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

[Planigale]

A paper here suggests Sweden may be right!
https://www.bmj.com/content/371/bmj.m3588
Lock downs may result in a final mortality higher than a more liberal approach allowing herd immunity to develop in low risk (younger) people.

The author accepts lock downs may be (and were) necessary to stop the health service being overwhelmed by surges in cases. The argument is that in the end they do not save lives.

 

[zooterkin]

A paper here suggests Sweden may be right!
https://www.bmj.com/content/371/bmj.m3588
Lock downs may result in a final mortality higher than a more liberal approach allowing herd immunity to develop in low risk (younger) people.

The author accepts lock downs may be (and were) necessary to stop the health service being overwhelmed by surges in cases. The argument is that in the end they do not save lives.

“In the absence of an effective vaccination programme”. The strategy was adopted in the knowledge that it was a temporary fix, pending the development of a vaccine. If such a vaccine is not forthcoming, then obviously things may get worse.

 

[lionking]

“In the absence of an effective vaccination programme”. The strategy was adopted in the knowledge that it was a temporary fix, pending the development of a vaccine. If such a vaccine is not forthcoming, then obviously things may get worse.

Exactly. Sweden's "we had to destroy the village to save the village" approach may be possibly vindicated if a vaccine is not found, but I doubt even then.

To make a policy decision, as they did, to accept death rates amongst the highest in the world and result in ever increasing infection rates is shameful. The Swedish government and those who support it should hang their heads in shame, and distortion of the facts as some here are doing (CC) doesn't change its culpability.

 

[dann]

It is also worth noticing that this is based on the UK! Effect of school closures on mortality from coronavirus disease 2019: old and new predictions (BMJ, Oct. 7, 2020)

Population About 70 million simulated people matched as closely as possible to actual UK demographics, geography, and social behaviours.

Main outcome measures Replication of summary data on the covid-19 epidemic reported to the UK government Scientific Advisory Group for Emergencies (SAGE), and a detailed study of unpublished results, especially the effect of school closures. Results The CovidSim model would have produced a good forecast of the subsequent data if initialised with a reproduction number of about 3.5 for covid-19. The model predicted that school closures and isolation of younger people would increase the total number of deaths, albeit postponed to a second and subsequent waves. The findings of this study suggest that prompt interventions were shown to be highly effective at reducing peak demand for intensive care unit (ICU) beds but also prolong the epidemic, in some cases resulting in more deaths long term. This happens because covid-19 related mortality is highly skewed towards older age groups. In the absence of an effective vaccination programme, none of the proposed mitigation strategies in the UK would reduce the predicted total number of deaths below 200 000.

It seems to be based on a model akin to the Hammer without the Dance but with protection of the vulnerable exclusively. It seems to be based on the same idea Sweden's herd-immunity strategy was based on:

Conclusions It was predicted in March 2020 that in response to covid-19 a broad lockdown, as opposed to a focus on shielding the most vulnerable members of society, would reduce immediate demand for ICU beds at the cost of more deaths long term. The optimal strategy for saving lives in a covid-19 epidemic is different from that anticipated for an influenza epidemic with a different mortality age profile.

If you build into your model that "the most vulnerable members of society" are actually shielded, your model is very different from reality. In real life, actually shielding the elderly from the virus consists in hammering it down - preferably eliminating it. As soon as the virus starts spreading again, nursery homes are hit as again. It's what happened in both Sweden and Denmark in recent weeks. Measures to protect only "the most vulnerable members of society" while letting the virus rip don't seem to work - except in models. We know how well it worked in Sweden ... When you are dealing with "simulated people" only, you need to be aware that it is extremely easy to protect simulated vulnerable people!

 

[dann]

Inquiring minds want to know - so Anders Tegnell doesn't!

Enligt ett pressmeddelande som KTH lagt ut på sin hemsida, och som DN var först att rapportera om, har mängden virus som hittats i avloppsvattnet i Stockholm fördubblats de senaste veckorna – och är nu på samma höga nivåer som i maj i år.
Tegnell om KTH:s studie: ”Vad tillför det här?” (SvenskaDagbladet.se, Oct. 6, 2020)

According to a press release placed on the website of the KTH, which DagensNyheter was the first media to report, the amount of virus found in sewage water in Stockholm has doubled in recent weeks – and is now at the same high level as in May 2020.
Tegnell about KTH’s study: “What’s the use of this?”

