, but that of course lags behind the number of cases by a few weeks.

> they perform an almost negligible number of tests in Sweden

According to https://www.worldometers.info/coronavirus/ , they have about 9k tests per 1M pop, which is lower (half of Denmark or 3/4 of Finland, but higher than France or UK), but definitely not negligible.

It will be interesting checking back in 2-3 years and evaluating the efficacy of approaches by different countries. As referenced in the interview, each country has to eventually reach herd immunity. For the majority of the world this will be when 60-80% of the population has antibodies through the natural spread of the virus.

Assuming healthcare systems are not at overcapacity, our resources will best be spent protecting at risk groups. These are mainly old people, given that the average life expectancy of those who have died is just over a decade.

I'm confused why so many people are extraordinarily emotional and passionate about shelter-in-place. We should be focused on increasing healthcare capacity, and more importantly securing the safety of at-risk populations which are primarily composed of old people.

This is where honest and effective communication over the objective risks for different groups is essential. If you are under 30 with no pre-existing conditions, the odds of dying are < 1/100,000. The numbers are commensurately promising for those without underlying health conditions in their 30s, 40s, and even 50s.

It is silly to prioritize shelter-in-place going forward, across most of the developed and developing world. The costs are tremendously high, as we actually want most relatively young and healthy people to be exposed to the virus to protect at-risk populations.

There was even a recent study published that revealed if we intentionally infected young and healthy people, death rates from C-19 would nearly halve. A solution could turn out to be staggering payments to very low risk groups to get infected, taking into account people's various living situations. Unfortunately, I think most governments would prefer 2x,3x,4x, etc. death rates over paying people to infect themselves.

I believe many people will look back and admire the Swedish model for their practical and effective approach. Excessive shelter-in-place has tremendous costs, with minimal benefits once healthcare systems are stabilized. Hopefully nations around the world accept this reality and act accordingly.

Is it just me or his answers are super vague and uncertain?

I've expected some irrefutable arguments and unshakable confidence, but it's mostly "I think", "I [don't] believe" and "hard to know". Zero proofs or data, mostly his opinions.

Well, its an informal interview. As the dude say, in the mornings they review data and do an analysis with experts.

everything is an opinion and estimate at this point -

the transmission rates in the population with respect of their way of living,

the sensibility to infection of different ages, races etc

I salute Sweden for not giving in to the lockdown hysteria and trusting that people can and will act cautiously without the threats and mandates.

Perhaps a cultural difference. Swedes tend to respect a bit of humility. Especially if you can pull it of with confidence ;)

To us Americans f.ex. can seem way to confident and boasting. If I generalize a bit.

At the extreme we have things like this https://en.m.wikipedia.org/wiki/Law_of_Jante

I don't understand why certain media are lauding Sweden's strategy. It's not succeeding by any objective standard.

For example, if you filter out tiny countries like Andorra (which result in statistical aberrations), Sweden has the 5th highest death rate in the world (per million population). And it's increasing, having gained several spots in the past 5 days.

It may turn out be that Sweden's right in that closing borders, schools, and businesses doesn't have much of an effect, although there's significant evidence for the effectiveness of closing schools in respiratory illnesses. But Sweden's strategy is not working as a public health strategy.

If they had sufficient testing and encouraged the use of face masks to slow the spread, it would probably have worked.

Some southern states are about to try the same strategy so we'll see how it works out.

It was a cynical decision, disguised as "we don't want to impact people's freedoms" and "we follow the scientific truth".

Sweden's progressive government hates older people which they perceive as more conservative. So they decided to let them die.

If the epidemy would affect younger people as much as older people, Sweden would take the same actions other countries had and limit the number of deaths.

Are you seriously saying that the government is on purpose making their strategy kill old people?

Because that is some grade-a conspiracy paranoia.

This is one of those cases where a single day in the media cycle makes for a very big difference:

https://www.forbes.com/sites/davidnikel/2020/04/22/sweden-he...

I think Sweden did it wrong, valuing the economy more than the lives of people. I think there are some political ideologies at work, but I don't want to get into these.

In my country we have 3x less cases and 8x less deaths per million people. I do think that quarantine payed off. We can recover the economy but we can't recover lives.

Each nation's strategy seems to come about due to its very specific circumstances. Leaders will defend (to death) their bullshit ideologies and false securities, and stick to a plan made in the heat of the moment.

