You have to look at the excess deaths figures. That is, how many usually dies from January to June in a normal year and compare that to how many extra that died in 2020. For Sweden the excess deaths almost exactly matches the number of Covid deaths, give or take 10%.
That is not the case for many other countries. For example, the UK had almost twice the number of excess deaths as Covid deaths in a few weeks in April. That indicates that Covid deaths were under reported in the UK. There are also some indications that Covid deaths have been under reported in other countries.
In other words, comparing countries by their Covid deaths/capita rates is meaningless. The statistics are likely completely wrong because different countries use different definitions of "Covid deaths" and different reporting procedures.
It is not the highest in Europe but it is very noticeable. In contrast, the surrounding countries of Finland, Norway and Denmark show almost nothing.
As for which figures to take, we don't know, they are all wrong. Each country has a different way of counting depending on what they think is important.
For example hospital deaths are very consistent. Hospitals generally have good reporting, testing, etc... good to see daily evolution, but it is an underestimate. Recorded deaths from nursing homes and at home are less reliable. Sometimes, there is no testing, so we are not 100% sure it is COVID, there may also be delays. The picture is now more complete but you lose a bit of consistency. Excess mortality reporting can also have long delays, and it doesn't care about COVID at all, so things like behavior change under lockdown can have an effect, the advantage is that it is the least likely indicator to miss anything.
And if you look at all the numbers, we can split Europe into the bad (Italy, UK, France, Spain, ...) and the good (Norway, Finland, Denmark, ...). And by all metrics, Sweden is in the "bad" camp.
If you read the comment you replied to again, you'll note that they didn't claim there was no excess mortality in Sweden. I'll quote the relevant bit here for you:
> For Sweden the excess deaths almost exactly matches the number of Covid deaths, give or take 10%.
And they are saying that a good match between excess mortality and reported Covid death is not, in itself, an argument to say that Sweden is doing a good job. It has more excess mortality than its neighbors even if these might be underreporting Covid death so this argument is not exactly relevant.
The implication is that Sweden is doing a great job with the reporting. I think the whole point of OP's comment was that the statistics are meaningless because many countries skew the reporting, while Sweden does not.
> The statistics are likely completely wrong because different countries use different definitions of "Covid deaths" and different reporting procedures.
The main problem in Sweden hasn't been the rejection of a lockdown, it's not protecting the elderly care well enough. But this is what happens when there are barely any educated people within it. Compared to Norway for example that have a mandatory 3 year nursing education to be working within the elderly care. Heck the absolute majority of the elderly didn't even get any treatment once the infection was a fact.
And these country's are much in a lockdown still. Norway for example - you're not allowed to travel far north from Oslo. In comparison to many other countries, Sweden's tactic could go on for years while many others would and already have started to give up on theirs.
You are allowed to travel everywhere in Norway now if you are a resident, even if you are from Oslo. However, there was a couple of weeks where that was not allowed.
Norway is actually almost back to normal,except you can't have gatherings of over 200 people. It has been this way for almost a month now, and there have not been any increase in confirmed covid cases yet, which is surprising.
> However, there was a couple of weeks where that was not allowed.
News to me and I've been here in Norway all through the COVID time. There was a period when we were not allowed to spend the night in a holiday home unless it was in the same kommune as one's usual residence but as far as I remember there was never any country wide ban on internal travel. There were a few kommunes who set up border controls that were most likely illegal but that's about it.
And resident status is not relevant here either. As long as you went in to quarantine on entry to the country (was 14 days, now 10), whether resident or not, you are free to travel where you like.
If you know that anything I have said here is incorrect I would appreciate it if you could provide addresses of web pages (Folkehelseinstituttet, osv.) that would set me right.
The big question is how did Norway handle elderly care. Did they have employees traveling from Oslo and going from home to home, and house to house, often without time enough to even wash their hands?
Because during the worse time, that was the kind of environment being reported around Stockholm. There were not enough people and a universal lack of safety equipment. Many workers also had to rely on the mass transportation system in order to get between homes. Elderly care, both private and state owned, often operate from a single cental point and fan out.
This is an important observation. In the Netherlands, where I live, I've had a number of people look at me with great surprise and mistrust when I mentioned that the Dutch have done a terrible job with this epidemic. The Guardian plots show that the Netherlands is one of the worst when it comes to under-reporting.
This is not to say however that the Swedes have done a good job. While their numbers are credible, their magnitude is still unacceptably large: 0.5/1000 Swedes have so far died of the corona virus.
Considering COVID has closed many of life's fun things, there will be an entire generation of people who have effectively "lost" a year of the things they hoped they would do in their lifetime. By stating open, Sweden might decrease life expectancy in years, but increase it in terms of 'things achieved in a lifetime'
Yes, people die. That's true of all countries and all times. What we might call civilized societies have however strived to reduce those numbers as much as possible. This was done by trying to avoid violence, improving lifestyles and developing better medical techniques in order to prevent or repair diseases and injuries.
Containing and minimizing the effects of a pandemic is just one aspect of what we might call a civilized attitude towards human life. Conversely, not doing so is uncivilized and I might add immoral and irresponsible.
> there will be an entire generation of people who have effectively "lost" a year of the things they hoped they would do in their lifetime
This almost doesn't merit a reply. A few months of not going to festivals and the cinema is by no measure a catastrophe. It's not fun, but suggesting that your right to fun should trump others' right to life is, again, uncivilized, immoral and irresponsible.
> Containing and minimizing the effects of a pandemic is just one aspect of what we might call a civilized attitude towards human life. Conversely, not doing so is uncivilized and I might add immoral and irresponsible.
The reality is that everyone is prepared to allow others to die for their own convenience. I intentionally phrased that harshly, but it is indisputably true. In the US, 70,000 people died from the influenza season of 2018-2019. We could have sharply reduced that through quarantine measures. But no one wants to do that.
Once you accept that everyone is prepared to allow others to die preventable deaths for their own convenience, then all you are talking about is a matter of degree. It can't be immoral to believe 1 death is okay, but 2 is wrong. That's just an opinion. The only difference between believing 70,000 is okay, and 700,000 is not is a gut feeling about how much preventable death is worth it to maintain our living standards.
It has much less to do with people dying directly from Covid and more to do with the sheer number of severe Covid cases overloading healthcare systems to the point that patients with other serious conditions can't receive medical treatment.
This occurred in Italy, New York City, etc., and is now being seen in some cities in Texas and Florida. This condition is what incentivizes societies to lock down, not just the mere occurrence of a new disease.
If a society's healthcare system can handle a severe influx of serious Covid cases, then you typically have seen that government's restrictions lift.
>This occurred in Italy, New York City, etc., and is now being seen in some cities in Texas and Florida.
Not Florida. An article from yesterday (https://www.news4jax.com/news/local/2020/06/18/florida-has-l...) ominously claims that "less than 25%" of ICU beds are available in the state, but actually read it and see that 90% occupancy rates are normal, and only a few of those in the ICU are COVID19 cases.
Texas? Let's look at Houston, where for a month it's been "we'll be running out of ICU beds in two weeks" every week.
Italian and New York hospitals were overwhelmed because a) both places put sick elderly into old age homes. b) Like elsewhere early on, doctors put everyone serious onto ventilators in a mistaken belief that they should treat patients like they do ARDS cases based on blood oxygen levels. This damaged healthy lung sacs and caused long-term dependence on mechanical respiration that doctors found almost impossible to wean patients from, and other side effects like deep vein thrombosis; Nick Cordero is a recent example. This article from three months ago (https://www.statnews.com/2020/04/08/doctors-say-ventilators-...) was completely vindicated in retrospect.
(And even NYC being overwhelmed was thankfully temporary. That's why the military hospital ship sent there was not used.)
56 Florida ICUs are at capacity, with a further 35 are above 90%[0]. Five days ago the largest hospital operator in Houston, TMC announced that they were at 102% [1]. There’s a little bit of flexibility there; TMC can get that down to 72% by converting every possible bed to an ICU space[2], but they are now operating above official capacity.
I agree that there’s a lot to criticize in how NYC handled their hospitals, and that in a pinch hospitals in Texas and Florida can scrounge up extra beds. But those hospitals are filling up.
As I said, a 90% ICU load is normal; hospitals routinely transfer patients elsewhere to maximize utilization across as many facilities as possible. Again, only a small portion of ICU patients are there for COVID19, and a good chunk of the remainder are people who postponed procedures during the lockdown.
Let me clarify. By "normal" I meant that 90% is not an unusual or undesirable situation. To some extent, an ICU bed is not being used is going to waste; from a hospital administrator's perspective, the ideal situation is 100% utilization at all times with every excess patient smoothly being transferred elsewhere. This of course is unrealistic—you want to leave some surge capacity (thus my 90% figure) if possible—but, generally speaking, a hospital will transfer excess patients elsewhere (either within the same system, or to others in the region), and accept others' excess patients to fill up its own empty beds.
COVID19 patients are not making up a large percentage of ICU patients at the moment; see, for example, the hospital in the aforementioned article with 100 ICU beds. Yes, the 100 beds are full at that moment, but only seven are COVID19 patients; no doubt some other fraction are patients who put off procedures during the lockdown. That hospital is sending new patients it can't handle elsewhere, and will also move some existing patients elsewhere when practical/safe. This is possible because there is no overcapacity on a regional or statewide level.
Thanks for this response, its a good counterpoint with solid evidence, but the main point still stands - societies aren't merely shutting down because of a virus - it's because of a fear of healthcare systems being overwhelmed.
Not sure where you get 70,000. On average it's 16,000 - 40,000 per year, there was a really bad flu on 2017-2018, which killed about 61,000 people, but on 2018-2019 it killed 34,000[1].
Anyway, your point stands, but there are people who think covid deaths are no higher than a bad flu, and your numbers seem to mislead in that direction.
I am leaning towards the lock down skepticism. It's not that I think that Covid is not worse than a flu, it is worse, but there response is unparalleled. We have had a strict lockdown and lots of deaths anyway. The initial predictions about the virus turned out to be way off, it seems to be more infectious and less dangerous than we were initially told
Initially lockdown was to "flatten the curve", stop the hospitals an in particular the ICU beds from getting overwhelmed. That worked, and while it got close to breaking point here in Spain we made it through.
I noticed as new data emerged from Sweden - they hadn't spiralled out of control as many, including myself, predicted. Flatten the curve seemed to be forgotten about, and it turned into a pointless competition of who has the least cases, least excess deaths - pointless because this is far from over.
Or maybe we are past the worst of it already - the Diamond Princess cruise ship showed only 20% of the passengers infected - so maybe covid only affects 20% of the population.
You calling that a strict lockdown? When I go to a park and see tons of people there, half of them not wearing any masks. We aren't even fining people for not wearing them.
Someone here mentioned how Vietnam handled it, they reacted quickly and had steep fines (for their income) and achieved 0 deaths and now it's 80 days since last infection was reported.
There are other countries that handled it really well: Australia, New Zealand, Taiwan, South Korea, Finland.
Assuming you're talking about USA. The USA is probably an outlier since it essentially had no lockdown, no enforced mask usage, and very weakly enforced business closures. All the states had were half-assed "Stay At Home suggestions" that people pretty much ignored (and still ignore).
I wouldn't look at any state in the USA for evidence of whether lockdown works or not, because it pretty much wasn't done here.
> Can you explain why the estimates on this page are different from previously published and reported estimates for 2017-2018? (For example, total flu-related deaths during 2017-2018 was previously estimated to be 79,000, but the current estimate is 61,000)?
> The estimates on this page have been updated from an earlier report published in December 2018 based on more recently available information. There is a trade-off between timeliness and accuracy of the burden estimates. To provide timely burden estimates to the public, clinicians, and public health decision-makers, we use preliminary data that may lead to over- or under-estimates of the true burden. However, each season’s estimates will be finalized when data on testing practices and deaths for that season are available.
All preventable deaths should be prevented - this is the gold standard. In reality, of course, things don't work out that way. The analogy with a flu season is deeply misleading. The coronavirus has, in half a year, killed more people than the worst flu seasons, with extraordinary measures in place all over the world. It's completely reasonable to assume that without lockdowns we would have had millions of deaths already.
> The reality is that everyone is prepared to allow others to die for their own convenience.
It may be so. Those people are morally wrong however. This is a deep point that I have insisted on in other comments as well. Casually weighing human life against economic cost is not acceptable in what we might call a civilized society.
> The only difference between believing 70,000 is okay, and 700,000 is not is a gut feeling about how much preventable death is worth it to maintain our living standards.
That is not true. Deaths caused by the regular flu are deeply regrettable and should be prevented as much as possible. If you dig into the data however, you will see that the coronavirus not only kills many more people than the flu, but it also kills people who would otherwise have many more years left to live. Diabetes, a heart condition or age > 65 yrs. shouldn't be death sentences in a modern civilized society.
> Casually weighing human life against economic cost is not acceptable in what we might call a civilized society.
The reality is quite different. We accept a risk of death to ourselves and others in everything we do. You do it, too. Everything. You even risk death by doing nothing.
You could say "if it cost $1b to save this life, we should do it". But how many lives could be saved at $1b each before we run out of money? Then what? And what about the lives that could have been saved at $1m apiece?
If someone not willing to give up all of his assets to save someone else's life, is he uncivilized and morally wrong?
> You could say "if it cost $1b to save this life, we should do it".
This a common, yet unrealistic, hypothetical. In reality, of course, death is inevitable regardless of the economic costs. Past a certain point everybody, so far, has died. The amount of things that we can do in order to prevent any given death doesn't scale with the economic cost, past a certain (quite low) point. Spending 1B on a person won't get you 1000 times better 'medical stuff' than spending 1 million; therefore, a trade-off of e.g. one life for 1B vs 1000 lives for 1m is illusory.
In practice all societies have limited resources. My position is, however, that those limited resources, in the case of an acute health crisis, should be focused as much as possible on mitigating that crisis, without having primary concern for the economic costs.
> All preventable deaths should be prevented - this is the gold standard.
It absolutely isn't; it is complete nonsense.
Firstly, it directly conflicts with right to die; it asserts that if we can intervene in any suicide, then we should. How can stepping on the right to die be elevated to a gold standard?
Some people take risks, and those risks are fatal. Deaths in dangerous sports and other activities are easily preventable: just forcibly take away the right to engage in them. Closing off Mt. Everest to climbers will certainly prevent deaths. By your gold standard, that must be what should be done.
Preventing some deaths may even require lives to to be imperiled; someone has to be asked to risk their own life to save others.
No, no, no; live and let die is the gold standard.
People should be sometimes left to the consequences of their actions and circumstances and that includes dying. Obviously not always, and not as a rule, but sometimes. Often enough that "all preventable deaths should be prevented" is utterly preposterous.
There is no right to die in most countries in the world. Got horrible painfull and untreatable disease, but a few years left on the clock? In most places you are doomed to suffer through it. The only exception i am aware of is netherlands.
Secondly, most of your post conflates me engangering myself my choice ( i choose a dangerous sport and suffer) vs someone else endangering me (unsafe building collapses on my head).
Note that, normally, a writer can't conflate A and B, if they don't make even the slightest reference to B. That said, I've pulled off "the impossible" before.
It may be so. Those people are morally wrong however.
I'm willing to bet that you have taken many unnecessary car trips in your life. By doing so you have increased the risk to other drivers, cyclists, and pedestrians of suffering a fatal accident. Sure, it's a very small increase, but surely that outweighs your selfish desire to visit your friends or go to a movie.
Casually weighing human life against economic cost is not acceptable in what we might call a civilized society.
It's not only acceptable, it's essential in order to make reasonable decisions.
Deaths caused by the regular flu are deeply regrettable and should be prevented as much as possible.
Flu vaccine reduces risk of death. Coronavirus has no vaccine yet. I do think we take the flu too lightly. Urgent care and hospitals definitely need to be more risk averse even after this pandemic is over, and I hope we learn that lesson in this pandemic.
To my knowledge all modern nation states have some sort of stat like that; it’s either relevant for healthcare expense planning, or disability/life insurance schemes. I believe the US rates it down to the value of each limb for the latter; and my private AD&D insurance does the same.
The response to the coronavirus has been many orders of magnitude more strict than the response to the flu. All this while be less than an order of magnitude as deadly, probably 3X-4X. This is why I think it is perfectly valid to compare it to the flu.
The collective response has been outsized to the actual risk of death, and I believe this is due to fear rather than sensible policymaking.
If it really was about reducing all cause mortality, most governments could do so much to reduce the primary causes of death, like heart disease and cancer, by banning things like cigarettes and enforcing healthier diets among the populace.
Imagine what banning sugar alone would do to the rates of obesity and type 2 diabetes in the US. But no one wants to do that.
> All preventable deaths should be prevented - this is the gold standard. In reality, of course, things don't work out that way.
Yes, in reality a lot of people die driving cars all around the world no matter the amount of on board safety devices and yet cars are legal everywhere. There are countless similar examples.
Preventable is what people agree or tolerate to prevent.
Really? Here in Norway children would only be vaccinated against influenza if they already have other severe conditions such as diabetes, chronic heart or lung disease, etc.
First, economy was never a consideration for the Swedish Corona strategi.
Secondly, the flue has quite reason, like year 2000, taken more lifes in Sweden then what Corona has taken this year. And I would be surprised if that would be exceptional to Sweden.
That not even consider there are more people living in Sweden today then 20 years ago. A couple of years earlier, the death rate per 100 000 was higher then Corona this spring.
And yes, there are some strong indications that there was Corona in Sweden in December, in Svärdsjö, Dalecarlia. A woman that has not been outside of the region got Corona signs on X rays of her lungs.
And that I guess isn't exceptional either. So, we probably hade Covid-19 a lot earlier than we has thought. Which could explain the explosion of the spread.
> Casually weighing human life against economic cost is not acceptable in what we might call a civilized society.
Human life and economic cost are not separate things. The economy is a comprehensive (if incomplete) description human life. When we shut down the economy we cause millions to lose jobs, to lose incomes, to lose structure, to lose community, to lose activities that give their lives purpose and joy.
The economic shut down is killing people. It's also reducing quality of life and length of life. That's not to say it's not worth it. The effects of lockdown are hard to measure and no one can be sure if it's worth it or not. But this framing of economic cost vs human life as if it's just a little money is wildly inaccurate and damaging.
> It's completely reasonable to assume that without lockdowns we would have had millions of deaths already.
I agree that it's a reasonable assumption. Ivor Cummings dives into some statistics a bit more, and it isn't so clear that the lockdown had the effect, rather that it might be do to with seasonality and the way the virus spreads. I am interested if anyone has any decent criticism of the numbers he bring up in that video, as they seemed reasonable to me?
> The coronavirus has, in half a year, killed more people than the worst flu seasons
That's not true. The flu seasons in 1968, 1957, 1918, and 1889 each killed over a million people worldwide, twice as many as COVID-19 in roughly the same timespan, and that out of a lower total population, and despite lockdowns and quarantines.
(Who is downvoting this simple truth? How is anyone going to discuss this issue if we can't even talk about basic facts?)
You are referring, I think, to years with pandemics that were not caused by what can be called the 'regular' flu. It's especially comical that you have included the 1918 flu pandemic among your counter-examples.
At least for Sweden, it is still true that the worst flus have killed more people than corona on a per capita basis. And we don't have to go back very far at all to find cases of this. 1993 and 2000 where particularly bad and topped corona.
But that is corona with social distancing and very widespread working from home, so it isn't really an apples to apples comparison.
What is "regular" flu? There are many strains in circulation, including those that caused past pandemics. We have vaccines and acquired immunity, so it's been some time since the last truly deadly flu epidemic, but the flu should not be dismissed so lightly.
And why wouldn't I include 1918 in a list of flu pandemics that killed over a million people?
Is it? I see it acknowledged, and often paired with the observation that the worst flus have not been mitigated by extreme social distancing as we have now.
Let's look at British Columbia, Canada where we have managed to stabilize at ~10 cases a day. How long before we get the same number of deaths with our population of 5 million people. Hmm, 5 million divided by 10 divided by 365 is 1369 years. Even if we consider 10 cases for every one detected case that's ~137 years! Longer than a human life span. Ignoring things like improved treatment options, vaccines, and other things that are going to change in our understanding.
So I think this proves the argument wrong.
If you consider the other costs you're avoiding, long term issues for sick people, the cost of treating all these people in hospital, the potential for people to get sick with this multiple times (we don't know if you get any immunity by getting sick) then it's even clearer.
They have only stabilized at that level if you are willing to permanently keep things the way they are. Are you comfortable with the restrictions currently in place being permanent?
I think we can keep things where they are. The current restrictions aren't great but they are sustainable:
- Virtually no travel in and out of the country (goods still flow though).
- No gatherings > 50 people.
- Keep 2m away from others (except for "bubbles").
- Wash your hands.
- Masks in certain situations (not mandatory for most).
- Various limitations in place as to how businesses operate, e.g. distance between tables in restaurants, physical barriers, cleaning, one way aisles in stores etc etc.
Since I'm not the type or age who goes partying out in crowded bars or to packed concerts that stuff doesn't really bother me personally. Sure, it's no fun, but the alternative seems like a lot less fun. In my (global) company we all switched to wfh when this started and I'm fine with that.
Wow. All I can say is that you have very different priorities than most others. Most are ok with those changes temporarily. Almost nobody is willing to make that sacrifice permanently.
Permanently != until there's a vaccine or effective treatment.
There's lot of room for optimization/improvements. Travel might be ok to locations that have this under control, for example. We might find better solutions for keeping the transmission low. We could decide to clamp down harder and eradicate the virus locally so that we can trade off local restrictions vs. travel restrictions.
It's just between all the bad options here this seems to be the least bad. 2 years of the disease raging through the community until (maybe) there's herd immunity sounds so much worse. I'm pretty sure the Americans who think this is the way to go will change their minds come this fall assuming the current trend continues. Maybe I'm wrong... Let's catch up in December ;)
> Youre are going to have the same number of deaths sooner or later as long as the hospitals aren't overwhelmed.
Even assuming there's never a vaccine or effective cure, this is not true: temporarily reducing the R number (lockdowns, distancing, masks) reduces the overshoot in the total number of people who get the disease (some proportion of which will die). It's the difference between scenario 0 and scenario 1 in the excellent https://ncase.me/covid-19/ playable models.
Quoting the site: "This reduces total cases! Even if you don't get R < 1, reducing R still saves lives, by reducing the 'overshoot' above herd immunity. Lots of folks think "Flatten The Curve" spreads out cases without reducing the total. This is impossible in any Epidemiology 101 model. But because the news reported "80%+ will be infected" as inevitable, folks thought total cases will be the same no matter what. Sigh."
What I said: "temporarily reducing the R number (lockdowns, distancing, masks) reduces the overshoot in the total number of people who get the disease (some proportion of which will die)."
The R is reduced while any effective measures are active. The playable sim for Scenario 1 has them active while there's blue shading over the graph, deactivating them once herd immunity is reached in that sim. In that case, compared to scenario 0 (do nothing), fewer people have been exposed so fewer people die. So it is not true to say, as you did, that "Youre are going to have the same number of deaths sooner or later as long as the hospitals aren't overwhelmed."
> There's no avoiding society returning to normal as people need jobs to pay rent and buy food.
You've moved the goalposts, but even so, the later sims suggest other things that can be done with less invasive measures like test and trace, wearing masks and social distancing. These don't prevent people doing jobs. They do decrease the number of people who die.
What's a preventable death? Everybody dies eventually, there's no such thing as a preventable death. There's delaying death, but everyone dies. Period.
I feel that in this thread people are quite stubborn about interpreting things literally, or misinterpreting them all together.
I will give it my best shot at clarifying:
Preventable refers to what a given society can be expected to manage given its limited resources and given other moral constraints, such as not impinging on people's freedoms unnecessarily. A number of the terms I have used have vague meanings that can't be clarified (not by me at least) within the scope of an HN comment. A good faith interpretation of my statement would be that a society should hold saving lives as its highest priority, as long as this does not cause catastrophic costs or dystopian levels of population control. Some temporary economic costs and some temporary restrictions on certain freedoms should be accepted, I think.
