Swedish epidemiology boss says questioned Covid-19 strategy seems to be working | Hacker News Reader

Swedish epidemiology boss says questioned Covid-19 strategy seems to be working

reuters.com

92 pointsmrfusion259 comments

Some important context not mentioned in the article:

During summer, Swedes are spending as much time as possible outside (to make up for the dark cold winter months). Most offices are closed anyway, and unlike many other countries in Europe which have removed their previous limits, Sweden still has a 50 people limit on public gatherings and strict rules for how restaurants and bars can operate (for example, only table service, no bar service, even for outdoor venues). Amusement parks are closed. The authorities still ask people not to use public transport if they don't have to. Plus, people in risk groups (who don't have antibodies) are still asked to limit their interactions with others and to limit their mobility.

So considering that infections are happening mostly indoors, that Sweden nowadays has more restrictions in place than many European countries that locked down and then opened up, and that Swedes generally protect their personal space and don't get too touchy with others (in comparison to some other cultures), it's not a surprise that the numbers in Sweden are going down.

I'm happy about this trend. The way I see it, the country gets a second chance now to get things right ahead of fall/winter. Sadly, considering that the state epidemiologist and his team still are the same (and that he evidently mostly cares about telling everybody how great his strategy is/was), I guess they'll find ways to screw things up again.

You are also describing reasons why Sweden went for this strategy - their availability of space, limited physical contact etc. The argument is whether the strategy is working or not for Sweden vs a full lockdown in Sweden and not whether Sweden's strategy would have worked in other countries.

This would be okay if the strategy was explicitly "we will let people die and then hope that everything goes well once everyone's outdoors in summer." At least then people would honestly debate whether that's a morally/economically solid stance to take.

But in that case they'll also have to explain what their strategy will be at the end of summer.

They have been very transparent what the strategy is. Long term, since this won’t go away in just a few months the restrictions must be sustainable. Take into account the overall health and well-being of the people, don’t worry only about COVID-19. Only do what there are scientific evidence that it actually makes a difference. Make sure that the spread is slow enough so the health care system doesn’t get overwhelmed.

> Take into account the overall health and well-being

This is a very concise way of putting what some believe is the best plan, thanks.

I don't think there is any clear or morally unambiguous answer to the first part ("we will let people die"). It simply is either people die now of virus, or die later of economic fallout. Also see the Trolley Problem [1]

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

I'd say that the fact that Sweden still had the same level of restrictions as they previously had is proof that their approach is working exactly as intended - the people behind it have long said that the goal isn't to push for herd immunity, but to impose measures that are sustainable in the long term rather than a short-term lockdown. Especially since many of the countries that have locked down and then opened up are seeing a resurgence of the disease, and their definition of opening up is sometimes as strict or stricter than Sweden's rules (for example, the UK bans gatherings of over 30 people and restricts restaurants and bars to table service only, amongst many other restrictions).

The UK is a bad example, cause they have been doing worse than Sweden in every regard. There are plenty of countries in Europe which have much more relaxed limits now, for example Germany, Switzerland or the Czech Republic. Probably the other Nordic countries too (I'm not entirely sure about the latest there though).

According to:

https://covid19.healthdata.org/sweden

Germany is currently socially distancing at a similar rate as Sweden.

They previously had stricter social distancing and have far fewer per-capita infections and deaths, but the model says they’ll hit a nasty second wave in mid October.

Time will tell whether Sweden’s bet pays off in the long term.

Our (Germany) rates are actually somewhat surprising to me. We seem to generally have done very well when compared to other (European) countries of similar density.

> but the model says they’ll hit a nasty second wave in mid October.

I am wary of modeling "that far" in time, because while vaccines may take a little more to get ready, there are plenty of trials starting or going on for pharmacological treatments, which may give readouts as early as September.

While perhaps they won't be able to avoid infections, they might change clinical management significantly, in particular monoclonal antibodies.

How in the world will “time tell”?

Sweden has a worse death rate than its comparable neighbors, it’s economy has been hit as much if not more, and it has no greater “herd immunity” than the rest.

And the neighbors are opening up in a way Sweden cannot.

Essentially, Sweden did go into lockdown, and the difference from its neighbors were at the very margins. The economy was affected linearly by the additional activity at the margin, in other words, not by much, but on the other hand the virus growth was impacted exponentially, causing a significantly higher infection and death rate.

And this is Sweden, a country with a highly educated population, extremely good social and health systems, that was far better equipped to implement voluntary measures than the vast majority of the world.

>Especially since many of the countries that have locked down and then opened up are seeing a resurgence of the disease

Isnt that the expected result? Did anyone think something else would happen? The original communication everyone was fed was "hospitals arent ready, close down to flatten the curve to buy time." They asked for a delay, not spread prevention. Spread prevention being, stay locked down forever until everybody gets its slowly.

Sweden made a contrarian bet: that hospitals won't be flooded, and a few less ambitious measures that people will tolerate for a longer time is better than a large list of freedom destroying measures that can only lead to riots if imposed for too long (depending on the countries, you had things like lockdown at home, with only shopping on some days depending on the last digit of your social security, or only going out for 1 hour per day with printed, signed and dated papers to present to the police, etc)

It worked better than for Serbia, where people were recently rioting for being locked down again for a whole weekend.

I also think the bet depended on Sweden's culture of social responsibility.

Doing something similar in the US would never work. We don't have a culture of social responsibility. It's why draconian measures were required. Recommendations don't work and laws/ordnances only work to an extent. In essence, the US has such a self-centered culture that the only option to combat a pandemic like this is draconian lockdown that borders on infringing on individual rights.

  Conquer with Inaction

  Do not control the people with laws, 
  Nor violence nor espionage, 
  But conquer them with inaction. 
  For: 
  The more morals and taboos there are, 
  The more cruelty afflicts people; 
  The more guns and knives there are, 
  The more factions divide people; 
  The more arts and skills there are, 
  The more change obsoletes people; 
  The more laws and taxes there are, 
  The more theft corrupts people. 
  Yet take no action, and the people nurture eachother; 
  Make no laws, and the people deal fairly with eachother;
  Own no interest, and the people cooperate with eachother;
  Express no desire, and the people harmonize with eachother.
                -- Lao Tse, "Tao Te Ching"

I didn't realize there were guns in the 4th century BC.

A 6th century BCE philosopher had an opinion on guns?

It's also important to note that Lao Tse was trying to make sense of the collapse of his entire way of life during the Warring States period. He was trying to find an answer as to how the governments of the day failed so badly and descended into such chaos.

While it is true that community spirit can thrive under pressure, we should not be seeking to attain community spirit at the cost of overall quality of life. We should not allow COVID-19 to run rampant so that people learn the usefulness of masks. This falls into the same trap that Lao Tse fell into, thinking that the perceived causative opposite will result in the opposite outcome. If this were true, then the Sudan and Somalia would be the happiest places on Earth.

> We don't have a culture of social responsibility. It's why draconian measures were required.

Sounds backwards to me. I'd bet a logical approach like Sweden's would have been much better tolerated and observed, especially in the long term. The current "new plan of the week" here in California is for the birds.

Not to mention that a significant portion of US deaths were a direct cause of NY forcing sick into nursing homes.

Colorado went a couple months recommending but not requiring face masks. The governor finally enacted a mandate because people weren't abiding by it.

And? I know many folks have been convinced that cloth-mask wearing is the primary factor in reducing transmission. But, deep down I think we all know that it's not that important compared to other things.

Also, folks do comply voluntarily when they see local stats and people around them getting sick. Yes, scolding when statistically no one in a rural state has it is not surprisingly effective in the short term.

What other things?

Any of the dozens of other guidelines that should be followed, minus the cloth mask. One not often mentioned but touched on here is getting outdoors in the sunshine.

Locally I often see folks hiking alone in the sun wearing cloth masks and it is clear they don't understand when they are actually useful or not. Anti folks don't appear to either.

> but deep down we all know...

From 18 July Wall Street Journal:

Face Masks Really Do Matter. The Scientific Evidence Is Growing.

New research suggests that face coverings help reduce the transmission of droplets, though some masks are more protective than others.[1]

Face masks are emerging as one of the most powerful weapons to fight the novel coronavirus, with growing evidence that facial coverings help prevent transmission—even if an infected wearer is in close contact with others.

Robert Redfield, director of the Centers for Disease Control and Prevention, said he believes the pandemic could be brought under control over the next four to eight weeks if “we could get everybody to wear a mask right now.” His comments, made Tuesday with the Journal of the American Medical Association, followed an editorial[2] he and others wrote there emphasizing “ample evidence” of asymptomatic spread and highlighting new studies showing how masks help reduce transmission.

%< snip %<

Researchers say the benefits of widespread mask use were recently seen in a Missouri hair salon, where two stylists directly served 139 clients in May before testing positive for Covid-19. According to a recent report[3] published by the CDC, both wore either a double-layered cotton or surgical mask, and nearly all clients who were interviewed reported wearing masks the entire time.

After contact tracing and two weeks of follow-up, no Covid-19 symptoms were identified among the 139 clients or their secondary contacts, the report found. Of the 67 who were willing to be tested, all were negative for Covid-19.

%< snip %<

Wearing a mask is “one of the most urgent things we can do to get our country under control,” said Melanie Ott, director of the Gladstone Institute of Virology. “We’re all waiting for the vaccine, we’re waiting for therapeutics, and we’re not there.”

“We have masks, we have social distancing, and we have testing,” she continued. “But there’s not much more in the toolbox here.”

1. https://www.wsj.com/articles/face-masks-really-do-matter-the...

2. https://jamanetwork.com/journals/jama/fullarticle/2768532

3. https://www.cdc.gov/mmwr/volumes/69/wr/mm6928e2.htm

> (...) is better than a large list of freedom destroying measures that can only lead to riots if imposed for too long

Do you have any example of such a civilization-destroying reaction to basic public health measures?

I mean, Spain was locked down for a long time, and they did had armed forces personnel patrolling the streets, and Spain didn't descended into chaos although they still remember quite well what's it like to live in a dictatorship.

