Deeply pessimistic and largely untrue, you seem to have forgotten the Ebola outbreak, it seems to have small outbreaks but is now well under control, you post almost suggests we leave these virus to run their courses and I do not subscribe to that.
casdave, you really should try to include usernames in your quotes.
The Swedish strategy was always presented as a more sustainable approach. If every other country lurches for the next year between partial lockdowns and they slowly catch up to near Sweden’s fatality rate, then Sweden’s policy gets some justification. If next flu season every other country besides Sweden is swamped with a combo epidemic, Sweden’s style gains some justification.
I’m not betting my house on any of that. I do think we’ll have some interesting data if/when second waves come and next flu season.
You are of course free to share your beliefs now, including if the word between are “toilet plunging for the department of”. The value of what you say is still based on what you say.
A key aspect of the Swedish approach was that they would do BETTER at protecting the highest risk populations while having the Resolveds bucket grow with lower risk individuals, at a rate that did not overwhelm the system.
Not sure where you are getting your numbers but the sources I find say that they not only failed to do better at protecting the vulnerable populations, they did worse. In terms of policies for elder care they were completely horrible. In that aspect they completely “fucked up”.
Numbers. No not 50%.
New York was not 75% of the dearths occurring in nursing homes, it was 20%. New Jersey was higher, but at 52%. Overall in the United States it was 35% … not 75%.
How did they fuck that up so badly? Many ways. It is shameful enough to not have enough PPE for staff to use and for staff to be inadequately trained in its use, but another level of fuck up to “not require use of protective gear in homes unless a resident had Covid-19 symptoms.” There was NO appreciation that care workers can spread when asymptomatic and presymptomatic. Workers worked, intimately with their charges, across large populations within and across institutions.
Yes there are ways to do better at providing a protective shield around those under care, and not just better than Sweden did, but better than most places have done. Yes more full time staff so fewer exposure. That staff organized as teams taking care of specific cohorts, not working across the institution, let alone across many of them. Staff all trained in wearing PPE, instructed to wear it when within 6 feet of ANYONE, understanding why doing that outside of work matters, and supplying it amply there. Regular testing of asymptomatic staff and patients with rapid contact tracing and isolation in this high risk cohort. So on.
If you are willing to spend a bit more (but still small on the scales this disease moves in) pay extra to have staff live on campus in RVs for the duration. Maybe departures allowed but no return to work until tested negative upon campus return. The basic of that not my idea - it’s been done and it worked well.
asahi this bulk was not the “over 60 relatives” … it was specifically mostly people in nursing homes. No trust required. Relatives are not visiting and if visits would be allowed would be with strict guidelines enforceable.
I have had no discussions with Tegnell, so am not privy to what he was thinking, but the idea is one that has been well discussed and is valid, given assumptions nor more or less valid thatn others that have been put out there. If the assumption is that relying on a vaccine to come over the hill in time to save the day is not something to bank on, and that suppressing rates to near zero long term is some combination of a fantasy and nightmare - not achievable without lots of unintended consequences including deaths worldwide as a result of the worldwide economic impacts of the interventions, then one can only conclude that whatever the number of Resolveds is, for the specific society and place, that slows down spread, is going to happen. (Be that 60% assuming it behaves like an influenza, or much less assuming some nonspecific immunity from other human coronaviruses providing partial protection. What can possibly be controlled in that set of assumptions is the who make up the Resolveds (the higher risk individuals or the lowest ones) and the when the cases occur most (over spring and summer when there is health system capacity or during the winter when healthcare systems are already near breaking with influenza cases.
What were those “design standards”?
So yes, better infection control standards make a difference. It can be done.
A long way from Sweden, an NYT writer who lives in Brazil says it’s in “coronavirus free fall”: https://www.nytimes.com/2020/06/08/opinion/brazil-coronavirus-bolsonaro.html
Are you drawing a comparison between the Brazil and Sweden responses or results? 
It looks like Sweden’s response was framed by a top health official that put all his eggs in the “herd immunity” basket. He has since apologized and admitted that he was wrong.
Brazil, on the other hand - their response seems to be framed by a right-wing Trumpian president, who puts the economy above deaths, and who has explicitly said that he takes no responsibility - despite being responsible.
** Euphonius Polemic**
The the less than forgivable error that he made was to make assumptions based on no evidence whatsoever.
He assumed that it was possible to get herd immunity, and yet we still do not know the extent of any protection recovery from infection can make, nor do we know how long such protection may last, now did he have the slightest clue how long it would take to achieve that assumed herd immunity - if any immunity is very short lived, such as a few months then a long run up to 90% infection and recovery could end up simply as an endemic merry go around.
What we do know and have done for pretty much the whole outbreak is that social distancing does at least buy time and in the case of those nations that were very fast on the implementation it works well.
