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  #151  
Old 04-29-2020, 10:02 AM
Francis Vaughan is offline
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The idea that some of the hardest hit places were seeded with a large cohort of travellers, all infected, seems to have some value. Here in Oz nearly every case has been sheeted home to an individual traveller. Very few cases were many generations removed from the external source. We were likely lucky. The annual massive arrival of students from China was stalled, had it occurred we might have been more like NY.
The early stages of an epidemic are not exponential, since it doesn't always start with just one infected person. Get a significant cohort of travellers, probably of a range of stages of infection, all arriving in a short time period, and you have a bubble that is going to hit you hard, with apparent growth much higher than R0 for a short time.
Countries that avoided travellers arriving from hot-spots likely have seen much more straightforward and manageable growth. If somewhere starts implementing a lockdown at say about the time of the first local detection, the actual curve they are sitting on may be very variable. Testing usually starts with hospital admissions of serious cases. Some countries may have had a single infected person arrive, and see a serious case present and test positive only a few weeks after the first infected person arrived. Others may have had a few hundred returning holiday makers, and at the time of the first local positive test, may have thousands of infected, and many ready to die. But at the time that either country test their first positive case, things look very similar. One is going to have a vastly harder time.
Moreover luck plays a part in the apparent progression in a country with a very small number (or even one) infected traveller. A lucky chance could have the infected traveller themselves be the one presenting with a serious progression, and the country alerted very early in the game. Or poor luck could mean that it is a third or fourth hop infectee that first presents to hospital and is tested. So for countries with limited exposure to travellers, there may be substantial variation in the apparent early progress of the epidemic.

Al of this of course stems from the peculiarly nasty long infectious incubation period. So is not typical.

I keep noticing that many countries have a knee in their statistics in the early stages. A growth rate of 1.35 suddenly drops to about 1.1. But not everywhere. NYC didn't, it just ran along at 1.35, actually rose for a while and then gently curved over. Many countries run along at 1.35 and curve over slowly, but some have a pronounced kink. There could be many reasons. As we know, testing is, at best, hard to compare between countries. Sweden's testing regime is just plain insane. As is Japan's. Neither have any clue what is really going on. Even death reporting may be suspect. But the kink is curious. Maybe it relates to what I describe above. Dunno.
  #152  
Old 04-29-2020, 10:16 AM
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That seems literally impossible. We're talking about a virus that is highly contagious and quite deadly, if it was going around prior to the healthcare crises it would not have been unnoticed. If anything, in most places there appears to have been fewer than average respiratory patients before February, due to a mild winter and a mild flu season.
We're also talking about a virus that was not recognizable and easily mistaken for influenza. And I have no idea why you're referring to 2019-20 as a "mild" flu season, when it was regarded as one of the longest in a decade -- at least here in the US anyway.

https://time.com/5758953/flu-season-2019-2020/

As it turns out, the 'heavy flu' season was most likely the beginning of COVID-19, which was likely coinciding with the influenza season. So again, people were walking around with COVID-19. People were dying from flu-like symptoms, leading healthcare professionals to conclude that they probably died from flu. And many other carriers were asymptomatic. It probably wasn't until late January that people really began to watch for flu, and by that time...too late.

NYC is particularly vulnerable given its population density and the fact that it is a major transportation hub. Moreover, it's one of the few American cities where people use mass transit heavily. So it's not surprising why NY/NJ got hit hard. I am less familiar with Lombardy and Northern Italy, so I'm not in a position to explain why it would have been so bad there. Perhaps it's not just a matter of where it hit, but also who it affected first: older adults. It's also clear that Italy did not take the threat seriously in the early stages of the outbreak. The rest of the world, on the other hand, had just enough time to watch in horror to what happened in Italian ICUs and to at least respond to the extent that they could. Luck *is* a factor.
  #153  
Old 04-29-2020, 10:20 AM
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... I'm guessing you wouldn't disagree, but what works for Sweden may not work for everyone. Sweden might have a healthier population of young people (i.e. less obesity, fewer smokers, etc) than other countries, which means that attempting herd immunity would seriously backfire elsewhere (as it seemed to in the UK, for instance). Sweden is also much less population-dense generally, with only one major metropolis (Stockholm). "Luck" might be factoring in their numbers to some degree.

What caught my attention, though, was the epidemiologist's claim that Sweden might be achieving herd immunity by next month, which makes me skeptical to say the least. Sweden isn't anywhere near the top in terms of testing for COVID-19, and how can anyone confirm herd immunity without knowledge of exposures? It's frankly an almost Trump-like, statement without any evidence to support whatsoever ...
I've been explicitly clear that Sweden is a specific culture and circumstance, and that what works for them may not translate across societies. That said its not becoming a complete disaster should be no more dismissed than Italy becoming one. What specifically have been the differences, whether by fiat, voluntary changes, or baseline cultural or other norms, that kept them from completely exploding in the face of a relatively lighter touch? Their population pyramid is not dramatically bottom weighted, really very similar to the United States'. Indeed they smoke less and have significantly less obesity. Less multigenerational/crowded living conditions. People willing to listen to guidance that is not mandated. Its worth developing some hypotheses as to which of there and many other differences mattered and to consider which ones are valid and potentially transferable. It is important to know what of the things being done across the world are actually the biggest bang for the buck effective at reducing the rate of new infections and at reducing deaths (not necessarily the same things).

