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Comment by anon84598 | Hacker News Reader

Sweden isn't performing a lot of tests for one:

https://www.thelocal.se/20200414/understanding-swedens-figur...

Why do they need to perform a lot of tests if their strategy isn't dependent on testing?

If you're not testing a sizeable enough sample of the population, then whatever number of cases you give has to be taken with a rather large helping of salt.

For example, my country's CDC has the official number of confirmed cases in the low hundreds with a dozen deaths, but anyone wise enough knows that between the ridiculously low number of samples tested (less than ten thousand in a population of a couple hundred million), the poor public health infrastructure, the anaemic government response and general public health illiteracy, the real number of cases is easily an order of magnitude or two higher.

Completely agreed. Sweden is worth observing in terms of number of deaths and how overloaded their hospitals get. But their number of cases, like in a lot of countries, is essentially garbage data that can't possibly help our understanding of the situation to consume.

Right, but in planning for a hospital overrun you can't see it coming if you have no idea how many sick you have, if you don't test.

Are you suggesting that as long as your hospitals aren't overrun, inflection rates aren't worth knowing ?

If your hospitals aren't overrun, and you don't expect them to become overrun in the future, improving your estimate of infection rates doesn't seem like a high-leverage activity. The argument for doing a lot of testing is that it enables good contact tracing, which Sweden doesn't seem to be planning to do anymore.

Because if there’s a giant spike of currently asymptomatic carriers, you’d want to know.

If they at least did testing + contact tracing (like NZ) they probably could have saved a tonne of lives even without locking down

Every developed country did testing and contact tracing, even the ones popularly seen as doing nothing. That was why leaders were saying it wouldn't be a problem in February; they didn't expect a magic cure, they expected their testing and contact tracing to handle it.

I definitely want to know. But it seems like Swedish public policy is that the current measures are the strictest sustainable ones, so they're going to maintain them until strict measures are no longer needed. It's not clear that early visibility of a spike would change that.

Given that mortality rate is closely tied to the availability of ventilators, it would be catastrophically short sighted to not react to a spike with strong, short term measures.

This turns out not to be the case. Ventilators don't actually help much with COVID-19. If you end up severe enough to not be able to breathe on your own you're likely to die, and the ventilator only prolongs it. So running out of ventilators won't actually cause many more deaths.

The way to prevent a lot of deaths is simply to prevent people from catching it at all.

Most recent numbers I've seen are that if you go on a vent, you've got a 70% (San Fransisco) to 90% (New Orleans) chance of dying. Not great.

Anecdotal word from family members working in ERs is that none of them have been on a shift with a successful code run on a covid patient. CPR is low single digits 30-day survival based on Chinese numbers released this week. It was something like (1) patient survived out of 37 attempts.

The question of if the 10-30% of vent survivors would have survived without a vent is fair, but that's a maximum efficacy at this point.

Vents are definitely not the answer everyone thought they would be.

Given the misery and problems associated with long-term ventilator usage, I'm not sure vents for covid is a good idea at all

Yeah, I started to go there earlier, but stopped myself.

Doctors seem to be doing a better job of informing patients (or families) of those issues before intubating, especially if they have multiple risk factors, and a surprising number of cases have opted not to vent.

But also:

1) There are quite a few really sad stories of patients getting dropped at the ED curb by a spouse as if they'll get checked out and be right back out to go home, only to be immediately intubated and sedated, and ultimately dying without family by their side and no chance to say goodbyes.

They now make a lot of effort to make phone calls or video chats to family before intubating anyone, but it's still rough without anyone being able to be there, and then not being able to speak either. And it just adds to the weight of what the nurses have to deal with, emotionally.

2)There's also the murky topic of straining hospital resources. You obviously don't know ahead of time who the 10-30% of survivors will be and you want to save whoever you can, and hopefully we never get to the point of true rationing. But...

It's hard to be blind to the fact that it's a huge amount of risk, resources, and physical & emotional effort that are seeing relatively little success. I don't have an answer. Hopefully we get better at it.

10-30% survival odds are much better than 0, and the negative consequences of being ventilated depends on the ventilator settings; more time is worse, but it also varies by the ventilator pressure.

Germany is seeing better results by ventilating earlier, FYI.

Some of the folks on vents would have survived anyway. Probably fewer than survive with.

But I don't know, severe permanent lung damage guaranteed, delirium and dementia likely, and the misery of the treatment itself, all for a 1-in-5 chance of surviving (where survival is measured only at 30 days)?

I'm not saying nobody should be allowed to make that choice -- they should -- but I don't know that I would.

I guess I'm not sure what to say in response to that. Swedish officials simply don't agree that strong short term measures are required to ensure a sufficient number of ventilators.

Every strategy is dependent on testing, because every strategy requires an accurate assessment of sickness rates. If you don't know the extent of the problem, how can you even formulate a plan to fight it?

If by "strategy" you mean herd immunity, Sweden isn't doing that. No one is publicly claiming to be trying that anymore.

You can call it herd immunity or not, and Sweden has indeed picked "not". But their plan is to keep doing what they're currently doing. The Swedish government has no phase 2 where they expect to contain the coronavirus more strongly.

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