What is Norway doing very different than Denmark?
Looking it up it seems Norway is not as rigidas some. Beginning March 12 they announced
That is a much narrower set of closures and controls than Denmark has done, yet they are doing much better?
They do have a tiny fraction of the population density that Denmark does too. I don’t think that’s the whole picture - after all, Spain’s half the density of Italy, still getting flattened - but it’s probably part of it
An alternate hypothesis is that quarantine level controls broadly implemented are not required to flatten the curve substantially; more targeted measures and chosen behaviors by those who rightly understand themselves to be at highest risk (often beginning before governmental edicts and guidelines are announced) may flatten the curve well enough.
My WAG though is similar to yours that SARS-CoV-2 infections are much more crazy widespread than most have thought, with many of the younger and healthier cohorts never even considering they had COVID-19 if they had any symptoms they noticed at all, and lots of silent community spread before the disease becomes recognized in the community as the norm not the exception.
I have this article as of today: it is in German, if you don’t understand German I recommend translating it with deepl.com , it’s much better than Google.
The I look at the FT corona page and Schweden does not look much worse than the other skandinavian countries, but not better either. But the deaths we see today are the ones who got sick ten days ago and who were infected ten days before that. So the question would be if Schweden has squandered those three weeks: the first article says yes, the data say maybe.
Swedens population is 10.3 Million (wikipedia), they have reached 477 deaths (Worldometer), that is just short of 50 deaths/Million (46.3, to be precise).
Norway has only 5.2 Million inhabitants, and 77 deaths: that is 14.8 deaths/Million.
Denmark: 5.8 Million, 187 deaths: 32 deaths/million
Finland: 5.53 Million, 27 deaths: 4.88 deaths/Million
I see a difference and it seems statistically relevant. And it seems to me the trend is worsening.
Norway declared the epidemic under control yesterday.
It seems when the government started talking about social distancing everyone felt that at last there was an excuse not to have to deal with other people. People from the capital, the other side of the fjord, the municipality next door or other tiresome people. (Everybody). The governemnt was aiming for a Re of 1.4 they got something below 0.7
Not sure how that would fit with the expected reproduction rates and introduction times. Here in Oz there is pretty aggressive contact tracing, so much so that only a small number of known cases are of unknown providence. Almost all can be traced directly back to an infected traveller. If there were a large asymptomatic cohort we would expect many untraceable infections presenting, but we don’t see them. I don’t know how aggressive other countries are about this. But I can’t see why patterns of infections should be wildly different.
No arguing there. The Nordic pool is doing much better than most other Western countries have done, and the others are doing better than Sweden is in a statistically relevant way.
But a “statistically relevant” difference between Sweden and the rest of the Nordic pool, still apparently on track to stay within their limited surge capacity, still better than most other Western countries have seen, is quite a different thing than the cautionary tale for all others to see that you were setting them up as.
I did try to state carefully when I phrased it as “lots of silent community spread before the disease becomes recognized in the community as the norm not the exception” … Australia’s course of it so far (and they are early yet, only 3 days past 1 death/million and not yet to 2 deaths/million) has not been the norm, and is closer to the exception.
It seems to me we are approaching this situation from two very different mindsets (which is legitimate). You are looking for the best news and want to find comfort. You are looking for a panglossian best world where the solution is near. I see what could go wrong. I don’t want it to become bad, but fear it will.
There are too many variables and nobody can (yet) explain the differences between countries. We see that some differences are stark an unexpected. You think the scandinavians are doing better, even the Swedes, though they are the worst in the North. I suggest you look somewhere else: Germany. They (we) are doing very well concerning the death rate (the infection rate not so much). Nobody knows why. Perhaps it’s the ICUs, we have more than most other countries and people are getting treatment in time. Let’s hope we can keep it up. Ah! And it’s free of charge, so people are not afraid to use the system.
Sweden is about to get much worse, I am still of the opinion. So bad that they are about to change tack and do as all others do. What has kept Scandinavians disease-low for so long? Perhaps their way of living, more isolated than in the South (Italy & Spain come to my mind). That makes transmission slower, but keeps it just as prevalent on the longer term. The longer term is starting to happen now.