I missed the epidemiologist claim of herd immunity by next month. Can you quote it please? I read something about that their model states that by May 1 they think they will have 26% having or having had COVID-19 and a link to the page explaining that, but no claim that such represented herd immunity. Following the link I read this:
Quote:
The new calculations - which are also based on updated data on the number of reported cases - indicate that there are approximately 75 unconfirmed cases on each reported case of covid-19.

The results produced show that the day when most people were contagious in Stockholm County occurred on April 8. About 70,500 people were contagious then, according to the results.

For the curve not to turn upwards again for Stockholm, it is necessary that everyone continues to take their responsibility to protect themselves and others from infection.

- The number of infected people is still at a high level, it is not a place to release any precautionary measures, says Anders Wallensten, Deputy State Epidemiologist at the Public Health Authority.

The results of the mathematical calculations also show that 26 percent of the population in Stockholm County has or will have had covid-19 on 1 May.
From there one can follow links to the model itself but I'd surely agree that 26% seems like an absurdly high number. At 228 deaths per million currently they'd have to be assuming an overall IFR of 0.1% or less for 26% of the population to have been infected within a few days. Based on current antibody testing results at least that seems to be an overly optimistic assumption ... although deaths do lag.

But models .... what can you say?


That said there is a practical way to consider it. Infection rates (and their proxies of hospitalization, ICU, and death rates) starting to come down can be understood as herd immunity for the specifics of the circumstance and place. How much it translates to changing specifics of behaviors, rules, and such? There's the rub. From the link they clearly do NOT believe they have a number already infected sufficient to provide herd immunity in their business as usual circumstance or even to slightly reduce their precautionary measures, whatever number they believe have been/are infected.
  #154  
Old 04-29-2020, 10:24 AM
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Sweden's testing regime is just plain insane. As is Japan's. Neither have any clue what is really going on. Even death reporting may be suspect. But the kink is curious. Maybe it relates to what I describe above. Dunno.
Dude, get the fuck off your high horses. Reading something online does not make you an expert, and even less so if it isn't true. As it happens, the amount of tests per million inhabitants in Sweden is slightly higher than in the UK and slightly lower than in the Netherlands. What's so insane about that?
  #155  
Old 04-29-2020, 10:31 AM
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Well the UK testing strategy to date has been abysmal, so if Sweden's is only slightly higher then it is slightly less abysmal.

Not going to go into what it is that makes the UK testing so poor, but it is and this says nothing at all about the UK tracking - which is virtually non-existant, making the testing of absolutely minimal use - as will be seen when the numbers of non-hospital deaths are finally published.
  #156  
Old 04-29-2020, 10:31 AM
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My apologies, DSeid: it wasn't their epidemiologist, but their ambassador who is reported to have made the remarks.

https://www.npr.org/2020/04/26/84521...mbassador-says

Quote:
About 30% of people in Stockholm have reached a level of immunity," Karin Ulrika Olofsdotter told NPR. "We could reach herd immunity in the capital as early as next month."
Reacting to this specific comment, though, there is no established immunity yet - we don't know how immune people with antibodies truly are. We'd assume some level with many viruses, but the presence of antibodies does not automatically equate to full or even substantial "immunity." Given that this is an RNA virus, COVID will have different mechanisms than, say, a DNA virus for which we can just inject virus, build antibodies, and develop partial or even full immunity. To develop more robust immunity, we'd probably better off having a tool similar to what Bill Gates has touted, which is an RNA-type vaccine that could enable our body to equip itself to fight the virus. It's highly specious, and irresponsible, to tout herd immunity when there's just no evidence of it at all.

Moreover, I'm wondering what their calculations of immunity are being based on. They've not even tested as well as many of the countries that have been impacted by this event, and suffice it to say, very few countries have tested an adequate percentage of the population. When I hear statements like this without any merit whatsoever, I frankly begin to wonder if there's not, in fact, a deliberate attempt at some kool-aid drinking.
  #157  
Old 04-29-2020, 10:35 AM
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Dude, get the fuck off your high horses. Reading something online does not make you an expert, and even less so if it isn't true. As it happens, the amount of tests per million inhabitants in Sweden is slightly higher than in the UK and slightly lower than in the Netherlands. What's so insane about that?
Yeah, maybe a little less of the smarmy, lol.

Dude, we're using evidence. You need evidence to claim that there's herd immunity, and you need evidence to claim that a strategy is working. You're going in reverse, using the absence of evidence of a complete meltdown to suggest that Sweden's "strategy" is "working." That's not a very logical position to take.
  #158  
Old 04-29-2020, 11:13 AM
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Dude, get the fuck off your high horses. Reading something online does not make you an expert, and even less so if it isn't true.
Personal attacks are not permitted outside of the Pit. The rule around here has always been to attack the post, not the poster. This is clearly attacking the poster.

