Anders Tegnell defends Sweden's virus approach
startribune.com
startribune.com
I personally feel a lot of respect to Tegnell. Sweden might have taken a better or a worse approach than, say, France but it is clearly not catastrophic: there are no mountains of corpses on the streets there are a number of countries with lockdowns and worse per capita death rates; second wave, if appears, will likely go much easier on Sweden, etc.
I think other countries should take a page out of Tegnell's book and instead of trying to exorcise dissent and label opponents, admit to uncertainties in their policies. This will not make their argument weaker; it might still mean that lockdowns are a better option. But it would also open policies for discussion and debate. Good policies will still win. But then they win by merits, not because of trying to silence any opposition. My 2c.
Scientists (which Tegnell is, effectively) are not meant to be politicians, and them getting into political matters is an excellent way to corrupt science. Although Sweden is not a place where one would look to think of corruption, there are still serious ethical issues with this. This is also a form of experimentation in COVID-19 that is among the riskiest and most dangerous in the world.
Early on in the COVID-19 pandemic, the significant differences in death rates in developed countries for COVID-19 were attributed mostly to whether COVID-19 severely penetrated care homes, mostly designed for the elderly. We know that Sweden did not have proper PPE protection in these care homes to protect their most vulnerable, and it still does not. Sure, the death rates worldwide have been going down, at least in developed countries, because, perhaps we have become smarter at treating it, despite having no effective treatment for it.
Still, it is not prudent to expose people needlessly to a virus that we know is deadly--and we know little about. A lot of these deaths could have been prevented, with relatively little pain, although it takes a lot of sacrifice.
One of the countries I am sovereign to, Croatia, (the other being the USA) has not had any COVID-19 cases for 3 days in a row [1]. You know, a former war-torn Yugoslav country that is up and rising and just became part of the EU in 2013. This kind of stuff is not rocket science. Even war-torn, economically suffering countries can be successful at these sorts of endeavors. It just requires brave political leaders (along with a strong emphasis on public health--which a lot of ex-Yugoslav countries actually have) who can deal with crises (which Croatia has legitimately dealt with before).
People are quick to forget that the Swedish strategy was everyone's strategy in February. It was (most) other countries that changed strategy from "we must prevent healthcare from being overwhelmed" into "we must eradicate the outbreak at all cost".
It was different to stay on the first strategy, but just because other countries changed doesn't make the first strategy any more an "experiment".
I was surprised to learn that the aggressive approach has become more the rule than the exception. This is great for the world but sad for my country.
Here in the US we are still taking the weaker “we must prevent healthcare from being overwhelmed” strategy. Having (mostly) succeeded at that (so far) we’re already looking to ease the lockdowns.
I tabbed through the statistics [1] and confirmed that much of the world is indeed on the path of “we must eradicate the outbreak at all cost”. Whereas in America the total cases are still climbing linearly (new cases roughly constant) in many other countries the total cases have decelerated (new cases decreasing or even approaching zero).
Simply not true. Taiwan (with a population 2.5 times that of Sweden) adopted a strict containment and suppression policy as soon as they detected the epidemic risk, which was at the end of December 2019. And of course China had moved to containment and suppression by then too.
have you been paying attention to what's going on? I would not describe it as "relatively little pain"...
Staying at home for a couple of weeks is easy least in comparison. All it takes is a dash of political leadership.
So yeah, op is right on the money.
But I do think it is dangerous to try to play the two roles at the same time. Science demands an honesty that few politicians can afford, which the current discussion about Anders Tegnell so well demonstrates.
Sweden has a long and revolting involvement of medical experimentation and eugenics on its own citizens, such as unconsented sterilisations, or feeding mental health patients diets designed to induce tooth decay so they could study the teeth rotting in the victims (I will not describe those so afflicted as patients).
In this context, the decision of a prominent Swedish scientist to "go it alone" and experiment on the population who have entrusted themselves to his care is unsurprising as well as tragic.
(And an actual brilliant scientist learns from their results and modifies their hypothesis. He seems to have done very little of either.)
As a Swede I‘m appalled at their handling of the matter, particularly when it comes to protecting the elderly. (Which is to say they didn’t.)
Saying that Tegnell "goes at it alone" is completely misinformed and comparing the situation to eugenics research is just going to show everyone how little you know about this situation. Stop wasting everyones time...
For example the argument that the high death in Sweden would not have been any different had we shut down completely because most deaths happened at old age care where the same people travel around the whole city thanks to state trying to cut down on costs. Tegnell did say that they expected the old age care to take steps to limit this travel when they set up the guidelines but this never happened in Stockholm apparently. I know that in my home-town they compartmentalized the care a lot after the outbreak, every person only sees the same two to three faces and the personell groups don't meet any more. And the death rate is no different to last years average in our state.
We do not experiment on people without asking for permission in Sweden. We do expect people to treat us with some respect.
Those over retirement age by definition can choose where to go during the day.
Quite a lot of this argument boils down to political philosophy: Personal Choice vs Nanny Knows Best.
[1] https://www.cebm.net/covid-19/covid-19-mortality-over-time-o...
You somehow left out the fact that people can't see where the virus is or who carries it. Thus if you are, say, in a retirement home operated and visited freely by those you claim that have nothing to worry about then what chance do they have to avoid being exposed to the virus?
And all it takes is one exposure to get the virus to spread like wildfire within the retirement home. That's been observed in Italy and Spain.
The problem is even more serious if elderly live with family.
Additionally, you also left out the fact that your reference shows signifixant excess deaths in the cohort 46-64yo representing an increase of about 18% wrt the baseline.
Framing the argument in this way is the source of the problem every time this comes up.
Solutions don't adhere to philosophies. Some situations call us to work together, and sometimes the best way to work together is for everybody to cede a little control and defer to somebody doing the coordination.
That's all there is too it. We should agree to let everyone live their lives without unnecessary limits, but we should also agree that when collective action is needed, we are also prepared to accept that and to make it work.
Unless they are not able to. Or require basic resources. Or require medical attention they can't get at home. Or...
It's not a great generalisation.
This virus doesn't just kill or leave people unscathed, it also leaves people with long term damage or knocks them out for a couple of weeks. Sitting in bed for weeks is not appealing at all to most people.
https://i.imgur.com/oiybcsx.png
Sweden will easily pass France in the next few days, yet new infections are now 500% greater than those of France.
Again, please keep in mind this is a per capita chart.
For this reason alone, we are unlikely to know the effectiveness of Sweden's herd immunity for months if not years.
We don't know. Covid19 leaves some people with long-term, perhaps permanent damage. You might lose working-age tax-paying people from workforce, having to pay them disability allowance, and this might offset part or all of your savings in pensions.
The epidemic is already over in Sweden:
https://en.wikipedia.org/wiki/COVID-19_pandemic_in_Sweden#De...
(more up to date graph: https://lockdownsceptics.org/wp-content/uploads/2020/06/IMG_...)
Yet a much lower level of infected population than conventionally understood has been reached. The models that assume the virus will continue to grow until 60%-70% have been infected are therefore wrong, reality itself is proving that.
There are now a whole lot of theories being explored as to why this is.
[edit: someone complained about the original graph link not matching worldometers. It's worldometers that's wrong so I replaced it with a Wikipedia link, which sources its data direct from Swedish health authorities. I left the lockdownsceptics link because it's a bit fresher]
Sweden (or any other country to be honest) is nowhere near herd immunity, which kicks in at 60% (though some studies seem to have pointed to a lower number around 45%/47% something like that, anyway), Stockholm I think is around 10%, maybe 15%
And even when you reach 60%, there's still an infection inertia
I think it's fine for Sweden to have tried their approach, at these times, there are no real right or wrong answers, and Sweden's population probably is a little more sensible than most other countries.
Other than geometric tidiness I see no point in your comment.
In fact, it ignores the denial of service impact that an epidemic has on a national health service, and plays down how it advocates for a population culling.
