Sweden's unusual response to coronavirus
bbc.com
bbc.com
You’ll always be able to find people that won’t follow recommendations (So taking clickbait pictures of people drinking isn’t difficult).
I think the gradual approach might mean we are always “one step behind” since the idea is to introduce measures as they are needed, which you notice two to three weeks after you need them. That’s my fear, at least.
On the other hand I think we’ll se authorities facing the opposite problem in Italy and elsewhere when lockdown needs to continue for longer than people accept (already reports of this). In the end I think we’ll see that differences will be small between countries despite varying policy, and that policy will converge to the successful ones.
I hope authorities will be quick to introduce further restrictions if and when they are needed. More importantly I hope people are doing this before authorities require it, if reports of healthcare overload appear.
Looking at the curves now, I’m pretty satisfied, but again if they start to point north further restrictions need to be introduced two weeks back in time, which is difficult even for our trusted authorities.
Not much has changed at all, maybe a few less people out at lunch, but it’s definitely alarming to me.
Banning meetings of 5 people outside in a park (who take reasonable precautions and keep distance) might have marginal effect compared to some much more important measure, so don’t ban small park gatherings - instead try to get more adherence to the things that are important. This is my interpretation of the reasoning. If it’s based on self enforcing rather than policing it needs to encourage adherence to the important parts.
I don’t worth much about small groups walking outside or meeting in parks. What does bother me is packed public transport at rush hour. That just isn’t good and we should try to fix it. Same with some gyms still being open. Thought people would realize that they shouldn’t go so they’d close by themselves, but no.
even though the numbers are very different absolutely (for many obvious reasons), the curve doesn't look very satisfying to me comprared to others
left Italy, right Sweden
Also: population density is much different
https://sedac.ciesin.columbia.edu/downloads/maps/gpw-v3/gpw-...
https://sedac.ciesin.columbia.edu/downloads/maps/gpw-v3/gpw-...
Death curve is of course interesting too but harder to interpret at the low numbers we still have and says more about spread in certain age groups than the general population.
In Italy we have less than 100 deaths in the range 1-49 and only 347 in the range 50-59
87% of deaths are in the range >=60
In France, we have a stricter lockdown (e.g. we're not allowed to wander to more than 1km from our home - which is BS in my opinion). I'm wondering if the bulk of the measures is enough: closing school, restaurants, preventing gathering and so on... If this is the case, I don't expect different outcome in Sweden compared to other western countries.
I think the most important ones are the ones you can't really enforce. Like "wash your hands". Most importantly "stay at home if you are sick even if just slightly". That one is hard to enforce but easy to encourage: ensure everyone has good paid sick leave from day one and has zero risk of losing their jobs even if they are sick a long time.
If there is a positive effect it’s due to something secondary, such as people that are allowed further than 1km might get on a bus, or might go to a different shop with too many people.
But still: it’s a ban of going out in nature, at a time when basically everything else is banned but going out in nature is safe and healthy. It should be encouraged!
ICUs being overfilled isn’t an argument for why millions of people can’t walk in the forest.
Californian here. The problem with driving to a forest to take a walk is that everyone is doing it, and thus the forests get pretty crowded, so they've clamped down on that too.
https://www.independent.co.uk/news/world/americas/coronaviru...
I understand that this situation has to be taken very seriously, but my point is that we shouldn't accept all lockdown measures blindly. Some make sense, but others are more debatable. All other countries face the same issue, and most didn't go as far as us (France).
(BTW, french hospitals aren't saturated, except in a few places in the country. For instance, there are very few cases in my area, and this is after two weeks of lockdown, so we don't expect a significant rise at that stage. hopefully)
The biggest "Expats in Paris" FB group had the admin do a long rant-sticky about being sick of people flaunting restrictions, resulting in overloading hospitals, specifically naming "solitary bicycle rides" as unacceptable, which I think is just across the line of hysteria. (Yes, it's forbidden, which does not mean it increases the risk of spread)
It could be that Swedes are following the norms established everywhere else, even if 'lockdown' orders are not that hard.
In Quebec, restaurants started to empty out long before they were ordered closed.
