Stockholm Won't Reach Herd Immunity in May, Sweden's Chief Epidemiologist Says | Hacker News Reader

Stockholm Won't Reach Herd Immunity in May, Sweden's Chief Epidemiologist Says

npr.org

49 pointsXplor114 comments

> With 39.26 deaths per 100,000, Sweden's mortality rate is not only higher than that of the U.S. (29.87 deaths per 100,000) but also exponentially higher than those of its neighbors Norway (4.42 per 100,000) and Finland (5.56 per 100,000)

Small thing, but the usage of 'exponentially' in this context, comparing several discrete datums, really does bug me. If humanity's greatest weakness really is our failure to understand the exponential function, then we don't help ourselves by using the term as a clumsy proxy for 'substantially bigger'.

Order of magnitude higher implying exponential activity = "exponentially higher"

Well, that would make sense when describing the relationship between two functions, but not between two datapoints, right? Since exponentially pertains to growth, not magnitude.

“Exponentially higher” can refer to magnitudes, not growth. If I have $1000 (10^3) today and $100 (10^2) some time ago, I have exponentially more dollars now than then even if that value grew linearly over that time period and continues to grow linearly. I won’t have exponentially more over the next time period, because it’s not growing exponentially, but it’s still correct to say at that point my bank account is exponentially higher.

Well, that is referring to growth, just growth sampled in a discrete fashion.

Lines are infinite, so you can pick two points on any line with a nonzero slope where the second point is exponentially higher than the first. That doesn’t mean the line is an exponential. Both of these views only look at the magnitudes of the two points with respect to one another and not the trend of the growth of the curve from which they were sampled.

I think we should call two points that are separated by more distance than the first point squared. For something to be exponentially away from something else, it would have to be at least itself squared. So 26 is exponentially far from 5 (5^2).

> If humanity's greatest weakness really is our failure to understand the exponential function

If this is in regards to dismissing coronavirus concerns, I don't think that was the problem - more a case of people assuming the exponential growth would be magically stopped earlier by some governmental force or whatever.

When the first case in the city I live in was announced, I remember thinking to myself, it's just one case, they're now quarantined and they've probably done proper contact tracing and the country is preventing people coming in from infected regions abroad. I was perfectly aware how quick exponential growth happens, but to some extent had faith that "the system" would prevent it from going out of hand.

Indeed, this was also one of my hypotheses. The problem is that there was much more asymptomatic transmission that it was initially assumed.

Even later, when the exponential got out of control, I expected the states to step in with much more drastic measures than the lockdowns we have witnessed. I thought there will be tanks on the streets, I thought one day we will wake up and see the military everywhere à la 1968 Prague.

I think somebody - when making those plans - realized there isn’t a tank for every street - or even every town.

edit: typo

Rearom said>"I thought there will be tanks on the streets, I thought one day we will wake up and see the military everywhere à la 1968 Prague."<

Only in the states with Democratic governors!8-))

I live in Europe

So perhaps you (all) are making progress?!8-))

It's quite a famous quote from some notable smart person who I don't remember. I think they were talking about population growth (perhaps ironically). My intention was not to make a sly point about reactions to coronavirus.

Oh I never imagined it could be contained. It's not the 1950's where folks lived and died within 2 miles of the spot they were born.

People travel promiscuously today. Even if only 1 in 100 did, it'd defeat 'containment'. And far more travel than that.

Heck we are more careful with pets and cattle, than with people. Because, disease. People were somehow exempt because it's inconvenient to quarantine - takes time. And now we're reaping the result of this.

If you thought it was inevitable as soon as a single case appeared in your country, that just seems misinformed. SARS was contained.

Nope. SARS burned out that summer. Became less virulent when conditions changed.

A disease that was killing folks worldwide, cause zero deaths in the USA. Despite spreading across half the country.

There were many countries that saw single or double digit cases but no more. I don’t think that can reasonably be characterized as “burned out”.

We (I?) was talking about the USA.

The US epidemic did get a bit bigger, into the low hundreds, but they were spread across half of the states. That still looks a lot more like containment than an outbreak which happened to die off.

I see that now. Interestingly, no deaths in the USA though worldwide the rate was ~10%.

To me, spreading to 29 states then disappearing seems more like dying off than containment. In fact, it seems more like "uncontrolled spread" followed by a lowered R-factor in the summer. Which is what the doctors in my daughter's medical school initially suggested would happen to Corona-virus, "just like SARS". Unfortunately this one has a much higher R-factor.