Concerning Berlin, where I am, I can tell you we are not keeping our distance. I was in Brussels just two weeks ago (yes, we still travel - by car in my case, all on my own, so I was isolated) and they are much stricter concerning isolation and keeping the distance. I was in the Viktoria-Louise-Platz today, a very nice square. It was full. The bars and restaurants were closed, but people sat on the tables in the sun (they leave them outside, just chain them so they don’t get stolen). People walk the dogs and play with children, talk to the neighbors, sit on the lawn drinking beer (drinking beer on the street is usually not forbidden in Germany, but it is now: they still do it) and play music. Still, only two people died yesterday (see link above). Something is not right or about to change.
I hope I am wrong: I am in the middle of it as well.
I think you’re off. Dseid is somewhat conservative in his projections but he isn’t just looking for good news and not naive about how bad even his conservative estimates would be. His main position has been that western countries have basically all started to level off (drop below 20% daily increase) around 2 weeks after hitting 1 death/million.
Correct CarnalK.
Pardel-Lux, I am most certainly not looking for “good news”. I have been, and continue to, try to parse out what we do and do not know. Things don’t have to be zombie apocalypse to be bad. Once again, a bad flu-level event occurring in a 5 week window rather than a 5 month window is very very very very bad, overwhelming surge capacity of most health systems across the world potentially by severalfold. I am very aware of how limited in utility the models are in the absence of critical key inputs, which we right now simply do not have to any degree of confidence. I believe we have a responsibility to be careful in stating what we do and do NOT know, and see many on this board stating as fact things that are best one set of guesses.*
You see differences that are stark and unexpected; I see fairly frequent commonalities that are remarkable and unexpected, even in the face of very different governmental approaches, very different cultural norms regarding physical distance/lifestyle, and very different age group demographics. Given the varied demographics (age, baseline health status, smoking frequency, and more), cultural norms, lifestyles, adequacy of health systems, and timings of governmental responses, I’d expect stark differences and could rattle off a bunch of potential reasons for the differences on a moment’s notice. But such commonalities … that is surprising.
CarnalK has pointed out the tendency that almost all of the Western countries (Germany inclusive) have had to slow down in deaths/million rate at around the 2 week mark after hitting 1 death/million. By the 20 day mark it becomes more consistent with all that have passed that mark continuing to flatten out from there. We can even include South Korea and Iran in this mix. I’ll throw in a few that are only up to day 19:
South Korea the low at 1.06, and France suddenly counting some from past days that they had not included before an outlier at the top, but the vast majority clustered at 1.07 to 1.11, median of the broad group at 1.10, and all flattening out more from there. Their curves are all amazingly similar in shapes to each other and hitting similar growth trajectories from that point on. Despite different cultural norms, different demographics, and different official policy approaches.
That is a simple observation.
The speculative hypothesis is that those countries that have not hit those points yet will follow similar trajectories as well.
One can also hypothesize as to why the curves are so similar in shape, even as the absolute numbers of deaths vary significantly. It could be because actual behavior changes that have the most impact occur on similar time courses before governmental action has a chance to have much impact. It could be because of characteristics of the disease. I could be a combination of both or some other explanation I cannot think of.
Sweden not doing MUCH worse than Denmark by this point, and worse than most other Western countries, is something that should give pause to those who believe that strict quarantines are the only way to flatten the curve at all. It surprised me, I’ll admit. If they roughly join the other countries in that 1.07 to 1.11 cluster by day 20, which is in two days and before the week end (!) then the prediction that their approach is a definitive disaster and that they are “about to get much worse” begins to become falsified, yes?
*Please note, this is not making any statement about how one should respond in the face of uncertain information. If there is a reasonable chance that a hurricane is going to make landfall as a Cat 5 dead on at the barrier island my MIL lives on, I would strongly advise she comply with evacuation orders, and not tolerate her arguing that they don’t really know that it will hit there. It would still have been the right choice if the storm ended up not being so bad after all or shifted course.
There is a difference between comparing government mandated isolation behaviour and what is actually occurring. Sweden has little in the way of laws prescribing behaviour. But the advice to citizens is much the same as anywhere else. They have a country where people tend to take the advice.
So, a much more difficult question arises. Can we attribute the changing rates to actual behaviour, or to as yet unknown rates of spread through an asymptomatic subset of the populace?
