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Comment by thaumaturgy | Hacker News Reader

It's been very hard for me to understand this line of thinking. As I see it, there are so few cases in California because of the measures that have been taken. Do you think California would not have many more cases if the measures were relaxed? Or do you think that the cases would not be all that bad? Or do you think that they would only affect people that you aren't personally concerned about?

I'm asking honestly for an explanation here, because you're certainly not alone in this view, but I haven't heard a rational justification for it yet, and I haven't been able to come up with one myself.

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> there are so few cases in California because of the measures that have been taken

This is probably true, but other countries haven't locked down hard and aren't seeing a big spread. Our options aren't binary. It's not as if the only choice is "Nuke everything" or "Surrender".

The US is not a very densely populated country, and density seems to have the biggest impact on the spread of this thing. We probably could do something like this:

- Dense city? Quarantine. - Moderately dense? High risk individuals quarantine, everyone else social distances, but works. - etc

Across the board, if your business is the sort that can WFH (such as software companies), then you do work from home. If not, then you're open, but with precautions. Restaurants are open, but pickup only, etc.

The point is, we've used a nuke, and it's not at all clear to me that that was the right decision.

> This is probably true, but other countries haven't locked down hard and aren't seeing a big spread.

Which countries might that be? If you're referring to South Korea, they're ahead of the game enough on testing for this to be workable (unlike us). If you're referring to anyone else, they're simply not at that point yet in the curve, but will arrive there.

Various European countries. Sweden comes to mind.

Sweden has more deaths per capita from coronavirus than the US, has an exponentially increasing death rate (i.e. they haven't turned the corner yet), and a very high case fatality rate of 9.4% indicating that they're severely under-testing. This is not what a successful disease prevention strategy looks like.

Sweden's deaths per capita is neck and neck with the United States and following approximately the same trajectory with no lockdown. It's neither appreciably better nor appreciably worse.

http://91-divoc.com/pages/covid-visualization/

The US, like the UK, did a terrible job early on when containment was most critical. Several states are in lockdown now but arguably, the reason for our awful current new cases/death rate is due to the resistance to taking action in February when it first hit. There are also many places in the US that are not in lockdown. From another comment: “Approximately 44 of 50 states have lower per capita death rates than Sweden.“ The US cannot be compared directly to Sweden because it doesn’t have a single policy like Sweden. It’s also worth noting that Sweden has taken some lockdown measures ie your comment about “no lockdown” isn’t accurate. Finally, it’s early days and time will tell. The UK changed their policy because there is no credible evidence that herd immunity is effective. I believe Sweden will as well once the disease spirals out of control. And hopefully less people will die as a result. Unfortunately, there will also be the insufferable few that claim we could have survived without being cautious because you can’t prove that those measures were responsible for saving lives. Don’t be that person.

> the reason for our awful current new cases/death rate is due to the resistance to taking action in February when it first hit.

The reason is actually NYC, specifically Cuomo and DiBlasio passing the buck back and forth and doing nothing. If you remove just NYC, the rest of the country is for the most part doing a lot better than Europe.

It's even worse than that, de Blasio was basically in denial and wasn't doing anything, even through mid-March when cases were exponentially skyrocketing here. It took all the heads of his public health department threatening to resign for him to actually start doing things, and the idiot even went to his gym on the last day that gyms were even open.

Both he and Cuomo took way too late to act, and now we're all suffering for it. Cuomo has since at least gotten better, but de Blasio has been terrible throughout.

Sweden has by far the highest number of cases/deaths with respect to neighboring countries. Finland has 1/10th of the number of deaths per capita [0]. They are also faring much worse than Denmark and Norway (in terms of both cases and deaths) where much stricter measures are enforced.

[0] https://www.forbes.com/sites/davidnikel/2020/04/14/sweden-22...

Why limited to neighboring countries though?

The fact is Sweden has no full quarantine and they have less infection rates and less fatalities per capita than many countries with full quarantine.

It's clear that full quarantine may not be effective.

You have to compare states with comparable population density, cultural norms and roughly comparable initial cases. Climate plays a huge role in how much people engage in potential infection prone activities. E.g. like being outside in parks, beaches.

Uk is on full quarantine. There are no cultural norms because there's no culture there at the moment.

It should have less than Sweden if quarantine is effective.

The question is: how many infections happened before the quarantine was established? In UK the quarantine was started way to late. That the UK has in common with Italy, Spain and France. But in all these countries, a massive infection rate has been drastically reduced by the quarantine.

In Sweden, there seem to have been only very few initial cases and the virus seems to be slow to spread there - it probably helps that Sweden is over 80% larger than the UK and has only 1/6 of the population. Also, at this time of the year it is much colder than the UK, less reason to be outside in big groups.

If you check the infection graphs, in the UK the quarantine finally seems to have an impact on the infection numbers, which stopped growing a while ago. Sweden still seems to have growing infection numbers.

It's still SPREADING at a more rapid rate in U.K. than Sweden on full quarantine.

Full quarantine is effective, almost tautologically so. If the virus is still increasing exponentially then whatever quarantine measures you do have in place simply aren't full enough yet. At the extreme end of a full quarantine, imagine everyone is prohibited from leaving their homes for any reason, and once a week someone in a fully sealed bunny suit comes by to drop off food for the week. That's a pretty darn full quarantine, and you better believe it'd be effective.

Fortunately, we don't need to go to such extreme measures to get the replication rate below 1, but my point is, that extreme measures absolutely do work. The virus isn't magic; it needs to spread through relatively close personal contact. If you eliminate personal contact and sharing of spaces entirely, it cannot spread at all.

Sure it's effective.

But is it more effective than simple washing hands and social distancing?

I think Sweden is proving that it's not.

Additionally short of what you're proposing...full total lockdown...the virus isn't going anywhere...it will be in society when we emerge from quarantine immunologically naeive ready for another wave of Corona.

Japan fits. Some cities are more restricted, but even here personal freedom remains. The emphasis is for people to choose to do the right thing.

> other countries haven't locked down hard and aren't seeing a big spread

Let’s be precise. Some other countries haven’t locked down hard and aren’t seeing a big spread yet.

You mentioned Sweden. Here was Time a few days ago:

> A head doctor at a major hospital in Sweden says the current approach will “probably end in a historical massacre.” He says healthcare workers at his hospital who have tested positive for the virus but are asymptomatic have been advised to continue working. He asked to remain anonymous because “it is frowned upon to speak of the epidemic or to go against the official vision” but said he felt a need to speak out from an “ethical and medical point of view.”

And a good contrast is Bulgaria, which shutdown early, on March 13th or so (https://www.reuters.com/article/us-health-coronavirus-bulgar...), and which has a death rate on par with South Korea's. The neighbouring countries (Romania, Serbia, Greece) are also low but at least 2x that rate.

it all depends on circumstances. Romania had 400k workers returning from Italy in the past month. It is harder to contain.

On a per capita basis sweden isn't really more worse off than many other countries that have shutdown. It's about middle of the pack. Personal responsibility lets us have our cake and eat it too.

http://91-divoc.com/pages/covid-visualization/

By “personal responsibility” I guess you mean something like «each individual person makes their own decisions without official guidance about how their behavior might affect their neighbors – during a severe crisis when nobody has access to complete or accurate information – and we just all hold our breaths and hope none of them make bad choices».

Personally I would call this “government irresponsibility”, but I guess we’ll find how it turns out within a few more weeks.

I’m not sure “have our cake and eat it to” is a good way to describe a crisis that is killing a whole lot of people and smashing the economy (in Sweden and many other places).

> and we just all hold our breaths and hope none of them make bad choices. Personally I would call this “government irresponsibility”, but I guess we’ll find how it turns out within a few more weeks.

This approach absolutely infuriates me too, and it is the fault of "the government", but I am very curious what a more precise explanation is. Is it the current individuals in government? The ongoing culture within government? The broader culture of the country? Or maybe a mix of some of these, plus other things that I'm not able to perceive or imagine.

I bet we (humanity) could get get pretty close to the correct answer, if we made a collective and proper (easier said than done) effort to find out.

A good first step would be for you to stop supporting racist misogynistic islamophobic homophobic xenophobic narcissistic politicians who are pathological liars, science deniers, global warming deniers, and who don't believe doctors and epidemiologists, but do spread racist conspiracy theories.

Hi Don, I am always glad to hear from you (and I mean that 100% sincerely, though that may be hard for you to believe) - I think our perspectives and axioms are so incredibly divergent, that with a little effort on both our parts, a tremendous amount of learning could be achieved from proper discussion.

> A good first step would be for you to stop...

I have no hesitation whatsoever to admit that your approach may be correct, and mine incorrect, but I suspect this feeling is not mutual - is my intuition correct?

The problem (or more accurately, a problem) we have under our current form of democracy (in the US) is that we have an infinite number of variables that can be taken into consideration (and different people will select a different set for analysis), but we are only offered a single choice, with two options: Democrat or Republican.

I can respect your decision (analysis), and would be happy to devote literally hours to listening to your reasoning (I've extended such an offer in the past, as you may recall), but I suspect you don't feel the same way. Rather, it seems to me that you are determined to not like me, and accordingly, will look only at variables that support your conclusion, even if the values of those variables are absolutely incorrect (because they are based not on evidence, but rather speculation within your own mind).