Since this is an emotional topic I am not going to give you a warning, but do not do this again.
  #159  
Old 04-29-2020, 11:52 AM
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My apologies, DSeid: it wasn't their epidemiologist, but their ambassador who is reported to have made the remarks.

https://www.npr.org/2020/04/26/84521...mbassador-says



Reacting to this specific comment, though, there is no established immunity yet - we don't know how immune people with antibodies truly are. We'd assume some level with many viruses, but the presence of antibodies does not automatically equate to full or even substantial "immunity." Given that this is an RNA virus, COVID will have different mechanisms than, say, a DNA virus for which we can just inject virus, build antibodies, and develop partial or even full immunity. To develop more robust immunity, we'd probably better off having a tool similar to what Bill Gates has touted, which is an RNA-type vaccine that could enable our body to equip itself to fight the virus. It's highly specious, and irresponsible, to tout herd immunity when there's just no evidence of it at all.

Moreover, I'm wondering what their calculations of immunity are being based on. They've not even tested as well as many of the countries that have been impacted by this event, and suffice it to say, very few countries have tested an adequate percentage of the population. When I hear statements like this without any merit whatsoever, I frankly begin to wonder if there's not, in fact, a deliberate attempt at some kool-aid drinking.
Well politicians ... what can you say?

Thing is of course that even if you have in hand believable large scale antibody test results demonstrating X% of a specific population has immunity, you cannot with any confidence say that such does or doe not mean that there is herd immunity based on the number.

First there isn't A number that means herd immunity ... there will be different numbers for different circumstances, depending on how people interact within a particular society and with how many.

Second whatever number serves for anyone as the big picture guess is just that ... a guess. Or a huge range of guesses.

Really we only can know what level of infection is needed for herd immunity in any specific place and circumstance by knowing what fraction has been infected (or are otherwise immune) and the after the fact observation that new infection rates are decreasing at that level in the "resolved" bucket. The rest is model guess work with inputs that are of low confidence to date.

So the politician is correct ... "could". Or could be not. It is not impossible that for their society and circumstance they will be able to release the precautions they have and avoid a big rebound. I hope they release their precautions only after they have solid evidence of being over the current surge and then in calibrated stages as well with careful monitoring and appropriate reactions to what the monitoring shows.


As for the vaccine - am I understanding you correctly that you think that a vaccine will likely give BETTER protection than infection does, that you have doubts that true infections can ever give enough protection to an individual to give herd immunity while you believe a vaccine can??

Natural infection usually results in stronger and more lasting protection than immunization does. It just does it with much greater risk. Usually a single infection leads to decent protection of some duration, in some cases lifelong. Often vaccines need multiple doses to build up to the same level, if the same level. The issues with disease reaching herd immunity impact is the harms getting there and the limits of getting enough of the population in the resolved bucket to get there (could never be reached with chickenpox for example ... COVID-19 is not chickenpox contagious).

For COVID-19 one cannot rationally hold both the belief that vaccination is likely to achieve herd immunity but natural infections might not.

Yes there are a few exceptions ... the vaccines for HPV, tetanus, Hib, and pneumococcus actually do give more protection than natural infections do ... but they are not the norm to be expected. Only one of those is a virus (HPV). Counting and depending on any vaccine to be both safe and effective in any specific timeline is a big enough assumption. Believing that it would give better protection than natural disease does is completely unrealistic to rationally expect.
  #160  
Old 05-02-2020, 08:12 PM
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The Swedish statistics authority reports that the reproduction number R dropped below 1 on the 20th of April. Cite, sorry it is in Swedish.
  #161  
Old 05-03-2020, 02:07 AM
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I note that they seem to have selected a specific date when recorded infections were at a low point in the reporting cycle.

Sweden has an obvious weekly cycle of peaks and troughs, April 20 was at the lowest part of that cycle - worth noting that only 4 days later the number of reported new infections was just over double that figure - so it is to be hoped that their calculations are based upon a 7 day average - and yet on the 3 day rolling average their caseload per million is actually higher on 2nd May than it was on 20th April.

If I were from Sweden I would not be at all reassured in their national statements.

https://ourworldindata.org/grapher/d...y=OWID_WRL+SWE
  #162  
Old 05-03-2020, 03:01 AM
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The Swedish statistics authority reports that the reproduction number R dropped below 1 on the 20th of April. Cite, sorry it is in Swedish.
Please indicate when a link is directly to a PDF. e.g. Cite [PDF]
  #163  
Old 05-03-2020, 07:47 AM
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I note that they seem to have selected a specific date when recorded infections were at a low point in the reporting cycle.

Sweden has an obvious weekly cycle of peaks and troughs, April 20 was at the lowest part of that cycle - worth noting that only 4 days later the number of reported new infections was just over double that figure - so it is to be hoped that their calculations are based upon a 7 day average - and yet on the 3 day rolling average their caseload per million is actually higher on 2nd May than it was on 20th April.

If I were from Sweden I would not be at all reassured in their national statements.

https://ourworldindata.org/grapher/d...y=OWID_WRL+SWE
The Swedish FHI should be reasonably independent of the government and composed of professionals. Its not a goverment statement.