If you need the army patrolling the streets to enforce the rules, I think that riots are not too far away.

I also learned in this thread they happened in other countries like Serbia.

I would expect them to happen in more european countries if there is indeed a second wave, and they do not have the foresight to deploy soldiers in the streets.

And that the country was happy with a much higher death rate. Sweden has less than half the population of Australia and they have had 5,667 deaths and Australia has had 128.

Oz is probably the sparsest country in the world.

With the majority of the population living in cities on the coast. Sydney? Melbourne? Big, dense cities. We're not all out living in the bush shouting cooee at each other.

If you measure average population density across the entire country, sure, but the vast majority of the country is practically uninhabited.

Sydney and Melbourne are much like any other large city in the world and, at around five million people each, combined they represent ~40% of the country's population.

The early success Australia saw in dealing with this pandemic had nothing to do with sparse population.

> And that the country was happy with a much higher death rate. Sweden has less than half the population of Australia and they have had 5,667 deaths and Australia has had 128.

When Australia went into the first lockdown they had essentially no community transmission.

It is unclear that the lockdowns had any impact at all.

Now that there is significant community transmission in Melbourne we can see if the second lockdown is effective.

I've seen different messaging spread around. With Australia, for example, I've heard people say they did a great job "squashing the virus", so I think there's definitely surprise from some people that cases are surging again.

For example, I found an article called "Coronavirus: Are Australia's numbers at risk of escalating?"[0] (to me, the headline itself seems a strange question to ask, since the answer is obviously 'yes').

From the article:

"Australia has reported just over 7,400 cases, far fewer than many nations. It has seen 102 deaths - the last was a month ago.

Since May, the country has entered a phased exit from lockdown restrictions as the curve flattened.

But in the last week there's been a rise in cases in Victoria, mostly in the state capital Melbourne.

Concern has crept back into public conversation: Is this a small setback, or could it be something more sustained?"

To me there seems to be a widespread misunderstanding, perhaps perpetuated by the media, that locking down the country would stop the spread of the virus entirely.

[0]: https://www.bbc.com/news/world-australia-53132585

Well, we didn't exactly lock it down properly ... In Melbourne the poorly trained security guards responsible for quarantining returning passengers in a hotel were having sex with the passengers.

It was also mentioned by the Victorian Premier yesterday that roughly 90% of people who felt sick were still out and about in the community and that roughly 50% of people who got tested for Covid were still active in the community before they got their results. Some of this would have been because they couldn't afford to miss work etc, but it's still disappointing.

Yes, but that changed very quickly to "lockdowns reduce total deaths" once it became clear that the predictions of hospital overload were wrong.

Now you have places like New Zealand that appear to be trying to keep themselves COVID-free forever, without any clearly articulated path out of the restrictions.

You do realize New Zealand at the moment is almost restriction free outside of external travel? At this point they have fewer restrictions than any major country in the world including Sweden.

Throttling all external travel is a severe and major restriction, especially for a country that derives significant revenue from tourism. It's not some minor thing that can be blown off. Travel to/from NZ will be minimal for as long as that continues, and they have no way out.

5 times as many deaths as their neighbors, with as much, if not greater economic hit than their neighbors, and an economic hut that is continuing unlike their neighbors who are now much closer to normality.

If this is exactly how it’s supposed to be working I shudder to think what the bad case scenarios would have been.

Short term economic damage is a) hard to measure and b) meaningless

Sweden’s betting on long term recovery in light of second/third/etc waves. As much as it detracts from the catastrophic fear and loathing narrative, it has sound economic and epidemiological foundations.

Yeah I also noticed lately that the numbers collapsed after a peak on June 24th. The people being diagnosed on the 24th should have been infected just about on midsummer. And then the numbers collapsed. That matches extremely well my experience that after midsummer (June 21st) most Swedes clear out the cities, going to summer houses or abroad or, failing that, being outdoors as much as possible.

So I was "surprised" to not even see that fact be mentioned in the article and would be cautious about attributing this to the Swedish strategy. Did they make any policy changes in the days leading up to the 24th?

There is no real "collapse" in numbers, the number of hospital cases have been in a (noisy) straight line down from April and forwards: https://www.icuregswe.org/data--resultat/covid-19-i-svensk-i... (the graph with "Antal vtf" on the y-axis). Those graphs are directly from the hospital reporting systems.

Tegnell reflected on mistakes in his approach. News that was quickly rephrased as "Wrong approach admitted" (e.g. by Bloomberg).

https://www.theguardian.com/world/2020/jun/03/architect-of-s...

That's more than we can say for US/China. They keep up the appearance of being "the best". While the approach of Sweden was much more measured and transparent in my opinion.

Also, Sweden left it's constitution in full effect. Most countries did not, which I find VERY problematic. Constitutions should be pandemic proof.

Sorry, which countries ditched their constitutions during COVID?

Here's a list of countries with HR abuses during the pandemic. Most democratic contries have Human Rights provisions in their constutions.

https://en.m.wikipedia.org/wiki/Human_rights_issues_related_...

Most European states, including Russia have also signed the European Convention on Human Rights.

China, Poland, Turkey, Turkmenistan...

All of these countries had troubling human rights issues pre-COVID.

Poland had HR issues?

Absolutely.

https://www.washingtonpost.com/news/worldviews/wp/2018/01/27...

> Israeli Prime Minister Benjamin Netanyahu and Polish Prime Minister Mateusz Morawiecki spoke by phone Sunday and agreed to open a dialogue to avoid further diplomatic fallout following Poland’s initial approval of a law making it a criminal offense to mention Polish complicity in crimes committed during the Holocaust.

I believe they backtracked a bit on that one after the outcry.

https://en.wikipedia.org/wiki/LGBT_ideology-free_zone

> An "LGBT-free zone" (Polish: Strefa wolna od LGBT) also referred to as "LGBT free zone" (Polish: Strefa wolna od LGBT) refers to some regions of Poland which have declared themselves unwelcoming of an alleged "LGBT ideology." As of June 2020, some 100 municipalities (including five voivodships), encompassing about a third of the country, declared themselves "LGBT-free zones".

I’m sorry, do you seriously consider these issues to be as bad as the human rights situation in China?

You asked "Poland had HR issues?", not "Poland had HR issues of exactly equal magnitude to China?"

The highlighted issues make it clear Poland was willing to infringe on speech/expression rights even without the excuse of COVID.

Are there countries which don’t have HR issues?

Yup. Iceland and generally nordic states, Canada.

Are you from any of those countries? If not, how do you know?

So you basically asked a question but with the assumption that the answer is unknowable.

Great show of good faith there /s.

How did you know that China had human rights issues?

> Sorry, which countries ditched their constitutions during COVID?

It really depends on your personal definition of "ditched their constitution".

For example, Spain "declared state of alarm" which suspends temporarily some constitutional rights.

Unfortunately during a state of alarm is when you need your rights the most.

Your comment doesn't make any sense. Could you elaborate on that in case you've just left out any key detail?

Well what I mean to say is during a panic the government has the most means and motivation to step on your rights. It’s also a time when the tyranny of the majority can come into play.

The interment of Japanese citizens during WW2 is one example.

That happened in a country with a Constitution, which sorta proves that you shouldn't put your faith in a Constitution.

The only way good things get done is if people continually fight and push for them. Laziness will doom you, no matter what pretty words are on a paper somewhere.

And in a pandemic, "good things get done" has a very different definition than it does at other times, something no static set of law is going to be able to anticipate. You have to be active and you have to be flexible.

It depends on which rights.

Certainly, many rights need not be affected by a pandemic at all, and countries that have tried to use it as an excuse to crack down on those rights should be condemned. For example, the Indian government has threatened freedom of the press by trying to censor news coverage of the pandemic. [1]

On the other hand, as an opposite extreme, freedom of movement is something that in normal times is considered a right, but absolutely can and should be limited during a pandemic.

Other rights are somewhere in between. For example, in the U.S., the use of the Defense Production Act to compel ventilator production could be considered a violation of economic freedom (which has often been thought of as a right, though it's not a Constitutional right), and it wasn't strictly necessary. But in practice there wasn't too much controversy over it; most people seem to tolerate the idea of the government temporarily commandeering the economy in emergencies, especially for something as obviously beneficial as making ventilators. (Though there might have been more controversy if a Democratic president had done it, but that's getting into the political weeds…)

[1] https://cpj.org/2020/03/indian-supreme-court-denies-governme...

> For example, Spain "declared state of alarm" which suspends temporarily some constitutional rights.

A procedure that is presumably permitted by said constitution, right?

> A procedure that is presumably permitted by said constitution, right?

Yes, the Spanish constitution does explicitly support state of alarm, which is a way to suspend constitutional rights.

https://english.elpais.com/politics/2020-03-13/what-is-a-sta...

Then when they needed that state of alarm extended, they started negotiating with separatist parties and all sense of decency vanished in a puff of smoke.

de facto Italy did. None of the early acts went through the parliament, but were moves made by the PM alone.

Suspensions of rights in exceptional cases is granted only in the case of war, or by law (and that means going through the parliament).

Did Italy throw out their constitution, or does it permit emergency acts by the PM? The distinction is critical.

There's no such thing as a state of emergency, only the state of war. Anything else needs to go through the parliament, directly or indirectly.

By indirectly I mean something akin to the USA executive order, but agreed upon the cabinet, not the PM, then countersigned by the President, who can veto it. Then it lasts 60 days and must be confirmed by the parliament, or becomes void.

Keep in mind the constitution was written right after WW2, so the writers were carrying the scars of "emergency measures" going into dictatorship.

There are a few things that can be done by the health ministry, but nothing as big as a country wide lockdown.

There's a law from 1992 that describes the process of "state of emergency" and decrees

https://www.gazzettaufficiale.it/eli/id/1992/03/17/092G0253/...

Starting from article 5. It seems that any such state of emergency can last up to 12 months and be extended for 12 more months. The current state of emergency is going to last until the end of July, and there are discussions about extending it.

That's a regular law, not part of the constitution, article 77 of the constitution provides further rules:

https://www.senato.it/1025?sezione=127&articolo_numero_artic...

