I’m short on time and haven’t looked at your link but I’m wondering if there’s a breakdown of ‘presumed’ flu and confirmed flu. As with COVID and other tests, there’s often a lag time between testing and confirming the results. And I would imagine that in really ‘heavy’ seasons, they may look at symptoms and lump ‘presumed’ cases into the category of confirmed cases. The danger of doing that is when you have a new disease that mimics the flu in some regards, which COVID-19 does. That’s why I made reference to the ‘heavy’ flu season to begin with: I suspect that some cases that were contributing to the rough flu season were actually the beginnings of COVID-19, especially if the cases were in January and early February.
J09 and J10 are confirmed influenza virus infections. J11 is presumed flu.
Unfortunately they are “lumped together” (as J09-J11 or even J09-J18) in easily found public stats I can find.
I haven’t seen a breakdown between J09, J10 and J11. I would be interested in seeing it (for whatever country). I believe J11 is FAR more used than those other two.
The rapid flu tests they give you at the doctor’s office are really really inaccurate:
So while I don’t doubt that there were cases of COVID misdiagnosed as flu, the reality is that the doctor’s judgement is likely as good or better than the test. I am also not sure that flue is the most likely disease to conceal COVID. Severe COVID, sure, but for people with mild symptoms, people who go to their doctor or urgent care facility, it’s really not flu-like at all. The most distinguishing feature of flu is the rapid onset: you go from “am I getting a cold?” to “I want to die” in a matter of hours. COVID seems to be the opposite: it comes on gradually, and you feel more and more crappy over several days, even a week. I don’t think many doctors would think “flu” if a patient presented like that, and if they also had a negative flu test, it is even less likely. It is my understanding that you get the J11 diagnosis when you have a negative test but the mack-truck progression.
Yeah I wouldn’t trust the codes used for much. But the CDC does break things out by different proxies.
One report is percent of our-patient visits that were for influenza like illnesses (ILI). That’s the one that shows a clear late third peak that was very unusual beginning around week 10.
Another is reports of positive tests by the public health labs. Dropping by week 10, like in many flu seasons.
Influenza associated hospitalizations- overall second only to 2017-18 in recent years but had flattened off by … week 10.
Pneumonia and influenza mortality combined. Typical year until a huge spike … beginning about week 10.
Put it together and it was a bad flu year that looked like it was falling off maybe just a bit late and testing fewer positives but then jumps in ILI and deaths from pneumonia beginning about week 10.
Yeah I wouldn’t trust the codes used for much. But the CDC does break things out by different proxies.
One report is percent of our-patient visits that were for influenza like illnesses (ILI). That’s the one that shows a clear late third peak that was very unusual beginning around week 10.
Another is reports of positive tests by the public health labs. Dropping by week 10, like in many flu seasons.
Influenza associated hospitalizations- overall second only to 2017-18 in recent years but had flattened off by … week 10.
Pneumonia and influenza mortality combined. Typical year until a huge spike … beginning about week 10.
Put it together and it was a bad flu year that looked like it was falling off maybe just a bit late and testing fewer positives but then jumps in ILI and deaths from pneumonia beginning about week 10.
It turns out most places aren’t located in the United States. Shocking, but true. The fact is the flu season in Europe was unusually mild with a peak of only two weeks, which is what makes it seem impossible to me that any other disease could have been misdiagnosed as flu to any notable degree in Italy or pretty much anywhere else. That would require flu itself to have been virtually eradicated, which to the best of my knowledge it has not been.
What you linked to documents that influenza was peaking in Europe, Italy inclusive, end of January into early February. In Italy end of January was seeing nearly half a million cases diagnosed clinically as influenza in a week.
COVID-19 exploded as a diagnosis during February.
What seems impossible to you is pretty widely accepted by most experts. COVID-19 was there no later than mid January unnoticed and not diagnosed as COVID-19 anyway during Italy’s influenza peak and spreading.