In all of our conversations, you exhibit (so I perceive) extreme confidence and certainty in your beliefs, as well as an utter lack of concern (if not even realization of the very possibility) for the notion that you may not 100% correct in your beliefs - not just about me and my true beliefs, but also what is the necessary set of actions to achieve your (and my!) intended goals. If my perception is accurate, and if you are unwilling/unable to realize and rectify this situation, it seems reasonable that the consequences of this is that you will continue to have a highly flawed model of me in your mind.

I would recommend thinking of such ideas via mental experiments, such as: if one wrote software with such disregard for the importance of accurate analysis of reality, would you expect your program to function correctly? I suspect not. So why then would you expect different behavior when it comes to human and societal interactions? After all, are humans not in a sense extremely analogous to hardware that is executing software, all within a shared, interactive environment? I like to conceptualize humanity as a kind of MMORPG, not only because it's fun to look at it this way, but I think there is great utility in viewing things from a third person perspective, as it can often be helpful in achieving greater emotional separation from the situation, and therefore realize clearer thinking.

Furthermore, I speculate that if this sort of behavior is occurring at scale (across the broad population), the consequence may be that we may never be able to turn this ship around, and things will continue to get worse - ironically, bring about the very opposite of what your intended goal is!

Once again, I am putting a stake in the ground. Throwing down the gauntlet. I challenge you to engage in a proper conversation, with the goal (at least) of discovering what I really believe. I'm not asking that you agree with me, but only to face what my beliefs really are. Thus far, you[1] have been unwilling to engage in a serious, nuanced conversation, or even admit (consider?) that there could be value in such an exercise. You are free to do as you choose of course, as am I. I will continue to occasionally post comments from my perspective, and be open to proper discussion and challenges from all sides. If you choose to continue to respond with downvotes and inaccurate, hateful accusations, that is your right (although technically, it is very much counter to the HN Guidelines). And even though you may feel hate for me, and "people like me" (or so you subconsciously speculate), I will not feel hate for you, or people who hold beliefs similar to yours, because that road leads to hell.

[1] Actually, this is a bit harsh in that it could easily be interpreted as an assertion that you are unique in this regard. Rather, quite the opposite is true - it is my perception that I haven't encountered a single comment that has indicated a willingness to properly consider my fairly unique perspective. To be clear, this is not an assertion that all people on HN are in some way guilty of wrongdoing, but only that I have not encountered anyone "doing the right thing", for my definition of "the right thing" (dealing with this subset of reality honestly and ethically).

https://en.wikipedia.org/wiki/Sealioning

As predicted.

Let me know when you muster up courage proportional to your ego, and maybe we can have a discussion that consists of something more than insults and evasive tactics.

> On a per capita basis sweden isn't really more worse off than many other countries that have shutdown.

This is so untrue.

Norway and Denmark had initially many more cases then Sweden but since their curves flattened.

As of yesterday

Norway - 26 deaths / milion

Sweden - 102 deaths / million

Denmark - 52 deaths / milion

U.K. 166 deaths per million with a full lockdown in place

"with a very late full lockdown in place". It actually proves that locking down early works and things get out of control extremely fast

It doesn't prove anything about lockdowns given that the UK has plenty of healthcare capacity and in fact like elsewhere its hospitals are nearly empty right now. If fewer British people survive in their hospitals all it may show is those hospitals aren't very good, but it wouldn't be due to being "too late" as that would require deaths due to overload.

If you look at the huge drop in cardiac ER admissions it's clear that people are dying because they are having heart attacks and not going to hospital when they should. There's actually a severe problem with hospital underload right now. Governments, supposedly following the science, have built emergency field hospitals and shut down other medical work to protect hospitals that are now nearly empty. This was not predicted by anyone pushing lockdowns and is a grotesque mis-prediction with deadly consequences.

Nobody will talk about it at the moment, but I suspect when all this is studied in years to come the UK will be seen to have done worse partly because its population over-reacted to government extortions to "stay home, save the NHS". People are going to die just because they aren't going to hospitals they've been told they need to "protect" as some sort of moral mission. The NHS is often called a national religion, which isn't quite right - it's a religion to some and unfortunately those people aggressively attack anyone who points out what an institutional failure it is. It's easily believable that people will be avoiding hospitals in the UK in greater numbers than elsewhere right now.

We need to watch out for a lot of retroactive nonsense in the coming months. People will claim epidemiologists predicted all this (they didn't), that the lack of lockdown explains differing death rates (already disproven completely by the case of Sweden). Cold logic is all that will clear the fog.

UK was the country that first wanted to isolate the elderly and get young people infected and immune. The current case count is a reflection of that rather than the lockdown which came afterwards.

False. Sweden has had no lockdown at all and has had less fatalities per capita.

You may want to pick a less terrible example. UK went into lockdown very late, tried to insist on some bullshit herd immunity theory, very nearly lost even its PM, and is now paying the price in blood.

That's extremely overdramatic.

But there is also "Beglium - 359 deaths / million" which had early lockdowns. They started their lockdown one day before Denmark. By cherry picking countries one can chose a story to tell. I think it is too early to say if Sweden's strategy was stupid or not.

I guess Denmark and Norway as both Nordic countries with similiar wealth and culture are as similar to Sweden as possible.

one can argue that Sweden has a larger immigrant population than those countries. Majority of deaths in Sweden are from immigrant populations. They are blamed for not following the social distancing rules that most Swedens follow day to day. Also they are poorer, live in larger families in small houses etc. and it is harder for them to follow the rules.

One can also argue that the virus doesn't care about your ethnicity, and just because it's hit some particular community hard first doesn't mean it's not going to spread through the rest of your society too absent serious measures being taken. In the US, focusing on the "others" who had the virus, in our case the Chinese, while not taking effective measures early enough to stop the disease, was a huge mistake. It was a distraction, an excuse for racism and not doing more. This is not just a disease of poor immigrants. It's coming for everyone.

https://www.nytimes.com/2020/04/07/us/coronavirus-race.html

That doesn't remotely change the fact that non-black people are still dying in droves, and you can't attempt to minimize this pandemic as saying "Well it's mostly black people dying, so if you're not black don't worry", which is the analogy to the post about the poor foreign immigrants dying from it in greater numbers in Sweden.

Don't just drop a link, let's hear your real argument here.

I'm not making an argument. I'm just providing a reference to counter the claim made. I have no dog in this fight other than I like to see references and evidence. Hence why I only dropped a link. You don't need to pick fights with everyone, you know?

How much of that is related to a higher percentage of black people doing more dangerous jobs (one with increased contact with the public)

Of the three people they mention in the article, two take buses.

There's not even an attempt to control. Are black judges living in Westchester statistically more likely than white judges living in Westchester to suffer more from the disease?

Belgiums population density is much much higher

Belgium counts deaths not in hospitals much more accurately. Really, looking at worldometer numbers and comparing between countries makes no sense whatsoever, yet everyone (including media) does it anyway.

Know what else Belgium has? A flattened growth rate. Sweden’s on alone a bad track.

Belgium has people concentrated in a few centers, is a travel hub in the middle of Europe and has a high density of EU employees. With that they imported cases from pretty much everywhere at an early stage.

I'd say it's too early to tell. The consequences can lag for up to three weeks, no?

Yeah not really worse off, just worse off than all their neighbors?

They have roughly an order of magnitude more deaths per million than Finland does (11.6 vs 99). We're somewhat locked down in Finland.

On the other hand, Sweden also took measures, they just weren't as extreme. The virus spread in Europe mainly through travel and large groups of people. Sweden has neither (also because no neighboring country would allow travel). They didn't impose a lock down but it's not like nothing happened in Sweden.

I hope you're not looking at case numbers, because Sweden is so far behind on testing compared to most of europe.

Look at the rate of growth for deaths per day (filtering out weekends because obviously swedes refuse to die on weekends)

Most places are seeing a plateau in number of daily deaths while Sweden is still growing exponentially

I'm looking at deaths per capita. It can still be manipulated but it's the hardest to manipulate.

Look at the trend... 15% of their deaths happened in the past 24 hours

It's very hard to compare the US with Sweden. In Sweden people are able to stay at home without losing much income due to a strong welfare state - which has also been made event stronger due to the virus. In the I assume that a lot of people would be economically forced to disregard "personal responsibility".

The good thing is we’ll see in the end. Lots of predictions. It’s almost as if you can’t be criticized for being too cautious. Sure, but the good will won’t last forever.

The US accepts 22k deaths a year without blinking due to flu. That’s just the flu. What’s the magic number we’re willing to accept? 50k? 100? There has to be a percentage of the population we are willing to accept as casualty because we already do, just unstated.

The lockdown will ultimately spread misery far and wide if left unchecked. Massive rise in poverty, violence, drug abuse, depression, crime, suicide, homelessness, prostitution, etc.

People need to be more clear on what they’re willing to accept. Right now there is no real discussion on “what next”. Lots of obsessing over the current body count though.