> in this thread people are quite stubborn about interpreting things literally, or misinterpreting them all together.
My complaint is a bit different. I'd say "preventable deaths should be prevented" and people will interpret that as if it said "all". I reply that if I meant "all" I would have said "all".
Your case is a bit different, because you said "all" but did not mean "all".
Cancer is a rather big problem. It taxes society quite a bit, costs a lot of money and in general inconveniences quite a lot of people that need to support or help cancer patients.
Would you agree then that perhaps it's a better idea to let cancer patients die rather than try and find cures or reduce the chances of dying? Why or why not? If you had cancer but of the curable kind, would you accept the state killing you because it inconveniences others?
My point is not that society should take no effort to reduce preventable deaths. Society should do whatever we collectively want to do.
Rather, my point was that it's hypocritical to argue that anyone that does not want to continue major disruptions is either immoral, uncivilized, or an absolute monster.
Everyone attaches some value X to human life, and some value Z to normal functioning. Not everyone values these things the same. But everyone certainly has a value, and almost everyone is okay with allowing many tens of thousands annually to die a preventable death in order to avoid disruptions to life. That being true, let's stop the moralizing arguments, and focus instead on why coronavirus is worse than other illnesses, and why it's worth it to continue our efforts to disrupt it.
In other words, my argument is really about language and rhetoric, not the coronavirus itself.
I think your argument is nonsense and pedantic to be completely honest.
For example, being against the treatment of the Uighurs in China would be an example of moralizing if we took your argument to the extreme. The government in China simply places lesser value on their lives and since we all attach different values to human lives it's hypocritical to criticize their treatment.
You're avoiding the actual argument at hand in favor of nitpicking the rhetoric. Basically, tone policing. And I don't think tone arguments solve anything over than diversion.
> It's not fun, but suggesting that your right to fun should trump others' right to life is, again, uncivilized, immoral and irresponsible.
That's not the argument he was making. And as a society we have to accept some negative externalities and weigh up the benefits, otherwise things like (recreational) road-trips would be banned.
I'm not exactly sure what OP's argument was, but it sounded like "Think of all the fun activities people sacrificed while we tried to handle a deadly worldwide pandemic!" I don't think this is really convincing to a lot of people and frankly it sounds borderline disgusting to me.
In the past, generations have willingly sacrificed their lives at war, ostensibly fighting for the common good, yet today we can't even stomach a year without pedicures and dining out? That's pretty sad and gross.
>What we might call civilized societies have however strived to reduce those numbers as much as possible
Unless you're claiming that no civilised society exists, that's not true at all. A civilisation built around minimising death as much as possible would look very differently to any that currently exists.
Resources are always a trade off. People working at those festivals and cinemas could have went in to medical care pre corona virus. People building festival stages and cinemas could have been building hospitals. If festivals and cinemas didn't exist then that would be less driving and less road deaths.
At some level festivals and cinemas existing is putting some peoples fun over others right to life, corona virus or no.
What's reasonable is exactly what's up for debate though and they didn't say "civilisation is 5000 fun utils to 1 QALY saved ratio but doing nothing about corona virus actually costs you 3 QALY for every 5000 fun utils so that's disgusting, what they said was
>It's not fun, but suggesting that your right to fun should trump others' right to life is, again, uncivilized, immoral and irresponsible.
I really don't understand what you're trying to accomplish here: are you seriously asserting "unless you can assign objectively quantifiable values to 'right to fun' and 'right to life' and prove the latter is larger than the former, your argument is invalid?"
The argument was made that "avoiding unnecessary death > fun/comfort things to do". The counter argument was "if that was true, we'd ban lots of things" and that it's more of a question of how many deaths vs how much fun/comfort.
One death a year vs permanent lockdown? We won't lock down. 99% of society dying vs washing your hands once a day? We'll make hand-washing mandatory. The deaths from Covid-19 and the responses to it are somewhere between those extremes.
The important point here is: it's not a matter of moral principles, it's a matter of where on those scales you put the deaths/counter measures. Pretending that it's a moral argument (as in "you're immoral if you accept any amount of unnecessary deaths for non-essential things like going to festivals or having pineapple delivered to your door") is simply not working unless you (demand to) ban plenty of things.
They're not even trying to say that one is larger than the former without objectively quantifying it! That would be a start.
I would like a argument. Any. Instead there's just a bunch of people treating corona virus as this exception where you're sociopath to consider any other facet of life when deciding how to respond to it.
> Containing and minimizing the effects of a pandemic is just one aspect of what we might call a civilized attitude towards human life. Conversely, not doing so is uncivilized and I might add immoral and irresponsible.
This is acting under the assumption that something can be done, that the thing done is effective, or for that matter, isn't harmful. There were, of course, many things done. Were all of them effective? Were some of them harmful?
Doing something harmful, like for example forcefully depriving many of a livelihood during a pandemic, can be considered immoral and irresponsible.
There are many ways of mitigating the harmful effects of the lock down. State aid targeted directly towards individuals (and not corporations) is a good idea, I think. The same goes for a freeze on mortgage payments, rents, evictions etc.
These are all measures that a modern state can take to prevent people from suffering economically.
Depends. If you give someone a furlough handout, they can keep buying food, paying rent, paying for services (keeping other people's jobs viable, basically).
If you let someone go bankrupt, lose their job, house, etc. they are suddenly not contributing to the economy and other people start losing their jobs. And that person then needs welfare payments anyway to avoid starving to death etc.
In the former case the government might borrow to pay for that, but if you borrow money, you have to borrow it off someone. Someone has to buy those bonds; e.g. pension funds.
"The young" will be not will be worse off overall; it has to balance out overall. Some of them will be creditors. The balance won't be evenly distributed, but future governments can decide by how much with tax strategies.
Compare to climate change, a problem we are very definitely kicking down the road to future generations.
This was already the case long before COVID, different problem, requiring an entirely different solution. Look to fix political systems in order to address these issues.
> There are many ways of mitigating the harmful effects of the lock down. State aid targeted directly towards individuals (and not corporations) is a good idea, I think. The same goes for a freeze on mortgage payments, rents, evictions etc.
I think it's a bad idea to have people with little understanding of economics, but a high sense of moral superiority, fix the problems they create through their incompetence. Politicians are the last people you want doing this.
Freeze evictions? Landlords go bust. Freeze mortgages? Mortgage servicers go bust. Now what? Mortgages when created are aggregated into securities with guaranteed contractual payments. No payments? What happens to the securities and the organizations that own them? Banks, pensions, retirement accounts, etc? What happens to the mortgage market and the young family who needs to buy their first home?
Actions have consequences. It's nice to have ideas over the internet, but reality is a bit more complicated.
> I think it's a bad idea to have people with little understanding of economics, but a high sense of moral superiority, fix the problems they create through their incompetence.
Not sure who you're referring to here.
> Freeze evictions? Landlords go bust. Freeze mortgages? Mortgage servicers go bust.
Corporations are legal fictions that do not have a right to life. Let them go bust and save the individuals working for those corporations. Once the crisis passes, they will re-create the legal fictions and continue their work.
> Mortgages when created are aggregated into securities with guaranteed contractual payments.
This should probably not have been allowed to happen in the first place.
In general valid replies to your comments are easily available. Your condescension is, however, tiresome, so I will not pursue this thread any further.
It's easy to dodge the questions and act morally superior when you don't personally have to make the hard decisions or accept responsibility for the consequences. Others don't have that luxury.
These are all problems caused by the economic system.
If an economic system can't cope with a relatively minor external stressor - and Covid is not nearly as dangerous or destructive as some stressors - then the problem is with the economic system.
Actions do indeed have consequences - and trying to use the wrong tool for the job because you can't imagine a better tool is possible is not a wise action.
> These are all problems caused by the economic system.
What problems? There are no major structural problems yet. There will be major structural problems if OP's ideas are implemented because they're not sound. That's not related to the economic system, that's related to OP's ideas.
Yeah, we've heard all of that. However, is it really true?
How many lifes could be saved if we directed 50% of world wide military budget towards ending hunger?
Let that sink for a while, and let me know if you still think the "we are just protecting you" narrative is really honest.
In my country less than 80 people have died because of the COVID-19. One can argue that many more have died because of lack of access to the medical help. Not because the health care system was overwhelmed—far from it. But the access was very limited for the sake of "preparation" to deal with COVID.
That's not a number we will know for decades. Saw an article in Sweden saying cancer detections are down 30% since the start, those undetected cancers are still developing. Unless they somehow can be caught a couple of years down the line they will sadly show up in the stats.
> A few months of not going to festivals and the cinema is by no measure a catastrophe.
Do you have any data to support that? For many people their mental health has a great effect on their physical health, and in a country like Sweden where a lot of people have mental issues already (including stress, loneliness, various forms of depression etc.), yes you could make a case that making people even more isolated by sitting at home would increase their stress and loneliness which has an effect on the health.
Young people aren't just losing a few months of festivals. A generation of kids are losing a year (possibly more!) of schooling. Young adults are graduating into career-crippling unemployment which may haunt their lives for decades. People are getting laid off, burning through their meager life savings, losing businesses that they've worked themselves half to death to establish. Suicide rates are up. We're just beginning to see the economic and geopolitical consequences... the last great depression precipitated a world war that killed 3% of the world population.
All so that 75 year olds can have an extra month or two of average life expectancy?
I have octogenarian parents who I love deeply and would prefer to see live forever. I also have a young son. I would grind up my parents and feed them to my child if that's what it took for him to thrive. And I would expect my child to do the same for his children.
Stop moralizing, this isn't "right vs wrong". It's basically picking which demographic bears the brunt of an extremely unfortunate but naturally occurring phenomenon. I'm not at all sure we picked the right one.
It's potentially a lot more if you let the virus get out of control. The hospitalisation rate is difficult to pin down, but could be something like 4% for people in their 40s. That proportion starts to get closer to the overall death rate if your health system is overwhelmed.
That study estimates years of life lost for people that died, not the infected population:
Among patients dying of COVID-19, there appears to be a considerable burden in terms of years of life lost
I don't think you are deliberately misusing statistics here, but this common confusion massively overstates the risk of infection in the same way that the early focus on Case Fatality Rates did. To be meaningful, those Years Of Life Lost numbers need to be multiplied by the Infection Fatality Rate.
I can't find an IFR for 75+, but the CDC currently has 1.3% for age 65+. The average 65yo has 19.1 years of life remaining (2010 stats, also from the CDC).
1.3% * 19.1 years = ~0.25 years, or about 4 months.
This is probably a conservative estimate - older people have fewer years remaining.
Look, if covid-19 actually reduced the average lifespan of the population by a decade, I'd be in a panic too. Thankfully, it doesn't.
I'm don't think I'm deliberately or accidentally misusing statistics. I think it's useful to look at it from both points of view.
You said "All so that 75 year olds can have an extra month or two of average life expectancy", which gives the impression that the virus is only taking people a couple of months ahead of their natural death; this is not the case if you look at the average. People are dying with years of useful life left.
You might also like to do that calculation for the worst-case scenario of hospitals being overwhelmed, to see the much more serious situation we're trying to avoid.
> All so that 75 year olds can have an extra month or two of average life expectancy?
In a "More or less" episode the insurance industry debunked that "an extra month or two": it's more like 5 years on average in a first world country.
That's some significant grand-parenting time.
Also, "flattening the curve" was not only about trying to save those old people but to not overwhelm hospitals and cemetaries. The system cannot handle so many excess deaths in so little time.
Your argument sounds like we should have let the virus go rampant and in 6 months:
1. let health workers go grazy
2. wipe out all 75+ people from the planet
Maybe the grand-children could give kisses of death to grandparents and problem is solved?
Newsflash: the world isn't steady state. What we think is 'normal' today can change, and by adapting to change we ensure our continued success and survival as a species. Entitlement as to what you feel your life should be like is a good way to be frustrated and rather than to see that a generation of kids lost a year of schooling (which isn't actually the case, most countries had only a few months interruption the bulk of which got caught by remote schooling) think about it this way: we don't get all that worked up about those countries where there are very few or poor levels of school to start with and even in the rich West 200 years ago (an eyeblink on the scale of human history) there was hardly any schooling to begin with.
The big difference this time around is that the rich West is confronted with some of their organizational and political failures.
Grinding up your parents if that's what it took for your son to thrive is a false choice, your son will thrive regardless of whether or not your grind up your parents because it isn't the end of the world to lose a year of schooling. Just work a bit harder the next year and you'll be fine.
I've watched an 8-year-old do "remote schooling". It is nonsense. We might have better luck with mature high school or university students, but the only young kids in my general vicinity receiving education are the ones whose parents can afford to hire private teachers.
It's not clear yet whether the schools here will be opened this fall. A lot of it depends on the outcome of discussions like these - and the "save lives at all costs" crowd is pushing strongly for "no". It really doesn't help to throw around terms like "survival of our species" - there is no plausible scenario where the survival of our species is threatened by Covid-19.
Well, one of my kids is an 8 year old and did 'remote schooling' and managed to keep up with the regular curriculum just fine. The big difference is in the schools, not in the kids.
> All so that 75 year olds can have an extra month or two of average life expectancy?
Extra years. There's plenty of elderly with additional risk conditions who could manage and live with them for years w/o the extra strain of a poorly understood high-impact novel infectious agent.
But the idea that vulnerability is confined to the retired is wrong. Excess death stats are also up in the 45-65 range. And I'm personally acquainted with cases 45 & under people are already looking at severe lasting health effects and have been informed of COVID attributable deaths in that age range a degree or two out from my circle. This is unsurprising at a certain breadth of infection no matter the relative difference in risks for younger demographics. Very small numbers across very large populations = large absolute impacts. Let it burn through the population without suppression measures and it's not going to look prettier.
And that includes the economic effects. They're bad. But the idea that we could have chosen not to have them is false. Once contact takes on additional risks, some large portion of people stay away from contact underlying many economic activities whether there's civil direction or not, because all transactions are still cost/benefit. The only way to stop that would have been to totally suppress knowledge of the pandemic or have crushed the disease itself from the start. Distancing measures and other civil restrictions we're left with are basically a question of how coordinated activity is, not a difference in the order of the impacts. That kind of reduction happens when people are confident they're safe and they don't present a risk to those they care about.
Also, while everyone whose career has crossed the last crash or two knows it sucks, it isn't clear the impacts move beyond economic:
And while we're considering quality of life issues -- are we really saying that a year of public education is worth the tradeoff of having a parent or grandparent relationship? I think it's interesting that some of the societies that are doing much better than the West seem to have a culture of respect for the contributions elders make to their families and societies in general. I wonder if there's a connection.
And as for whether people should be moralizing: these are moral issues, which usually makes it a good time to do so. Apparently you agree, given that your own comment does. Which might even be appropriate if your moral case were the stronger one.
The problem is, covid has tons of indirect negative consequences on people's health. Folks overall stopped moving around and exercising so much. Tons of people with all kinds of medical complications stayed at home rather than receiving checks and treatment in hospitals. Imagine finding some lump on your body, but staying at home. Or missing regular health check.
Probably impossible to estimate how many people died because of this, and how many will have their lives shorter because they didn't get treatment earlier. Here at local cantonal hospital, this has been recognized as a big failure of general directions given to the population, and is a huge problem for old people.
Its far from the trivialization you make out of it about some kids missing some festivals and parties.
> A few months of not going to festivals and the cinema is by no measure a catastrophe. It's not fun, but suggesting that your right to fun should trump others' right to life is, again, uncivilized, immoral and irresponsible.
What are your thoughts on a state of permanent lockdown in order to eliminate the tens of thousands of worldwide deaths that occur every single year due to the common flu?
Perhaps life to most of the world involves balancing several factors, one of which is risk to personal health.
> What are your thoughts on a state of permanent lockdown in order to eliminate the tens of thousands of worldwide deaths that occur every single year due to the common flu?
Total lock-downs might not be necessary. From what I can tell, the working from home-thing pretty much stopped this year's flu epidemic; one of my customers talked about sick-leave being down by over two thirds since the pandemic hit. They've already changed their policies so that anyone with cold or flu symptoms are required to work from home from now on.
> Perhaps life to most of the world involves balancing several factors, one of which is risk to personal health.
No doubt about it. However, this pandemic has shown us that there are plenty of measures that can be taken without major disruptions.
Personally, I'm all for telling people with a sore throat and fever that they should stay the fk away from things like sports events, even if it's just a flu in that specific case. The only reason the flu does go around like it does is because we let it. We don't have to.
Keep in mind that years of life lost by dying sooner are actually a complete loss, while a year in quarantine is still partially lived. It varies a lot from person to person. If it was all about yourself, what do you think would be a reasonable exchange rate?
Economists and medical ethicists calculate that exchange rate as the quality-adjusted life year (QALY) metric. It was originally designed to provide guidance on medical interventions but the same calculation can be applied to public health measures.
It's not possible to calculate that exchange rate, because you don't have access to the counterfactual. You're not taking the ratio of lockdown years to years lost to deaths, right? Both of those belong in the expenses side...
Sweden didn't lock down, that is the typical worst case you would get. So lives saved is the deaths per pop in Sweden compared to deaths per pop where you are.
The picture you’re painting doesn’t represent reality — there were definitely lock downs (mostly related to elderly care, but also to varying degrees for the general public). People have worked from home since February.
You, as so many other, are ignorant about Sweden.
We have had rules about social distancing, visit band in elderly homes, social distancing and washing hands. And if possible, work from home.
Schools from age 16 are distance nu teaching, so are universitets.
All gatherings över 50 persons are forbiden and we are to told to not travel IF not needed.
We still uphold laws, so the government bor riksdag can force lockdown om People. But can close Stores and restaurants that doesn't follow rules.
And about Corona deaths, we are probably have more correct reports of deaths than many countries, like UK. Which probably are under reporting.
That based on all deaths reporter. The exccess deaths compared to previous five years are about the same as the reporter Covid-19 deaths.
And the över deaths in Sweden are in pair with Denmark, higher then Norway but lower that Finland and Scotland (yes, part of UK).
And Finland has Hard lockdown, so Scotland and Denmark.
Even IF you compare Copenhagen area with Skåne area (South part of Sweden) with about same population, the death rate reporter of Covid-19 is higher in Copenhagen. There are areas in Sweden that have lower death rates then Finland, on pair with Finland.
So No, you are basically ignorant of the death rates of Sweden.
And yes, death rates of Covid-19 in Sweden are still lower than some bad influenza years, like in 2000. Even through the population in Sweden was smaller then, total number of deaths in flue was Word. And letting children go to school was a good Choice, as Corona isn't pushed by children, many are better going to school then forced to be at home. And they are not loosing important time in school with their friends and some normalities.
And the all deaths are now down to under normal years. Most thanks to the changed in behaviour has almost erased the flue in Sweden.
Comparing total deaths data, without different rules to define IF deaths are Covid-19 or not, shows that the lockdown in UK, Denmark and Finland did not do much difference. Not compared to Sweden, with moderate and mostly informed population about how to defeat the spread of the Corona virus.
But, that isn't interesting to wrote about, I guess. As it could show that the lockdown is the only solution, that it also cost life and sufferings.
No, Sweden has an exceptionally low population density. You cannot just grab a country and take it as a model for any other country. The same measures as in Sweden would lead to a catastrophe in many other countries.
This is what happens is democratic societies with a demographic pyramid that's upside down: lots of old and relatively few young. Politicians want to get re-elected and cater to the largest, most influential voter group (old people) and disregard younger voters agendas.
> lots of old and relatively few young. Politicians want to get re-elected and cater to the largest, most influential voter group (old people) and disregard younger voters agendas.
I really don't follow your argument. Do you believe young voters are totally indifferent to the idea of seeing their parents and grandparents die?
It is not about old people, they don't want this either. If anything old people are a lot more conservative and libertarian. Once you are 82 you sure made piece with dying after all most people you grew up with have long passed.
It is more about catering to the sort of voter that is easily scared, exposed for the first time to the fact that life is indeed fragile and limited, a voter that looks at someone to protect them.
Old people are the pawns and "protecting" them is the spectacle of demonstrating competence in governing.
There's a standard way of looking at this, and in the US the answer is yes, the life of everyone is worth the same, and that's how other economic decisions are made in the US (e.g. safety regulations need to meet this same standard). Suddenly changing the way you value lives to suit a particular outcome for a particular decision doesn't seem right. If you are going to look into the economics you should consider not only deaths but costs of all other hospitalizations, long term effects and various other second order effects. (check out the recent Planet Money episode about the value of lives in the US and their discussion of whether or not the US should lock down, tl;dr economically yes by orders of magnitude).
Stuff like highway safety is done with a single cost per human life saved. That's fine there, since the cause of death isn't terribly sensitive to age (and to the extent that it is, there are effects in both directions--young people drive more and more dangerously, but are more likely to survive a given accident, so it partially nets out).
But like many diseases, the coronavirus is far more sensitive--the IFR for a 75-year-old is >100x that of a 25-year-old[1]. That's the reason why health care spending is near-universally assessed by cost per quality-adjusted life-year (QALY) saved. To do otherwise would yield absurd results, paying the same to restore a dying child to perfect health as to extend a centenarian's life by another month of agony. Around the usual ~$100k per QALY saved and counting both the deaths and loss of quality in severe but non-fatal cases, I believe that masks, social distancing, remote working where possible, and closure of the highest-risk businesses (theaters, nightclubs, etc.) until a vaccine is available are likely cost-effective, but facility closures beyond that are not (except to any extent required to stop the medical system from getting overrun).
If it kept my loved ones and other random people from dying, sure. Everyone optimizing for their own benefit only is bowing down to the altar of Moloch.
If you look at your argument without the "I bias", there is (or at least I'd argue there is strong empirical evidence for) a tradeoff between "lives saved [from Covid]" and "decrease in the quality of life" which IMHO is the argument of the OC.
No, considering that the past 6 months also mean my parents and grandparents stayed safe, which I actually care about a little bit. Not to mention my God-parents, uncles, and the well-being of my friends' relatives.
We live in a society, and Covid19 is not just a question of personal choices.
Not to mention, people who have defied quarantine orders and have spread this to their loved ones can become depressed and suicidal, so quality of life for many who would spread this disease will become abysmal.
That is the estimated risk of death, not the risk of becoming a carrier of the disease, possibly an asymptomatic one, who spreads it to others.
This is what's really frustrating about this whole "trade-off" argument: it's fine to make trade-offs for yourself, but you do not have the right to implicitly force your choice on others. If you sit within six feet of me not wearing a mask, my risk of falling off a mountain does not increase by any measurable amount. If you have Covid-19 and don't know it yet, the same cannot be said.
A grandparent might accept a 20% chance of dying, if it means regularly taking their grandchild to the park in the last few good years of life they have left. Most of the people at great risk of CORVID only have a few good years left.
Or, look at things like obesity or smoking or drinking (all of which might be getting worse - will people develop bad habits in quarantine?). People are willing to take risks (and overburden the health system) over lots of things, and we accept that the government shouldn't make it illegal.
Actually, why don't we just create quarantine safe old people's homes, and force them all into it? Then we can protect old people in quarantine, and let young people risk CORVID to build up herd immunity, then plunge the country into a brief elimination lockdown. It would be kinda inhumane to the old people we would be locking up (though people seem willing to take extreme measures anyway) but at least it would be quick.
Now tell this to the people dying painful deaths after a horrible battle on a respirator. Your death will not be in vain, because we prevented people from "losing" a year of getting frequent haircuts and going to events!
Human wellbeing is not fungible. It is not acceptable to let a significant portion of people suffer to prevent a moderate inconvenience to a larger group of people.
It's an argument you have to accept on some level, unless you propose to make more radical changes to society. How many thousands of people could we have saved from car accidents in 2019 by banning nonessential driving?
> unless you propose to make more radical changes to society. How many thousands of people could we have saved from car accidents in 2019 by banning nonessential driving?
I'm pretty sure that mandating driver's license to be able to drive, and passing laws and regulations to enforce the use and adoption of safety systems such as seat belts, air bags, and helmets, not to mention criminalizing wreck less driving, is a pretty radical change to society.