I can absolutely see information workers working from home without the order.
So it may be the the 'de-facto' situation in Sweden is quite similar to that of other places on soft lock down.
Well, it could be but it's not that there is any numbers to back up anything yet. I do think that the difference in reality is smaller than the percieved difference in policy. Some headlines would have you believe that we are ignoring the pandemic and everyone just goes to work normally.
Edit: This is not to say that I have any idea about elsewhere. And, again, just one fairly not useful data point. Just an observation.
Or it could be, as the article noted, that more than 50% of households are just one person.
For comparison in China the doubling time is in the order of 2 years now and in the US it is 3 days now.
Look at deaths, icu admittance and hospitalisations. Not case numbers.
We have a worrying trend in deaths doubling every 3 days or so, but at least it is a bit slower the last 2. ICU admittance trend is great suddenly, for some reason I don't understand (trending downwards last several days).
Many companies allow employees to stay home for minor flu symptoms of the employee or their children. You will be fired in countries like Spain if you remained home so often. (update: I mean that you can do this always, not just now because the new virus)
Stockholm, the "big" city, has 2.5 million habitants in its extended metropolitan area. So, not so big. Swedish are not in love of big gatherings. Cultural behaviour than is the opposite than that of Italy or Spain.
All my friends at companies like Electronic Arts, Epic, King, Klarna... are already working from home. Stockholm is a technological hub. Office work has been moved home fast and eficciently thank to the tradition of “VAB'ing”. In any given meeting some one is working from home, anyway. The subway is emptier than ever. Many companies have shut down offices and operations continue from home. But, that is something that you do not read in the news.
The virus growth is exponential, we may not need complete isolation just yet. Probably it is just a matter of time. So, getting to conclusions right now is premature.
Sweden has stayed consistent with what experts have been saying. There's no use in closing the borders when the virus is already in the country.
Same thing with outlawing movement in and out of Stockholm. There's already a very clear recommendation and instruction to avoid travel within the country to avoid spreading the virus. There's no real way of enforcing a full quarantine unless you divert police officers who could be doing other things, or the military which we are reluctant to do (see Ådalen 1931, which is a reason why you don't want armed military to interact with citizens).
Letting up to 499 people gather freely is not what experts will tell you is the way to stop this, so clearly they have not. If anything Sweden is among those that have listened least to medical experts. Norway and Denmark is following the advice much closer, closing borders or not.
So, all the Swedish jokes about Denmark are wrong? ;)
> yet had a very strong response from around 12 March.
I think that Sweden is in the wrong not taking it more seriously.
My point is that it is going to take some time until numbers show the mistake. I expect the initial curve to be less pronounced than in Mediterranean countries. Once reached a critical point, that difference does not matter, thou. To double the number of cases each three days or two days, even being a big difference, will still overflow hospital capacity.
I don't know what the situation is there (hopefully people accept other people better), but in Hungary I have heared of my friends being mask shamed multiple times: people speak badly of them because they wear masks when they go shopping.
In Taiwan it's the opposite: people who don't wear masks (at least a home made one) are the ones looked down upon, as they are infecting other people.
That doesn't explain the difference
In Italy as employee I can't stay home as long as 18 continuous months if I'm I'll and I can't be fired after that, they just start cutting my salary
We have now a third of deaths in the world
It isn't explained by intensive care either
Probably in Sweden people live already far from each other and population density is low, while also being a bit younger on the average
Looking at Stockholm, hardest hit in Sweden, numbers from 2014 said that 45% of the people had moved there from elsewhere, and since then more and more people have moved here. For people moving within Sweden, that usually means leaving their parents in their hometown, which makes it very easy to avoid having contact with them as soon as everyone realized how serious this is.
Another factor is that in Sweden there's always been a distance between the older generation and the younger. Since preschools and after-school care is inexpensively available to everyone, you don't need to rely on grandparents watching their grandchildren. People who live in Stockholm and have the grandparents here may arrange for them to pick up the kids a couple of days a week, but as I said above, a lot of people don't even have the grandparents in Stockholm. It's been reported as a problem for a long time that a lot of old people live alone in Sweden and lack social contacts. In this specific case that may actually be a good thing!