> accepts 22k deaths a year without blinking

The US spends a lot of effort trying to convince people to get flu shots, take antivirals if they get sick, and stay away from vulnerable populations while contagious; hospitals prepare extensively for increased use during flu season (and medical workers are vaccinated, making flu much less personally risky for them), widely distribute easy-to-administer flu tests, treat people and keep them alive as best they can, etc. Estimated flu death numbers are also not comparable to current reported Covid death numbers, because they include a ton of guesswork, since many of the people who die while infected with flu officially succumb to some other condition (according to death certificates).

We don’t go into total economic lockdown for 2 months per year, because it would be impossible to enforce and extremely expensive, but we sure did during the last comparable pandemic, the 1918 flu.

Currently (and this will hopefully change as medical knowledge improves), Covid seems to be more than 10x more deadly than seasonal flu for most demographic groups. In an unchecked Covid epidemic (with hospitals overwhelmed) it appears that on the order of 1% of the population dies. (This has happened in some towns in Italy, where a very high percentage of the population was likely infected.)

> lockdown will ultimately spread misery

Having 1% of the entire population die within a matter of months is going to cause an extremely severe economic shock with or without official actions.

Let’s not talk abstractly. How many deaths within your family and circle of friends are you willing to accept?

The logic still applies. Obviously, I hope for zero deaths. But I also don’t forbid them from driving, despite the high number of deaths for that mode of travel. I don’t tell them to quarantine themselves every flu season.

Anyway, I’m not sure we’ve overreacted. I’m just saying it’s possible and it’s pretty amazing how it’s hard to have a conversation about it. People treat the topic like there’s only one answer and anyone who dissents is a murderer.

The risks of driving and seasonal flu are fairly well understood. And there are mitigation’s in place: seatbelts, traffic laws, theraflu, flu shots, etc.

I’m not calling you a murderer. I’m asking you to put a hard number in the risk you are willing to absorb.

Mine is 0.

> Mine is 0.

To be perfectly fair, the current lockdown _IS_ going to kill people that would've survived otherwise. People that now won't go into emergency rooms out of fear of contracting Covid19, poor people whose source of income is completely dried out. And longer term, this is going to cost massive amounts of money, a fraction of which would of course be used to prolong someone's life in some way, eventually. I think the question raised in this thread is simply one of "what's the trade-off". It's very clear that there are costs to this lockdown, and at least to me it's also very clear that that some of those costs are human lives. However, we can't estimate those costs. We do have a guess of the rough fatality rate of covid19, and we do have models that will tell us how many people will die if we don't go into lockdown. But we don't have the same luxury for estimating the amount of people hurt and dead because of it that could otherwise be saved. We can quantify the monetary loss, but not how much of that loss would've otherwise gone towards saving lives. I think the question of "what are the human costs of this lockdown" is a fair one to ask. Don't get me wrong, I too think the lockdown makes sense and overall does save lifes. But the lockdown is not without risk, and even more importantly: I have not seen any estimate of the risk. Is it lower than 0.5-5% of the population? I think so, but both of us haven't done the math, so you talking down to people who ask about it is wrong.

> To be perfectly fair, the current lockdown _IS_ going to kill people that would've survived otherwise. People that now won't go into emergency rooms out of fear of contracting Covid19

You've got the blame all wrong here. These people that are dying who would've survived otherwise are directly being killed by the pandemic, not by the lockdown. If the pandemic were completely uncontained then the hospital system would be way more overwhelmed and you'd be much more likely to die of other causes for lack of healthcare. The lockdown is saving lives by helping to preserve healthcare resources so that if you have some other need like a heart attack there might still be a doctor free.

It's not like, if the lockdown weren't happening, then there wouldn't be a pandemic. What would happen is that the pandemic would be way way worse.

Good question. How many deaths within your family and circle of friends are you willing to accept from political instability resulting from lockdowns?

Zero. And so far there have been zero, but I know of people who've actually died from COVID-19.

We are very, very far from political instability still. Let's not be alarmist.

Of course. It's not like a global recession in the midst of widespread political polarization has ever caused problems before.

> The US accepts 22k deaths a year without blinking due to flu. That’s just the flu. What’s the magic number we’re willing to accept? 50k? 100? There has to be a percentage of the population we are willing to accept as casualty because we already do, just unstated.

Unfortunately the worst case death numbers for an uncontrolled pandemic crack into the millions in the US alone. That is, frankly, more deaths than anyone with a sound conscience is willing to accept.

Also, we have vaccines for the flu that significantly decrease your chance from dying of it. I get the vaccine every year. There's a big difference between being completely at the whim of a disease and being able to take proactive measures against it to help protect yourself. The only proactive measure that works against COVID-19 (which is much deadlier than the flu mind you) right now is social distancing, so it's not surprising to see so many people using the only effective measure that currently exists. Don't underestimate people's desire to not suffer a debilitating illness that leaves them unable to breathe for a week before killing them. Social distancing would be happening regardless of the official stay at home orders.

> Lots of obsessing over the current body count though.

I mean ... yeah. These are our friends, our family, our neighbors. Each one of them was a real person who is dying unnecessarily, and more deaths like them could be spared through better social distancing. This isn't "obsessing", it's a very real concern. You'd care more if it were people you knew dying. I've already had people in my extended contacts die of it (I live here in NYC), and it's rough. Hell, I already got it, and fortunately recovered. Let me tell you, spending days unable to catch your breath even just from walking is terrifying. You'd understand more if this was affecting you more personally. It's not just some abstract discussion about numbers.

Stockholm (the worst hit part of Sweden) has about half the deaths per capita of the state New York (26 deaths per 100k vs 56 deaths per 100k) despite Sweden having laxer restrictions. And Stockholm is generally more densely populated.

So while I too am a bit skeptical of the Swedish policies it is doing pretty average on a global scale. Worse than some countries with harsh lockdown but also better than some countries with harsh lockdowns. It is too early to say for sure if the Swedish policy was stupid or not.

In Swedish news the currently most popular theory for why we have more deaths per capita than our Scandinavian neighbors is not necessarily our lax lockdown (though it may have made things worse) but lack of supplies and poor routines in old people's homes. This is of course speculation.

Is it really the best comparison to use Stockholm vs. New York state instead of Stockholm vs New York city? A city-city comparison seems more logical, no? In the latter comparison, we have NYC 2x as dense as Stockholm with a much larger population.

I don't know the particularities of Sweden, so maybe it makes more sense as you have outlined it. My apologies if that's the case!

Most of the cases in New York are concentrated in and around NYC, which is an international travel hub with 3 very busy international airports in the area. I don't think there are many places in the world which are going to have had the same number of asymptomatic and symptomatic carriers pass through. So on that basis I don't think it's a good benchmark for most other cities or countries to use.

I wonder if it's better to compare Swedens overall per-capita infection rates with other states in the US where there is a lockdown but whose capitals/major cities are more secondary cities from the perspective of international travel. Let's try North Carolina (picked for being closest in population to SE and also being not a top airport hub or travel destination compared to its neighbors) though it does have significant business and educational centers, it's probably a fair comparison to Sweden wrt population density.

NC total population: 10.5 million NC confirmed cases: 7,285

SE total population: 10.2 million SE confirmed cases: 11,445

So anyway, there are other states and countries that are doing better and worse than Sweden, but I don't think that Sweden is in any way demonstrating that it is doing better by trying to ignore the problem and possibly to blame the lack of strict enough sanitation ("lack of supplies and poor routines"), it's just coming later than to higher-volume travel centers like WA, NYC, the UK, France, Italy, etc.

In any case, the idea of doing better or worse will, in the end, be measured in per capita deaths at the end of this disaster, and we haven't gotten there yet. I truly hope that Sweden finds its way through with as few deaths as possible, but I don't think that's what they've done.

You've gotta compare deaths, not confirmed cases, because cases are being so severely under-tested right now (especially in Sweden, which has a nearly 10% case fatality rate, indicating that they're probably only catching 1 case out of every 50, or more). Deaths are the most reliable statistic we have right now because they're the least likely to be under-reported (though they still suffer from that). Once this is all over and we can do population studies based on widespread blood antibody testing then we'll have better stats, but that's years out.

So, comparing the deaths per 10M population, Sweden is currently at 1,014, whereas North Carolina is at 114. So Sweden is suffering roughly one order of magnitude worse from the pandemic than North Carolina is at the moment. And keep in mind that North Carolina went into a shelter in place order over two weeks ago while Sweden hasn't yet, so there's a loooot more pending cases in Sweden's pipeline than NC's.

Without air traffic and closed borders, a country that's not that affected could get through it with few measures. Not sure if many countries are still at that stage but it's no coincidence that international travel hubs got affected worst.

> Stockholm (the worst hit part of Sweden) has about half the deaths per capita of the state New York (26 deaths per 100k vs 56 deaths per 100k) despite Sweden having laxer restrictions.

So far. It's way too early into this unfolding disaster to be making pronouncements like this while the figures are still increasing exponentially. NYC has had shelter-in-place for several weeks now while Stockholm has not. If you'd done this analysis a week ago, and then two weeks ago, you'd see Stockholm looking progressively better and better in comparison to NYC the more you go back in time. In other words, they're catching up, because here in NY we're sheltering in place and it's working, and in Sweden they aren't (yet) and thus their spread is higher.

> And Stockholm is generally more densely populated.

Not in comparison to NYC it's not, which is the fair comparison for Stockholm because Stockholm is a city whereas all of New York is a much much larger state that amounts to 1/3rd of the land area of the entirety of Sweden. NYC's density is 10,715/km2 vs Stockholm's 4,200/km2.