So not only was there a significantly shorter flu peak than normal, but you also think it was a misdiagnosed different disease and nobody anywhere noticed? That’s honestly completely absurd. If that were the case there should be thousands of samples that show CoViD-19 presence from earlier than February, and they’ve found what, one?
It’s right there in the link. If the “hundreds” who were hospitalized had CoViD-19 and we know only a small percentage of those infected with the virus are hospitalized, what does that tell you?
I think the best, most accurate answer is I don’t know - I wouldn’t know how many cases were misdiagnosed. It could have been tens, hundreds, or more than that. I’m not suggesting that the heavy flu season in the US was exaggerated; I was just remarking (as has been documented already) that COVID-19 was circulating earlier than previously thought and that some of those early cases, including some deaths were missed.
My entry into this hijack was the claim that this an exceptionally light influenza season and that COVID-19 couldn’t have been brewing unrecognized and unlabelled during it.
It had been a fairly typical influenza season in Europe reaching peak as COVID-19 was identified in Italy. Overall December through February together had been a slightly worse test positive influenza season that the previous year (see it presented graphically here). Visits for ILI were pretty lockstep with the year before in Italy. Not surprisingly across the world as populations (independent of and prior to mandates) populations began to socially distance, influenza dropped quickly, ending the season a bit earlier than usual. The short two weeks peak by the way refers to something different that you think it means and actually argues that something else WAS going on: it is two weeks of peak percent of the swabs sent of sick people being positive for influenza. It means that there was more of the time that the swabs sent of sick people suspected of having influenza were NEGATIVE for influenza, and thus the illness was being caused something else …
Clearly, at peak of flu season, many individuals could have been infected with SARS-CoV-2, some significant number asymptomatic or mildly symptomatic, some much sicker, spreading COVID-19 in places like Italy, unnoticed, many weeks before any were diagnosed. How many? Dunno.
What does this aside have to do with Sweden again? Oh yeah. It is thought by many experts that NY and Italy had already had some significantly wide seeding, hidden in the fog of flu, before anyone even thought start changing their behaviors, let alone before there was governmental response; Sweden and its Nordic peer group likely not.
Sweden’s 7 day rolling average for mortality as tracked in this publications tracker has been higher than the UK, Italy and Belgium. The recent rolling average is more astounding considering how high the deaths per million in these countries has been.
At this moment, in deaths per million per Worldometer:
Sweden 371
UK 521
Italy 532
Belgium 790
vs. Sweden’s neighbors
Sweden 371
Denmark 95
Norway 43
Finland 54
Sweden allows people from other countries to go into their country, so people can go to Sweden from another country, but when they return to their own country, they’re subject to a quarantine. Unless it’s a long work project, that doesn’t allow people to go back and forth for work.
In separate but related news dated May 19, 2020, Sweden is reported to be in very deep economic crisis despite not locking down as other countries have done.
Sweden is affected by the global economy like everyone else, maybe more so. Half of Sweden’s GDP comes from exports, and demand for those exports have “dried up.”
Although the article doesn’t mention it, the lockdown of borders from other countries could impact the demand from people traveling from neighboring countries.
And again, Anders Tegnell claims that the strategy Sweden took wasn’t to put the economy above lives. He says that the strategy was put into place because it’s sustainable. ISTM record bankruptcies and high death rates aren’t sustainable.
It also seems to me that the businesses like restaurants, gyms and personal services really can’t go on indefinitely with a fraction of its customers. Most business like that that aren’t at full capacity, at least some of the time, are losing money.
The Bloomberg article concludes.
So far, people have theorized that perhaps Sweden will achieve herd immunity, but Tegnell claims that’s not the goal. Herd immunity has not been achieved. Then people have theorized that Sweden’s approach will fare better economically. It doesn’t appear so. Tegnell claims it wasn’t meant to save the economy. One of the other claims is that the second wave for other countries will level out the amount of death. But what if it doesn’t? The first wave of people can’t come back from the dead for a do-over. The upside of this what-if seems small while the downside is already happening and can’t be reversed.
