Sweden Says Controversial Covid-19 Strategy Is Proving Effective | Hacker News Reader

Sweden Says Controversial Covid-19 Strategy Is Proving Effective

bloomberg.com

I think we'll have to wait for the end of this to see which strategy has been effective and which one has not.

Sweden might not be at a plateau yet and turn into the UK in a couple of weeks time. Or they are indeed at a plateau and they will reach herd immunity with minimal societal and economical damage.

Other countries with hard lockdowns might look good in comparison to Sweden at the moment but might have a hard-hitting second wave.

Whatever the outcome, we won't know until this is over. Which is why I am not a big fan of comparing 'effectiveness' at this early stage.

That framing implies that all the relevant actors have committed to strategies that they'll see through to the end.

Learning from what's happening in Sweden should help guide decisions elsewhere.

The process of comparison is messy and politicized and in some sense always potentially premature, but I don't think for all that it should be forsworn.

> Which is why I am not a big fan of comparing 'effectiveness' at this early stage.

The state broadcaster in Australia (ABC) broadcast an hour-long episode of their program "Foreign Correspondent" in which the Singaporean government were granted a platform to explain how their approach was far more civilised and liberal, with better results and more freedoms than the efforts of Australia. They prated on and on about the benefits of their system of both disease control and government trust and how low their disease numbers and civilian discontent was.

The disease control aspect has not aged well.

I don't think there is a one size fits all strategy.

Sweden's strategy can work for them because it relies on the public to make the correct choices.. which can work when people observe hygiene rules, social distancing, etc.

But this sort of strategy can't work with if you have a population that isn't willing to actively participate in minimizing the risk.

Or countries with hard lock down could look worse. Locking young people with the sick and old could be killing more people than it saved, but I doubt we'd release that study

If you're interested in hearing about Sweden's strategy, what has and hasn't worked, etc. then I can highly recommend this interview with chief epidemiologist Anders Tegnell from earlier this week [1]. It's one hour long but he answers most questions I think people would have about Sweden's strategy.

To give a very quick summary: One-third of the fatalities have been in elderly homes which were not protected as well as they should have been and this is something that they are working on. It seems like recommending that people stay home if they have any symptoms is good enough to keep reduce the spread of the virus enough for the health care system to keep up. And a lot of measures have voluntarily been taken by individuals and companies to reduce the spread as well so it's not like Sweden is just business as usual or something like that.

[1]: https://youtu.be/Wo10IIMHYXk?t=651

Tegnell has quickly become a rather controversial figure in Sweden with a large host of detractors on one side and a fanclub on the other side. There have been several calls from experts in the field for Sweden to change its policy [1, 2, 3], the latest of which saw 22 professors, researchers and doctors call for politicians to step in and take control. While it undoubtedly is interesting to hear Tegnell speak about his strategy you need to keep in mind that there are many experts in the field who disagree with the way Folkhälsomyndigheten deals with the pandemic.

[1] https://lakartidningen.se/Opinion/Debatt/2020/03/Sverige-bor...

[2] https://www.dn.se/debatt/folkhalsomyndigheten-har-misslyckat...

[3] https://www.svt.se/nyheter/inrikes/forskare-kritiska-til-fhm...

There will always be people who don't agree with whatever policy is chosen ofc. Judging by opinion polls Tegnell is actually much less controversial now than he was when the pandemic started here (trust in Folhälsomydigheten rose from 50% in March to 71% in April) [1].

And as is mentioned in [3] the numbers cited by those researchers were not accurate. That doesn't mean that they're automatically wrong, but it's worth keeping in mind.

We'll ofc have to wait a year or two to find out if Sweden's strategy was ultimately a good or a bad one. But if you want to know what's being done and why it's being done then Tegnell is the person to listen to since he's very much at the center of it all.

[1] https://www.aftonbladet.se/nyheter/a/70OzwW/fortroendet-for-...

Exact same thing in France with professor Didier Raoult, who has become a folk hero for some and a crank for others (generally split along political lines).

I see a lot of the "Sweden is sacrificing the elderly for money"-arguments in media. But of course that's not the intent.

What options do countries have? Any vaccine or cure is at least one year away, if not more. There is no miracle cure (Tweets don't count).

Let's say you are a country with SARS-CoV-2.

So, your goals are A. stop the spread, and B. protect the most vulnerable and C. try to keep the number of hospital visits low enough to not collapse the healthcare system, so that people ending up in hospitals have a chance of making it out alive.

Do you 1. lock down the country hard; or 2. keep the country (semi) open, reaching for herd immunity, or 3. do nothing?

If you do #1: prepare to be locked down until a vaccine/cure exists and gets deployed. This is at least 1.5 years. Are you ready for this? Sure, this keeps the death rate low. If you open the lockdown early, people start dying again. Prolonged lockdown hurts the economy, and the healthcare system will also suffer greatly. If the economy collapses, things go to shit really fast, and don't expect help from the hospitals. And, in general, any immunization within the population will proceed slowly if at all.