With covid19 all people is asked to do is wear a mask and practice social distancing.
No, in Scotland for weeks I couldnt visit friends, and still cant drive more than 5 miles for social reasons.
We could make those things permenant, it would really reduce road traffic deaths if noone could socially drive more than 5 miles, or drive to visit friends.
The official stay at home order where I live forbids me from visting my family. I'm ignoring that part of it - everyone I know is, at this point - but it's a much more severe imposition than the phrase "practice social distancing" makes it sound.
You do agree that a temporary emergency measure that is expected to take between a few weeks and a couple of months doesn't come close to compare with all the driving regulation, don't you agree?
I mean, Spain had to endure a couple of months of isolation and we don't see Spaniards complaining that it's the end of the world.
At a fundamental level, yes. By degree of magnitude not even in the same galaxy. If you take a 200 million mile road trip you might contribute to one death, vs. going to a party and risk contracting and spreading a pandemic that has has already claimed hundreds of thousands of lives.
Remember, the game plan that virologists came up with for COVID acknowledged that most people will get it eventually. The point of the lockdowns was not to eliminate spread, which is impossible, but to not overwhelm the system.
And also to provide time for treatments to appear, with the eventual prospect of a vaccine.
And also to avoid panic and shortages of essentials caused by mass avoidable deaths and work absenteeism, both of which would have been the inevitable and predictable outcome of attempting to carry on as normal.
IMO the argument is already over. In fact there shouldn't have been an argument at all. There was never a rational case for trying to avoid lockdown, or failing to test/trace, or setting up other basic mitigation measures - either on humanitarian or on economic grounds.
> In fact there shouldn't have been an argument at all.
This is an awful way of thinking.
> There was never a rational case for trying to avoid lockdown
This is untrue. Many virologists and epidemiologists made rational cases against lockdowns. Sweden followed the strategy of Anders Tegnell, who is a renowned epidemiologist. The case for or against lockdowns was ultimately decided by the perception of public opinion, with politicians trading off the risk of "having done too little" versus "having done too much".
The New York times is spinning a narrative that Sweden, because of no lockdown whatsoever, had a really bad outcome. It's just not true. The amount of deaths controlled for population is lower than in Spain, France or the UK, all of which had a total lockdown. Their current fatality cases are near zero. Their economic contraction is half that of the rest of the EU.
First of all no, not lower than France's, but it was much lower for a while. Secondly, their economic contraction might be somewhat less, yet the death toll compared to Norway much higher, which did not suffer much worse economically. The question boils down was it worth for a modest economical benefit allow 5000 people to die or not. Some people think it is okay, most do not.
> Secondly, their economic contraction might be somewhat less, yet the death toll compared to Norway much higher, which did not suffer much worse economically.
This is cherry-picking. You can always tell if somebody is making a bad argument when they pick Norway - a sparsely populated oil-rich welfare state - for a comparison.
> The question boils down was it worth for a modest economical benefit allow 5000 people to die or not. Some people think it is okay, most do not.
No, that's an oversimplification. You are assuming that the lockdowns could've prevented these deaths, yet we have other countries that had strict lockdowns and that had similar death rates.
You also have countries like Germany and Netherlands with modest lockdowns and lower death rates.
There are a lot of factors at play here and the numbers are all over the place, but there is no evidence that lockdowns actually do better in the long run. Part of the problem is that most countries did do some form of lockdown, so Sweden is one of few in the control group.
No, comparisons with Norway are just a pet peeve of mine.
It doesn't really matter anyway, I already admitted that countries like Germany and Netherlands did have fewer deaths with modest lockdowns. These are samples in favor of a lockdown.
However, there are also countries like France, Spain and UK that had the strictest lockdown, yet they had higher death rates. Those hint at strict lockdowns being no more effective than modest lockdowns when compared against Germany, or even being completely inneffective when compared against Sweden.
There is no clear correlation between having a lockdown and having fewer deaths, so you can't claim that Sweden would've had a far different result with a lockdown. That's just an unknown, there are many more factors at play.
Also, the costs aren't just economic. Lockdowns are a severe restriction of civil rights. There's a great deal of suffering caused by lockdowns. They can destroy livelihoods. They limit medical care. There's more domestic violence, more suicides, more depression.
Unknown, but highly probable. It is like saying, yea it is unknown if you press the light switch and the light would turn on. Unknown yes, highly probable - yes. Lockdowns have been since medeival times and always turned out to be a working soluction.
"Everyone gets COVID" is not an unavoidable eventuality. The spread of the virus can be attenuated enough so that it a decreasing amount of people, and eventually a vaccine can be developed.
The plan is/was also to understand it, find effective protocols for managing it, etc.
(And we also have pretty good chances of coming up with a vaccine in about 1 year.) It's not "just the same amount of death, but slower, so the crematoriums don't get overwhelmed".
...pretty good chances of coming up with a vaccine in about 1 year.
This is just wishful thinking. We've never had effective vaccines for this sort of virus. (The yearly flu vaccine is like 30% effective.) Sure lots of research groups are working on vaccines, but many of them are academics who have no particular duty to work on research likely to have an immediate payoff. The researchers who do have such a duty, i.e. those who work for private drug firms, are mostly developing treatments like the antiviral remdesivir. Effective treatments of various sorts are closer than any vaccine, for COVID-19. IMHO, the most likely eventual winner will be a scaled-up version of the convalescent plasma therapy, which unlike the current version will be able to produce effective antibodies without drawing blood from humans.
At least one phase 3 clinical trial is about to start this month. I too am surprised that the one year estimate is not complete nonsense, but it seems it's not. (Of course the mRNA vector might simply not pan out, but there are still others currently undergoing phase 2.)
Efficacy is always a question, sure, yet it seems the spike protein is stable (conserved across mutations).
If the mRNA stuff works well then it'll likely work for the flu too. (It be easy to pack one shot full if flu strains.)
My understanding is that the spike protein already mutated in the human population, some time in January or early February. Researchers who started work on earlier samples had to start over because the later spike protein version has such superior fitness that it has largely replaced the earlier version in the wild.
So, stability over e.g. a month doesn't guarantee stability over longer terms.
> Covid (any vaccine based treatment really) is even more difficult as you need to wait for six months to assess transmission.
Technically, you don't. There are volunteers ready to get infected with SARS-CoV2 and I wouldn't put my money on "ethics" standing in the way in this case.
It also completely ignores the knock on effect of increased poor health due to COVID. Organ damage leads to reduced quality of life and economic output.
Studies like this show that this is a false choice, there is no real option to 'choose the economy' for example. As we saw from studies of the Spanish Flu, cities with late and light lockdowns actually suffered more economically than cities that locked down earlier and tighter because the effects of an un checked (or less well managed) outbreak that lasted longer were so devastating. More people sick and dying is a huge drag on activity, including all the people that have to look after them, and people self-isolate anyway out of fear. Pandemics like this are a juggernaut, there's no real option to ignore and carry on.
can we get past the deaths anyway, like 20% of people are going to have weeks if not months of below average capabilities plus some unknown percentage of lung damage.
Everyone keeps forgetting this is a NOVEL virus, between rare severe impacts to children, there have been neurological any circulatory issues so saying it only matters to the people who die I think is ludicrously naive.
Where did the virus come from? How did it arise? Is it deadlier than we realize? Will it remain what we see now? Does it target specific populations? Do children have unexpected long terms side effects of having it? Will it wipe out the entirety of the elderly if we allow it to circulate? Will people get reinfected by it after a short time or long time? How rapidly will it mutate to become deadlier? How rapidly less so? How many will die in the meantime?
There too much unknown to dismiss what this disease can do.
New Zealand hasn't even begun dealing with Covid-19 yet, unless their plan is to keep the borders closed permanently, or at least until the development of the first vaccine in history for any coronavirus.
They are probably the farthest away from reaching herd immunity of any developed country.
Their plan is to require a strict quarantine for all arrivals from overseas. That will be permanent, at least until an effective vaccine is available. It may work, at the cost of their tourism industry.
At age 65 (or any age) I'd evaluate my risk and modify my own activities. I wouldn't even dream of asking others to give up their work or school or favorite activities because of my own frailty.
Not sending kids to school is about keeping the teachers, administrators, and their dependents and contacts safe. It's about grandparents who care for the children and would be at risk. I don't think it's about your mom.
You asked a wrong question. You should have asked if it is ok if all her friends, all the neighbors in 60s and 70s, all the sick people of younger age, all the doctors in emergency rooms, all the people who need a surgery, but cannot get because ERs are full are under the risk, just because some 20 y.old dude wants to go to the beach.
People smoke, drink alcohol and do drugs. Those are much much worse than covid for your health. Sweden will still have much higher life expectancy than Denmark and Finland this year even though they got higher covid deaths since Sweden is much better at policing those drugs.
In 2000 the overall total deaths was actually higher then Corona this year.
That even though the population was smaller back then. And a few years earlier it also was a be ad flue year.
Actually the current death rate are lower for last month then the mean value of previous 5 years same month.
But I guess that doesn't fit the common view of how it should be in Sweden.
Nor that the total death rate are in pair with Denmark and lower then Finland, with much harder lockdown.
The Dutch think of their healthcare as the Brits think of their NHS. It's more faith than fact.
I find it impossible to have a reasonable discussion on the subject, even people in healthcare (I worked in a famous Dutch hospital). People are dug in, evidence-based medicine is a tool to improve statistics first, patient care second, and nobody knows what anything actually costs, despite the national DBC-accounting system which was invented for insurers. Hint: not even the Dutch statistics bureau can tell you what the total cost of Dutch healthcare is. I've heard this is very politicized issue, all behind the scenes of course.
I think the NHS was at one point very good, especially in terms of price/performance ratio. What you see now is the result of over a decade of governments that have a fundamental antipathy towards any kind of public service, and who consider the NHS as an obstacle that must be torn down before a more private system can be established. The difference in quality of care is visible, and the policies the system must work under essentially amount to sabotage.
You cannot know that until after the pandemic is over.
The Swedes are betting that nobody in the world will be spared from COVID and therefore the delta in deaths is temporary. They are front-loading it while attempting to keep the economic impacts as low as possible. They anticipate the rest of the world will be contending with shutdowns, re-openings, shutdowns, re-openings, and when all is said and done, the death rate per capita will be the same the world over.
So far, they the Swedes have bet one way, much of the rest of the world has bet the other way. Time will tell, but it is much too soon to make that judgment today.
They haven't seen any benefit to their economy compared to other nordic countries at all.
Partly because they are export dependant and nobody's buying & partly because enough swedes are staying home (not going to pubs etc.) for the economy to tank but not enough to avoid 10 times as many deaths as their neighbours.
So, yes, time will tell. But for now they are getting the worst of both:
Sweden hasnt any had any hospitals overwhelmed. they're just front loading the deaths that every single other country is going to have but is just delaying.
A vaccine in the next couple years is not unthinkable I'd say.
If you have a look at the current infection rate in a lot of European (and others) countries, even reaching 50% of the population infected would take decades.
So yes, I believe that delaying is not the only possibility.
I've posted elsewhere but my wife (40yo and in great health) has been suffering from a range of issues since her infection over 100 days ago. She cant climb stairs without getting out of breath. Her covid symptoms for the first two weeks was relatively mild. She is in a Slack group with over 7000 others. Predominantly women over 40 or men 2o to 50. All with serious long term issues after getting covid. It is a small number, but not small enough to wave away.
Yep but to be fair that isn’t a younger age group. Broadly speaking under-20s are pretty much unaffected. 20-40 aren’t particularly affected either if in good health and without comorbidities. 40+ can be quite seriously affected and over 65s it’s a double digit risk of death. It’s super non-linear.
It seems speculatively like this is due to age-linked expression of ACE2.
Two young people I know here in Stockholm have had complications: my team lead (who is in his mid-thirties) had an embolism in his lung after covid. He now has to inject blood-thinning medication twice a day. We’ll see how this works out for him.
I would argue a decent metric is human hours. For example, if a safety protocol costs n people x hours in return for saving y lives, then we can strike a balance. In general I'd argue that n * x ~= y * (human life expectancy in hours).
You could apply this to things like airport security and check how the sum of all the time passenger spend in line compares to the lives saved. My guess is especially in the airport example the lines have taken more human life than terrorists.
That isn't really how terrorism works though is it? 'they' want the population to be fearful doing normal things - it isn't just the life lost but the changes in behaviour people have to make.
Similarly if I died of covid now, it isn't just the 40ish years of life ahead I lose, but the impact on my wife, children and wider family. I've seen friends lose 72 yo grandfathers - who could have provided years ahead of fun and good memories with their grandkids.
Any death is unacceptable. This is, of course, unattainable in practice, so I would suggest looking at Eastern European or East Asian societies for a rule of thumb (e.g. Czechia, Slovakia, Greece, Taiwan, South Korea, Vietnam etc.).
This is not how society works. We could drastically curtail the number of deaths by outlawing cars, alcohol, and social interaction indefinitely, regardless of covid, but we don't. Refusing to understand that tradeoffs are involved is not helpful.
Also leads to undesireable conclusions. If the metric is minimize death, best way to achieve this is kill everyone alive today, or at least sterilize them. Everyone alive today will die someday, guaranteed. If they do not have any kids, there will be consequently be no further deaths. Same outcome for all sentient life. If minimizing suffering is the ultimate meteric, then the optimal solution is elimination of all sentient life.
While not explicitly specified, my comment was referring to deaths caused by the coronavirus. If you read past the first sentence you will also notice that I explicitly said that this is an unattainable standard and I have provided a number of countries that can be taken as reference for what an acceptable death rate might be.
Some deaths are caused not by the coronavirus itself, but by the lockdown. Suicides, as well as consequences of foregone or delayed diagnostic tests and other medical appointments, for example. In the US, where unemployment often means no health insurance, many thousands of lives are lost per percentage point of unemployment. I'm the third world, you've got future deaths due to foregone immunizations. So the goal is not minimizing Covid deaths at all. The goal is minimizing deaths, and it's not at all clear that going into max lockdown mode in fact minimizes the sum total of deaths.
Also, how many elderly people have died due to flatten the curve procedures that sent positive cases back to nursing homes to free up hospital beds for younger patients? An enormous percentage of the US deaths were nursing home occupants. It is precisely the lockdown procedures that have resulted in such high death rates. This is the huge uncovered scandal of the pandemic response.
from an high level/abstract point of view, all deaths (I am now specifically referring to the coronavirus, but this works for deaths in general) should be avoided. This is obviously not possible in practice, hence some deaths have to be accepted. What can be considered acceptable is relative, but it helps to look at the countries that have managed to keep their deaths low and take their numbers as a yardstick for other societies.
I think it was the wording. You said not acceptable and acceptable for the same exact thing. In this last post it was all deaths should be avoided, but that some deaths are acceptable. I think everyone can agree that all deaths _should_ be avoided, and probably those same people would agree that it would be impossible to attain that goal... specifically for Covid.
The inclusion of Vietnam on these lists always surprises me. There is no excess mortality data for Vietnam, nor any data on infections (e.g. from random population sampling). All we have is their self-reported number of cases (i.e. confirmed infections) and deaths (zero!), which come from triumphant news releases from the Communist Party (usually paired with reminders about how great this success will be for their economy in the post-COVID world), repeated with zero critical thought by overseas media.
- Nobody knows if there was some excess mortality here, because there's no monitoring.
- There were thousands of "suspected cases" in the official reports, which remained suspected cases and never progressed to a confirmed case or a confirmed non-case (as they would if they were tested) until they stopped reporting numbers.
- People with confirmed close contact with known cases were told to isolate and were only tested if they showed symptoms (this is also normal practice in many/most Western countries).
- The supposed "large" number of tests carried out in Vietnam represents only 0.2% of the population.
- A significant portion of those tests are of people who had to be tested anyway, rather than community testing (e.g. overseas Vietnamese arriving home; the large number of charter flights that were allowed as exceptions from Korea and other countries, for employees of large firms with factories in Vietnam - e.g. LG - who did not stop during the lockdown).
- The lockdown was largely not enforced, and while streets were much quieter than usual, there were many people outside throughout. Smaller bars and restaurants only closed for a few weeks, and of course nobody wore a mask inside them. Many informal businesses (e.g. street food) never closed.
I think Vietnam's "success" is largely down to some environmental factor (average temperature/humidity, sunlight exposure, the general "outdoor" way most people socialise) keeping the number of infections or the severity of those infections down, and I think the chances that COVID caused exactly zero deaths are almost zero.
> if you fail to self isolate, you go to a gov’t camp
There are a few instances of this, which of course the govt made sure were widely reported. It's very unlikely in general that they would know, though.
> all int’l flight have been stopped; only repatriation flights are happening
This is completely false, as you can verify on any public flight tracker website. The number of flights is greatly reduced, but they never stopped. Also, extra charter flights were put on for (at least) Samsung and LG employees to come from Korea, regularly, even in the middle of the lockdown. The "all international flights stopped" line was repeated many times in the local media, and most people here believe it, despite it being untrue.
> for those foreigners who made it in before the flights stopped, they all went to gov't facilities
Not true at all, I know many people who did not have to.
> if someone tests positive, they will lock down all the people around them for 24hr, disinfect common areas and test
They notify the people around them and tell them to self-isolate. They spray some bleach around. They do not test unless symptoms are shown.
Maybe there is a bit of variation across Vietnam? I’m just sharing what my in-laws observed where they live.
When I say “all international flights” stopped, I mean, you can’t just hoop on the next flight to Vietnam. Yes, there are still repatriation flights happening and flight for certain purposes, but “normal” air travel has stopped, no?
So regardless, would you agree that Vietnam is going far beyond a lot of countries in trying to control the spread?
> Maybe there is a bit of variation across Vietnam? I’m just sharing what my in-laws observed where they live.
Perhaps. My experience was with HCMC and Hanoi.
> When I say “all international flights” stopped, I mean, you can’t just hop on the next flight to Vietnam. Yes, there are still repatriation flights happening and flight for certain purposes, but “normal” air travel has stopped, no?
Actually, there were normal, scheduled flights throughout the lockdown. There are right now, there were last week, and there were every week before that. You can trivially confirm this on a flight-tracking website (one of the ones that goes on the ADS-B data, so you see actual aircraft tracks, rather than just a flight schedule website which may show you flights that didn't actually operate). Visa waiver, visa-on-arrival, e-visa and visa issuance for tourists completely stopped, so in practice a tourist can't board a flight to Vietnam, but a small number of flights have continued running throughout, indicating sufficient demand from people who are able to fly here (Vietnamese citizens, people with residence permits, people who were able to get issued non-tourist visas in their home country, ...)
> So regardless, would you agree that Vietnam is going far beyond a lot of countries in trying to control the spread?
I'd say they're pretty much on par with any of the places that aren't a massive failure. But I also think the question of which country did it better or worse is not very interesting, and mostly a pointless political distraction from useful questions like which control measures have a meaningful effect and which don't.
Agreed that it certainly can feel "fluked" or random which areas are overwhelmed and which recover, but I have to disagree with the idea that Vietnam didn't take it particularly seriously.
I was there in February, for around a month.
As a foreigner, I was regularly receiving SMS updates about covid infections. There was a website which detailed exactly when and where people were testing positive. Hotels and guest houses, if allowed to remain open, were being closed for deep-cleaning.
Buses and trains were stopped and my temperature checked, towns and islands were quarantined where someone tested positive, contact tracing appeared to be in full force and foreigners were requested to register their movements and check in daily(iirc) to a web portal.
Again, this was in mid-February.
Luck and climate seem to be factors, but Vietnam acted when they had a low caseload and handled outbreaks sufficiently well to keep R below 1. It wouldn't be all that surprising to me if there really were no covid deaths there.
I was curious. Not very convincing data. Mortality has gone down in Sweden in the long term so covid is not actually a big deal? I don’t see the connection
Taiwan has 7 COVID-19 deaths[1]. It seems far-fetched to suppose that they would be somehow covering up the 12000 additional deaths that would be required to reach Sweden's per-capita numbers.
South Korea would have had to neglect to report 99% of COVID-19 deaths.
Really? I've been in Da Nang, Vietnam for over 5 months now, and the fine for not wearing a mask only came during the short quarantine period (@3 weeks) at the start of April.
When I arrived at the end of January (during the Chinese New Year) there were thousands of Chinese tourists mobbing the convenience stores buying up all the masks they could find. At the time I wasn't really aware of what was happening, but clearly they were a step ahead of the game, likely based on past history with SARS and news coming from friends and family back home.
It's pretty amazing how low the case count has been in Vietnam; some locals say, "don't believe the government", but you'd expect any outbreaks/deaths related to COVID-19 to have gotten out by now if the government were in fact trying to hide something.
What if next year a more virulent strand of Covid comes along that kills almost everyone in the world who didn't get exposed to Covid-19. Will you still consider their measures as ALL WORKING? We have no idea how the future is going to unfold. Everyone is faking it while demanding that everyone do as they say.
There's no plausible argument from counterfactuals here.
But let's pretend anyway - do you not think that even if a more virulent strain of Covid did arrive, country with proven measures in place has a better chance of dealing with the problem than a country whose current response is a chaotic shambles?
What i'm saying is there is a problem with monocultures. They are more susceptible to being wiped out in a single stroke. I'd say that following a scientific approach, we might want to consider not advocating for everyone to take the exact same course of action. Also, that we have to be careful to not judge success or failure too soon, that assessments can change after a bit more time has passed.
If the course of action has the effect of saving lives, what is wrong with that?
The measure of success is all past and current. If Vietnam loses control over covid, then we can definitely blame them for that. Why? Because they effectively controlled it in the first place.
If they continue their direction, they will be one of the only countries on the planet, not totally infected. Pretty amazing really. If they start experimenting and doing things differently, at least they've setup the protocols for managing things correctly.
Here in the US, we go through these bullshit 'phases' where we go from phase 2 to phase 3 and then back to phase 2. Well, anyone with half a brain could have figured out that wasn't going to work. At least Vietnam is taking this seriously.
They shut their borders entirely... we (the US), can't even do that.
What a strange argument to make. What if next year we discover anyone that is infected with the current covid all drops dead after a year of infection? We have no idea how the future is going to unfold so let’s all do random things?
True. And Sweden stands out when you compare it to other Nordic countries. My point is only that you can't draw too many conclusions from just looking at leaderboards at https://www.worldometers.info/coronavirus/ and similar sites.
I would be careful comparing Covid deaths across countries.
A good example is the child mortality statistics - the US counts babies born alive, but then die, but other countries just count them as stillbirths if the death happens with X period of time.
Not saying Taiwan is hiding tens of thousands of deaths, but you have to assume some wiggle room in the numbers.
This, and we have to look at the sum of all deaths when Covid19 dies out. Maybe they did just go through it faster than other countries, but also gain group immunity faster and have faster economic recovery. Too early to tell I think.
Edit: A flattened curve may still have the same surface below it. Did Sweden keep it below critical IC capacity (are they keeping it there)? I guess that is an important thing to know.
Extra deaths don't have to come from underreported covid deaths. For example suicides and untreated medical conditions during social distancing and lockdowns can increase the number of deaths.
While reduced traffic and thereby fewer road accidents, fewer transmissions of influenza etc possibly reduce the number of fatalities. This goes both ways and getting really meaningful numbers might be quite hard.
there are additional deaths that can be attributed to the lockdown, as well as some reductions in deaths that can be attributed to the lockdown. but neither are anything close to on the same scale as people actually dying of covid.
there's obviously some margin of error, but it's pretty safe to treat the unattributed excess deaths as being caused by covid-19
If those were significant, we’d see an uptick in countries that introduced restrictions early on and avoided the epidemic.
In Poland we had quite serious restrictions introduced very early on and we don’t see any excess deaths in the stats - march and april were actually below average in terms of mortality.
Similarly in other countries with similar scenarios.
It's bit early to compare death figures. We are in the middle of a pandemic.
A second wave can change the numbers.
My main problem with the swedish way is, that it all depends on building herd immunity without even knowing if an infection leads to a long term immunity neither do we know the long term effects of an corona infection.
