The epidemiologist behind Sweden’s controversial coronavirus strategy | Hacker News Reader

The epidemiologist behind Sweden’s controversial coronavirus strategy

nature.com

196 pointsvanilla-almond498 comments

One thing is missing from this discussion that needs to be understood: the Swedish government and related agencies generally do not do things based on common sense.

This may sound ridiculous, but in most cases, it's not. Common sense is wrong so often. The view of the Swedish government is that they are not more intelligent than the citizens. Unless things can be scientifically proved, the individual rights of citizens should not be restricted.

This permeates a lot of public policy in Sweden; I recently had reason to investigate to what extent maternal/neonatal care followed the best of our scientific knowledge and it was extremely close. If you think that's a given, think again. Many countries base their maternal/neonatal care on common sense and old wives' tales instead.

Both approaches are valid, but they are different. With policy based on common sense, you accept that you occasionally (often?) force something wrong on the public, potentially against their better knowledge. With policy based on strong evidence, you are more rarely wrong, but you also get way fewer opportunities to force things on the public, simply because there are so few things we truly know to be true. Doubly so during a novel pandemic.

That's an attractive thought, but I'm less than convinced it's true. For example, I doubt there's much scientific evidence behind Sweden's zero-tolerance drug policy that literally equates heroin with cannabis [1], or their policy of criminalizing all sex work [2], with the admittedly unusual twist of making buying, not selling, illegal.

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

[2] https://en.wikipedia.org/wiki/Prostitution_in_Sweden#Current...

> with the admittedly unusual twist of making buying, not selling, illegal.

The twist is probably based on the supposition that for selling to be illegal would mean endangering the the lives of sex workers, who (I assume, as the reasoning goes) are likely to be financially vulnerable. When selling is illegal, there is more risk for the person rendering the services.

A concern for the lives or welfare of sex workers may be among the points used to sell the Nordic model but based on the Norwegian experience they don’t actually care about them.

https://www.amnesty.org/en/latest/news/2016/05/amnesty-inter...

> “If a customer is bad you need to manage it yourself to the end. You only call the police if you think you are going to die. If you call the police, you lose everything.”

> --Sex worker in Norway

> Amnesty International heard how some sex workers who have reported violence to the police in Norway have been evicted from their homes or deported as a result of engaging with the police.

> Under Norway’s laws, sex workers are at risk of forced evictions as their landlords can be prosecuted for renting property to them if they sell sex there.

> A representative of a Norwegian sex workers’ rights organization explained: “If landlords don’t evict, the police will launch a criminal case against them...The police are encouraging landlords to take the law into their own hands and enforce it themselves.”

> People who do sex work are also unable to work together for safety, or hire third party support like security, as this would likely qualify as ‘promotion of prostitution’ under the law.

When buying is illegal, it still imposes risks on sex workers. First, it hurts their income, meaning fewer sex workers are available, meaning it’s more likely victims will be coerced. Those who participate willingly can be put at risk from their customers when those customers are prosecuted.

There are exceptions to that general approach, of course. Even Swedish politicians need to be elected by popular vote, and this requires some amount of people-pleasing, along with the terrible consequences of that.

As far as scheduling goes that basically mirrors the US and UN. Those categories aren't "levels of danger", but whether something has accepted medical use.

That will always vary country to country - in the UK diacetylmorphine is medicine, despite being highest schedule. And poppy straw is class A just as fentanyl. Does that make it correct to say they are "literally equated"? That's absurd.

(Not saying there aren't very dumb things about the national anti-harm reduction approach, but the scheduling isn't exactly unique internationally, nor really an aspect of what makes the system a massive mess).

Sex work is not criminalized, as you yourself point out.

Just because a legal system places two different things in the same category doesn't mean they're saying they are equal.

For instance, in many states, it is both a felony to steal something worth $300 and commit murder. No one on the planet would say they are equal. In the same way, I doubt there are any legislators in Sweden who say that cannibis and heroin are scientifically equal. They're just classified the same for legal purposes.

But unless I'm reading this wrong, the penalties are equal for dealing either drug.

That doesn't match your analogy, where the two crimes - while both classified as felonies - have radically sentencing guidelines.

>For instance, in many states, it is both a felony to steal something worth $300 and commit murder. No one on the planet would say they are equal.

Nobody is. It's like saying stealing and murder shouldn't both be considered crimes because they're so different. Felonies are just crimes that are considered more serious than lower crimes (misdemeanors)--there are loads of grade and classifications within that spectrum. Felonies tied to monetary values are generally written when $X monetary value is a large amount. $300 could've easily been a full month's rent a few decades back, so it was written as a serious offense.

The problem is the law is incredibly slow to update with the times.

You need more than scientific knowledge in order to make policy, you also need a quality metric against which to measure the desirability of outcomes. Science can tell you what is likely to happen if you pursue a certain policy, but it cannot tell you if that outcome is good or bad, or more to the point, whether the tradeoffs inherent in any complex policy decisions are worthwhile.

There is a dark side to this. Scientific consensus follows certain rituals and heuristics. Even if you can assume that the scientific consensus is the closest to truth you can get (this is debatable), the approach will fail in some situations.

In particular, in war-like situations where there is little published science, data is scarce, data changes fast and there are policy considerations to be made across a multitude of disparate fields - fields that can not all be quickly evaluated with the scientific method.

IMHO, as I've been saying throughout this crisis, many institutions that do well in peace-time are in a terribly dangerous situation when they follow their normal heuristics and routines today. Strong top leadership (political or otherwise) can mitigate this danger.

One interpretation of that as a strategy is "in a crisis with imperfect information we should centralise all power to popular people".

If someone working to evidence (ie, science) can't make good decisions how on earth will strong leadership help? We've seen crisises that led to actual war time situations (pretty much all the wars in the Middle East, particularly when recently the 'strong leadership' in the US when they speculated wrongly that Saddam Hussein had WMDs) where with benefit of hindsight the entire planet would probably have been better off with weaker leaders, more evidence and people just sticking to their normal routines.

Centralising power without a proven strategy is going to lead to more misses than hits. Even now, we don't know what the endgame here is. The lockdowns could still conceivably be failures if they turn out to have delayed all the deaths by 12 months instead of preventing them. We don't know. It is too early to say what did or didn't work.

>evidence (ie, science)

An abrupt leap.

I would move away from a passing vehicle without peer-reviewing its existence. If international and inter-city travel had been shut down in early February some nations would have remained fully functional today. Not to say I agree with current quarantines, but you have to admit there are thresholds for action.

I'd like to know your stance on climate change, btw.

Given that Scientific consensus has limitations, what do you propose is better in situations where data is scarce?

How does a strong leader mitigate this danger? Is the leader making choices by following their intuition? Does the leader make choices based on public sentiment?

One possible mechanism by which strong leadership could be more effective is that inaction and uncoordinated action can be less effective than any coordinated decision, regardless of whether that decision happened to be optimal.

I don't know how often this happens in a pandemic or in a political setting, but as an example from software engineering bikeshedding seems somewhat common -- it probably doesn't matter whether curly braces get a new line, but there's probably a benefit to only doing it one way in a codebase. Not that strong leadership is the only path to resolution either, even accepting that some cohesive decision needs to be made, but it does solve that class of problems.

Let me clarify. You can follow a scientific approach, and you can follow Science the ritual. When uncertainty goes up and time is of the essence, the latter is to a large degree subjected to the limitations and blind spots I highlighted. The former might not, if you adapt it to the current limitations.

I am a scientist, by the way.

What I mean by strong leadership is an intelligent leader that can quickly review evidence from multiple disparate fields and experts (scientists among them) and choose a good approach that takes all available constraints and uncertainties into account. The way a skilled military commander would do.

In particular, such a leader does not focus exclusively on a single metric or concern, unless this is warranted by the situation. But that would be an exceptional circumstance in an exceptional situation.

You may think that the focus on reducing death rates is focusing on a single metric to the exclusion of everything else, but this is not the case. There are plenty of exceptions to this rule being made in every country with a lockdown. Critical infrastructure, economics, mental health, healthcare that's unrelated to Covid19 and so on.

Strong leadership "can" mitigate this danger. An interesting question is how likely it is that it'll mitigate it rather than exacerbate the problems. I suspect the type of strong leaders humans usually elect are not the ones that will maximize the chances of mitigating.

Yet most strong top leaders I can name have (a) gained power during some sort of crisis, and (b) turned out to be on the wrong side of history.

I'm unsure what you mean about strong leadership and also why you believe scientific approach means to strife for scientific consensus.

However regarding strong leadership I think the current crisis shows that the autocratic states are typically do worse, look at Russia for example, or even China if they would have reacted better early on we would not have this crisis.

> the approach will fail in some situations.

Well... yes. Everything does. Treating this as a non-starter could be used in literally anything.

> In particular, in war-like situations where there is little published science, data is scarce,

This is actually probably one of the most well researched fields in existence. I'm a little confused about this statement. What do you think they do at places like Annapolis?

I presume marvin is talking about a particular war when in progress, not the phenomenon of war in general.

However, dealing with the novel corona virus isn't necessarily a scientific problem, but more of an engineering problem (as opposed to a problem to be solved with common sense).

Science tries to remove inprecise assumptions. Engineering accepts inprecise assumptions and works around them, e.g. building in a safety factor; using masks when there is some evidence they lower R0.

> If you think that's a given, think again. Many countries base their maternal/neonatal care on common sense and old wives' tales instead.

Not a general attack on what you write, just a warning against taking this too far.

As both a father of small children, and as someone born in the early eighties I recently found reason to take a closer look at SIDS which peaked around here around the time when I was born:

Turns out it was explained by doctors and nurses telling people to let their infants sleep upside down instead of on their backs which is what has always been done. And they had good reasons for what they did as well, at least thats what they said:

- sleeping upside down was supposed to strengthen the kids neck and improve early development

- another argument was that it would protect them from being choked if they vomited

Once people went back to allowing their kids to sleep on their backs, SIDS almost vanished over night.

Turns out Chestertons fence is there for a reason.

Same goes for a number of other BS ideas that doctors has pushed even around here like the idea that mothers should use wipe their breasts with antibac before allowing infants to drink milk.

I wonder what the long-term effects of the "put them to sleep on their back" advice will be, though.

Our son hated (and continues to hate) sleeping on his back. We put him down that way because that's what medical advice recommends today, and if he died of SIDS because we didn't we'd feel terrible. But as soon as he learned to roll over, the first thing he did was start sleeping with his butt up in the air. I'm told this is very common, and most infants don't like to sleep on their back, and will avoid it if possible.

Are we going to find out in 20 years that we've raised a generation of kids with lower cognitive abilities and poorer emotional control because they didn't sleep well when they were newborns? That they have asthma and sinus problems from mucus dripping down their throat while asleep? That there's some other unknown risk factor we're not accounting for? That's certainly the case with a lot of common parenting wisdom from the 80s.

Oftentimes both sides of Chesterton's fence suck, but they suck for different reasons. And humans have a bias toward fixing problems they see, not being grateful for problems that were silently averted. That's why we perpetually tear down fences and generate new stocks of problems.

"Turns out Chestertons fence is there for a reason."

The bummer is when there's no followup research to validate the new policies.

For example, Atul Gawanda attributes some of the reasonability for the opioid epidemic to updated standards of care for managing pain but then those advocates failing to do any followup studies to assess the outcomes.

[Am Swedish and not a fan of the current policy]

This evidence-driven decision making process (which is indeed the default here) works remarkably well when things are moving slowly. It kills bullshit beautifully. This is normally something I'm quite proud about.

However, it breaks down so badly when you're suddenly facing a one in a hundred years pandemic and you can't act decisively 3-4 months into the pandemic because there's no evidence yet.

Sweden is "peace-damaged". We haven't really had to deal with any national-level crises the since the spanish flu about 100 years ago. The last war was in 1814. 500 soldiers died.

Note that the above mostly applies to national governance - this is the stuff that really gets set into code and culture over time.

At a local e.g. hospital/research unit/private company level, there's fantastic innovation happening on a daily basis, just as in the rest of the world.

[Am living in Sweden but not Swedish] I disagree with you that this is about a "slow evidence based decision process" (paraphrasing). That is actually the most infuriating about the policy. I have encountered this quite often here, it's a "we know better than everyone else" attitude.