It's not clear, and I'm not a constitutional lawyer, but I found some interesting articles that describe the situation:

https://www.agensir.it/italia/2020/05/07/dpcm-e-coinvolgimen...

Context: the emergency acts are "decreto legge" and "dpcm" they are listed here:

http://www.governo.it/it/coronavirus-normativa

And this explains what dpcm are:

https://it.m.wikipedia.org/wiki/Decreto_ministeriale_(ordina...

Apparently, article 77 describes 2 deadlines: 5 days for the parliament to vote on the decrees and 60 days for the laws to be finalized.

I think that the crux of the issue is: whatever is inside those "decreto legge/dpcm", it has to be approved by parliament... There have been multiple such decrees, and the only controversial point is for how long can a parliament decision be delayed (in theory only for up to 5 days, but I'm starting to get lost in details).

Due to how many decrees have been created, I'd need to check for when each one of them has been (or is being planned to be) voted on

Most of them, were, IIRC, only "reported to" parliament. After reopening on May 4th, some of them were voted.

I admit I worded my post poorly: a state of emergency exists, but limiting constitutional rights is, AFAICS, only permitted through law.

"DPCM" are mere administrative acts, and a few people expert in the judicial system have raised objections about their use in this way (including the head of the constitutional court). In particular, the debate is whether they can or can't limit constitutional rights.

Either sidestepped (the Netherlands), or temporarily overruled (most countries of Europe).

Constitutions provide freedom of movement/association/gathering, usually, putting a fine on being close to others or gathering is messing with the constitution.

It's okay to do so, but only in real crazy events. A virus with a 99+ survival rate is not such event IMHO. We need to make our constitutions virus-proof.

> That's more than we can say for US/China. They keep up the appearance of being "the best".

That appearance is long gone in the US. Last week Trump complained to the press that the US isn't doing as bad as we think because Mexico and Brazil are also doing poorly.

So there's a long way between "we are the best" and "hey, maybe just maybe we don't suck as much as other countries that are doing awfully bad".

I wish this article went into more detail about the relative death rates.

The fact that Sweden’s death rate “far outstripped that of other nordic” countries (all else being equal) would tend to indicate the Swedish strategy failed, no?

Are there important confounding variables that would explain the higher death rate?

I know for sure that a lot of the deaths are from nursing care homes (but I don't know in how large percentage), something seen also elsewhere in the world.

47% of all deaths are from nursing homes (July 8th). https://www.svd.se/fortsatt-stor-andel-doda-pa-svenska-aldre...

For Norway that number is 58% according this page: https://www.vg.no/spesial/2020/corona/?utm_source=corona-wid...

Depends on whether a few more deaths now is better than whatever the alternatives are / were with regard to death rate and economic damage, no?

The death rate maybe higher but they are in decline right now and that without lockdown, I would say the strategy succeed.

How so? If they achieved the same results as others on roughly the same timeline, yet with more deaths, how is that a successful strategy?

Because other countries implement lockdown. Lockdowns is not without cost.

We don't know the results yet. Numbers are going up in countries that are lifting their lockdown.

Lockdown has its own issues, economic and psychology / mental health.

Plus, some types of death are an economic boon because they:

a) cause economic churn and the associated fees, charges, and taxes

b) free up resources that were tied up with non-producers

"non-producer"? Oh, you mean human being.

They locked down, just not formally. They saw the same economic damage their neighbors did.

https://www.nytimes.com/2020/07/07/business/sweden-economy-c...

Sweden saw the same level of damage to their export-oriented industries as their neighbours did, but less damage to the service industries that are directly affected by a lockdown and less of a decrease in mobility: https://www.imf.org/en/News/Articles/2020/06/01/na060120-swe... You can't just lump the two together and claim it shows that not locking down causes about the same level of economic damage as locking down, especially given that those export losses are presumably directly attributable to their neighbours' lockdowns.

This indicates Sweden wound up with relatively similar de-facto restrictions (a social distancing strictness of ~50 versus ~60 for the other Nordic nations) and a substantially higher death rate.

It also says "Sweden did not record an economic contraction in Q1 of 2020", which is a misleading claim, given the lockdowns largely came in the last few weeks of that quarter, and later goes on to acknowledge "Forecasters agree that Sweden will face a severe recession in 2020".

I don't think this really supports the case you're trying to make.

Because Sweden's economy relies on exports. They have economic damage when their neighbors lock down, independent of their own lockdown status.

There's barely any lockdown in Norway either. It's been like that since the beginning of June at least.

The problem is they had a higher death rate than the neighbors on the same timeline. Oh and their economy also suffered just as bad as neighbors who locked down. Not sure how it could be a success with more deaths and everything else being the same.

But maybe Sweden is done having excess mortality where other countries still have a ways to go?

How can you possibly predict the future that way? Why would Sweden be done and not the other countries?

Immunity.

I think the numbers show that countries who don't have a second wave had a strong first wave, where the lockdown came too late.

Examples: Italy, France, Germany

Then you have countries that had a strict lockdown on time, which resulted in rising rates as soon as lockdown was lifted.

Examples: Israel, Hong Kong, Singapore

Having said that, the latter countries do seem to fare better than the former, second wave or not.

I'm not trying to predict the future, I'm just saying it's possible.

At the same time, it's not possible at this time to declare "sweden's strategy has failed" - there's plenty of time for other countries to catch up on excess mortality.

I do think there's a very real chance that, assuming hospitals are not overwhelmed, there won't be a lot of difference in overall mortality between developed countries. This disease is, apparently, super infectious after all, and eradication seems unlikely.

I wasn't saying it was a failure, but that it is hard to call it a success. Again I think we will need to wait a while to determine true successes or failures (although I think here in the US it is trending towards being a tremendous failure).

> * How can you possibly predict the future that way?*

100% of pre-vaccine, pre-containment pandemics ended in herd immunity.

The science is clear. If left alone, COVID-19 would rapidly burn itself out (and take about 0.5% of the population with it).

Smallpox? Polio? Ebola? None of these ended with "herd immunity"

Before vaccination measles epidemics happened every few years, killing over 2 million people each year. https://www.who.int/news-room/fact-sheets/detail/measles

> Before the introduction of measles vaccine in 1963 and widespread vaccination, major epidemics occurred approximately every 2–3 years and measles caused an estimated 2.6 million deaths each year.

Where's the herd immunity to measles?

Herd immunity doesn't necessarily mean "fully prevents outbreaks".

https://en.wikipedia.org/wiki/Herd_immunity#History

> Herd immunity was first recognized as a naturally occurring phenomenon in the 1930s when A. W. Hedrich published research on the epidemiology of measles in Baltimore, and took notice that after many children had become immune to measles, the number of new infections temporarily decreased, including among susceptible children.

(Measles is also fairly uniquely virulent. https://en.wikipedia.org/wiki/Basic_reproduction_number)

yes Sweden economy affected because their neighbors shutdown their economy but most likely it would have been even worse if Sweden did lockdown.

At its peak Sweden had over 100 daily deaths. Yesterday it was 7 and no longer any excess mortality.

For some more context to the numbers Germany had at it's peak ~300 deaths a day, it had 5 deaths on the 20th (83M people).

21 new deaths today:

"21 nya dödsfall med bekräftad covid-19 har inrapporterats det senaste dygnet, enligt Folkhälsomyndighetens senaste uppdatering."

21 new deaths with covid-19 reported the last 24 hours. The deaths are not necessarily from today.

Edit: For those interested in the stats (English): https://www.svt.se/datajournalistik/the-spread-of-the-corona...

Yes, here's a Norwegian site comparing the different Nordic countries per capita[1]. Other than Iceland being an outlier due to it being tiny, Sweden outstrips all other countries on pretty much any measure by a wide margin.

It seems like the number of patients under intensive care is slowly falling for Sweden but they're not anywhere close to where the other Nordics were months ago.

[1] https://www.vg.no/spesial/2020/corona/norden/

You can't quite compare countries like that and claim that Sweden would have had the same rate as the other. The world is full of examples where neighboring countries have radically different caseloads. I don't know enough to meaningfully discuss the details but I suspect you can't just claim Norway is the same as Sweden.

What is most remarkable is the trajectory the epidemic took within Sweden. No comparison is necessary to another country. That they have achieved a substantial reduction of their caseload without any of the invasive measures. Nobody would have ever believed that to be possible!

Other countries should learn from Sweden rather than being in denial - it demonstrates that other measures can be just as effective, and we need to understand how that was possible and whether the measures are transferable.

But if their economy did worse than their neighbour, what was the point of avoiding invasive measures? They have more deaths, more cases, and worse economic output, what exactly is successful here?

You should visit Scandinavia sometime. The Swedish and Norwegian economies cannot be compared easily.

because it simply not true,

their economy did not do worse their people are happier and pretty much looks like they would agree to do it again the same way

that is the real test of measures, would you do the exact same thing again?

which country would want to take the same type of measures once more

That's a nice example of survivor bias: you can't ask the dead.

Sweden has a population of ten million people and an economy very tightly tied to the rest of the EU, so exactly what measures we did I don’t think made a huge difference for the economy.

Quality of life. Additionally "our neighbours are doing something wrong and bad so we should too" is not a justification.

Lockdowns cannot stop COVID deaths and in the beginning nobody claimed they could. The idea that Sweden has performed worse than Norway is a massive goalpost shift that is rightly being called out as nonsense. Especially because it's clear how much corruption there is in these figures. Did the UK really do so badly compared to its neighbours, or is that a result of the health body defining a COVID death as anyone who ever tested positive and then died at any later point, of anything at all (i.e. all COVID infections are fatal according to UK stats).

Of course it's possible.

Flu and basically all other airway-transmissible diseases always mostly disappear during the summer months in Sweden.

Now to see if infection rates can be kept low when autumn comes.

If transmission is from cough and sneeze droplets this would make sense, as it spreads fastest when transmitter has covid and they have a cold or the onset of the flu.