Analyser av avloppsvattnet kan visa coronavirusnivåer eller utbrott av kräksjuka. Men forskare anser att det saknas ett intresse hos politikerna att satsa på analyserna.
– Det är inte rimligt i längden att det svenska folkhälsosystemet bärs upp av frivilliga studenter, säger David Nilsson, docent vid KTH.
Forskarkritik om avloppsprov (SvenskaDagbladet.se, Oct. 8, 2020)

Analyses of sewage water can show the levels of coronavirus or outbreaks of norovirus. But researchers say that politicians are not interested in investing in the analyses.
– In the long run, it is unreasonable that the Swedish health-care system is based on volunteer students, says David Nilsson, lecturer at the KTH.
Researchers criticize the response to sewage testing


The analyses of sewage water seem to agree with the rise in reported cases in Sweden in recent weeks:

Tuesday, Sep. 15: Sweden: 840* *since Friday, according to SVT.se
Tuesday, Sep. 22: Sweden: 1199* *since Friday, according to SVT.se
Tuesday, Sep. 29: 1,543 since Friday, according to SVT.se
Tuesdag, Oct. 6: 1,862 since Friday, according to SVT.se

 

[PhantomWolf]

LATEST UPDATE. according to WHO Coronavirus Disease (COVID-19),
Data last updated: 2020/10/6, 3:07pm CEST

Newly reported cases in the last 24 hours:

U.S. 36,136
Australia 13
Sweden 0
Denmark 377
New Zealand 3

Sweden must have truly succeeded in “eliminating” the virus but poor New Zealand. It’s new cases in this category have more than doubled since yesterday’s tally. Naturally, the difference between 1 and 3 isn’t an earth-shattering increase but it does (again) dispel the fantasy claim that they have “eliminated” the virus more than once. I mean seriously, that “elimination” story will be the centre of jokes for a decade.

The cases in NZ are people that are in isolation after coming into the country on flights from elsewhere, they aren't in the community and aren't a threat to people outside of the isolation facilities.

We currently have 0 cases outside of the Isolation Facilities and have had for about 12 days since the last small outbreak was deal with. Auckland returned to level 1 the other day, meaning the entire country is back to Level 1 now.

We have indeed eliminated the virus from our community twice, actually technically 4 times since we had three outbreaks during the second "wave".

 

[lionking]

The cases in NZ are people that are in isolation after coming into the country on flights from elsewhere, they aren't in the community and aren't a threat to people outside of the isolation facilities.

We currently have 0 cases outside of the Isolation Facilities and have had for about 12 days since the last small outbreak was deal with. Auckland returned to level 1 the other day, meaning the entire country is back to Level 1 now.

We have indeed eliminated the virus from our community twice, actually technically 4 times since we had three outbreaks during the second "wave".

While I agree with this post in the main, NSW was basking in the glory of 14 days or so of no community transmissions. Until today, with 8. So I wouldn’t be as sure as you seem to be that there will be no further outbreaks and soon.

I think Australia’s policy of controlling the virus is more practical. Get down to 5-10 a day which are easily traced and controlled and live with that.

ETA a vaccine, of course, would make the goal of elimination much more practical.

 

[banquetbear]

I think Australia’s policy of controlling the virus is more practical. Get down to 5-10 a day which are easily traced and controlled and live with that.

...zero cases a day is much more practical to trace and control than 5-10 cases a day.

 

[lionking]

...zero cases a day is much more practical to trace and control than 5-10 cases a day.

Of course. What about my post did you not understand? You seem wedded to elimination as the only solution. I’m saying controlling a low number is a decent, achievable solution, particularly with larger populations than NZ.

 

[banquetbear]

Of course.

...I'm glad you agree with me.

What about my post did you not understand? You seem wedded to elimination as the only solution.

You said "Australia’s policy of controlling the virus is more practical." Then you agreed with me by saying "of course (zero cases a day is much more practical to trace and control than 5-10 cases a day)." So what part of my post did you not understand? Do you agree with me or not?

I’m saying controlling a low number is a decent, achievable solution, particularly with larger populations than NZ.

That literally wasn't what you said. I responded to what you actually said and you agreed with me. It this is what you intended to say then I would have said something different. I think Australia could get to elimination if it wanted, and there are a number of scientists who think it would be a valid strategy. But (as I've already stated in this thread) I'm not wedded to elimination as the only solution (outside of NZ). Australia’s policy of controlling the virus is a practical one. But it isn't more practical and it won't produce better (health) outcomes than the New Zealand strategy which is what you compared it too.

 

[dann]

Of course. What about my post did you not understand? You seem wedded to elimination as the only solution. I’m saying controlling a low number is a decent, achievable solution, particularly with larger populations than NZ.