Perhaps this mechanism is the great randomizer that ensures that every combination is tested, some risk distribution strategy.

Sweden is starting to see sharp increase in daily deaths - 172 yesterday and 185 the day before - which for a country of 10 million is a lot. For instance Czechia with roughly same population introduced lock down very early on and now their total is 210 - while Sweden's is 1937...

Where are you getting those numbers from? They're much higher than suggested by this graph:

https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_S...

So far the net result of Sweden's strategy is that they have 2,021 coronaviris deaths, more than 4x more than Poland, which also has almost 4x bigger population - so Sweden has 16x more deaths per 1M of citizens than Poland.

There is no controversy. They just messed up and are now saving their faces blabbing about herd immunity and hoping that the spread will stop magically. I do not have hopes up yet.

This was the most sane and reasonable thing I've read about handling the pandemic, and I'm super bummed it's not regarding my home country.

Sweden’s approach is an optimization of how to respond to the epidemic and how to respond to the general life disruption.

The optimal response to the epidemic is everyone stays in their house for 1 month with no human contact. In that scenario, the virus is stopped and everyone dies because no one works the food chain, etc.

The world’s current response is heavily weighed towards optimizing the response toward the epidemic, but the potentially fatal assumption to this approach is that a vaccine will soon be developed. If a vaccine is not soon developed, the same amount of people will still get sick, people will still die, but additional people will die due to life disruption.

While their strategy seems to not have led to disaster, it's not certain whether one would call it success. Shutdowns clearly didnt work well in some countries (france,spain,italy,uk) but they seem to work well in most eastern europe countries and germany. People are not being infected at large .

Some of his remarks are generally questionable and worth a second thoughts

> Closing borders, in my opinion, is ridiculous, because COVID-19 is in every European country now.

There are many countries with very few COVID cases, and some of them are summertime destinations for swedes (like greece). It's certainly dangerous to open borders with a highly infected country like sweden without rigorous checks. Europe is big.

> Each country has to reach ‘herd immunity’ in one way or another

Not all countries are looking to get there fast. In fact countries that delay the spread are hoping for a potential cure/treatment that will make herd immunity much less painful. Herd immunity isnt even necessary - plenty of diseases don't need immunity/vaccines.

Also, while it's nice that sweden chose a relaxed, voluntary approach, the lockdown measures have wide support in many countries.

He s right that governments should be measuring the impact of measures though. Sweden should be doing so too, it would be very useful to know which are the most important infection routes, now that other countries are opening up

Even if you assume 100% of the population will eventually be infected, the final percentage will have a much easier time and chance of recovery than the first ones because of what we've learned as time goes on, even without a vaccine. In fact, they're already learning better ways to treat the disease.

The stupidity of saying, "We really can't do much right now, so fuck it" is unbelievably irresponsible. If you knew you were definitely going to get the virus, when would you rather it happen, right now or a year from now? Sweden is essentially saying it doesn't matter.

> We really can't do much right now, so fuck it"

For many people it's more of "I can take my chances relying on the government when I'm not allowed to work" or "I can take my chances catching a virus that is probably coming for me anyway"

Locking down doesn't terribly help vulnerable populations. It's only advantage is that it keeps people who were less likely to catch it to begin with from catching it, and as a result reduces the hospital load.

Here in Iowa the majority of outbreaks are either in nursing homes or meat packing plants. Locking down does nothing to help them. We could shut down the meat packing plants, but then we kill the food supply chain, which is a disaster for everyone. Nursing homes are basically sitting ducks no matter what.

If it's a fire we can't put out except by letting it burn through, then our best choice is to open up to the point that we are burning at maximum capacity. Hospitals here are laying off workers because they aren't allowed to do anything except wait for a crash of Covid-19 patients that so far hasn't come.

If the bottleneck is the hospitals like people have been saying all along, then hospitals being so empty they can't even pay their staff means we have gone to far.

Wouldn't a lockdown translate to limiting the nursing homes' exposure to the virus?

That's the theory, but it has proved pretty ineffective in practice. Nurses don't live onsite, so there is no actual way to seal the residents off from the outside world. Once it gets in you're no better off than had there not been a lockdown in place.