European (all-cause) mortality is conveniently reported on https://www.euromomo.eu/graphs-and-maps

Notably there are substantial excess in 2018 or 2019 during the same weeks. Not quite sure what to make of that.

If you were subtracting 2020 from 2018 then it looks like you would end up with 80 thousand fewer deaths in the first 10 weeks of 2020. What is that about.

It's almost as if this isn't nearly as bad as people scream

The comparison with other "nordic" countries seems arbitrary. If we go by latitude, why is there such a huge variance in death rates between Belgium, France, Netherlands and Germany?

The biggest factor is probably outbreaks in retirement homes. I think you can make the argument that the strategy failed to protect these elderly people, but it might also be the conditions in these facilities that are to blame.

Yes, in Sweden the problem was the nursing homes and they were run (and still are run) badly. The other measures that could have been done (within the covid response itself) would probably not have helped this, goes the argument (but certainly a major overhaul of how the nursing homes are staffed and run would have helped - that would never have been possible in the short timeframe though).

In Sweden immigrants from Iraq, Syria, Somalia and other countries form a large part of deaths and ICU patients.

It will be interesting to see why this is eventually. There’s language barriers, people living in close quarters and perhaps the vitamin D thing as well?

Link to article in swedish MD magazine (in Swedish): https://lakartidningen.se/aktuellt/nyheter/2020/04/utlandsfo...

Poorer populations are dying of COVID at higher rates throughout the world. In the US, at least, the lockdown is mostly protecting the rich.

I wonder if Sweden’s approach is more economically and racially equitable than full lockdowns. I’d love to see a study of this that’s backed by quality data.

People always jumps to “it must be poverty!” when the Vitamin D thing comes up.

There is a strong correlation between Vitamin D levels and COVID-19 outcome, regardless of skin color. Independently, there is a strong correlation between having low Vitamin D levels and living in an environment to which dark skin is not adapted to.

That alone should be enough to raise some caution, there is no need to wait for better data because Vitamin D supplementation is in order either way.

Unfortunately, the media is mostly silent on this, likely because it wants yet another social justice narrative instead.

> Independently, there is a strong correlation between having low Vitamin D levels and living in an environment to which dark skin is not adapted to.

Honest question: what skin color is actually adapted to western Europe or much of North America? Virtually everyone I know with a lighter skin tone needs to apply sunscreen for any outdoor activity to avoid rapid sunburns, and virtually everyone I know with a darker skin tone (jokingly or not) suspects they have a Vitamin D deficiency.

There is no one such skin color for the latitude range you are describing.

Just look at the “average” skin color of whatever ethnicity has been in a particular environment for tens of thousands of years. Native Americans clearly have darker skin than Anglosaxons.

Also, much of western Europe has been colonized by peoples that previously spent thousands of years up further north. The weather in Britain is different from France, and so forth.

> There is a strong correlation between Vitamin D levels and COVID-19 outcome,

They didn't adjust for confounders like BMI or poverty.

https://www.nice.org.uk/advice/es28/chapter/Factors-for-deci...

> Evidence was from 5 published studies in peer-reviewed journals. One observational cohort study (D'Avolio et al. 2020), 3 observational prognostic studies involving published data sets using correlation or regression (Hastie et al. 2020, Ilie et al. 2020 and Laird et al. 2020) and 1 case-control survey (Fasano et al. 2020) looked retrospectively at the association between vitamin D status and development of COVID‑19. None of the studies were intervention trials of vitamin D supplementation for the prevention or treatment of COVID‑19.

> Four of the studies found an association or correlation between a lower vitamin D status and subsequent development of COVID‑19. However, confounders such as body mass index (BMI) or underlying health conditions, which may have independent correlations with vitamin D status or COVID‑19, were not adjusted for (D'Avolio et al. 2020, Fasano et al. 2020, Ilie et al. 2020 and Laird et al. 2020). Vitamin D status was based on serum 25‑hydroxyvitamin D (25(OH)D) levels in 3 studies and the proportion of participants taking a vitamin D supplement in 1 study. The largest UK study (Hastie et al. 2020) found an association between vitamin D status and COVID‑19 only in a univariable analysis (with this single potential causative factor). Importantly, no causal relationship between vitamin D status and COVID‑19 was found after adjustment for confounders such as comorbidity, socio-demographics, ethnicity, BMI and other baseline factors.

Is it valid to treat ethnicity as a confounder for vitamin D given that the belief is dark skin colour in northern climates results in lower vitamin D?

"The largest UK study (Hastie et al. 2020) found an association between vitamin D status and COVID‑19 only in a univariable analysis (with this single potential causative factor). Importantly, no causal relationship between vitamin D status and COVID‑19 was found after adjustment for confounders such as comorbidity, socio-demographics, ethnicity, BMI and other baseline factors."

A couple of problems with interpreting that study:

First, it only looks at infections, not course of infection. The million-dollar question is not whether Vitamin D prevents an infection altogether, but how high the risk for a severe course of COVID-19 is, given a Vitamin-D deficiency.

Secondly, it adjusts for ethnicity and the "Townshend deprivation index" as a proxy for socio-demographics.

You have to look at the huge impact of being classified as "black" (i.e. very dark skin color), and the large impact of being classified as "south asian" (likely moderately dark skin color). No other factor besides "poor health" even comes close. These people are largely Vitamin-D deficient, so by controlling for that factor, you are implicitly lowering the impact of Vitamin-D. It's like saying "Oh yeah your Vitamin-D levels are low but really the problem is that you're black". If you look at the controlled numbers, being insufficient in Vitamin-D becomes protective (OR ~= 0.9), which doesn't make any sense.

"Townshend deprivation" measures household overcrowding and lack of access to a car, which are obviously factors that increase the risk of contracting any viral infection. Again, this shouldn't be controlled for in order to answer the question.

Of course a single-variate analysis is not enough, because many diseases are causal for low Vitamin-D levels, but a multi-variate analysis with too many variables isn't meaningful.

Sure they are but significantly more people deficient in vitamin D are dying as well for reasons that have little to do with Poverty. Complete racial equity is likely impossible.

On twitter Jacob explained it in more detail:

https://twitter.com/JacobGudiol/status/1283308801043636231?s...

The death numbers is not counted the same way in Sweden and Norway, in Sweden they count every one that had covid-19 even if they died of something else after they recovered from corvid-19, they do not count it that way in Norway.

This theory can be dismissed by looking at excess death counts. A very clear spike in overall, country-wide deaths - of all kinds - can be seen in Sweden that is not seen in Norway.

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

Screenshots of the current charting, for posterity: https://imgur.com/a/1DC95no

But Sweden has roughly double the population of Finland and Norway, so Sweden (1000 weekly deaths) is comparable to Finland (500 weekly deaths) and not that far off of Norway (200 weekly deaths).

Irrelevant. It's how far the spikes go above normal per-capita that matters, which is why each chart has a different Y axis that fits that particular country.

The pictured charts clearly show Sweden and the US seeing substantially more deaths than normal, while Finland and Norway stayed at roughly their normal rates.

The countries have significantly different lifespans and normal mortality, because of health care systems, age distribution, culture, genes etc.

It doesn't really give anything sensible when you compare unadjusted total mortality per capita across countries.

That doesn't explain the huge amounts of deaths compared to normal values, though. Which Norway so far haven't had. https://news.ycombinator.com/item?id=23916552

On the other hand as of ~3 months ago it wasn't enough to show all the typical covid-19 symptoms to be allowed to get tested at all (in the Stockholm region at least). They have since expanded testing, so in principle anyone can get tested now (if they can manage to book a time slot at least..).

It's too early to say the Swedish strategy failed, because the Swedish strategy was "do badly at the start to do better later", and "later" isn't finished yet.

On the flip side it would be possible to say it succeeded, if it did so much better that they are already better off than the rest of the world, but I don't think we're really there yet either (and the epidemiologists point is really just that there are signs that they might be there in the future).

Right. The denominator in rate is per "unit of time" and we dont know the period. The two ways you could compare them are equal points on a bell curve, or equal time periods. What you can't do is compare two instantaneous speeds and then argue that one car has a faster average speed.

> It's too early to say the Swedish strategy failed, because the Swedish strategy was "do badly at the start to do better later", and "later" isn't finished yet.

So, at this moment we are only celebrating that Sweden succeeded at the "do badly at the start" part?

Of course not, the article is rather celebrating the signs that the "do better overall" part of the plan will work out.

I think that celebration is a bit premature, from your reaction I assume you do to, but that doesn't mean it isn't a real thing.

To me it seems that Sweden's strategy has been celebrated since the first day, and the celebrations never stopped. At this moment I wonder what would it actually take to make the celebrations stop.

Lockdown kills too. In Australia there were about 700 excess deaths from January to April 2020 due to people being unwilling or unable to access normal medical care:

https://www.macrobusiness.com.au/2020/07/covid-19-drives-up-...

Yeah, Sweden has a remarkably high death rate due to very old populations like 80+ or 85+. I mean, really high, it's been pretty terrible. So would probably be quite different and more "normal" numbers if it hadn't hit our nursing homes like it did. Death rate is very low in comparison if you instead look at figures for age 70 and lower. This problem has also been acknowledged as probably the greatest problem and a failure during the coronavirus crisis by Swedish epidemiologists despite "Protect the elderly!" being an early, daily mantra.

It's been asked why Sweden then had this problem and not our Nordic friends. Some answers might be understaffing or underestimated equipment needs. When the crisis hit them, there was already a global shortage of disinfectants etc.

It's also been asked how the virus entered the nursing homes to begin with. A too liberal stance for visitors a bit too long? Or brought in by staff using too crowded public transports?

Many questions and the investigations are still ongoing.

Compounding the death rate problem in Sweden was probably also a lack of centralized detail management and confusing directives that even led to palliative care for elderly in nursing homes not even being covid-19 victims. In Sweden, nursing homes work quite independently from each other, and even hospitals are strongly regionally controlled rather than directly state controlled even in a crisis like this. (there are some exceptions though, in these catastrophies, staff can be flewn across the country to help man understaffed hospitals etc)

tl;dr I think nursing home infections are the single outstanding factor for the abnormal Swedish death rates. If they are infected, they already have particularly weak immune systems that can often not even begin to fight this beast off. Hell, they probably often already have respiratory diseases and/or use immunosuppressants.