You'll also note that R kept declining every day after the 20th.
  #164  
Old 05-03-2020, 08:20 AM
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No question that Sweden has a 7 day cycle. And that confirmed cases are of limited value. Death rates are better but lag and will show being past the peak only two to three weeks later, and the 7 day moving average of daily death rates (preferred to avoid that 7 day cycle noise) will lag even more ... and it shows a very consistent drop now, having peaked on 4/24, now 63% of its peak rate. You have to go back to 4/14 to have that number being lower.

It is quite clear that they are past the peak of this surge anyway, and did it without overwhelming their healthcare system. They nevertheless failed at protecting their most vulnerable to the degree their approach had called for.

How will they do from here? Are they right that having taken the hit they've taken now will lead them with less deaths over the longer haul while allowing them to recover faster? That we won't know for many months.
  #165  
Old 05-05-2020, 08:23 AM
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One key question is the extent to which the peak and decline in cases in countries which have implemented stricter lockdown measures can be attributed to those measures. Government officials seem to take for granted that this is the case - which you would expect, given that they like to credit themselves for things - but ISTM that the evidence is shakier. It looks to me like there's a natural cycle which is somewhat independent of such measures. In particular, it seems that even as hot spots peak and begin declining, other less plagued areas are still rising, even though they have the same lockdown measures in effect. So it looks to me like it's at least to some extent a matter of timing, and that at a certain point in the cycle cases will decline. Assessing the comparison of Sweden's approach vs that of other countries could also shed some light on this.

Obviously this is not to say that these measures have zero effect. It seems obvious that they have some effect. But even assessing the level of the effect is of enormous importance, because when balancing the beneficial health impact of these measures against the devastating economic impact, it's important to know just how much value to put on each side of the scale.
  #166  
Old 05-05-2020, 08:35 AM
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It seems obvious that they have some effect. But even assessing the level of the effect is of enormous importance, because when balancing the beneficial health impact of these measures against the devastating economic impact, it's important to know just how much value to put on each side of the scale.
Bears repeating yet again - Sweden was relying on its citizens' trust of their government and willingness to voluntarily engage on restrictions themselves.

They didn't "do nothing". They engaged in fewer restrictions, for example closing schools and banning events with large crowds but largely leaving restaurants and bars open, and asked people to voluntarily limit their own actions and engage in responsible social distancing practices. They also pro-actively set up field hospitals and ramped up acquisition of testing and PPE supplies.

You can compare results across nations, but trying to tease out 'trust in our government' out of the data as a confounding variable is difficult to impossible. However, it clearly doesn't exist in the US to anything remotely the same degree, so as a strategy, it's one that even Sweden believes is not possible everywhere.

Also, by their own metrics, they have not succeeded yet. Their stated goals was to minimize deaths. They believed they could achieve this over the long term while enacting fewer restrictions but still not overwhelming their medical system. The latter appears to be achieved (?) but the former won't be established for quite some time. At the moment, that former goal is not looking so good unless their neighbor countries see more and worse secondary and tertiary waves of infection and death - which is what Sweden is essentially betting on.

Last edited by Great Antibob; 05-05-2020 at 08:38 AM.
  #167  
Old 05-05-2020, 08:42 AM
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Obviously this is not to say that these measures have zero effect. It seems obvious that they have some effect.
U.S. NBER study attempts to measure just that (in the U.S.): WHEN DO SHELTER-IN-PLACE ORDERS FIGHT COVID-19 BEST? POLICY HETEROGENEITY ACROSS STATES AND ADOPTION TIME (PDF link)

It shows that Government orders do change the (stay-at-home) behavior of people to a statistically significant degree (compared to states whose governments didn't have those orders), and that those behavior changes in turn do correlate with a very significant reduction in infection rates after 2-3 weeks (but not a few days).
  #168  
Old 05-06-2020, 08:45 AM
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I wonder if it's possible that in some cases different countries are predominantly infected with different strains of the virus, so that both the natural patterns and the effect of various courses of action will vary by country/area.
  #169  
Old 05-06-2020, 09:01 AM
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A paper in preprint states that the US/Europe virus strain is a far more infections strain.

https://www.biorxiv.org/content/10.1...04.29.069054v1
  #170  
Old 05-06-2020, 10:08 AM
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Why do scientists (and many journalists writing about it) hold up Sweden's do-nothing herd immunity approach to COVID-19 as a model where "we have much to learn from them", while the early "do nothing" approaches of the US, UK, and other countries is universally condemned?

Is this another case of blindly idealizing Scandanavian solutions -- "if Sweden does it, it has to be good", or is there a method to the madness that seemingly works in Sweden, but not under similar conditions in other nations?
I have not seen a lot of glowing coverage of Sweden's approach. However, assuming this ends of up being effectivelya "piggy back" flu (we have no guarantees this wont' mutate, we have no guarantees an effective vaccine will ever be developed), a disease that just comes back every year, I think the U.S. needs to take a strong look at following this model. Hope is not a strategy. We're banking on game changers that may not happen.