Studies found lung damages in people with mild symptoms, if these will heal or be permanent is unknown.
Also other long term effects are unknown.
For examlpe the corona virus just has to raise the probability of lung cancer and the swedish way will have severe consequences.
> In other words, comparing countries by their Covid deaths/capita rates is meaningless. The statistics are likely completely wrong because different countries use different definitions of "Covid deaths" and different reporting procedures.
Very true. At the other end of the spectrum, consider North Korea, which is apparently reporting ZERO Covid-19 deaths and also ZERO Covid-19 cases, so its official infection and mortality rates are 0% and 0%.[a] If we were to judge only by those official figures, it would appear the country has done a truly incredible job at combating Covid-19.
Additionally, we must also look at what percent of the population is at high risk.
India is a way younger country than Sweden. This means, with the exact same deathrate-by-age India would see far fewer deaths-per-capita with all else being constant.
> You have to look at [confounding factor] [... therefore] In other words, comparing countries by their Covid deaths/capita rates is meaningless.
Sorry, that's wrong. The fact that there is uncertainty in data (which there always is) doesn't mean we can't make legitimate inferences from the data we have. Sweden is clearly, via many metrics (INCLUDING excess deaths), experiencing very elevated mortality rates due to covid. That's just obvious.
No, the science isn't done yet (and won't be for years, probably) to nail down exactly how much they're seeing. But we can ballpark it pretty well, and it's bad.
Considering that the health care systems were partially shut down too, how do you determine that covid was the culprit rather a change in the health care system for those counted as excess deaths?
No. Those are "reaction to COVID" deaths or just normal deaths.
If you order an island evacuated because of an impending natural disaster and some people die in the evacuation they died from the evacuation, not the disaster. Just because your actions are lowering the overall body count doesn't mean the deaths are the fault of whatever disaster the people died avoiding.
FYI also, using CDC data the number of US excess deaths (all causes) nearly exactly matches the number of COVID fatalities (excluding periods where "excess deaths" turned out to be negative).
Would be cool to tally this up for all countries, to see who's lying about their COVID numbers.
How can you attribute every excess death to covid alone, at least directly? There are many countries where family violence has increased, alcohol consumption, suicide, etc. I don’t think every excessive death can be attributed to covid.
Not only that, but if you have a patient in a hospice with stage 4 lung cancer who dies and tests positive for Covid, does that go in the "Covid death" bucket?
Honest question. I don't know the answer. I assume it's left up the physician's judgement?
COVID-19 doesn't kill on its own, but weakens your body that other diseases kill you. The most common way of killing is pneumonia, which is basically done after it weakens your body other bacteria that you otherwise would be safe from steps in and kills you. Another common symptom is causing blood clotting, so some people died of stroke.
Yes, maybe that stage 4 lung cancer patient would die anyway, but then there are other deaths that are covid-19 but aren't counted. In fact no one would count is as covid cause in such obvious scenario.
BTW: also it's exactly the opposite to what you're trying to imply[1].
It's not left up to physician's judgement, it's mandated that all such deaths are reported as COVID-19 deaths. This is based on WHO guidance.
This has upset a lot of physicians and pathologists, exactly because their own judgement is being overridden and they know it's broken the statistics completely. In the UK they are calling for a systematic review of all deaths attributed to COVID:
The COVID death counts are hopelessly over-counted. This is why there's a cottage industry of people pointing out things like "COVID deaths" which mysteriously also suffered from being murdered, or drug overdoses, or undiagnosed leukaemia.
Then you get into the problem of care homes being authorised to report COVID deaths without any testing or formally trained opinion at all. In France, as soon as there is a "suspected case" in a nursing home (e.g. due to coughing), all deaths are considered "suspected Covid19 deaths", and as soon as there is a "confirmed case" in a nursing home (even if symptomless), all deaths are considered "confirmed Covid19 deaths":
Over-counting of COVID is absolutely rampant. The top voted post on this thread is claiming that all excess deaths must be caused by COVID, as if shutting down hospitals have no impact. In reality:
"More children died after failing to get timely medical treatment during lockdown than lost their lives because of coronavirus, new research by the Royal College of Paediatrics and Child Health (RCPCH) suggests."
Of course the numbers for children are small. For older people it's more extreme. In the UK emergency ward admissions halved, including for cardiac arrests. There's now a backlog of 2.4 million cancer patients awaiting diagnosis or treatment. The excess deaths from lockdowns will be with us for a long time.
I agree measuring excess deaths is wise, as it also measures those 'killed by the lock down' who couldn't get chemo etc. I am very pro lockdown, but that means we need the clear numbers all the more.
Sweden is currently seeing 20 to 25% more deaths in year that they would in a standard year. Though their covid deaths have slowed so that will likely be around 10 percent by the end of the year if they don't see further waves.
I agree, but realistically we need to use the blunt number of excess deaths, as each country is handling the tracking of covid deaths so differently. And it also helps show if the lockdown caused issues - by comparing against other causes of desth where countries have been tracking covid deaths in a meaningful and repeated way.
As I say, I believe lockdown, esp in the way that NZ/Australia/Vietnam/South Korea did - is the way forward - the more proof we have for that, the better.
I feel UK started too late, didn't put tracking in place, and gave very confused messaging. As an island nation, we should have had a head start in protecting our people but it feels like the economy was put first.
Australia is locking people in tower blocks without warning, including people who were only visiting and thus have nowhere to sleep, including people who have run out of food. Even friends trying to deliver food were turned away.
It's completely insane, unbelievably nasty, truly evil. The virus is not dangerous. I'll repeat: the virus is not dangerous. Excess deaths in the UK, relatively badly hit by a series of bad decisions, matches the famous plague of 1999/2000. You probably don't remember that one, because nothing happened.
NZ meanwhile is now terrified of re-opening their borders in the belief that this NOT DANGEROUS virus can be kept out forever. They have no plan for how to do this without going full-on North Korea. It's also incredibly self destructive. The Virus Is Not Dangerous.
Your post says your wife gets out of breath sometimes after a relatively mild COVID infection. That sucks and I'm sorry to hear it, but I'm not sure that rises to the level of dangerous, exactly. Lots of people end up out of breath just from obesity, which is I guess can be considered dangerous in some ways, but most people probably wouldn't actually describe it that way relative to many other medical ailments.
She is a healthy 40 yo who used to exercise far more than me and do yoga multiple times a week. She's fit healthy and active until she was infected with covid. The breathlessness (sometimes accompanied with massively increased heart rate) also registers as very low blood oxygen levels on her meter. This isn't sometimes, this is after any activity. This is also just one of the symptoms she's had - massive fatigue, numbness, migraines (never had them before) - it goes on.
For someone like her to be breathless - is certainly a sign that something serious can happen to those that catch covid. This, while not happening to everyone is getting more attention now: Coronavirus: Thousands say debilitating symptoms last 'for weeks' - BBC News
https://www.bbc.com/news/health-53269391
The common theme on the Slack group she is on, is that these are younger and healthy people, and that their covid was not particularly severe.
She also struggles to concentrate for any length of time, even reading a kids book to the children can be too much for her. There is no way she could work right now, and can't even do much more than supervise the kids for short periods of time - I am very lucky to have a flexible employer.
This appears similar to post viral syndrome or ME - and is happening at far higher levels than seen with our more common viruses like the Cold or Flu - though was also seen in people who caught SARs - it was not questioned that a percentage of those who had SARs were ill n months later, I'm sure in time it won't be for covid too. Just in tne mean time it means people believe the only risk is of death and that it will only affect the old and infirm.
The problem is, and I know you will hate to hear this, is that these sorts of anecdotes may or may not mean anything. Symptoms like that have a long history of turning out to be false alarms. That's the reason medical trials have placebos: health is weird and people can cure themselves or make themselves sick from all kinds of ways that logic dictates shouldn't happen, like 'thinking' themselves into it, or just via random chance.
Does COVID-19 cause breathlessness in a tiny percentage of people who caught it? Possibly, it's a respiratory virus after all. Does it cause loss of concentration? Hmm, maybe, who knows. The body works in mysterious ways. But if it can cause that then more or less any symptom at all is fair game.
Seen another way, do people with wifi sensitivity truly feel headaches when wifi is turned on? They certainly believe they do, their suffering seems to be real, yet we know their self-diagnosis cannot possibly be correct ... at least not without significantly rewriting the laws of physics and biology as we know them.
It may be that your wife should lose the Slack group and see a doctor. The risk is that the collection of symptoms she's reporting (which have no known link with respiratory diseases) actually have another cause and COVID is a distraction. It could be an undiagnosed case of something else that needs attention. We know that COVID is being spuriously linked in the media to all kinds of random conditions and symptoms, and especially when in a community of other sufferers, it's possible for incorrect inferences to be made.
That isn't correct. JP Morgan and UBS both analysed this with public data and concluded there was no correlation between severity/length of lockdown and outcomes. Not sure where you got the idea that countries with early lockdowns at 'insignificant excess deaths' in general.
Bear in mind you don't know how many people died OF covid, only those who died WITH it at the time of death, which is a totally different thing. Cases where there are no other obvious causes of death (e.g. amongst the young) are vanishingly rare.
If there are excess deaths now and this disease disproportionately impacts the elderly, the assumption likely is that it's mostly picking people off early and that 1+ years from now we should observe a deaths deficit relative to the baseline years of 2018-2019. From there we should be able to start calculating the cumulative years of life lost.
That's what I would expect if they got it under control quickly. It's the countries where it has gone wild for several months, especially in long term care facilities, where I would expect the drop in future months/years.
> In other words, comparing countries by their Covid deaths/capita rates is meaningless. The statistics are likely completely wrong because different countries use different definitions of "Covid deaths" and different reporting procedures.
Sounds a lot like comparing sprint velocities between engineering groups.
I've seen similar large errors in statistics on infant mortality. Different countries define it very differently, for example a different line between a miscarriage and infant mortality.
I could also indicate that the excess deaths is due to the lockdown or from how a country are handling the Covid-19 pandemic, i.e. not handling other cases in time.
Yet the numbers in Copenhagen and the Malmö region are comparable despite having very different policies. The population density is about the same (although the density characteristics are not).
Comparing disease outcomes at all is futile because they are incredibly sensitive to initial conditions. One sick person travelling in January made all the difference.
The serious outbreaks in the US and South Korea began at the same time. Arguably, South Korea’s circumstances were worse because there’s was driven by a secretive cult that hid their illness and misled contract tracers. Look at where both countries are today.
An immediate, thorough response makes all the difference.
Also just not having any initial sick people and closing the airports works great.
Your "at the same time" statement is off by a few days and off by a few days makes a huge difference in outbreak severity. That's why you need to keep in mind that small numbers of infected people and seemingly short time intervals change the result radically.
Do you honestly believe the difference between South Korea and the US’ outcomes is those few days? The difference in response on any dimension between the two countries, from their testing to contract tracing to on-demand hospital expansions is so staggering as to make this claim absurd.
I’m not sure what you’re talking about with airports. South Korea has had less incoming travel restrictions than the US.
I was referring to New Zealand. I don't think comparing SK to USA is nonsense but I do think comparing Sweden to China or New Zealand to USA is complete nonsense. If anyone feels compelled to do so they need to realize they are cherry-picking and compare NZ to Utah instead.
Phylogenetic analysis showed that in most countries there were multiple seeding events before the infections were discovered. In short, it wasn't just one sick person.
The jury is still out on "economic failure." The evidence cited on the economy is thin at best.
The main piece of evidence is that "Sweden’s central bank expects its economy to contract by 4.5 percent this year, a revision from a previously expected gain of 1.3 percent." Economic forecasts are ridiculously unreliable. In the US, economists forecast (on average) that 8 million jobs would be lost in May. Instead there was a 2.5 million gain in jobs. Not a single economist surveyed by Bloomberg though there would be any gain at all (https://www.bloomberg.com/opinion/articles/2020-06-06/may-jo...). The hard data we have on GDP so far: Sweden's GDP grew by 0.1% in Q1 2020 (0.4% annualized), Germany and the UK's GDP fell.
The other evidence is that unemployment has risen in Sweden and spending in Denmark has only fallen 4 percentage points more than Sweden. But Denmark has propped up employment by "covering 75 to 90 percent of all worker salaries over the next three months, provided that companies refrain from layoffs."(https://www.nytimes.com/2020/03/28/business/nordic-way-econo...). And from the numbers in the article, Denmark's unemployment rate has still risen proportionally more. Granted, Sweden has very generous unemployment benefits, but I'm not aware of a similar layoff prevention program.
The NYT has fallen into the bad habit of writing to a narrative, conscious or unconscious, rather than investigating more honestly.
In this case they want to paint the alternative path as wrongheaded and foolhardy. I’m glad someone tried something different in light of a lack of hard evidence. Time will tell if one or the other was better, but at least we’ll have baselines to compare against.
Just because a few countries in Europe and the early big ones in China/SK have slowed down they act like it's over. Yet there's still plenty of very major outbreaks in South America, Middle East, India, Russia, south east Asia, some African. They all have upward hockey stick growth still. Not to mention the delayed US south/west wave.
It's far too early to pick winners/losers of COVID in the midst of the global peak, assuming this is actually near the peak. Let alone measuring the economic consequences.
Yup I found the overwhelmingly negative tone of this article off-putting. It doesn't quote any opposing viewpoints. It doesn't quote anybody actually living in Sweden, or any sort of public opinion polls on how Swedish people feel their government is handling things. It only compares Sweden's death rate to countries with lower rates (when countries with higher rates exist). And it seems to paint a straw man argument about what Sweden's reasons are for not implementing lockdowns (I don't think it was just about the economy).
It also doesn't delve very deeply into why Sweden's fatality rate is higher than average. It seems to imply that it's all because Sweden didn't implement forced lockdowns. But I am living in an area that also didn't implement forced lockdowns, and we have experienced virtually no deaths from covid in my city thus far. What measures specifically could Sweden have taken to save lives? And is there anything that they did well?
I have found a lot of the coverage on covid to be fairly sensationalist (ranging from "it's all a big hoax" to "the world as we know it has ended"). Does anyone have any suggestions for more rational, honest, and detailed coverage of covid?
The first image people are greeted with in the article says everything needed about the editorial nature of the article. It is:
It is taken of the area which has one of the lowest covid-19 death rates. Compared to its nearby city in Denmark it even has a significant lower rate of deaths.
It is taken over the wrong time period. Both nationally and locally in that area, the death rate is going down. The image is from a few weeks ago during the warm weather when the rate was almost the lowest point of the whole measure period of the pandemic. The trend in that region is still downwards.
It is the wrong demographic when talking about death counts. In Sweden the wast majority that died occurred in elderly care homes in low social economical areas, not young people on the beach located near expensive and hip restaurants in the second highest social economic area.
But it makes for a great narrative tool, which illustrates the editorial values of NYT.
There is actually a bit of a similar thing in Sweden where the government steps in and pays a large portion (roughly 90% maybe? a bit unsure since none in my immediate circle is affected), but only on the condition that you have taken some specific other measures. For example Volvo had to end the contract for like 5000 contractors to be able to get the benefits. source in swedish: https://www.svt.se/nyheter/lokalt/vast/5-000-konsulter-och-b...
I also remember that the government made it easier for people to join the A-Kassa, the state unemployment insurance. Normally you have to have been paying the insurance fee for half a year or something before you're eligible for payout but I believe that requirement was scrapped.
I work in e-commerce in Sweden and so far we're looking at 100%+ growth numbers for this year. It's crazy. I expect it to slow down towards the end of the year, but so far it's been crazy.
One thing missing from this report is that a large proportion of the deaths were in care homes, and ministers have publicly stated that not entirely locking down care homes from the outset was a big mistake. If they had done this, the figures may well not look nearly as bad.
Also, what will count is not the first few months but the entire lifetime of this pandemic. I'll be interested to see where countries are a year or two from now.
This isn't to say I support the Swedish government's strategy - I don't feel like I know enough to say what the best strategy is, although I do think that that the worst strategy is to have no strategy, seemingly like the USA and UK.
This. It's pretty obvious at this point that a general lockdown is worthless as a replacement for locking down care homes specifically - Spain had one of the strictest lockdowns in Europe but massively screwed up their handling of their care homes, and ended up with an even worse per-capital death toll than Sweden. Unfortunately, mainstream media publications have been spinning this instead as evidence that herd immunity wouldn't work by taking the incredibly high infection fatality rate from Spain, scaling it up, and claiming this is the best measure of how many people would die to achieve herd immunity.
The same thing happened in Quebec and it lead to one of the highest per-capita death rates in the world (5,500/8,500,000)
The previous government gutted budgets for care homes which lead to chronic understaffing. When the pandemic hit, the current government enacted a fairly strict lockdown but still did nothing to help the situation in care homes, which was worsened by caretakers staying home by fear of catching the virus. This in turn lead to patients being neglected and to caregivers working in both "cold" and "hot" facilities, causing even more outbreaks.
Sweden has been doing this a long time too. Some areas have a pool of extras that travel around the whole city to different places to work. This might have spread the virus very effectively to the most vulnerable.
Heard on the radio today that we have less educated people working with elder care compared to our neighbours and that this could have made a difference too.
> It's pretty obvious at this point that a general lockdown is worthless as a replacement for locking down care homes specifically
New Zealander here, our general lockdown went very well and enabled us to isolate clusters of transmission and prevent it becoming community transmission. While two of our clusters were rest homes, several others were not - a school, a St Patrick's Day celebration at a pub, and a wedding, are significant "not rest home" examples.
So yeah, I think your focus on rest homes is too specific.
New Zealand is a special case where it may be feasible to isolate yourself from the rest of the world and reach zero cases. With that said, it remains to be seen that it is possible to maintain zero community spread over the long term, and whether the economic impact of isolating yourself from the rest of the world is worth it.
We aren't economically isolated from the rest of the world. We're still exporting and importing. Exports in some industries are higher than ever. We're still bringing in workers in certain key roles. NZers can leave (though they'll probably need to pay for quarantine when they get back). The main things that are suspended are international student and tourist arrivals, and when the flood of NZers returning home abates, we'll probably be bringing them in through the quarantine system.
What was the death rate and high-severity rate of infection for each of those clusters? The reason people focus specifically on the retirement homes is that it tends to have the most dire outcomes.
Right. From what I've read, it seems like the most effective strategy would be locking down elder care homes tightly. And also tightly locking down staff at elder care homes. Because once one resident gets infected, there's no way to prevent other residents, and staff who care for them, from getting infected. At least, short of staff wearing ebola level protection, and changing between residents. Which would be impossibly expensive and time consuming.
Others in the general population who are at serious risk of complications, such as elderly and those with preexisting conditions, should also isolate themselves. As I gotta say, I have done.
But I suspect that it will turn out that general lockdown is neither good enough, nor worth the long term economic consequences. Except of course that those long term consequences will arguably mitigate global climate change.
Don't forget that deaths are just one measure of the damage covid brings.
My wife is/was a fit and healthy 40yo no underlying conditions - she had covid 4 months ago and has barely been able to climb the stairs some days. The 'crazy' thing is that her actual covid infection wasn't hat bad and she had no shortness of breath etc at the time. But here she is with symptoms very like ME some 100+ days later.
Obviously that doesn't happen to everyone but it appears a significant proportion of those getting ill have serious symptoms some time after the illness, with no clear end in sight.
Maybe she carries that susceptibility sequence from Neanderthals. It'd also be good to focus on isolating people with that and other relevant genetic markers.
So basically focus on isolating all people above 60, all people with comorbidities, and any with genetic sequences that are ill-defined, likely many of them that we haven’t uncovered, and more expensive to test for than Covid screening?
Easy.
Or lockdowns, easy accessibility to testing and good contract tracing. Which has worked well in lots of countries
I’m not talking about Sweden, or the US, or Italy or the UK or France,
But NZ, Vietnam, China and Australia (current flare up not withstanding) have pursued policies of lockdowns, contract tracing and heavy testing. Your proposal is more convoluted and relies on the imperfect information we have regarding susceptibilities (genetic susceptibilities) being correct, and being able to scale tests to a couple billion people almost immediately so we can tell who should stay inside.
Sure, but it's likely that this won't be going away. So as soon as you relax lockdown, it may well come back. Unless there's a vaccine, which I'm not betting on. And then there's the chance of another zoonotic virus in a few years. Time will tell, but it may turn out that isolating vulnerable populations is the best long-term strategy.
You’re right that it’s a marathon not a race. But isolating the vulnerable (on a semi permenant Basis) is not easy or good for these people. With good testing infrastructure and contact tracing, we can minimise harm. We just have absolutely no definite idea who are those who are otherwise healthy who are going to end up hospitalised (say for my age group 30-40 males it currently looks like 1:500 will end up needing hospital support) and that’s even before you look at those who may do fine without hospital but still be carrying some serious consequences (ie original poster’s partner).
I for one would like to avoid getting this altogether
Maybe more than marathon. I mean, the influenza strain that caused the 1918 pandemic is still circulating. Notwithstanding herd immunity through vaccination.
Who knows - I have nearly 4 percent neanderthal dna (according to 23andme) which means I have more neanderthal dna than 99 percent of people alive today, and it didn't hit me at all.
It will be very interesting to see what we learn in a year or more, but it does appear that there is the possibility of physical for healthy people - on her slack group (with over 7000 'long haulers') some people are showing heart scaring, some lung damage, some kidney issues. The only commonalities for most is that while they felt ill with covid, most were not dangerously ill. And many are resting negative to the antibody tests as it appears their T cells fought the virus. The research can come too soon for us.
> But I suspect that it will turn out that general lockdown is neither good enough, nor worth the long term economic consequences.
Hang on, this is an article showing that a looser lockdown still ends up with your economy hammered anyway. This should not be surprising, analysts if the Spanish Flu pandemic showed that cities that locked down later and lighter actually suffered more economically. This is because the higher infection and death rate, and larger number of people caring for sick relatives. People ended up
Locking themselves down anyway out of fear, and the epidemic dragged on for longer.
Now we know this wasn’t due to special conditions back then, it’s true now too. There simply isn’t an option to ‘choose the economy’.
It’s so simple. (1) Your economy will be hit whether or not you lockdown. People are gonna reduce their activity due to the threat of the disease.
The lockdown affects behavior at the margins. And at the margins, the economic gains are linear to the additional activity due to not having a lockdown, but the growth of the virus is exponential.
Then the fact that the virus persists longer means places without a lockdown that did not drastically reduce the spread of the disease continue suffering economically.
Those are good arguments. I'm very curious what the data will show over the next couple years. However, I'm concerned that data for incidence and mortality will be too incomparable to draw reliable conclusions.
> Hang on, this is an article showing that a looser lockdown still ends up with your economy hammered anyway.
Well, there is effectively no "looser lockdown" when you're part of the EU, and even more economically tied to the rest of Scandinavia.
But anyway, the most important point is that a general lockdown that doesn't adequately protect the elderly, and others with preexisting conditions, won't reduce the death rate very much.
Spain had one of the strictest lockdowns in Europe AFTER doing almost nothing to stop spreading the virus for a long time. They only reacted when there was no alternative.
It is not just bigger than Sweden, official deaths in Spain are 27.000, the real number (taking seasonal death rate) is way over 43.000, making it the biggest per million deaths rate in the (Western) world, as Belgium (the one with the biggest number) did consider the seasonal rate.
By the way, in Spain the gobertment "resurrected" over a thousand people, going from 28.750 to 26.830 overnight.
Remember that Spain did nothing because the socialist-communist government did not want to cancel the women's day march the 8th of March and waited until 9th for starting to do something. They announced that and waited another week before implementing what they had announced.
While doing nothing, they minimized the problem, and told the people not to worry, they were in charge, only a couple of cases were expected. TVs joked about coronavirus and denounced other countries attitude against Spaniards, putting them on quarantine for staying in infected countries.
So Spain has the most deaths of the Western world because they waited almost 2 weeks letting more than a million people(100.000 positive PCRs test) get infected before doing something.
The lockdown made that million people only infect from 5 to 6 other million people(it could infect more than 40 million). If was extremely painful for the economy and made the country temporarily a dictatorship of the socialist-communist that put them in that position in the first place.