Perhaps it's time to relearn the basic principles and merits of "flattening the curve", not to mention the benefits of gaining some time until a vaccine is developed.
There are systematic statistics on overall excess deaths which will include people whose deaths are a short term response to lockdown, so we can pretty conclusively say that lockdowns reduced short term excess deaths. They don't account for future excess deaths due to situations like cancelled operations you mentioned or different responses to a second wave, but they don't account for future deaths of COVID survivors where cardiac and lung damage caused by the disease is a comorbidity either.
As a more straightforward example, it's simpler to compare countries with closed pandemics - say Iceland or New Zealand. Iceland has much higher deaths per capita, but they didn't lock down nearly as hard (groups limited to 10, schools open for kids below age 10, etc.). If you do the math, Iceland lost about 120 extra years of life, or something like ~3 hours per person. Is depriving everyone of additional liberties for a month worth increasing life expectancy by 3 hours?
The case for France vs. Sweden is a bit more complex, since Sweden, even though it isn't locked down, will be "unsafe" for large numbers of people longer. The raw math and projection models suggests Sweden will lose an extra 1-2 days of life per person, but more analysis is needed to really understand benefits and costs.
The problem with "extra years of life" metrics is that they artificially play down the death wave on older segments of the population, as if those dying from covid19 who happen to be older than 40yo should not matter to society.
The consequences of this nonsensical pick of statistics indicators is that a death wave of thousands of people per day that happens to hit harder on the > 40yo segment is watered down with "all this just to gain 3 hours of life" nonsense, as if all the coffins were only piling up because instead of being delivered on scheduled they needed to be delivered 3 hours earlier.
It does seem to me that a more just system would consider "time lost" as a metric since surely it can't be binary.
This analysis is flawed, because it compares the entire cost to only parts of the gain. Economic depression because no-one dares to go outside of fear for their lives, has for instance negative value too.
There's a lot of math and viewpoints that should be considered here. It does not seem to me that proponents of lockdowns are even doing any maths, it seems like they take it for guaranteed that lockdowns are the only choice.
We can’t know this number conclusively until a few years from now. The pandemic is still ongoing and does not have a flat distribution of impact over time.
So all this analysis is based on a false premise.
That "3 hours" mean that you're likely to loose one of the relatives or friends who are in high risk group. Suddenly a month of lockdown is worth to give your loved ones years or even decades.
Not arguing one way or the other, but I most certainly would not call it likely. Germany had more deaths than Iceland per capita and none of my relatives or friends are or know anyone even infected, let alone dead.
In Germany, you’d need to know about 440 people to even know someone who has been confirmed infected, in Iceland still around 200. To know someone who died, you’d need to know 9,661 in Germany and 36,363 in Iceland.
Not even close. For example, no one I know has been directly hurt by the coronavirus. And neither has anyone they know, including my friend from Wuhan.
(Why "directly"? I do know someone who had a mental breakdown related to isolation.)
Assuming we'll all contract COVID-19 anyway, eventually, it makes little sense to adopt strong restrictive measures on personal liberty to slow the spread down to a crawl. Sure, you have to impose some restrictions in order not to overload hospitals and whatnot, but anything beyond that is just extending the suffering (both making living harder and ensuring it will go on for a longer duration), is it not?
I would also add that delaying the spread also contributes to making it progressively harder to get the disease to spread.
France has already lifted many of their lockdown restrictions.
> Assuming we'll all contract COVID-19 anyway, eventually,
That's a big assumption, and not necessarily correct.
First, we won't all get it - herd immunity means infection rates max out at something like 60% to 90% of the population. I understand this maximum is to some extent a function of how fast your infection rates rise due to a sort of momentum effect.
Second, we may be able to suppress maximum infections indefinitely (or until we get a vaccine or treatment) with tracing, local lockdowns and so on. It's not clear if this is an effective long-term strategy, and is disputed by some epidemiologists, but seems to be the leading preferred strategy by most experts.
> it makes little sense to adopt strong restrictive measures on personal liberty to slow the spread down to a crawl
The problem is that you can't really adopt half measures. That's linear thinking, and it's an exponential curve. You either keep the reproduction rate above 1 or below 1. Above 1 you get an accelerating increase and eventually overwhelmed hospitals. Below 1 your infection rates start halving.
Luckily, the measures required for keeping R<1 don't seem to be too intolerable. Spain, Italy, France etc. have managed to squash their epidemics and are getting close to having something like normal society back.
"Assuming we'll all contract COVID-19 anyway, eventually" is not a reasonable assumption - it was the worst case scenario that the world has avoided and (as it seems) will continue to avoid. It's reasonable to expect that if we solve this issue through a vaccine in 2021, then by that time perhaps 10% of the world's population will have contracted COVID-19 and almost everyone else will not. And the expected difference between Sweden and France is going to be that by the time that we have a solution, one of them will have burned through more of their population for no good reason.
If you start with 10 cases and immediately take action like Taiwan, you have 7 dead. If you start with 10 cases and do nothing like Sweden, you have 4500 dead.
It couldnt feed its citizens without an economy.
Also note there's no exponential explosion in the rate of infection in Sweden or anywhere else that is opened its economy like the model for quarantine predicted to flatten the curve.
It's reached a steady-state in all of these places.
But, looking back on it, I'm pretty impressed with the results. Good foresight? Luck? Not really sure, but you can't really argue with results. As time goes on, you can see that it's a bit like surfing those huge 50 foot waves. If you can manage it, everything will be fine. If not, you are crushed. Fingers crossed.
The reality is that nobody really knows why, and there's a long list of potential confounded explanations (https://anond.hatelabo.jp/20200518004632 in Japanese).
It's really shocking to me to see to see that in 2020 humanity is so technically advanced (space probes at the edge of the solar system, chips at 7nm), yet so ignorant (how much do face masks, school closures, or climate differences affect the virus spread?)
https://www.bloomberg.com/news/articles/2020-05-22/did-japan...
Shows how hard this is to actually find out. We have an enormous set of natural experiments and still each result is giving rise to more questions than answers. Are smokers better off? Does malaria drug X really help? How much do masks help? Do kids spread it a lot? Why are men more affected? We have no clue. We probably never will either, for many of the questions!
Changing course in the US is seen as weak and politicians hate to do it, even when it’s the right thing to do.
Also: US media is in a bad place. They have lost their sense of civic responsibility and are blatant fear mongers now. It’s lead to a lot of hysterics in the US.
Sure, it wasn't the apocalypse, and not one serious person claimed it to be. Everyone could see from the IFR that even with the highest estimates it wouldn't kill the human race or anything; but even with the lowest estimates, letting it run amok would kill millions of people.
Big restrictions severely harm the poorest people. Most people are poor. They also damage economy and civil rights. Governments spend like crazy to make up for the damage and few dubious interest groups benefit the most. And politicians enjoy their power trips and erode civil rights. That's a huge toll.
If cemeteries in your place can't keep up, maybe its exceptionally bad there, but this is not the general situation. Also, if somebody dies there, there is no societal need for his body to be put in those cemeteries.
Some relaxing of COVID-19 restrictions can make a lot of sense even if millions of people are going to die as a result. So far 4500 Swedes are dead due to COVID-19 [1]. In recent years, over 50 million people die each year [2]. I'd say the Swedish model is doing fine, except for the most vulnerable group of people - old or sick people. The state response should focus on how to help that group, not to shut down whole country.
Of course, the proper local action depends on the local situation, how bad the outbreak is there, cost/benefit analysis.
[1] https://thenewdaily.com.au/news/coronavirus/2020/06/04/swede...
This is my point. When the medical system wasn’t overwhelmed, the restrictions should have been eased, but weren’t in many places. The goal posts were moved dramatically.
The early estimates for the IFR from February turned ouf to be quite accurate.
The only countries worse off than Sweden are significantly poorer - besides Belgium, which seems to be the only country counting correctly (e.g. untested excess deaths in Covid proximity are included).