As far as I know the age distribution of covid-19 related deaths have been exactly the same in Sweden as other countries (+/- some standard deviation)

Do you have data to demonstrate that the age distribution is different?

Many other countries (especially the US) also screwed up their handling of old folks homes.

Also, I don’t know what data you are citing, but note that many data sets are normalized by number of estimated or confirmed of cases, not by total population size.

I believe one of the Swedish epidemiologists who helped engineer Sweden's COVID response said not to compare the death rates today, but a year from today and see how they compare then.

We don't know. If there is no vaccine ever, and no long term immunity from getting it, then it doesn't matter what you do every country will eventually be infected and have the same death rate. Sweden just happens to be there first but everyone will get there.

Of course my assumptions are big. If there is a vaccine then it is personally worth a lock down to not get it. If there is herd immunity I want everyone else to get it while I personally lock down.

This is not really true. For one thing both cases and deaths have been strongly clustered so that population level rates are not so interesting. What matters is whether your ancestors adapted to life in northern latitudes, what your weight, insulin resistance, and vitamin D levels are, and how densely urbanized your environment is. Another factor is that Sweden aggressively labeled all hospitalizations and deaths involving a COVID-19 diagnosis as being COVID-19 cases and deaths even if the patients were very old and had chronic health problems. This is a major difference between both Denmark and Finland which tended to be very cautious about labeling hospitalizations and deaths as COVID-19 related and had low testing rates as well. Looking at all cause mortality figures yields very different results.

I found it interesting that the general consensus seems to be that Sweden failed, and yet NY state was just hailed as "doing it correctly" by Dr. Fauci [0] (despite one of the very highest per-capita death rates in the world). We didn't do much better here in MA in terms of deaths, although like NY we're only seeing a very small (and importantly flat) number of cases here.

Meanwhile Australia, a country that was previously hailed as having done it right and contained COVID-19 has now locked down 6.6 million people [1], closed state borders between Queensland and NSW [2] and currently seeing record numbers of infections [3].

Only time will tell which is the best strategy.

[0] https://abc7ny.com/covid-19-ny-fauci-anthony-cuomo/6324584/

[1] https://www.cnn.com/2020/07/06/asia/australia-victoria-coron...

[2] https://www.marketwatch.com/story/australia-shutting-border-...

[3] https://www.bloomberg.com/news/articles/2020-07-22/australia...

> found it interesting that the general consensus seems to be that Sweden failed, and yet NY state was just hailed as "doing it correctly" by Dr. Fauci [0]

You should read the sources you quote. Dr. Fauci's comments are on NY's approach on "how to successfully bring down cases of coronavirus." It says nothing about what enabled the epidemic to spread like wildfire, which is Sweden's case.

Taken right from your own source:

"Again, we have a problem. We need to admit it and own it. But we have got to do the things that are very clear that we need to do to turn this around, remembering we can do it," Fauci said."

I did read it. My point was that it seems to me that Sweden and NY are at about the same place now. Sweden basically just let it happen and NY locked down and imposed significant measures. Both had significant deaths in the elderly population (although significantly more in NY than Sweden) and both now have very few new cases & deaths, so the outcome has been similar.

Also interesting is that CA took very similar measures to NY with very similar timing and now are seeing the exact opposite to NY (although the media seem to be a bit quiet on that!).

> Also interesting is that CA took very similar measures to NY with very similar timing and now are seeing the exact opposite to NY

CA did not act with similar timing relative to disease progression, whether on initiating the lockdown or reopening; particularly, it began quickly reopening when cases had barely flattened, earlier than New York either on the calendar or with regard to the progression of the epidemic, whereas NY didn't start reopening till they had dropped way down and still hasn't opened indoor restaurants in NYC, while California had reopened bars and restaurants statewide before beginning reclosing.

> although the media seem to be a bit quiet on that!

California's woes resulting from the premature reopening are heavily covered in the national (and even international) media. If you mean that the false claim that California policy closely tracked New York’s and got different outcomes isn't getting media play, you are right, but that's only because it's completely false.

New York was somewhat slower on the calendar and even moreso with regard to cases in closing, which was a big initial failure relative to California, but California bungled even worse with rushed reopening.

Was going by the information on rt.live regarding closing and re-opening for NY and CA, it shows the following dates (and may well be incorrect):

         | Shelter Start | Shelter End | Reopening Start
  -------+---------------+-------------+------------------
  CA [0] |     Mar 19    |      ?      |      May 25
  NY [1] |     Mar 22    |   May 28    |      May 15

Agreed that NYC itself didn't re-open at the same rate up but my understanding is that it was similar in CA (county by county and the more populous counties such as the SF bay area did not re-open as much).

For sure though, when NY locked down the community spread was likely far greater than it was in CA which I think shows in the C19 related deaths.

[0] https://rt.live/us/CA

[1] https://rt.live/us/NY

> Was going by the information on rt.live regarding closing and re-opening for NY and CA, it shows the following dates (and may well be incorrect):

For California, that's definitely wrong. California moved into Stage 2 reopening on May 8.

> Agreed that NYC itself didn't re-open at the same rate up but my understanding is that it was similar in CA (county by county and the more populous counties such as the SF bay area did not re-open as much).

That's loosely, qualitatively, true, but even most of the more populated counties had reopened more than NYC, and several counties had variances to go ahead of the statewide reopening.

Thanks for clearing that up. Hmmm ... seems to be a lot of misinformation out there even from "good" sources, such as Johns Hopkins and the NYT. For example regarding the situation in Mass:

https://old.reddit.com/r/CoronavirusMa/comments/hurn8r/the_n...

and:

https://old.reddit.com/r/CoronavirusMa/comments/hv7mri/a_not...

(kudos to /u/eaglessoar on /r/CoronavirusMa for providing excellent stats and coverage of the situation in MA).

The population desity is slightly different, so i am not sure if you are comparing two comparable entities, like apples and oranges.

NYC is extremely densely populated you would expect it to be an epicenter. Sweden, not so much.

Population of Sweden (a country): 10.23 million

Land area of Sweden: 173,860 mi²

Population of NY State: 19.45 million

Land area of NY State: 54,556 mi²

Keep in mind Sweden's most populous city (Stockholm) has a population of 1 million. NYC has a population of 8.4 million. Not to mention Sweden is culturally homogenous while NY is extremely diverse.

Please justify your comparison.

I was merely saying that the consensus seems to be that Sweden has failed in it's experiment and been irresponsible in allowing a higher per-capita death rate compared to it's nordic neighbors. However it seems that NY (state) is now being held up as an example of a good response -- specifically with Dr. Fauci called Gov. Cuomo's response "doing it correctly" (despite 32K deaths many of which it seems might have been directly related to a policy of discharging COVID patients into nursing homes [0]).

[0] https://www.usatoday.com/story/opinion/voices/2020/07/22/and...

In Australia, there has been an increase due to failings of the state government of Victoria in poor practices by guards of returned travellers in forced quarantine resulting in its spread, particularly to public housing apartment complexes[1]

As this jump occurred during school holidays, it looks like Melbournians have spread it to NSW as well which is why there is a jump in NSW. [2]

Australia would still be in a relatively good position if it wasn't for the incompetence of the Andrews Government.

[1] https://www.abc.net.au/news/2020-07-21/coronavirus-quarantin...

[2] https://www.smh.com.au/national/melburnian-linked-to-sydney-... [2]

Definitely agree.

Although to get slightly meta about this, the core blame lies with the 25 years trend of Australian governments outsourcing or selling off every possible previously-government-owned service they can (mostly to China-owned corporations) for a short term sugar hit of revenue for the currently incumbent politicians, to make themselves look good, without caring about the negative long term consequences to government revenue.

Profitable government monopolies like the Land Titles Registries have been sold to private international owners, who then raise costs for citizens, in order to recoup their investment faster.

Politicians strongly favour awarding outsourced contracts to their donors. In this case without opening the contract up for tender or competitive bidding, and obviously without much due diligence e.g. I read that one of the security firms donated $76k to Dan Andrews party last year.

So government outsources work to contractors who subcontract the work to independent ABN holders, who in turn can subcontract the work out to their employees, who in turn might be subcontractors themselves to the last company in the chain.

Politicians and public servants are normally happy with this arrangement because they can then wash their hands of blame for any mistakes, and pin it on the outsourcers who stuffed up.

In this case though, the blame is serious enough that it has jumped the subcontractor firewalls and burned its way all the way back up to the top (Dan Andrews).

Right, but its a bit of role reversal since Victoria is run by a Labour government which outsourced this to poorly trained security guards, whereas NSW with its Liberal (read conservative for Americans) government got the police to do it.

Labour ==> Labor

I know, I know. Its not my fault they can't spell :P

> The fact that Sweden’s death rate “far outstripped that of other nordic” countries (all else being equal) would tend to indicate the Swedish strategy failed, no?

Why are we only comparing Sweden to other nordic countries?

They are very comparable. Similar geographical- and population size, density, culture, climate, lifestyle.

They pushed their deaths forward by dealing with the pandemic with a light hand. I have a feeling two years from now the total damage will be comparable to other countries in Europe.

At this point in time, asking the question "Was Sweden correct?" feels like pure speculation, more like a betting game. The players (i.e: European countries) did play their cards, but it's way too early to know the result. What's the point of continuously asking?

it's what media are doing all the time. Comparisons are quite meaningless in general (different populations, climate, density, conditions, behaviours, healthcare systems, genes, luck), more so if the pandemic is far from over

I live just across the border from Sweden, in Denmark. Our health authorities proposed the same strategy as Sweden - but our prime minister overruled them, and chose a bigger lockdown quickly, after a serious warning from the Italian health minister about the grievous ramifications of doing just a 'measured response' like the epidemic playbooks prescribe. I'm glad she did. She chose a strategy that bought us time - and since then we've learned several important things: One is that social distancing is a much more effective weapon against viruses than we had imagined - so it's not inevitable that everyone will eventually get sick. And the other thing we've learned is that in addition to its relatively high mortality rate, this virus causes many more side effects by messing with our blood vessels, causing all sorts of organ damage. A significant number of those infected end up with decreased lung capacity or neural damage causing decreased cognitive function and/or decreased motor skills. So yes, Sweden probably took a smaller initial hit to their economy compared to ours in the first months, by not locking fully down. But what percentage of the population needs to get permanent nerve damage before it can be felt on your GDP for the next generation? Sweden's strategy does not allow them to avoid this, because the infection has already run much of its course. I'm glad we chose a more cautious approach. I think Sweden executed more or less what was considered best practice in the epidemic playbooks - but I think those playbooks will be re-written based on what this virus has taught us.