Swede here. The leadership in Sweden has consistently tried to find different ways of justifying the strategy. Blaming the results on failing elderly care has been one such tactic. When you compare the raw numbers the proportion of elderly care deaths is actually in line with (or even less than) neighboring countries.
I feel like Tegnell’s original mistake was his disbelief that asymptomatic spreaders existed. His entire strategy was based on this and worse, he loudly and publicly criticized other countries that chose to lockdown because unlike him they were fully convinced about the existence of asymptomatic spreaders.
Once his strategy to protect the vulnerable failed dramatically due to asymptomatic carriers (and the fact that people make bad decisions), it was too late for him to back down and it’s been Iraq war all over again. One day he is criticizing other countries saying that what they are doing is not sustainable and then in the next breath complaining that his strategy has been misrepresented and what he is doing isn’t different from what the rest of the world is doing.
It’s been unfortunate to watch his inability to admit his initial mistake lead to so much unnecessary suffering and pain.
He's made a long string of bad judgement calls and spurious statements.
However, I'm more appalled by the government's complete mismanagement. They have completely pushed responsibility onto this single man, who cannot be held accountable in public elections. His job is to be a key advisor. The politicians are the policymakers and the only enforceable decisions they've made is pretty much to prohibit gatherings of more than 50 people and close down high schools.
To a degree, they did a sane thing: listened to the advice of an expert. Now if you look at the other side of the ocean where the orange man didn't listen to the advice of an expert, look what happened.
I don't know how these things work in government, but relying on the opinion of just a single expert might not be the best strategy to win here. It's unlikely though that policy makers will come out in the worse shape here than they were before because even though they might have failed (a big if in the long run), they've relied on the advice of the experts rather than their beliefs.
Let's look at the track record of the supposed experts at FHM. A few favourites:
"The virus will not spread in Swedish society under the current circumstances. We might see a few cases." (February)
"A large proportion of the population will gain immunity, this will lead to herd immunity. No patients will have to be triaged away." (March)
"The number of ICU patients and infected elderly is stabilizing. Our measures in society are proving effective." (March)
At some point, a responsible and reasonably intelligent person will realize that maybe this particular expert is lacking in expertise and the two dozen or so of other domestic experts (all of them virologists, epidemiologists, professors in medicine etc.) that are fervently recommending stricter measures might have a point.
Swedish politicians have a great knack for avoiding the responsibility they ask for in the elections, and they're really good at shifting blame. I sure hope they won't get away with it this time.
How do you completely lock down a care home? It's a labor-intensive industry and you can't just put care on hold for a few weeks like you could with an assembly line. The only way to keep a virus like this away from care homes is to keep it away from friends and families of caretakers and from their friends and families. You can't focus prevention when you are dealing with presymptomatic spread.
I believe there was one place in France where the care workers moved into the facilities and then the movement of people and items into it were strictly controlled. I believe no one died from Covid-19 at the facility.
This is exactly what needed to be done, in Sweden and elsewhere. Pay staff triple and have them stay with the old folks and get everything delivered by externals with as little contact as possible. And no new admissions into the care homes.
> Will you force them with a gun? To forgo all friends, family, comforts of home, and be literally trapped at work for months?
Seems far more reasonable than locking down entire countries for months, asking people to forego friends and family (without even mentioning the consequent unemployment).
You wouldn't need to force anyone with a gun. A five-fold increase in wages - untaxed - would be more than enough incentive. The cost would be a drop in the ocean compared to the damage wrought by the measures adopted so far.
In every country (except maybe Iceland which doesn't have a standing army), the military has plenty of medically trained soldiers who are used to doing these things away from home for months
That's a drop in the bucket compared to the number of care workers needed, at least in countries that are not massive outliers in terms of both low life expectancy and a very large army.
GP said "pay staff triple". For 70% of nursing home workers in USA, that would be enough to get it done. The other 30% aren't rich enough to ignore tripled income, but rather they have family situations that would make it impossible. It's a pipe dream anyway, since our Congress is only capable of giving public money to rich people.
Ban visits, quarantine any goods coming into the building for three days, strict hygiene requirements for staff entering and existing the building. It would be really difficult, but when the other alternative is letting a highly contagious virus spread rapidly through a susceptible population I'd say that's worth it. As others have pointed out in this thread, strict lockdowns haven't prevented a horrifying number of deaths in care homes.
I don't think it was really possible in the early stages of the pandemic, and might not be possible now.
Care workers have to go in and out of elderly care facilities. We still don't have much data on how good COVID-19 testing at tracking pre-symptomatic cases, but the data points at "certainly not 100% accurate".
Even if you tested _every_ care worker before they entered the building, you'd likely miss some asymptomatic cases who could go on to transmit to the elderly. Nevermind the fact that earlier in the pandemic, the kinds of near-instant tests we have now (allbet with unimpressive reliability) weren't available.
Sure, it's not going to be perfect. But at the other end of the scale in the UK, for example, they were discharging people they knew to be infected into care homes. If you tested everyone you would miss some, but you'd catch some. You'd provide proper PPE to everyone (that is, if you hadn't cancelled pandemic preparedness measures as in the US and UK) and so on. The risk wouldn't be eliminated, but you could at least reduce it with some relatively simple measures.
> a large proportion of the deaths were in care homes
… which is no different from other countries. I seem to recall articles comparing the numbers, and the proportions seem similar in many places.
> Also, what will count is not the first few months but the entire lifetime of this pandemic.
Considering only the improvements in treatments made between March and now, it seems fairly evident that a strategy of front-loading deaths was ill-considered. Even if all countries eventually end up with the same percentage of the population infected (which is far from certain), it's likely that those with a late wave will have considerably fewer deaths.
Yes, because they're now the ones who really needed mechanical respiration in the first place. The earlier "putting everyone with a <95% blood oxygen level on ventilator" strategy harmed people by damaging healthy lungs via overoxygenation, and causing breathing dependence that doctors found difficult/impossible to wean from and all sorts of other complications, such as deep vein thrombosis. (This is what happened to Nick Cordero.)
Yes, but presumably (1) that harm affects everybody put on ventilators and (2) those who are now put on ventilators are the most desperate cases, so better ventilator triage as such does not seem to explain the improvement in ventilated death rates to me (even though it may explain improvement in overall death rates).
It's all been reactionary. Individual states and even cities are opening up when people clamor for summertime fun, and then frantically closing back down when the inevitable spike hits a couple weeks later. There is no attempt at cohesion or long-term planning. There is no leadership. They're all just winging it.
It's been no more reactionary than most other nations in the world. There is absolutely long-term planning by the majority of states. To the extent that states are frantically changing their strategies, it's because we're learning more about the virus and how it spreads, and shifting our strategies.
Take New York, for example. Its high death rate can be largely attributed to Governor Cuomo's disastrous decision to force nursing homes to accept COVID patients from hospitals. He has since walked back that strategy, and New York continues to maintain a phased lockdown strategy with a structured re-opening plan with measurable criteria[1].
Governers Inslee, Newsom, and Kate Brown have been receiving (well deserved) praise by the media for their structured approach to handling the outbreak[2].
Governor DeSantis deliberately focused Florida's COVID strategy on nursing homes, deploying the National Guard to the nursing homes, and prioritizing testing resources in LTC facilities[3]. To this date, Florida has among the lowest deaths per capita in the Union, and lower deaths per capita than most of the EU[4]. As a result of this, even despite a recent increase in cases, their death rate remains mostly flat — especially relative to the same metrics in most other States[5].
Between March 16-23 (at the outset of the outbreak), every single US state ordered a state of emergency, 11 had stay-at-home orders, 30 activated the state national guard, and 48 closed their schools[6]. By as early as March 9th, the States were doing the VAST majority of COVID testing[7]
As of right now, 36 out of 50 US States have a lower per capita death rate[8] than France, Sweden, Italy, Spain, the Netherlands, and Ireland[9]. 15 States have a lower per capita death rate than Germany and Denmark, who have seen the best COVID outcomes in the EU. The US, to date, has administered more tests per capita[8] than Belgium, Australia, Ireland, Italy, New Zealand, Canada, Switzerland, Germany, Austria, Norway, and Sweden (to name a handful).
It would take the most uncharitable reading of the situation to conclude that the US member states have been any more "reactionary" than typical peer nation-states.
Wish I could upvote this more. To hear it said, you’d think half the US has died already. Another great point that people always forget is that the US, at least in situations like this, is better thought of as similar to a collection of small countries. Policies are not the same across the board. Sorta like how not every EU country is doing the same thing, and wouldn’t you know it, some EU countries are doing better than others.
Washington and below all have close to equal death rates, and marginal differences are probably hard to attribute to any specific set of policy. This, of course, should not detract from the commendable numbers we see in Utah, Hawaii, Vermont, Texas, Oregon, etc.
Yes, "among the lowest" != "the lowest". Great insight.
Just look at the data: the drop-off between Florida and Oregon (spanning 23 States) is equal to that between Mississippi and Colorado, which are adjacent data points.
US states do not have a clearly articulated strategy. A clear strategy would be something like "apply mitigations and lockdowns as lightly as possible while keeping R below 1 so the number of active cases continually declines, until we have a vaccine or we have suppressed community transmission". AFAIK no governor has said anything that clear.
A lot of state actions seem to have been driven by a strategy like that, but a lot seem more like "people got tired of lockdowns and we kinda hope things might not get bad if we reopen, so we're reopening".
> but a lot seem more like “people got tired of lockdowns and we kinda hope things might not get bad if we reopen, so we’re reopening”
This isn’t unique to the US, the entire world is playing a giant game of economic chicken with COVID, and the entire world is beginning to re-open, even without a vaccine or any sort of “plan”.
Just like the EU, the US is a mixed bag. You have States like Germany with exemplary planning and strategic decision making, but you also have Italy’s and Spain’s. You have States like Washington, California, and Utah with exemplary planning, but you also have New York’s and Louisiana’s.
As with any collection of generally autonomous governments (especially where the power to enforce lockdowns and issue curfews is vested), strategies can vary, outcomes can vary.
Sure, there are many other countries that likewise lack a clear strategy. But it's not good to grade on a curve here. Americans should be demanding a clear strategy, both from the states and from the federal government; they mostly aren't, and I don't know why.
Nobody is grading on a curve here. The whole point is that, while it is fair to criticize certain States for their lack of a clear strategy (there are only a few), when it comes to COVID, the US as a whole is not a monolithic entity, it is a collection of States.
Each State has its own government, and each government has its own infectious disease agency (each with billions of dollars in funding), a chief executive, and a legislature. People forget that individual American states have GDPs on par with sovereign countries. California is comparable to the UK, NY to South Korea, Texas to Canada. The US State with the lowest GDP per capita, Mississippi, is comparable to Portugal.
At the outset of the outbreak, the vast majority of US States initiated systematic responses comparable to that of peer nation-states. Most citizens of most states ARE demanding a clear strategy from their State governments, and that's what they're getting.
The CDC provides an advisory role, and has no authority to issue lockdown mandates, close businesses, close schools, or issue testing or mask requirements. The US States may rely on the CDC advice, but it can also choose to ignore it or supplement it with the recommendations of their own State disease control agencies. Keep in mind that the CDC and the FDA both dropped the ball multiple times during this outbreak (dragging their feet on approving new testing, flip flopping on mask policy).
While it would be awesome for the Federal government to coordinate the perfect COVID response, the US is set up in such a way that the States don't need to rely on such an ideal.
Australia and New Zealand aren't good comparisons for testing rates because they have negligible community transmission. When no-one's infected with COVID-19, people aren't going to seek tests as much, and a higher testing rate is not necessary.
And still the number of deaths per day has fallen by 90% and still dropping. It’s doing what viruses do, quickly burn through the elderly and infirmed and then taper off.
That is the same as "no strategy". Without coordination of the lockdowns, travel monitoring, national testing and contact tracing, you're just going to have shifting hotspots of infection. This also leaves behind an embittered population whose lockdown sacrifices were for nothing.
That's not the same as "no strategy", because this level of decentralization is how nation-states work today.
It's also, incidentally, how the EU works. There are open borders between member states — and while some member states "closed" their borders, this has been largely unenforceable in land crossings because there are no border patrol agents between every single land crossing between EU member states. Border enforcements have only been enforced at airports.
In the US, nationwide air travel came to a near complete stand-still during the outset of the pandemic, so inter-state travel was already at the same levels you had in the EU.
The US's strategy has been the same as the EU's, and it has been to let the member States define the strategy.
As of right now, 36 out of 50 US states have a lower per capita death rate[1] than France, Sweden, Italy, Spain, the Netherlands, and Ireland[2]. 15 States have a lower per capita death rate than Germany and Denmark, who have seen the best COVID outcomes in the EU.
The US, to date, has administered more tests per capita than Belgium, Australia, Ireland, Italy, New Zealand, Canada, Switzerland, Germany, Austria, Norway, and Sweden (to name a handful). This is not because the US has a nationwide testing regime, rather it's because testing systems have been administered at the State level, with varying strategies (some focusing on nursing homes, some focusing on drive-thru testing etc).
> That's not the same as "no strategy", because this level of decentralization is how nation-states work today.
It's one thing to leave pandemic response to member countries like the EU does. Each country knows it's responsible for its own response. Money is budgeted and spent specifically for this purpose.
That's not the system in the US - or hasn't been. The Federal government maintains what, until recently, was the world's premier infectious disease-fighting organization - the CDC. The implication was that pandemic response occurs through this organization. In the past, this is exactly what happened.
You may recall the one state (Washington) earlier this year whose brave scientists decided to test for COVID on their own. They were told in no uncertain terms from the feds to stand down or else.
So the idea that this pandemic response is up to the states doesn't hold water. Had the states known that they'd be left twisting in the wind, they could have taken steps beforehand.
That's one likely outcome of this event (assuming it has a clean endpoint): states realizing they really are on their own - and acting like it.
> That's not the system in the US - or hasn't been. The Federal government maintains what, until recently, was the world's premier infectious disease-fighting organization - the CDC. The implication was that pandemic response occurs through this organization. In the past, this is exactly what happened.
While you're right that the Federal government has the CDC, every single US States has its own infectious disease/health agency[1]. Furthermore, the EU also has its own centralized disease agency[2]. Structurally, both the US and EU are very similar in this regard. The only key difference is that (to your point) the EU States may override the ECDC, whereas US States may not — certainly a worthwhile policy change for the US.
> So the idea that this pandemic response is up to the states doesn't hold water. Had the states known that they'd be left twisting in the wind, they could have taken steps beforehand.
But this is factually incorrect, States did take steps beforehand. By March 23, every single State declared a state of emergency, and 48/50 States closed their schools. By as early as March 9th, the States were doing the VAST majority of COVID testing[3]. As of right now, the US has administered more tests per capita than Belgium, Australia, Ireland, Italy, New Zealand, Canada, Switzerland, Germany, Austria, Norway, and Sweden (to name a handful). This is not because the US has a nationwide testing regime, rather it is because testing systems have been administered at the State level[4].
> While you're right that the Federal government has the CDC, every single US States has its own infectious disease/health agency[1].
Those appear to be general public heath agencies with names like: "Department of Health Services"; "Medicaid"; and "Department of Health and Environment". I don't see one mention of the word "infectious" to indicate specialty.
None appear to be a unit with a mandate along the lines of "Detecting and responding to new and emerging health threats"
> By March 23, every single State declared a state of emergency, and 48/50 States closed their schools.
I was alluding to steps that might have been taken many years ago. Like, for example, establishing rapid response teams. Like, for example, giving states carte blanche to do their own testing when needed and not be forced to wait around for the CDC to do something. Certainly not reprimanded for taking the initiative.
> Those appear to be general public heath agencies with names like: "Department of Health Services"; "Medicaid"; and "Department of Health and Environment". I don't see one mention of the word "infectious" to indicate specialty.
Lmao what, that’s your argument? That’s just what the states call it. Take, for example, the Minnesota Department of Health. Among other things, its main charter is “disease control and prevention”[1]. This is true across the board. Every single US State has such an agency, whose staff are currently working full time on COVID. “I don’t see one word of the word infections”. Come on, really? THAT’S the best you got?
> "ECDC has approximately 300 staff and commands an annual budget of over €50 million."
What’s your point? The EU has funded their centralized agency less than the US, so? That doesn’t change the fact that the US has a federalized structure similar to the EU, where the States have a similar level of autonomy as their counterparts in the EU. The US State health agencies fall under the purviews of the State governments, which are wholly independent from the Federal government.
> "CDC's budget for fiscal year 2018 is $11.9 billion.”
Take this and also compare the budgets to the state government health agencies. The New York CITY Department of Health, whose responsibility includes infectious disease prevention has a budget of $1.6 billion, with 6,000 employees[2]. That’s just for the CITY of New York!
Random anecdote about the difference: I (in Germany) can't really remember seeing anything about what ECDC said or thinks in the past months in the media, only about country-level (and lower) authorities. Whereas US-CDC seems quoted quite a lot in US media.
Oh for sure, the CDC is certainly more talked about by the media, but the power and structure of the agencies is fairly similar.
It's only a matter of time until EU's agencies impose supremacy on its Member States. The EU supreme court is already starting to penalize member States for violating policies[1].
ECDC has primarily the "power" to coordinate data exchange between member states, and afaik no authority to force lower-level health authorities or healthcare providers to do anything, unless member states were to explicitly adopt their suggestions as binding in local law.
The mess that's going on with ECB is an IMHO quite special situation (which also is an odd example for "already starting to penalize for violating policies". There is no "starting to", obviously EU law has enforcement tools - although the court itself can't use them)
In the EU, land crossings were re-manned on many borders and during the main lockdown (which is now mostly over) passenger travel on many land borders was stopped. On many borders (though not all) physical border checkpoints still exist even if they're widely open almost always, and the legal and administrative framework for controlling land borders is still maintained. Of course, it is now much easier to cross the border illegally outside of these checkpoints than before, but this still allows effective control of travel as most people are not criminals.
"Border enforcements have only been enforced at airports." is absolutely not true. For example, I recall the international issue of making transit arrangements through Poland when back in March many people were stranded as the Poland-German border was suddenly closed; if I recall correctly, the agreed solution to repatriate these people was a police-escorted car column that was allowed to transit through Poland without these people being allowed "proper entry", but before that they were stuck for days in their cars as they could not get through the border.
This is a key difference between EU and USA - the Schengen agreement allows member states to temporarily "opt out" of the free travel, reinstate border controls and impose travel restrictions (up to a full closure of borders) for various purposes, and many EU countries did just that due to Covid; while in USA, as far as I understand, the constitution greatly limits the right of states to prohibit interstate travel.
> This is a key difference between EU and USA - the Schengen agreement allows member states to temporarily "opt out" of the free travel, reinstate border controls and impose travel restrictions (up to a full closure of borders) for various purposes, and many EU countries did just that due to Covid; while in USA, as far as I understand, the constitution greatly limits the right of states to prohibit interstate travel.
The Supreme Court has directly addressed this in the case of disease epidemics and found that, in the absence of specific Congressional action preempting such regulations, states are free under the Constitution to respond to epidemic disease (and several other kinds of crisis) by enacting and enforcing travel restrictions, even though they impact interstate commerce.
While no state has adopted border closures for containing COVID-19, several have adopted quarantine policies affecting interstate travel and adopted border checkpoints as part of the enforcement mechanism.
> while in USA, as far as I understand, the constitution greatly limits the right of states to prohibit interstate travel.
The US States have been imposing varying levels of requirements on inter-state travel from other states. New York requires anyone entering from a set of states to quarantine for 14 days[1]. Maine requires visitors from a list of States to have been tested (I'm traveling to Maine and will be getting tested ahead of my trip)[2]. These are just a couple handy examples, but it's true across the board.
And finally this is all moot because, per my original post, the results really speak for themselves: the majority of US States have lower per capita death rates than the major EU member states, and a small handful have lower per capita death rate than the best EU member states (Germany, Denmark).
> New York requires anyone entering from a set of states to quarantine for 14 days[1].
Does it actually enforce this, or is it just an advisory? Has anyone been fined or arrested for breaking quarantine? Are they conducting papers-and-purpose-of-stay-please inspections at the interestates, prior to entering the state?
The only state that I know of that actually enforced quarantine is Hawaii, and even there, the beaches have magically filled with tourists over the past week... I'm sure all of them sat inside their hotel rooms for the entire two-week quarantine period...
> lower per capita death rate than the best EU member states (Germany, Denmark).
You repeat that a couple of times in your posts, I am curious where do you get that from? Germany and Denmark are not "the best", they are both above the median in the EU.
The main point is that any criticism you might level against the US States for its supposed "lack of strategy", ought to just as easily be leveled against Germany. Instead, Germany is widely regarded as having a coordinated/successful strategy[1][2].
Even among the EU States with the fewest deaths / M — that is Hungary, Finland, Slovenia, Estonia, Poland, Croatia, Latvia, etc — you have comparable US States in Maine, Utah, Idaho, West Virginia, Oregon, Wyoming, Alaska, Montana, and Hawaii.
> In the EU, land crossings were re-manned on many borders and during the main lockdown (which is now mostly over) passenger travel on many land borders was stopped.
Which was one of most nonsensical measure and it is real shame that EC did not prevented that. It caused real problems for people living near borders and working in neighboring state, and for cargo transit.
Covid-19 prevalence was not homogenous inside each country and inter-country neighboring areas/districts were often more similar than far-away intra-country areas. Therefore, any movement restriction would make more sense on more fine-grained level, but doing it on country level is just political tool to mobilize nationalistic support.
> Border enforcements have only been enforced at airports.
That's wrong. Most land borders, also within the Schengen area were closed and only a small amount of people, i.e. citizens, workers were permitted to cross.
Things are slowly opening now within the EU. But that you could just waltz over any old land border is flat out wrong.
I don't think that is true. In my state the governor shut things down quickly and completely and we haven't started opening back up yet. The result is very very very few cases of Covid-19.
Coordination of lockdowns makes no sense past a county or small state. Do you believe NYC and rural Nebraska should be coordinating schedules when they have vastly different situations over time?
The federal government doesn't need to order anyone to do anything. Fighting a pandemic is in everyone's best interests. It just needs to ensure there's a consistent strategy that everyone is executing.
It doesn’t need to do that at all, any more than the EU government needs to ensure there’s a consistent strategy among its member states that everyone is executing.
Different strategies apply for different states, because they have different elderly populations, different density characteristics, and different health system capacities.
Further, we still don’t know which approaches are the best, since we’re still learning about the disease. The fact that there are 50 separate approaches being tested affords us a wealth of data to operate on to shift strategies. As you said, fighting a pandemic is in everyone’s best interests, and states can and will change their strategies to minimize suffering.
An example: Governor Cuomo employed a fairly disastrous nursing home policy, which is largely what caused New York’s staggering death rate (at this moment, the highest in the Union). To be fair to him, he didn’t know that the virus would have this effect, and upon seeing the results from other states (FL, TX) which specifically protected nursing homes, course-corrected his own State’s strategy. This is a win for everyone, in the long run.
> In Florida, all nursing home workers were required to be screened for COVID-19 symptoms before entering a facility. On March 15, before most states had locked down, DeSantis signed an executive order that banned nursing home visitations from friends and family, and also banned hospitals from discharging SARS-CoV-2-infected patients into long-term care facilities.
> Instead, states like New York, New Jersey, and Michigan actually ordered nursing homes to accept patients with active COVID-19 infections who were being discharged from hospitals.
> The most charitable interpretation of these orders is that they were designed to ensure that states would not overcrowd their ICUs. But well after hospitalizations peaked, governors like New York’s Andrew Cuomo were doubling down on their mandates.
> As recently as April 23, Cuomo declared that nursing homes “don’t have a right to object” to accepting elderly patients with active COVID infections. “That is the rule and that is the regulation and they have to comply with that.” Only on May 10—after the deaths of nearly 3,000 New York residents of nursing homes and assisted living facilities—did Cuomo stand down and partially rescind his order.
Way to argue against a strawman - please explain where "coordinate" means "everyone all at once with no regard for local conditions".