Anders Tegnell - author of Swedish strategy says that the measures are working and deaths are concentrated in Somali, Iraqi and Syria - born population.

https://www.expressen.se/nyheter/coronaviruset/folkhalsomynd...

https://www.aftonbladet.se/nyheter/a/2Gx0Ev/fodda-i-somalia-...

Country of birth Number of cases Over-representation

Somalia 283 7

Turkiet 150 5,1

Irak 242 2,9

Finland 188 2,3

Eritrea 55 2,1

Syrien 197 1,8

Iran 83 1,8

Forna Jugoslavien 60 1,6

So pehaps this is what's been planned after all. Remember that Swedish eugenics laws lapsed only in 1976.

https://www.economist.com/europe/1997/08/28/here-of-all-plac...

But it's not stopping the spread. A friend's office in Västerås just had a case and only now went wfh, while that friend already wfh but still drops off and picks his kids up from school and is getting symptoms now.

The comment about the deaths being primarily in particular communities sounds like the opposite of working, though. Can you provide context regarding why it's working if people in some communities are dying?

* Edit: thanks for clarifying. I didn't realize that your comment about measures working as intended was hinting at a eugenics motives of the policymakers when I first read it, but do now.

Well the real reason there is no lockdown in Sweden is that the owners of the country said No to lockdown. The rest is just unique Swedish doublespeak.

https://www.ft.com/content/3b8ec9fe-6eb8-11ea-89df-41bea0557...

> An estimate from The Economist finds that the value of Swedish billionaires’ fortunes is equivalent to a quarter of the country’s annual gdp. Only in tax havens such as Cyprus or Monaco, or captured economies such as Russia or Georgia, are plutocrats more dominant

https://www.economist.com/briefing/2019/11/28/in-sweden-bill...

Perhaps. Or perhaps cultural behavioral norms, or even just lack of understanding due to language barriers is to blame. Strategic, covert genocide seems fairly unlikely to me, but then I'm relying purely on personal heuristics, which in turn rely upon my limited knowledge of Sweden.

Maybe it's just concentrated on poorer parts of the population? Generally poorer people tend to live closer together and can't afford staying home when they're sick. Immigrants tend to be poorer in most countries, including Sweden. I'm not sure how it helps to name place of birth for infected, finding out the actual factors determining the spread would be more helpful.

Keeping with the spirit of precision:

- that doctor is making a prediction about the future, based (in part) on evidence that you and I are unable to verify

- there has been no shortage of incorrect opinions and predictions from those who are genuine experts throughout this crisis

Please note that I am not disagreeing with you. Rather, I am adding benign supplementary information.

I keep hearing these stories about how Sweden's approach will end in disaster, but their new case rate is ~500 per day with >10,000 existing cases. A 5% growth rate of new cases strongly implies that they are already past the peak.

What am I missing that would imply things are about to get vastly worse there?

(I do see some other specific mistakes there that lead to a higher death rate, but I don't see the concern about things suddenly getting worse in the future)

Existing cases counts are at worst fantasist, at best state and policy dependent. You can't compare case counts between countries.

Then what you're missing is that sweden case counting method report very low numbers (either that or their mortality rate is absurdly high, which seems more unlikely).

> - Dense city? Quarantine. - Moderately dense? High risk individuals quarantine, everyone else social distances, but works. - etc. Across the board, if your business is the sort that can WFH (such as software companies), then you do work from home. If not, then you're open, but with precautions. Restaurants are open, but pickup only, etc.

How is this _that_ much different from what's being done now?

Michigan has banned selling seeds.

Governors are forcing businesses closed or no seating allowed.

Those guidelines are good ones to maintain for perpetuity. Would decrease the thousands of flu deaths we see each year too but today's situation is closer to a nationwide lockdown than a PSA about washing hands

Well for example there's lots of non-essential business that can operate while enforcing social distancing. Closing bars and restaurants makes sense. But closing stores were you walk in and walk out does not make sense. Banning fishing doesn't make sense. Very broad strokes have been used to lock stuff down.

And at least in Michigan, they're not taking the time to open up low risk businesses now - instead they're filling in even more of the gaps that allowed life to continue. No golf courses, even without any staff contact. No landscaping. No landscaping supplies. No motorboats or jet skis. No travel between two residences you own.

But at least you can still buy lottery tickets!

Some of these can be explained at least. Landscaping is very non-essential, and it's hard to maintain social distancing while doing it because the way the crews operate is it's a bunch of guys riding together in one truck between each job sites (it's not a caravan of different vehicles, one per vehicle).

Additionally, my mom has been complaining about the landscapers where she lives and is angry that they're still allowed, because they flagrantly violate social distancing and get near her when she's trying to go on walks around her neighborhood.

Things are getting so bad in Detroit that bodies are piling up in unrefrigerated rooms in hospitals. Now's not really the time to be questioning if they're being too strict with the social distancing; at this point they really just do need everyone staying home, period, and not coming into contact with anyone. Motorboats and jet skis sure as hell aren't essential, and might tempt people into congregating with people they shouldn't be congregating with (boating is typically a social endeavor for example).

I'd say that landscaping is at least a field that has the possibility of operating while social distancing.

As for bodies piling up in Detroit... While that's true, additional restrictions added today won't have any impact there. Either the previous restrictions were sufficient, in which case Detroit should be peaking soon, or they weren't sufficient and there'll be several times that number of bodies before these restrictions start to have an effect.

My personal view is that low-risk activities should be allowed whenever possible to maximize the time period that people will willingly endure these restrictions. It looks like this won't be a sprint but a marathon, and people's willingness to comply is extremely relevant there.

I am in Tokyo and it's been going on longer here than many places.

Gradually increasing pressure has been the approach. It feels to me like you're right. I am willing to accept more pressure, though already burdened. It's because there's been time to adjust.

You're missing the point, which is that if you think the situation is bad now, just wait how bad it'll be in two weeks if we don't act even more stringently now. Letting up on the restrictions now would be exactly the wrong thing to do when the healthcare system is already bursting at the seams; it'd make things much much worse in the weeks to come.

The very earliest that it makes sense to even start considering reducing the restrictions is once the healthcare system is back to operating at under its maximum capacity. And you have to ease things back slowly, ready to clamp back down if necessary if the healthcare system seems ready to be overwhelmed again.

My reading is that either restrictions were sufficient before, or the new ones won't be enough either. And the more onerous the restrictions, the less likely it is that people will be willing to follow the important ones in the future.

It doesn't logically follow that just because mild restrictions weren't sufficient, that stricter restrictions won't be. China used very strict restrictions and they stopped the spread of the disease hard.

Every incremental improvement you can do to decrease the R_0 will have its effect. Progressively stricter social distancing measures as required absolutely will work, so long as they are being obeyed anyway.

> so long as they are being obeyed anyway.

And that's MY point. How long will people be willing to obey the current restrictions? How long would they be willing to obey even stricter ones, or more lenient ones?

I don't think obedience can be assumed forever. Even China had to weld people inside their apartment buildings. And I don't know if that would be practical here.

The talking point the anti-governor folks are repeating is that landscaping companies can’t even deliver mulch to your driveway. Which, sure, I guess that’s overly draconian but in the grand scheme of things I can’t bring myself to be angry about it.

There's inevitably the potential for person-to-person contact in business anyway, yes, even running a mulch yard, delivering mulch, getting a receipt signed on delivery, etc. It's not unreasonable at all to shut down all non-essential businesses until our healthcare system starts operating under its maximum capacity again, and to define "essential" strictly.

Given that we're in the early stages of the worst pandemic to hit the world in over a century, like you, I too can't bring myself to be angry about landscaping being shuttered, or jet skis, or whatever other silly unnecessary things people are complaining about. If even one more person dies because a landscaping company opened back up a month earlier, then it wasn't worth it. And that's easily a possibility we're looking at here.

What you're not thinking of is that restrictions such as this also cost lives. Suicides will be up and there will be much more economic stress afterwards.

> it's hard to maintain social distancing while doing it because the way the crews operate

I have no idea how to quantify it, but social distancing at a grocery store, surrounded by an ever-rotating group of people, seems much more risky than a work-crew, which is composed of the same 6 people all day.

The work crews are hanging out all day every day, whereas you do your grocery shopping once a week maximum, for less than an hour, and everyone wears a mask to reduce the chance of spreading anything.

On the work crew, if one person gets it, basically everyone else on the crew is guaranteed to get it too. In the grocery store, a single visit, especially with proper precautions taken, is unlikely to spread it.

But the grocery store workers are there all the time, and interacting with a wide variety of people. Sure, the chance per person is lower - but overall?

And the spread on a work crew is limited - there's only 6 people there. But that grocery store worker? Can you define super spreading event?

Seriously, how is allowing kayaking/sailing but banning motor boats, even when alone, anything but taking advantage of the crisis to push through an environmental agenda?

People wonder why others are afraid to give the government more power, this is one of the best examples of why.

It could depend on the store.

Over here in The Netherlands, most supermarkets have, to various degrees, implemented measures to protect workers (plexiglass, timed restocking, etc.) and measures to encourage social distancing (reminders and lines on the floors, a maximum number of customers via a set number of carts and having an employee wipe down the carts and handing them out manually at the entrance, old-people-hour in the morning, etc.).