It seems to me that the lesson we should be learning from Sweden is different.

The measures undertaken in Sweden weren't sufficient to control the spread of the coronavirus at the start. They saw exponential growth like anywhere else that did not impose a lockdown. But the growth stopped faster than predicted by any models of herd immunity. They're now seeing 300 new cases a day, compared to 1100 at their peak. They've had about 1% of the population test positive, and about 0.1% of population die - and neither of those numbers look likely to grow significantly. You can quibble over testing statistics or death reporting, but they've had about 50% of the testing rate of Florida [0] and the excess deaths are within a factor of two of reported deaths[1].

If only 20% of people are immune to Covid-19, with a base reproductive rate of well over 1, this slowdown simply couldn't happen. The truth is there's something else going on: either it's way more infectious (but less dangerous) than realised, or more likely, a very large proportion of people have baseline immunity to the infection. It spreads rapidly through those who had no previous immunity and then burns out.

So it's not that Sweden did things right. They chose to be the control case for the lockdown experiment, and they got lucky that the virus isn't as bad as we thought. Back in March, it was a totally reasonable belief that the virus if unchecked will spread to 60-70% of people and kill 1% of those - we'd only seen the spread rates from the early days of the pandemic in China. Now, the only observation we have from leaving the virus unchecked points to a much lower number.

It's still rational for governments to err on the side of caution and wait for more data (especially on long-term effects), and to manage the pandemic to avoid saturating hospital and ICU use. But it's not rational to treat a disease that threatens to kill 0.1% in the same way as one that threatens 1%. If we see similar results in Florida - a region with good data and a reckless/casual approach to lockdown - we should see a peak in terms of new cases/day in the next three weeks and then it will be time to really accept that the risk is lower than we thought.

[0] almost all stats from https://www.worldometers.info/coronavirus/country/sweden/

[1] excess deaths from https://www.euromomo.eu/graphs-and-maps/

Come on, it was pretty obvious from very early on (during the Wuhan outbreak, then validated in Italy soon after) that the disease did not kill 1%, the symptoms for the vast majority of those that get sick are mild (to even being asymptomatic), moreover that the age skew was extremely strong. The median age of death is over 80!

All these factors together were used to decide on the strategy. Subscribing it to luck is unfair. It is more about expertise or lack thereof. A bureaucrat with little practical expertise is less likely to take risks since they are afraid of being exposed as lacking knowledge. Anders Tegnell most certainly was not afraid of going against the grain.

Introducing lockdowns in nursing homes early on would have avoided probably 60%-80% of deaths. This applies to Sweden and other countries as well.

> Come on, it was pretty obvious from very early on (during the Wuhan outbreak, then validated in Italy soon after) that the disease did not kill 1%

I don't think this was that obvious. Without widespread testing it was hard to tell how many people had got the virus. In China, 1 in 20 people who tested positive have died. In Italy it's a shocking 1 in 7. That's using today's figures: it was even more back then.

I remember respectable bodies estimating 0.5% or 1% mortality rate, though I can't find a WHO source that is more committal than "it appears to be worse than seasonal influenza". I'd call it a calculated risk.

To know the actual mortality rate you would have to test every single person in a country. Right now is more of the cultural thing: How likely is the person experiencing flu-like symptoms to go and test for coronavirus? Seems that in Italy only seriously sick people would go and take test, that's why you have this shocking 1 in 7 rate - because most of the mild cases go undetected.

"[..] that the disease did not kill 1%"

This is new for me. My understanding is that the current total mortality estimation is a little below 1% but, as you say, very skewed to old people.

That is: for old people is a lot more that 1%

Can you share any data that contradict that?

Some other explanations: The rest of Europe shut down and also shunned Sweden (most still do when it comes to travel from/to Sweden), which effectively put them in a forced isolation whether they wanted to or not.

Same goes for lockdown. While it wasn't mandated as strongly as other countries, lots of people self-imposed those restrictions. So it cannot be compared as lockdown vs no lockdown.

Neither of these offer any explanation to why there would be exponential growth for four months, followed by a flattening of the curve and a sharp decrease.

Being isolated from international travel is helpful when other countries have the virus and you don't, not the other way round. And I haven't seen anything to suggest that people restricted their movements in June/July than the previous months.

You're right that it's not a perfect control group as there was some change in behaviour. But that's not relevant to my argument that we now have a good data point for the total "area under the curve". If they'd had no change in behaviour, we'd have seen the peak somewhat earlier. I don't have a good feel for whether people in Florida are restricting their behaviour more or less than Swedes - seems close enough to consider them the same.

> there's something else going on: either it's way more infectious (but less dangerous) than realised, or more likely, a very large proportion of people have baseline immunity to the infection. It spreads rapidly through those who had no previous immunity and then burns out.

I don't think this can be the explanation, because it would not account for how geographically localized it was in Sweden. The Stockholm metro area got hit heavily, but the rest of the country was comparatively spared, and it never became big in southern Sweden. If people had prexisting immunity to coronaviruses you'd expect the immunity to be equally distributed, so it should burn through the entire country.

To me, that sounds more like there was an outbreak that started in Stockholm, but then they added social distancing measures which were enough to slow it down...

> it would not account for how geographically localized it was in Sweden. The Stockholm metro area got hit heavily, but the rest of the country was comparatively spared,

This doesn't match the statistics from here [0] [1].

The case rate in Stockholm county is 9.5 per 1000, making it the fourth hardest hit. 15 of Sweden's 21 counties, accounting for 80% of the population, have rates of 5 per thousand or higher - higher in the urban areas. The deep south of Sweden is the exception, not the rule - despite being home to a large city in Malmö, Skåne and the four surrounding counties have only 3 cases per thousand. I don't have a better explanation for this discrepancy but it's definitely not an outbreak localized to Stockholm.

[0] https://www.statista.com/statistics/526655/sweden-population...

[1] https://www.statista.com/statistics/1103949/number-of-corona...

I think it’s an artifact of how widespread the contagion was when restrictions were implemented. Stockholm has about twice the death rate as Västra Götaland, but lower case incidence. This is all plausibly explained by the observation that the epidemic started in Stockholm, and there were already hundreds of cases there when restrictions were enacted on the 18th of March. Protective gear was in short supply, supply lines were disrupted and the spread spiralled out of control. Other parts of Sweden had a far smaller case incidence at this point, so the restrictions were more effective, and by the time it became widespread in, for instance western sweden, supplies weren’t as scarce, certain lessons had been learned etc.

You're ignoring that Sweden implemented mostly the same social distancing measures that everyone else has. That's why their spread slowed down. No official nationwide lockdown does not mean the virus was unchecked. Besides, viral spread is not a direct function of government policy. In all likelihood, Swedish people saw their numbers going off the charts and started taking it more seriously and being more careful in their daily lives.

Does falling death rates really indicate widespread immunity? I'd like to see the randomized immunology tests to back that up (maybe he has them, but this article doesn't indicate it). I haven't heard of anywhere near herd-immunity levels yet.

Yeah, this sounds like an assertion that is entirely based on wishful thinking rather than evidence. Don't get me wrong, it might be true -- but you really need to provide some evidence if you're going to make claims like that.

https://science.sciencemag.org/content/early/2020/06/22/scie...

It’s at least plausible. The traditional definition of herd immunity assumes a homogenous population as the term has mainly been used in a vaccine strategy context. The above paper revises the definition based on a heterogenous model with the conclusion that the dynamics may be quite different in an actual epidemic.

antibodies tests shows the opposite, but antibodies do not explain immunity fully (T cells have an important role as well)

The 40% immunity number (antibodies + t-cell) is based on randomized immunology tests.

What 40% immunity number? I don't see that in the article here.

where does this 40% come from, do you have the source?

Herd immunity just means that the R factors drops to one without any mitigating measures.

Right now, Sweden has an R around one, without any enforced mitigation. Of course people's behavior still makes a difference.

That, to me, indicates widespread immunity, even if there is no herd immunity by definition.

How? A bunch of people died. Compared to Finland, Denmark, or Norway it looks like a disaster.

Doesn't this person have a vested interest in saying their approach is successful?

Also, the article fails to define success -- death toll, economic impact, and long term health consequences from exposure to covid are certainly all factors and the article only mentions one.

Don't other people who recommended other approaches have the same biases? Politicians and scientists alike

Of course. When we evaluate the efficacy of a strategy, maybe we shouldn't just repeat what the author of that strategy says. This is a place where we can look at data and draw conclusions rather than just become a mouthpiece for someone.

Yes, I agree, the debate needs to be open. I also think that being allowed to champion your own opinions and defend your past choices is a given, not least since these people whom I may disagree with may have good arguments that should be considered.

it says: "decline in new critical COVID-19 cases alongside slowing death rates"

Belgium is (about) the same size in Sweden, has (almost) twice the mortality rate. Why?

Nobody really now yet, and its not over either, the pandemic still very much a thing.

But some clues points towards that the virus slipped into the nursing home system in both countries.

Perhaps Sweden having 15 times more land could have something to do with it.

No, 85% of Sweden's population lives on 1.5% of the land area.

It's successful in the sense that the pandemic is greatly slowing down. Like most public health officials, he's not particularly concerned with "success" in the sense of "we can rub it in other countries' faces that our response was better".