Neighboring states and counties should be coordinating schedules, travel restrictions, and stay-at-home requirements. Here in the Bay Area alone San Mateo, Santa Clara and San Francisco counties had conflicting requirements for how far away from home you could be and for what reasons.
Most places are already doing that, and have been for a while. See Newsom's orders/recommendations. They could agree if they wanted, apparently they don't for reasons we may not know.
Taiwan. 7 people have died. No major economic impact. Now exporting masks to other countries. No brushing aside deaths of the elderly and disabled as if those people’s lives were nothing.
Their’s was demonstrably the best strategy and everyone else is just making excuses.
Taiwan and Germany have the advantage that they have strong domestic medical testing industries. This allowed Germany to do 5x to 10x as many tests as France, Italy and Spain. In turn this enabled them to accurately map the spread of the disease and use targeted tactical lockdowns to eliminate outbreaks at the local level. Korea did the same.
Without the same testing capacity, this strategy simply wasn’t available in most other countries. However now that testing capacity has ramped up, we should be able to employ more efficient lockdowns from now on. It’s still not a magic wand though, Germany’s economy has still suffered significantly even with a relatively efficient lockdown.
Lots of very different countries have beaten the virus in different ways. Apologists for the failed US response have to resort to special pleading: "it's not fair to compare the USA to South Korea ... or Taiwan ... or Germany ... or Australia ... or New Zealand ... or Japan ... or Vietnam ... or China ..." American exceptionalism at its least fine.
Of course some countries have dramatically different demographics, geography and medical systems than others which can have a huge effect. As has been pointed out in a parallel thread Vietnam locked down all international travel very early, and demographically has a far younger population than most nations which has a huge effect on relative mortality rates.
For New Zealand they have an extremely widely geographically dispersed population, which you can think of as built-in demographic social distancing. They also locked down early and there was strong popular support for the lockdown.
It's really pretty ridiculous to expect radically different countries with completely different geography, demographics, medical systems and lockdown policies as though they're all assumed to be equivalent as a default. Specific local conditions can have a massive effect. But anyway I'm not even sure I understand what your point is Why do you think these countries outcomes were so radically different from, say, that in New York, or Lombardy? Or what's happening right now in Texas?
> For New Zealand they have an extremely widely geographically dispersed population
I don't know the answer, but is this actually true? Sure, the density as measured as a ratio between population and land mass indicates a dispersed population, but is the population not centered in a handful of cities?
A quick search indicates that Auckland, a single city, contains a third of New Zealand's population.
FWIW Vietnam's youthful demographics are pretty much irrelevant; what's impressive about Vietnam is not its mortality rate but that they shut down viral transmission.
My point is that many countries with wildly different conditions have successfully suppressed the virus, which I think suggests that just about any country could have suppressed the virus with the right policies. At least, one should not confidently assert that there is no way the USA, western Europe, etc could have successfully suppressed the virus.
> FWIW Vietnam's youthful demographics are pretty much irrelevant; what's impressive about Vietnam is not its mortality rate but that they shut down viral transmission
The young are less likely to get sick, those who don't get sick are less likely to spread the virus. Youthful demographics are not irrelevant to shutting down viral transmission.
I have had the impression that the age effect on sickness and transmission is much less than on mortality, but I admit I don't remember any specific data on that.
I'm not saying they couldn't have suppressed it, I'm saying they couldn't have done so without a lockdown. Once the virus is progressing through your population there's no other way, though masks certainly seem to help. With sufficient testing you can track it's progress and employ smarter lockdown strategies of course.
As to your final question(s): I think the key differences are: developing a national strategy to defeat the virus, not live with it; clearly communicating that strategy; and sticking to it.
Countries with SARS experience were quick at developing and communicating those strategies. Other countries like NZ and Australia were not absolutely quick but were quick enough because the virus got here later.
Also, the choice to offshore medical supply infrastructure was a deliberate one by many wealthy countries. That this was foolish and short-sighted is not any more of an excuse than anything else with their poor responses.
Vietnam has a population 10 years younger than Taiwan / Sweden / Germany. This is a very significant factor when we are talking about Covid, and explains the very low mortality rate in Vietnam.
But yes: Vietnam still did great, most likely thanks to very early intervention (as early as January).
Vietnam has low mortality because they stopped the spread of the disease early on. If they had allowed it to sweep over the country, like Sweden, this population age difference might have been a factor. Thankfully, it never came to that.
Yeah. Every country had vast majority of deaths in care homes.
In fact, this is a complete repudiation of the Swedish experiment because the one thing they did say they would do was protect the vulnerable. It was the only goal they had. And they failed miserably.
A very large percentage of US deaths are also from the same type of residents - care homes, elderly communities and such. I read that it was as much as 40%. I need to find source.
55k+ deaths, 296k+ cases, staggering numbers. Out of a 1.3M nursing home population
(https://www.cdc.gov/nchs/fastats/nursing-home-care.htm), which makes you wonder if the recent decrease in deaths is driven by the fact that the majority of the susceptible nursing home population has already been affected.
Deaths per 1M population are significantly higher in Italy(577), Spain(607) and the UK(654) than they are in Sweden(539). And Sweden have been a lot more honest in counting than most countries.
There seems to be a drive to discredit the inalienable human rights approach, in this case by implying it was a financial decision; but i have to say i am impressed by the way they have handled this situation, the only response on earth that involved treating their citizens like adults.
South Korea never had lockdowns, outside of shutting down bars when they traced some superspreading events back to them. The idea that they’re somehow less committed to human rights when they’ve preserved freedom of movement, while avoiding mass deaths, is laughable on its face.
South Korea, Taiwan, Japan etc. have all done so much better that comparing the responses of “the west” is just nitpicking extremely flawed plans and executions. I know who I’m going to look for guidance in any future outbreaks
For most society level problems we are OK as long as most people behave responsibly most of the time, so this approach is great. We can inform our citizens and they can enforce good behaviour amongst themselves by tutting and grumbling in a disapproving way.
This is not true of a contagion. Occasional "just this once won't hurt" violations are enough to break containment.
That's why the countries that enforced strict measures early — suspending individual freedoms — have had better outcomes for their health and economy.
Fighting a contagion is like hygeine in a kitchen. You know which surfaces and utensils are clean or dirty, and you don't put the dirty things back with the clean things until they've been cleaned and dried.
In the same way, you try to establish regions where a contagion is/may exist/is not, and then expand the clean regions. If people have their inalienable human rights, then you can't do the basic containment strategy, because your clean regions keep getting contaminated.
Endangering the lives of others has never been an inalienable right. If not wearing a mask or being physically close to others currently breaks the non aggression principle it is reasonable for society to impose temporary measures until it no longer breaks the NAP. The countries that dealt with SARS understand this and have had the best responses globally.
> Endangering the lives of others has never been an inalienable right
That's simply wrong. I am allowed to drive a car, which is inherently dangerous to pedestrians (140,000 accidents per year in the US). I am allowed to have a lot of (or all?) contagious deseases in public, which is dangerous to the elderly and immune-compromised. I am sure there are many more examples. Small dangers are everywhere. I am all for wearing masks but let's not make up stuff.
Any coherent explanation of this pandemic is going to need to explain why some countries that didn't do very much (e.g. Japan) ended up with far fewer deaths per capita than countries that locked down (e.g. EU countries and the United States).
Sweden is somewhere in the middle -- they are being criticized, yet other countries in Europe which locked down have ended up with a higher per capita death rate.
Why is it that Cambodia and other nations in southeast Asia have negligible deaths despite doing very little to combat the virus, while countries in the EU which locked down have way more deaths per capita?
Somehow the models about the spread and death rate of this virus seem to differ on a geographical basis, and that needs to be explained.
At this point, any analysis of the pandemic that does not attempt to tackle this problem is selectively ignorant.
It’s not about comparing policy from the top down but rather comparing public opinion of the virus from the bottom up.
Asian cultures have take the virus much more seriously than European cultures and regardless of government policy that is going to be a major determinant of how much the virus spreads.
Put in another way, two countries can apply the exact same policy against the virus but have diverging outcomes because of public opinion of the government, of the virus, and of their fellow citizens.
And that's the case with Sweden too. What many foreigners, incl media abroad, does not realize is that Swedens reaction was not that different to other European countries in terms of goal. Flatten the curve. In terms of means it differed, it uses recommendations. But people trust government much more than other countries, so in practice the life of many Swedes was restricted very similar to other countries.
It's just wrong to say they are being "lax" here. If any other country would have tried the same means, it would hve failed utterly. Just as you say -- two countries doing the same policy could get very different outcomes.
My partner (American w/ Chinese parents) strongly believes a major difference is the sense of collective responsibility in Asia. A kind of deferral of individuality to benefit society.
There are singificant cultural differences. According to an italian friend of mine many italians disrespected the distancing measures, plus there are differences in how closely people generally interact and their living situations.
A German college truly believes that this virus was created by Adolf Gates to enrich themselves with the pandemic while helping China destroy the German economy.
The scene around conspiracy theorists Heiko Schrang and Attila Hildmann sure is fascinating. Wearing masks is the ultimate evil to them, for some reason.
There's even big differences on Covid death rates within Switzerland's German-speaking, Italian-speaking, and French-speaking regions. Much higher death rates in the Italian and French parts than the German part [0].
One explanation could be different cultures, or just geographical proxomit to Italy and France that were harder hit than Germany and Austria. This would also explain that Germany has higher rates in states that are close to the French border.
It's not strongly related to any of those things. The situation would be very bad in Norway/Denmark too if we didn't react like we did.
Compared to both Sweden and Britain, Norway reacted quicker and harder, with way more testing than most other countries. As it got out of hand, even more restrictions like shutting down a lot of business types, public transportation, schools and travel was added. Working from home was also recommended and used by basically everyone who could. Long after this happened in Norway, things where mostly as usual in both Sweden and Britain, despite the number of infections climbing fast.
They already had masks on when others questioned their effectiveness and to this day, 95% people wear masks outside.
They have hand sanitizers on pretty much every shop entrance and chairs are placed with certain distances apart.
They don't wear shoes at home and public spaces don't have litters all over.
They don't hug and kiss frequently like some countries do.
Some stop visiting restaurants when they read news that daily infection count goes over 100. (Not 10,000.)
Apparently they don't riot shouting in the middle of the outbreak.
How about that they have been acting clean before covid happened and government not exactly handling the situation strictly wasn't really the cause of the difference in death rates?
Also interesting is that they have a train system with packs of people squashed in a cabin but the infection rate is still low and someone needs to prove/disprove the BCG vaccine theory.
It means, whatever you have stepped on outside, you don't just spread it all over your house... Maybe you don't step on Covid infected materials but who knows? It's just another possible source.
Demographics of the population, when countermeasures were rolled out, how severe those were, reporting errors, reporting standards (and changes to those standards as the pandemic progressed), how wealthy / healthy the country is, how much IC capacity they had relative to the size of the population, whether they had a pandemic plan already in place, previous experience with pandemics, initial number of infections prior to planned approach, temperature, humidity, culture of handshakes, prior mask wearing, genetics and so on. This is going to be a very complex problem to get a grip on in such a way that the model does not end up to fit the available data (in other words: that it would not have much in terms of predictive ability).
> some countries that didn't do very much (e.g. Japan)
Japan had a strong preexisting culture of wearing a mask when going out in public if you're the slightest bit sick.
> countries that locked down (e.g. EU countries and the United States).
The early EU countries (Italy, France, Spain) and the US didn't lock down until far too late when their local epidemics had already spiraled out of control.
The US in particular locked down far too late, too little, and has now re-opened despite still having a huge number of active cases and community transmission. On top of that, it sounds like a large number of people there are still refusing to wear masks.
> Why is it that [...] nations in southeast Asia have negligible deaths
I'm less sure here but I'd guess it's a combination of age demographics (fewer very old people who are most likely to die of the virus), lack of testing/reporting, and higher overall death rates due to disease which masks the effect somewhat.
yeah, i think the cultural aspect can not be ignored!
The stereotypes of some cultures being more cold and wanting to keep their distances is grounded in reality. In e.g. france or italy having very close contact for example when greeting is the norm. I can imagine that it helps to spread the virus.
Good point about greetings. Places where people get all over each others' faces to say hello have had a worse time of it than places where people bow politely from a distance.
> Sweden is somewhere in the middle -- they are being criticized, yet other countries in Europe which locked down have ended up with a higher per capita death rate.
According to this [0], Sweden is 5th in Europe but given that you have Italy (first outbreak in europe), closely followed by the second, Spain and the incompetent response of the UK Government, this only leaves Belgium, which seems to count pretty much all deaths.
Based on the ideology of the lockdowns, Sweden ought to be the worst in Europe, but it’s not. If Italy waited too long, then Sweden waited even longer! Where is the apocalypse that was predicted? Sweden being in the middle of the pack, despite not locking down when others did, is hard to explain.
This is a very complicated topic that involves things like trust in government, sense of community, etc ...
Lockdown is a last resort measure, not the first response.
All things considered, Sweden is doing remarkably well but if you compare it with its scandinavian neighbours rather than with Italy or the UK then things look appalling.
You have to look at where in the population the deaths occur in combination with policy and cultural behavior.
In Sweden the wast majority occurred in elderly care homes located mostly within strong mass transportation distance. (The image in the article is almost ironically capturing the wrong demographic in the wrong location in the wrong part of Sweden, in a time period after the one for which they base the article, but it is eye catching so for nytimes I guess that is the editorial guidelines that they will use).
Japan with a large portion of the population being elderly, and with a strong mass transportation system, I do wonder why they have so few deaths. Maybe they imposed very strict testing and restriction for all workers getting anywhere near such places? Maybe they use a lot of automation in elderly care resulting in significant less human contact and exposure? Cultural difference?
Finland did one thing that Sweden did not. They closed the capital. No one in, no one out. I am not sure how the elderly care homes outside that zone managed in regard to finding replacement for employees, but it seems to have been an effective measure. They also seem to have implemented rules for zero visitors.
Apart from clear differences in how people act in public spaces when sick, and countries "count" differently.
For instance, in Denmark, each and every dead person that is tested positive for Corona virus, count towards the death toll, even if they died from something obviously different. Even dead people is sometimes tested. It's not the same in all contries.
We will not have the full picture until we analyze the excess mortality rate on the other side of the pandemic. Then we can start to see what did the countries lowest excess death rate per capita do different.
> Apart from clear differences in how people act in public spaces when sick, and countries "count" differently.
The only solid metric for COVID-19 deaths is excess mortality, that is, the actual number of deaths - the statistically expected number of deaths (e.g. extrapolating from the last 2-5 years).
This metric is independent of testing capacity and malicious actors like politicians just outright lying to the public to try to save face. You can "hide" dead people, but doing so is much harder than hiding COVID-19 related deaths.
You can't conclude from this metric what the source of all these extra deaths are, but if they are not caused by COVID-19, every alternative explanation I can think of is even worse than a global pandemic.
I get it that this metric sounds to be the only good one, but lockdowns surely have minimized certain other deaths (car accidents, etc.). Thoughts? (Haven't read the links, or articles, so it might be mentioned there)
The data shows that these two do not balance each other out. Otherwise there would be no excess mortality, or it would be negative, i.e., less deaths. From just looking at this metric, we can't tell - but other metrics like car accidents per month per capita do show that this is the case.
One interesting thing is that COVID-19 lowers the mortality rate in the mid-to-long term. It disproportionately targets the weakest, so in the next couple of months and years, less people than the expected average will die, because the weakest are already dead, and that will lower the mortality rate per capita for one generation at least. At some point, it will hopefully raise again, and that too will be due to COVID-19, because the reason for that will be that we wouldn't have a recent-enough COVID-19-like event.
---
Point being, one should be careful when comparing mortality rates and absolute death counts. One needs to factor in both to get the full picture, and for rate, the period over which the rate is computed is very relevant.
> Why is it that Cambodia and other nations in southeast Asia have negligible deaths despite doing very little to combat the virus, while countries in the EU which locked down have way more deaths per capita?
One possible explanation for this is the kind of strain carried by the index case(s).
There are dormant strains and there are virulent strains of the virus, so the kind each country gets determines the kind of symptoms and this in turn shapes the initial reaction of their health care system.
Any coherent explanation of this pandemic is also going to need to wait until the pandemic is finished. It is totally possible that there will be no vaccine and COVID-19 is just an ongoing thing for the next 70 years.
If that is the case, how much can the lockdowns really help? I'm on board with slowing the disease down and giving the medical community 6 months to get their bearings. But it has now been 6 months and the question is "what is going to change going forward?".
We know we can't make vaccines on demand - we still don't have one for herpes afaik.
The stated objective of the lockdown was not to overwhelm the ICUs. As far as I know the ICUs in Sweden have not been overwhelmed. So how is that a failure?
As for the economic impact, given the amount of life support injections into the economy, I think the real economic impact of the shock is yet to be seen. Defaults are only starting to rise.
I have been willing to be frustrated with moving the goal post, but there is new information that mayors and governors know that the general public doesn't have a good way to know:
The low mortality rate and managed ICU capacity isn't the whole story. there is a large population of recovering and recovered that have serious complications, that seem random and are unproductive to our society. Blood clots resulting in amputations. 90 day recovery time periods. Other unknown and randomly targeted blood oxygen issues.
The mayors and governors and public health ministers are reacting to that in their own municipalities and countries. The outcomes are not equal, the variables have many different names between jurisdictions, and therefore the stats are not easily collectable. But for people on the front line and getting briefed by those on the front line, they see something horrible that they need to move the goal post to "cases" instead of just deaths and ICU capacity.
99% of the cases that last for months, like Nick Cordero, are from the early days of the pandemic where doctors mistakenly put people who didn't need mechanical respiration on ventilators, damaging healthy lungs and causing breathing dependence that doctors found difficult/impossible to wean from and all sorts of other complications, such as deep vein thrombosis (again, see Cordero's case).
The mean time between symptoms and death is two weeks (https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scena...). Anyone with symptoms is in two weeks, three at the most, either going to be at home wondering what the fuss is about—the vast, vast, vast majority of cases—or dead.
If the complications are a serious problem, as you claim, then I have a few follow up questions:
1) You're making some significant claims, and should therefore have significant data and evidence to back up your claims. Over 3 million people in the US have tested positive for covid. What percentage of them needed to have a limb amputated? That should be easily verifiable. What percentage of them had a blood clot and serious damage? What percentage of them currently have persistent long term damage? If you're making the claim that these things are such a serious problem, you should have data that backs up how common the problem is, and how bad it is.
2) How different are the complications from the normal complications that the flu/pneumonia/etc. can give? Tens of thousands of people get the flu, have complications, and die every year. Tens of thousands of elderly people get the flu, and have long-term damage for the rest of their life. As a society we don't care about that at all. Are you saying covid does more damage, or has more complications? If so, where's the evidence comparing the level of damage/complications?
It's my theory at the moment that this "complication" talk is just another viral "meme" that's mostly driven/spread by people just repeating what other people said, which spreads like wildfire, but never has any actual data backing it up. Of course there are people that have had serious complications. But there's people that have had serious complications from every disease. And it says nothing about how common it is. For example, if 0.00001% of people that get covid have to have a limb amputated, yeah that's horrible, and yeah it'd be great if we could just snap our fingers and make that not happen, but is it really something to focus on?
Those are great questions, the crux of it is that having two flus going around simultaneously is just as bad as it being no different than complications with the flu. And then the possibility that its worse should be just enough to say "look over there and corroborate the concerns".
> Over 3 million people in the US have tested positive for covid. What percentage of them needed to have a limb amputated? That should be easily verifiable.
I find this article a little disingenuous and here is why: Sweden-5420 deaths out of a population of 10 million while no lock down.
Michigan-6005 deaths out of a population of 10 million and we have been locked down since mid March.
To be clear, I was in favor of the lockdown at first and I still am in favor of keeping things like bars and casinos closed but it’s become clear that the virus doesn’t have much affect on younger populations and that the death rate has been dropping. Here in Michigan, while our daily new cases is still creeping up, our 7 day moving average of deaths has continued to plummet.
While Sweden did not have a mandatory lockdown, it wasn't like they stood by and did nothing either. They actually implemented many measures to reduce the spread of the virus:
- Closed high schools and universities.
- Banned gatherings of over 50 people.
- Banned visits to nursing homes.
- Reduced restaurant capacity and required social distancing in restaurants.
- Recommended social distancing, working from home, and avoiding unnecessary travel.
If you look at mobility data you'll see that even in the absence of official lockdown policies people were already changing their behavior to protect themselves, and the difference between Sweden and other places is not actually as big as people think.
Sweden and Michigan have about an equal number of cases (~74k) but Sweden has a better survival rate so far.
Is it possible Sweden just has a healthier population than Michigan? Life expectancy in Sweden is about 4 years higher than Michigan. This also means their population skews older, but means people are healthier on average.
The obesity rate in Michigan is about 50% higher than Sweden. Numerous studies have shown that obesity is a significant risk factor for COVID-19 death.
>it’s become clear that the virus doesn’t have much affect on younger populations
That was something expected before the lockdowns. The lockdowns were sold as a way to buy hospitals time, by flattening and slowing down the spread.
How can you even compare Swedens rate until the whole thing is over, everywhere? A flattened curve will take longer. Sweden purposely chose the frontloaded, higher initial rate.
Part of the trouble so many folks are having with modeling this disease is that there are several "tiers" of geographic division that are involved and different densities of community spread at each tier. There's spread at the level of countries/nations, at the level of states or provinces, and all the way down to the level of neighborhoods. A few cases in a country is very different from a few cases in a household in terms of density of cases, likelihood of spread, and mortality rates.
Without knowing those distributional statistics at different levels, all you get are lies and damned lies, not statistics.
About 50% of the deaths in Sweden have occurred in Stockholm per the Financial Times[1], which has a population under a million. Just by looking at a smaller geographic division - a city/metro area - we get near an order of magnitude higher per capita case rate and mortality rate.
At the same time, San Francisco County - comparable population to Stockholm - has had 4023 confirmed cases and 50 deaths. Alameda County has a population about 60% larger, and has had 6,991 confirmed cases and 140 deaths. So, it is possible to have a comparable population and a comparable density to Stockholm, Sweden and yet have many times fewer cases and deaths.
We could go back and forth until we're blue with why that might be the case, but I can tell you empirically, looking at some Bay Area counties versus Detroit or Stockholm, it is possible to have many times fewer cases and deaths than they've experienced. And that is a tragedy that is unfolding every day in those places.
Thank you. It's still sad to see that Alameda County has 2/3 the people and 1/20th the lives lost. Sweden's strategy deserves criticism because it is demonstrably not necessary to lose that many lives.
All the states around Michigan were locked down too. I’m sure there were a small amount of people crossing but we were effectively closed.
We had a pretty strict lock down here and people followed it better than I expected they would. I’m not sure what to think but I do find it odd that 2 similar sized populations took radically different approaches and ended up in essentially the same spot.
Sweden did not close its borders, although it followed EU guidelines to close its borders beyond the EU. The US closed its borders to certain areas of the world, which is what this is comparable to.
US states can impose mandatory quarantines on people arriving from other states. However as a practical matter that will be difficult to enforce in any state with a long border.
The problem is that people ignored the lockdown. Also the virus doesn’t discriminate. Younger people will die but may take longer to do so. Also we are detecting cases earlier than back in March where you had to be really sick to get a test.
I mean, of course the virus "discriminates" in the sense that there is a huge disparity in mortality rate between age and pre-existing condition groups.
Sure, it can infect anyone but it's obviously false to act like the effects are equal across demographics.
It's been verified that primary school teachers, who have all gone to work as usual, as primary schools never closed, haven't shown a significantly higher number of infection than others.
Edit: I'm letting my original comment stand as it shows how I was subtly misinformed regarding the situation of Sweden. I don't think I'd be the only one.
Wait, with all due respect, 5420 deaths on 10 million people? On a country left completely unchecked? That doesn't sound like the impending doom I thought the virus would bring.