If you do #2: some people in the risk groups will die because the virus is everywhere. And, for this choice to work, immunization must be a possibility, so that herd immunity can develop in the first place. Over time, the population may resist the virus.

If you do #3: many people in the risk groups die, the healthcare system collapses and you'll be in a really bad place. The population may become resistent, though.

Option #3 is not really good.

Assume you choose #1, i.e. total lockdown. Once you open up the lockdown, you'll be in situation #2. So why not do #2 directly?

If you don't believe that immunization through exposure to the virus can happen, then #1 is the only choice -- hope for a vaccine and be prepared for economic carnage.

But, in all other cases #2 is the saner alternative. I think this is why Sweden is doing what it's doing.

Option #2 sounds great if you know what immunity means in this case.

We don’t know how long immunity lasts or what it looks like, there are even reports of reinfection.

There are also severe complications to the heart, lungs and liver after the disease, which wouldn’t occur with option #1

An outright cure at a year strikes me as unlikely, given the record with anti-virals.

But improvements in supportive care (anticoagulants?) and lucky repurposing might win meaningful reductions in morbidity (some permanent) and mortality within months.

I'm not sure how to weight that possibility. (Metaculus has settled on a likely ~5% relative risk reduction for chloroquine, which is no game changer.) But it seems underweighted in general in discussions about different paths to herd immunity.

The strategy isn't even that different from e.g. Germany or Austria (I use these countries because I've been following them more closely).

Yes Germany and Austria closed more shops at the beginning to stop exponential growth. Now they start to slowly open stores again with the goal to not overwhelm the health care system.

I think almost no country tries to go for zero infections, only to spread the infections out over a longer period. No infections would also seems a bit unrealistic for most countries.

The advantage of a #1->#2 strategy is that it gives time for the healthcare providers to prepare for the eventual inrush of SARS2-patients. They can get needed materials, information on how to best treat those who are infected and build out and/or reorganise to be able to give the type of care typically needed for SARS2 cases.

It might even end up being less destructive for the economy since a relatively short lockdown followed by a progressive opening-up to a level where health care can cope with the case load probably gives more confidence in a good outcome and with that a higher consumer confidence. Given that #1 is the policy followed Sweden's neighbours while Sweden follows #2 it will be interesting to see how the respective economies fare after the pandemic is over.

You can view Swedish ICU admissions data yourself here: https://www.icuregswe.org/en/data--results/covid-19-in-swedi.... New admissions to the ICU due to Covid-19 appear to be flat or possibly even declining.

You do have to keep in mind that hospitals in Stockholm - which is currently the epicentre of infections in Sweden - have adopted a policy to not admit people with a 'biological age' of 80 or over to intensive care, nor will they admit people with a 'biological age' of 70 with at least three serious conditions or 60 or over with at least two serious condition [1, 2, 3, 4]. These guidelines have been in use for a few weeks now even though there still is enough capacity to admit at least some of these people. The guidelines also state that intensive care treatment of patients who fall into one of the two categories should be discontinued. According to these guidelines people who will be denied intensive care will be offered palliative care instead. The concept of 'biological age' is not well-defined here which makes it hard to actually apply these guidelines. It is used because it is not allowed by Swedish law to deny care based on physical age whereas the law does not say anything about triage based on 'biological age'.

[1] https://www.aftonbladet.se/nyheter/samhalle/a/lAyePy/dokumen...

[2] https://www.expressen.se/nyheter/coronaviruset/ingen-intensi...

[3] https://www.dn.se/sthlm/dokument-visar-vilka-som-inte-far-in...

[4] https://cached-images.bonnier.news/cms30/UploadedImages/2020... (the actual guidelines for Karolinska university hospital)

That policy is precautionary to give doctors guidance on how to prioritize patients if/when the hospitals run out of space/resources.

To my knowledge, these decisions have not had to be made yet. As mentioned in [3] Stockholm has space over and is accepting patients from the Sörmland region.

> To my knowledge, these decisions have not had to be made yet.

According to people working in health care in Stockholm they have used these policies for a few weeks now [1], the article (from the 2nd of April, 2½ weeks ago) contains two references to cases where patients were denied intensive care (and, as a consequence, died) who would have received care before these policies were enacted. The (anonymous) nurse states that Sjukvården är inte öppet ärlig med att vi redan har en katastrofsjukvård där man inte prioriterar de som man bedömer är sjukast, utan de som man bedömer har störst chans att rädda which (loosely) translates to care givers are not open about the fact that we already optimise for throughput instead of prioritising those who need the most care

[1] https://www.aftonbladet.se/nyheter/a/9v4z2q/sjukskoterska-vi...

The article is almost three weeks old. The anonymous nurse predicts the imminent total collapse of the health care system where even the field hospitals will overflow and it's too late to do anything about it. This has clearly not happened.

The nurse goes on to blame deregulations and financial aid to banks and corporations. This seems more like the personal feeling of a rather leftist nurse published by a left of center tabloid.

I am sure there have been misinterpretations of the directives and there have probably been times where prioritizations have been done based on local and short term conditions. But it is not an active and commonly used policy.

With the disclaimer that I'm only using Google Translate, it appears this document is from one hospital and is not a requirement, merely a guideline / informational document.