The most similar countries to Sweden, regarding political structure and wealth, are Denmark and Norway, which have 20% and less than 10% of Swedens death rate, respectively. I'd say it's safe to assume that at least 80% of Swedish deaths could have been avoided with a conventional approach.
> I'd say it's safe to assume that at least 80% of Swedish deaths could have been avoided with a conventional approach.
What do you build that assumption on? Comparison to other countries, thinking "they have 1/4 the deaths and strategy X so if Sweden had strategy X they would have 1/4 the deaths"?
Half of the deaths were in elderly homes, and they could perhaps have been avoided with a different approach. That's the big failure. Old people who don't have care in their homes or live in elderly homes (e.g. retired healthy people) have been in full "lockdown" just like in most other countries.
The same is true for Norway, with Oslo leading the list and also having the most inhabitants. So there is no difference here between the countries.
The most successful countries have already managed to reduce their infection rate to almost zero.
And we don't know exactly why Sweden are hit the way it is. The exact week (February 24th to Mars 1st) where the schools in Stockholm had a winter break was the worse possible time for getting the virus back from Italy and the Alps. E.g. Gothenburg which winter break was two weeks earlier wasn't nearly as badly hit. There are just too many variables to assign any clear causes and effects yet.
But they shut down immediately to stop further spread. In Norway, things were spurred on even faster because a royal testing screwup in one of the biggest hospitals sent 30 people in quarantine. I think that event spooked everyone to take it seriously right away, along with some video conferences with doctors in Lombardy.
Textbook case of reducing the exponent of an exponential function early for massive benefits, if you ask me. That’s a very simple explanation. I don’t think the truth is more fancy than that. Even a week or two is an eternity when the doubling time is 3 days, everyone being unprepared and all.
OTOH, Sweden has pretty similar politics and cultural values compared to Denmark and Norway, which means people would react similar to measures like lockdowns etc. Additionally, health care professionals have a similar social standing (as opposed to Spain, where healthcare workers are often poor, which significantly worsened Spains problems).
I fully agree that we cannot have a complete understanding of the situation until everything is over, BTW! But Norway and Sweden are similar enough that a factor 10 difference in outcome cannot be ignored.
The outbreak is likely most defined by how large the initial/seed outbreak is, which depends on how early it happened (how ready people was and how much they had changed behavior already).
Some cities and countries had lots of travel in Week 9 (Week of feb 24) because of holidays. This is e.g. All of Belgium, and the Stockholm region in Sweden.
In Sweden its striking how much better regions that had the holiday just one week later fared (e.g. Sweden's second and third largest cities).
Obviously an initial/seed outbreak of 5000 infected people in a city, compared to an initial outbreak of 50 people will be very different.
It's like commentators on this particular subject assume this diseases was distributed evenly across all countries and the outcomes after that depends on the mitigations applied...
It's also peculiar how some routes didn't incur a lot of spread but others did. E.g. compare the travel from the Italian alps to Scandinavia - tons of people infected. But packed high speed trains between Lombardy and Rome left several times per day during the time when lots were infected but no lockdowns were in place, yet Rome managed with a lot less disease. No one can really explain that yet. Is it something about how the virus spreads that makes planes worse than trains? Is it something about the particular population in Rome having had a Coronavirus cold last season that Lombardy didn't? Who knows.
Maybe leaving schools, stores and restaurants open is not what's behind the high number of deaths in predominantly Stockholm, but something else, like how the elder care homes are managed. It doesn't seem fair to point to Sweden's high death numbers when Stockholm is a big outlier that skews the average. In most other parts of Sweden the people are doing fine, without lockdown.
That's not a correct way to count and is one of the reasons why comparing "COVID deaths" between countries is meaningless.
It's not valid because:
1. It assumes COVID is the default cause of death even though it's known to be a very mild disease for virtually everyone (0.2% IFR and estimates keep falling, not 100%).
2. It assumes lockdowns don't kill anyone, but that's known to not be true for all kinds of reasons.
The problem with this kind of reasoning is it looks motivated. It's what leads to fiascos like the New York Times publishing a list of 1000 COVID deaths and the 5th person on the list turned out to be a homicide victim. It's how you get reports of a 19 year old dying of COVID and then it turns out he had leukemia. It's how you end up with COVID death counts going down by large amounts in various parts of the world, as we're seeing now, because cases get re-evaluated and discovered to be incorrectly attributed.
And all that ignores the problem of severe co-morbidities in the elderly, who often are claimed to have died of COVID even when they had major pre-existing problems and were about to die anyway.
These things destroy public confidence in disease statistics. The message that COVID death counts don't mean anything hasn't really got out yet but in time it will.
And this nonsense of how Sweden will be better of in a second wave.. why? Because people are already dead?? They are not even done with the first wave, they are litterally #1 in deaths pr capita.
There have been a multitude of reports from other countries on how they fail to account for all deaths, let alone all deaths from the disease, for instance.
The death toll is severe though, no two ways about it, but therea are also a lot of factors to weigh in, such as:
- What could have been done instead? There are several countries with radically different measures that still face high numbers of reported deaths
- Would more severe restrictions have mitigated the most damaging vectors? A lot of the deaths come from elderly homes, for instance, and further lockdowns wouldn't naturally have prevented that (as much as, say, more personnel in elderly care)
- What will the secondary effects be? The effects of Covid-19 go beyond the deaths from the disease itself. How many will die from the economical impact of lesser, or more severe restrictions? For instance.
These are all difficult considerations and near-impossible to answer.
Look here[1] to see that Sweden is the only Nordic country with under-estimated deaths for this period.
Living in Sweden I must say I'm really tired of constantly hearing that other countries are just "cheating" by under-estimating their covid death-rates. The whole thing is seen as some type of bizarre competition.
When the supposed herd-immunity rate was re-calculated by the Swedish-resident statistician Tom Britton to possibly be around 40%[2] the news was widely discussed as though Swedes had won some sort of 'race' - one of my colleagues actually punched the air and said "I knew we'd be first!" (the actual rate of antibodies is around 7-10% in the worst-affected Stockholm area)
[1] https://www.nytimes.com/interactive/2020/04/21/world/coronav...
[2] https://www.expressen.se/nyheter/coronaviruset/hoppfulla-teo...
The assumption then is that the difference between 1% immunity, 10% immunity or 20% immunity is massive when it comes to how strict any tracing regime, temporary lockdowns and so on need to be during the next outbreak. If that's the case remains to be seen. But if it is, then that's the answer to the "why?".
There is no evidence that the quality of data from Sweden, should be better then anywhere else. Sweden actually has a testing problem, so by design, missdiagnosed could be higher in Sweden. There are very very vey few undocumented people in Scandinavia.
Looking at graphs of excess deaths compared to previous years the graph for Sweden is pretty much identical to most Europen mainlaind countries. It spikes at the same time, and it goes down at about the same rate at the same moment, which is when the governments of some countries went into lockdown, while Sweden just advised social distancing etc. But the effect was pretty much the same as e.g. here in the Netherlands, Belgium, parts of Germany, France, Switzerland, etc.
I get this feeling some people really want to rake Sweden over the coals because their policy is supposedly 'killing more people', but the numbers only show this when you compare against direct neighbors, and not at all when you compare to EU mainland countries. Coincidentally, Sweden was one of the first countries that had its first confirmed cases, way before other countries, and way before everyone realised this was going to get bad. So it's very likely that the high number of early infections that went undetected lead to a later spike similar to countries in mainland EU, and, as a result of that, similar statistics in terms of excess deaths. Other nordic countries may have dodged the bullet simply by virtue of a having a little more time before the exponential increase in infections started to get out of hand.
Also (and this seems to be an unpopular opinion around here), maybe we should accept the fact that a certain number of deaths/capita will be inevitable, even for those countries like Norway/Denmark etc, at least in their more densely populated areas. Countries like Netherlands and Sweden had a big spike where many people died in a short time, the vast majority being old (80+ year old) people and people with one or more comorbidities. In the past three weeks, the excess deaths here have been negative compared to other years, and if you look at the area under the graph for total excess deaths for this year so far, it's not that much higher than for the 2018 flu season, which was a much lower spike but it lasted for much longer. It's very likely that over the next months, barring a vaccine, excess deaths in countries that have very few corona fatalities so far will go up and linger higher for a long time.