People usually live in households with two parents and one or two children, or alone in single households. The areas that have been hardest hit in Stockholm have been poorer suburbs with a high amount of immigrants, and it's a lot more common in these areas to live many generations in the same small apartment. Unfortunately, this means that the virus is easily transmitted from the children to the grandparents. Outside of the largest cities, it's very common to live in a house, which makes it easy to keep your distance to the neighbors.
Swedes have been accused for a long time of being socially distant already. A Swedish wedding will never compare in number of guests with a Turkish or Indian wedding. There's an old joke that if you leave your apartment and hear someone else in the stairs leaving theirs at the same time, you wait a while so you don't have to talk to them. People make an effort to not meet people, in contrast with socially warmer cultures.
Even before the virus, people would fill subway cars in Stockholm by using one of four seats for themselves, and you'd stick out if you shared a four-seat group with someone if there was an empty group of four seats available. I talked to international colleagues before all this started, and they were surprised that no one wanted to do small talk in the subway. They came from cultures where it was expected that you sit down next to the only other person in the subway car and started talking to them, while in Sweden that would make you seem like a drunk or a crazy person. The social distance is built in.
Also, no tradition of kissing on the cheek. Hugs are common between friends, and handshakes when you meet new people, but no kissing. I have a feeling this would be more common in Italy and Spain, as well as multi-generational gatherings.
All that said, it's way too early to say that everything is going to be fine in Sweden. I hope it is, but we're still in the unknown part of this. We still have a lot of people who live in cramped conditions in certain areas, and we had issues with the bus companies using fewer buses in Stockholm when all this started which led to overcrowding.
What? I think there used to be lots of big gatherings. Dance places with hundred(s) of people, crowded restaurants indoors and outdoors, picnic parks and beaches filled with people (in the summers), running groups with sometimes 30 sometimes 100 people. (I'm in Stockholm b.t.w.)
I fear Sweden is still basing their approach on those optimistic models, that likely don't apply to this particular pandemic. They seem to be making the same mistake UK did, except they haven't changed paths yet. They say they are only doing what is "scientifically proven", without realizing that peer review and randomized controlled trials alone are not enough for situations where decisions need to be made in short time with imperfect information.
Let's skip Facebook and Twitter and analyse the data that we have. What does it tell us?
The interesting question is whether they could help to implement useful political interventions based on which parameters matter. The answer seems to be yes in many cases.
Nine dead until now, but we'll see...
People can still cross the province border for a variety of reasons, for example for their daily commute.
> People over 60 are not allowed to go out.
The government told vulnerable people to stay home, but nobody is monitoring or enforcing this. If a certain 60 year old wants to go out and hang out at the mall for the whole day, they can without anyone stopping them.
Comparing to Spain where I've been the past month. At least Murcia is still quite quiet, but I'm afraid the horrors of Madrid might come down here sooner than later... :(
All countries underestimated the pandemic. From China to the United Kingdom, USA or Italy, every country underestimated it. The main difference is the attitude once lock downs are needed.
Maybe South Korea was the exception. But, South Korea is a high-income country in a permanent war with its north brother. The country is probably prepared for a biological attack similar to a pandemic. And, even South Korea seems to have lowered its standards and cases are growing up.
> I fear Sweden is still basing their approach on those optimistic models
Yes. It is surprising how everybody is blinded by exponential growth. "It is just 10 cases, it is just 50 cases, it is just 125 cases, it is just ... oh shit!"
The vast majority of new cases in Taiwan are imported now, and everyone coming back has to self-quarantine for 14 days.
IMO, I think it's very difficult to draw any important lessons from countries that are warmer climate like Taiwan, Singapore, Vietnam, or Thailand.
My gut feeling is that the culture of wearing masks, not shaking hands etc. is just as important of a factor as the climate. I guess we'll find out by observing cooler Japan.
Measures might be eased up after Easter, based on interim scientific findings and recommendations from several ministries.
Communication, timing, updates have been timely, though people and businesses worry about how to deal with the new economic reality.