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  #171  
Old 05-06-2020, 01:36 PM
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I think the U.S. needs to take a strong look at following this model.
Two huge differences between Sweden and the United States: socioeconomic inequality is one difference, and access to affordable healthcare is another. These factors discourage a lot of people here from using the healthcare system. We'd also need to do a much better job of contact tracing and producing readily available (and reliable) testing. Right now, we're just engaging a a big guesswork exercise.
  #172  
Old 05-06-2020, 01:55 PM
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Two huge differences between Sweden and the United States: socioeconomic inequality is one difference, and access to affordable healthcare is another.
And, a third may be a difference in adherence to the social contract between the two countries. Even without a government order to socially distance, many Swedes might well have been doing so anyway, because it's prudent and responsible to do so. We Americans do seem to have a stronger tendency to say "you can't tell me what to do," and more skepticism about advice from health experts.
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Old 05-06-2020, 03:39 PM
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And, a third may be a difference in adherence to the social contract between the two countries. Even without a government order to socially distance, many Swedes might well have been doing so anyway, because it's prudent and responsible to do so. We Americans do seem to have a stronger tendency to say "you can't tell me what to do," and more skepticism about advice from health experts.
Right, most Swedes are like that*. About half of Americans arent.

And Sweden has just about the best health care system in the world, free to citizens, and with plenty of hospital beds. The risk there is lower. There wont be- as in America- lots of people going untreated. Not a lot of people in prisons, not that many homeless either.

Whether or not the Swedish system was a Good Idea or not is a interesting question. Both sides have good points. But it couldnt work in America.

* they have their own Nazis and goth youths, of course.
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Old 05-06-2020, 06:45 PM
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... Right now, we're just engaging a a big guesswork exercise.
In every freakin' direction. We need to have much more serious analysis at granular levels to determine, in which specific regions and circumstances, because each is unique, which intervention is likely to be a great return on the investment, saving more lives and life quality than it costs in the same over time, and which may, over time, be causing more harms than goods. Guessing that something is required without evidence when there is solid evidence of harms caused is not a tolerable approach any more than guessing that removing it is for sure safe enough is.

We can at least rank order some things that are likely the biggest long term costs producers vs the least and rank order things that most clearly of major benefit vs the least evidence thereof.

The way in which Sweden failed demonstrates the huge importance of protecting the most vulnerable very strongly.

On the other hand they also demonstrate that closing schools is not necessarily required, and that is an item of huge costs to kids, their families, their families ability to work inclusive of essential jobs, and, given that some of those who are essential workers will upon grandparents to help them in lieu of school days, and have more contact with them, increases exposure to a higher risk population.

Doing the exact same as Sweden is not a good idea and not realistic in American culture even if it was. But their lack of complete disaster and still to be determined possible better outcome by end of all waves of infections, shows minimally that the same blunt hammer is not necessarily the only possible approach to all places that rates of infection need to be nailed down.
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Old 05-07-2020, 06:13 PM
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Sweden ambassador admits a big failure to prevent elderly deaths from coronavirus as death toll passes 3000.
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Old 05-07-2020, 06:36 PM
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i am not so sure I would be so quick to call Sweden a failure. They are at 300 deaths per million with no major disruptions to the economy and have already turned the corner. When 500 deaths per million is closer to what most European countries can expect to end up.
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Old 05-07-2020, 06:49 PM
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It's a higher death rate than it's neighbors Finland and Norway which did lockdown. And their economy is expected to contract just as much as any other European countries (7% decrease of GDP).
  #178  
Old 05-07-2020, 07:01 PM
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I think it's fair to say that Sweden's approach didn't result in disaster, but it likely resulted in deaths that might have been otherwise prevented. As I've said before (either here or elsewhere), maybe Sweden just got lucky.

So, Sweden could have prepared a little better but chose to show up to every other class and cram the night before the midterm. Ended up with a B, though they could have gotten an A with a better approach. They're relieved and realize that they got a little lucky in that the professor put the questions on the exam that they were able to answer, so they're still in good shape, I guess, but that doesn't mean that the results are replicable. At least they can do better going forward.
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Old 05-07-2020, 07:31 PM
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I think it's fair to say that Sweden's approach didn't result in disaster, but it likely resulted in deaths that might have been otherwise prevented. As I've said before (either here or elsewhere), maybe Sweden just got lucky.

So, Sweden could have prepared a little better but chose to show up to every other class and cram the night before the midterm. Ended up with a B, though they could have gotten an A with a better approach. They're relieved and realize that they got a little lucky in that the professor put the questions on the exam that they were able to answer, so they're still in good shape, I guess, but that doesn't mean that the results are replicable. At least they can do better going forward.
I'm curious why you're talking in past tense. I've noticed a lot of people doing this. We're not even in the middle of this thing yet. Saying Sweden has "ended up" with anything is kind of driving me crazy.
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Old 05-07-2020, 08:27 PM
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i am not so sure I would be so quick to call Sweden a failure.
By the same token, it's already not a success, at least by their own metric, which they claim is overall deaths.

It's not an abject failure and may not become one, but it's certainly not a success story, either. That is, unless their neighbor countries suddenly see more deaths for whatever reason.
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Old 05-07-2020, 09:36 PM
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Definitely more accurate to say that it so far, through a first surge, has not been a disaster.

Clearly they failed at one very important aspect of their plan, and yet still were not a complete disaster.