Dunno. I suspect not. Comparing the different levels of government mandated lockdown is only a proxy for actual behaviour. As are estimates of asymptomatic cases when there is no random testing. I really wish every country out there would get on with even a small scale proper random test regime. There is an argument that the tests remain a limited resource, but better information right now on this question is almost certainly worth the effort.
ETA Seems there is some progress on this front.
You can’t be that dismissive of government edicts. The simple and well recorded fact is that everyone kept going to gathering spaces until they were closed down.
“Everyone” is the big question. No doubt there were media reports and videos of people out and about, but you can be pretty sure they were selectively shot. The effect of compliance has a non-linear effect on R. We really just don’t know where the parameters sit. There are other reports that suggest that the majority of Swedes were indeed complying with the recommendations. Certainly the work from home cohort was very large. I work with a large Swedish company, and I know they sent their workers home weeks ago. Indeed the company ethos is one of very high social responsibility, and to be ahead of any recommendations, let alone any legal requirements. I don’t imagine they are alone.
There are published reports based on Google location data for various regions (including Sweden) at COVID-19 Community Mobility Reports which are probably a better proxy for actual behaviour.
Picking off a couple of numbers, Sweden’s “Retail and Recreation” trend is down 24% from baseline, while “Parks” are up 43%. By comparison the numbers for New York (State) are -62% and -47% respectively.
I hear what you say, I am sorry I used the word panglossian, that was not well thought.
Maybe being half Spanish, having family in Italy and living in Germany makes me more pessimistic. A colleague of mine in Brussels died too, that felt like a close hit. In Germany we have it good so far, at least that is the feeling, but what family and friends tell me from Spain and Italy is heart breaking. Sorry if my words were off. That is not an excuse, it is an explanation and an apology.
Let’s compare the current death rate per million for Sweden with other countries in the region:
Denmark - 35
Norway - 16
Finland - 6
Iceland - 18
Estonia - 16
Latvia - 1
Lithuania - 6
Sweden - 59
Sweden’s death rate is 70% higher than the next highest country, Denmark - which is itself far higher than others in the region.
The Google numbers are really interesting. Parks are all over the place everywhere. Different counties in NY are seeing massive spikes in park numbers as well. Given a lot of places are giving a dispensation for personal exercise outdoors we may be seeing that reflected in the parks utilisation. The graph on park usage is so wildly varying that the one number summary (which seems to simply be the number on the day at the end of the sampling period) is basically useless.
Perhaps more interesting is Recreation & Retail and Workplace. Sweden is -24% and -18%, which isn’t anything special. Taiwan’s numbers are basically flat. South Korea not far from Sweden, but actually less of a lockdown. New Zealand is -91% and -33%. Which is huge. I am starting to wonder how much the ability to isolate the country is playing into the infection numbers. That is a big variable that is hard to capture.
The numbers are a week old, so although dated in terms of understanding how current compliance is working, they are not bad for relating to infections and deaths. The lags make this all a bit difficult.
Sweden does not have a do nothing approach. For example everyone gets sick pay from the first day now with at least the 80% pay (used to be one probation day). The agency in charge - Folkhälsomyndigheten - say we are in it for the long haul and want to lessen the compliance fatigue. The agency is a publih health agency and not just disease control so have a broader scope in their thinking. I hope the strategy is right for our country but I think it’s too early to tell.
Nice to have someone actually in Sweden (I assume?) joining the discussion.
When you say ‘everyone gets sick pay from the first day’ - is that people who are diagnosed with coronavirus? People who think they might be sick and need to stay home just in case? Is it easy to get tested?
Yes, I’m a swedish person in Sweden.
Before Covid-19 for any sickness that made you unable to work you had one probation day with no pay, day 2-14 you get 80-90% paid by your employer and after that the state pays (unsure how much).
Post Covid-19 you get 700 SEK (about 70 USD) the first day and then the 80%-90% of your salary until day 21. All of this is paid by the state. You don’t need a doctor’s confirmation until day 22.
This is for all types of sickness, not just Covid-19.
It’s not easy to get tested, you only get tested if you are admitted to a hospital, work in a hospital or live in a retirement home. This is one area I wish would improve but epidemiology is not my area of expertise (I’m a tax lawyer) so I defer to and trust Dr Tegnell - Sweden’s Dr Fauci.
The public health agency have daily press briefings. One early error was that information was not available in more languages.