Sweden's liberal pandemic strategy questioned as Stockholm death toll mounts

[Ryokan]

The largest source of excess deaths, especially compared to neighboring countries, appear to come from elderly care homes.

Despite being just 60, my mom is in a care home.

She's blind, a cancer survivor and a stroke survivor. She never recovered from her stroke, so she's immobilized, in a wheelchair and requires constant care.

I'm very happy that Norway shut down when it did and to the extent we did. Covid-19 is not rampant in care homes here like it is in Sweden.

My mom probably wouldn't have survived getting the virus.

 

[dann]

The number of deaths per day in Sweden appear to have decreased - April 10: 887, April 11: 899 - but …

Därför är dödstalen så låga just nu (Aftonbladet, April 12, 2020)
”Blir tuffare i slutet av april” (Aftonbladet, April 9, 2020)
Sjuksköterskan Sofia: ”Vi gör saker vi aldrig hade accepterat förut” (SVT.se, April 12, 2020)
Så påverkar corona möjligheten att opereras (SVT.se, April 9, 2020)

 

[dann]

Swedish Television (SVT) has received information that several acute clinics in Stockholm are fighting to make the supply of oxygen suffice for corona patients.

Enligt uppgifter till SVT Nyheter kämpar flera av akutsjukhusen i Stockholm med att få syrgasen att räcka till för coronapatienter.
Tunga kritiken: ”Ofattbart att fältsjukhuset inte har öppnat” (SVT.se, April 12, 2020)

 

[Rolfe]

Hmmm. I suppose time will tell whether this is accurate or not. Various commentators seem to think it's not far off the mark.

https://twitter.com/kausmickey/status/1248701952675835904

A document from Karolinska hospital in Stockholm (Sweden’s best hospital) reveals that they will no longer give intensive care to patients over 80, those over 70 with 1 underlying health issue, or those over 60 with 2 under-lying health issues.

This comes after the Stockholm region being heavily overloaded by coronavirus patients.

 

[angrysoba]

Well, it does look as though deaths have decreased a lot over the last two or three days. 77, 17 and 12 (iirc)

Let’s hope it continues to go down and that this is not an artifact of the recording of deaths that may be affected over the Easter weekend (I notice that fatalities seem lower almost everywhere - not just Sweden - though and think it could be misleading).

 

[Sherkeu]

Hmmm. I suppose time will tell whether this is accurate or not. Various commentators seem to think it's not far off the mark.

https://twitter.com/kausmickey/status/1248701952675835904

About a week ago I read that this isn't different than normal in Sweden. Aggressive end-of-life care is not given if it is shown to have little effect on outcomes.

 

[Arcade22]

Hmmm. I suppose time will tell whether this is accurate or not. Various commentators seem to think it's not far off the mark.

https://twitter.com/kausmickey/status/1248701952675835904

Björn Persson, head of operations for intensive care at Karolinska, says that individual doctors should have the document as support when they make difficult decisions.
- We have an extreme situation in intensive care with a very high load. In this situation, it is extremely important that we use our resources for the patients we believe have the greatest chance of surviving and benefiting from intensive care, he says and continues.

- Although you may not have a chronologically high age, and may be in your 60s, but in combination with, for example, severe diabetes, cardiovascular disease or stroke, the biological age can be high. Of those who have a failing health and end up under intensive care and come out of it, many of the patients die within the immediate time. Intensive care is very tough for the body even for a healthy person. Then we make an individual assessment in each case.
...

- To me it is nothing strange or controversial. There is nothing that stands out or is really new. In my eyes, this is exactly how we reason about each patient when intensive care is being considered. The difference is that it is formalized in text clearly now, which I think is valuable, says Mattias Bergström.

According to Karolinska, the new decision support is based on the National Board of Health and Welfare's new national guidelines for intensive care priorities in extraordinary circumstances, which were developed especially during the pandemic. Karolinska's decision support is more specifically held than the National Board of Health's guidelines. According to Lars Sandman, professor of health ethics at Linköping University, it is expected that an interpretation of the document will be made.