In the official data, Day 1 is 2020-01-22. If you plot the confirmed cases for Italy, Spain, S.Korea, Finland, Sweden, Denmark, UK, US and Switzerland in the same graph, you can see how Sweden's rate follows the general trend until about day 50. From that point onwards, the growth rate of confirmed cases drops.
Knowing how badly Finland has handled this mess, I have serious doubts about the Swedish numbers. Such a sudden and rapid deviation feels more like a change in reporting (and testing) policy than anything else.
1. Long state of indecision. For a very long time, as the news from around the world brought images of falling skies, the Finnish government actively avoided making any decisions. G: "we defer to THL". THL: "we defer to government".
2. President had to intervene to get the government off of their asses. How messed up is that?
3. Artificially limiting the supply of ICUs. Of the 300 units in the country, half are earmarked for "not to be used for COVID-19 cases".
4. Completely ignoring the effect of people returning from their holidays. That's 200k potential transmission vectors, not taken into account at all. Until it was too late.
So the people who were supposed to be in charge have shown nothing but incompetence and avoidance of responsibility. The measures that are in place now seem good (quarantining an entire province!), but the handling of the pandemic until very recently was nothing short of disgraceful.
[0]: https://www.aftonbladet.se/nyheter/samhalle/a/70GQRV/nya-str...
A “long” winter? It‘s been a record-breakingly mild winter. It felt like we went from autumn, through a weekend of snow, directly to spring.
Yeah. This sounds very weird. No, you do not want to sit outside. It is sunny, but cold (4 to 8 degrees).
> It‘s been a record breakingly mild winter.
Yes. It has felt like actually a short winter with spring stepping in early in the year.
80+ 17.51%
70-79 6.77%
60-69 1.74%
50-59 0.56%
40-49 0.08%
30-39 0.10%
0-29 0%
The data from other countries matches this distribution. Keep in mind that the CFR is what we have but not the number we want. The one we want is the infection fatality rate (IFR). This is the number of deaths divided the total number of cases (not just the reported ones). The IFR numbers are likely to be lower due to the fact that widespread testing is not in place in many countries.
If the hospitals are overwhelmed, the death rate is going to go way up.
https://aatishb.com/covidtrends/?country=Finland&country=Ger...
Small number are problematic. There are 2.27 Popes per square kilometer in the Vatican.
Case counts also lag measures by 2 weeks.
With the numbers we’re looking at (10-100 deaths), a single nursing home being hit is the difference between entire countries. Any judgement on effectiveness needs weeks more of data.
The way it’s being communicated to me is that by testing people they will bring more people together and thus spread the virus.
What about looking at number of people in need of emergency care?
(regardless of if they get it or not)
Did these things change in current medicine?
All said covid is >7x as deadly as seasonal flu and you have more deaths with no comorbidities.
You have some studies proving this? Because all the studies I have read flu is a lot more dangerous. For all ages.
Every study I've seen the seasonal flu has a case mortality rate that varies form year to year in the close neighborhood of 0.1%, the low estimate of the case mortality rate I've seen for covid-19 is around 1% in countries with functional healthcare systems. The ratio of cases requiring hospitalization is similarly at least an order of magnitude greater for Covid-19, which is also why it poses a danger (already being realized in several parts of the United States, and very much realized, e.g., in Italy) of overwhelming the healthcare system, driving the car mortality rate higher for all conditions, including itself.
We don't annually overwhelm the healthcare system because of the seasonal flu and exhaust ICU capacity and PPE supplies, which should be a clue that whatever you are seeing claiming the flu is worse is not only bullshit, but bullshit that isn't even trying very hard to convince anyone paying even a little bit of attention.
The only data broad enough to predict true cases is Diamond Princess or perhaps Iceland where you've had enormous testing. Even on Diamond Princess, you have 10/712 infections resulting in death which is worse than flu (for this population), but not 10x as bad. Iceland has 2 deaths and 25 hospitalized against 500+ cases 1.5w ago, suggestive of a sub 1% CFR.
Additionally, flu CFR is reduced by targetted vaccination of the most vulnerable people (demographics of who get infected are more likely to survive than general population).