Do you have any links to reports of hospital layoffs? I too live in the Midwest and haven't seen any, though midwestern news sites are atrocious unless it has to do with football.

There have been several stories, including one just yesterday where one of the main hospital groups in the state (Unity Point Health) is laying off / furloughing employees.

Here is a story directly related to it though [1].

"""

"The loss of revenue over the last few weeks due to the inability to provide non-emergency care is destabilizing core health services in rural America," the NRHA said.

"""

[1] https://www.iowapublicradio.org/post/small-town-hospitals-ar...

Edit:

Here [2] is a link to a "live blog" post, so it's sort of a moving target, but under "11:00 am Tuesday" there is this headline:

"UnityPoint Health announces cuts to staff hours and pay"

[2] https://www.iowapublicradio.org/post/liveblog-tyson-foods-su...

Okay, you said "Hospitals here are laying off workers because they aren't allowed to do anything except wait for a crash of Covid-19 patients that so far hasn't come." You're in Iowa, yet the first link is an extremely small hospital in Tennessee. The second link refers to a Unitypoint Health which has operations in several states.

Hospitals are losing revenue for elective surgery. UP Health is cutting doctors pay 15%, and furloughing some other employees. Not sure if those are medical providers or administrative staff.

And saying that we're waiting for "a crash of Covid-19 patients that so far hasn't come." is not factually accurate, even in the Midwest. I can name several hospitals in Nebraska that are so full, they're using the ER for non-COVID patients since the COVID patients have filled entire wings.

Here's an article about Grand Island, one of Nebraska's hotspots. The article is 8 days old, and the situation has become worse.

https://www.omaha.com/livewellnebraska/our-resources-are-bei...

For Omaha/Bellevue, Bellevue Medical Center is using the ER due to a lack of rooms.

Here is another article about hospital layoffs [1]

As to the number of patients, it is highly regional. This is the official state of Iowa Coronavirus info page [2].

My coworker's wife is a doctor here in Story county. My neighbor is a nurse at the clinic across the street from my house. Both have said business is way down and they are having trouble finding enough work to fill their time.

My mom is recently retired from the hospital in Mitchell county. She fills in for people in her old department when they are short staffed. She said last week what would normally have been a ten hour day for her took two hours to complete.

We are strangling the majority of hospitals because the minority are overrun. That isn't sustainable.

[1] https://www.vox.com/2020/4/8/21213995/coronavirus-us-layoffs...

[2] https://coronavirus.iowa.gov/

I really think this is a case of It is difficult to get a man to understand something when his not feeling responsible for the deaths of thousands of his country people depends on him refusing to understand it.

"We are in the middle of the epidemic"

I'd love to know what metric he's basing that statement on

That's probably the least controversial statement in the interview.

Curious to hear what you think were the most controversial statements were?

"Closing borders, in my opinion, is ridiculous, because COVID-19 is in every European country now" has to be up there

Closing borders seems like a perfectly reasonable step for a great many countries.

Particularly those that are vastly more connected via land-based mass transit (often directly into cities that have higher populations than the entire country of Sweden)

Ironically, if all other borders are closed around you, then yours are effectively closed too.

Interestingly enough, you're wrong.

Denmark has closed it's border

But Danes can go to Sweden, because Swedens border are open. And while Denmarks borders are closed, danes are always allowed to return home.

Quite a few irresponsible danish people are going on vacations in Sweden these days

I have a few; assuming this question has been made in good faith.

> I think it has been overstated how unique the approach is. As in many other countries, we aim to flatten the curve, slowing down the spread as much as possible — otherwise the health-care system and society are at risk of collapse.

It is not overstated how unique the approach is, primarily because it is totally and completely unique and quite wildly so compared to not only Swedens nordic neighbours but the entire world.

> there is not much legal possibility to close down cities in Sweden using the present laws.

this is an argument for creation of those kinds of laws, that's the job of parliament and generally has happened in most other countries in Europe.

> Around 15 people from the agency meet every morning and update decisions and recommendations according to the data collection and analysis. We talk to regional authorities twice per week.

Twice per week is nothing, given that the virus has a 4-7day lag in even presenting symptoms and the exponential rate of growth, the lack of testing (it is advised _not_ to seek testing) it's not even possible to have real numbers.

The whole idea of treating this as a scientific approach requires the collection of data which is not being done.

