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?
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.
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.
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
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).
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.
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.
Do you have data to demonstrate that the age distribution is different?
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.
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).
So, at this moment we are only celebrating that Sweden succeeded at the "do badly at the start" part?
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.
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...
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."
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!).
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.
| Shelter Start | Shelter End | Reopening Start
-------+---------------+-------------+------------------
CA [0] | Mar 19 | ? | May 25
NY [1] | Mar 22 | May 28 | May 15
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.
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.
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).
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.
[0] https://www.usatoday.com/story/opinion/voices/2020/07/22/and...
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]
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).
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...
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.
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.
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.
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.
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.
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.
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
https://www.nytimes.com/2020/07/07/business/sweden-economy-c...
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.
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.
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.
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).
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?
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)
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.
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.
https://www.nytimes.com/interactive/2020/04/21/world/coronav...
Screenshots of the current charting, for posterity: https://imgur.com/a/1DC95no
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.
It doesn't really give anything sensible when you compare unadjusted total mortality per capita across countries.
"21 nya dödsfall med bekräftad covid-19 har inrapporterats det senaste dygnet, enligt Folkhälsomyndighetens senaste uppdatering."
Edit: For those interested in the stats (English): https://www.svt.se/datajournalistik/the-spread-of-the-corona...
Why are we only comparing Sweden to other nordic countries?
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.
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.
https://www.macrobusiness.com.au/2020/07/covid-19-drives-up-...