The psychology behind this is fascinating. It's not just the measures that help, but the fact that simply being handed a cart after passing through the turnstile puts me (and I suspect everyone else) in 'awareness' mode. I've noticed that I myself generally pay more attention to not hover around employees, and take a detour via a quiet aisle whenever I can.

This stands in contrast to all the non-supermarket stores I occasionally visit. aisles are narrower, they don't have a designated entrance-employee, and at best there's some A4 glued somewhere asking me to pay by card if I can. Not only is it more difficult to practice 'social distancing', I don't notice a similar change in 'mindset' and have caught myself more than once leaning over an employee or passing close by other shoppers. And interestingly, both myself and said shopper seemed to notice this less (in the supermarket I've noticed many more older customers wait intentionally for me to pass at an appropriate distance).

And that's not even considering weird situations like our local HEMA (a very popular convenience store) implementing a bunch of measures, but then if you want to go and pay for your stuff you have to pick up an unclean scanner gun for the self-checkout, essentially undoing any measures they implemented. Out of curiosity I stuck around to see if these 'guns' are cleaned. They're not.

I guess my point is that stores are trying to implement sensible measures but so far it's mostly been supermarkets that seem to do a decent job (even if there's quite a bit of variation between stores from even the same company). I imagine it's much easier for these chain-stores to both get expert advice /and/ implement measures nation-wide. For those who have serious concerns it's a good reason to avoid 'mom and pop' stores though.

I guess what I’d like is for the gov to provide methods that would allow business to remain open if they complied with certain measures. They shouldn’t need their own expert, the gov should be able to provide measures.

Agreed! I'm kind of expecting that something like that will happen over here eventually.

I agree... they closed access to waterways here because they were seeing some boats too close together. That makes a lot of sense if you don't think about it, and clearly should not have happened.

> density seems to have the biggest impact on the spread of this thing

Pick two random people Jo and Chris. If Jo wants to pass a letter from hand to hand via intermediary carriers so it gets to Chris, what’s the shortest time for it to get to Chris?

Ways to slow down the letter passing are to prevent long distance connections (close airports), slow down connections (only go to supermarket once a week), remove connections (close pubs).

To avoid any carriers passing a letter to you, you want to avoid: highly connected social people; gatherings of connected people; reduce number of meetings.

Density is one aspect, but perhaps not the most important.

Hmm.

One of the traits of this virus that makes it so different from past potential epidemics is that it's able to spread rapidly through a population for up to two weeks before it starts becoming "visible" (symptoms start to arrive in large enough numbers to become alarming). At the tail end of those two weeks, the infection may have spread enough to become very difficult to control.

So, if we took some kind of middle road, and then two weeks later the virus exploded, would that change how you felt about the approach?

I'm still treating this question honestly, btw. I completely agree that it would be nice if such severe measures were unnecessary and the damage to people's livelihoods could start getting addressed. But, the problem that policy-makers are dealing with is that this isn't an infection that responds well to a "wait and see" approach; by the time you start to "see" and react, you could be in deep trouble.

It's also an open question for me. I'm wondering though if, even with the limited data we have now, there are examples of countries that took a similar approach and had their two-weeks-later 'explosion' (or possibly three, is what I've heard).

People want to make things complicated and not take anything at face value, but if you look at global cases on a log scale, you see how they started exponential, flattened out, and then once there was a foothold outside china, went exponential again, and now is flattening again.

Wouldn't it be logical to assume this will repeat as soon as people decide it's under control again? How can you go back to normal, before everyone has caught it, and expect the rate not to go back to exponential?

Another complication and I'm sure the task force is wrestling with this. If you undo the restrictions you're never going to be able to put them back in place and have the adherence you did the first time. I just don't believe the people will accept being on lock-down for weeks, then getting a taste of getting back to work and then being asked to go back on lock-down. I also didn't believe people in the US would follow the lock-down rules anywhere near to the degree they have so :shrug: who knows?

Ooof, I hope you're wrong about this, and that people would enjoy more having sporadic periods of freedom rather than months straight of lockdown, but I can't say that for sure. You may be right.

> The US is not a very densely populated country, and density seems to have the biggest impact on the spread of this thing.

The US has the highest number of confirmed coronavirus cases of any nation. The US is seeing about 2,000 confirmed coronavirus deaths a day at the moment:

https://coronavirus.jhu.edu/map.html

Contrast the US results with Australia's or South Korea's results. Australia and South Korea are doing much better.

> The US has the highest number of confirmed coronavirus cases of any nation.

Your statement isn't very useful. It's the per capita death rate that matters the most of any metric. It's non-sense to compare the US to countries with 5% or 20% of the population using absolute numbers.

In terms of density, it's the NYC region that overwhelmingly accounts for the problem in the US. NY + NJ = majority of US deaths. The NYC region is the most dense on population in the US, which dramatically magnified its outbreak.

Approximately 44 of 50 states have lower per capita death rates than Sweden. Most US states are doing extraordinarily well in fact.

Half of US states are seeing no serious outbreak at all.

Arizona has 7.3 million people and only 131 deaths.

Belgium has 11.4 million people and 4,000 deaths. Sweden is considered a relatively good outcome in Europe so far, they have 10 million people and 1,000 deaths. Texas has three times the population of Sweden with 1/3 the deaths.

Some more examples:

Utah 19. Oregon 55. Arkansas 30. Washington DC 67. Delaware 41. Hawaii 9. Idaho 33. Iowa 49. Kansas 69. Maine 20. Minnesota 79. Nebraska 18. New Hampshire 23. New Mexico 31. North Dakota 9. South Dakota 6. Montana 7. Vermont 29. West Virginia 9. Wyoming 1. Puerto Rico 45.

Lower population density helps a lot in most cases. However San Francisco is also one of the most dense cities in the US and only has ~15 deaths or so. That's thanks largely to climate, which impedes transmission heavily. The same reason the entire San Diego County only has 53 deaths.

> It's the per capita death rate that matters the most of any metric.

The US has the 15th highest per capita death rate. It's on track to go up in that ranking:

https://www.worldometers.info/coronavirus/#countries

And Sweden is higher in the per capita death rate and on track to go up much higher in that ranking.

Yes. Contrast Sweden and the US to Australia and South Korea. Australia and South Korea are doing much better. The Australian and South Korean response has been competent.

Australia has a mandatory stay-at-home order, and they issued it earlier in their outbreak than we did in theirs. That explains why they're doing so well.

In South Korea they all gravitated to masks very early, and they developed enough testing capacity early on to allow contact tracing to remain viable (so far).

Australia is outside of the Covid Belt of temperatures that is ideal for SARS-CoV-2 transmission.

Australia is spared for the same reason most of Latin America, most of Africa and hotter climates in Asia have been.

Nigeria, Egypt, Mexico, Argentina, Colombia, Indonesia, Vietnam and Thailand don't have such low death rates because they've been running testing at the rate of Germany and doing tracing & lockdown & testing & quarantine as well as South Korea. It's the hotter climates. It's hot in Melbourne, Perth and Sydney during the Winter in the Northern Hemisphere, ie during the outbreak so far. Melbourne has been shielded for the same reason Lagos Nigeria has been.

Australia's measures are without question further helping to limit cases. Having a warmer climate during the outbreak time while simultaneously implementing aggressive measures, is the ideal double whammy to get a good outcome. The climate makes it dramatically easier.

> Nigeria, Egypt, Mexico, Argentina, Colombia, Indonesia, Vietnam and Thailand

Indonesia is only testing at the rate of 116 tests per million people. You only find what you measure. When the rate of testing is that low you can't make any claims about the true coronavirus death rate in Indonesia:

https://www.worldometers.info/coronavirus/#countries

And it hasn't helped that the Indonesian government has been deliberately withholding coronavirus information from the country:

https://www.thejakartapost.com/news/2020/03/13/we-dont-want-...

There is no such thing as "Covid belt of temperatures". Please provide reliable sources. This is just your pet hypothesis.

I used to think per capita means more but in this case does the absolute growth rate have anything to do with total population?

I read it's not due to climate I read it's because there was already a Coronavirus in the area and they have built a herd immunity.

> Sweden is considered a relatively good outcome in Europe so far

I don't think that's true. Germany or Austria might be good outcomes. Sweden had few measures in place but their death rate is far higher than most neighbours.

Thank you I've been saying this for a while but have been being crucified by the flat curver movement who takes no accountability in proving that their method is working with hard data.

Sweden is one of the few countries that didn’t lock down. I’m Danish, and we locked down hard and are now on the process of reopening where as Sweden has 4-5 times the amount of deaths we do per capita, despite being a much, much larger geographical area and they’re closing down more and more as we are opening.

The political fallout the Swedish government will face over having so much more dead than Denmark and Norway is likely going to destroy their current government and lead to a further increase of their right-wing populist party.

So yeah, there are countries that didn’t close down hard, but they look royally fucked because of it. I think the only country where the government failed where the current administration is gaining popularity is the US. For some reason.

> The US is not a very densely populated country, and density seems to have the biggest impact on the spread of this thing.