There was a study posted here recently that showed a very high correlation between the chance of dying from corona now and the 'normal' (ie: before-corona) chance of dying in the next year, through different age groups, health risk factors and some other variables. I think it's fair to say we have to wait for at least one or two years before we can draw any conclusions at all about which countries handled this right and which didn't, or if it even mattered at all. One data point that indicates that maybe there wasn't really a way to prevent all these deaths, is that when you compare countries where the number of hospitalized corona patients spiked similarly before any measures were taken, it seems there is next to no difference in the progression of infections and deaths between countries with ultra-strict lockdown measures and countries that were a little less strict. Things like face masks, closing schools or banning outside activities appear to have had no effect whatsoever.
And yes, some number of deaths is inevitable. That does not mean that every life saved isn't still a life saved. There is not a set quota of deaths that will inevitably happen, and you can choose to have them happen sooner rather than later. Any extra deaths will mostly be on top of the number of unpreventable deaths.
Sadly, the discourse affects the results. When everybody believes a lockdown will work, it does. When about half the population isn't sure about it, it just wastes money.
It would be great to have some countries go all-in in one strategy and others all-in in another, and compare results later -- but when people talk, you end up with lots of countries effectively doing something in the middle, without the advantages of either extreme but essentially all of the costs.
As far as I can see, calling Tegnell a scientist is incorrect. He may have a Ph.D but does decisively not behave scientifically. Instead he should should be called a bureaucrat, which much better describes his behavior.
The catastrophe that is swedish covid-19 strategy, probably started as something like this: http://www.openias.org/swedens-covid19-strategy
They believed Covid-19 was much more infectious and much fewer people were seriously affected, than we now believe.
This was understandable at the time, since it's known that early on in an epidemic only serious cases are noted, and so infectiousness is underestimated and mortality usually overestimated. However, towards march it became definitely clear for most everybody else that covid-19 was fairly serious for many people and the Chinese mortality numbers were not vastly exaggerated.
Because of his belief in an exaggerated infectiousness, Tegnell believed herd immunity would be reached fairly fast. Most of april Tegnell spent on justifying his faulty assumptions, believing herd immunity was to be had in Stockholm in may. To justify this, they used highly dubious modelling and wishful thinking: https://twitter.com/AdamJKucharski/status/125408476749626163...
Sweden currently is now sitting in a horrible quagmire. The infection is still uncontrolled and mortality, though below its peak, is still significant. Testing infrastructure has still not been built out, and is still not done on all symptomatic cases. Likely because the infection was seen as having a similar severity to flu, and therefore it was presumed better to just stay home for a few days, than to go and get tested.
Tegnell can not admit having been wrong, because of bureaucratic honor. The population which are, like in all other countries, generally not very scientifically literate or interested, have not quite fully grasped the situation. But judging by the latest polls of confidence in the government, many are starting to suspect something is not quite right.
I fully support a very open debate, and believe all opinions have a right to be heard. But the Swedish situation should not be confused with science. It saddens me to say, that only very few countries have been more passive, bureaucratic and unscientific handling this crisis. And that seems to have cost quite many lives and much suffering for swedes.
This is a strawman!
[0] https://www.youtube.com/watch?v=bfN2JWifLCY [1] https://www.svt.se/nyheter/inrikes/folkhalsomyndigheten-drar... [2] https://www.aftonbladet.se/nyheter/a/3Jyxmq/flockimmunitet-i...
Both Johan Giesecke (a consultant for Folkhälsomyndigheten, which is Tegnell's workplace) and Anders Tegnell has repeatedly been saying, that modelling suggests, herd immunity will occur in may.
Along with many others, who are working at the Karolinska Institute, that are closely cooperating with Folkhälsomyndigheten, like the the professors Jan Albert, Anders Björkman and Tom Britton.
Here is Johan Giesecke saying it in english: https://www.youtube.com/watch?v=kOxITQQ8F3w
https://i.imgur.com/Wca1VeY.png
I'm not sure what changed.
I wouldn't worry too much about it.
From another comment below:
Sweden vs Czech Republic (both 10M):
New cases (7 day average): https://i.imgur.com/fciq4Ra.png
Total deaths: https://i.imgur.com/do9Zbvn.png
Can’t reveal my source but one region of England had over 80% complete compliance with government guidelines. That was as of a month ago.
That's an odd thing to say. What is the reason?
In my opinion he _lacks_ charisma. He's just a scientist. Which is good.
They are also basing their strategy on the belief that getting the disease grants immunity, which, according to WHO, there is currently no evidence of.
Perhaps saying that they were "wrong about almost everything" is an exaggeration, but they were certainly wrong about a few very important things.
There strategy is focused on the long-term. Obviously allowing a higher infection rate is going to lead to more deaths initially, but their argument is that eventually everybody everywhere else will be infected (it will keep coming back), in which case the death toll over the long run is the same.
>They are also basing their strategy on the belief that getting the disease grants immunity, which, according to WHO, there is currently no evidence of.
There's no direct evidence of but it's still incredibly unlikely it's not the case, given what we know of how all similar viruses behave.
- Foreseeing the possibility of local transmission in Europe during the early stages despite first cases popping up in Italy (when many informed, interested lay people understood that this will happen with high probability).
- Not recommended any measures to prevent thousands of travelers returning form Italy, Austria and the US from spreading the virus in Sweden in early March.
- Claimed that there won't be any risk for widespread spread in Sweden.
- Over and over again made claims that "the peak of transmission has been reached" once it started in Sweden during March/April - every time incorrect.
- Underestimated the fatality rate (by being overly optimistic and by a assuming that most infected with the virus won't show any symptoms - a totally baseless assumption).
- (Ironically) denied the existence/significance of asymptomatic/presymptomatic transmission (he's still not admitting that it plays a significant role).
- Not foreseen that asymptomatic/asymptomatic transmission will, through workers, bring the virus into elderly care.
- Made multiple, way too optimistic claims about when Stockholm might have reached herd immunity (May, June) - in reality, it's far far away.
- Making assumptions about effective, lasting immunity without the existence of any actual evidence for it (thanks tsimionescu for the addition).
- Ignored/denied the potential of wide-spread usage of masks to reduce transmission (instead, only focusing on its disadvantages "False security", "people not using them correctly")
- Claimed that children don't spread the virus in significant ways (as far as I know, there is no consensus about that).
This is just an excerpt. I'm an armchair epidemiologist (however one who has monitored this situation closely since February), so I am not stating that I got everything from the list above perfectly right. But I am informed enough to understand that he has been mostly wrong, ignorant, or unwilling to take in new information. Which makes me wonder: Why outsource everything to an "expert organization" when they perform so incompetently.
I have no time now to present you with sources for each of the things from this list. You can either do that yourself, conveniently assume that I'm making all this up (which I don't), or present me with anything he did/claimed which actually turned out to be correct. It's harder to find that, than to find things he was wrong about.
Personally I also think he lacks Charisma. But judging from how large parts of the Swedish population at least until recently loved him, some even got themselves tattoos, he clearly seem to have something which captivates the broad masses.
But I would add that if you take a risky decision in a scenario where the potential downside is mountains of corpses on the streets (or a Lombardy scenario), and then it turns out not to happen, you might have not made the objectively right decision. In hindsight, you got lucky, so it was OK; but maybe confronted with the same situation again you should choose differently. (I guess Tegnell would argue that he had reasons to be confident that Sweden wouldn't become Italy, and that it wasn't just a matter of blind guessing.)
I get the impression social media is killing off this sort of approach (or maybe it's some other cultural driver). There seems to be a clear trend toward monoculture for everything.