I live in Sweden and what I'm witnessing is:

1) Offices have closed down, working from home is prevelant

2) Restaurants are definitely not closed, many are busting at the seams. Parks are full, social distancing measures are taken only by the few.. I wear a mask when walking around and I get scoffed at.

3) People 'trust the government' and see that there's no restrictions so they don't put any restrictions on themselves. outwardly they think they've done enough.

4) Gyms are open, my PT had COVID-19 symptoms and continued to go to the gym, she was not tested because seeking testing is discouraged.

A lot of the predictive modelling is based on models made in january and assumes "influenza-grade" immunity (as in you have essentially life-time antibodies to the current strain) but there is no scientific study to defend that assertion for SARS-CoV-2. In fact new studies seem to indicate that antibodies drop off significantly within months.

> she was not tested because seeking testing is discouraged

Can you elaborate? Is testing discouraged by the government? Medical professionals? Social pressures? Do you think the discouragement stems from a lack of available testing kits or from a place of fear/issue avoidance?

Testing was discouraged due to lack of reagents. They wanted to make sure what little reagents they had were used for hospitalized people and the elderly. There simply was not enough reagents in Sweden to do contact tracing at any useful scale, so we stopped doing that when we started to get too many cases.

That is what I heard from people I know who work at or close to the labs doing the testing.

Government and Healthcare systems are intermixed in this case.

The healthcare system recommends staying away from doctors offices to prevent the risk of spreading the virus, thus you will not be tested until it progresses badly enough to go to ICU.

The government agencies tell you to stay home and not meet anyone if you have symptoms. Yes, you are unlikely to be tested at this point due to lack of resources. Those who are tested are: medical staff and patients who are admitted and kept in hospital care for covid.

Yes, it was asked in good faith. With that follows some good faith follow-up questions:

> It is not overstated how unique the approach is, primarily because it is totally and completely unique and quite wildly so compared to not only Swedens nordic neighbours but the entire world.

AFAIU Tegnell is meaning that the swedish approach is the same in that the measures will have the same effect as complete and total lockdown, just not forced by the government? So the difference is actually quite subtle (enforced by law vs enforced by the people) or am I misunderstanding here?

> this is an argument for creation of those kinds of laws, that's the job of parliament and generally has happened in most other countries in Europe.

I see what you mean, but given that the experts are also saying that it is not necessary, should it be pushed through anyway?

> Twice per week is nothing, given that the virus has a 4-7day lag in even presenting symptoms and the exponential rate of growth, the lack of testing (it is advised _not_ to seek testing) it's not even possible to have real numbers.

If I understand your point here correctly, is that you feel that having uptodate numbers is more important than the government agencies currently do?

> Twice per week is nothing, given that the virus has a 4-7day lag in even presenting symptoms and the exponential rate of growth,

WHy is the 4-7 dag lag important with the twice-per-week meetings with regional authorities?

> 4) Gyms are open, my PT had COVID-19 symptoms and continued to go to the gym, she was not tested because seeking testing is discouraged.

Going out with symptoms is an offence so I assume your PT was told to go home? https://www.expressen.se/nyheter/expert-att-sprida-corona-ka...

> I wear a mask when walking around and I get scoffed at. What are your thoughts on the Swedish Public Health Agency's information that masks are not needed?

https://www.folkhalsomyndigheten.se/smittskydd-beredskap/utb... https://www.svt.se/nyheter/inrikes/experten-forklarar-sa-anv...

Just fyi, I'm also Swedish and live in Stockholm so also seeing all this first-hand. And I put a lot of faith into what the government and their agencies are saying so it's interesting to hear from someone who doesn't!

> AFAIU Tegnell is meaning that the swedish approach is the same in that the measures will have the same effect as complete and total lockdown, just not forced by the government? So the difference is actually quite subtle (enforced by law vs enforced by the people) or am I misunderstanding here?

The outcome might be "the same" (only history will tell us if this is actually true) but the path we're trying to follow is not the same as any other country. This is why it is unique. Not the outcome, the path.

> I see what you mean, but given that the experts are also saying that it is not necessary, should it be pushed through anyway?

FWIW there are many in the scientific community in Sweden who desperately do not agree with Anders. Ideally a technocracy is great, but this does not feel like a technocracy. I'm not saying that because of political pressures, but because the "do nothing" approach is not based in any science that anybody can cite.