I also want to take issue with DSeid
On the evaluation of the additional deaths in nursing homes - firstly there is the ethical one of deciding to strip out figures that may the data look bad - this is bad science and pretty contemptible - those lives were worth preserving for as long as they could have been viable.
But leave this aside, if the deaths in care homes is around 50% that still leaves the per capita death rates twice as high as Denmark and four times higher than other Skandinations - in no way whatsoever could any part of Sweden’s policy be considered effective - even the economic hit will be massive.
Maybe by chance some good might come of the larger number of infections - but that isn’t a way to manage risk, I repeat - the driver behind risk management is to fail toward safety, not bet on hopeful outcomes.
It’s not shameful shenanigans to point to a failure in a particular demographic. Frankly, it would not be particularly intelligent to ignore such a distinct failure which makes up a majority of the deaths caused.
Here in Ontario, long term care home deaths is also about 70%. If you ignore that and try and tell me “oh, the problem is you didn’t shut down the entire province quick enough”, you are the one ignoring data. You are the one shouting down a thoughtful look at what’s happened.
casdave,
If it is unreasonable to function on the assumption that herd immunity is possible then there is no reason to work on developing a vaccine, the goal of which is to get enough protected enough so that herd immunity is achieved. It is a rare vaccine that provides stronger or longer lasting protection than natural disease does. The advantage of a vaccine approach is achieving a larger number in the Resolved bucket all at once and doing so with fewer adverse impacts, but it assumes that herd immunity is possible.
I know of no experts who do not believe that herd immunity is possible.
Without or without vaccine this virus becoming endemic, possibly seasonal, like influenza is, is considered by many a very probable outcome. Of course no one knows. I’ve not read any experts who expect eradication.
It would be completely ascientific to not consider which demographics have had what happen. Again, operating on a very reasonable assumption to base a model off of, that one cannot depend on a vaccine to be available to save the day and that the actions to suppress it to very low levels for potentially years or more are some combination of unrealistic and of huge morbidity and mortality harms, the idea of gradually building to whatever functional herd immunity is at a rate that does not overwhelm the system, letting it happen more in the lower risk groups than in the higher ones, and at a time of year when the system has its greatest capacity rather than wintertime contemporaneous with influenza, is rational and has very good modeling support. I’ll don’t have tiome right now to find the article again but I’ve linked before, but there was a very good article published in Israel in which having younger individuals without identifiable risk factors volunteering to get infected in closed campuses in waves, in rapid succession, resulted in many fewer total deaths, for example. The reasons to not do that are not the science of it but the policy of it.
In that model having four times as many deaths as Denmark now, much less than most other countries even if not as low as Denmark and other Nordic nations, when that level is way below health system capacity, would be on target. It would have been the level that achieved about 7% with antibodies by mid April and therefore likely somewhere north of 20 by now and more of course before a second wave hits. Herd immunity or not having more in the Resolved bucket means less rapid and severe spread in a next wave.
To me the “bet on hopeful outcomes” is the bet that there will be no second wave and the bet that a second wave hitting a region with virtually no one immune timed with influenza won’t overwhelm systems and cause massive deaths. It is a very hopeful bet that countries that have had few cases, and thus virtually no one in the Resolveds bucket, will be able to maintain suppression long term and not have new waves at the worst possible times. Hoping that that disaster of a wave occurring timed with influenza won’t happen could be construed as reckless, depending on your POV.
In any case whatever ones take is on that, it is pretty contemptible to not do better at providing a better shield around nursing home populations, to just shrug that old people gonna die because creating system approaches that protect them is too much to bother with.
And it would be very ignorant to not recognize that Sweden failed to provide that shield, a necessary part of testing the model. Also it is surprising that despite that failure
And you’re still free to continue to demean the janitorial profession. I only mentioned my background as you were the one who stated: “There are instead nonscientific beliefs that are being held sometimes misrepresented as “what the science says” by those who have no clue what science is actually about.” Since my job title is Head of Data Science, I happen to have a clue as to what science is all about. Data, too. I happen to suck at toilet plunging (and equally tennis and Williams Electronics’ Defender), but I have a huge respect for those who clean for a living.
I’m not going to create a quote wall of the rest of your post as I have no idea who you are addressing, but it sure as hell wasn’t me. Nevertheless, I’m pretty sure I can simply paraphrase your take throughout this thread as: Sweden fucked up nursing homes (or old people, or some Venn diagram of the two), but the jury is still out on the other aspects. Feel free to nuance the shit out of that if you’d like.
I’ll pull data directly from the government websites that are in charge of reporting on Covid-19 for Denmark and Sweden.
Deaths by age group in Sweden on 06/09/2020 (4717 total deaths):
[ul]
[li] 0-69: 542[/li][li] 70 +: 4175[/li][/ul]
So, in Sweden 88.51% of Covid-19 deaths were in those 70 or over.