The thing is the story they give is "we are evidence based, rational...,have the best methods", but completely ignore scientific evidence from outside Sweden. Example 1.: asymptomatic spread, despite several countries having evidence to the contrary the story here is, it's not important (in fact they slightly changed the tune is used to be negligible or nonexistent) Example 2: the chief epidemiologist has repeatedly said he "believes" the spread will go done in summer, without significant evidence. Example 3: sometimes the statements even contradict themselves. Example masks, the story (and there is actually a lot of propaganda around this) is still they don't help, because non95 masks are not completely closed. On the other hand the recommendation from the public health agency, (same who gives advice about the masks) for health workers treating covid19 patients is either goggles +mask (often there are no Googles) or visor without mask. How can a surgical mask which is not 100% tight not help, but at the same time a visor which is open to the sides is sufficient.

> Sweden is "peace-damaged". The last sort of national crisis we had besides the spanish flu was the Swedish–Norwegian War of 1814.

The second World War was definitely a national crisis. Huge military mobilisation, disruption to the iron and shipping industries including thousands of sailors dead, rationing, accidental bombings...even though Sweden was neutral that was a far bigger deal for her than the coronavirus has been.

Besides the deaths of those sailors it was a big meh.

This whole thing is kind of like driving a car, except that when you turn the steering wheel, nothing happens, and then two weeks later the wheels start to turn.

They admit thus in the article, when they say there’s no point closing the schools. The time when doing that would have made a difference was a month ago and they didn’t do it, so the damage was done.

> it breaks down when you're suddenly facing a one in a hundred years pandemic

What if you're not actually facing such a thing and you only think you are because the initial non-scientific estimates from government "scientists" are 2 orders of magnitude off the mark, just like the last few times? https://mobile.twitter.com/amasad/status/1252824592453742598...

New York’s hospitals being overwhelmed, and a massive spike in excess mortality in the city isn’t an estimate. Those are real people sick and dying right now. The same with Spain and northern Italy.

Those regions got hit hard too soon for lockdowns to prevent disaster. Fortunately those disasters gave us a wake up call to lock down early enough elsewhere. If we hadn’t it’s pretty clear every city or region would eventually look like them.

Most countries are seeing excess mortality compared to previous years, much larger than could be explained by a bad flu year, which means that covid-19 is absolutely a real threat, we haven't seen anything like this in a hundred years, and countries should absolutely take measures to protect the population.

Have you read the Ferguson paper? From the re-tweet you posted, I doubt it. The 1.2 million figure was the absolute highest estimate in the whole paper, and was mentioned off-hand as a worst case scenario if no preventive measures were taken.

In fact, if you read his paper and look at his estimated deaths under various different interventions and time period, and the current death toll, he actually may have underestimated the death toll.

Here, read the paper: https://www.imperial.ac.uk/media/imperial-college/medicine/s...

It's not really true vs false, it's a matter of deciding what level of evidence is convincing. One point is that we already know the approximate effectiveness of social distancing from many 1918 data points and its epidemic with similar contagiousness. Some places in 1918 did it and some did not, like San Francisco vs Philadelphia where the difference was stark.

Maybe the effect will be less this time for some inexplicable reason but I would not want to run the experiment in my country.

So no requirement for parachutes in planes, then? They’ve never been proven in a double blind study.

Proven in a double blind study is not the only method of proof. You can also use model organisms. So you throw goats out of airplanes with and without automatically opening parachute ave see what happens. Or you can have an extremely good grasp on the mechanism of action of what you’re doing. Somewhere on Earth today a complicated piece of machinery is being fabricated and assembled that has never existed before and is going to be 90% as good as the final production version.

Multiple methods of proof of varying reliabilities exist.

Epidemics are something for which the mechanism of action is fairly well understood. The exact response of R to various measures is not known beforehand, but we can make decent guesses about what will reduce transmission.

Well, yes. But there's not enough time right now to do that goat study, and that's what we're advocating if we want to follow science to the exclusion of common sense.

There’s both inductive and deductive reasoning. A fact can be proven be mere logical reasoning.

I don’t need a double blind study in that case because gravity has been proven before and there’s no reason to assume it doesn’t apply to everybody (or rather every body) alike.

There has been a randomized controlled trial to test if parachutes reduce injuries when jumping out of planes.

However, it found that parachutes do not reduce injuries: https://www.bmj.com/content/363/bmj.k5094

They don't block 100% of the air, so they can't possibly be effective.

I think the term you're looking for is conventional wisdom vs common sense.

Agreed that conventional wisdom is often wrong.

I can imagine a wild in which the US pursues science based policy, but it swiftly results in the corruption of science to provide evidence that fits certain conclusions. I think this already happens to a degree in certain fields, and especially among think tanks.

This isn’t a reason to avoid science based policies, but just a potential snare along the way.

> Unless things can be scientifically proved, the individual rights of citizens should not be restricted.

Sorry, but this doesn't make, err, common sense. If you have a huge fire, would you put off evacuation order until it is scientifically proven that an area will burn down? By the time you are sure, it's usually too late.

We already have a lot of scientific knowledge about how fires burn that we can apply to firefighting, so this is a non problem.

But it’s exactly the kind of country I want to live in. It’s my life, my right to do what I want within reason. Within reason should err on freedom.

It is not logical either - numerous exceptions can be found, including in this pandemic.

That's one way of looking at it. But the one that decides seems quite sure of the opposite of what is considered common sense.

https://tegnellcitat.se/

He's not a humble man.

Except that the article gives evidence to the contrary.

There is nothing very 'scientifically more accurate' about Sweden's approach to COVID.

This is the 'Swedish Model' narrative which borders on propaganda, promulgating an exceptional view of the Swedish government.

More often than not, bureaucrats take decisions they think are right, but which can just as easily be base on the arrogance or myopic view of the local institution.

Every response in this COVID article illustrates that:

- 'Closing borders' has been imminently successful in slowing the spread of Covid in almost every case - either giving more time for officials to prepare, aggressively suppressing it (Korea), or - locking out the disease almost completely (Taiwan).

- The 'trust-based' Swedish approach is irrational - because the issue is not 'trust'. The issue is literally physical distance. If Swedes are 'going to restaurants and school' and 'restaurants are a serious vector' - then COVID will spread, it's that simple.

- "What evidence was this approach based on? It is difficult to talk about the scientific basis of a strategy with these types of disease, because we do not know much about it and we are learning as we are doing, day by day. Closedown, lockdown, closing borders — nothing has a historical scientific basis, in my view. "

This is not true! We have historical data from pandemics, particularly from America which demonstrate cities that went on lockdown were able to recover more quickly from the Spanish flue. Moreover - the issue is risk. The more 'unknowns' there are, the more likely we err on the side of caution, not risk.

- "We do not need to close down everything completely because it would be counterproductive" we're 100% certain that lock-downs prevent spread - the issue then becomes one of value vs. cost, but it's not fair to them to indicate it's 'counter-productive'.

Even his testimony about 'asymptomatic spread' is strongly challenged by some evidence. Yes, we don't know for sure, but to assume the negative, given the consequences, does not fit this 'we use science not common sense' pragmatism. It's just plain risky.

"I recently had reason to investigate to what extent maternal/neonatal care followed the best of our scientific knowledge and it was extremely close. If you think that's a given, think again. Many countries base their maternal/neonatal care on common sense and old wives' tales instead."

This is only anecdotal and it's not substantiated.

...

The media perspective is mind-blowing: everyone seems to give 'Noble Sweden' the benefit of the doubt with respect to their measures, talking about the supposed effectiveness of it ... but if a Republican Governor were to suggest literally the same measures, they'd be mocked mercilessly on CNN.

This is happening literally, today on CNN: governors/mayors wishing to make limited openings of their states, remaining still more closed than Sweden, and wherein they have fewer cases than Sweden, are getting the harsh treatment.

I do think they all need to get hard questions from the press, but let's not pretend there's anything more magical going on here with respect to the policy or behaviuor, and treat these groups more 'in kind'.

This has little to do with common sense vs Science. You can easily make the scientific case towards controlling the borders and isolating, it simply hasn't been done in Sweden's case. Handwaving away the necessity for scientifically vetting the idea of closing the borders, behind the idea that every country in Europe is already infected isn't good enough to claim a meritious victory for science over common sense.

The four debates Jordan Peterson did with Sam Harris about the reduction of information down to science and the necessity for building value structures and behavioural interpretations of facts proves to me that Science can't tell you how to behave. It can show you what facts will prevent death and what won't, but we never have enough resources to sciencetifically test every single decision tree outcome, there are an infinite number of objective facts. We make best guesses about which idea to follow based on value structure and gathered information we build over time.

Sweden's version of common sense is to follow what the scientific signallers are telling them, their reaction to the virus is an expression of culture and law that has little to do with the facts. They can't lockdown even if it was better.

Australia locked down and followed the norms for great success with double the population to Sweden, despite having similar issues with aged care facilities. Finland is performing well.

I don't see the evidence to support the Swedish solution, nor it as virtous example of science over common sense.

>I don't see the evidence to support the Swedish solution, nor it as virtous example of science over common sense.

The strong point of Sweden's response is that the Swedish economy is going to suffer much less. Other countries will have to piece their economies together after their lockdowns end. Furthermore, Sweden can keep things going as they are for a long time. How long do you think Australia could keep its lockdown going?

If there's going to be evidence to show that Sweden was right then it'll likely take a few years before we can measure the economic impact and all that brings with it. I'm not saying they are right, I'm just saying it's too early to tell that they're wrong.

I'm all good with Sweden doing what it wants, it's nice to see a country stand up for it's own values and culture and laws in the face of a deadly virus and find an outcome that works.

Pushing a weak argument about the virtues of science as a reasoning for doing so seems a bit much.

Australia will go as long as necessary, it is taking this opportunity to do the largest economic reform in 30 years. Australia relies on reform to stop itself from becoming the 'poor white trash in asia' (Lee Kuan Yew). Reductions in corporation tax, strengthening of unions and many more changes. Retail had been slowing down pre-covid and the mining is out of it's boom cycle. There has been rumblings for change coming for a while and all this lockdown is a great way to rejig the setup. We are setting up our agriculture to boom in the 30s so in the long term we should be okay.

Australia is talking about being to reduce the lockdown in 4 weeks.

The Australian lockdown isn't complete - shops are still open, can go to offices if required, schools will open next term except in one state (it's holidays at the moment).

The economic cost is high, but unclear how much more than Sweden. Unemployment in Sweden hit 8% in the most recent quarter[1], while Australia's is forecast to reach 10%.

The IMF is forecasting -6.8% growth in Sweden[3], vs -6.7 in Australia[4]

[1] https://www.nytimes.com/reuters/2020/04/20/world/europe/20re...

[2] https://www.abc.net.au/news/2020-04-13/coronavirus-unemploym...

[3] https://www.imf.org/en/Countries/SWE

[4] https://www.imf.org/en/Countries/AUS

The IMF predicts that Sweden's GDP is going to shrink 6.8% this year. Denmark, Norway and Finland are predicted to shrink only 6.5%, 6.3% and 6.0% respectively, despite locking down more aggressively than Sweden.

https://www.imf.org/en/Countries/SWE

https://www.imf.org/en/Countries/DNK

https://www.imf.org/en/Countries/NOR

https://www.imf.org/en/Countries/FIN

Deferring decision making from experts to the common people is exactly what "common sense" is.

And it's a pretty bad idea to use common sense to solve a problem that zero people alive today have ever encountered. None of have endured an unvaccinatable pandemic.

It's notable as well when evaluating Sweden's number is that they are far more trustworthy than most countries. One interesting metric is excess mortality. Some places have wild unexplained excess mortality from the statistical expectation, that isn't fully explained by reported Covid-19 deaths. This suggests that Sweden is reporting deaths far more accurately than other countries, so when we evaluate the relative success of their strategy, we should keep that in mind.