From what I've read about SARS-CoV-2 it doesn't reproduce that way, it mutates relatively slowly in the usual random minor errors fashion.
Because of the slow mutation rate of SARS-CoV-2, we're able to easily trace its spread across the globe by comparing genomes of collected samples. [1]
This of course also bodes well for vaccination efforts, as well as developing robust herd immunity.
[0] https://en.wikipedia.org/wiki/Recombinant_virus#Natural_reco...
[1] https://www.nationalgeographic.com/science/2020/03/how-coron...
So we will get herd immunity to COVID-19, or all be dead. And that hasn't happened in the last million years.
There is no vaccine yet, so the only sure thing is herd immunity. The US is especially vulnerable because we have so many patients in so many locations - testing and tracing isn't going to work in the US. The horse left the barn on that one.
"The SARS-CoV-2 spike is significantly different from any other Sars that we have studied"
https://www.cambridge.org/core/services/aop-cambridge-core/c...
Once in a while a flu virus learns to trigger the immune system of those with immunity to flu viruses, and then flu pandemics happen, but that is a rare occurence relatively speaking.
herd immunity is a property of the herd and not any single person, though.
In Sweden, 4,500 people have died. In neighbouring Norway, 237 people died. Even adjusted for population, Sweden has 10x the deaths.
I'm a scientist as well and my math skills say their strategy sucks.
Sweden is not the highest in Europe, per capita, it’s fifth [0]. So it’s pretty bad out of 31 countries but better than Belgium.
[0] https://www.statista.com/statistics/1111779/coronavirus-deat...
The world's apparent obsession with the Swedish strategy isn't about Sweden at all. It is about their own strategies, trying to prematurely pat themselves on the back for doing the right thing, whatever that was. There's myriads of variables that differ between Any two countries.
Sweden's path has been conventional. The attention is coming from nations that executed extreme and even revolutionary policies of universal home arrest, "shutting" an entire nation like a coffee shop, and sending a 30%+ of the workers onto unemployment.
This ultimately comes back to the so-called "Trolley problem,"[1] which some posters in this thread have brilliantly acknowledged. Would we throw the whole world out of work, or imprison them, or bankrupt them, to save 1 life? If not, what is the limit or deciding principle?
You say "this", and then proceed to state the exact fallacy the OP made as a truthful observation.
> Sweden's path has been conventional.
Yes. Sweden's path has been conventional. Italy's path has been conventional as well.
There is this whole wave of misapprehension and misunderstanding on HN, especially when it comes to the pandemic: "My opinion is backed by facts, therefor all other opinions must be political and I do not need to think about them because my opinion is correct", which is a form of circular reasoning.
> This ultimately comes back to
This ultimately comes back people whose day-job entails shoveling data with computers and being (or at least feeling) smarter than average, and as such feel at least somewhat qualified as a statistician/epidemiologist.
One of the few things that is clear is that the spread and the course of the disease has an enormous amount of unknown confounding factors.
This means that any approach within general ethical boundaries is valid: from making future prediction based on the most advanced epidemiological data to date, to a system-wide shutdown of "doing the things that are very likely to worsen the situation".
None of the scientific advisors to the various democratic governments are complete idiots, and even none of the elected government officials involved are out to willfully wreak havoc on their populations.
Find out what works. Find out what doesn't work and why it doesn't work even though it seems to work elsewhere.
Sweden's approach is valid. Italy's approach is valid. The chances of any one person getting it exactly right the first time are negligible, so there is no point in cheering for what one believed to be the "winning team".
To spell it out for you: you are not right. You are, at best, less wrong. And to paraphrase the OP, "it is about their own opinions, trying to prematurely pat themselves on the back for believing the right thing."
Quarantine is an age-old method of disease prevention. There is nothing revolutionary about it.
And your mention of the trolley problem is bogus. Early containment measures would have saved lives and the economy. There was no dilemma there.
I think you used the right ethical analysis tool, but I think you got the ethical analysis wrong.
As opposed to abusing the situation to rebalance a ponzi scheme pension system? After all, most of the people dying have stopped contributing taxes, so nothing of value was lost. Right?
Another thing to note is that most countries didn't just cause a huge number of people to lose their jobs with no plan, only US did that (because it's a 3rd world country). Normal people use the QE money to keep everyone safe and healthy until the danger passes. Which it does, if you take proper measures and close down travel from red zones.
Viruses don't become benign just because people aren't in the mood to deal with them anymore.
Tegnell and folkhälsomyndigheten (FHM) have clarified their strategy as:
Keep the number of infected people down at any one time to not overwhelm the health system.
Groups at risk for severe disease should quarantine themselves.
But they have also repeatedly indicated that they don't want to stop the spread of infection completely.
And that they are not running a strategy aiming at herd immunity, though when most people have been infected there will be herd immunity.
That sort of communication leads to confusion, as the difference between a strategy that aims for herd immunity and one that will lead to herd immunity, at best is purely semantic.
I think it's a bit more than semantic at least. "use mitigations that are as effective as possible while still being sustainable in the long term". So long as healthcare isn't overwhelmed and R is kept under 1, these mitigations aren't leading to herd immunity because the outbreak is going to disappear before that, most likely.
If you accept an R on or over 1 then you are using a strategy that will lead to herd immunity.
Of course, in the long run we are all dead anyway, so I'm not certain what's best!
What's alarming is that there isn't sympathy or discussion of the way lockdowns are putting lives at stake, when control of the virus is an illusion.
It's natural to be alarmed at overly authoritarian responses, the justifications of which are diminishing as we get more information.
Sweden, as far as I understand, is doing very little authoritarian intervention, but are providing thre public information so they can make their own choices with respect to risks they want to take.
I think we must remember that "lives at stake" aren't just Covid infected. People will die in 10 years from budget cuts coming from things we do now. This isn't about counting bodies in the spring of 2020 (only).
I think there is at least two things going on: - The long-run approach being taken makes it seem like nothing is going on, since there isn't much action. Slow and steady easily registers and stillness. - Tons of misreporting, in all directions. I get newsclips from friends in the UK that are just out wrongwrongwrong, and they are wrong in different ways and directions!
With this being said, I hope that Sweden's approach is in't the best! Why? Well, that would mean that large parts of the rest of the world is doing something better (if we simplify it into "lockdown" vs "limited restrictions"). That would cost us here in Sweden 1000's of unnecessary death, but perhaps spare millions in the rest of the world.
And now the US is reopening and attempting a similar approach to Sweden. You can’t shut the world down for months and months waiting for a vaccine.
* UK 585
* Spain 580
* Italy 556
* Sweden 450
* France 445
* Netherlands 350
* USA 330
I've watched over the last few months as people in the US flip flopped:
Center-left folks who cite Sweden as an economic model but trashed the way they handled the virus due to their support of lockdowns.
Center-right folks who normally claim Sweden is nothing like the US and therefore we can't emulate their economic policies, but then point to them as a model for reopening.
Similarly, every single mention of antibody tests on here results in a similar collection of highly-intelligent people not recognizing their own drive to validate their preconceived beliefs.
That part about recklessly endangering Europe (!) is hyperbole, UK, Spain and Italy has more deaths capita but apparently the EU can handle them, so...
* Source for death per capita is https://www.worldometers.info/coronavirus/#countries. I've heard something about them not being fully reliable, but the death statistics should be comparatively easy to aggregate, so I'll use that number unless obviously wrong.
A lot of course being in the eye of the beholder.
I think that seems a less cynical and perhaps simpler explanation for why people would be obsessed with Sweden.
It seems to me that Sweden's strategy is attracting more attention (in form of primarily criticism) than f.x. Belgium's, despite the latters deathrate being ~2x that of Sweden's. To me that indicates that the issue is the strategy in itself, and not the magnitude of the failure of it. Other countries have failed worse (although thankfully the vast majority of countries are currently doing better than Sweden, hopefully forever). Why would people care about 4000 dead in a small country far away, when many don't give a damn when 4000 people die from starvation or malnurishment?