The expectation of some is that there will be at least one more wave, possibly in the Fall, possibly around the same time as influenza might hit. The question is if their having had more now sets them up to do better then, and if they can recover faster otherwise than their peer group.
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Old 05-07-2020, 11:08 PM
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Sweden's per capita death rate is now worse than the U.S.'s: https://www.businessinsider.com/us-s...-deaths-2020-5
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Old 05-08-2020, 01:10 AM
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Sweden's per capita death rate is now worse than the U.S.'s: https://www.businessinsider.com/us-s...-deaths-2020-5
It actually has been right from the start, but both the US and Sweden are still climbing relative to the other worst-hit countries. Since the per-day rates are still awful (only Belgium and UK are worse, though Ecuador seems to be making a surprise run for the title), this will probably be the case for a while
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Old 05-08-2020, 01:24 AM
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In contrast to Sweden, Denmark locked down early and heavily. They've eased restriction over 3 weeks ago and see no surge. If the trend holds, Denmark saw fewer deaths early without a spike after easing so far.

Danes and Czechs say easing lockdowns has produced no Covid-19 surge
Encouraging signs from EU states who acted early
reported on 4/30/20

Quote:
Denmark and the Czech Republic have said partially easing their lockdowns has not led to a surge in new coronavirus infections
. . .
In Denmark, daycare facilities and schools began reopening two weeks ago, followed by hairdressers and other small businesses on 20 April.
Denmark has 89 deaths per million vs. Sweden's 301 deaths per million. In Denmark, active cases and daily deaths are decreasing on a trend basis. Denmark has 43 people in serious/critical condition as vs. Sweden at 425. Denmark has roughly 5.8M people vs. Sweden's 10M population.


I feel sad for the people who have lost loved ones to the virus in Sweden. I understand that people die from preventable causes all the time. But the attitude of the government just seems so cavalier. They keep touting their success except for those pesky 2.7M elderly who died, If you're elderly and survived in a home, you now can't see your loved ones while they go on with business as usual. It's also the responsibility of the elderly not in care homes to shelter in place without much support. I saw a video of a volunteer bringing an elderly person some groceries, but that's not government assisted. I also saw a video of a woman whose father died from covid. She seemed all the more upset because she felt it was preventable.

I have read many conflicting articles about Sweden. Tegnell insists that people can continue on their path indefinitely. But I've seen other reports where they say they're social distancing with one guy saying he hasn't seen his relatives for a couple months. If so, that's untenable for most people not to see relatives for a year or so. Now people can't see people in elderly care homes. Will that go on for a year or more?

Tegnell says they're not trying for herd immunity. But then what are they trying to do? Their economy is projected to be just as affected as neighboring countries, so leaving businesses open isn't projected to eliminate that problem. I suppose they can be trying to avoid a second wave. But avoiding a second wave only counts if the first wave isn't large and declines at some point.
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Old 05-08-2020, 04:54 AM
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I feel sad for the people who have lost loved ones to the virus in Sweden. I understand that people die from preventable causes all the time. But the attitude of the government just seems so cavalier. They keep touting their success except for those pesky 2.7M elderly who died
Oops, typo. That should have been 2.7K.
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Old 05-08-2020, 08:14 AM
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Please indicate when a link is directly to a PDF. e.g. Cite [PDF]
Why do we still do that?

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Old 05-08-2020, 08:23 AM
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I'm curious why you're talking in past tense. I've noticed a lot of people doing this. We're not even in the middle of this thing yet. Saying Sweden has "ended up" with anything is kind of driving me crazy.
As I said, this was the midterm; there will be a final exam in the fall and winter, when flu season hits and when cooler temperatures bring more people together in one place.
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Old 05-08-2020, 08:27 AM
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I feel sad for the people who have lost loved ones to the virus in Sweden. I understand that people die from preventable causes all the time. But the attitude of the government just seems so cavalier. They keep touting their success except for those pesky 2.7M elderly who died, If you're elderly and survived in a home, you now can't see your loved ones while they go on with business as usual. It's also the responsibility of the elderly not in care homes to shelter in place without much support. I saw a video of a volunteer bringing an elderly person some groceries, but that's not government assisted. I also saw a video of a woman whose father died from covid. She seemed all the more upset because she felt it was preventable.
It's worse than cavalier; it's public officials who were touting an approach that had absolutely no scientific basis to support it, and rather than acknowledge they made mistakes, it seems that from the looks of things they're trying to defend themselves. They've been banging on the "herd immunity" drum for a long time, but guess what: it's not always possible to develop a herd immunity. Each virus behaves differently. What we've seen in Sweden - and frankly in the US - is a shit load of hubris from public officials who were simply not at all prepared to do their fucking job, and they're finding every excuse possible to explain it. It's maddening to watch and to listen to.
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Old 05-08-2020, 08:29 AM
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Sweden's per capita death rate is now worse than the U.S.'s: https://www.businessinsider.com/us-s...-deaths-2020-5
Officially, yes.

But emphasis on "officially."

The data are shit, both in Sweden and the US. I trust their data marginally more than ours though.
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Old 05-08-2020, 12:19 PM
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... avoiding a second wave only counts if the first wave isn't large and declines at some point.
They've definitely declined. Death rates, ICU demands, hospitalization rates, so on, are all consistently off their peaks.