Yes, and COVID-19 would be a lot less bad if we had a broadly effective (even if as imperfect as the season at flu vaccine tends to be) generally available vaccine that would naturally be more likely to be taken by the most vulnerable, but alas we don't, which reinforces the point that COVID-19 is, in the real world, significantly worse than the flu, even if you could construct a counterfactual scenario where that would be less true despite the diseases each retaining their intrinsic traits.
What would change though if that were true is that the calculus could shift away from locking down (SIP) to limited social distancing measures (to reduce r0) and a complete isolation of your most vulnerable populations. Basically, go for some sort of herd immunity if you can keep the herd's IIR below 0.01% or so.
You still have to compare that to the baseline of the demographic. I.e. once you’re over eighty, you have almost a 1% probability to die within the next month.
True absolutely, but not true if you condition on me being fit enough for a cruise today.
10/710 infections on the Diamond Princess died. Would you expect flu to kill that many? (Older population but healthier than average older population).
So what you are seeing in Italy (or Wuhan for that matter) is a symptom of:
1. A 4 month flu season compacted into a month 2. Hospitals collapsing from the load pulling death rate way up. 3. A lack of vaccination (which limits the deaths/year due to flu)
Honestly, we won't know what the case was until a few months from now when broad, randomized seriological tests are run.
And of course lack of vacination is an important factor, but you can't exclude it.
edit: also even if it would kill in percentage the same amount of infected, an higher infection rate will converge to an higher total infected percentage of the population, so an higher absolute number of dead and critically ill.
“The way in which we code deaths in our country is very generous in the sense that all the people who die in hospitals with the coronavirus are deemed to be dying of the coronavirus.”
Flu kills millions people every year
Then, like all winter time respiratory illness it kills people who have comorbidities that probably wouldn't have killed them without covid-19. The people with moderate but well controlled asthma or diabetes -- the chronic conditions that we don't think of as life-ending.
Then the ICUs start feeling pretty overwhelmed, and the ages of the people dying gets lower, and they have fewer and less severe comorbidities. Maybe only a small percentage of these people die, but covid-19 infects so many people that this small percentage of a very large number ends up being pretty large.
This is the point healthcare systems start building field hospitals in sports halls or convention centres. It's when they requisition ice rinks to act as temporary morgues. They start locking down movement just to try to reduce this very large number of people getting infected.
ICU doctors and nurses are now overwhelmed, and they're improvising PPE out of binbags. They're reusing PPE using weird new sterilisation techniques. Other HCPs have less access to PPE, because it's all been used up. Where they would have had FPP3 and eye-shields they now have a plastic apron and a loop surgical mask.
And they're faced with something they feel like they should be familiar with (pneumonia is pretty common) but which doesn't act like other types of pneumonia. Here's one example, but there are loads more: https://twitter.com/iamyourgasman/status/1241267189048578048
> When I was in med school you didn't die because of the flu.
The real situation is a bit more complicated than that, isn't it? Plenty of people die from flu, and it's the flu that kills them, and we have medical statisticians who can tell us what the excess mortality is each year.
This is simply false.
The most extensive research here, posted in HN yesterday indicated that Corona represents about '1 year of living' worth of risk for individuals.
It's killing a lot of people with 'conditions' who would otherwise live a long time.
Looking at urbanization:
Denmark: 87.5% [0]
Sweden: 87.4% [1]
Another statistic is Copenhagen Metropolitan area compared to Stockholm, which both is about 2.5 million. Though Copenhagen jumps to 4 million if you go by the Öresund region including parts of Sweden. [2]
[0]: https://www.statista.com/statistics/455812/urbanization-in-d...
[1]: https://www.statista.com/statistics/455935/urbanization-in-s...
The epidemic is still growing fast though and since some countries are naturally lagging behind others, the effectiveness of measures will only be seen in the aftermath.
Maybe what they're doing works for them for some other reason.
EDIT: though the higher relative numbers of severe cases and deaths might indicate they don't know how many cases they really have.
The cumulative number of patients admitted to intensive care is 278, and since we had 510 intensive care before the start of the pandemic, that is not a problem at all.
Unless you have reason to believe that the ratio of patients requiring intensive care somehow has decreased radically during the course of the pandemic, the growth of cases is most certainly not exponential.