Because it says something about _your_ country and _your_ strategy.
For me that is the simplest and not at all cynical interpretation of this. I will admit this is speculation, but I don't think I claimed certainty.
PS. I'm _guessing_ our Achilles tendon is certain organisational deficiancies in the care of the elderly. How it's done and at what stages of life one is moved between different kinds of care. Even if I'm right (big if) I fear that the outfall from this might be "me caveman gruk, weak restrictions bad for COVID19, dum-dum-donut", or the equivalent opposit. That would be sad. PS.
PSS. Belgium seems to be the most "liberal" country in terms of including suspected COVID19-related deaths in the official statistics, but those are the numbers at our disposal. DSS.
I am inclined to agree with grandparent's comment: there is a lot of "we did better then them!" at play in the media.
One doesn't need to set foot in Sweden to form an opinion about how things are going.
It scares me that there are people (even in this thread?!) who say Tegnell is some wicked scientist experimenting on the swedish population.
Feels like some people read a buzzfeed article on viruses and suddenly they are an expert that somehow figured out the things that the government agency for national health did not. "No, my extremely limited knowledge about virology tells me that I am right and the only logical conclusion is that Tegnell is a wicked scientist". For gods sake... Grow a brain, will you?
Scientists are trained to make judgments based on experimentation and evidence. In a fast moving novel pandemic situation, where there is no time to carry out experiments, where evidence is confused and hard to corroborate, their utility is much reduced. That is why politicians exist, to make these hard decisions. It is unfair to pillory scientists such as Tegnell, as it is the politicians who abdicated responsibility in the face of this crisis that should rightfully face condemnation.
Except of course, there was evidence, from China, Taiwan, South Korea and elsewhere. It was clear what needed to be done, and how to do it. Shame on Sweden, and other places, for not heeding that guidance.
Maybe "be infected", not "die"?
Otherwise there's little reason to flatten the curve (meant to allow for better treatment).
Where I live, in Victoria, Australia, the state government has used the lockdown time to plan for and deliver a huge increase of ICU beds [1]. Thankfully, it looks like these beds may not even be necessary, but initial modelling suggested a peak of 10,000 active cases with only 500 IUC beds available.
[1] https://www.theage.com.au/national/victoria/thousands-of-bed...
Perhaps counterintuitively, the points on the strategy curve that have both lowest death counts and shortest widespread economic crisis are the same. I've published these simulations here: "Surprising COVID-19 Strategy: Reduce Economic Damage and Deaths Simultaneously" https://www.youtube.com/watch?v=NuNrkG188HA
- No effective treatment or vaccine will arrive within a year.
- Measures that completely eradicate the virus aren't sustainable for the time it takes to do so or until a vaccine arrives (e.g. lockdowns),
- Without at least some immunity, "Test, Trace, Isolate" is not a viable strategy for dense regions.
- Without at least some immunity, a second wave is unavoidable, and risks being worse than the first, if it arrives early next season. It's better to have a small immunity in the low risk population now, than let risk high risk groups later.
- Even a small level of immunity has a large effectiveness in limiting spread, i.e. 10% or 20% immunity in a region can make a big difference, so if that can be achieved in the low risk population that is a good thing.
- Asymtomatic spread, presymptomatic spread, and spread from children are all possible but not significant (That is: if symptomatic spread is controlled, that is enough).
Some of these assumptions have been challeneged, some were not at all controverrsial to begin with but have changed over the last months.
Are they? The current IFR estimates (general, not counting age divided groups) range between 0.2 and 0.9%. That might still include a significant number of individuals, but it's not very high (of course by age groups, this changes).
I still wonder whether the high death rates in some countries, including my own, were not due to the virus itself being very deadly, but because it found "niches" of vulnerable people (hospitals, nursing care homes). I don't think anyone has yet studied these dynamics in depth.
It might still be true, but the actual support for it seems to just be cherry-picking.
The point I was trying to make, which I don't at all think is based on fear, uncertainly and/or doubt, is that any two countries will differ on so many variables that one can almost freely pick what correlation one thinks is the important one. To do something akin to that and the go "shame on you" feels wrong.
I have been closely following the progress of the situation in the country and the leadership is very messy and very clueless about the entire situation, both from the government and from the portuguese health agency in particular.
https://www.euromomo.eu/graphs-and-maps/#z-scores-by-country
Data for each county in Portugal is available here: https://github.com/dssg-pt/covid19pt-data/blob/master/data_c... - graphing this data shows that Lisbon and its surrounding councils have been putting on new cases at a steady rate (linear for now!), albeit low numbers in the grand scheme of things. I don't know what the Portuguese government is going to do about that, or how effective their action may be. I live nearby, so I am particularly concerned.
One could argue, like some Iraq war proponents do, that the idea was ok for Sweden, but the failure was in execution. But one can not argue that it wasn’t a significant failure.
The actual spread of the virus is a fraction of what Tegnell predicted. They were predicting close to 60% by the end of May. It was in the low teens with about a week to go in May in Stockholm.
Their primary goal was to protect the vulnerable ie the elderly. But Tegnell did not believe in the existence of asymptomatic carriers (well after other countries had locked down because of them) so care workers who were infected but not showing symptoms were in constant contact with the elderly since his guidance required them to avoid going in to work only if they showed symptoms.
Both of these were the primary stated goals. Neither were achieved.
That's why elderly care facilities were the first, if not only ones, to face quarantine.
However, when you have years of poor management of elderly care, and elderly care companies that refuse to heed the recommendations, there's not much "Sweden" can do in the moment wihtout severe effort.
Either the state (highest level) should have forced an intervention, or all actors should have acted responsibly. But there is too much inertia. The elderly care is so poorly managed, it was not only a disaster waiting to happen, it actually was a slow burning dumpster fire even before Covid19.
So many wasted opportunities.
Edit: Also, your comment basically justifies the lockdowns in every other country. Tegnell’s whole argument was that the enlightened Swedes didn’t need a mandatory lockdown because they would simply do the right thing without the government telling them. And there is some truth to that in a society that is wealthy, well educated, and highly trusting of its government. Despite that, it’s citizenry failed to achieve what Tegnell said they would.
How in the world would you expect other countries’ citizens to voluntarily do what the government was recommending when Sweden couldn’t? His criticism of lockdowns in other countries was completely unwarranted based on his own reasoning for why Sweden didn’t need a lockdown (which also, as you point out, turned out to be wrong).
It will be very interesting to see how things go in Norway compared to Sweden in the next weeks and months.
That much should be obvious. The criticism early on was "Oh my god look at these simulations you'll have 25k ICU beds needed and you have only 1k", 50k will die before july!
When that didn't happen, somehow now the message is that 4k dead and emergency hospital capacity never even used is a complete failure - because Norway has fewer deaths?
I think if anything we should be happy that most of Europe managed to actually contain this disease and people weren't left to die without ventilators as the early alarms said. Whether 500 or 5000 die in a country is a big difference, but remember we were fearing tens of thousands in every countruy.
Of those over 70, half of the deaths were in care homes and another 26% had home care [2].
Many of the workers in care homes have reported that their companies/bosses won't allow them to stay home when they're showing symptoms and some have been forced to work without protective equipment.
There have "only" been 42 deaths under the age of 50 [2].
[1] https://www.svd.se/90-procent-av-alla-doda-i-covid-19-over-7... [2] https://www.svt.se/nyheter/inrikes/halften-av-alla-doda-over...
In the age group between 50 and 70, which you didn't directly mention, 455 people have died.
[1] https://www.svt.se/datajournalistik/har-sprider-sig-coronavi...
Croatia has not had a single case of COVID-19 for 3 days in a row [1], and has been allowing citizens of several European countries, including ones like Germany, come there [2], since mid-May.
This stuff is not rocket science, and while Croatia will not completely eradicate COVID-19, which is unfortunate, it still is impressive.
[1] https://koronavirus.hr/en [2] https://koronavirus.hr/frequently-asked-questions-and-answer...