You might be right, and I hope you are. But at least 'intuitively' my experience is that the more insular a community is, the more exposed those /within/ that community are because of frequent interaction.

So, basically, a big city is not very insular, but people spread the virus via public transit and whatnot.

A small, rural town is insular, but the locals interact much more than the city-folk. All it would take is one infected out-of-towner to trigger rapid spread locally.

I wouldn't be surprised if the problem that, for now, seems to be contained to liberal metropolises, will find their way into all sorts of rural communities because just one person passed it on. I hope I'm wrong.

I think you are correct. Georgia's heat map approach to graphically displaying infections based upon per capita case rates really highlights this, IMO: https://dph.georgia.gov/covid-19-daily-status-report

it seems to me it's not only density but mobility too. The US is a very mobile place, people can move around very easily. I think you have to consider that along with density when looking at how fast a virus can spread.

I hope a side effect of the virus spread is proving wfh feasible to many skeptics. Working from home goes a long way to reducing pollution and increasing productivity and morale. It's definitely not one size fits all and doesn't work for all personalities and jobs but it should be used where it can work. At a min, it keeps people off the roads/tracks.

I personally think something should have been done, but it's an open question if we went too far or not far enough and am willing to listen to the argument that we went too far. It's unlikely what was done was the absolute perfect policy prescription given all the trade offs involved.

Personally I'm looking to Sweden's data, a country that instituted some social distancing measures (no crowds above 50) but not all (Restaurant dine in still open) for some clarity. Their numbers are worse than Denmark's right now but not absurdly so (2x deaths per capita).

Give it time. They're still in full exponential growth, whereas every place that enacted social distancing rules a couple weeks ago or more is now plateauing.

Possibly, their numbers the last 4 days are bizarre, potentially due to holiday effects.

My guess is what's going to happen is they will see more deaths, but not an unreasonable number and both sides of the debate will declare victory as they move the goal posts sufficiently.

My guess is that they'll end up having to do more stringent social distancing measures anyway, but that a lot of people will end up having unnecessarily died because they waited so long relative to other countries. Because currently they are on track for an unreasonable number of deaths, and it would reasonable to change the course of action so that that doesn't happen.

I'm not seeing a lot of subtlety in these outcomes, nor possibility of both sides (credibly) claiming that they were right. We'll know soon enough either way.

Sweden's number of confirmed cases is not in full exponential growth right now. https://www.worldometers.info/coronavirus/country/sweden/

They've fallen behind in testing capacity, like many others. You have to go by hospitalizations and confirmed deaths because those are the only stats likely not to be underreported too badly.

Exactly, look at the logarithmic curve of deaths and you see a clear flattening so no "exponential growth" as you where saying.

15% of deaths happened in the past 24 hours, that's not a flattening of the curve

Maybe you're being fooled by the lack of reported deaths in the weekends in Sweden? It does mess up the curve quite a bit. But it's been like that every weekend if you look at daily deaths. And it makes the log graph look less exponential than it is

Also the log graph is a day behind the reported numbers, so tomorrow you'll see a sharp rise as they're at 1200 deaths now, making it clear that it's indeed exponential

So last tuesday they reported 114 deaths yesterday they reported 114 deaths. You can't be seriously looking at the bar graph of daily deaths and see an exponential growth. If anything it seems to have stagnated. Yes we underreport during the weekend and overreport the first days after the weekend and monday was a holiday for us. But it is clear as day if you look at the logarithmic chart over deaths that our growth is slowing.

Similar cherry-picking leads to: Last wednesday 96 deaths happened, which was around 15% of total deaths at the time. And this wednesday 170 is reported, which is around 15% of total deaths now. That's exponential growth

You are right though, given the numbers there's decent likelihood that it's stagnating. But there's also a decent risk that it's still exponential

Again, 3 day weekend...

> and am willing to listen to the argument that we went too far.

In all honesty I want to do the same. But upon reflecting, that's more to do with my desire for things to 'return to normal' than anything else.

There's so much we don't know yet. What if immunity isn't a thing (I'd say unlikely) or not as binary as we think (much more likely; multiple articles I've read indicate that having a mild version of this also provides mild inoculation)?

What if the hope of the 'iceberg' theory is untrue, or very selectively true?

What if allowing this thing to roam free and cause mass inoculation also leads to mutations that mess up our plans (unlikely, from what I've read about coronaviruses).

My point is that until we have a better grasp on these potentially game-changing issues, we should prioritize study, we should prioritize testing on mass scale, we should prioritize PPE for our health care workers, and we should prioritize finding ways to minimize the consequences of our possibly-too-careful aproach.

But we shouldn't let down on that 'over-careful' approach until we know more. Regardless of the economic impact.

Not all cities issued a shelter in place in California at the same time. Bay Area was early, and then the state issued one a week later. You think you’d see a hot spot somewhere in the state but doesn’t appear to be the case. Unclear to me that SIP is the main reason why we have few cases vs if we just required face masks and social distancing while keeping more businesses open.

Yeah, fwiw I would not argue with someone that claimed that nobody has a complete picture of all of the factors in the virus's infection rate. There has been a lot of conflicting and incomplete information and it's been difficult to stay up-to-date. It might be that there's some sort of difference between California and New York or northern Italy that would make California far less susceptible. Maybe environmental, or demographic, who knows.

The problem though is that we don't know that California would somehow turn out differently, and because of this thing's damnable asymptomatic incubation period and rates of spread, by the time you realize you haven't taken it seriously enough, it's going to be very bad.

So imagine you're sitting at the table with the governor and CalOES. They're asking you to make a decision today: tank the economy, or not. In two weeks you get to see how it turned out: either you saved the economy and only several hundred people died, or several thousand people have died and your healthcare system is on the verge of collapse and the economy tanked anyway because sick and dead people don't do a lot of shopping.

Sweden has far fewer cases and death rate without a massive lockdown. If this disease is really so deadly, why isn’t their country being massively depopulated? Same for states in the US that haven’t implemented any lockdown measures.

Sweden has the highest death rate per capita of all developed nations.

Where is that stat? The sources I have seen do not show that.

The stat that they're specifically referring to is the case fatality rate, but that has a lot more to do with the denominator (Sweden's utter failure to test) than the numerator (actual number of deaths).

While current Swedish strategy carries a high risk of bringing it to that point, that statement is absolutely false right now. Swedish deaths per 1 million are currently 102, significantly lower than Spain (397), Italy (348), France (241), Belgium (383), etc.

Source: https://www.worldometers.info/coronavirus/#countries

I'd like to believe that Belgium, Italy, France and others in Europe are also developed.

Sweden: https://imperialcollegelondon.github.io/covid19estimates/#/d...

Greece: https://imperialcollegelondon.github.io/covid19estimates/#/d...

Where would you rather be?

The data I have seen does not corroborate this — in fact exactly the opposite.

According to [0] Sweden has 11,445 cases and 1,033 deaths (CFR: 9%) as of 6pm PT 4/14. For a population of 10.3 million [1], this is a confirmed infection rate of 0.11%.

According to [2] California has 23,338 cases and 758 deaths (CFR: 3.2%) as of 6pm PT 4/14. For a population of 39.5 million [3], this is a confirmed infection rate of 0.06%.

By all accounts, Sweden is being hit far harder by this virus than California or Sweden’s own neighbors are, and based on this evidence it is reasonable to infer that the distancing measures or lack thereof have an effect on transmission.

[0] https://www.worldometers.info/coronavirus/country/sweden/

[1] https://en.wikipedia.org/wiki/Demographics_of_Sweden

[2] https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/Immunization...

[3] https://en.wikipedia.org/wiki/California

A Forbes headline from today reads "Sweden: 22 Scientists Say Coronavirus Strategy Has Failed As Deaths Top 1,000"

It is. The ongoing data already show it. And in another month or two it's going to be really obvious how much worse they were hit by countries that locked down sooner (I say sooner because at this rate it seems inevitable that Sweden will be forced into some form of lockdown too, just tragically too late to save many tens of thousands of lives). Let's regroup in a couple months and see precisely how poorly their strategy turned out.

Look at their fatality rate compared to other European countries. Also read the recent news about change of approach of Sweden and The Netherlands. Read about the current situation of the UK and go back in time an look at their initial response vs e.g. Germany. Compare the two. Lockdowns are saving lifes.

Sweden also has a fairly low population density outside its larger cities, as well as a relatively small (10M) population. And its measures aren't without criticism - consider they have 100 deaths per 1M people, which places them 10th on countries with over 1K cases.

There's states in the US with similar densities; I'd imagine those would be spared most of the deaths, even if stricter measures weren't implemented, but what about the coasts?

Honestly, the US, large and heterogenous as it is, should implement different measures per state. It's obvious to me that what works for some places may not work for others so well.

Even if you look at Germany, you will see huge regional differences. If you look at the map of the positive tested, you can clearly see spikes in the huge cities (Berlin, Hamburg, München) and in densely populated regions. You can also still see that the infection density is higher around the places of initial infections (Bavaria for example, many skiing tourists who got infected in Austria/Italy). On the other side, there are less dense populated regions with a noticeably smaller infection rate.

And interestingly, those on holiday seem to have brought it back at a much greater rate than business travelers. E.g. Frankfurt isn't an epicenter despite having the largest airport and a lot of business travel, esp. to China. Many of the early outbreaks can be traced back to either Italy or Austria during Easter holidays. And that's where centers of infection remain.