Deaths by age group in Denmark on 06/09/2020 (593 total deaths):
[ul]
[li] 0-69: 74[/li][li] 70 +: 519[/li][/ul]
Hmmm, in Denmark only 87.52% of Covid-19 deaths were in those 70 or over. What a drastic difference. :rolleyes:
Sure, Denmark has just 56.75% of the population of Sweden, so let’s put them on the same scale.
If Denmark had the same population as Sweden and it was distributed across age groups as it is today, their deaths would look like:
[ul]
[li] 0-69: 130[/li][li] 70 +: 914[/li][/ul]
Sweden had 417% higher deaths, after adjusting for population differences, than their neighbor Denmark, counting only those under the age of 70. And they’re not even done yet. The Youyang Gu model expects them to have almost 51% more deaths by September 1st than they do today. Denmark, just 17% (of the already significantly lower value, in case you missed that).
Sweden Fucked Up.
Dseid
You may have misinterpreted my remarks on herd immunity - I did not say that herd immunity was not possible, what I stated was * we do not know if herd immunity is possible*
We also do not know how long immunity might last, and we do not know how long it might take to achieve herd immunity.
In that sort of scenario the risk management option is to take very robust measures to reduce spread - at the very least so that we can obtain that information and then plan accordingly.
Once that sort of information is known then informed policies can be made about allowing development - or not - of herd immunity, and in the culture of risk management it would be very irresponsible not to try develop a vaccine - which may or may not be possible, and again once we know IF that is possible we can develop informed policy.
As for per capita death rates, whilst it is true that Sweden’s rates are lower than some nations, the blunt fact of it is that Sweden is fifth worst in the entire world, (not including the tiny populations of a couple if city/island/principality states) and really not all that far of a few of those, and of those Spain and Italy are doing much better with their lockdown policies whilst UK and US have also failed badly - so given that the vast majority of the world is doing much better than Sweden, it is not much comfort to cling on for your population.
Sweden had the potential to be a leader on controlling this outbreak - with a very socially responsible population compared to many nations and should have been the very model of what the rest of us should do in our selfish societies but instead your policy makers seem to have held out for Covid ‘manifest destiny’ and really let you down.
I think of what might have been and the example of community responsibility, social cohesion and shamed the rest of us selfish pigs into understanding the world isn’t just about me me me and instead it is about us us us - Sweden could have shown us the way such a pity really.
Here’s an article you don’t have to pay for.
CBC: COVID-19: Majority of region’s long-term care deaths occurred in for-profit homes
DMC, here’s a question. If at the beginning of this ordeal we’d have had a crystal ball tell us that about the worst this thing could get, if you really and truly fucked it up, was to lose about 500 people under the age of 70 by June in a country the size of Sweden…do you think the world would have still done what it did?
That’s not really a valid way to assess Sweden’s response.
Yep, this ^
This again.
And this as well.
As I alluded to earlier, sometimes an obvious failure is obvious failure. Sweden failed, and it’s a waste to keep debating this or seeing this in a different light somehow.
Just to put the pages and pages of posts into some sort of broader context:
"*In 1997, the Swedish Parliament adopted a new long-term goal and strategy for road safety, Vision Zero. The goal is that no one should be killed or seriously injured through a road accident.
Vision Zero is an ethical stance stating that it is not acceptable for human mistakes to have fatal consequences. It can be viewed as a paradigm shift, where the ultimate responsibility for road safety is shifted from the individual road-user to those who design the transport system, for example, road management bodies, vehicle manufacturers, legislators, commercial transport operators, the police authority and others. The responsibility of the road-user is to comply with laws and regulations.*" source
Sweden led the world in this, arguing that ANY death was unacceptable on the roads, and that all parties needed to contribute to minimising road fatalities.* This was their moral position for a situation where action / non-action made a difference in possible outcome.
By their own measure of ethical competence, Sweden has catastrophically failed. A road fatality and a covid nursing home death are exactly the same - they do not exist in separate categories where one should be prevented and the other just left to lucky chance. They had numerous opportunities to take assertive action to prevent deaths, to actively scale back the rate of deaths and to finally take responsibility for this clusterfuck.
We do get hung up on the rising number as this goes on, but the moral and ethical failure point was at the beginning where the decision was made to devalue some lives and to privilege others. While ‘they’ put their trust in one epidemiologist, ‘they’ bear collective responsibility for this decision which, to me, seems more to have been made because it was an easy non-confrontational minimum-paperwork cop-out, than for any tight scientific reason.
- Just out of interest the latest road fatality figures released in 2018 per 100K people - Sweden 2.8, Europe - about 10ish, USA - 12.4, Russia - 18.0. They could make a difference when they tried.
Fairly ridiculous comparison, imho, but whatever.
Oh, I’m far more interested in the response to Sweden’s response.