Elimination may not be the only solution, but it is obviously the most effective solution. The Hammer & the Dance is bloody annoying, and I fear that people are much more likely to get so tired of it that they become susceptible to the ideologues preaching herd immunity. When you have already experienced how effective the elimination strategy is, very few can be persuaded by the anti-maskers and virus deniers to let it rip.

So I wouldn’t be as sure as you seem to be that there will be no further outbreaks and soon.

I didn't see PhantomWolf claim that he was sure that "there will be no further outbreaks." Iceland shows us that a couple of infected psychopaths can get the whole thing started again.

 

[lionking]

...I'm glad you agree with me.



You said "Australia’s policy of controlling the virus is more practical." Then you agreed with me by saying "of course (zero cases a day is much more practical to trace and control than 5-10 cases a day)." So what part of my post did you not understand? Do you agree with me or not?



That literally wasn't what you said. I responded to what you actually said and you agreed with me. It this is what you intended to say then I would have said something different. I think Australia could get to elimination if it wanted, and there are a number of scientists who think it would be a valid strategy. But (as I've already stated in this thread) I'm not wedded to elimination as the only solution (outside of NZ). Australia’s policy of controlling the virus is a practical one. But it isn't more practical and it won't produce better (health) outcomes than the New Zealand strategy which is what you compared it too.

Oh, the magical NZ. I think too many of you think you are really in Middle Earth, where different rules prevail.

As I pointed out earlier, NSW had no community transmissions. Until they did. In my view complete elimination of this virus without a vaccine is magical thinking. But carry on.

 

[PhantomWolf]

Oh, the magical NZ. I think too many of you think you are really in Middle Earth, where different rules prevail.

As I pointed out earlier, NSW had no community transmissions. Until they did. In my view complete elimination of this virus without a vaccine is magical thinking. But carry on.

You have to remember that we went 109 days without community spread until it got through the border three times in a few weeks, one of which led to our largest cluster and 3 deaths. We are very aware that this virus is sneaky and can slip through the protections. In one case an infected worker carried it out of isolation, in another, a returnee carried it out of isolation after testing negative on both day 3 and day 12. We still don't have a clue how the virus escaped to cause the major cluster.

However, what we do know is that fast contact tracing and isolation for those close contacts, and infected, works and ends the clusters quickly. We also know that having 8-10 cases a day can quickly turn into having 50-60 cases a day. Having 0 cases a day is a much-preferred target and is achievable, even is that means putting out spot fires as they occur. This doesn't require magical thinking, just the will to do it.

 

[dann]

In my view complete elimination of this virus without a vaccine is magical thinking.

That's what Tegnell's fans claim: "Impossible!"
But at this point, it has already been done - in more places and more than once. I see no reason not to do it. It saves lives and health, and it is probably cheaper, too.

 

[Tippit]

However, what we do know is that fast contact tracing and isolation for those close contacts, and infected, works and ends the clusters quickly. We also know that having 8-10 cases a day can quickly turn into having 50-60 cases a day. Having 0 cases a day is a much-preferred target and is achievable, even is that means putting out spot fires as they occur. This doesn't require magical thinking, just the will to do it.

And a population of less than 5m, and all isolated on a relatively small island nation, and with a full travel ban initiated only a few days after Trump's China travel ban, which was relentlessly mocked, but for all the wrong (and hypocritical) reasons.

We shall see if you can hold out with the travel bans until a vaccine arrives.

 

[Tippit]

That's what Tegnell's fans claim: "Impossible!"
But at this point, it has already been done - in more places and more than once. I see no reason not to do it. It saves lives and health, and it is probably cheaper, too.

You see no reasons not to do it, despite the obvious demographic, geographic, and political factors that make it uniquely impossible for non-islands with massive, mobile populations to do. Admit it. You wouldn't mind sealing people in their homes a la the Chinese in Wuhan, right? You have Karl Marx in your signature. This wouldn't be so surprising.

 

[Chanakya]

... Admit it. You wouldn't mind sealing people in their homes a la the Chinese in Wuhan, right? You have Karl Marx in your signature. This wouldn't be so surprising.

What the hell has Karl Marx got to do with it? You'd have a point had it been Lenin, or Stalin, or Trotsky, or one of those goons of whichever persuasion.

I find this line of thinking incomprehensible. A vaccine, or maybe vaccines, plural, will likely be available in a few months, a year tops (hopefully -- but obviously that's not certain). What kind of snowflake, what kind of restraint-less lightweight entirely lacking in determination and self control, is unable to stay put for a matter of months, in order to protect themselves, and more importantly to protect the old and vulnerable in our midst? I can understand when it comes to peoples, nations that are poor, masses of their populations starving -- but for the rest?