It's still early enough in the pandemic that the effect you're seeing here might only be that denser areas get it first, not that they get it worse. People in less dense areas do still regularly come in close contact with other people, so there is the potential for the virus to spread there even if the people live spread out on farms or whatever.

Given it a few more months and I suspect that the differences between the urbs and suburbs will be less.

52% of Swedish households are 1 person households[1] so they were sort of self-isolating by default. As you can see from the other replies, that wasn't enough to keep transmission at bay.

[1] https://ec.europa.eu/eurostat/web/products-eurostat-news/-/D...

I’ve participated in Homeland Security pandemic exercises. One in particular had a R0 of about 2, and a death rate of 1.3%, with a hospitalization rate of 10%, and and acute care rate of 3%. All numbers lower than CoVID-19.

What happened in the exercise was that all hospitals got over run, very quickly, it took months for the infection rates to flatten.

Nobody could get into a hospital and get any proper care, entire families started dying, the death rate jumped up to almost 12%. Remember the calculated death rate is based on proper care. Police, Fire, EMS, got hit hard and they all walked off the job.

Nursing homes, assisted living facilities had death rates of almost 75%, (we’re starting to see 50% now).

Hospital workers started walking off the job. The economy didn’t slow down the economy flew into the ground at 500mph and exploded in billions of tiny pieces. The country went into immediate shortages of everything, which didn’t really matter because basically everyone stopped going to work.

When you might get sick and you know you can’t get care and without care you have a 12 in 100 chance of dying you can’t get people to leave their house, for any reason. People start dying home alone.

The death rate gets even higher because of food shortages, prescription drug shortages, and underlying health conditions fuel the fire. Power disruptions, water, sewage issue because no one is working. Crime becomes a problem, because a) the police aren’t working and b) people get desperate.

Once things start to unravel you can’t simply re-ravel things.

In a normal flu season about 40 Million people get infected, with 30-67K dead a year spread out over 6 months.

If we respond to COVID-19 like we do with the flu, we could see 150-200 million infected because it spreads more easily, those numbers would overwhelm the country, maybe have 20-35 Million dead, the economy might stop for a year or two, or three or four.

We don’t know if infection confers immunity, what happens if it doesn’t? What if getting it makes you more susceptible to a second and worse infection? What if we can’t develop a vaccine?

You’ll be gambling with a lot of lives.

I agree with your point in general, but this claim is overblown:

> If we respond to COVID-19 like we do with the flu, we could see 150-200 million infected because it spreads more easily, those numbers would overwhelm the country, maybe have 20-35 Million dead

Even without any medical treatment at all, the death rate from COVID-19 is much lower than 13%. It might even be below 1%, once you factor in all the asymptomatic cases that we're only just starting to discover from blood antibody testing. So we're still talking about millions of deaths, which would be absolutely horrible enough in its own right, but we're not looking at double digit death numbers. COVID-19 fortunately isn't that deadly. Other diseases are though ... so in a way, as bad as this seems, we did still get somewhat lucky.

Your exercises were worthless because they were based on the assumption epidemiology is usefully correct, and it's clearly not.

I mean, I wonder how you reach the conclusions you do? Just read your own post back to yourself. You say the numbers in SARS-COV-2 are worse than for your simulation yet the outcomes observed in reality are empty hospitals that need to furlough workers because they are so underworked. Reality has disproven the simulations, but it sounds a lot like you're concluding reality is wrong?

He's clearly talking about what would happen without intervention. We do not live in that world

"empty hospitals that need to furlough workers because they are so underworked"

This seems to be a meme, but I think it started with misinterpretation of elective procedures being cancelled and employees that couldn't be repurposed being furloughed. It doesn't make any sense to equate this with hospital resources in general being plentiful. The point of no elective procedures is that some resources are freed up. Bottlenecks aren't applicable to everything equally.

There's no mis-interpretation. All those procedures were cancelled because of a belief that hospitals would be overflowing and every bed would be needed. Clearly those predictions were well wide of the mark.

I think there are open questions about how much our current actions are preventing deaths vs delaying them, what the difference is in terms of number of deaths caused by stay-at-home order vs more mild social distancing, and what downstream effects and deaths will result from a new global depression (especially in the developing world).

Are there any examples of milder social distancing without extensive testing and contact tracing that has been effective? There are certainly a lot of examples of delayed or poorly enforced / adhered social distancing that has proved to be ineffective.

Sweden. Also look how different states/counties are affected in US

Sweden has one of the highest deaths/million.

Yup, it's worse than the United States even. They're not a model of success at all.

It's not worse than US: http://91-divoc.com/pages/covid-visualization/ (third plot on page)

Wrong data. You're looking at confirmed cases, which Sweden is massively falling behind on because they're under-testing so badly, as you can see from their absolutely incredible (as in unbelievable) reported case fatality rate of 9%. It's not that 9% of their population is dying from this, it's that they're not even catching 1 out of every 50 people that even have it. Their stats look low because they're so severely under-reported.

The correct figures to be comparing here are per capita deaths. Sweden is currently sitting at 1,014 deaths per 10M people while the United States is at 789. Ergo, Sweden's outbreak is roughly a third worse than the US so far, and growing worse.

I totally believe that the coronavirus has been in California since December and peaked in February. I’m sure if we look back we can find evidence of people getting sick and recovering. Those who died were listed as death from pneumonia or something else.

If COVID-19 had been spreading uncontrolled in California for four months prior to containment measures being enacted, the number of deaths by now would be truly mind-boggling. It's simply not possible for this to have been the case, because it would have been obvious sheerly looking at the all-cause death rate in the state increasing by many times its normal value months ago. This didn't happen, ergo COVID-19 was not spreading uncontained in California for that long.

The main snag with this model is hospitalizations. Even if we grant that there was no testing available, and that early deaths of covid19 would have been attributed to cardiac disease or pneumonia, and that there may have been some kind of less lethal early strain or some other voodoo, the hospitalization rate would still be expected to be constant, and it hasn't been. Health care workers have broadly been reporting pretty typical case loads up until early to mid March.

For some corroborating data, there's a "smart thermometer" company [1] that uses the aggregated data from their thermometers to maintain health "weather" metrics for the US [2]. Right on their health weather page, you can see a chart showing typical rates for seasonal infections across the US, up until March 1st. And if you're concerned that New York is tilting the results, then you can even zoom in to the San Francisco area [3] and see the same behavior.

Kinsa's CEO has published a writeup on medium [4] that compares a couple of different areas with different responses and timelines, and he says that the data he's seeing suggests that stay-at-home orders are making a big difference in infection rates. They have more stuff like this on their Twitter account [5].

I would think that if this were the same disease all the way back in December, the data would look very different. There'd be no explanation for the fall-off of fever rates all the way up to March 1, when it suddenly started climbing.

[1]: https://www.kinsahealth.co/

[2]: https://healthweather.us/?mode=Atypical

[3]: https://healthweather.us/?regionId=06075&mode=Atypical

[4]: https://medium.com/@inders/your-sacrifices-are-saving-lives-...

[5]: https://twitter.com/kinsa

It's rational, you just haven't seen the data causing people to ask these questions. Perhaps because aforementioned newspaper outlets aren't showing you.

Here is some.

Graphical comparison of UK (hard lock down) with Sweden (not much lockdown e.g. restaurants and shops still open)

http://www.theblogmire.com/a-comparison-of-lockdown-uk-with-...

There's basically no difference.

Switzerland's proportion of positive tests as a fraction of all tests (i.e. is it spreading) shows no epidemic and no effect from lockdown, again, presented visually here in the tweet that's a reply to the first:

https://twitter.com/FScholkmann/status/1249703752904425478

In Switzerland the apparent reproduction number started to fall before lockdown began (see the shaded graph):

https://medicalxpress.com/news/2020-04-lockdown-impact-covid...

https://www.tagesanzeiger.ch/ansteckungsraten-flachten-berei...

(you can delete the paywall to see the headline and summary)

There are other reasons to be skeptical. Epidemics naturally come and go very quickly. The "lockdown" concept comes from epidemiologists. These people have a history of proposing extreme measures that turn out to have had no effect when compared to control groups, or when people simply realise that the epidemic entered decline before the recommended measures were implemented. If the lockdown ends up having no effect it'd be counter-intuitive but entirely predictable from how things worked out in the past. For instance, look at the history of foot-and-mouth disease in the UK.

> As I see it, there are so few cases in California because of the measures that have been taken.

California has been spared because it's not in the Covid Belt. That's a term I've come up with to describe the ideal climate that SARS-CoV-2 thrives in. All hard hit regions exist in the Covid climate belt.

Not all the least hit areas (eg South Korea) exist outside of the Covid Belt. You can also limit its spread with other aggressive measures. Climate provides a substantial natural impediment, although it doesn't entirely stop the spread either. It's why Texas, New Mexico, Arizona look like they do right now versus Michigan and New York. It's not because Texas has had amazing testing and tracing and quarantine measures.

It's why Tehran was hammered by the virus but Baghdad was not. It wasn't luck, it wasn't testing, it wasn't tracing, it wasn't lockdown measures. Baghdad is a hotter climate than Tehran during the December > May time frame.