So you're saying that the doctors and nurses who sacrificed their lives fighting SARS in Toronto and elsewhere did it in vain?

Come on, don't wave people's deaths around like this. This has nothing to do with whether some epidemiological fact is true.

No. They very well may have saved thousands, and god bless them. But nature lent a hand as summer came on and it got to the USA.

Summer had very little to do with it, IMO. SARS spread almost exclusively in a temperature controlled environment, hospitals. Hospitals around the world learned their lessons from the mistakes made in Toronto, applied them effectively, and stopped the disease.

So, that sounds consistent. Outside, the disease quit spreading. Because it was summer, and hot.

SARS did not spread very effectively in the community. People were not very contagious before they became sick enough to be hospitalized.

SARS spread very effectively in hospitals, though. SARS was contained through very strict isolation protocols in the hospitals.

About "being more careful with pets and cattle", I have an example that's more literal than you think: In Germany there have been several Covid-19 outbreaks between workers at meat processing plants, which highlight their bad living conditions. One satirical TV show promptly came up with the idea of also having food labels for the living conditions of the workers, besides the labels for the conditions in which the animals are kept...

in literature "exponentially" can be used in a lot of ways that are appropriate but not mathematically correct. you can use it as a euphemism, as a metaphor, as an adjective, like a loose comparator, etc... everything is valid.

the same applies to a lot of other mathematical concepts (i.e. the double negative, etc...)

I don't think it's asking for an unreasonable amount of rigour to require that terms like 'exponentially' not be used to describe discrete differences in magnitude? I mean, you might as well say 'additively', since for any given (x, y) pair of positive numbers there is some n such that x+n=y, just as there is some n such that x^n=y.

yes, I feel the same way, especially in data/scientific oriented articles. Unfortunately, most data journalists are writers first and scientists second, which kind of biases the way things are presented in written form.

Take it as a synonym for "order of magnitude" and make your peace with the term? In scientific (aka exponential) representation, the exponent is actually higher in this case...

I think it's worth trying to be prescriptivist here. Exponentiality is a specific, important phenomenon, and it frustrates me to see language diluted in this way. I wouldn't care in the context of a reddit post, but NPR should know better.

NPR should know better and only use the rigorous mathematical definition of the term exponentiality?

If they would’ve said “an order of magnitude higher”, you would be bitching that 8x higher isn’t even a single order of magnitude. You just want to complain.

Words have flexible definitions outside of academics and science, let it go. It saddens me when pedantry is the top comment on an HN post.

I refer you to my previous reply:

https://news.ycombinator.com/item?id=23311027

Considering this article is specifically about the math and numbers behind the situation, we need them to use the numbers and terminology correctly.

I'm a technologist but somehow have found that my friend group is mostly English professors, and they are not idiots. This conversation comes up every time we hang out, with them stating that "exponential just means a lot."

Time to play hardball. From now on I'm referring to any two lines in a poem that rhyme as a 'couplet'. Let's see how they like that :p

Examples help quite a bit. Tell a story, a gamma ray causes a mutation in the very room you are in and causes a common virus to be virulent and deadly. It takes 2 days to make you sick enough to spread and is virulent enough for each person to spread it to 8 people on average.

So 8^11 is about the people on the planet, so in 11*2 days everyone on the planet will have it. Sure one a noticeable fraction of the planet have it, the rate of spread will slow, that's called heard immunity.

Then maybe discuss how with such quick growth that some countries drop the ball. What looks like a over reaction while it's happening looked like a under reaction in hind sight. Mention specifically Wuhan, NYC, and Italy as examples.

Might also be worth mentioning that in the 1918 pandemic the first wave broke records, made the news, encourages changes like social distancing and masks. But it was the second wave that was worse, caused by opening up things to quickly.

An aside of your aside;

While I have no problem criticizing some of their choices and (IMHO) lack of transparency, I do take some issue with the comparisons (not yours) in the text you quoted.

It's true that the death rate is higher, but an often ignored factor is the (differing) chosen qualifier for covid deaths between countries [0].

Compared to UK/Italy/Spain/France/US/etc, Sweden doesn't have many "unaccounted" deaths during the pandemic [1].

[0] https://www.nbcnews.com/health/health-care/trump-admin-won-t...

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

This is a fair point, although I tend to think (based on nothing other than intuition) that Sweden likely has reasonably similar metrics to its Nordic neighbours?