A chart published by the NYT:

    Location | % extra | excess death# | official C19 d# | unexplained difference
    Spain    |  66%    | 19,700        | 12,401          | ~ 7,300
    England  |  33%    | 16,700        | 10,335          | ~ 6,300
    NYC      | 298%    | 17,200        | 13,240          | ~ 4,000
    France   |  21%    | 10,500        |  8,059          | ~ 2,500
    Holland  |  33%    |  4,000        |  2,116          | ~ 1,900
    Istambul |  29%    |  2,100        |  1,006          | ~ 1,100
    Jakarta  |  36%    |  1,000        |     84          | ~   900
    Belgium  |  25%    |  2,300        |  1,632          | ~   700
    Switzer. |  21%    |  1,000        |    712          | ~   300
    Sweden   |  12%    |  1,100        |  1,160          | ~   -50

It would probably help to state the unexplained difference as a percentage of official C19 death count (and narrow the columns). I took the liberty:

             |   %   | excess  | official| unexplained
    Location | extra | death#  | C19 d#  | difference%
    --------------------------------------------------
    Spain    |  66%  | 19,700  | 12,401  |   59
    England  |  33%  | 16,700  | 10,335  |   61
    NYC      | 298%  | 17,200  | 13,240  |   30
    France   |  21%  | 10,500  |  8,059  |   31
    Holland  |  33%  |  4,000  |  2,116  |   90
    Istambul |  29%  |  2,100  |  1,006  |   109
    Jakarta  |  36%  |  1,000  |     84  |   1071
    Belgium  |  25%  |  2,300  |  1,632  |   43
    Switzer. |  21%  |  1,000  |    712  |   42
    Sweden   |  12%  |  1,100  |  1,160  |   -4

The spanish case is interesting. Must be noticed that the virus hit particularly hard in the retirement homes that contribute to 12.000 of the 20.000 deaths. Some elder in retirement homes weren't hospitalised. Some people say that their parents were "rejected" by hospitals (non belonging to a prioritary group). We breath a dense fake news atmosphere in any case, so this part can be wrong. Not all people that died in retirement homes this weeks died by coronavirus necessarily.

Retirement homes can not and are not designed to provide real medical care. This part has failed clearly. Some of this people could have been saved in normal circumstances. Specially if the retirement homes were more transparent about numbers and the people would had a clear protocol to follow.

Another special circumstance of Spain is that we are one of the countries with more life expectancy. We have lots of elder people, therefore much more people by million falling in a high-risk category. I don't see anybody explaining that in the news, but surely must have some statistical effect. Maybe we should start adding to the charts a category of people killed by million of people over 65yo.

This mean also than some countries in Africa (or Brazil) could go through this problem "relatively unscathed", just because they have lots of children and young adults. Same with poor US states that could behave different than rich states in this sense. Only time will tell us.

This table is missing Norway, Denmark, and Finland which would be the most interesting to compare Sweden to.

Sweden: 1,937 deaths. 50 fewer seasonal deaths than expected.

Norway: 187 deaths. No increase in seasonal deaths.

Denmark: 384 deaths. Seasonal deaths unknown to me.

Finand: 149 deaths. Seasonal deaths unknown to me.

Sweden has approximately twice the population of the other Nordic countries, so per capita they have between ~2.5x and ~6x the Covid19 mortality of their neighbors, who have stricter preventive measures.

Honestly, I can't see how Anders Tegnell and his colleagues can sleep at night with the uncertainties they are powering through. By rights they should be terrified that they've gotten one of their assumptions wrong.

Denmark has ~2.5x the per-capita covid-19 mortality of Finland, should Danish authorities be terrified that they've gotten their assumptions wrong?

The UK has ~2x the per-capita covid-19 mortality of Sweden, should English authorities be terrified that they've gotten their assumptions wrong?

You are cherry-picking like crazy!

There is clearly no evidence that stricter measures have any effect. If that was true, then there should at least be a linear correlation between strictness of measures vs. excess deaths, and that's simply not the case. You're extrapolating a linear correlation using a couple of data-points that happen to support your theory, i.e. Sweden vs other Nordic countries. Sweden vs. all of Europe paints a completely different picture, so you're not looking at that, because you're cherry-picking.

There are so many uncertainties around this whole situation, and I think the only thing we can say with certainty is that if a country has no or a low rate of excess deaths, that country is doing "ok". Not doing great, not doing shit, just doing ok.

Compare countries of similar population:

pop 10.7e6 https://covid.observer/gr/#daily

pop 10.7e6 https://covid.observer/cz/#daily

pop 10.3e6 https://covid.observer/se/#daily

pop 10.3e6 https://covid.observer/pt/#daily

pop 9.8e6 https://covid.observer/hu/#daily

pop 8.9e6 https://covid.observer/at/#daily

pop 8.6e6 https://covid.observer/ch/#daily

I want to point out the high absolute numbers of deaths, the deficient recovery, and that the curve shows no decline in Sweden.

I would be completely unsurprised that when this is over, an angry mob captures Tegnell and tears him limb from limb while alive.

Sweden has a higher rate. The theory is that the bulge in death rate is bigger up front vs a prolonged one that continues for months. It will be interesting to see long term results. Sweden also seems to have the same problem with long term care homes that many other nations (France, Canada, etc) are having.

Sad to say, I'm completely unsurprised that countries with rampant Covid19 spread have a lot of deaths in their retirement homes. It's practically deterministic.

People are contagious in the pre-symptomatic or asymptomatic case. So all that's needed is that one employee of the retirement home gets sick and goes to work before they know, and the game is up. Dead patients everywhere.

I'm sure this is discussed and considered on the highest levels of policy in the jurisdictions that have been the most proactive in getting a handle on the epidemic early, and missed in most others.

I'm sure a strict face mask policy could have helped slow things down, but that's sadly been a hotly contested topic.

I don’t think the up front deaths are in any way intentional. It’s very hard to compare strategies since there’s many other factors that control the outcome. Like Sweden had school holidays ending with a lot of people coming home from skiing in Italy just when the situation there exploded. And as you mentioned, the virus got into a lot of the nursing homes.

This is one of the things I wondered when I saw the "flatten the curve" charts and simulations a few weeks ago.

Is there a valid statistical model for letting COVID-19 spread quickly, and "getting it over with", compared to flattening the curve and letting it create fewer mortalities over a longer time?

I suppose even if the total number of mortalities is projected over time, there's real hope that we could find more effective treatments over time.

And Germany is another outlier

It looks like Germany put lockdown measures in place about a week earlier than France, Belgium or the Netherlands, if you compare the number of deaths at the time the mesures were enforced.

Getting a lockdown in place a week earlier mathematically translates in a 4x reduction in deaths a few weeks later, which is more or less what we see when comparing France and Germany.

Likewise the UK enforced the lockdown a few days later than France (proportionally to the state of the pendemic at the time of the measures), more or less like Spain. Looks like they are both heading towards 30k or 40k deaths until the pendemic gets under control. A few days really matter when you're fighting a pendemic that double in size every 3 days.

Reddit user /u/Anaemix made a nice graph of the Swedish stats [1]. Döda per dag translates to deaths per day.

[1] https://i.imgur.com/oXyrncm.png

That chart is really hard to read. Am I supposed to take away that Sweden only has about 50 or 60 more COVID deaths than the official count? This seems hard to believe. These types of numbers don't tend to have that level of quality at this stage of a disaster. I guess time will tell.

The opposite. Sweden has counted 50 or 60 extra cases as COVID than can be accounted for simply by excess mortality. That sounds impossible, but the difference can come from a few places:

1) Excess mortality is only an estimate. There could be other reasons why non-covid mortality is lower/higher than previous years (e.g. less serious flu season)

2) The tests can have some false positives.

3) If the way you count deaths is "anyone who died and tested positive for Covid", it's possible that the people you're counting didn't die from Covid but happened to have the virus in their system (or would've died even if they didn't catch Covid).

All this is saying is: in past years, X people died in Sweden during this period on average. This year, Y people died. (Y - X) are the "extra deaths", so to speak, and so this is comparing extra deaths to reported Covid-19 deaths.

No it's even weirder; the gap implies that there are 50-60 fewer non-COVID deaths in Sweden than there would be otherwise since the pandemic began.

The excess mortality problem isn't about trust. No one has alleged that existing studied covid death numbers in Lombardy or New York or wherever are due to people lying.

It's just that some people, in every health care system, end up dying without a test being done. It's certainly plausible that Sweden has been far more conscientious about testing unknown deaths (or testing at-risk people before symptoms, etc...). That doesn't say anything about their trustworthyness.

FWIW, my money is on a bunch of these cases being discovered in Sweden too, they just didn't show up in the check the Times did. Epidemiology is just hard, and there are no magic tricks to play with the science.

Pretty hard to hide excess death. That's precisely the point of this chart. You can miscount Covid deaths, but it's pretty hard to miscount deaths overall unless there's a fraudulent cover-up. Deaths are all recorded and tracked. Bodies don't just disappear.

The excess UK deaths linked to coronavirus are likely to be currently around 43,100.

For an explanation see: https://www.ft.com/content/67e6a4ee-3d05-43bc-ba03-e239799fa...

For today's latest numbers see: https://twitter.com/ChrisGiles_/status/1252983884284821505

Super interesting, thanks. Do you know if anyone has graphed the excess mortality on a month by month basis? That data would be invaluable in understand the timelines of actual spikes in excess mortality, irrespective of covid-19 testing and diagnosis. For example, did it spike up in March in NYC compared to Jan or Feb?

The New York Times article mentioned has more complete data, including the graphs you want.

https://www.nytimes.com/interactive/2020/04/21/world/coronav...

Could reduced deaths from driving etc. also be significant in this analysis?

> A chart published by the NYT:

Do you have a link to the source?

https://www.nytimes.com/interactive/2020/04/21/world/coronav...

Do you have a link to this?

Couldn't you in fact make the opposite case?

Sweden as the outlier is not reporting accurately and others are?

The UK has seen huge excess mortality above the average which is being attributed to large numbers of undiagnosed deaths in care homes and in the community.

Its far too early to make any claims as to superior accuracy when almost every country is struggling with accurate testing across their entire population.

In which case you'd expect Swedens numbers to get revised strongly upwards.

Sweden also has no conclusive sign of flattening yet.

> Sweden as the outlier is not reporting accurately and others are?

Huh?

If a country is in lockdown, and still experiences excess mortality, but the official covid-19 deaths aren't enough to cover that excess, then.... what the hell did people die of?

The expectation is that because of lockdown, the excess mortality from non-covid-19 causes should be lower than previous years, and therefore all the actual excess, and probably more, is attributable to covid-19. Which means that countries where the official covid-19 number is lower than excess mortality, like the UK, are underreporting, while countries where the excess mortality matches the official covid-19 number, like Sweden, are not underreporting.

> The expectation is that because of lockdown, the excess mortality from non-covid-19 causes should be lower than previous years

It is hard to say whether this is true. There are two reasons why there could be excess mortality caused only indirectly by covid-19 (so not part of covid-19 mortality):

1) Overwhelmed hospitals cannot offer proper healthcare to some patients with non-covid-19 illnesses. This might happen in Italy or Spain.

2) People are too frightened by covid-19 to visit doctor even in acute cases of other illnesses (e.g. minor stroke) and sometimes visit them too late. This was reported by doctors in Czechia.

Your underlying assumption is a) Sweden is reporting correctly and b) won't in future find excess deaths in the community - as other countries have:

https://www.independent.co.uk/news/health/coronavirus-care-h...

UK coronavirus deaths more than double official figure, according to FT study:

https://www.ft.com/content/67e6a4ee-3d05-43bc-ba03-e239799fa...

I don't think you can assume that non-covid-19 causes should be lower than previous years. For example, the main cause of deaths in normal years is cardiac problems. If Covid-19 is discouraging people from seeking help, and especially from going to the emergency room when they they think something might just possibly be wrong, then you can get a big increase in cardiac deaths.

There's a very definite possibility that what people died of is lockdown and fear. More specifically, there have been some really worrying alarm bells going off in multiple countries about people not seeking medical attention for really serious conditions, or not receiving it when they did.

The total number of people that have died on a certain date is not going to be revised, why would it be?

The excess is that number minus a historical average which will also not be revised.

Because of the huge amount of excess deaths that get assigned as probable covid cases. This is happening right now in the UK.