- It was a conscious choice that we did not go into such medical parameters, nor to specify any type of age for a so-called cut-off limit. However, there is a general writing about the importance of a high chronological age, says Lars Sandman.

https://translate.google.se/transla...kument-visar-vilka-som-inte-far-intensivvard/

 

[Arcade22]

Well, it does look as though deaths have decreased a lot over the last two or three days. 77, 17 and 12 (iirc)

Let’s hope it continues to go down and that this is not an artifact of the recording of deaths that may be affected over the Easter weekend (I notice that fatalities seem lower almost everywhere - not just Sweden - though and think it could be misleading).

The deaths seem to have plateaued and perhaps decreased, but that sharp drop is with almost complete certainty caused by a backlog of reporting. Pretty much every weekend sees a drop like that which is subsequently revised once staff gets back to work after the weekend.

 

[angrysoba]

The deaths seem to have plateaued and perhaps decreased, but that sharp drop is with almost complete certainty caused by a backlog of reporting. Pretty much every weekend sees a drop like that which is subsequently revised once staff gets back to work after the weekend.

Yeah, that's what I fear. The downturn may be illusory.

 

[dann]

Well, it does look as though deaths have decreased a lot over the last two or three days. 77, 17 and 12 (iirc)

Let’s hope it continues to go down and that this is not an artifact of the recording of deaths that may be affected over the Easter weekend (I notice that fatalities seem lower almost everywhere - not just Sweden - though and think it could be misleading).

It is an artifact of recording! And Easter probably doesn't make recording better.

The number of deaths per day in Sweden appear to have decreased - April 10: 887, April 11: 899 - but …

Därför är dödstalen så låga just nu (Aftonbladet, April 12, 2020)
”Blir tuffare i slutet av april” (Aftonbladet, April 9, 2020)

Translation of the two titles:
This is why the number of deaths is so low right now
"It will get tougher in late April"
(I assume that tuff in Swedish means tough, but I don't really know)

 

[dann]

Hmmm. I suppose time will tell whether this is accurate or not. Various commentators seem to think it's not far off the mark.

https://twitter.com/kausmickey/status/1248701952675835904

I think it refers to what I posted here:

Doctors in Sweden receive a letter telling them how to distinguish between coronavirus patients, i.e. which patients won't receive intensive care if hospitals run out of hospital beds in intensive-care units:
Dokument sendt til læger: Sverige forberedt på at prioritere mellem coronapatienter (TV2, April 10, 2020)
Dokument visar: De prioriteras bort från intensivvård (Aftonbladet, April 10, 2020)

The if is important. I don't think that is has actually happened yet.

 

[dann]

https://translate.google.se/transla...kument-visar-vilka-som-inte-far-intensivvard/

On the one hand:
"- We have an extreme situation in intensive care with a very high load. In this situation, it is extremely important that we use our resources for the patients we believe have the greatest chance of surviving and benefiting from intensive care, he says and continues."

On the other hand:
"- To me it is nothing strange or controversial. There is nothing that stands out or is really new. In my eyes, this is exactly how we reason about each patient when intensive care is being considered. (...) According to Karolinska, the new decision support is based on the National Board of Health and Welfare's new national guidelines for intensive care priorities In extraordinary circumstances, which were developed especially during the pandemic."

 

[Arcade22]

Patients are being discharged from the intensive care unit at Karolinska - and more than 80 per cent of those in intensive care survive. The situation is much better than expected, says David Konrad, chief physician at IVA Karolinska University Hospital.

Intensive care at Karolinska Hospital in Stockholm has so far been able to handle the burden of corona patients better than expected, according to David Konrad, who is chief physician and head of function at Karolinska University Hospital's intensive care unit. Today, 177 intensive care units are open at Karolinska University Hospitals, but they are ready to go up to 216 if needed.

- There are still empty beds left, not only at Karolinska but the intensive care unit in Stockholm in general has made an incomparable increase. I think we are now at a total of over 300 percent against where we normally are, so many are struggling, says David Konrad of the Weekend Studio.