My intuition is the same, but I have not found any substantive confirmation for it.

That, but also a misunderstanding of the strategy: herd immunity works on the thesis that the total number of victims is independent of speed of spreading. So naturally, you'd expect more dead/hospitalized sooner under this (lack of) regime, but also a shorter active period. I.e.: a sharper peak, but roughly same area under the curve.

The reason most countries chose not to do this, is because they expect the peak to be too sharp to handle all the hospitalizations.

We need to count these total after a couple of years to see which strategy worked.

Which is of course why choosing a strategy is and will always be an informed guess. We won't know which strategy works best, which assumptions turned out to be true of flawed, until after the show.

Sweden provides us with an upper bound. I think they're showing it's perhaps not as bad as we once thought it might be. Which is why many countries are now relaxing or looking to relax rules to regimes more similar to Sweden.

It provides us with an upper bound in Scandinavian countries with populations that behave like Swedes.

How does that generalize to other countries with different densities, distancing compliance, healthcare, etc?

Another way to read this is that Sweden is quite a lot worse than it's neighbors, but people there still followed the rules so it's actually a lower bound?

Nit pick. There is another imprecision lurking in the quoted statement. Epidemics are subject to power laws, making it misleading to take averages over large populations. US mortality rate may be 29.87/100k, but that is an average weighted by population between 50 states with different geographies, demographies and policies, for example NY's 120/100k vs. CA's 10/100k.

In common English, I'm not sure "exponentially" has ever meant 2^x. I think it may have moved straight into English from mathematics already wrecked. I thin the majority of the time I see it, it's being used for x^2 or similar polynomials.

You won't be able to "solve" this until the general population is aware of the differences between those two functions, which is probably pretty hopeless.

> we don't help ourselves by using the term as a clumsy proxy for 'substantially bigger'.

I thought about it too and I noticed more unfortunate conflicts in colloquial use. For example "weight" when we mean mass and "phenomenon" when we refer to remarkable events or people. I recognize languages evolve, so I'm not upset about it.

I wonder how prevalent it is in other languages.

I took it as a clumsy way of saying "order of magnitude", which is accurate.

Not correcting OP, but the NPR quote.

It is an order of magnitude higher, not exponentially. Exponential rates are change over time. A static comparison uses relative static factors.

I'm Swedish but I live in Scotland and I've been watching the Swedish approach to COVID with great interest. I remain fairly sceptical but I also thought this interview[0] with Johan Giesecke who was the previous state epidemiologist and is advising both WHO and the current state epidemiologist interesting. In particular it seems like Sweden messed up the response in elderly care which is something that everyone is admiting to.

I do think it's too early to say whether Sweden's approach is as bad as it currently looks, likely this is not something that can be measured and compared to other nations for years.

0: https://www.youtube.com/watch?v=bfN2JWifLCY

Mistakes in elderly care appear to be the main driver of high death rates.

About "messing up the response in elderly care": I wonder what the strategy was there - if you want to protect the elderly, you also have to limit the freedom of movement of the employees that care for them and of the visitors, otherwise one of them will inevitably bring the infection in. But even if you do that, these persons can be infected by the people they live with - where do you draw the line? So I don't think it's about messing up in elderly care, it's more that the whole plan is unrealistic, it's just in elderly care that it shows...

You can only accomplish so much, but many places didn't even do the basics. I don't know what Sweden did specifically, but there are stories from many countries of elder care homes being required to accept coronavirus patients.

Widespread use of PPE by staff, stringent hygiene requirements and general carefulness come to mind

I don't condem their approach on this situation, not having a lockdown. What I don't aggree with is not making wearing a mask mandatory. At least this should've been made a must for everyone

That is not unique to Sweden

You may find this hard to believe that but there is very little evidence that masks work for this particular disease,

The group think is strong with the masks - but in reality, the scientific evidence is scant and inconclusive at best. This is why CDC never recommended them in the first place.

There are a large number of people that put all their faith in masks, because what else is there? They fervently hope and really want masks to work. And I understand that I wish masks worked, but do they really? The scientific evidence is just not there.

This post will be heavily downvoted for the same reason. It is a psychological thing. When they put on the mask people feel like they are doing something.

People strongly believe that masks HAVE TO WORK it just MAKES SENSE THAT THEY WORK, HOW COULD MASKS NOT WORK?, in reality, the evidence is not there. Masks feel to me like a superstition or flat earth belief. Where is the evidence?