It's not clear how Sweden's strategy is working compared to other Nordic countries. Norway has at the time of writing 255 deaths, Sweden 5646, and 19 vs 769 new cases today.[1][2] Norwegians are more or less back to normal life. Economically, Sweden did far worse than Norway as of 25. of June, with 25% more bankruptcies than previous year - same period - vs only 6.5% increase in Norway.[3]

[1] https://www.worldometers.info/coronavirus/country/norway/

[2] https://www.worldometers.info/coronavirus/country/sweden/

[3] https://e24.no/naeringsliv/i/AdjrvM/svenskene-fikk-konkursru...

Don't you think Sweden would have done even worse had they locked down?

This argument that hey look Sweden is still doing badly is ludicrous. Of course they do badly, no country is unaffected, Sweden is more industrialized and depends more on exports than Norway. Norway has a 1 trillion dollar stock market reserve from the oil. They will do fine.

The idea that locking down would have made things better in Sweden is absurd.

> Don't you think Sweden would have done even worse had they locked down?

I mean, we've only got all the other Nordic countries to compare against to evaluate this...

This dodges the question that I posed. Let me ask again:

Are you arguing that Sweden would have done better economically if they locked down?

Because that is what we are talking about.

No, I'm arguing Sweden saw the same economic damage - because people aren't stupid, and avoided doing the things a formal lockdown would have restricted anyways - without the infection control benefits of a formally managed one.

https://www.nytimes.com/2020/07/07/business/sweden-economy-c...

That's the absurdity right there. Saying that no lockdowns cause the same damage as full lockdown.

When it comes to coronavirus NYT is no different then Fox News, they are looking stuff up in their gut, ignoring all evidence, pushing a narrative based on a preconceived notion.

Why does the NYT not state how surprising is that the caseload in Sweden did not spiral out of control, and is actually decreasing? Regardless of what the death rate is (which is still much lower than many other European countries) it was and is completely at odds to the narrative of epidemics control. A balanced, fair journalist would state that.

> Saying that no lockdowns cause the same damage as full lockdown.

It's borne out by various bits of evidence; most people wind up DIYing their own lockdown, even if the government doesn't order it. Restaurant reservation numbers dropped dramatically before the first lockdowns, for example, and didn't jump back up to normal in states that reopened early.

https://www.latimes.com/food/story/2020-03-14/restaurant-res...

https://www.economist.com/graphic-detail/2020/05/19/american...

The benefit of a formal lockdown is enforcement for the small proportion of people who YOLO things.

Some food for your gut:

https://www.marketwatch.com/story/sweden-didnt-impose-a-lock...

https://www.thesun.co.uk/news/11775892/coronavirus-ravaged-s...

It's way too early to say what the best strategy would've been, but with hindsight-information it's not far-fetched to lean on a scientifically sound middle-ground. It's also too early to tell all the direct consequences of the virus itself.

Bingo!

> they are looking stuff up in their gut, ignoring all evidence, pushing a narrative based on a preconceived notion

It's obvious this is the case because their narrative hasn't changed despite so much changing and being proven wrong. There's no revising understanding based on evidence. It's defining your moral belief beforehand (e.g. anyone resistant to the draconian measures imposed by government is a misanthrope) and interpreting every development to support it.

Truth-seekers invite opposition, criticism and debate. I've seen none of that during the pandemic.

Any time I've seen people offer divergent arguments, it's met with the immediate response that disagreement is dangerous because "there's so much at stake".

It's all just the same politicizing, moral-superiority and demagoguery that's become far too common over the years.

The Scandinavian countries are actually quite different economically with regards to e.g. which industries represent most of their GDP. Since they are so small they are not very diversified. They're smaller than many US states and most people wouldn't make claims like this comparing those.

> They're smaller than many US states and most people wouldn't make claims like this comparing those.

People absolutely would, should, and do. Right now, the contrast between New York and Florida on reopening policy is pretty clear, despite differences in their economies.

For a contrary view regarding the economy:

https://markets.businessinsider.com/amp/news/sweden-coronavi...

From that article:

> A report from the research firm Capital Economics published on Tuesday found that the Swedish economy was the least harmed in Europe, describing it as the "best of a bad bunch."

> Though Sweden was not immune to the pandemic's economic impact, it was the only major economy to grow in the first quarter of the year, the report noted.

Can you explain how Sweden's performance in the first quarter has anything to do with Covid?

Most of the lockdowns happened at the end of the first quarter and lasted for most of the second quarter.

Maybe I'm missing something but it sounds like they are grasping at straws there when more accurate data shows the opposite picture.

As a Norwegian I don't trust a Norwegian newspaper to be anywhere near impartial with regards to the economic question. I also think it's hard to compare Norway and Sweden economically given the amount of money spent on stimulus by Norway this year because of "the oil".

Are the Covid deaths counted the same way? It seems for example that Sweden are very aggressive with labeling a death as Covid and e.g. Finland are undercounting.

The number of cases seems more clear cut, and I agree that it's not clear that the strategy either failed or succeeded. Just pointing out some potential pitfalls comparing even these two relatively similar countries.

Look at my sibling comment to yours ref counting deaths. From the source [1] Finland didn't have nearly as high spike in overall deaths as Sweden (see Z-scores)

[1]: https://www.euromomo.eu/graphs-and-maps

Unless you have reliable information about Sweden exaggerating the number of Covid deaths, I can't see the argument. Even if Sweden wrongly labelled 25% as Covid deaths, that's still a significantly larger number population size taken into account.

The bankruptcy numbers aren't a matter of opinion, these are public numbers that are regularly published by each respective country.

I didn't claim you made up the bankruptcy numbers. I just pointed out the economies are different. We are discussing a strategy for dealing with the virus, not who has the most money. If you've been to Scandinavia you will know who has the most money.

Exaggerating is a strong word. I don't think any two countries count deaths in the same way however.

As a Finn, I would be very interested to hear what are the sources for your claim that Finland are undercounting Covid-19 deaths. Further, could you elaborate in which way you claim Finland to be undercounting, such as Covid-19 deaths outside hospital setting, and is the undercounting supposed to be a country-wide policy, or limited to some specific regions?

Also what is the source for your claim about Sweden being very eager to label deaths as Covid-19? The excess death counts published by NY Times and Economist show only Belgium overcounting, and Sweden with more excess deaths than official Covid-19 deaths. If anything, Sweden's official total is unfortunately still missing hundreds of deaths, more than have died of Covid-19 in Finland or in Norway altogether.

Lots of people also say that Sweden's numbers are higher, because they count covid deaths differently. But looking at the number of deaths for this period compared to baseline [0], the number of deaths really spiked. While Denmark and Norway had overall normal numbers.

[0]: https://i.imgur.com/a2JEZ4j.png

Do you think it's possible that since more people have had the virus in Sweden, they are "through" to the other side while Norway isn't? How would that affect the excess death number?

I wouldn't know. But that's part of Tegnell's argument, yes. That when the second wave hits or this just goes on for years, Sweden will be better off. Hard to say right now, I think. 20/20.

Interesting to see this after reading this article yesterday: https://www.usatoday.com/story/opinion/2020/07/21/coronaviru...

Thanks for the link, I think the OP's article is from a month earlier.

I don't think we're going to have any idea which strategies actually worked for another year or so. If there's a large second wave this winter in other countries, and Sweden doesn't suffer from that due to immunity already acquired, then we may say Sweden's strategy worked. But if other countries that locked down early manage to keep it under control into the winter without having to lock down again (and suffer the economic, psychological and non-covid health consequences of that), and then a vaccine becomes available or other methods to reduce the death toll and health consequences, then we would conclude that the deaths so far were unnecessary and Sweden got it wrong. Most European countries are at the end of the beginning right now, but not necessarily the beginning of the end.

exactly, thanks for expressing this correctly and clearly. It's all speculations now.

The only thing we can say is that the contagion is under control at the moment (contrary to what many predicted) but the strategy has costed a number of (probably) preventable deaths. Let's review this in 6 months or so.

EDIT: rephrasing.

the problem is with your word "preventable"

what you mean by "preventable" is "at a cost that we don't have a way to quantify", hence will call that cost "inconvenience" and only focus on what we have "prevented"

all these measures that we take will kill many times more people than the disease. It is just the new deaths and damage are a diffuse costs whereas the benefits are concentrated and visible.

> all these measures that we take will kill many times more people than the disease.

I have seen this claim repeatedly, but always without numbers.

I completely agree that the measures have economic consequences, and the economic consequences will cost lives. But how do you know that the number is greater than the fraction of population killed by the coronavirus?

For example, the coronavirus in Sweden killed 0.05% of the population. Also, at least 0.7% got sick, with various consequences. Could you estimate what fraction of their population have other countries killed by the lockdowns? Ten percent? One percent? Zero point one percent?

> But how do you know that the number is greater than the fraction of population killed by the coronavirus?

You can measure it. For example you can look at excess mortality in the UK and then look at what fraction of that excess mortality is directly attributed to COVID.

Lots of people are doing this kind of data analysis on twitter.

Of course the guesswork comes in when you try to imagine how people would have acted without a lockdown.

Without lockdown would people still have gone for non-essential medical checkups for example?

I haven't looked at data from other countries yet. In Slovakia, the total mortality this year is lower than in the comparable period during previous years. I haven't investigated it, but my guess is fewer car accidents, and fewer people dying from the usual contagious diseases.

Of course it is possible that some deaths will come later, such as people who missed their medical checkups, have a condition that could have been cured a few months ago but is fatal now, and are still alive at the moment. I don't really think this is a large part of population.

I also suspect that if you do the simple calculation "excess mortality minus confirmed COVID deaths", this will be an overestimate, because many COVID deaths are misclassified as something else, e.g. pneumonia. And all those misclassified excess deaths would then appear as "victims of lockdown".

> I also suspect that if you do the simple calculation "excess mortality minus confirmed COVID deaths", this will be an overestimate, because many COVID deaths are misclassified as something else, e.g. pneumonia.

I think it depends on the country - a lot of countries are labelling any deaths with COVID symptoms as COVID (even though the symptoms are common to other illnesses like the flu).