And this wouldn't be surprising - most hospitals do have written policies for how they'll triage should it become necessary.

They have 3x the deaths per capita than germany and 30x that of south korea. "Better than italy or spain" is a rather low bar.

South Korea is a huge outlier.

Not really. If you look at the Asian Tigers (South Korea, Singapore, Hong Kong, Taiwan), and going by COVID-19 deaths per capita (rather than infection rates), South Korea is actually the worst performer.

Singapore is 2.5X better than South Korea. Hong Kong is 3+X better than Singapore. And Taiwan is 2X better than Hong Kong.

And it's got nothing to do with "but the West is free and democratic." Taiwan and South Korea are super-free democratic countries.

Stop letting western governments off the hook for their incompetence.

Singapore and Hong Kong have both had to go into lockdowns. Their death toll is lower because they reacted earlier, and everyone agrees the West should have reacted earlier, but they don't reveal fundamental flaws in western strategies if they have to do the same kinds of things.

Taiwan reacted incredibly early - their response started on 31 December, reportedly because some CDC official was trawling a web forum and happened to come across a screenshot of a Wuhan doctor's group chat. They've certainly done a lot of other things right, but I think it's fair to say that's a multiple week head start beyond what anyone else could reasonably have gotten. Heck, it was 2 weeks before the WHO famously declared there was no person-to-person transmission.

> Taiwan reacted incredibly early

Pretty interesting to guess why:

- they're Chinese, so they understand what's going on in China

- they in fact understand it better than mainlanders since they are not bound by the censorship therein

- they get first hand reports since iirc a million Taiwanese are in mainland China at any given time

- they are on constant alert against Pekin aggression

Taiwans reaction was great because they still very much had the last SARS outbreaks in mind, and as a state that has been denied WHO membership they have not many options other than making dead sure this is handled propperly as a pandemic in Taiwan could weaken it enough for mainland china to consider attacking them.

One-third of which were in elderly homes [1]. This is an issue that's being worked on but apart from the failure to protect elderly homes, the Swedish strategy seems to be working well enough at the moment.

[1] https://www.svt.se/nyheter/inrikes/en-tredjedel-av-alla-dods...

If you discount those 1/3rd (why should you? it's still a policy failure) it would still be 2x the rate of germany.

It would still be high but it's honestly way too early to tell if Sweden is doing better or worse than Germany since the virus will likely be around for quite a while.

It's also worth pointing out that different countries haven't been reporting COVID-19 deaths in the same way. Finland, for example, have just now started including nursing home deaths in their statistics [1]. In Sweden, it's my understanding that pretty much anyone who was infected with and suspected of dying due to COVID-19 has been included in the statistics, even if the actual cause of death might have been something else.

[1] https://yle.fi/uutiset/osasto/news/finlands_coronavirus_fata...

Even if other countries are missing some deaths (most are), these charts look still very different. Sweden 1200 deaths vs Finland&Norway at 80-150: https://images.app.goo.gl/krLeDxnBHCdQ9817A

>>One-third of which were in elderly homes [1].

That's entirely irrelevant. In Spain, about 80% of the deaths were of people over 70yo, with 40% concentrated on the cohort of between 70 and 80yo.

Let's also remember that some countries (like the UK) don't even include deaths in care homes in their numbers(!).

I’ve noticed that whenever NY Gov Cuomo says the curve is flattening it has the same effect as Gillian saying the words “smooth sailing”. I think Cuomo really needs to stop trying to characterize trends based on one day’s data. He sounds like a youtube “How To Beat Baccarat” video - bet you could learn to master his strategy get a cool t-shirt for only $29.95.

He can't stop everyone else from characterizing one day's data, so even if he knows it's mostly meaningless it's best to get ahead of it. And it's seemed like he does know that - he's consistently tagged "we need a consistent trend over multiple days to be sure" to his analysis.

Social distancing has been a thing for a while in that region.

Look at the "Swedish bus stop meme".

https://archive.md/2eyP2

Isn't their strategy basically the same that Johnson was doing in the UK initially?

Here's an article from a far more reputable news media organization published today also which says the policy is a disaster:

https://www.theguardian.com/world/2020/apr/19/anger-in-swede...

That article is specifically about elderly homes, not about the overall strategy. Elderly homes have been a disaster. But the decision to not force a lockdown via regulations like other countries have done has worked well so far.

Speaking to my family who lives in Sweden, while there is no official lockdown, they sure seems to be mostly confined to their homes. It's based on recommendations rather than regulations, but the effect is the same.

And here is one [0] from another reputable news source that says more or less the opposite.

I think it's too early to call out a "winner strategy" - I think there will be a new wave when the different countries opens up - but that's my guess, and hey - I program computers on a daily basis, as far away as you probably can get from this kind of science.

(and yeah, I am a Swede)

[0] https://www.washingtonpost.com/graphics/2020/world/corona-si...

None of them is reputable in this question. Both are heavily biased.

I guess if you call killing bunch of innocent people "effective". But I think it's way too early to start comparing strategies.

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