"Large" depends on what one defines it as. For the value of "large" defined as overwhelming the healthcare system (which btw DrDeth, does not have many hospital and ICU beds relative to most), their first wave was not large. For the value of "large" defined as relative to Denmark's first wave, their first wave was large.

Their approach to nursing homes is a model in what not to do, albeit so far no one has provided a great model in what to do. That is clear.

But even with that horrific fail included their approach otherwise has not been a complete disaster so far, and end of all waves and their aftermaths might (or not) turn out to be a relative success.
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Old 05-08-2020, 01:22 PM
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In contrast to Sweden, Denmark locked down early and heavily. They've eased restriction over 3 weeks ago and see no surge. If the trend holds, Denmark saw fewer deaths early without a spike after easing so far.

Danes and Czechs say easing lockdowns has produced no Covid-19 surge
Encouraging signs from EU states who acted early
reported on 4/30/20



Denmark has 89 deaths per million vs. Sweden's 301 deaths per million. In Denmark, active cases and daily deaths are decreasing on a trend basis. Denmark has 43 people in serious/critical condition as vs. Sweden at 425. Denmark has roughly 5.8M people vs. Sweden's 10M population.




I feel sad for the people who have lost loved ones to the virus in Sweden. I understand that people die from preventable causes all the time. But the attitude of the government just seems so cavalier. They keep touting their success except for those pesky 2.7M elderly who died, If you're elderly and survived in a home, you now can't see your loved ones while they go on with business as usual. It's also the responsibility of the elderly not in care homes to shelter in place without much support. I saw a video of a volunteer bringing an elderly person some groceries, but that's not government assisted. I also saw a video of a woman whose father died from covid. She seemed all the more upset because she felt it was preventable.

I have read many conflicting articles about Sweden. Tegnell insists that people can continue on their path indefinitely. But I've seen other reports where they say they're social distancing with one guy saying he hasn't seen his relatives for a couple months. If so, that's untenable for most people not to see relatives for a year or so. Now people can't see people in elderly care homes. Will that go on for a year or more?

Tegnell says they're not trying for herd immunity. But then what are they trying to do? Their economy is projected to be just as affected as neighboring countries, so leaving businesses open isn't projected to eliminate that problem. I suppose they can be trying to avoid a second wave. But avoiding a second wave only counts if the first wave isn't large and declines at some point.

Everybody is winging it: Tegnell is unique because he does have to get re-elected.
He’s doing exactly what his mission is: flattening the curve to under the capacity of the ICU’s. He is doing exactly that. He doesn’t have to justify his actions to the electorate: he has to do what the science, of there is any, says.

In Holland the schools were closed because public opinion demanded it. The RIVM still think that was unnecessary and not effective. I think all the numbers are more or less a matter of luck: Italy and Spain had an unfortunate football match (Bergamo-Sevilla?) in the southern part of the Netherlands the arrival of Corona coincided with carnival. Speed and communicating the importance of social distancing effectively: after that the timing of large gatherings just before the “lockdowns” has more influence than the extent of the lockdown. France and Spain have an especially rigid lockdown regime, Germany is much more permissive: yet the numbers favor the Germans.
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Old 05-08-2020, 02:53 PM
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Heís doing exactly what his mission is: flattening the curve to under the capacity of the ICUís. He is doing exactly that. He doesnít have to justify his actions to the electorate: he has to do what the science, of there is any, says.
That's one mission - that's the minimum standard for success. The hypothesis that you can just allow people in supposedly 'low-risk' categories to go on about their lives and segregate them from those with higher risk seems great on the surface, but it's not sound public health policy at all. The fact that ICUs haven't been overwhelmed isn't evidence that they're succeeding; it's evidence that they're not failing based on the worst metric.
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Old 05-08-2020, 03:10 PM
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...
"Large" depends on what one defines it as. For the value of "large" defined as overwhelming the healthcare system (which btw DrDeth, does not have many hospital and ICU beds relative to most), ....
You are right. I relied upon a Swedish poster on another board. They do have a excellent health system, however.
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Old 05-08-2020, 06:43 PM
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That's one mission - that's the minimum standard for success. The hypothesis that you can just allow people in supposedly 'low-risk' categories to go on about their lives and segregate them from those with higher risk seems great on the surface, but it's not sound public health policy at all. The fact that ICUs haven't been overwhelmed isn't evidence that they're succeeding; it's evidence that they're not failing based on the worst metric.
So now we went from "flattening the curve" to "do whatever it takes to save everyone"?

That is not normal behaviour for goalposts.

"it is not sound public health policy" -- LOL -- What does that even mean? Because I sure as shit didn't get public health policy for nCOV-19 in school. Maybe I was sick that day.

This is a new virus in a world that is much more mobile than during earlier pandemics. If you know what "sound public health policy" in this case is you should probably go tell someone: Right now everybody making a WAG and, to misquote Rutte, "making 100% decisions with 50% information". Complete suppression seems unlikely, immunity might not last, IF there is a vaccine developed it will take at least a year to produce in meaningful numbers... If you think there is a one-size-fits-all approach to this, I am jealous of your certainty.
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Old 05-08-2020, 06:53 PM
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Officially, yes.

But emphasis on "officially."