Questioning the efficiency of masks is heresy, you'll get banned from Youtube or Facebook for questioning masks, but not for questioning vaccines or for promoting vitamin C as a cure for cancer ...

Why is that? Because there is no evidence, if there were you'd be pointed to that.

One of the best things about wearing a mask is I no longer touch my face. Without something covering it I rarely noticed how often I would do it.

I’ve also noticed people are less inclined to take elevators with me and takes wider berths when walking. Which are all wins as far as I’m concerned.

The fact it prevents a cough or sneeze from shooting 6ft is also a benefit.

Touching your face makes not difference at all. Just one of the nonsense promoted by the scaremongers. COVID patients do not sneeze either.

Touching face maybe reduces hepatitis and other gastro-intestinal diseases.

The virus enters your nose via aerosols that will pass through masks just fine.

“COVID patients do not sneeze either.“

COVID prevents people from sneezing? I would assume one would still sneeze whether or not they have COVID.

it is not a symptom, treating everyone as a potential suspect is the exact problem that dehumanizes people

you should not be wearing a mask just because there is 1/100,000 chance you might be sick.

But people with COVID including asymptotic carriers still sneeze, yes?

Yes, you should, if it decreases the R0 factor to the point the disease dies out. Kind of the whole ball game here.

So you don't vaccine your kids either ? Because, you know, the chance they'll caught measles or chicken pox is not that high...

For me it's the same way of thinking

Do you have sources or articles? I’ve read quite a few and I’m unconvinced to say the least.

The study showing it doesn’t stick long to to surfaces lends some support to touching your face but I’d rather be safe than gamble on those probabilities and a longer term accumulation.

The worst and most common argument I’ve heard is that “it only prevents you from infecting other people, not them from infecting you”, as if that isn’t a major piece of the puzzle.

I know most infections happen with extended close contact and masks are pretty useless outdoors - which is why I only wear it in close quarters indoors. But I can’t imagine it doesn’t help at some level with the way it limits the velocity of your exhales and protects touching, even if it’s 10-30% safer than it’s worth it IMO.

I take elevators and live in a building with thousands of other people sharing the same public spaces. There seems plenty of opportunity.

> COVID patients do not sneeze either

First, coughing absolutely is a coronavirus symptom even if sneezing isn't.

Second, I sneeze every day, sick or not. And I don't even suffer from allergies. You're conflating it not specifically being a symptom with it not happening. Sneezing happens for different reasons.

I am as much for science based thinking as anyone but the facts that there is little proof that they work is silly to point out, when there is very little proof that they don't work. The lift of people wearing masks in public is so small that on even a tiny percentage of "working" it's worth it. People pointing out that there is little actual proof, as if there has or has been the proper amount of time and resources for proper peer-reviewed studies in a variety of environments, are likely actively harming people by encouraging more risky (even if it's a small percentage of chance of it being risky) behavior.

> This is why CDC never recommended the

I thought it was because there were not enough masks early on

Cyclists should be familiar with this debate, as it is closely mirrors the bicycle helmet debate.

Seems like it should work, and there is some weak evidence that it is better than nothing, but mostly we wear it as a talisman to ward off evil car-spirits. Despite weak evidence (because of it?) opinions run strong, and some cycling forums have to ban the subject in the interest of civility.

Maybe it's worse than the bike helmet debate, because the general left/right debate has been applied to it. So you get people berating those in masks, or castigating the President when he doesn't wear one.

Might as well be putting stars on our bellies.

glofish>"You may find this hard to believe that but there is very little evidence that masks work for this particular disease,"<

glofish is right, there's little evidence that masks work for Covid-19. Peruse the following and other articles:

"The Face Mask Debate Reveals a Scientific Double Standard":

https://www.wired.com/story/the-face-mask-debate-reveals-a-s...

>"COMMENTARY: Masks-for-all for COVID-19 not based on sound data":<

https://www.cidrap.umn.edu/news-perspective/2020/04/commenta...

>"Do face masks really reduce coronavirus spread? Experts have mixed answers:"<

https://www.livescience.com/are-face-masks-effective-reducin...

In Australia, we've been told to not wear a mask for a few reasons:

- its hard to wear them right without training, (you adjust them regularly, which means you're touching your face more).

- They can become little virus breeding grounds (if exposed) - they're moist and if virus lands on them it may breed

- they can be very claustrophobic

- masks were in short supply in the beginning and they were needed by medical personnel.

Not a doctor, this is just the reasons I've heard. If more infections occur that advice may change.