I thought the novel corona virus had a death rate of about 1% to 2% and a bigger spreading rate that was bigger than 1, if no measures were taken. So, I'd expect between 100,000 to 200,000 to have died. I'm really happy that didn't happen. It also makes me curious as to why. Is it because of Sweden's demographics (people living alone)? Or is it because the virus isn't as deadly as we think it is?
How come 0.05% died and not 1% to 2%? Isn't this evidence that the coronavirus isn't as big as a threat as we thought? I mean 0.05% deaths is 40 times smaller than 2% deaths.
It's awful what happened, but the highest flu season in The Netherlands, for example, killed an estimated 9444 people [1] on 17,280,000 people, which is slightly higher than what the Swedes had to go through now (also rounded to 0.05%). I know that the novel coronavirus is not a flu, but if this is it, then well, I've seen worse, apparently.
I know the virus isn't done, but it had months to roam free in Sweden. One would expect it would double up every 5 days in terms of how many people would be infected.
Edit: they did need to maintain social distance apparently. I wouldn't call that "doing nothing". Sure a lot more can be done, but I feel the media are framing the Swedes a bit inaccurately. Belgium seems to be way worse (9774 on 11,460,000 people, ~0.1% is getting truly uncomfortable)
>How come 0.05% died and not 1% to 2%? Isn't this evidence that the coronavirus isn't as big as a threat as we thought? I mean 0.05% deaths is 40 times smaller than 2% deaths.
Because the 1% death rate is a reference to people catching the disease, not the size of the population. Sweden as of now appears to have about 73k officially confirmed cases.
Swedes still voluntarily distanced and closed down, hence the economic damage mentioned in the article. Given that there is no widespread immunity still with total infections in the single digits, those deaths will eventually go up.
I'm not sure if the American attitude of indifference is taking hold here now, but 5000 deaths when 4000 of them could have been avoided is no matter to brush aside, it's in fact a straight up disaster. This is an unprecedent amount of needless death in modern Swedish history.
I'm not American, I'm Dutch. And there's a huge difference between WOII levels (which is what 2% deathrate in The Netherlands would be), versus an extra amount of death people comparable to the worst flu season.
In The Netherlands, the worst flu seasons still have a higher death toll than corona. I hope it stays that way for everyone.
This is empirically false. It's at least 25% worse than the 2018 flu season, which was the worst flu season in decades, and that's with unprecedented mitigation measures in place.
The average high for the flu is 650,000 fatalities a year.[0] COVID-19 has so far caused 540,000 fatalities,[1][2] and the year is far from over. Quick napkin math would suggest at least 1 million will have died from COVID-19 at year's end, globally.
That's far higher than all regular flu seasons, although nowhere near as bad as previous flu pandemics.
> the worst flu seasons still have a higher death toll than corona.
Do you have a link to the statistics please? I think you're comparing two different methods of counting death. I think for covid-19 you're counting people who died after testing positive, or people where covid-19 is listed as the cause on the death certificate. But for flu I think you're counting excess mortality.
You're right though, I think something different was counted. In one case it was covid-19 deaths vs excess mortality. A sister comment rectified it, fortunately. It took this source [2] that references the excess mortality of the Dutch worst flu season and covid-19.
Then you get:
> De oversterfte in week 10 tot en met 19 van de COVID-19 epidemie was 9.768
> De oversterfte tijdens de 18 weken griepepidemie werd geschat op 9.444
(I think you can gather which is which but you could use Google Translate to be 100% sure)
So COVID-19 is actually higher and in 10 weeks rather than 18 weeks. And also, now that we're comparing a bit more apples to apples (The Netherlands), then we have to take into account that an "intelligent lockdown" (whatever that means) has taken place.
We had less death per 1 million than the Swedish as we were on 6132 at the time of this comment with covid related deaths.
So in conclusion, I made a few subtle errors that ultimately really add up. I wish I could still edit my top comment, I am happy I could already admit one error I made (that Sweden wasn't 100% roaming free), but using different units of measurement (covid related deaths vs excess mortality was another one).
One big question would be why they chose April 2020 as the comparison point rather than May or June -- did the number of deaths per month in Sweden actually drop?
(I haven't read the article closely, and don't have a horse in this race --- I just thought it was apropos. Feel free to tear it to shreds if appropriate.)
Even official numbers from Socialstyrelsen over the last 10-20 years showed that weekly excess deaths were only significant certain weeks, with other weeks even being lower than other years.
It’s really deeply misleading to say that Sweden let the virus go “unchecked.” Sweden didn’t enforce a hard lockdown but strongly encouraged social distancing, mask wearing, staying at home, etc. Sweden did have a strong (if likely inadequate) national response to coronavirus. And Sweden was subject to EU-wide travel restrictions, including virtually no foreign tourism.
Thanks for the clarification - I had read recently about Sweden considering a facemask policy but I misremembered it as about making them compulsory. Didn't realize that they were still discouraging it (at least as of late June).
> instead one should only "stay home if feeling sick"
My understanding is that this isn't true, but maybe you're being a bit pithy and I misunderstood - it's true that there weren't any bans or strict stay-at-home recommendations, but there were definitely recommendations for people to limit time outside of the home. Even in March Swedish employers were encouraged to implement remote work and Swedes were discouraged on travelling within the country.
Late response: I had thought Sweden was changing this due to increased data about asymptomatic spread. The fact that they apparently aren't is quite discouraging...
I don't know. That's the policy. Only those that wear a mask in their profession should do so. Not otherwise, regardless of how you feel. Instead of using masks, Swedes stay home if the feel sick.
> Belgium seems to be way worse (9774 on 11,460,000 people, ~0.1% is getting truly uncomfortable)
Belgium counts all suspected deaths as well, including those that have not been tested for COVID-19. Which means Belgium is the country closest matching their excess death with COVID-19 fatalities. The Netherlands, for example, leaves about 50% unexplained due to their counting.[0]
Belgium is the closest of the 8 countries/regions considered in that article - not of the EU or the world. Reported deaths there comprise 93% of excess deaths.
Overreporting is possible too. Ireland is at 150-160% according to recent reports [0].
Massachusetts is the exception because our re-infection rates (Rt) have been successfully driven down to well below 1.00 (~0.90 in a recent report), despite having started with a nearly out of control situation. We've gone from thousands of new cases per day to now averaging ~100.
The doubling days started out at around 2.4, stayed stubbornly in the dozens for many weeks, then rise, to now averaging well over 400. The original terrifying exponential growth has clearly been halted.
New levels of opening ("Level 3") are now happening this week - gyms, movies, restaurants, all w/large spacing requirements. In the few times I've gone out (making heavy use of delivery), seeing generally very good mask compliance - 75-90%, but less on one recent trip, which is worrying.
I'm concerned about the opening, but confident that the plan is really data driven, and this is as far as they will go until a vaccine, and they'll quickly roll back if numbers slide.
Not sure they were "driven" down by policy per-se:
According to rt.live, we started March 3rd with an Rt of 2.22 and were already in a steep Rt decline by the time Baker issued the stay-home request on March 24rd (Rt 1.22) and got below Rt 1.0 a week later on March 31st.
Baker issued his mask order May 6th (Rt 0.88) and we've been bouncing around at that since although we're creeping up now from our low of 0.75 around when reopening started and been slowly ticking upwards since late May to Rt 0.98 now.
A few weeks ago we had the lowest Rt in the nation, now we're only 5th lowest. Hopefully the start of Phase 3 this week won't push us up over 1, but I suspect it will.
A day later, 30 more deaths and we're now 7th lowest, our Rt is up to 0.99 and 3-day hospitalization average is now going up for the first time in a while. The state is now also offering expanded free testing to anyone so it'll be interesting to see how that changes it.
Yes, the Rt declines before the lockdown are curious, but I wonder if they are statistical anomalies related to initial small numbers or some other factor. It could also be that the people were independently starting to take measures, distancing, masks, etc. I know I was, and I'm not the only one.
The chart of inferred infections by date seems to show very strong correlations to the lockdown measures:
* very steep rate of rise in cases until 24-March
* a bit of reduced slope right at the date
* sudden peak/drop-off about a week later on 01-April
* steep decline, then flatter decline during lockdown
* then, a week after lockdown ends / next phase, around 25-May, the declining slope flattens
And the Rt starts to increase again in the last week of May
So, yes, the re-opening is looking very much like it's increasing re-transmission rates. Today just hit 1.01 on that chart.
Interesting times ahead. New England overall has relatively flat growth rates. Let's hope they continue measures to keep it that way!
Actually, the chart for every state shows the initial high value and steep decline of the Rt rate
So, this is likely of no practical value and some kind of data artifact. Best guess is spread before testing, and testing rates ramping up as it spreads, logging new cases at rates faster than they are actually being created, and normalizing to actual Rt rates as the testing catches up
It's honestly hard to find a lot of fault with Massachusetts' response compared to most other places--at least within the constraints of testing availability and other constraints at a national level. And people have been pretty good at following restrictions as far as I can tell.
That said, like elsewhere along the Northeast Corridor, outcomes have not been great overall especially in poorer immigrant communities. But that doesn't align nicely with a narrative that bad outcomes are a result of bad government policy or kids going to the beach or whatever.
As Nate Silver has noted on multiple occasions, we'll probably come out of this maybe not understanding why results were so different in different places or, at best, understanding that the differences are due to factors that couldn't realistically have been controlled for.
Remember that IFR (infection fatality rate) is the (total number of deaths / total number of infections). You can't use 10 million as the denominator because not everyone in Sweden has actually been infected.
An antibody study[1] indicated that 7.3% of Stockholm has been infected, but that number is 1) from April and 2) is going to be higher than average because Stockholm was harder hit than the rest of the country.
> How come 0.05% died and not 1% to 2%? Isn't this evidence that the coronavirus isn't as big as a threat as we thought? I mean 0.05% deaths is 40 times smaller than 2% deaths.
Naive death rate is deaths/totally cases of infection, not deaths/total population. Most of Sweden never contracted covid in the first place.
A first approximation of Sweden's covid death rate would be around ~7.4% to date (almost certainly lower in practice bc total infections > officially diagnosed)
It has not been running rampant in Sweden, because many individuals altered their behaviors as well. Which is to say, Sweden is nowhere close to herd immunity, so it stands to lose many more lives in the future as well. So far: it has lost many more lives per capita than its neighbors, and is economically worse off.
There are also two other important reasons to have locked down early in the pandemic:
- with time, we have already learned how to treat patients better and reduce mortality. This includes proning, dexamethasone and remdesivir which will reduce deaths. So exposing people to it in spring 2020 will produce very different mortality outcomes compared to fall or spring 2021
- We also have important therapeutic advances happening in monoclonal antibodies, and of course phase 3 trials of vaccines.
I would bet that, with some luck, other European communities avoid ever accumulating the deaths Sweden did.
Finally, it's more than deaths: many long-haul COVID patients are facing permanent disability and diminished capacity. The statistics aren't capturing this yet, but collectively, I think it was very foolish to have tried to push for herd immunity so early in a pandemic.
> I thought the novel corona virus had a death rate of about 1% to 2%
That's the guess at least. But we don't know. The argument for being careful about covid-19 isn't because we know it's more dangerous than other things, it's because we don't know.
It's still novel, we've only been tracking it since last December. The flu been around for a long time. Maybe we'll live with covid-19 for a long time, or maybe we'll find a vaccine.
As it seems right now, it's deadlier than the flu and we weren't really ready for it, so it caused a ripple effect of problems. No matter if a country implemented a quarantine or not, they took a lot of damage one way or another.
It's too early to make any conclusions around this, time will tell what was the best way considering the circumstances
Handwashing practices, physical greetings (kissing in some cultures), sharing of eating utensils, personal space, city density; There's no reason to expect R0 values to be the same all over the world.
I feel that so many of these articles on Sweden fail to mention the reason for Sweden's strategy and often say it due to another reason. The reason that the Swedish government has given for the strategy is that they think that people can follow the restrictions long term. It's not to save the economy or to create heard immunity (which I have heard from many people.) I think it's too early to judge Sweden's strategy as presumably the intent is that things will be better down the line.
On a more personal note, I live in Sweden and I am not a Swedish citizen and I can say that things aren't "Business as usual here" and plenty is being done to stop the spread of the COVID 19. I can't say I 100% agree with the policy but I also don't think it's the huge mistake people make it out to be.
I have linked below an explanation for the strategy by one of Sweden's top epidemiologist and the one that's often credited as the architect of Sweden's strategy.
One thing I don't see discussed and it's an unbacked intuition is that all the different government strategies seem to revolve around differences in 'group' trust levels.
Both the Swedish 'no-lockdown' and the Dutch 'intelligent' lockdown are government policies that actually work locally because the government trusts that the population will follow the guidelines given (which they do for the majority).
Equally when I discussed with Dutch and Swedish people (anecdata) they all believed their national strategy was correct because they trusted their governaments competence and the science advisors that were being consulted.
I think many of these strategies cannot be translated to other countries were there isn't a shared trust level, i.e. population trusting the government's competence, and equally the government trusting civil society (biggest example being the US).
This is meaningless. There were no economic gains expected, just avoiding a greater disaster. Given that Swedish economy is fairly integrated with its lockdown neighbours, it would be surprising if there were any economic gains; instead, it is probable its neighbours benefitted from Sweden having avoided lockdown.
Also, the higher death rate is normal and acceptable, in a tradeoff against deaths caused by confinement and the unnecessary prolongation of the epidemic. Herd immunity will arrive earlier, and lockdown-caused deaths will perhaps make Swedes survive more and better.
I think it's misleading to phrase things, as the article does, as just "more deaths" vs "the economy". The drawbacks of a large-scale mandatory lockdown (as opposed to asking people to do their own social distancing) also include other things like psychological effects on the population, political consequences (setting a precedent of severely restricting personal freedoms), and, well, enjoyment: making 10 million people more happy for a few months doesn't seem entirely negligible from a utilitarian perspective.
This isn't to take position for or against Sweden's policy here, but there are far more variables than simply excess deaths (or DALYs) and economic impact.
It's my first comment on HN. I am not a native english speaking person so I am sorry for some wrong wording in my answer.
I am from Portugal. In first 2 months we were considered an example on how to deal with an pandemic.
Today, our best business partners, I list UK in this scenario, does not give Portugal a safe destiny badge.
People tend to overcome rules. UK people are flying to Spain an then get a bus to Portugal.
Today's news was about 2000 students from Netherlands partying in Portugal, Algarve.
I am a young and healthy person AFAIK, but my mother is not. Neither my father in law or some of my closest friends.
Any death caused by irresponsible behaviour should be treated as an law infringement.
I really don't care if I get Corona. Pretty much I do, or in this case, I don't do, is thinking about people that does not have the chance of saying: fuck it.
It's the world we have, but I am sure it's not the world I wanted.
Bare with me: any death that could be avoided they should be avoided. And we could avoid alot of deaths if we think about others, an not that much about ourselves.
60 years ago you didn't have internet, lot's didn't even have light or bathroom in house.
Divorces are up with confinement. Are those people really meant to be together?
Don't look to much to your belly, and look around. Learn how to respect others without expecting the retribution.
You will feel great when you give up something you think it's aquired by right to something you think it's just right.
Sweden is much hated because it demonstrates how the scientific epidemiological models, the studies on mask effectiveness, lockdown estimations etc are all junk science. None of their models would have predicted the trajectory for Sweden, not even close.
And that is because none are based on sound science but are guesstimates at best yet are paraded around as the product of the best minds in the world.
Much is made about the growing anti-science sentiment in the world, the rushed pseudo scientific justification will only strengthen that.
Give it a year and most of the justification will be walked back, it will turn out that wearing a mask is actually detrimental to public health. It boggles the mind that people assume there must be no ill effects to breathing through a mucus-laden cotton sheet filled with microorganisms captured from the air, ...
> I don't understand how people assume it is healthy to breathe through a mucus-laden cotton sheet filled with microorganisms captured from the air, ...
Tell that to the millions of people who go skiing every year, or the people who work in hospitals all day long, every day.
I wash my mask every time I use it and I rotate through several of them. Nobody is asking you to wear a dirty mask.
none of that mask wearing is done at the scale and in the manner forced upon the population
nurses change their masks all the time, nobody skis every day for eight hours, (FWIW the vast majority of people skiing don't wear masks over their mouths)
> I wash my mask every time I use it and I rotate through several of them
Like every hour? If not good luck with that, it is a pit of infection, a wet and warm substrate for bacteria and fungi.
do yourself a service and read a real scientific paper on masks (pre-covid when people dared studying the negative effects) and read what happens on the inner side of a mask
in a nutshell stuff that would leave your body when you exhale will now be trapped on the inner side of your mask where it gets more and more concentrated, far more concentrated that what normally enters your lungs, the new stuff gets deposited on top the old, building it up to form a biofilm unlike any other part of the body
The microorganisms in the warm and wet environment breed, bacterial growth happens fast, doubling times can be 15 minutes. Within an hour you got yourself a bacterial colony right there in front of your mouth, every breath you take is filtered through that mucus laden bacterial colony
Would you like to quote a 'real scientific paper' for me to read? Or just have a snarky response.
People have been wearing face coverings since the dawn of time.
Can you tell me the number of deaths attributed to wearing a mask? I can't even google it since all the things that come up now are recommendations to wear a mask.
> in a nutshell stuff that would leave your body when you exhale will now be trapped on the inner side of your mask
If you want to take the 'it is just a flu argument'... I'm more worried about catching covid than I am about the microorganisms coming out of my own breath. They are already in me, in a very concentrated form.
The actual death toll was 5,400, and now the deaths are declining precipitiously. Of course every death is a tragedy, but the harm done from a national lockdown, which includes youth missing out on a year of school, and thousands of small businesses being destroyed, would have been more of one.
Like Michael Levitt, who's the 2013 Chemistry Nobel Laureate for research in complex systems, says, society has forgotten that people die.
10,000 people per million die every year in Sweden. That rate increasing by 500 is not that abnormal - it happens in bad influenza seasons. If every one was forced to stop working and shelter at home for months every time an infectious disease temporarily rose the death rate by 10%, it would lead to disaster over the long run.
90% of deaths in Sweden have been of those over the age of 70. If the statistics are anything like those in Italy, almost all of these victims had pre-existing conditions.
This is not to lessen the tragedy of their death. This is to point out that most of this tragedy predated their coronavirus infection - their life expectancy was already very limited due to other factors.
One interesting thing about Sweden is the high percentage of people who live alone. It's a big deal because in China most deaths came from an infected person spreading it to their family. Makes you think that if Sweden's numbers are as bad as they are without large-scale family spread, it would be absolutely horrific elsewhere.
Sweden are a model of pragmatism, taking a sensible choice to not have an authoritarian lockdown. Freedom of choice, freedom of movement and freedom of commerce are sacred.
Disagree, it was incredibly reckless. We still don’t fully understand the virus’ transmission vectors, R-values, etc. It very easily could have had a higher fatality rate or transmission rate potentially killing many more people. Claiming it’s a model of pragmatism is a post-hoc rationalization of poor policy.
What went wrong in Sweden? I genuinely don't understand that.
The news keeps showing Swedes walking in parks and down streets, but that's not how people catch the novel coronavirus. Meanwhile, people were working from home and mass gatherings were banned; the public were trusted to figure out the details, but they're not idiots. It could have worked.
What was everyone doing in Sweden that people weren't doing in Finland and Australia? Or were there less visible differences, in surveillance and contact tracing maybe, that haven't been so widely reported?
I don’t believe the article has addressed Sweden’s main argument for not shutting down: that herd immunity should be the prime driver. Essentially, that everyone is going to eventually have roughly the same death rate, so might as well get it over with.
That remains to be seen; if Sweden’s peers can prevent flare-ups, it looks like Sweden was wrong.
Sweden's strategy nor argument has not been herd immunity. In my understanding, Sweden's intentions are to recommend or mandate measures deemed sustainable for a long time ahead.
Arguments in favor of minimal restrictions include: avoid exhaustion of compliance in the population; avoid disrupting the economy, and negative effects on economy likely will affect population health; …
One could claim that actually the main "argument", which isn't really much an argument, is that the government could not legally order a lockdown.
Or, well, they could still order it. But since it would have been illegal, it could not have been enforced in any way, as it would also be illegal to follow any order to enforce it.
Some politicians wanted a lockdown, but soon found out that Swedens crisis response laws are not triggered by disease, at least not unless it's a clear threat to the continuation of the state as such. Covid IS serious, but this far it doesn't look like a civilization ending disease.
Well it's not only that, if you overwhelm your healthcare system you're going to end up with excess deaths even if the same number of people get the virus in the end. Also, we've learned some mitigation techniques over the last few months (like steroids in late stage treatment) which means that the idea that 'everyone will get it eventually' just isn't relevant - its likely that our survival rate will go up over time even without a proper vaccine.
Whether this is an issue for Sweden should be clear from the death rate among the infected, but that data isn't mentioned in the article. I assume that figure is difficult to calculate without a precise/consistent case count for multiple countries.
Ironically, medical researchers wouldn't have learned those mitigation techniques (like Dexamethasone) without a large population of patients to use as experimental subjects. In other words, if we succeed in slowing down the spread (which would be a good thing) then medical research into treatments and vaccines will also slow down.
It would take longer to complete the vaccine phase 3 clinical trials. We need to see that the vaccinated group has a significantly lower risk of infection than the control group. But if the disease spread is already slow due to other measures then we need either more time to be sure whether the vaccine really works.
Exactly. It also means that we can't judge Sweden's approach for another 12-24-48 months.
Who knows how many times other countries will go in and out of lockdown in the coming years, and how long that will drag on. Melbourne just fully locked down again due to a rise in cases.
It's clear every country will eventually give up and go with Sweden's approach because they'll run out of "free" money, it's just a question of how long they will drag it out, or if a mass-produced vaccine can be effective and arrives in time.
Statistics is just statistics. Many compare Swedens death/capita to other countries figures and conclude it is bad. But this is in fact not a god measure at all because this figure dont account for how far the spread is over the population, Sweden is very different here. Because Sweden have been more open they are also far ahead of other countries and much more people have been exposed and got antibodies. Sweden cant simply be compared to others that are more in the beginning in the pandemic. Sadly media forget this.
The virus cant be stopped so sooner or later other couties must open up and then they going to get more death. Just look at Spain that open up now had to lock down a reginon now with 200.000. Saying Swedens way is bad right now is far to early to conclude, when the pandemic is far from over. We have to wait at least a year or two.
Sweden is right to be concerned about their economy. Its not just about skipping a few haircuts -- a shattered economy kills people as sure as coronavirus does. Every shuttered manufacturing plant has a body count associated with it and its own case mortality rate.
I don't know how many people died as a direct result of the Great Depression but based on what I've been told by relatives the suffering was considerable with deaths due to lack of food, homelessness and despair. I do know that the Nazi party would never have come to power in Germany without the world economic collapse. They were a minor party on the wane in the late 20s only to get their second wind in the elections following the crash. It's also possible the Japanese militarist would never have come to power without the Great Depression for more complex reasons. WWII was the result at the cost of 45-70 million lives. Economic catastrophes are not just about money -- they have life and death consequences. I wish more people would have taken this into consideration before they carpet bombed the US economy to combat the pandemic. I guess they figured that no matter what, the US was safe from the kind of civil unrest that gripped the Weimar republic. A strong man taking control of the US? Fascist and antifascist battling in the street? That could never happen here.
The economic gains part of it is not really relevant. Today each country is exposed to the global economy. If everyone else has economies that are broken then that will trickle over to Sweden inevitably. But that doesn’t mean that it is not worth pushing for Sweden’s strategy. If more countries did so, perhaps Sweden would collect economic gains.
As a Swede that did not agree with the strategy at the time (it was hugely risky), given what we know now, I'm starting to think it was the right decisions (for the wrong reasons). The reason the economy is in trouble has more to do with that the rest of the word shut down, it being a highly export dependent economy. Sweden did not shut down, practically nobody wears a mask (still), social distancing is minimal (crammed subways, buses and beaches), schools have remained open, yet there has not been a single death in the worst hit area of Stockholm for the past 5 days. Again, I think given the uncertainty and lack of evidence in March, not shutting down was an extremely stupid risk, and Tegnell and crew have shown to been wrong at practically every turn, but at this point you have to look at the evidence and reassess. It would seem Stockholm has reached the point of significant herd immunity, which is probably true for other hard hit areas like NYC. Less hit areas will probably have second waves, and unless a vaccine is here soon, my guess is most of the world will go through the same thing eventually.