The data are shit, both in Sweden and the US. I trust their data marginally more than ours though.
Death rates do not make good comparisons until the virus has passed. One country might just take longer to get there.
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Old 05-08-2020, 07:05 PM
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So now we went from "flattening the curve" to "do whatever it takes to save everyone"?

That is not normal behaviour for goalposts.
It's not a change in goal, though: it's a recognition that it probably isn't even possible to "just allow people in supposedly 'low-risk' categories to go on about their lives and segregate them from those with higher risk." With COVID-19, it turns out that there are a lot more low-risk people who are actually asymptomatic (or presymptomatic) and shedding the virus, so allowing low-risk people who display no symptoms to take care of vulnerable people (e.g., in nursing homes) or deliver groceries or otherwise interact just allows the virus to spread almost unchecked in vulnerable populations.

Sweden's goal was never "flatten the curve"; it was to stay within hospital capacity while protecting their vulnerable populations. So far, they've apparently succeeded in the former, but the second part of that initial goal has failed. They have not protected their vulnerable; their chief epidemiologist now says the high death toll came as a surprise and the Swedes thought nursing homes would be able to keep the disease at bay much more effectively. (cite)

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"it is not sound public health policy" -- LOL -- What does that even mean? Because I sure as shit didn't get public health policy for nCOV-19 in school. Maybe I was sick that day.
Exactly what measures are necessary with this new virus is still largely unknown, but the broad general goals of "sound public health policy" are still basically the same as they have been for the flu and measles and AIDS and STDs and any number of transmissible diseases: reduce transmission to reduce morbidity and mortality. The argument here is that the Swedes did not worry overmuch about the "reduce transmission" part, and their vulnerable citizens have paid the price.
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Old 05-09-2020, 12:09 PM
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So now we went from "flattening the curve" to "do whatever it takes to save everyone"?
Nowhere did I say or even suggest that. I'm saying that Sweden has a public health system that each citizens invests a lot of their tax dollars to support, so ideally, you'd rather it be able to do more than just set the bar so low that all the health system is capable of is making sure that hospitals don't quite get to the point where patients are admitted by the hundreds every few hours and have to lie down on floors or gurneys in the waiting area while waiting to be admitted. That's a really low bar, and I suspect that the average Swede aims a bit higher than that.

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"it is not sound public health policy" -- LOL -- What does that even mean? Because I sure as shit didn't get public health policy for nCOV-19 in school. Maybe I was sick that day.

This is a new virus in a world that is much more mobile than during earlier pandemics. If you know what "sound public health policy" in this case is you should probably go tell someone: Right now everybody making a WAG and, to misquote Rutte, "making 100% decisions with 50% information". Complete suppression seems unlikely, immunity might not last, IF there is a vaccine developed it will take at least a year to produce in meaningful numbers... If you think there is a one-size-fits-all approach to this, I am jealous of your certainty.
Yes, it's a new virus, but it's not the first pandemic and pandemics are inevitable thanks to modern air travel. Unfortunately, Sweden is not alone in failing to take the threat of a deadly epidemic as seriously as they should have. Despite its obvious failures, Sweden still did some things right, like investing in a good healthcare system that provides universal access. Unlike here in the US, Swedes probably don't have to waste precious time trying to determine whether they can afford tests, whether tests are covered by their insurance companies, whether they can afford to be admitted to the ER, whether any of these medical costs - from testing to treatment - are "in network" or "out of network".

Last edited by asahi; 05-09-2020 at 12:14 PM.
  #198  
Old 05-10-2020, 09:31 PM
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We're also talking about a virus that was not recognizable and easily mistaken for influenza. And I have no idea why you're referring to 2019-20 as a "mild" flu season, when it was regarded as one of the longest in a decade -- at least here in the US anyway.

https://time.com/5758953/flu-season-2019-2020/
That article published on January 4 doesn't give much information on how "long" the American flu season was. It does show the early start --- but other graphs I've seen show an early stop, giving a "mild" flu season overall.

Although flu tests aren't very good, they are comparable year on year. The 19-20 flu season was mild, and stopped before the start of the C19 season.
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Old 05-10-2020, 09:47 PM
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That article published on January 4 doesn't give much information on how "long" the American flu season was. It does show the early start --- but other graphs I've seen show an early stop, giving a "mild" flu season overall.

Although flu tests aren't very good, they are comparable year on year. The 19-20 flu season was mild, and stopped before the start of the C19 season.
Don't know where you are getting that impression but here's the CDC site. Scroll down to "Outpatient Illness Surveillance. ILINet" and then to "Influenza-Associated Hospitalizations" and "Pneumonia and Influenza (P&I) Mortality Surveillance".

2019-20 was in no shape or form a mild flu season with an early stop. Possibly as bad as 2017-18 which was an exceptionally bad one. In lab confirmed influenza hospitalizations it was only behind that year. The issue mainly is if some later ILIs and pneumonia deaths were actually Covid-19, in retrospect. That lack of clarity is exactly the point that was being made.
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Old 05-11-2020, 05:20 PM
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Here is an interesting interview with Dr Anders Tegnell, Sweden's top epidemiologist. While they have't had a perfect response he feels that Sweden has done quite well in dealing with the virus. An interesting read.
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