I don’t think virus can replicate on cloth? They can’t replicate independent from their host, right?

The reasoning I heard was - you breathe on the mask it gets moist and has some mucus on it maybe, maybe its enough for the virus to multiply, making a nice little culture dish, particularly if you wear it all day. I have no idea, this is just the reasons that I've heard put up.

Bacteria and fungus could reproduce inside a web mask, moisture and a source of food (spit, sugar, mucus, protein, or similar) is enough. Virus however need targeted cells to invade and take over the cell mechanisms to reproduce the virus. Said target cells for COVID19 are unlikely to be reproducing in your mask.

So buy (or make) 2 masks, use them on alternate days, and make sure they dry out completely between uses. If particularly scared/careful wash and dry them between uses.

(from below) Yah, think I misremembered that - I think it was because they were worried people wouldn't maintain the masks well and bacteria would grow.

- Not really that hard, and wearing still reduces face touching for most people

- Virus needs a host to replicate. Bacteria may be, but we haven't seen an epidemic of bacterial stuff in South Korea, Taiwan, or Singapore

- really?

- you can make your own masks from old clothes.

These are just the reasons we've been told by the medical folk.

I would disregard the advice (at least on this matter) of any medical professional that claims that viruses replicate outside of a host.

It's downright malpractice.

Yah, think I misremembered that - I think it was because they were worried people wouldn't maintain the masks well and bacteria would grow.

Who is "we've" and who is "the medical folk"?

> its hard to wear them right without training

We don't talk enough about the goals for wearing masks. My mask may not be helping me because I'm not disciplined enough about wearing it, washing it, touching it. But if I cough or sneeze into a mask, the people around me are a lot more protected.

This is the same advice we received in NZ.

The one thing that can be said about lockdowns is that it's not some obvious clear cut "it definitely helps a ton" type of thing. If that were true we should see nations and US states with strict lockdowns do much better than those without.

Instead some places with more strict measures (say the UK and Belgium) are doing worse than Sweden, and Sweden's curve is also flattening. The number of confounding variables just seem too large to make anything close to definitive statements about anything at the moment.

https://www.facebook.com/1515215380/posts/10222241141166862/...

In Denmark, which took a different strategy similar to most countries, we never quite had a full lock-down as seen in many other countries.

Majority of retail continued throughout the "lock-down", but with an abundance of care taken in terms of keeping a 2m distance, limited number of customers in a shop (queue stretching out of stores is a common sight), and alcohol sanitizers everywhere.

The majority of businesses and institutions have reopened (schools and kindergardens being the first ones), and restaurants, café and cinemas have just recently opened (with appropriate restrictions).

What is interesting is that Sweden has seen the roughly the same level of economic contraction as Denmark, despite the vastly different policies.

Closing schools is an over reaction though. Denmark has significantly lower life expectancy than Sweden and will have it this year as well. Why? Largely alcohol and tobacco. Sure, Denmark having less alcohol and tobacco measures than Sweden is great for your economy, but limiting them like Sweden does would save way more lives and have way smaller effects on peoples lives than your current Corona measures.

All of these articles pointing at Sweden as if it was a failure really has didn't consider how minor effect it had in Sweden, I'd say that the other Scandinavian countries over reacted instead. Maybe not Norway since they seem to value life higher, but both Finland and Denmark will still have lower life expectancy than Sweden and if they cared about life they would put resources on other measures than Corona.

Sweden also has a larger immigrant population, many of whom have difficulty synthesizing Vitamin D. This factor should not be ignored.

https://www.sciencedaily.com/releases/2020/05/200512134426.h...

https://www.bmj.com/content/368/bmj.m1101/rr-10

> A risk factor that we want to highlight, however, is the low vitamin D levels found in the Swedish-Somali population. Vitamin D status is strongly related to low sun exposure and dark skin. In two different studies, the great majority of Swedish women of Somali origin had very low levels of S-25(OH)-D (< 25 nmol/l).[3,4] In Finland, Somali women required more than twice the amount of vitamin D in order to maintain recommended vitamin D status. [5] In addition, vitamin D deficiency was twice as common, regardless of gender, in immigrants from Africa compared with those from the Middle East.[6]

The superficial bashing by foreign journalists of the Swedish strategy will become a case-study in confirmation bias. It's remarkable how eager a large variety of people are to justify their own policies by sloppy and superficial conclusions like for example deaths per capita, like lockdown or not is the only single variable that goes into that.

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