More and more discharged: "Is there a slight slowdown"
Currently, 127 corona patients in intensive care are being cared for in Karolinska. Every day, between six and twelve new intensive care patients are discharged.

- But we also now see that more and more people are being discharged from the intensive care unit, so we are approaching a little bit the plateau phase you are talking about. There is a slight slowdown - it may be temporary, it is too early to say - but it looks a little better, says David Konrad.

https://www.svt.se/nyheter/inrikes/over-80-procent-overlever-intensivvarden

Google translate apparently doesn't work on the webpage.

 

[dann]

For those of you who may find it difficult to understand the Swedish attitude, I can recommend this article:

Sweden Continues With Controversial Coronavirus Strategy: Is It A Big Mistake? (Forbes, April 10, 2020)

Some of the attitudes described in the article are close to being verbatim sentences written by the Swedish posters in this thread.

 

[Rolfe]

It will be interesting to see what happens. I think at the moment that a lot of things are being prohibited and prevented in many western countries that are actually extremely low risk. Once more data are in it might prove perfectly OK to allow more activities. However there's a strategy difference between locking down tight at the start then strategically relaxing, and being very light touch at the beginning and only tightening restrictions if it's seen to be necessary. Every single principle of epidemiology says the first approach is the right one.

Even in the Chinese studies nobody was identified as having caught the virus out of doors. All the crazy park policing is probably helping to do nothing but make people stressed and anxious. The preliminary German study also found nobody who had caught the virus in a shop or a restaurant, although I think that may simply be a feature of the small sample size (500 people at that point). Nevertheless it has been suggested that Wuhan found it so difficult to get the virus under control at least partly because it's a bit of a midden. Communal toilets and insanitary restaurants and food outlets. Germany, with better public hygiene all round, wasn't experiencing the same problems. Cases in France also appear to be falling off a cliff.

So we could see a gradual opening up to something closer to the Swedish situation as other countries reasses their strategies. However we don't know if Sweden is still permitting too much contact, and if it needlessly cost lives in the early period by not being more restrictive.

It's looking as if the main route of transmission of this virus is indoors, especially in gatherings which are fairly large but quite intimate. Birthday parties, funerals and so on, where an infected person may talk face to face for a fairly prolonged period to several other people. There was a choir practice of about 60 people in America where 40 became infected and two died. It's suspected that the physical act of voice projection by a trained singer produces a dangerous aerosol from deep in the lungs. I would imagine that these sorts of gatherings and indeed theatres and concerts and so on might be off the agenda for quite some time.

On the other hand parks, beaches and fields are probably quite safe as long as people mostly keep their distance. You're not going to get it from someone who just walks past you. Shops and indeed restaurants might be possible to operate with reasonable safety if the viral prevelance in the community is low.

So we'll see. However my experience in animal disease control very heavily favours the "lock down tight at the first sign of trouble, evaluate the situation and then relax gradually and strategically" policy over the "let's not over-react and see how this goes" approach. I give you Foot and Mouth in 2001 as an example.

 

[angrysoba]

For those of you who may find it difficult to understand the Swedish attitude, I can recommend this article:

Sweden Continues With Controversial Coronavirus Strategy: Is It A Big Mistake? (Forbes, April 10, 2020)

Some of the attitudes described in the article are close to being verbatim sentences written by the Swedish posters in this thread.

It also sounds very similar to what is going on in Japan. Now, finally, here in Osaka restaurants have to close after seven or eight o'clock. Yesterday, a large family restaurant across from me had customers well into the evening.

It is something that *maybe* can work if the vast majority of the population are not twats about it.

We still have people going out shopping in the city centres, and going to parks to soak up the sun. And, as I may have mentioned, the subways are still packed.

How long can the eggshell dance last?