There is a lengthier interview by UnHeard with Professor Johan Giesecke (another experienced epidemiologist) of Sweden on YouTube [0]. It’s worthwhile listening to their perspective.

One of the comments he made was that no lockdown would work in democratic countries and the real test will be fatality rates between Sweden and others in 1 year. He believed it’ll be very little difference between those countries that have implement the lockdown and those that haven’t

I had watched the simulation of covid19 infection by 1blue3brown[1] and some of his modeling appeared to me (maybe I misunderstood them) to confirm Swede’s point of view.

Ultimately the same number of people got infected albeit in a “flatter” rate. However one counter point by Johan Giesecke was that these flattening the curve is motivated by the assumption of a static capacity of ER rooms to deal with this pandemic and he pointed out they have increased capacity. Overall I found listening to his side very informative, at least it gave me a different view of looking at from their view.

[0] https://youtu.be/bfN2JWifLCY

[1] https://youtu.be/gxAaO2rsdIs

You don't have to assume static ER capacity and the like to be logically in favor of flattening the curve. You can assume a 100% increase in COVID treatment capacity or even 300% and still note that without any flattening you are going to have series logistical issues with disposing with all the bodies that drop day after day after day. I agree that roughly the same number of people are going to get it over a year, but the goal is for them to get it over a year instead of 1 to 2 months. That's a huge difference in capacity constraints.

It is also why this approach would be foolish in countries with less developed treatment capacity. Capacity, for example, that is already at it's limit even with social distancing.

So, did Sweden have logistical problems? If not, how is their way wrong?

Inability to dispose with bodies is a reason to put 16 million Americans out of work and cancel school?

With such an enormously high r0 as currently predicted, completely stopping the virus once firmly established is an impossibility, but many examples e.g. Finland and Korea have shown that you can seriously reduce infections and deaths. There's no reason a lockdown followed by extensive testing shouldn't work, and indeed it _has_ worked in countries such as Korea and Taiwan. In fact, it worked in Hong Kong and Canada during the original SARS epidemic.

There has to be a willingness to act early and responsibly, closing your borders, attempting to isolate highly infected areas, and slowing the spread of the disease as you dramatically ramp up testing. It seems as if the Western world has complete amnesia of previous events like SARS and is throwing caution to the wind as they assert that nothing could have been done to prevent this.

It's a policy choice to allow all of the reaction to work through the private sector instead of just deploying a national response strategy. In the U.S., the CDC tried to take the lead on testing (good) and essentially banned any other testing infrastructure (bad) and fell on its face with contamination issues (very bad), and pivoting to opening the testing infrastructure was a good policy choice. But the real answer has always been: DO BOTH. The CDC could be doing a million tests a day right now. Why don't they? It's madness.

Reminds me of "Contact". Why build one, when you can build two for twice the price? :)

The reason the CDC aren't doing a million tests a day right now is because there is a massive global shortage of every single consumable needed to do this and no easy way to expand manufacturing. Even Germany, which has pretty much the best testing capacity for coronavirus of any country out there in per-capita terms, has been stalled at about 50,000 tests per day for a few weeks and it's not for any lack of desire to expand that. Trusted American media institutions like the New York Times and their Editorial Board have been giving people wildly overblown ideas about what would be possible if it wasn't for the hated Trump and his incompetence for stupid, partisan reasons.

China is the most prominent example of how dramatic an effect quarantines and social distancing can have. There was a massive outbreak in Wuhan, with tens of thousands sick. Two months later, there were almost no new cases.

Extensive testing and contact tracing currently seems to be keeping case numbers under control. We'll see if they eventually have to go back into lockdown mode, but for the moment, it looks like the measures taken turned things around.

In Wuhan, the army was called in. Roads out of the city were not only blocked off but actually torn up in some places. People were strictly limited to their housing blocks and had to await food deliveries. The Chinese state was able to rely on the fact that each apartment block already had its appointed minor Communist Party official who could ensure discipline. The population already had a single government-controlled app for communications, and this could easily be upgraded to show the three-colour health code before citizens were allowed to move anywhere in public.

A lockdown so strict simply would not work in most Western countries. The legislation is simply not there for that, even with the emergency powers that some authorities have, and enacting such legislation would require time and debate. Also, China was deeply concerned with protecting its elderly people due to such ingrained cultural respect for the elderly, but in other countries citizens may well feel that, if the army has to be called in, better that the army help with triaging and disposing of the mainly elderly victims than enforcing a crackdown on the population at large.

> lockdown followed by extensive testing shouldn't work, and indeed it _has_ worked in countries such as Korea and Taiwan

Korea and Taiwan had no "lockdown", they had contact tracing and targeted quarantine. They never closed non-essential businesses, and Korea didn't even ban flights.

Hong Kong had 300 deaths from SARS, they had over 600 suicides above the average during the same period.

This time around they are keeping businesses open

Two points: - Your numbers don't indicate the number of lives saved by shutting down. It could well have been more than 600. - It seems likely that it is possible to reduce the number of suicides in such an event with better planning and support for vulnerable people.

Okay, so mathematically proven that for every life lost to a respiratory disease two more will commit suicide. Impeccable math of yours.

That was a good interview, and obviously he's very experienced, but I'm still concerned with a lot of things he said.

First of all, he claimed that the death rate was going to turn out to be 0.1%; but he didn't even give a hand-wavy answer for why he thinks that. Now obviously, he's a professional who's been studying epidemiology for decades, so his "gut feel" is actually worth something; but I'd feel a lot better about that if he at least gave some other evidence that corresponds to that.

Later in the show, when the interviewer asks him how many deaths he thinks the UK might have in total, he says "12,000"; and the interviewer says, "We've already had 13,000". I mean... dude, your model is obviously off by at least a factor of 2 or 3; what if it's a factor of 10?

He claimed that Korea was backtracking because they couldn't contain it; but looking at the numbers just today, they're still above 10,000, which is what they've been at for weeks now. (I think he may have gotten Korea confused with Japan, who do seem to be having hundreds of new cases on a regular basis.)

But, I mean -- he does have a point: suppose you get to the place where Korea and Taiwan are. Are you really going to keep the country hermetically sealed for the next 18 months while we wait for a vaccine? Are you really going to keep people under lockdown that long?

If you don't have a coherent plan to prevent sickness, but only to delay it, then this "controlled burn" approach -- where you try to let your country become infected as fast as your health capacity will safely allow -- is going to lead to exactly the same number of deaths in the end, but will reduce the economic and societal impact greatly.

>but I'd feel a lot better about that if he at least gave some other evidence that corresponds to that.

I can't speak for the man himself but recent evidence from California, the Netherlands and Germany (Heinsberg) suggests that the true number of infections may be underestimated by a factor of 20x-100x, which would drastically push down the fatality rate.

I read a blog analyzing the numbers out of California, which said that they'd made some pretty critical errors; namely, it wasn't clear what the false-positive rate of their test was, and that even a fairly small false-positive rate would put "0" within their error bars.

Germany is running nearly half a million tests per week now against a population of 83 million. I can believe that their true infection number is 2 or maybe even 3 times the official number, but I have a pretty hard time believing 20x.

The Heinsberg study specifically said they shouldn't extrapolate to the entire country since the epidemic there had some unique characteristics. E.g: they had an event which boosted spread a lot.

20x-100x underestimation seems like fairy-tale land. Even 3x underestimation is hard for me to believe, but 100x ??? That would mean 84M Americans have it, and that is _very_ hard to believe.

Anything above a factor 20x is wishful thinking. Limiting it to the studies that have been done in europe show 10-20x which is much more realistic

well when I look at Sweden https://www.worldometers.info/coronavirus/#countries it has 16,004 total cases, 13,517 active cases, 550 total recovered, 515 serious/critical, total deaths 1,937

and Denmark has 7,912 total cases, 2,441 active cases, 5,087 recovered, 80 serious critical, total death 384

So what does that tell me?

1. They have slightly over 12% death rate currently and Denmark has slightly over 4%.

2. They have very many active cases and no recovered cases yet so this makes me think like all these people that have it right have just barely gotten it. So it is a little bit early to talk about how successful it is (otherwise it is time to talk about why is it taking so long to recover in Sweden if they have had it a long time)

If indeed my supposition that they have just barely gotten all these cases and have not had the time to let anyone recover so that means they don't know how many of the people they have right now will actually recover or how many will get critical and have life long complications or die and they are already at a 12% death rate with another 3.2% currently critical === HOLY HELL WTF!!

on edit: of course percentage death rate only for symptomatic cases we know have it, there should be much larger portion of population that has it.

Comparing death rates across countries is highly misguided because is depends directly on the testing strategy. The sickness is not different in Sweden than in Denmark and neither country's health care system is overburdened (even in Stockholm, worst hit region of Sweden) which would otherwise be a strong contributing factor to a higher death rate. So there is little reasons to believe that there should be a difference, let alone such a stark one.

>They have very many active cases and no recovered cases yet so this makes me think like all these people that have it right have just barely gotten it. So it is a little bit early to talk about how successful it is (otherwise it is time to talk about why is it taking so long to recover in Sweden if they have had it a long time)

I'm struggling to find a good source on this, ([1] is the best I could find, though it's in Swedish) but Sweden doesn't track recovered cases so that number is meaningless.

[1] https://www.mabra.com/halsa/friskforklarad-fran-coronavirus/

Ok, then less holy hell wtf. Although I think though most of the cases they have are still relatively recent because I could swear I remember Sweden having less numbers of people than Denmark with it about a month ago.

When I look at this chart of death rates they had 451 dead on April 2 https://www.statista.com/statistics/1105753/cumulative-coron...

which argues a much lower number of cases back then (haven't been able to find how many active cases they had then though, so I may be wrong)

I think this article is right on target

https://www.project-syndicate.org/commentary/swedish-coronav...

on edit: added "then Denmark"

Perhaps the icu stats provides some insights https://www.icuregswe.org/data--resultat/covid-19-i-svensk-i...

Total case count isn't very interesting on its own because it depends highly on testing and policies related to testing. This is one reason why the reported death rates are total crap and why there is such interest in anti-body testing. What is less affected by testing policy and availability is the number of hospitalizations. The number of people currently in hospital presents a pretty good idea of the progress of the disease (it lags a bit.. typically 10 days).

Just growing the infection denominator alone should not change policy very much though without also considering how infectious COVID-19 appears to be. NYC, Italy, etc... have clearly had a lot of deaths from the virus regardless of the final death rate ends up being when this all over.

Where antibody testing does come into play (and assuming antibodies at levels those are tested for do give some immunity) is when things can start to go back to normal.

> So what does that tell me?

That you look at very unreliable data that is even more difficult to compare across countries?

No it tells me I was looking to get a really smart HN comment by somebody more competent than I in the relevant subject that would explain to me patiently why I was wrong - don't worry though - I shall continue to look.

on edit: I see some other people have replied with more cogent explanations as to why my worries are probably wrong.

A highly relevant XKCD: https://xkcd.com/2295/

> 1. They have slightly over 12% death rate currently and Denmark has slightly over 4%.

This site isn't a great way to compare death rates. There's some baked in assumptions. If we compare statistical results we need 1 to 1 comparisons, or an understanding of the limitations of the comparisons.

The lion's share of testing is going to those that are sick. We've already established that <20% of covid cases go to the hospital. It is frequently recommended that one does not go to the hospital unless one is seriously sick. We also know that covid is highly asymptomatic. These people aren't ever going to be tested unless they are in a study specifically that is looking at random but representative samples of the population. Additionally, these countries have different median ages.This is important when we're talking about a disease that affects people dramatically differently by age. (e.g. Italy would be expected to be hit hard because it has an old population that frequently smokes). Also, countries are not uniform in their travel structure, i.e. how dense the country is and strength of nodal connections between dense areas. Finally, strategies were applied at different times in their curves.

So the issues are:

- We don't have 100% testing coverage and this data isn't a representative sample.

- Countries aren't uniform in their age or habits or pollution

- Countries aren't uniform in density and nodal connections.

- Countries applied different strategies at different times.

You should also be aware that the way Sweden is counting deaths by CoViD-19 is by attributing ALL deaths which tested positive for the virus to the disease.