The only common way into New Zealand is a flight or an occasional ship. NZ has no immediately neighboring countries that it runs freight trucks to and from day in and day out, and it doesn't need to move large numbers of agricultural workers around internationally. Therefore, for New Zealand traffic is obviously going to be smaller and easier to control than European countries.
[1] https://www.cnn.com/2020/06/03/economy/may-jobs-report-previ...
https://www.rnz.co.nz/news/political/416633/budget-2020-50bn...
https://www.stuff.co.nz/business/121704549/almost-half-of-re...
It is not feasible to lock down Brazil or Mexico - more people would die because of the lockdown.
As for the Swedish approach - the rest of the world hates it primarly because long term it might just prove that the lockdowns were both ineffectual and unnecessary perhaps even more damaging.
OTOH I agree that lockdowns in many countries have been very poorly done. In particular, a lot of countries have used lockdowns as a delaying tactic with no clear strategy for eliminating the virus or avoiding endless cycles of infection and lockdown --- certainly no clearly communicated strategy. In those cases, indeed a relaxed lockdown with more infection might be better in the long term.
This is already what it's looking like when comparing across states in the US.
NZ's tourism industry is a large chunk of their GDP and will be reduced significantly until borders are open again. Re-opening borders after elimination is political suicide as all you need is one person to start the whole thing again.
Other affected industries are international students and TV/film production. We will be admitting people for those with at least a 14-day quarantine and testing. That's not much fun but if you're a student or a media producer NZ looks like a particularly good destination at this time.
All assuming we can keep COVID down, of course, which we shouldn't take for granted.
Yeah, our economy's going to hurt, but countries wracked by ongoing COVID and various levels of lockdown for the forseeable future will suffer worse.
Surely once you have opened the borders it is only a matter of time for a new case to be imported (if you look at NSW right now, we've had a week of no local transmission but near-daily new cases for returned travellers, who are luckily in forced quarantine).
You could force-quarantine everyone for 14 days but I would not call that an 'open' border and it wouldn't do much to help the tourism industry.
He predicted that the virus was circulating many times more widely than people thought (20-25%) -- and posited much of his strategy on that.
In reality that appears to be closer to 7%.
He was also particularly wrong in attacking other countries - and the underlying Imperial College study that influenced them - for locking down in the way they did.
18.1m people came in and out of the UK between January and March in the UK -- nearly twice the entire population of Sweden. What was optimal for Sweden would never have been optimal for others.
Yep. This is critical. The UK originally wanted to follow the Swedish strategy, but it was a disastrous failure that left us with the highest per capita excess death rates in the world, only brought under control by lockdown.
Sweden was somewhat more isolated hence the initial growth of the disease was slower, and was considerably more isolated over everybody else's lockdown period.
He said: we should have had more labs, locked down retirement homes, but we shouldn't have asked students to stay home.
Every country will have to adopt the Swedish approach eventually or find themselves caught in an endless cycle of lockdowns.
It seems to me that the experiment is countries trying to eradicate the virus through lockdown as opposed to just slowing it down, with no evidence that this is working or could ever work.
NoW that the virus is better understood and we know that the people at risk are mostly people at the end of their life the continued tyrannical lock down Of the general population in many countries is a failure of leadership, not a success.
The large number of hysterical articles condemning the Swedish approach reflects the fact that people don’t want to admit that they made a mistake and want to desperately justify doing something really stupid.
The R number will be lower at this later stage than they were in an early-hit country with no preparation.
The biggest mistake Tegnell did for Sweden, was wasting the first month of the epidemic out of hubris. This laid the groundwork for the persistent epidemic they have today, which stands in obvious contrast to their neighboring countries — most of which now have a daily life similar to Sweden, except with the epidemic under control.
10x per capita difference in deaths as compared to Norway, 5x to Denmark. Similar for other markers. Initial conditions similar, except for different response from leadership.
The estimates I have seen suggest that the people dying lose, on average, 10 years of their life. That's not exactly insignificant.
So on average everyone dying at that age loses 10 years of life.
75 to 80 years old is also the mean age of death from covid.
Im going to go out on a limb and say that it is likely that people on average that die from covid do not lose 10 years of life.
This does not make it less of a tragedy for the individuals involved.
It seems to be working in Vietnam, New Zealand, Hong Kong, Taiwan, South Korea, Australia, and others ... even China probably.
Those countries have achieved local elimination or very close to it and are reopening (or never locked down) and have not yet had to (re)turn to wholesale lockdown.
So "Every country will have to adopt the Swedish approach eventually or find themselves caught in an endless cycle of lockdowns" is, at best, not proven.
Four thousand people would like to have a word with you, but can't, because they are dead.
New cases (7 day average): https://i.imgur.com/fciq4Ra.png
Total deaths: https://i.imgur.com/do9Zbvn.png
I think there is a lot of "I believe X would give outcome Y and I see outcome Y therefore X must work". This mistake is called Affirming the Consequent.
Without clear signs of causation we can't know.
Swedens situation is not the worst in the world, but they really did not win much with their "strategy" either. Talk of "reaching herd immunity in a few months" was irresponsible and heavily fatalistic. As a country with a big public sector they could easily have followed a slightly more conservative approach. An "initial freeze, then plan accordingly" would be a more rational way to go. It was also irrational to assume that their economy can "rebound faster" when most of the rest world is shut down.
Epidemiology did not wear its best suit in this pandemic, and will lose a lot of respect in the eyes of many[1]. Scientists have a duty to inform people when their results are being misused or misinterpreted
1. https://marginalrevolution.com/marginalrevolution/2020/04/wh...
Anyone with a background in mathematical modelling should be extremely cautious of applying models in situations where there are serious ramifications to getting the wrong answer.
Hubris.
I think "locking millions of people inside" is one of the most serious ramifications you can imagine too. It's like we lost all grip of what suffering and cost is so long as we save lives. I'm not saying we should value lives highly but we sure didn't value them this highly last year and we probably won't next year...
Sweden's economy, which relies
heavily on exports, is expected to
shrink 7% in 2020
[neighbours] dropping mutual border
controls but would keep Sweden out
[0] https://www.nytimes.com/interactive/2020/05/15/world/europe/...
[1] "Preliminary evidence shows Sweden has suffered similar economic effects as its neighbors: The Swedish Central Bank projects the country’s G.D.P. will contract by 7 to 10 percent this year, an estimate on par with the rest of Europe. (The European Commission projects the E.U. economy will contract by 7.5 percent.)" (Ref [0])
Markets and money are vehicles for making agreements. They are all about negotiation. They are imminently and manifold fungible. They are contrivances. A deadly virus is not.
Let's also not forget for every death from C19 there are a handful-dozen people who survive to lifelong health problems from the episode. That has a cost, too.
Regardless about how you feel about Sweden's strategy Bloomberg's obvious manipulation is garbage.
Also, the medical approach to people getting sick with COVID-19 has significantly improved over the first month (e.g., early hospitalisation instead of sending a sick person to isolate themselves at home, weeding out drugs that did not work from those that worked, introduction of drugs to control trombosis and secondary damage from the virus, better approaches to when and how use ventilators, etc.).
That means that a number of the deaths that have occurred within the Swedish policy could have been avoided by delaying the infection. More importantly, Sweden's approach has not even achieved a significant level of immunity, as Swedes have been self-imposing social distancing and even a 'lockdown' (working from home).
In an interview in "unherd", Giesecke estimated that the deaths in UK without lockdown would be in the 12,000 (when they where 13,000), then corrected himself to 24,000 (they are almost 40,000 now), and then said they will not be 10x 12,000.
On freedom. The lockdown for reasons of public health is a limitation of our freedom that has been accepted (except in Sweden) by their citizens in their respective contracts as a society (constitutions, laws, etc.). So, per se, it's a limitation akin to not driving over a certain speed in certain roads. Moreover, many people (and students) have reported that the lockdown has been "liberating" - and for others have been depressing (it never rains to everyone's liking)
On ending the lockdown. Tegnell and Giesecke repeat and repeat and repeat that countries imposed a lockdown without a strategy out. Well that's just dire false. When the lockdown was being discussed, the press was already pointing that issue and several strategies were being considered (press from March already discusses the measure by measure approach).