In these countries it will likely be an overestimate.

> In Slovakia, the total mortality this year is lower than in the comparable period during previous years.

Yes, COVID has been fairly benign in a lot of countries and a massive killer of the old in others.

It's hard to deny that that a hard lockdown similar to the Chinese or the Italian one would have spared some of those lives, but it would have come with other costs (which, as you point, also cost lives).

So the "preventable" is speculative as well, nobody knows what would have happened with a lockdown , but there is an indication: the neighbouring Denmark was having a very fast spread of the disease until they imposed lockdown (which was a political decision) and they have had -until now- a much lower death toll per inhabitant.

But both approaches are reasonable IMHO. The Swedish strategy is based on pessimistic assumptions: we cannot stop the disease and the vaccine will be available late, if ever, therefore let's try to live with it and limit the damage. Herd immunity will eventually stop it. The Danish approach is more optimistic: let's block this now, whatever it costs, and hope that some cure (or a vaccine) comes before the disease starts spreading again.

Which approach will make less victims in the long run? We'll see, but both are bets.

Every country that tried full eradication has succeeded (Vietnam, New Zealand, Taiwan, Mongolia, etc). Trying to live with it does not work.

Many countries tried full eradication. You listed the only ones that succeeded so far (at least temporarily.... the thing about Sweden’s strategy is that it can likely continue indefinitely, whereas New Zeland’s is unlikely to continue for long)

Vietnam does not have the capacity to accurately test any reasonable swathe of the country, nor are they known for being transparent with any government data. I would take any data published from them with a lot of skepticism.

Vietnam absolutely does have the capacity to test. They have an incredibly advanced public health system, unlike the United States.

> June 23rd

> epidemology boss says "epdemic is being slowed down"

> all time high daily new cases in Sweden one day later[0]

[0] https://www.worldometers.info/coronavirus/country/sweden/

Their strategy might be working if you look at the cases however, lockdowns still seem to be the way more efficient strategy. Sweden is still far away from herd immunity and other European countries which had lockdowns have lowered the cases weeks ago. Even Swedens economy isn't doing much better.

>> Sweden is still far away from herd immunity

The point this guy is trying to make is that Sweden appears to be quite close to herd immunity, considering both infections and deaths are apparently declining by itself now. What makes you think this is impossible?

Summer tends to give other reasons for a decline. We will see what next winter brings.

And yet summer fails to bring that decline in the US and other places.

Compared to what?

Sweden; GP claimed Sweden’s numbers are I declined thanks to “the summer”, a claim which is disproved by the lack of decline in other places that experience summer at the same time.

The US has been exiting lockdown, which is a factor. I don't know what it means - there isn't a true control where we can say X is different.

Looking at the graphs of Sweden's infection rate, it seems like it peaked in early June and then went down. In May/June restrictions were only loosened, not made stricter. So any decrease in infections has to be in spite of the government's strategy, not because of it... right?

And as other commenters have pointed out, the death toll and mortality rate is inexcusable, and there was no economic gain from Sweden's approach. Just because the trend is going in the right direction now doesn't excuse the fact that their response had terrible results compared to neighboring countries.

No, it most likely peaked in early April if you look at the number of deaths and ICU admissions. The infection rate is mostly useless since we have changed testing strategy several times.

The quote below is what has stayed with me from the moment Anders Tegnell started appearing in news items online. It's from an interview published in 21 April 2020 in Nature:

The big debate we are facing right now is around care homes for older people, where we registered very unfortunate outbreaks of the coronavirus. This accounts for Sweden’s higher death rate, compared with our neighbours. Investigations are ongoing, because we must understand which reccommendations have not been followed, and why.

https://www.nature.com/articles/d41586-020-01098-x

The quote betrays a complete and utter unwillingness to assume any responsibility for the Swedish Publich Health Agency's "recommendations" and blame everything on others for failing to follow them.

Note that the PHA's "recommendations" were based on an equally recalcitrant unwillingness to accept that asymptomatic carriers can spread the disease. From the same article:

There is a possibility that asymptomatics might be contagious, and some recent studies indicate that. But the amount of spread is probably fairly small compared to people who show symptoms. In the normal distribution of a bell curve asymptomatics sit at the margin, whereas most of the curve is occupied by symptomatics, the ones that we really need to stop.

Because of this unwillingness to consider unsymptomatic carriers' potential for spreading the disease, the Swedish PHA's recommendations for care home workers were inadequate to protect care home residents:

The agency’s advice to those managing and working at nursing homes, like its policy towards coronavirus in general, has been based on its judgment that the “spread from those without symptoms is responsible for a very limited share” of those who get infected.

Its advice to the care workers and nurses looking after older people such as Bondesson’s 69-year-old mother is that they should not wear protective masks or use other protective equipment unless they are dealing with a resident in the home they have reason to suspect is infected.

Otherwise the central protective measure in place is that staff should stay home if they detect any symptoms in themselves.

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

This sounds like a desperate attempt to save face. Basically, their argument boils down to, "Well some countries did better than us and some did worse, so really our strategy wasn't so bad". The fact is a whole lot of people died in Sweden both in absolute numbers and relative to their neighbors. I know Sweden is used to being the smartest country in the room, but sometimes even the best among us make mistakes.

It's ok, just own it. No one has a perfect answer to this situation. You tried something different and it didn't work out.

You speak like the pandemic is over. We don't know yet. If it turns out that countries now lifting their lockdown will catch up I think Sweden's strategy was the correct one. No lockdown, no overwhelmed hospitals, currently no excess mortality and the least impact on the economy: https://markets.businessinsider.com/amp/news/sweden-coronavi...

> I know Sweden is used to being the smartest country in the room

Sweden being "smarter" than other countries is just a common American trope. For some reasons Scandinavian countries are misrepresented all the time by US politicians and media trying to make a point.

Fair enough. The American left worships Sweden.

From what I've seen they seem to worship a version of Sweden that doesn't match reality, though I'm not that well informed on the American left specifically.

You're better informed than you think, your take is pretty spot on. I have relatives in Scandinavia and they always joke that they wished they lived in America's version of Sweden.

Pretty much everyone has a vision of the rest of the world that doesn't match reality.

Even with billions of people on the planet, a virus like this doesn't spread evenly, even on a large scale. You always have pockets of infection caused by chance and opportunity.

So regardless of the viability of the strategy, the numbers can look different. We could discuss which country did best, but I doubt it would lead to anything constructive.

Of course a bad strategy can make it worse and I think Sweden was too naive with this, but you cannot really say which country had the best policies.

Whether their strategy was successful or not depends on the definition of success, but -- more importantly -- I think it is still too early to tell.

Much will depend on the endgame: if there is a vaccine soon, Sweden's strategy will look foolish, since it would have been better to enforce stricter measures and wait for the vaccine. If the vaccine takes a long time to arrive, they may have immunised a larger portion of the population much quicker than those with stricter measures (basically their Nordic neighbours) and will be in a position to return to "normal" much quicker.

Sweden has a high death-toll at the moment, but I think their strategy was a valid choice. It seems that there are strong diminishing to the measures. That is, even fairly light measures slow down the spread a lot, and the stricter measures have very little punch, but much economic impact.

Running the numbers on this, my team and I guesstimated that measures representing a 5% economic slowdown already reduce the infection rate by 60%, whilst a 10% economic slowdown would buy a infection rate reduction of around 70%. A 15% slowdown would buy an infection rate reduction of around 75%. So the thing is, the trade-off is not constant between economic impacts and the reduction in the infection rate, the policies seem to have (strong!) decreasing returns.

Sweden is closer to herd immunity than its neighbours. If the vaccine comes soon, the strategy of their neighbours will look better. If the vaccine takes a long time, Sweden's strategy may turn out to have been the better strategy. It is, quite simply, too early to say at this point.

I mostly agree, but I think there are some caveats here. If the duration of immunity is shorter than expected, or if long term health issues turn out to be fairly significant and prevalent, then Sweden's strategy won't end up looking too good.

And of course the other caveat is that when these strategies were implemented, the number of unknowns about COVID was much higher. So even if the outcome of their strategy ends up being acceptable, that still doesn't mean they made the correct decision base on the knowledge that was available at the time.

There is absolutely no reason to make such handwavy statements. Immunity can be measured, and he is the one who can measure it. this is soo unscientific

I'm afraid it's not that easy to measure, antibodies are only part of the picture

Some studies claim that immunity for SARS-CoV-2 only lasts for two weeks, which would make that "herd immunity" strategy completely foolish.

https://www.livescience.com/covid-19-immunity.html

In comparison to their neighbours they have a vastly higher death rate and their economy has not done any better, despite their lighter lockdown.

So unless this person is claiming that no further infections would occur if Sweden would stop all containment measures and go back to life as usual I don't see how this could be called "working" in any sense of the word.

For many people understanding Swedish Bureaucracy can be difficult. But you should be aware that in Sweden the political government cant fire Anders Tegnell. Its prevented by the Swedish constitution. Politicians cant involve themselves in Swedish government agencies. And due to labor laws he cant be prosecuted or dismissed from his service if he does not violate the labor laws. He cant be fired for "murdering" thousands of Swedish citizens with his advice ( that directly opposes the advice of CDC, WHO, or any other expert organization in 100+ countries).

Please Stop and Ask yourselves. Why Would This Person. Anders Tegnell ( working for a tiny swedish no so special agency ) Know better than the rest of the competence of the entire world.

"Folkhälsomyndigheten" have done all in their power to silence any objections from within the agency and the broader Swedish research community. Explicitly choosing an think-tank of outside experts not objecting the strategy.

We are talking about an government organisation where like-mindedness is the norm. They dont publish their sources for estimations, calculations or any of their "theories & strategies" either.

Here are 25 of the prominent swedish researchers objecting the "strategy" urging the rest of the world to please not Listen to Anders Tegnell. https://eu.usatoday.com/story/opinion/2020/07/21/coronavirus...

This reads like some conspiracy Nonsense, he can at any point be relived of his duties, also, the agency is not Tegnell, there is a lot of good people working there that would step up if needed.

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