This is very different from other countries statistics and one of the reasons why Sweden statistics are showing that there is very little undercounting of unexplained excess deaths when seasonally adjusted.

actually that seems to be the default method of counting deaths. I find it questionable to attribute (100% of) a death to covid when 4 other conditions existed and contributed to the fatality but there you have it. The undercounting issue has been a result of deaths of untested patients, e.g people found dead at home in NY.

Belgium on the other hand reports all deaths that could plausibly be covid related.

The whole thing is clearly an attempt at a graceful exit.

The original strategy was herd immunity. The argument being made was that Sweden was gonna get infected anyways, so better to get it out of the way sooner rather than later, while protecting the at risk. And this would reduce economic harm as well.

However, the Swedish decision makers seemed completely unaware of asymptomatic carriers, which led to the at risk (largely old people) being heavily exposed anyways due to the asymptomatic younger workers around them infecting them.

Further, the Swedish people, reflecting normal human behavior, shut down economic activity anyways.

The result was a slight linear short term economic benefit but an exponential, potentially long term, downwards public health situation whose economic effects itself will likely dwarf the direct economic benefit anyways.

So now that their plan has failed both in concept and execution they are changing their story saying that it was a Swedish cultural thing, where they trusted individual Swedes to take personal responsibility, because of the exceptional Swedish character.

This is pretty much the opposite of what's happening. The herd immunity strategy is working, antibody testing shows around 30% of Stockholm is already immune, with their mortality rate comparable to many other countries and lower than a few too.

The media that wants to paint this strategy as terrible and ineffective (despite all evidence to the contrary) is now scrambling to come up with an alternative explanation that allows them to say "but it wouldn't have worked here". A special culture is the perfect explanation.

>The herd immunity strategy is working, antibody testing shows around 30% of Stockholm is already immune

This isn't true (or, at least, isn't supported by studies). There was indeed a report [1] published that claimed that 30% of Stockholm has been infected, but it was a mathematical model and not antibody testing.

A study was recently published that showed that 11% of people in Stockholm had antibodies, but that was retracted [2] (only have Swedish sources for this, sorry) because the researchers didn't think that it was good enough.

[1] https://www.medrxiv.org/content/10.1101/2020.04.15.20066050v... [2] https://www.svt.se/nyheter/inrikes/nya-antikroppstestet-base...

It was 11 out of 100 people, using an antibody test that's known to have some false positives. So the error bars are huge. (The fact that this result has metastasized into obvious nonsense is exactly why people should be careful publishing incomplete scientific results.)

Can you cite that 30% number? That doesn't seem correct at all given the actual case count. It would correspond to a asymptommatic undercount of a factor of two hundred, which isn't supported anywhere. Even the Stanford study only guessed up to 60x or whatever.

Note that if Sweden were really approaching herd immunity new infection rates would be dropping, and in fact Sweden's outbreak is still growing. This at a time when it's objective size is very significantly larger than its neighbors' (who are dropping).

> The media that wants to paint this strategy as terrible

Are you sure it's the media's desires that are coloring interpretation? I mean, objectively Sweden's outbreak is the worst in northern Europe, and it's growing faster than pretty much anyone else on the continent. That's not consistent with "herd immunity".

My bet is that both Denmark and Sweden and other places that got these high numbers used tests that were both giving false positives eg by cross reaction to common cold corona viruses. We have seen this with early tests and as much as 20% of the population might have had just one of these 4 common ones. A Swedish study noticed this but didn’t get into the details and was essentially a bad study as it still concluded tests were 99%+ accurate. WHO was asked the other day if they had comments on these studies but all they had to say was diplomatic that they could help with input to make sure studies were performed correctly.

I wouldn't put as much faith in current antibody tests, especially where "In a low prevalence area for previous Covid-19 infection, which is most of the country, a positive antibody result could be a true positive or a false negative."[1]

[1] - Michael Osterholm https://www.cnn.com/2020/04/21/opinions/bergen-osterholm-int...

This is a new test from Karolinska Institute that can only have false negatives, not false positives.

With that said they had to retract the test results but that was due to other reason (accidentally including people who gave blood due to being infected).

That's in Stockholm, so the question is still, what about the rest of the country, they don't have the built up immunity. What's the exit from here?

Coming from the US, it wouldn't have worked here.

> However, the Swedish decision makers seemed completely unaware of asymptomatic carriers, which led to the at risk (largely old people) being heavily exposed anyways due to the asymptomatic younger workers around them infecting them.

Not unaware, but actively denying that asymptomatic carriers exist and trying to discredit reports saying that asymptomatic carriers play a role in the spread of covid-19.

https://www.svt.se/nyheter/vetenskap/tegnell-domer-ut-italie...

https://www.svd.se/oklart-om-viruset-smittar-aven-utan-sympt...

Disingenuous. A belief that asymptomatic carriers aren't the primary drivers of the epidemic may well be incorrect, but in no way is it equivalent to "actively denying [they] exist", or saying they don't at all contribute to the spread.

It's important to stick to the facts in the material when linking. Doubly so when sources are behind paywall and/or in a language understood by very few.

I think you've been misinformed here. Their strategy is still herd immunity. Some officials have said that's a bad way to characterize it - that their strategy consists of the things they do to mitigate harm, not the epidemiological fact that will eventually bring the outbreak to an end. (And I think that's fair - nobody calls the strategies that were applied during the Spanish Flu "herd immunity".) But they don't have any plan for ending the outbreak other than lots of people catching it and becoming immune.

Trying to suppress transmission until a vaccine is available is another option - one which potentially saves a lot of lives.

Swedish officials, rightly or wrongly, don't believe that can be done.

Do you believe this lockdown can last for a year?

As someone who is opposed to his plan I feel the other way round. The more data we get the more it seems to have worked. And Tegnell has increased in popularity.

Was his plan the best one? I am skeptical, but it is far from as stupid as I originally thought.

It would be a more convincing strategy if they actually effectively isolated vulnerable populations, which by his own admission they didn't do. You can't have it both ways. Either lockdown applies to everyone or you lock down vulnerable populations even more rigidly than a general lockdown would require (since those populations are far more exposed to infection than they would be under a general lockdown).

He is not a general to order that by decree. He can only urge actors to act appropriately.

> Further, the Swedish people, reflecting normal human behavior, shut down economic activity anyways.

If people are shutting down the economy and avoiding contact anyways, doesn't it mean that an imposed lockdown is unnecessary?

There are a number of options:

* lockdown until there is a vaccine or treatment

* slow down the spread

* do nothing

A vaccine or treatment is at least half a year away so unless your country is exceptionally rich the first option is not feasible.

Slowing down the spread can help making sure the demands to healthcare are met. This is not an issue in Sweden. It can help because treatment right now is better than treatment a month ago. And in theory at a certain moment there might be herd immunity. Or there may not be. Ultimately either a large amount of people or everyone will get ill anyway and then they will get better and immune or die.

Doing nothing means a lot of people get ill and then get better and immune or die and the country keeps running.

Sweden chose the last option because the first option is not realistic and the advantages of the second option are, in their opinion, not worth it.

In my opinion this is at least a defensible position to take. If a country does not have enough healthcare capacity the second option has to be chosen for as long as necessary. The first option, barring exceptional circumstances (your country is a self sustaining island that can handle losing all tourism and trade) is not viable.

I’m not sure what you mean by a downwards public health situation whose economic effects will dwarf the direct benefits. It’s terrible if a lot of old people die but realistically the economy will get over it rather quickly.

> There are a number of options:

>* lockdown until there is a vaccine or treatment

>* slow down the spread

>* do nothing

> Sweden chose the last option

No, Sweden did not choose that option.

So what did they do? Note that with doing I don’t mean issuing advisories etcetera.

I'm an American, so the usual caveats apply, but I think more should be made of this statement from the interview:

"The Swedish laws on communicable diseases are mostly based on voluntary measures — on individual responsibility. It clearly states that the citizen has the responsibility not to spread a disease. This is the core we started from, because there is not much legal possibility to close down cities in Sweden using the present laws. Quarantine can be contemplated for people or small areas, such as a school or a hotel. But [legally] we cannot lock down a geographical area."

If we take that as a given then the approach used in, say, Italy isn't doable. Why not put that out there and let there be a public debate about the issue? Is there a sense that this isn't the time?

Maybe there is a debate. I'm not exactly in touch with Swedish politics, so if someone knows, I'd love to hear about it.

Isn't this whole process of debate and individual responsibility basically irrevocably tainted in the age of mass misinformation? I don't know where we get if we walk down this train of thought, probably nowhere good, but when a not inconsiderable portion of the population has been directly targeted to cause them to believe the whole thing is just Bill Gates fault, who magically caused the Coronavirus and is holding back a cure, does debate have value?

This might be a good time when a representative democracy, composed of people who are willing to listen to experts and make the hard, unpopular, decisions, would be the best choice.

> Isn't this whole process of debate and individual responsibility basically irrevocably tainted in the age of mass misinformation?

Wasn't there an article here yesterday about the San Francisco anti-mask league [0] from 1918? I don't think misinformation and people acting incorrectly is something new.

0: https://en.wikipedia.org/wiki/Anti-Mask_League_of_San_Franci...

Totally true. Really shows it's a longstanding flaw in the idea that we can use direct democracy for topics like this.

Misinformation is nothing new and just as the amount of misinformation has increased, the amount of information has increased too. I would bet that the average citizen is better informed overall today than say 50 years ago.

Possibly. But there's been a huge signal boost for the extreme views. 50 years ago you couldn't find out about the corona protests and half an hour later be reading website after website after website about how 5G causes a virus.

Probably, but the core issue (at least in the US) is that a large fraction of informed citizens have moved to coastal cities, leaving the less informed citizens with more voting power. This means that misinformed citizens are gaining more influence over time, not less.

The misinformed weren't winning elections 50 years ago.

> Isn't this whole process of debate and individual responsibility basically irrevocably tainted in the age of mass misinformation?

maybe so, but if you assume this to be true, it's guaranteed.

The supposed "age of mass misinformation" isn't as big of a problem in Sweden as it is in the US.

For one, test scores and reading levels indicate the average Swede is far better educated than the average American.

Second, Sweden's media industry doesn't have competing private 24 hour cable news conglomerates fighting over eyeballs. In Europe, government financed media is more common, and thus there is not the same private incentives to drive fear and anger.

Does Sweden has issues with misinformation? Of course (mostly around fear of immigrants). But they don't have anywhere near the problem we have in the US with misinformation.

You right, that may be too far. But I don't know if we assume that direct democracy works well in the face of extremely important, time critical, issues requiring a lot of specialized information. I still have faith in democracy finding decent leaders, but I don't know if the populace has the required ability to consider all the nuance of this pandemic we're facing and then making an educated, forward thinking, and in all probability incredibly painful decision. It's been clear from a lot of the arguments I've heard people neither have a good grasp on exponential growth and it's consequences in terms of containment, nor on the timeline or steps required to get this all under control.

Your comment reminds me of the that Swedish "If crisis or war comes" pamphlet sent to all Swedish households in 2018. Right on the second page is a warning about "false information":

https://www.dinsakerhet.se/siteassets/dinsakerhet.se/broschy...

Maybe a "mental herd immunity" against viral propaganda is a necessary first step to develop a biological herd immunity ;)

Well, surely it's not working at the present time. A politician interviewed who went out to get the virus and then attended meetings was completely unconcerned about spreading it to his peers.

Interviewer: "But can you understand his concern [about his risk due to his health conditions]?"

Persson: "No, I do not. He's 50 years old. There is no risk to him. He doesn't get sick of this."

Interviewer: "But do you know that even younger people get sick and die of corona?"

Persson: "There is no reason to be worried. It's a hysteria. It is the same as with the climate. It is not possible to change. We cannot influence it politically."

https://www.svt.se/nyheter/lokalt/varmland/storforspolitiker...

And yet, somewhat bizarrely, Sweden has been latched onto as the model for a sane response to the virus amongst many conservative circles. I will hold my breath as they fail to take action against a disease with 10 times the IFR of the flu and many fold the transmissibility, with the CDC now reporting an r0 of 3.8–8.9 in a 95% CI.

Many would argue that the pamphlet is in itself untrustworthy state propaganda, so I can't even begin to guess at a good solution.