This would indicate that the swedish response is among the worst. Several countries with comparable health systems have a death rate which is many times lower, for example Germany. This saved many thousands of lives.
If the pandemic is expected to continue for many months, isn't it a bit premature to talk about current death rates as a metric for success? Given Sweden's 'herd immunity' plan, higher death rates at the beginning would seem to be a given. They didn't flatten their curve. But as they approach something like herd immunity, the number of possible carriers should plummet permanently (assuming immunity is a thing with COVID), and infections and deaths would permanently decline.
Nations which have held down infection numbers with shutdowns have, of course, flattened their curves. But they may well suffer from second/third waves which will hike up their total numbers.
They did flatten the curve[0], they kept their cases within hospital capacity (by banning gatherings over 50, reducing restaurant capacity, having people work from home, etc)
What they never did was crush the curve, which is the strategy most other countries switched to once they realized it was feasible
Herd immunity is certainly possible--we could hold a parade, and spray it with cultured virus. Obviously no one is doing that, because no one actually wants natural herd immunity. Sweden just thinks the cost to control the epidemic to the point that it doesn't end in that way is unacceptably high. If a treatment is discovered next month that cuts the IFR by a factor of ten, then Sweden was wrong. If no safe and effective vaccine is ever developed and treatment never improves, then Sweden was right. Reality will fall somewhere between those two unlikely extremes, and we don't know where.
Fewer infected is always good news[1], in Sweden or anywhere else--it means fewer dead now, more infections pushed until later when treatment will probably be better, etc. It's weird to see low infection rates twisted around as if they were bad, "evidence that herd immunity may not be possible". This is particularly true when the prevalence is compared to herd immunity from a model assuming a well-mixed, homogeneous population, which we know overestimates the herd immunity threshold (though not by how much, since estimates of the heterogeneity of the coronavirus are even more uncertain than those of R0).
Finally, herd immunity is a gradual process. Even in a crude homogeneous SIR model, you may approach it asymptotically but never get there. This is good--the only case where a disease "burns itself out" abruptly is when there's big overshoot, which implies many avoidable deaths. Perhaps that kind of overshoot could be desirable in a population of young people, if the small excess mortality in the young people were more than offset by their decreased ability to spread it later; but that's a narrow needle to thread.
For the avoidance of doubt, I believe Sweden did a bad job protecting elder care facilities (though many places that locked down did too), and I disagree with their position on masks. Their response otherwise seems reasonable to me, not obviously better than stricter approaches but also not obviously worse.
1. Unless you know the death count and you're looking for the denominator for your IFR, since more infected then means lower IFR. That was true early in the epidemic, before the first high-quality serosurveys, but not anymore.
Indefinite lockdowns, vaccines haven't been "proven possible" either. At some point you have to make a plan with the best information you have.
The fact that spread in New York has slowed down compared to other states that weren't initially hit hard implies that there's some immunity effect going on.
Simple: it's not over yet, but it might be for some hard hit areas of Sweden. We'll see. Then there is another question whether it was worth it to shut down the world economy over a 0.05% death rate, or a few years worth of flu at once. I'd say probably no. We didn't know this back in Feb/March, which is why I was very much for a quarantine then, but not now. I don't think the powers that be would have done a complete shutdown if they'd known what they know now.
The long-term success of Sweden's approach appears to hinge on this question. What evidence is there which supports that their hardest hit locales have achieved herd immunity?
My own observeration from Stockholm is: beaches crowded during heatwave, public transit is crowded as usual. Lots of movement of people, travel within Sweden etc. Practically nobody is wearing a mask. People are still generally careful, washing hands, keeping the distance in lines etc, but I don't think this can explain the cases going down. In March-April, I think people were the most careful, when hundreds were dying every day. Since then people have gradually become more relaxed, but the numbers keep going down.
Of course, it could be that these rather small measures have pushed r0 a bit under 1 ever since March. But there have also been reports that for each person tested with antibodies, two more are actually immune, which would put the immunity at maybe 30% two weeks ago. At least it's in the right ball-park, as some have proposed that herd immunity could be reached at much lower percentages than previously thought.
Sweden's total per-capita death rate is 50% higher than the Netherlands, 500% higher than Germany and Denmark, and 900+% higher than Finland, Norway, and Poland. All those deaths have not made you safer--your daily per-capita death rate is still several times that of those countries. Source: https://ourworldindata.org/coronavirus-data
The current death rate, 10-15 people a day, is insignificant compared to other causes of death. It is not reasonable to talk about percentage differences when we're talking 15 vs 3 deaths a day.
Do note that there's easily a 15-day delay when it comes to Sweden reporting somewhat correct number of deaths, so let's not focus on the "current" death rate too much. And I expect the reporting delay to actually be worse right now as we're in the middle of vacation time.
No one shut down economy for exteneded period of time in Norway or Finland, they did just intermittently and now they have exactly same economic situation Sweden. Not worse, not better, but much less death. So 5000 people are dead for nothing. Even more importantly, explicit denying medical care to everyone after, say, 75 y.o. will save lots of money which can be redirected to fun stuff (lowering taxes etc.), and your death rate will barely go up; no one does that though, because that would be considered completely inhumane.
Dont fall for the numbers game. The numbers in Sweden are reported on with an expected delay of 7 - 10 days for some deaths. The other game is the break-point in time 1400 - each day when public health agency ( state run ) report their numbers. They reported no new dead in Stockholm and then later on tuesday afternoon Smittskydd Stockholm ( regionally run ) reported 7 new deaths in Stockholm since monday...
Not really: I would much rather get the coronavirus today than three months ago. And would much rather get it 6 months or a year from now than today. Survival rates are measurably improving due to both improved procedures (proning) and better protocols on steroid use, as well as emerging therapies like remdesivir and monoclonal antibodies (in addition to convalescent plasma). Not to mention that many vaccines are barreling into phase 3 trials soon. I suspect history will not be kind to Sweden's approach.
Sweden did the right thing. Covid-19 is not worse than the flu. Norway recently also admitted the lockdown there was not neccesary according to the data they have now. In March they thought differently.
Norway: ‘Lockdown was not necessary to tame Covid-19’
According to Camilla Stoltenberg, the Director-General of the Norwegian Institute of Public Health (Folkehelseinstituttet), similar results would have been achieved in her country without a lockdown. She bases that statement on a study by her institution.
The study collected data on confirmed cases of coronavirus registered in Norway, the number of hospital admissions, the reproduction rate, etc. At the beginning of March it was feared that one person infected with the virus would infect four others. Only strict lockdown rules could bring that figure down. This hypothesis came from the Imperial College in London and gave forecasts for a number of European countries, including Norway.
Virus never spread as fast as was feared
In their report, the Norwegian Institute of Public Health now comes to a completely different conclusion: the virus never spread as quickly as was feared and was already on its way back when the lockdown was announced.
‘Our conclusion now is that we could have achieved a similar effect without lockdown. By staying open and taking a series of precautions to prevent the spread. It’s important that we admit that. Because should the number of infections rise again in winter or should there be a second wave, we have to be honest in our analysis whether such a lockdown has proven to be effective’.
According to Stoltenberg, who is herself a doctor and the sister of former Norwegian Prime Minister and current NATO Secretary-General Jens Stoltenberg, such draconian measures should only be announced in the future if there is an academic basis for them. And that was missing now, according to Stoltenberg.
Angelo Borrelli, the head of Civil Protection, who announces the latest figures every day at 6 p.m., said Saturday night that the 793 new deaths have been caused “by and with” the coronavirus. “We count all the dead, we make no distinction between with and by the coronavirus.” However, one wonders whether these daily figures reflect the situation correctly. The dead are said to have almost all had one or more other diseases, which leaves a question mark as to exactly how deadly the coronavirus is. At the same time, it has become clear that a large number of people who die at home (which is often a retirement home) do not undergo a coronavirus test."
"On Friday, April 24, 2020, Vittorio Sgarbi, a member of the Italian Chamber of Deputies, denounced what he claims are false coronavirus death statistics. Sgarbi feels that fake statistics are being propagated by the government and the media to terrorize the citizens of Italy and establish a dictatorship.
The member of the Forza Italia party slammed the closure of 60% of Italian businesses for 25,000 Chinese-Coronavirus deaths from the floor of the legislature. “It’s not true,” he said. “Don’t use the deaths for rhetoric and terrorism.” According to the National Institute of Health, 96.3% did not die of coronavirus, but of other pathologies stated Sgarbi – which means that only 925 have died from the virus and 24,075 have died of other things claimed Sgarbi, “….the virus was little more than an influenza. Don’t lie! Tell the truth!”"
For US data, I like how this table compares deaths from covid, flu, and pneumonia against the total deaths for all causes each week. I especially like that they show the ratio of current deaths vs the average of the 3 years prior for the same week.
The downside is how the data is slowly updated as each state trickles in data, so the most recent 4-8 weeks look lower now than if you check back later.
Still if you look back to April, flu deaths each week were in the hundreds, while covid deaths 9-15k. Saying it is 10x or more worse, doesn't seem unreasonable to me.
What really grabbed me is that the total US deaths in April from all causes was +40% compared to prior 3 year average.
Unfortunately covid deaths are highly unreliable as there is lots of evidence worldwide that people dying with covid are also counted with those dying of covid. Also lots of cases of dead people being counted while not being tested or positively tested for covid.
That's exactly why I like the link I posted. It tries to provide context on how many people die with covid, flu, pneumonia, or some combination of the 3.
Then more importantly, it looks at the overall death rate. Because even if you completely ignore the covid count, the fact that there are so many more people dying than normal should grab people's attention.
How do you think flu deaths are counted? Because that numbers shows also estimated death people - people who were never even tested on flu. Like, percentage of pneumonia deaths. And they contain also people also having other health issues and not just flu.
Flu deaths are counted as the number of people who die because of the flu - that is, they represent people who wouldn't have died if they didn't catch the flu. This is of course an estimate, and there are some pretty fundamental reasons why it has to be such as the fact that flu causes heart attacks and strokes but also just happens to be present in patients who have one for unrelated reasons, but it should be a pretty robust one because flu is an old and well researched disease and we have a vey good idea of how it behaves at a population level.
“Under these conditions, there does not seem to be a significant difference between the mortality rate of SARS-CoV-2 in OECD countries and that of common coronaviruses (χ2 test, P=0.11). Of course, the major flaw in this study is that the percentage of deaths attributable to the virus is not determined, but this is the case for all studies reporting respiratory virus infections, including SARS-CoV-2.”
“Under these conditions, and all other things being equal, SARS-CoV-2 infection cannot be described as being statistically more severe than infection with other coronaviruses in common circulation.”
“Finally, in OECD countries, SARS-CoV-2 does not seem to be deadlier than other circulating viruses.”
This is not the first time you've been called out on HN for quoting that outdated paper. The last time was 70 days ago (it was outdated 2+ months ago).
Another quote (from the abstract):
"It is concluded that the problem of SARS-CoV-2 is probably being overestimated, as 2.6 million people die of respiratory infections each year compared with less than 4000 deaths for SARS-CoV-2 at the time of writing. "
As of the Mar 19th 2020 issue of the Journal of Antimicrobial Agents.
Even without reading the paper, I can tell you that if this analysis were to be repeated, we would get different results, given that we are now (four months later) at 540,000 (confirmed, which is definitely an underestimate) deaths, rather than 4000.
"A report on the coronavirus by the German Ministry of the Interior was leaked on May 9th 2020 by officer Stephan Kohn to the magazine Tichys Einblick, one of the most popular alternative media in Germany. The report, on which a dozen or so doctors and professors from various universities in Germany have worked, states that “the state has failed in the coronavirus crisis in an almost grotesque way.” In a press release, the scientists concerned stated that “the observable effects and consequences of COVID-19 do not provide sufficient evidence that it is more than a false alarm in terms of health effects on society as a whole. The new virus has probably never posed a risk to the population in excess of normal levels […]. The people dying from corona are mainly those who are statistically dying this year because they have reached the end of their lives and their weakened bodies are no longer able to withstand random daily exposure (including to the approximately 150 viruses currently in circulation). The danger of COVID-19 has been overestimated. (No more than 250,000 deaths from COVID-19 worldwide within a quarter of a year, compared to 1.5 million deaths during the flu wave in 2017/18). Of course, the risk is no greater than that of many other viruses. In all likelihood, we are dealing with a global false alarm that has gone unnoticed for a long time.”
They also didn’t have anything positive to say about the ‘protective’ measures of the German criminal government. “The collateral damage [because of the measures] is now enormous and far greater than any observable benefit. […] Just a comparison of previous deaths due to the virus with deaths due to the protective measures prescribed by the State […] supports this finding. Much of this damage will continue to manifest itself even in the near and distant future. This can no longer be prevented but can only be minimized. […] The shortcomings and failures in crisis management have consequently led to the dissemination of unsubstantiated information, and thus disinformation, to the public. […] The State turned out to be one of the biggest fake-news producers in the coronacrisis.”"
Just to be clear: that is a "report on the coronavirus by the German Ministry of the Interior" in the sense that the "leaker" works there, wrote that report on his own (he wasn't part of the groups working on COVID specifically) based on at least cherry-picked data and then sent out on the official letterhead without permission.
From the provided link here is a list of some of the people who worked on the report and signed the press release:
Prof. Dr. Sucharit Bhakdi, University Professor for Medical Microbiology (retired) University of Mainz
Dr. med. Gunter Frank, general practitioner, member of the permanent guidelines commission of the German Society for Family Medicine and General Medicine (DEGAM), Heidelberg
Prof. Dr. phil. Dr. rer. pol. Dipl.-Soz. Dr. Gunnar Heinsohn, Emeritus of Social Sciences at the University of Bremen
Prof. Dr. Stefan W. Hockertz, tpi consult GmbH, former director of the Institute for Experimental Pharmacology and Toxicology at the University Hospital Eppendorf
Prof. Dr. Dr. rer. nat. (USA) Andreas S. Lübbe, Medical Director of the MZG-Westphalia, Head Physician Cecilien-Klinik
Prof. Dr. Karina Reiß, Department of Dermatology and Allergology University Hospital Schleswig-Holstein
Prof. Dr. Peter Schirmacher, Professor of Pathology, Heidelberg, Member of the National Academy of Sciences Leopoldina
Prof. Dr. Andreas Sönnichsen, Deputy Curriculum Director of the Medical University of Vienna, Department of General and Family Medicine.
Dr. med. Til Uebel, General Practitioner, Specialist in General Medicine, Diabetology, Emergency Medicine, Teaching at the Institute of General Medicine at the University of Würzburg, academic teaching practice at the University of Heidelberg
Prof. Dr. Dr. phil. Harald Walach, Prof. Med. University of Poznan, Dept. of Paediatric Gastroenterology, Visiting Professor University of Witten-Herdecke, Dept. of Psychology 4
Swedish officials has said over and over again that neither herd immunity nor economics is the basis for the strategy chosen. They tried to strike a balance between the impact of containment measures (isolation, mental health, lack of education etc) and minimizing the spread of the virus. Of course the first point is extremely hard to quantify, and thus the hard numbers are horrifying.
Most people in Sweden are taking plenty precautions and isolate on a voluntary level, highly encouraged by all institutions. However, if you are stuck inside with abusive parents or are getting depressed by the isolation, you have the choice to go out.
As others have mentioned, the true failure has been in elder care. How the virus was allowed to ravage care centers is completely unacceptable.
I think one aspect missing from the discussion of whether or not Sweden has done the right thing is just how much power a government has over its citizens.
In many cases I think the consensus in Sweden is that the government doesn’t have the right to keep people at home or force people to wear masks. The current government had to push to get legislation passed that allowed them to shut down primary schools and preschools, if needed.
When this is all said and done a lot of countries are going to have evaluate what all
of this has meant for their democracies.
Economics aside, there may be mental health wins for keeping a different mix as they have. Or losses, too — it’s really too early to say one way or another imho.
The idea of prioritising the economy is a falsehood. You can't have a strong economy with a virus like covid ripping its way through the population. Some people might go on as normal, but a huge portion of the population will be afraid of going outside.
The only feasible path to economic recovery is:
1. Keep the borders closed. Mandatory & monitored quarantine for anyone entering.
2. Lock down, test & contact-trace until the virus is basically eradicated. Mandating mask use outside of abodes or any other measure will help speed this along, too.
3. Open up, but keep borders closed except to places applying a similar approach.
this was supposed to be about economy? I thought they just wanted to preserve their way of life without draconian measures of countries which took those measures and got Fd anyway in matter of deaths or economy
it was pretty clear from beginning it won't have big impact on their economy either way
The opening paragraph of the article shows to me that the journalist in question has done a poor job researching exactly what happened in Sweden.
> Sweden has captured international attention by conducting an unorthodox, open-air experiment.
Almost every interview available with Anders Tegnell (swedish equivalent of Anthony Fauci) mention that the international community prior to covid had agreed that following a strategy similar to the one sweden are following now is the best choice. Somehow this translates to an "unorthodox" strategy. Never mind that during previous epidemics, like SARS, the current Swedish response was "the normal response".
> It has allowed the world to examine what happens in a pandemic when a government allows life to carry on largely unhindered.
I am really disturbed by this sentence. While it is technically correct that no lockdown has been imposed on the swedish people by the government, saying that life has "carried on largely unhindered" is straight up dishonest.
Ever since February or March there have been regular press conferences with the FHM ("swedish CDC") broadcast over public radio (and obviously you can listen to it on internet and in their app, with push notifications). The hospital system has almost completely shifted to handling covid, nationwide. Most companies have tried to shift their work to peoples homes as much as possible, just like FHM has suggested. Buying groceries online has increased by a large margin. Even the cars at my local supermarket are now practicing social distancing! Swedes, overall, have really taken the gravity of the situation to heart and made changes in their life to protect their community.
> but Sweden’s economy has fared little better.
This misses the most important points about the swedish strategy and shows a lack of knowledge about swedish economy and EU economy. The goal of the swedish strategy has been to preserve peoples health as good as possible. Locking everyone in their homes for several months is not a strategy that is resillient. It increases cases of domestic violence, people losing their jobs cause negative effects as well. The number of deaths related to covid have to be compared to overall deaths, but most importanlty the overall health. The goal was never to gamble peoples life away for the economy!
The article jumps straight into saying that Sweden did not gain anything, economically, from having no lockdown. Well of course not. How could a country with focus on exports and services thrive economically in a pandemic? If the inner market of the EU is as good as closed, who would make the bet that an export focused country would be thriving? Sweden is dependent on other nations, especially in the EU and Scandinavia, so of course the economy wouldn't fare well.
> Sweden put stock in the sensibility of its people as it largely avoided imposing government prohibitions.
This article is an example of poor journalism. It misrepresents the situation in Sweden, while containing crucial factual mistakes bordering on misinformation while also trying to steer american policy making in a specific direction.
The amount of deaths in Sweden from Covid19 have been very high and many of the deaths has been completely unnecessary. This is nothing else than a cruel state sponsored murder on parts of the elderly population. Its also likely that the actual death toll is significantly higher than reported since many of the elderly dying at institutions was never tested for Covid19 In-fact at many regions of Sweden autopsies has been suspended during parts of the spring. The recommended treatment for these elderly has been injection of morphine (yes to elders with breathing difficulties).
There are stories of staff sometimes opening the windows while elderly confined to their rooms grasping for air. Family was not allowed to visit but staff was moving without protection gear between the rooms of sick and healthy ( because in Sweden the government early decided that masks are ineffective ways of protection ). Its still the official stance of Sweden that masks does not help against Covid19. But apparently sneasing in your armpit and washing your hands helps. In the beginning this was applied also at the institutions for the elderly. Some heroes objected and bought gear and significantly lowered the death rate early on. Others followed the advice from the "experts" as a good swede does. And the result sometimes was 50-75% dead in the total population of residents at the care facilities.
The Architect behind these state sponsored acts of murder is a man called Anders Tegnell. And you will be surprised to learn that this is the second time this very dangerous narcissist has been causing suffering and deaths in Sweden. Back in 2009 during H1N1 influenza (swine-flue) he was the person responsible for the purchasing and injecting the unsafe Pandemrix vaccine in the Swedish population as head of the vaccine department. Today it has amounted to a total of 600 then children and youths developing narcolepsy. He spent the following years defending the government against the victims who was seeking economic indemnity from the Swedish state medical insurance. When the Swedish newspaper Svenska Dagbladet later acquired emails of this mater he was caught on record emailing that the goverment agency he was working for at the time "was at a point of no return politically".
He was then recruited as the State Epidemiologist of the Public Health Agency of Sweden in 2013 as a thank you for his service. Now in 2020 he is directly responsible for the deaths of about 5500 swedes. You could argue that he is also responsible for some of the deaths in neighboring countries where there have been imported cases from Sweden.
This person already before the beginning of 2020 had caused 600 direct cases of mistreatment can now add 5500 deaths to his CV. And likely 1000s of people with lung-damages, muscle damaged and other severe trauma damage from intensive care. There are also reports of increased diabetes onset among Covid19 survivors and the ME/CFS that will likely be the result for many who got the disease.
If you are interested of the numbers and statistics you can check https://c19.se/ it has deaths and infected on a regional level. It can be helpful to understand that the city of Stockholm has had 2344 officially dead and 21490 official cases among its population of 975904. Tests results of antibodies have been reported in ranges from about 10% - 17%. But since testing was not allowed for most people until very recently the numbers can be either spot on or very off.
It seems obviously wasteful to keep such businesses open where most the paying customers won't be showing up during a pandemic anyways. Why even pay to have the lights on? You need to mothball the operation ASAP and lobby for government assistance for the duration.
I was just poking at rough figures last night out of curiosity regarding when the other end of this arrives in terms of 60% herd immunity for the US. Just pulling numbers out of my ass, like 200,000,000 for 60% and an avg infection rate of 100,000/day. With those figures it's 5.5yrs before 60% gets infected. We're at more like 50,000/day last I checked, but who knows how accurate that is.
Either way, it looks like this is going to be a life of masks and social distancing for a long time. Hopefully a vaccine arrives in volume before 5+ years go by.
> It seems obviously wasteful to keep such businesses open where most the paying customers won't be showing up during a pandemic anyways
In Sweden people still seem happy to go out to bars and restaurants, even in the middle of a pandemic. It's non-stop work for the government to shut down venues that are crowded beyond the allowed covid19 congestion regulation.
This whole "even if restaurants and bars were open, nobody would go to them" narrative just doesn't bear out in reality.
We're seeing the same thing in the UK now as well.
I did read it (and insinuating I didn’t is against the rules).
Nowhere does it have any proof of restaurants losing all their customers. It says that economists predict a contraction (that hasn’t happened yet), that consumer spending at one point was down 25%, and that the manufacturing sector had to shut down due to supply chain issues.
I never said that restaurants have lost customers, just that there is still a very significant amount of people willing to go out anyway.
The Google Mobility report shows that retail & recreation (which includes restaurants) for Sweden is currently down only 1%!!! (workplaces -40%, transit -25%)
This is a very misleading article. Compare Japan (no lockdown) with Norway, Finland, and Denmark. Or we can compare some areas of Sweden with Norway. Sweden has high death rate for the same reason that many of the lockdown countries have hight death rate: Elderly care centers in some areas where not properly protected! 20 years of policies for cost reduction of care homes is the reason for the failure).
That is not the case for many other countries. For example, the UK had almost twice the number of excess deaths as Covid deaths in a few weeks in April. That indicates that Covid deaths were under reported in the UK. There are also some indications that Covid deaths have been under reported in other countries.
In other words, comparing countries by their Covid deaths/capita rates is meaningless. The statistics are likely completely wrong because different countries use different definitions of "Covid deaths" and different reporting procedures.
https://www.theguardian.com/world/ng-interactive/2020/may/29...