You needn't use your real name, of course, but for HN to be a community, users need some identity for others to relate to. Otherwise we may as well have no usernames and no community, and that would be a different kind of forum. https://hn.algolia.com/?sort=byDate&dateRange=all&type=comme...
This is a pretty scary artifact of their program.
The Swedish government has purposefully decided to obfuscate the facts, ignore the data, with the logic that a) it won't necessarily help and b) the data will only cause panic, etc..
Can you imagine the US government doing such a thing?
This is deeply, deeply disturbing and it's hypocritical to defend their actions in light of authoritarian tactics around the world.
The WHO and nations that have been successful (Korea) have been saying test, test, test test. It's a key to suppression.
I have some criticism of the lack of transparency from the Swedish government, but they did not stop testing to hide anything. The lack of testing resources was very real.
Testing has increased radically in almost every advanced country, in neighboring Norway, they have 4x more testing - do you not think that Sweden, a rich, advanced nation would somehow be able to figure out how to expand testing?
The testing/capita figures are here [1] where you can see that Sweden is, in fact, testing quite a bit behind most other rich nations (though not far behind Denmark).
So the question is, why are they failing so badly on this venue? Or have they actually decided to focus elsewhere?
I find it easier to believe they are actually competent, but taking a different approach and they are obfuscating/lying about their ability to expand testing.
[1] https://en.wikipedia.org/wiki/COVID-19_testing
Edit: I am adding the official Swedish statement as reference: "Almost all those who get Covid-19 have mild symptoms and recover without requiring medical care. There are thus no medical reasons to test all those who have a cough, sore threat, fever or other symptoms that may indicate a Covid-19 infection, but may in fact be caused by another type of infection. The Public Health Agency of Sweden recommends testing of those people who have a very high fever or acute respiratory symptoms and require hospital care." [2]
Unfortunately, they indicate that 'there is no medical reason to test for Covid unless high fever' which I think is a problematic statement in the context of a pandemic. Of course, there are 'medical reasons to test' beyond those factors.
[2] https://www.krisinformation.se/en/hazards-and-risks/disaster...
It's way too early to say (which is also pointed out by the government), but ICU cases (which is the critical metric here, since it's quite reliable and comparable, and the metric that matters the most for the Healthcare system) is showing signs of decline (or at least stabilizing).
In unsure if our approach is the right one (time will tell). It's clear that the government is taking this situation very seriously though, just using a different strategy. And honestly it seems to at least not be much worse than any other country at this point.
Sweden has now started anti-body tests on general populations to try to get more correct statistics across the whole population.
So yes, testing is amazing and super important in the early phase, i.e. Korea when it was fairly localized and contact tracing worked well enough. When community spread is there in several places all you can do is limit the it according to the models.
ICU admissions, as you say is a 'hard figure' of what matters, in some ways, yes I agree, I see what you are trying to say.
But what you are saying is like "We shouldn't count the Nazis coming across the border, let's just count the number of people they kill, that's all the data we need"
1) 'fewer ICU admissions' is absolutely not a hard fact (!), because the number of confirmed cases is growing quite a lot in Sweden [1], it's absolutely inevitable that many of them will end up in the ICU. Sweden Covid cases are growing rapidly, borderline exponentially. ICU cases will 100% increase unless Swedes are literally superbeings.
2) Other kinds of data are really important in terms of planning and modeling. This is the most existential crisis since WW2. Wouldn't it make sense to test as extensively as possible? Surely, the cost must be some kind of factor, but the alternative is an economic meltdown.
I don't think they have an excuse: 'rapidly expanding and pervasive testing' should be high on the agenda of every nation facing this crisis.
In fact, I think that cheap, pervasive testing will be one of the ways we can lift these lockdowns and get people back into the community.
[1] https://www.worldometers.info/coronavirus/country/sweden/
Or northern europeans are just more resistant to it.
There are plenty of state governors that are completely ignoring the data, and are refusing to implement lockdowns like their neighbouring states. No need to imagine, it's already happening over here.
The push was launched by the main opposition party to be able to open the economy earlier.