I remain skeptical of Sweden’s strategy. I might understand it a bit more if Sweden was in the position of the US where a deep recession might cause a number of deaths of despair, but Sweden has a strong social safety net with universal health care and guaranteed minimum income. Studies show that a strong social safety net can buffer the effects of a recession.
It would also be helpful when people claim that recession kills would quantify how many people will be killed so that it can be measured against how many people are killed by covid-19 now.
As for the second wave argument, they might have asked those people dying if they’d rather die now or take a small chance that something would save them in the future. Those people might have picked the latter, but they weren’t given much of a choice.
I have been wondering about the high death rate per million - versus the Swedish economy and had come around to thinking that although its a relatively high rate, the economy was still largely open compared to most other nations whose economies are shut down.
In terms of a strategy that would appear to have some sort of merit, especially given that we don’t really know the final result, but the previous post appears to refute that possibility, if that’s the case then Sweden does seem to have selected a poor option - but only time is going to prove it.
I had seen an article on the BBC that suggest that a large chunk of deaths are in elderly care homes - maybe Sweden has been ill prepared for this and that the rest of the country is actually does better than it appears.
I think the real surprise to the Swedes is the economic effects. But this is a global pandemic, and in a global economy it is impossible to avoid knock on-effects. A lot of the world has seen the major downturns in tourism and hospitality. Closed borders and lack of travel means that Sweden will be hit no matter what its internal policies are. But Swedes were also expected to avoid such activities as a matter of personal choice. So overall the economic impact was unavoidable. No matter what the implementation of policy was.
What will be interesting is their ability to bounce back. There is some evidence that an early hard lockdown leads to significantly faster recovery. But this time recovery is going to be driven by confidence and desire within the populace. Certainly there seems to be a lot of pent up demand for the chance to enjoy what has been denied for the last few months. So maybe tourism and hospitality will recover quickly once things are over. But until global restrictions are lifted it isn’t going to be easy. Retail will be interesting. My observations here on the other side of the planet suggest it will recover. Some areas are moribund. Car sales are non-existent. But they were already in deep trouble.
A geriatrics professor in Sweden says that the elderly in care homes were given palliative care and not taken to hospitals with proper treatment when they were diagnosed with Covid-19. He claims that this was active euthanasia. [This is a link to a translated comment. The original article is in the post.]
An anonymous doctor claims that instead of oxygen treatment, elderly patients in care homes are given a “palliative cocktail” which includes morphine. The lack of oxygen treatment, combined with the morphine, according to these doctors, gives the elderly patients a lower chance of survival.
Another article is about a guy who has a father in an elderly care home who was prescribed this palliative care. He stepped in to stop the treatment to his father. He claims this is why his father survived. Google translate version. Reddit post.
According to the same geriatrics professor in the first article, he’s received many calls from people who have relatives in elderly care homes who have been told that their care was prescribed by a doctor over the phone. The patients are left in the elderly care homes where the medical help is not trained for Covid-19 patients. They are also given palliative care which often leads to death.
This might explain something I found very curious in Sweden’s stats during the height of the hospitalization rates. On one day I’d check the stats and the number of patients in serious/critical condition would be roughly 500. The next day, it would be around 1,000. Then back down to 500 and back and forth like that for several days. It didn’t make much sense because 500 people weren’t dying every day and it seemed unlikely people were getting better and worse on a daily basis.
I’m surmising that when they got the call that some had Covid-19 at an elderly care home, they added them to the serious stats. But the next day, since they’re not transferred to ICU, they’re not in those stats. It also might be an explanation for why the hospitals were not overrun. Patients from elderly care homes weren’t transferred to hospitals to be put on ventilators. They were given palliative care.
California calls every elderly care home every day and has done so during the lockdown. They also transferred patients to hospitals and didn’t leave them to be taken care of by the elderly care home. They tried doing that for a while but stopped when they got pushback. It isn’t a perfect model, I’m sure but I’m liking it better than Sweden’s model.
I think Sweden’s model might point out why locking everyone down helps the elderly since there’s not much of a way to protect them from the general population, and if the general population isn’t spreading the virus in the peak, then the elderly might have more of a chance.