> If I understand your point here correctly, is that you feel that having uptodate numbers is more important than the government agencies currently do?

I'm saying that it's not possible to forecast this kind of virus without adequate testing _and_ very strong communication. Most countries are "OK" until they suddenly aren't.. then the peak of the issue comes 1-2 weeks /after/ they realise there is a problem.

>WHy is the 4-7 dag lag important with the twice-per-week meetings with regional authorities?

If people were presenting symptoms quickly then it would help map the spread of the virus and inform opinion on when the healthcare system will be overwhelmed so we can prepare.

> Going out with symptoms is an offence so I assume your PT was told to go home? [snip]

Nobody is taking this seriously. She thinks she just had a fever and a sore throat. I suggested it was possibly COVID-19 related to which she said "I doubt it very much" and that was the end of it.

> What are your thoughts on the Swedish Public Health Agency's information that masks are not needed?

That was a recommendation across the globe, but it's been contested and the current recommendation from most healthcare agencies is to use masks, with the empasis on tring to make your own and not to consume the medical grade ones : https://www.theguardian.com/politics/2020/apr/21/scientists-...

> Just fyi, I'm also Swedish and live in Stockholm so also seeing all this first-hand. And I put a lot of faith into what the government and their agencies are saying so it's interesting to hear from someone who doesn't!

For context I'm not natively Swedish, I'm natively British, so maybe I don't share so much the culture of high trust in the government. But I'm also gravely dismayed by the sheer and flagrant violation of the recommendations even by Swedes.

The prevailing mindset is not only selfish it is based on the notion that "If I break the rules but nobody else does I'll be fine". It is very common for bars and restaurants to be full (like I previously mentioned) groups of people going shopping and hanging around in parks with the warm weather.

The virus has not killed so many in Skane yet.. but I do fear for the future.

To be fair, in the nordic languages "middle of" something can mean "we're in the midst of an epidemic" or "we in an ongoing epidemic".

This also is the same in English. Colloquially it just means you're not at the beginning or the end. "I'm in the middle of the forest" doesn't mean you're at the centre.

The day with the most COVID-19 deaths [so far] in Sweden was yesterday. Sounds like the middle to me. Or maybe the upswing.

Where are you getting that from? FHM's Covid-19 tracker [1] shows the most deaths occurring on 8/4. Of course, because there's a lag in the reporting that is likely to change over time. Either way, the data for yesterday is too incomplete to make any statements about yet.

[1] https://fohm.maps.arcgis.com/apps/opsdashboard/index.html#/6...

It's from here:

https://www.worldometers.info/coronavirus/country/sweden/

Artifacts of data representation undermine the direct translation to deaths occurring on a certain day, but for the purposes of saying "middle of an outbreak" this is probably enough.

Two different ways to present the deaths: attributed to the date of death, or attributed to the date they were reported by FHM.

That makes sense, though I would advice against the latter way since it will show massive dips and spikes due to variation in reporting. Notably, the reports dip every weekend and there was a huge dip over Easter that took ages to get caught up.

Eh, not really. Reported deaths typically lag up to 5 days so this is mostly just that a lot of backlog was reported the same 24 hours (yesterday afternoon and this morning). Number of deaths per day have been relatively stable since the beginning of April.

The middle of the peak of the first wave, maybe.

If you're under the impression we're half way through the whole thing you're in for a rough couple of years.

Assuming effective pharmacological treatment (as opposed to a vaccine) isn't found first, though.

I don't think this was a statistical statement, it's colloquial. We're not at the beginning, it's not right at the end, we're "in the middle"

When a future article is written about the dangers of being contrarian to get attention, that same picture of Anders Tegnell will be just below the headline. His parents should have spent more time with him.

Please don't post nasty, empty things to HN. We've already had to ask you not to do this kind of thing.

Maybe you don't owe Swedish epidemiologists in Nature any better, but you owe this community better when you're posting here. Please stick to https://news.ycombinator.com/newsguidelines.html.

> We've already had to ask you not to do this kind of thing.

When did it become HN policy to cherry-pick long ago examples from among a plethora of highly-regarded comments like that? Pretty clearly other users think I've paid any debt to this community since whatever incident you're referring to (and I don't remember any) many times over. Bringing it up like this seems pretty empty and nasty in itself.

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