> Isn't this whole process of debate and individual responsibility basically irrevocably tainted in the age of mass misinformation?

The problem is not misinformation. The problem is whether a country is really willing to enforce a law that says every citizen has a positive responsibility to not infect others.

If you really enforce that law, then anyone who gets COVID-19 because they didn't take reasonable precautions, and then infects someone else, is legally liable for damages. They could be sued for all of the health care costs of anyone they infect. They could be sued for wrongful death if someone they infect dies. Depending on the circumstances and the details of the statute, they could be liable to criminal charges.

That's what "individual responsibility" means--holding individuals responsible, legally, when they harm others. And in a legal environment like that, misinformation isn't a problem, because people who act on misinformation end up harming others and being held responsible, and since nobody wants to be in that position, everyone learns, in their own self-interest, to not act on misinformation. Which in turn means that information sources that continually propagate misinformation die because nobody listens to them. And information sources that can reliably report accurate information thrive, and have an incentive to continue reporting accurate information.

> This might be a good time when a representative democracy, composed of people who are willing to listen to experts and make the hard, unpopular, decisions, would be the best choice.

Representative democracy will only be composed of such people if people have a strong incentive to act on accurate information and to not act on misinformation. Which, as you yourself point out, does not describe societies today.

>This might be a good time when a representative democracy, composed of people who are willing to listen to experts and make the hard, unpopular, decisions, would be the best choice.

There's always the next election. It's hard to do unpopular things if you don't expect them eventually to become popular. E.g. lockdowns may be unpopular now, but if crisis can be avoided, it wouldn't hurt your election results. There is an exception though; if countries like Sweden don't have strict measures and still thrive, a lot of people will see that as a failure of your government.

The key bit is "not inconsiderable portion of the population".

That is a very human perception failure and one that all politics and tribal psychology use. "Others are more dangerous than they are because they are other.and we say they are" not because they have an actual threat.

The reality is that these are incredibly small numbers but the hype about them is real.

Based upon this survey, more than a quarter of people don't want the United States shut down. That's a considerable proportion. That's the amount of people who vote in a president.

https://thehill.com/homenews/state-watch/494028-poll-more-th...

> This might be a good time when a representative democracy, composed of people who are willing to listen to experts and make the hard, unpopular, decisions, would be the best choice.

So basically, you want a return to some form of Aristocracy?

No. A representative democracy, like most nations whose citizens don't directly vote on everything have, have right now.

As opposed to the aristocracy we have now?

How many Senators and Congresspeople (and MPs in the UK) aren't multi-millionaires?

We needn't go to the margins of Bill Gates somehow creating corona virus. Here's some of the blatant lies and misinformation that came straight out of the supposedly legitimate leadership.

* Masks don't work, and you're too stupid to wear one anyways (WHO and US Surgeon General)

* There is no human to human transmission (WHO)

* The fact that there is a biolab in the exact area where the virus started spreading from is just a wild coincidence you racist (media Cathedral)

I have a hard time blaming people for going down conspiracy theory rabbit holes about Gates when all the people who should be setting us straight have no credibility.

Nice trick to slip an actual conspiracy in with two things that are not.

To be fair at least one of those three you posted is still a conspiracy theory, unless you have a source about the virus being man made - I don't think there's any evidence outside of coincidence.

The statement omits the fact that mandatory measures can be imposed when it comes to diseases classified as dangerous for the public, which covid-19 is. So while it's the citizen's responsibility not to spread diseases, the law also provides for mandatory isolation of people who are unable or unwilling to follow precautions.

The outbreak has absolutely dominated the news and public discourse for nearly two months now. There's lots of coverage of Sweden's strategy, including opposition to it, and its coverage in foreign press. Politics has been likewise dominated by the government's response and he opposition's reaction to it. I really don't get the feeling that there's a lack of debate on anything covid-related, although the nature of the event means that the usual Swedish process of taking decisions by slowly building up to a consensus cannot apply.

This is helpful to know, thanks!

> The Swedish laws on communicable diseases are mostly based on voluntary measures — on individual responsibility.

I don't know much about Sweden, but this would have a hard time working in the US. There is a large percentage of the population that would do nothing because the government suggested it. I think it's pretty clear that many states are opening too fast too early, but instead there are protests about people wanting to be free.

> I think it's pretty clear that many states are opening too fast too early

Not at all.. I think it's clear we locked down way too fast (and I was supportive of the initial lockdowns). At the time, we thought that -- even with the lockdown -- we would overwhelm the hospital systems in many parts of the country. Guess what... that didn't really happen. We didn't run out of ventilators at all. That means we over reacted. Now it's time to lower the restrictions with the new constants in mind, so that any subsequent peak more completely uses excess capacity, and more people can get back to work.

I'm a little confused. You think because the system was not overwhelmed, the US locked down too early? The point of the lockdown was to prevent getting overwhelmed, which appears to have mostly worked.

I guess I'm having hard time understanding the logic where since the system wasn't overwhelmed with a lockdown in place, there was no need for a lockdown.

The balance, nuance, respect for law-- this is absent from the public discussion in the U.S.

That may be, but I'm wondering what the reasoning is in Sweden, not the US.

Swede here - I get the feeling we trust our citizen and government response enough to not generally call for a hard lockdown. Some wanted elementary schools closed. Almost nobody is happy about how the elderly care works - but almost everyone were unhappy about the elderly care in general even BEFORE this.

The government actually did give themself increased authority to enact short term measures as needed. Parliament only demanded that any such measures are passed through parliament for approval within two days of execution, and I think maximum extent of such measure are three months.

But wrt to debate I think the general sentiment is that current measures are working fine. People are getting a bit restless with the spring coming, but besides that most internal debates right now is why there is not more action taken against restaurant owners and such. The municipal authorities are allowed to close down any such business that don’t take suitable measures to limit infection. And a apparently there’s some places that people aren’t too happy with.

That quote stood out to me, too.

It's hard to lock down an area in the U.S., too, but some states and cities have enacted nonessential business, school, and transportation closures that have been quite effective at flattening the curve without a geographic quarantine.

Maybe another question to ask: Can Sweden enact emergency facility and public transportation closures for other reasons? For instance, for a flood or some other disaster?

> I'm an American, so the usual caveats apply

What do you mean with usual caveats?

Just that since I don't live there and know the society/culture I may be asking a dumb question. I probably should have said something like "I don't know much about Sweden, so I'm asking from a position of genuine ignorance."

Ah thanks, I assumed it was an HN inside joke and I was a bit lost

Cheers

Well, that's not an excuse, laws can and should change as needed.

There may be a constitutional or-- as it's often put in Europe-- a basic law issue. But, I'm wondering why it is that we haven't heard about a debate to change these laws.

The simplest reason is probably because that type of internal political debate is unlikely to be reported by foreign media, assuming you aren't consuming any Swedish news.

That's not to say that too much discussion of these types of laws have been brought up, but a law was recently (quarantine throws off my sense of time, but I think last week) passed which gave the government significantly more power in terms of ability to close down businesses, airports, harbors, and more without needing to seek parliamentary approval first. This was after a bit of debate regarding the unprecedented nature of such a law and some modifications which were mostly aimed at not giving the government too much power.

They might not even be changeable. For Germany for instance:

"Article 79 states the Basic Law may be amended by an absolute two-thirds majority of both the Bundestag and the Bundesrat. Such a vote may not remove any of the principles underlying articles 1 and 20 as defined by the eternity clause, or remove or otherwise affect the essence of, any of the fundamental rights originally specified in articles 1 to 19; [32] but may clarify, extend or refine those original principles and fundamental rights. " (https://en.wikipedia.org/wiki/Basic_Law_for_the_Federal_Repu...)

So any coronavirus-fighting law that could be seen as "removing" one of those fundamental rights simply could not be made. Making these laws hard to change is deliberate, as allowing for changes in "emergencies" allows potential dictators to use emergencies as an excuse for broadening their own power, as Hitler did (and Hungary is doing now, under pretense of fighting the virus).

The legal argument is weak, and the disingenuous way he discusses it makes me question the veracity of his other points. The national government could 'strongly suggest' a lockdown and most people would comply willingly.

The reason for not doing that has been stated time and again earlier - they worry about endurance. We will have to keep up with modified behaviour for a long time, and overdoing it may compromise endurance.

go here and scroll down to Cases by Country, normalized by country population then highlight Sweden. Across the different metrics Sweden seems to be doing about average.

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

here's projections for Sweden but given how wildly these projections have fluctuated i'm not sure how valuable it is

https://covid19.healthdata.org/sweden

Cases are a poor metric because they're a function of per-capita testing, which is variable across nations. You have to go by deaths. In that case you can see that they're much worse than their neighbors Norway and Finland, and that they're closer to regions with catastrophic death rates like Switzerland.

The earlier lockdown measures are imposed, the greater the impact, hence the comparatively excellent numbers from Finland. Sweden has long held denial of asymptomatic transmission (especially by Tegnell, even in this article), which we've learned is categorically wrong. The IHME model has been considered notoriously optimistic, as the US number of deaths has been rising but the US peak is reported as 1 week ago. The IHME model assumes a full lockdown in the US until August, which has already been violated by a number of US states this week.

To back this up with some data, this article has information about tests per capita: https://www.thelocal.se/20200414/understanding-swedens-figur...

If Sweeden had been testing at the rate of Norway or Germany, they would not be in the middle of that cases per capita graph. This is despite Sweeden's infection growth being ~15 days behind Italy's, e.g. enough time for a lockdown to have almost entirely prevented it.

So it seems clear that Sweeden's policies have made infections worse. The questions that remain are: 1) Will their peak infection rate go over hospital capacity? 2) Will they have economic benefits from having population immunity faster?

Sweden's death counts are the most statistical precise ones so far, exactly because every death from someone tested positive for SARS-CoV-2 is counted as a death from CoViD-19. No other country is doing this, you can check that by following metrics such as "excess deaths" after seasonally adjusting deaths by country and adding their official death tolls [0].

[0] https://news.ycombinator.com/item?id=22945974

Why would you normalize by population in the early stages of an epidemic? If you assume a large and small country both have similar growth rate and number of initial cases, then their absolute case growth will be similar in the early stages. But the large country will appear "better" once you normalize for population. This is exactly the pattern I see when you compare Sweden to its smaller neighbors.

Why would you assume a large and small country both have similar number of initial cases? I'm under the impression a lot of the nordic initial cases were travelers coming home from ski trips in Italy. That ought to scale pretty linearly with population.

is this still the early stages? A number of countries have passed their peak.

A number of countries have most of their populations under what is effectively house arrest

Meanwhile, the virus still permeates, those same populations' collective immunity has barely changed, and we're only marginally closer to a vaccine

The fundamentals won't have changed when we do get around to removing the lockdowns

Some countries in martial law some shut down a massive portion of their economy. The controversial approach is relying on individual citizen responsibility. Fascinating times

> The controversial approach is relying on individual citizen responsibility.

Practically speaking this approach is what we are relying on in the US, too.

It probably won't work very well in the US though since workers' rights are much weaker in the US than they are in Sweden.

Telling people to stay home if they have any symptoms only works if people are actually able to stay home from their jobs.

> It probably won't work very well in the US though since workers' rights are much weaker in the US than they are in Sweden.

The demographic patterns emerging from this pandemic are already showing a strong skew along lines of existing privilege or lack thereof. In the US, this revolves around the nexus of race, poverty, and lack of regular prior healthcare access which, to your point, also aligns with the kinds of workers who have fewer rights.

To my knowledge, not a single country has declared martial law.

Sweden's approach is controversial because irresponsible individuals put responsible others at risk.

If it was something that affected only those individuals, noone would care. The problem is, that someone else can be irresponsible, and you die because of that.

Yes, we all get that, it's been rammed down our throats for months.

This has always been the case and is a risk of living in human society. Your life may end at any time due to someone else's irresponsible behavior.

Why is that suddenly a problem? We always had it. Most people posing danger to others in one or the other way. Driving a car is the most obvious example but there are countless other

My money is within a month Sweden going into full lockdown, and regretting their decision.

If it weren't for the states closing down here, Australia's death toll could have been much worse given the Federal wanted to keep everything open.

