Sweden today reported its highest number of new infections again.
Their data seems to have a weekly pattern so its not easy to tell if this is a peak or part of that cycle, but it does appear to be ratcheting upwards steadily.I would imagine that their deaths relate to cases that were diagnosed around two or three weeks ago and the number of infections has accelerated somewhat since that time and that will emerge pretty obviously in deaths in the next three or four days.
What is interesting about Sweden’s “way”, is that it is really one person’s way. Rather the architect is one Anders Tegnell, who is Sweden’s chief epidemiologist. He believes in gradual accumulation of herd immunity and protecting the vulnerable on the way, and he is not a fan of lockdowns. Nor however is the government, who are not even sure they have the power to force one.
Sweden believes in civic duty, and expects that the populace will do the right thing. There is no doubt that the citizens do take the responsibility to heart, and activities are much reduced across the country. But none-the-less. Anders expects the death rate to climb, peak, and then the country to enjoy a level of herd immunity. He believes that countries and Germany do not have sufficient scientific backing for their more strict lockdowns.
Heck, he might even be right. Personally I would not be betting that way. It is one thing to have the courage of one’s convictions, but another to be betting the lives of one’s countrymen.
One thing that’s infuriating about Anders Tegnell’s “way” is that he’s consistently denied asymptomatic and pre-symptomatic transmission as worth guarding against, and advises people to only stay home if they’re sick. This conflicts with everything else I’ve read on infectiousness - for instance here. And it means that he’s basically thrown aged-care workers under the bus as far as blame for the incredibly high infection rate in nursing homes goes. “Gee, they must have been not following recommendations” - well, no, the recommendations were to not start taking serious precautions until they actually were sick or had a resident sick, which is too late.
However, I will say at this point that it hasn’t ripped through Sweden as fast as I was expecting it to, so that is one point in favour of Swedish Strategy. But I don’t think it’s peaked yet even in Stockholm (last four weeks new cases: 1276, 1432, 1346, 1537) and hasn’t yet gotten significantly into the other cities of Sweden (Gotemburg, Malmo - both in the very early stages of spread) so I’m expecting the death rate to keep going up.
An update - Sweden has more COVID-19 deaths both in overall numbers and per capita: Sweden says its coronavirus approach has worked. The numbers suggest a different story | CNN
Yes, more deaths per capita than their Nordic peer group to date. Not quite the goalpost of “out of control”, “immoral”, “a disaster about to happen” … The pandemic is far from over. Maybe they will see disaster yet. Or maybe they will end of day have fewer deaths from all causes than their peer group. The Swedish tactic was be less severe in control approach and allow more of surge now, rather than delaying what they saw as inevitable, perhaps until it overlaps with a next flu season, when systems are more likely to be more easily overwhelmed. They bet their short of lockdown approach would result in a surge within system capacity.
The following from the article is accurate -
The goal of flattening the curve is keep the surge within surge capacity. Within their specific culture their approach has accomplished that goal. It has not been (and is looking unlikely to become) the absolute disaster that so many were 100% sure it would be. They clearly failed in a big way to adequately protect their most vulnerable as well as they could have however, and would have done much better with better implementation of keeping those specific populations more protected.
Any lessons learned from Sweden has to include not only what can count as their success but also their failure, has to include the need to do better at that than they have done as the foot comes off the brake.
There’s that, but Sweden has claimed their real goal is also to keep the total number as low as possible. Their rationale is their current actions will lead to fewer deaths later.
That’s their official reasoning, anyway. Still seems like an attempt at herd immunity to me, though, no matter how they deny it.
And to stay well within that capacity - that is the goal of flattening the curve generally.
But beyond that, Sweden has invested in a healthcare system, and one of the goals of investing in that system is to save lives, which may have been lost unnecessarily. If we find that later in the year, when COVID-19 is expected to reemerge in a second wave that coincides with flu, Sweden is focused a lot more on dealing with ‘normal’ health emergencies and less on COVID-19 relative to other countries, perhaps we could argue that its ‘herd immunity’ approach was well worth it, and Sweden knows something we don’t.
Beyond additionally, there are two concerns:
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 wouldn’t say that at all - not when their health expert seems pretty determined to declare himself a genius when all of the evidence that we have seems to suggest that his methods are comparatively worse than other countries in a similar position, and more to the point, when he makes bold statements with absolutely no evidence to support them
What Sweden seems to have avoided up to this point is a surge that is impossible to hide. New York’s and Lombardy’s surges were so bad that the health system was in a state of full-blown panic. Most likely, the reason for that is that COVID-19 was circulating in places like NYC and northern Italy long before people recognized it, and due to circumstances that aren’t yet clear, the disease spread within the community before it was detected. Sweden seems to have avoided that, but that has nothing to do with their health system’s approach. It’s just dumb luck. They also likely benefited from other countries locking themselves down, slowing the spread globally and in neighboring countries in closer proximity to Sweden.
And on that note, I’ll just add that I don’t think Sweden’s out of the woods at all. As Michael Olsterholm has said, we’re in the 2nd inning of a 9 inning game.
Yes, the original goal was herd immunity based on an earlier fallacious assumption that the virus was minimally harmful to younger people and the perhaps more rational assumption that the ratio of critical care equipment, emergency physicians, and hospital beds to critically ill patients would allow their health system to deal with serious cases.
But what’s disturbing about the herd immunity approach is that Sweden’s public health chief appears to be claiming he’s close to achieving a goal he’s not even attempting to measure. That’s getting away from the realm of science and more into the realm of superstition, attention whoring, and politics.
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.
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 R[sub]0[/sub] 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.
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.
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.
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:
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.
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?
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.
My apologies, DSeid: it wasn’t their epidemiologist, but their ambassador who is reported to have made the remarks.
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.
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.
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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.
The Swedish statistics authority reports that the reproduction number R dropped below 1 on the 20th of April. Cite, sorry it is in Swedish.