But, whereas other countries are looking conservatively with the evidence (that could be flawed because it is small and incomplete) that they already have, Sweden is relying in an evidence that will only be apparent in the future (if the events turn out to be advantageous for that approach).
If each country had been given an "ant population" with some infected individuals and their epidemiologists needed to manage the epidemic long term while a cure for the ant's illness is found, maybe, the Sweden's approach would have made more sense... At least, most people wouldn't have had much feelings for those ants that could have lived a couple of days longer.
I've seen this sentiment elsewhere that "Swedes have taken it in their own hands", no we are _listening_ to our experts on what to do (in many cases, people seem to have a harder time now that there is some sun out..).
I can't speak well of the Italian expert panel. On the day of the "reopening" (not a reopening, but I digress), May 4th, they quoted a non-public report saying that the worst case scenario (out of 92) would bring 150,000 Italians needing ICU care by June 4th. AFAICR, no other scenarios were made known.
The report was then leaked (or made known somehow). It had no author information, and contained a lot of old and inaccurate models, and totally arbitrary and unjustified statements. In short, it was utterly wrong.
A critique of the report (in Italian):
https://www.scienzainrete.it/articolo/fase-2-e-alcune-questi...
(second half, the first part is about some questionable policy decisions from a legal standpoint)
Some Italian experts also say that physical distancing and masks are useless (supporting an indefinite lockdown). The government itself said that masks were not effective until very recently.
There is also a lot of confusion (for the lay person) because many contradictory statements are often said.
That 40,000 number is "people who died, after testing positive, with a test administered by a Public Health or NHS laboratory"
The actual number (excess mortality) is closer to 60,000.
He has furthermore been a paid consultant for FHM for many months now. So he is not just anybody.
https://www.reuters.com/article/us-health-coronavirus-sweden...
What happened in 1993?
A Flu Pandemic...
That no one has ever heard about, that seemed to have no lasting impact, and occurred when the population was younger and 25% smaller (thus having a proportionally much greater impact).
Without the media panic, COVID-19 would have come and gone as a unusually deadly flu wave, nothing more.
Second, there was also a massive (and local) financial crisis in Sweden during 1992 and 1993, resulting in mass unemployment. The federal interest rate peaked at ~500% in 1992. While influenza deaths are always tragic, the financial crisis is what most people will remember from those years.
Also, the population was roughly 15% smaller in 1993 compared to 2019, not 25%. No matter how you measure it, COVID-19 has proven to be far deadlier over the span of a few months.
Given the explosive dynamics of COVID-19 that soon converges to R<1 going for herd immunity was most likely a bad choice.
For Germany cutting the flu in half worked - while the bad math of the epidemiologists-community seems to last forever...
I think this has been repeated a lot. No one is "going for herd immunity". Every country including sweden has two goals: having as few as possible infected and preventing healthcare from being overwhelmed. If partial or full immunity makes the virus go away that's a fortunate side effect of slow burn, not the "goal".
If you believe the first, then yes a lockdown like in Denmark or Norway is the best choice. If you believe it will take too long, then what matters is to minimise economical damage by containing the virus just enough making sure that the health system is not overwhelmed and to protect the most vulnerable groups. This is what Sweden chose and what most countries believed in as well in February. Sweden's health system was never overwhelmed, so the higher death rate in Sweden must be due to the higher infection rate in combination with the fact that they could have protected their elderly people better. But if the vaccin takes too long then neighbour countries will catch up.
> Tegnell's statement to reporters came after more contrite comments earlier in the day to Swedish radio in which he said “I think there is potential for improvement in what we have done in Sweden, quite clearly.”
> Asked if the country’s high death toll has made him reconsider his unique approach to the pandemic, Tegnell told Swedish radio “yes, absolutely.”
https://www.bloomberg.com/news/articles/2020-06-03/man-behin...
The reason I think Sweden's approach is wrong is that other countries are much more hesitant to work with them now. An example being Denmark opening the borders to Norway and Germany but not Sweden.
https://ourworldindata.org/coronavirus-data-explorer?zoomToS...
Then has to see that its also a group decision from the health authorities in Sweden where there is consensus on the direction board on how to act. Its not a one person decision.
Everything about the Swedish approach is a failure, and the amazing thing is that not only was the approach bizarre, but the Swedes have a very low testing rate relative to the number of cases - which seems like a weird move (innovate both in approach and in terms of "not knowing what's going on"). Positively 3rd world cases:deaths ratio - it's just embarrassing.
https://www.businessinsider.com/coronavirus-sweden-lockdown-...
Today’s article is consistent with the statements he made last month.
As others have pointed out, we won’t know if the approach was successful until after we see post-reopening trends.
In yesterday's press meeting, he admitted that given what they know now Sweden would have actually adopted a different strategy. It was at perceived as the first actual admission that the adopted policy was in fact too open.
Given that the policy mistake might have at this point lead to thousands of preventable deaths, he understandably treads very carefully.
We generally criticize everything, and everyone, but there are very few screaming matches. What is scalding criticism in Swedish eyes might not always register as such unless you are aware of the culture.
It's (probably) to some extent down to how written Swedish works in concert with our predominantly protestant culture.
Swedish is reasonably good for factual discourse, and quite awesome for writing a dramatic epic with words that soar. Hitting the space in between, without sounding ridiculous, is rather hard.
Most love songs and poems written in modern day Swedish are very indirect because of this, as they would risk sounding ridiculous otherwise. Life is rarely epic on the scale of the sagas.
This also makes public discourse sometimes seem a bit odd, because as the last thing you want to do is to make yourself and your criticism sound inane. Scalding criticism might look more like a slight disagreement if you read it in a newspaper and considered the words at face value.
In lieu of domestic alternate voices, we have other Nordic health officials questioning the Swedish strategy instead: https://www.thelocal.no/20200520/interview-my-belief-is-that...
Is Tegnell really the only credible epidemiologist in Sweden? Given that pretty much all of Europe has adopted a different strategy, that does not seem plausible. But is there anyone in the Swedish public sphere actually challenging Tegnell's ideas?
This could possibly be the worst lie I've heard this week. And I've listened to Trump.
https://www.aftonbladet.se/debatt/a/kJr5b6/jag-anklagar-er-f...
But in DN (behind a paywall) there have been other articles where those that questioned Sweden's policy have even been personally threatened.
Tegnell has been wrong about pretty much everything - from saying that the pandemic had reached its "peak" in Sweden when we had 137 cases[1] to being consistently wrong about how far we've supposedly come with 'herd immunity' - which was supposed to be around 50% by the beginning of June, but which has shown itself to be only around 7-10% in the worst-affected areas in Stockholm.
There is also a lot of finger-pointing in articles and comments by Swedes, accusing other Nordic countries of purposely under-estimating their covid figures - whereas the actual statistics[2] show that Sweden itself is the only Nordic country with massively under-estimated deaths.
[1] https://www.aftonbladet.se/nyheter/a/RRpj0A/statsepidemiolog...
[2] https://www.nytimes.com/interactive/2020/04/21/world/coronav...
And that angle to the story actually makes it a story, while "we still believe what we previously believed" really isn't something that, by itself, would warrant an article.
But sure, this outlier is "better worded" and "balanced".
Oh, and note the URL of this article: www.startribune.com/scientist-admits-sweden-could-have-battled-virus-better/570980492/
The model of exponential infections used to justify quarantine and flattening the curve has not happened any of the places opening up.
Coronavirus appears to reach a steady-state in the rate of infections in populations, just like numerous other infectious diseases.
The people in my town are absolutely terrified. Unemployment has skyrocketed poverty riots. This is a sad failure of leadership and science.
Sweden and Tegnell appear to have been right.