People have been saying that about Sweden for a long time. My money is on all other countries doing something closer to the swedish model when the next wave hits in winter.

These are really two independent issues. The justification for current lockdowns is nominally 'flattening the curve' because we were ill-prepared to handle a flood of serious cases. We can hope that, in another nine months, many of the specific shortages will have been addressed.

One issue that I would like to have seen mentioned here is whether Sweden's resources for treating the very sick have the capacity to handle an increasing rate of infection, if claims that it is over the hump turn out to be premature.

I think this is accurate. Fears of medical systems being overrun are generally overstated. The threat to doctors is already maximal, and by extending the length of the epidemic we're just extending the time they're at maximal risk. There's an argument towards buying time for more PPE availability but I think that's a bad bet. Lockdowns lifted before something like herd immunity is reached isn't going to help. If less than 10% of the population is immune, then you're in the same boat when the lockdown is lifted and you've achieved basically nothing but buying time. I don't think anybody would say we can endure a lockdown FOREVER. I think it's naive to think we can endure a lockdown for even one year without economic devastation causing far more harm than the virus, let alone the ambiguous timeline towards a vaccine.

A lot of people are going to die. More people will die if the lockdown is lifted, and many of those who would have died anyway will die sooner. But famine, crime, war, and authoritarianism will cost more. On a global scale I have no doubt that disease is less harmful than poverty in terms of happiness or lives lost. The same for any given country as a whole. For wealthy communities perhaps not.

It is frustrating to me that saying such things comes off as right wing or anti-science. I feel the calls to keep the lockdown going are a thing of entitlement from those who can afford to do so. There's a middleground where you lockdown those at risk, reduce travel, and encourage sanitation practices but open things up.

Why do you think the next wave will be in the winter?

I mean. In all likelihood covid 19 will last at least 2 years(til successful vaccine)? Wouldn't it be likely that most countries populations cannot stay at home that long? Not even intermittently(like 2mths locked down every 6mths)? Whereas if the swedes dont overwhelm their hospitals they can go on like this for as long as they like?

That is a bet quite many people would take. There are very few indications of that Sweden will go full lockdown any time soon. Something would need to radically change first.

"My money is within a month Sweden going into full lockdown"

I'm willing to take the other side of this bet. Do you have a way of organising it?

The mortality rate has been stable for a while now so I doubt that that will happen any time soon [1]. If people in Stockholm don't follow the recommendations then they might set up some more restrictions though.

[1] https://i.imgur.com/xJ16VGd.png

I agree. It seems extraordinarily risky to let another disease spread among the world population.

- What if there are long term effects?

- What if it becomes a seasonal disease?

- What if the next mutation is more severe?

Each country should b a good global citizen, and put in its best effort to make sure the spread is as limited as possible.

It sounds exactly what the UK was going to do until Imperial released a report that said it wouldn’t work.

For now Sweden has slightly fewer deaths per capita than the UK, so their last minute change does not seem to have helped much. While I was and still am in favor of a harsher lockdown the Swedish strategy does not seem to perform that badly.

There are countries with harsh lockdown doing both doing way worse and way better, so other factors may matter more.

I think the reason for that is that British people are less trusting of the government and will generally ignore rules if it doesn’t make sense to them unless they’re mandatory. Even the prime ministers dad said he’d still go to the pub just before the lockdown.

And Anders "debunked" imperials study because it was not yet peer reviewed[0]. While continuing with his "Scientific" gut feeling.

(No, I'm not making any of what I said up or being hyperbolic[1])

The serious lack of testing and fact that many doctors are saying they cannot attach COVID-19 as a cause of death unless it is a direct cause and has been tested for, give me pause to the numbers Sweden is putting out.[2] Since if you arrive to the hospital already dead then they will not "waste a test" on you confirming cause of death. I would much rather look at the Swedish death rate comparative to last year instead[3]

[0]: https://www.theguardian.com/world/2020/mar/28/as-the-rest-of...

[1]: https://twitter.com/bjornsing/status/1252888065959436288

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

[3]: https://www.scb.se/en/finding-statistics/statistics-by-subje...

I have no idea whether the paper is good or not, but an off-hand tangential comment in an interview is hardly a debunking.

Also note that if you have to react to an emergency you might not have the luxury to wait for the data and evaluate all possibilities.

Of course you should definitely reevaluate your decisions as data come in.

edit:

I can't see a direct comparison in your links, but FWIW euromomo [1] is showing a large spike in excess deaths for Sweden.

edit2:

as pointed elsethread, neighbouring Norway and Finland are seeing a very different scenario; the graphs show pretty much no excess mortality.

[1] https://www.euromomo.eu/outputs/zscore_country_total.html

Agree, excess deaths over a suitably long period is the only metric I trust at this point, and the only one that will be able to settle the debate over the effectiveness of lockdowns.

Although very early data (as it is everywhere) does it not look like the stats for excess deaths and the reported COVID-19 deaths for sweden line up pretty well?

https://www.nytimes.com/interactive/2020/04/21/world/coronav...

Although very early data (as it is everywhere) does it not look like the stats for excess deaths and the reported COVID-19 deaths for sweden line up pretty well?

https://www.nytimes.com/interactive/2020/04/21/world/coronav...

On the face of it, the numbers don't look too good for Sweden. Compared to the Los Angeles area (LA county and Orange County) we see 1937 deaths in Sweden vs 697 in the LA Area. The population is also about 18% higher in the LA area vs all of Sweden. We are assuming the numbers reported in the LA area are accurate, which they may not be.

I don’t think these kind of comparisons are meaningful until we are out of it. It all depends on exactly when the outbreaks started at the different places and what the long term infection rate will be.

These uncoordinated set of strategies by different countries seem to me like battles in RPGs; Sweden's probably opting to take less economic damage and instead take a x2 damage on health points.

The Netherlands is switching strategies, thinking that Sweden's strategy is cool, but they're dipping their toes first by sending in teachers and children to see if they take a great amount of damage.

Yeah, I agree with you there. I'm going to guess that the LA area has early exposure to the virus due to our close ties to China here.

> We are in the middle of the epidemic and, in my view, the science shows that closing schools at this stage does not make sense. You have to shut down schools fairly early in the epidemic to get an effect.

Could anyone shed some light on why Sweden chooses not to close down schools fairly early?

I live in Stockholm, Sweden, so while I acknowledge my bias I'd bet my money on the fact that other countries will change their approach rather than Sweden starting to follow others.

While there are some undeniable social (think multiple generations in a household), geographical and cultural (swedes are notorious in keeping their distance from other swedes) differences at play here, other European countries have gone for a "people can't be trusted so we must restrict individual freedom". While there is certainly some good reasons to think that this will work the means used to implement this have some really sad consequences. Look at France, people are getting fined and in some cases brutalized; protests are sparking in places where strict measures have been implemented, not because they are unfair but because they affect people unfairly! Easy for well-off people to "leave early, far and for a long time" but far from everyone has that luxury (oh if you understand French, check out Twitter on the "lockdown diaries" parodies and compare that to how people in the suburbs of Paris are being treated!). This is without even starting to talk about how the economic impacts will be spread amongst social classes. To me Sweden has chosen the most socially (in this case as opposed to morally) fair route to handle this crisis.

That being said, it's morally very difficult to defend this strategy in the face of a higher death toll amongst seniors in care homes. I cannot come up with a single argument that I don't know will get shot down immediately and that is a good sign that it's probably not morally optimal. We live in a time of humanism and human life comes first, rightly so but even with that said, it shouldn't hide the picture and justify every consequence out there. The approaches in many countries are incredibly reactive and short sighted in that regard.

To be honest, I'd like somebody to explain to me how a lockdown would have prevented more deaths in elder care facilities in Sweden.

Speaking of today's situation, that's straightforward. Fewer infections in the population in general, lower probability that an elder care worker in a given facility gets infected and goes to work contagious without their knowledge. Once that happens, game over.

This effect is evident just from different death rates per capita in countries that have similar demographic and housing situations, e.g. between the Scandinavian countries.

I'd expect that better working conditions would have been a much bigger help.

These workers would like to follow the general guidelines and stay home if they have any symptoms, but they generally work hours, not salary jobs, and can't miss too much work.

If they had the flexibility and leisure a lot of the swedish middle class experience at their office jobs, being able to call in sick, then more of the care workers could have obeyed the recommendation by the health authority.

But for now it's a low-wage, high pressure sector with less than ideal working conditions.

To add to that, the same patients meet very many different caregivers during a week due to the same working conditions, and this is also not good for preventing transmission.

I suspect that in the aftermath of this. There’s are the things that will have had the biggest impact on outcomes. The pre-conditions at the start. Not differences in response strategies.

Preventing general spread in the population prevents the care home workers catching it.

But his point is that they are just experiencing these deaths now rather than in 2 or 6 months time, and that does seem likely given a vaccine is at least a year away.

>That being said, it's morally very difficult to defend this strategy in the face of a higher death toll amongst seniors in care homes. I cannot come up with a single argument that I don't know will get shot down immediately and that is a good sign that it's probably not morally optimal.

It's easier if rather than "lives saved", you look at "life years saved". In this sense, somebody in their 80s who only has a couple of years left dying early is equivalent to the situation of a young adult being pushed into poverty by the lockdowns and never managing to recover a middle-class lifestyle, so they die a couple years earlier (I'm not sure about Sweden, but in English speaking countries poor people on average die a few years earlier). A 20-year-old commiting suicide due to sudden poverty, or depression from being locked inside, is equivalent to twelve 80-year-olds who have five years to live dying early.

If only life were so simple. Essentially you are saying:

if 12*(lifeexpectancy@80) > lifeexpectancy@20 and if (20 year old will commit suicide due to poverty or depression) then 12 oldies get to die.

That sort of reasoning is faulty in so many ways that it would be bothersome to work out all the various ways but let's start off with the assumption that those 12 people are not just as eager to live a few more years and that those last few years may be more precious to them and those around them than a 20 year old that may or may not commit suicide.

This sort of cold-hearted calculus is not going to solve anything at all, merely create rifts by polarizing what it means to be 'young', 'old', 'suicide prone', 'depressed' and 'suddenly poor'.

Being 'suddenly poor' is really hard in Sweden by the way.

I do like the reliance on the high trust society in Sweden, but I also feel like a wider circle of experts could be consulted for such a decision.

Even if it may not be a good model of human behavior, it's sometimes useful to consider "rational behavior" - if only to judge the resilience of certain mechanisms.

In this case, "social" behavior is in a sense very altruistic. If I am young and healthy, recent media reports (accurate or not) would suggest that limiting myself to staying inside, practicing more hygiene and such, is costly but doesn't significantly reduce my own risk. At the same time, isolating risk-groups may not be sufficient, and younger people may genuinely be at risk. So, it would be desirable if everyone practices social isolation.

If that is true, social behavior is a collective good: The more people stay inside, the easier it is for myself to go outside and, say, enjoy the sun in a park or have fun in a club. Thus, my incentives are not aligned with the goals of these recommendations. And if everyone thinks that way, social distancing will not be achieved in a "decentralized" fashion. Indeed if everyone is that rational, such a decentralized but workable "recommendation" does not exist.

Now, I stress that people do not fit this model, especially in Sweden. But in situations of anonymity, e.g. with many people involved, it has sometimes proven useful to check the robustness of one's decisions against the case where people act rationally. In that case, laws and regulation do make sense.

Is there a pronounced difference between coronavirus cases in Sweden vs neighboring countries? On a per population basis I'm seeing very similar numbers (links below). Anecdotal evidence is one thing, but these charts don't seem to tell that story. That being said, it's unclear to me the degree to which coronavirus statistics provided by different countries can be compared meaningfully, or if this is an apples and oranges situation (for any number of reasons).

https://www.worldometers.info/coronavirus/country/sweden/ https://www.worldometers.info/coronavirus/country/norway/ https://www.worldometers.info/coronavirus/country/finland/ https://www.worldometers.info/coronavirus/country/denmark/

Population numbers:

Sweden: 10.2 million

Norway: 5.4 million

Finland: 5.5 million

Denmark: 5.8 million

Cases are an unreliable metric because Sweden has done less testing per capita than Norway/Finland/Denmark. However, its deaths per capita is notably higher (and rising - from 14th global rank to 10th in the last couple weeks)

Sweden: 192 per million

Denmark: 66 per million

Norway: 34 per million

Finland: 27 per million

I have been following Sweden vs my country (Portugal) for a while. Population number is about the same.