 

[dann]

Virus isn't fond of sunshine, so being outside in the sun is probably safe if you follow the rules of social distancing. In Denmark, our parks are open, too. (The cherry-blossom park mentioned above was an exception because it could be expected that too many people would be there simultaneously.)
The weather (and the water!) isn't hot enough yet, but I could do with a trip to the beach. (I think that some of the photos of people on beaches in Florida may have been deceptive. In a photo, it's very easy to make it seem as if people aren't social distancing.)

My local park, Frederiksberg Have, has been regulated so that running is now prohibited. Exercise runners have been exiled to the neighboring park, Søndermarken, and they have to run in one direction only.
It seems to be working fine. I definitely don't miss the runners and would love to see the rule made permanent!

 

[Arcade22]

By the way, as a concrete example of how social distancing measures are working one can look at how the spread of the "winter vomiting bug" has been heavily decreased compared to recent years.

https://www.folkhalsomyndigheten.se...0ad7766/calicivirus-veckorapport-2020-v13.pdf

The green bars are confirmed cases of Calicivirus (norovirus) infections. The lines are past years.

The influenza season is also over at a way earlier date than usual.

 

[dann]

That the spread of the flu stopped as a side effect of social distancing has been mentioned in Denmark, too!

 

[dann]

It will be interesting to see what happens. I think at the moment that a lot of things are being prohibited and prevented in many western countries that are actually extremely low risk. Once more data are in it might prove perfectly OK to allow more activities. However there's a strategy difference between locking down tight at the start then strategically relaxing, and being very light touch at the beginning and only tightening restrictions if it's seen to be necessary. Every single principle of epidemiology says the first approach is the right one.

Even in the Chinese studies nobody was identified as having caught the virus out of doors. All the crazy park policing is probably helping to do nothing but make people stressed and anxious. The preliminary German study also found nobody who had caught the virus in a shop or a restaurant, although I think that may simply be a feature of the small sample size (500 people at that point). Nevertheless it has been suggested that Wuhan found it so difficult to get the virus under control at least partly because it's a bit of a midden. Communal toilets and insanitary restaurants and food outlets. Germany, with better public hygiene all round, wasn't experiencing the same problems. Cases in France also appear to be falling off a cliff.

So we could see a gradual opening up to something closer to the Swedish situation as other countries reasses their strategies. However we don't know if Sweden is still permitting too much contact, and if it needlessly cost lives in the early period by not being more restrictive.

It's looking as if the main route of transmission of this virus is indoors, especially in gatherings which are fairly large but quite intimate. Birthday parties, funerals and so on, where an infected person may talk face to face for a fairly prolonged period to several other people. There was a choir practice of about 60 people in America where 40 became infected and two died. It's suspected that the physical act of voice projection by a trained singer produces a dangerous aerosol from deep in the lungs. I would imagine that these sorts of gatherings and indeed theatres and concerts and so on might be off the agenda for quite some time.

On the other hand parks, beaches and fields are probably quite safe as long as people mostly keep their distance. You're not going to get it from someone who just walks past you. Shops and indeed restaurants might be possible to operate with reasonable safety if the viral prevelance in the community is low.

So we'll see. However my experience in animal disease control very heavily favours the "lock down tight at the first sign of trouble, evaluate the situation and then relax gradually and strategically" policy over the "let's not over-react and see how this goes" approach. I give you Foot and Mouth in 2001 as an example.

Animals are absolutely awful at social distancing, and they are even worse at washing their hands - not to mention sneezing into their elbows!

Everything you write makes sense. In another thread somebody wrote about a wedding where many of the guests came down with Covid-19, but none of the staff did. However, they obviously didn't have to use their lungs the way people do at choir practice.

When I understood the seriousness of the situation, I immediately gave up what is probably one of the most contagion-prone activities imaginable, and I warned the others against it: Salsa Cubana Rueda-style (scroll down to the video: Just Dance, Have Fun – and Enjoy the Cuban Vibe; I'm the one in the grey T-shirt with a green Che Guevara, of course!): You dance close with several people, touch hands, take deep breaths, and this time of the year it's always indoors. I'm actually surprised that I haven't heard about any of my friends and acquaintances coming down with it yet.