It's why Athens & Greece is largely spared but Milan is not. It's not because Greece implemented South Korea-style measures early on and they have a far better healthcare system than Britain. It's why Southern Italy is not hit like Northern Italy. They have different climates.

It's why Madrid is hit so hard but Barcelona and Lisbon are not. They have different climates.

It's why NYC is hit hard but San Francisco and Los Angeles and San Diego are not.

The entire San Diego County has 53 deaths.

It's why Texas is largely spared but Massachusetts and Michigan are not.

It's why Detroit was hit but Phoenix was not.

It's why Belgium and the Netherlands were hit but Mexico wasn't.

It's why Wuhan was hit but Hawaii and Jakarta and Singapore were not.

It's why Algiers (7.8m people in their metro, just south of Spain) isn't drowning in Covid cases and hasn't been hit like Madrid.

It's also why India and Pakistan have been largely spared bad outbreaks. Defying all predictions thus far to the contrary.

It's why Lagos Nigeria isn't being hit hard and the Netherlands and Britain were.

It's why Cairo isn't buried in dead bodies right now. The Cairo metro has 20 million people. Check out the temps in Cairo during the Nov > May time frame.

Look at the climates. Nearly all of the hardest hit areas exist in a sweet spot on temperature range.

Milan: https://weather-and-climate.com/uploads/average-temperature-...

Wuhan: https://weather-and-climate.com/uploads/average-temperature-...

NYC: https://weather-and-climate.com/uploads/average-temperature-...

Tehran: https://weather-and-climate.com/uploads/average-temperature-...

London: https://weather-and-climate.com/uploads/average-temperature-...

Boston: https://weather-and-climate.com/uploads/average-temperature-...

Chicago: https://weather-and-climate.com/uploads/average-temperature-...

Now compare to

Baghdad: https://weather-and-climate.com/uploads/average-temperature-...

Cairo: https://weather-and-climate.com/uploads/average-temperature-...

Los Angeles: https://weather-and-climate.com/uploads/average-temperature-...

Algiers: https://weather-and-climate.com/uploads/average-temperature-...

Lagos: https://weather-and-climate.com/uploads/average-temperature-...

Houston: https://weather-and-climate.com/uploads/average-temperature-...

Phoenix: https://weather-and-climate.com/uploads/average-temperature-...

Singapore: https://weather-and-climate.com/uploads/average-temperature-...

Las Vegas: https://weather-and-climate.com/uploads/average-temperature-...

San Diego: https://weather-and-climate.com/uploads/average-temperature-...

Athens: https://weather-and-climate.com/uploads/average-temperature-...

---

Compare Barcelona: https://weather-and-climate.com/uploads/average-temperature-...

To Madrid: https://weather-and-climate.com/uploads/average-temperature-...

Compare Milan again:https://weather-and-climate.com/uploads/average-temperature-...

To Rome: https://weather-and-climate.com/uploads/average-temperature-...

See those higher highs through the flu season? That 8-10 degrees of higher temps throughout Winter is the difference. Getting as close to the ~55-60 F or higher temp zone at the highs as possible during Winter is where you want to be. The regions that are, have seen dramatically fewer cases. This spans all variations of circumstances between nations (rich vs poor, good testing vs weak testing etc). At 64 degrees F and above, we know that influenza, for example, is heavily impeded by the heat.

This is why so many experts have been predicting a big downturn in the virus as Spring & Summer temperatures roll in.

This has already been shown by several studies. We already know why. 90-95% of all cases of transmission have occurred in the Covid Belt areas that have ideal climates for the transmission of the virus (otherwise Africa would be drowning in Covid deaths right now).

It seems to all fit together but I would not be too hasty in proclaiming the actual heat to be the affecting factor. Colder place will naturally be more densely populated for example.

> Colder place will naturally be more densely populated for example.

That's plainly wrong. The world has huge numbers of hot, very dense cities that have not been hit hard. The Philippines, Indonesia, Mexico, India all have obvious of examples.

Mexico City should be in extremely bad shape right now.

Check out the temps in Mexico City: https://weather-and-climate.com/uploads/average-temperature-...

Here are the top 10 most densely populated US metro zones (per the 2010 US census; population per sq mile):

Los Angeles, SF + Oakland, San Jose, NYC + NJ + CT (isolated, NYC is the most dense), Las Vegas, Miami, San Diego, Salt Lake City, Sacramento, New Orleans

Also, Riverside CA is #12, Phoenix AZ is #16. Both have been largely spared.

Now look at the per capita Covid deaths in LA, the Bay Area, Las Vegas, San Diego, Salt Lake City, Sacramento, Phoenix, Riverside. Then compare it to the Covid Belt areas.

If New Orleans hadn't made the mistake of holding Mardi Gras, they would look like other urban areas in Louisiana and the south broadly and would have dramatically fewer cases (eg Mississippi has 1/10th the deaths of Louisiana with 2/3 the population; Florida has over 4x the population of Louisiana, with half the deaths).

The Virginia Beach + Norfolk area is #22 on population density. It has so few deaths it barely registers. A couple million people live in that area, there have been only a handful of deaths. Average highs are 61 degrees F in November, around 50 from Dec > Feb, then 58 in March. ~12-15 degrees warmer than NYC throughout Winter. It never sinks into the Covid Belt ideal temperature zone, comparable to Milan, Wuhan, NYC, etc.

Check out most of the major cities in Florida. They're doing extremely well. The Jacksonville area has a dozen deaths in a metro of 1.5 million. Tampa and Orlando have done similarly well.

It's way too early to be making any definitive statements over what area has been hard hit or not. All we know right now is who got hit by it first, not worst.

Do you have any sources? Epidemiologists don't think that temperature has been playing a major role here, so do you have any sources that's not just you hypothesizing this?

Because one trend I see a lot on HN is people making wild guesses about things waaaaaaay outside their area of expertise ...

By wild guess you mean ignoring the comically epic pile of overwhelming evidence that shows climate is a very large factor in impeding the spread of the virus (and applies to locations regardless of testing rates or economic condition)?

I've been talking about this on HN for a while now. I've been making the same case over and over.

Guess what hasn't changed since I first floated it here? The higher temp areas I've been touting under this theory have continued to be spared compared to the Covid Belt climate areas, despite predictions by the so-called experts that everyone would be hit (the same experts that are so baffled by Texas and California). It's not testing or luck or lockdown measures or tracing. Texas did everything wrong compared to eg South Korea, they should look like New York / New Jersey / Michigan / Massachussets. It's the climate providing a big assist.

I've seen some really outlandish articles dancing around it. What crazy magic is this, that is protecting these states?!?

It's the climate.

Epidemiologists don't think so? Which ones? It's a proven fact that coronaviruses and influenza are both impeded by higher temperatures. What I'm describing makes perfect sense. We already know there is a direct correlation between higher temps and lower viability of such respiratory viruses.

From 2011 & SARS: "The Effects of Temperature and Relative Humidity on the Viability of the SARS Coronavirus"

https://www.hindawi.com/journals/av/2011/734690/

MIT recent observation with SARS-CoV-2: https://www.technologyreview.com/2020/03/19/905217/coronavir...

March from China: "High Temperature and High Humidity Reduce the Transmission of COVID-19"

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3551767

I appreciate the effort you're putting in to this and it's a shame you're getting downvoted this heavily.

I would want to see a very careful treatment of this data before I could be convinced that temperature is a greater factor in transmission rates than stay-at-home policies or population density. It would be really easy to cherry-pick examples.

A couple of counter-examples that come immediately to mind are Chicago and Florida. Chicago's climate should fit your model but they have about 1/3rd the cases per capita vs New York City. Florida meanwhile should be warm enough to be outside of your "Covid Belt", but cases there are expanding extremely rapidly and it's likely to overtake Washington state in per capita cases and deaths. Louisiana similarly has one of the highest per capita death rates in the nation.

Climate might be one factor, but it's not clear that it's a big factor, let alone the most important one.

Can you put together some actual data then? Like, get all the relevant data for hospitalizations and deaths by locality and find a correlation against climate data? And then do the same for things like density, how early and strictly social distancing measures were put into effect, etc., and see if it has more or less correlation than those?

My gut feeling here is that climate is not a significant factor, but that those others are. And you haven't come close to actually demonstrating it with rigor beyond it just being a guess that you have (which is fine; guesses are useful).

And you're right, the connection between climate and the spread of a disease is well known, which is why if it were relevant here there would be lots of people besides you talking about it. The articles you linked do seem to show that the virus might not survive for quite as long on surfaces at high temperatures and humidities, but that's just not really that relevant for how this disease spreads. People are primarily either inhaling droplets directly, or touching things that others have touched recently and then getting it into their face. The virus surviving for hours on a surface before being touched and then touched again to a face orifice was always on the long tail of transmission methods, so flattening that tail a little bit doesn't make a meaningful difference in the overall spread of the virus.

> As I see it, there are so few cases in California because of the measures that have been taken

How do you know though? The flat curver movement has set themselves up so there's no accountability, no reliance on data, no proof that it's working or not working. Just repeating what other people have said and patting themselves on the back that it's working.

Sweden has less per capita infections than many other countries and they have no full quarantine just basic social distancing and hand washing.

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