According to official data, Sweden has double the deaths of COVID per capita than Portugal (192 v 72 or something like that last time I checked). But latest data from my country has been suspicious since there has been a LOT of deaths above the average for March/April that aren't counted as COVID. I think at the time Portugal had 400 deaths of COVID, it had around 700 extra deaths about the average that weren't counted as anything.

NY times[1] and other studies have shown a big difference between average deaths in various countries and covid ones. Interestingly enough, Sweden is the one where the average extra deaths are all covid related, while most other countries have a big difference. (sorry for bad english, just woke up)

*edit: Just re-read the article and they added Belgium to the list. Belgium has the more deaths per capita in europe (world?), and they are also along with Sweden the only ones that don't have 'missing' deaths.

[1] https://www.nytimes.com/interactive/2020/04/21/world/coronav...

That does not look good for Sweden. I was just thinking that it would be interesting to compare total deaths per year for 2020 at years end to eliminate differences in methodology. It's a crude measurement, but if the coronavirus death toll becomes large enough compared to total population then it should give us a general idea considering how slowly death rates change in general. That could at least point us to who did things right, and hopefully some guidance for future policy.

Low official case numbers in Sweden are meaningless. They made a strategic decision not to track untested cases which would be presumed COVID-19 cases in most countries and they perform an almost negligible number of tests in Sweden which are officially restricted to be used for certain specific at-risk demographics.

The number of deaths per capita will give a clearer picture of the underlying situation comparing against the rest of Scandinavia, but that of course lags behind the number of cases by a few weeks.

> they perform an almost negligible number of tests in Sweden

According to https://www.worldometers.info/coronavirus/ , they have about 9k tests per 1M pop, which is lower (half of Denmark or 3/4 of Finland, but higher than France or UK), but definitely not negligible.

It will be interesting checking back in 2-3 years and evaluating the efficacy of approaches by different countries. As referenced in the interview, each country has to eventually reach herd immunity. For the majority of the world this will be when 60-80% of the population has antibodies through the natural spread of the virus.

Assuming healthcare systems are not at overcapacity, our resources will best be spent protecting at risk groups. These are mainly old people, given that the average life expectancy of those who have died is just over a decade.

I'm confused why so many people are extraordinarily emotional and passionate about shelter-in-place. We should be focused on increasing healthcare capacity, and more importantly securing the safety of at-risk populations which are primarily composed of old people.

This is where honest and effective communication over the objective risks for different groups is essential. If you are under 30 with no pre-existing conditions, the odds of dying are < 1/100,000. The numbers are commensurately promising for those without underlying health conditions in their 30s, 40s, and even 50s.

It is silly to prioritize shelter-in-place going forward, across most of the developed and developing world. The costs are tremendously high, as we actually want most relatively young and healthy people to be exposed to the virus to protect at-risk populations.

There was even a recent study published that revealed if we intentionally infected young and healthy people, death rates from C-19 would nearly halve. A solution could turn out to be staggering payments to very low risk groups to get infected, taking into account people's various living situations. Unfortunately, I think most governments would prefer 2x,3x,4x, etc. death rates over paying people to infect themselves.

I believe many people will look back and admire the Swedish model for their practical and effective approach. Excessive shelter-in-place has tremendous costs, with minimal benefits once healthcare systems are stabilized. Hopefully nations around the world accept this reality and act accordingly.

Is it just me or his answers are super vague and uncertain?

I've expected some irrefutable arguments and unshakable confidence, but it's mostly "I think", "I [don't] believe" and "hard to know". Zero proofs or data, mostly his opinions.

everything is an opinion and estimate at this point -

the transmission rates in the population with respect of their way of living,

the sensibility to infection of different ages, races etc

I salute Sweden for not giving in to the lockdown hysteria and trusting that people can and will act cautiously without the threats and mandates.

Perhaps a cultural difference. Swedes tend to respect a bit of humility. Especially if you can pull it of with confidence ;)

To us Americans f.ex. can seem way to confident and boasting. If I generalize a bit.

At the extreme we have things like this https://en.m.wikipedia.org/wiki/Law_of_Jante

Well, its an informal interview. As the dude say, in the mornings they review data and do an analysis with experts.

I don't understand why certain media are lauding Sweden's strategy. It's not succeeding by any objective standard.

For example, if you filter out tiny countries like Andorra (which result in statistical aberrations), Sweden has the 5th highest death rate in the world (per million population). And it's increasing, having gained several spots in the past 5 days.

It may turn out be that Sweden's right in that closing borders, schools, and businesses doesn't have much of an effect, although there's significant evidence for the effectiveness of closing schools in respiratory illnesses. But Sweden's strategy is not working as a public health strategy.

If they had sufficient testing and encouraged the use of face masks to slow the spread, it would probably have worked.

Some southern states are about to try the same strategy so we'll see how it works out.

It was a cynical decision, disguised as "we don't want to impact people's freedoms" and "we follow the scientific truth".

Sweden's progressive government hates older people which they perceive as more conservative. So they decided to let them die.

If the epidemy would affect younger people as much as older people, Sweden would take the same actions other countries had and limit the number of deaths.

Are you seriously saying that the government is on purpose making their strategy kill old people?

Because that is some grade-a conspiracy paranoia.

This is one of those cases where a single day in the media cycle makes for a very big difference:

https://www.forbes.com/sites/davidnikel/2020/04/22/sweden-he...

I think Sweden did it wrong, valuing the economy more than the lives of people. I think there are some political ideologies at work, but I don't want to get into these.

In my country we have 3x less cases and 8x less deaths per million people. I do think that quarantine payed off. We can recover the economy but we can't recover lives.

Each nation's strategy seems to come about due to its very specific circumstances. Leaders will defend (to death) their bullshit ideologies and false securities, and stick to a plan made in the heat of the moment.

Perhaps this mechanism is the great randomizer that ensures that every combination is tested, some risk distribution strategy.

Sweden is starting to see sharp increase in daily deaths - 172 yesterday and 185 the day before - which for a country of 10 million is a lot. For instance Czechia with roughly same population introduced lock down very early on and now their total is 210 - while Sweden's is 1937...

Where are you getting those numbers from? They're much higher than suggested by this graph:

https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_S...

So far the net result of Sweden's strategy is that they have 2,021 coronaviris deaths, more than 4x more than Poland, which also has almost 4x bigger population - so Sweden has 16x more deaths per 1M of citizens than Poland.

There is no controversy. They just messed up and are now saving their faces blabbing about herd immunity and hoping that the spread will stop magically. I do not have hopes up yet.

This was the most sane and reasonable thing I've read about handling the pandemic, and I'm super bummed it's not regarding my home country.

Sweden’s approach is an optimization of how to respond to the epidemic and how to respond to the general life disruption.

The optimal response to the epidemic is everyone stays in their house for 1 month with no human contact. In that scenario, the virus is stopped and everyone dies because no one works the food chain, etc.

The world’s current response is heavily weighed towards optimizing the response toward the epidemic, but the potentially fatal assumption to this approach is that a vaccine will soon be developed. If a vaccine is not soon developed, the same amount of people will still get sick, people will still die, but additional people will die due to life disruption.

While their strategy seems to not have led to disaster, it's not certain whether one would call it success. Shutdowns clearly didnt work well in some countries (france,spain,italy,uk) but they seem to work well in most eastern europe countries and germany. People are not being infected at large .

Some of his remarks are generally questionable and worth a second thoughts

> Closing borders, in my opinion, is ridiculous, because COVID-19 is in every European country now.

There are many countries with very few COVID cases, and some of them are summertime destinations for swedes (like greece). It's certainly dangerous to open borders with a highly infected country like sweden without rigorous checks. Europe is big.

> Each country has to reach ‘herd immunity’ in one way or another

Not all countries are looking to get there fast. In fact countries that delay the spread are hoping for a potential cure/treatment that will make herd immunity much less painful. Herd immunity isnt even necessary - plenty of diseases don't need immunity/vaccines.

Also, while it's nice that sweden chose a relaxed, voluntary approach, the lockdown measures have wide support in many countries.

He s right that governments should be measuring the impact of measures though. Sweden should be doing so too, it would be very useful to know which are the most important infection routes, now that other countries are opening up

Even if you assume 100% of the population will eventually be infected, the final percentage will have a much easier time and chance of recovery than the first ones because of what we've learned as time goes on, even without a vaccine. In fact, they're already learning better ways to treat the disease.

The stupidity of saying, "We really can't do much right now, so fuck it" is unbelievably irresponsible. If you knew you were definitely going to get the virus, when would you rather it happen, right now or a year from now? Sweden is essentially saying it doesn't matter.

> We really can't do much right now, so fuck it"

For many people it's more of "I can take my chances relying on the government when I'm not allowed to work" or "I can take my chances catching a virus that is probably coming for me anyway"

Locking down doesn't terribly help vulnerable populations. It's only advantage is that it keeps people who were less likely to catch it to begin with from catching it, and as a result reduces the hospital load.

Here in Iowa the majority of outbreaks are either in nursing homes or meat packing plants. Locking down does nothing to help them. We could shut down the meat packing plants, but then we kill the food supply chain, which is a disaster for everyone. Nursing homes are basically sitting ducks no matter what.

If it's a fire we can't put out except by letting it burn through, then our best choice is to open up to the point that we are burning at maximum capacity. Hospitals here are laying off workers because they aren't allowed to do anything except wait for a crash of Covid-19 patients that so far hasn't come.

If the bottleneck is the hospitals like people have been saying all along, then hospitals being so empty they can't even pay their staff means we have gone to far.

Do you have any links to reports of hospital layoffs? I too live in the Midwest and haven't seen any, though midwestern news sites are atrocious unless it has to do with football.

Wouldn't a lockdown translate to limiting the nursing homes' exposure to the virus?

I really think this is a case of It is difficult to get a man to understand something when his not feeling responsible for the deaths of thousands of his country people depends on him refusing to understand it.

"We are in the middle of the epidemic"

I'd love to know what metric he's basing that statement on

To be fair, in the nordic languages "middle of" something can mean "we're in the midst of an epidemic" or "we in an ongoing epidemic".

This also is the same in English. Colloquially it just means you're not at the beginning or the end. "I'm in the middle of the forest" doesn't mean you're at the centre.

That's probably the least controversial statement in the interview.

Curious to hear what you think were the most controversial statements were?

The day with the most COVID-19 deaths [so far] in Sweden was yesterday. Sounds like the middle to me. Or maybe the upswing.

Where are you getting that from? FHM's Covid-19 tracker [1] shows the most deaths occurring on 8/4. Of course, because there's a lag in the reporting that is likely to change over time. Either way, the data for yesterday is too incomplete to make any statements about yet.

[1] https://fohm.maps.arcgis.com/apps/opsdashboard/index.html#/6...

Eh, not really. Reported deaths typically lag up to 5 days so this is mostly just that a lot of backlog was reported the same 24 hours (yesterday afternoon and this morning). Number of deaths per day have been relatively stable since the beginning of April.

The middle of the peak of the first wave, maybe.

If you're under the impression we're half way through the whole thing you're in for a rough couple of years.

I don't think this was a statistical statement, it's colloquial. We're not at the beginning, it's not right at the end, we're "in the middle"

When a future article is written about the dangers of being contrarian to get attention, that same picture of Anders Tegnell will be just below the headline. His parents should have spent more time with him.

Please don't post nasty, empty things to HN. We've already had to ask you not to do this kind of thing.

Maybe you don't owe Swedish epidemiologists in Nature any better, but you owe this community better when you're posting here. Please stick to https://news.ycombinator.com/newsguidelines.html.

> We've already had to ask you not to do this kind of thing.

When did it become HN policy to cherry-pick long ago examples from among a plethora of highly-regarded comments like that? Pretty clearly other users think I've paid any debt to this community since whatever incident you're referring to (and I don't remember any) many times over. Bringing it up like this seems pretty empty and nasty in itself.

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