China does that by fiat. Civilized nations, one would have thought, would economically incentivize people to stay put, prop them up a few months, so that only those activities absolutely necessary are carried out. For the rest, what, is waiting things out just a few months more -- doing what can e done remotely, and for the rest as far as possible just letting things be, such an impossible goal, in order to prevent thousands of unnecessary deaths?

 

[Tippit]

What the hell has Karl Marx got to do with it? You'd have a point had it been Lenin, or Stalin, or Trotsky, or one of those goons of whichever persuasion.

Because Karl Marx is ultimately responsible for China, the only place (that I'm aware of) that has resorted to physically imprisoning people in their own homes.

I find this line of thinking incomprehensible. A vaccine, or maybe vaccines, plural, will likely be available in a few months, a year tops (hopefully -- but obviously that's not certain). What kind of snowflake, what kind of restraint-less lightweight entirely lacking in determination and self control, is unable to stay put for a matter of months, in order to protect themselves, and more importantly to protect the old and vulnerable in our midst? I can understand when it comes to peoples, nations that are poor, masses of their populations starving -- but for the rest?

China does that by fiat. Civilized nations, one would have thought, would economically incentivize people to stay put, prop them up a few months, so that only those activities absolutely necessary are carried out. For the rest, what, is waiting things out just a few months more -- doing what can e done remotely, and for the rest as far as possible just letting things be, such an impossible goal, in order to prevent thousands of unnecessary deaths?

Because the costs of imprisoning yourself, and embracing all manner of draconian measures for this disease far outweigh the benefits.

 

[Chanakya]

...
Because the costs of imprisoning yourself, and embracing all manner of draconian measures for this disease far outweigh the benefits.

To begin with, if they're embraced, as opposed to imposed, that would take care of one of your objections.

As for costs and benefits: those are subjective, I agree, and you're fully entitled to your values. But what I find incomprehensible, and what I'd invite you to discuss, if you like, is this: Do you then value human lives, yours as well as others', so little? Look at these heaps of unnecessary deaths in the US, that could so easily have been prevented. Is some amount of economic loss such a high price to pay, over a few short months, to save those lives? (Losses that can be mitigated for the most vulnerable by government policy.) (And, to repeat, I'm speaking of developed nations. I agree that there's a case to be made for poorer nations to take in their stride some deaths from the virus, to prevent more deaths from starving.)

 

[dann]

You see no reasons not to do it, despite the obvious demographic, geographic, and political factors that make it uniquely impossible for non-islands with massive, mobile populations to do.

The demographic, geographic, and political factors really don't enter into it. In the middle ages you might have had a point, but New Zealand isn't very difficult to go to even if you live on the other side of the Earht, which I do, more or less. By the way, we have already established that Sweden's population isn't very massive, pop. density 25, and I doubt that Swedes are more mobile than Kiwis is. Very few Swedes make a living following the herds of reindeer nowadays, and I seriously doubt that the ones who do contribute much to the spread of coronavirus.
However, if you consider idiotic Neo-Liberalist ideas of herd immunity, then you may have a point with your reference to political factors, but that is a very bad excuse.

Admit it. You wouldn't mind sealing people in their homes a la the Chinese in Wuhan, right? You have Karl Marx in your signature. This wouldn't be so surprising.

I have not only Karl Marx but also Bertolt Brecht, another commie, in my signature.
I was never a fan of Chinese 'communism', but I have noticed something that you probably haven't: At the very early stage of the pandemic, the media were full of news reports from China with terrifying descriptions of the inhumane way they treated Chinese citizens. You know, "sealing people in their homes."
In my country, this horror stories about China's inhumane pandemic response more or less vanished after a Danish TV team followed a Dane traveling to China where he experienced what it was like to live through the Chinese quarantine: It was a bit boring, but apart from that, it didn't seem so bad and it was obviously very effective.
At approximately the same time, we saw Northern Italy, the Bergamo region, for instance, "sealing people in their homes," which made most of the world realize that quarantining people may be a pretty brutal way to tackle a pandemic, but not really a sign of an autocracy at work. And it works!
There's the obvious success story of China's pandemic strategy:
Total cases: 85,500 (Sweden: 97,532)
New cases today: 11 (Sweden: 855) I assume China's new cases are mostly incoming travelers like in NZ)
Total deaths: 4,634 (Sweden: 5,892)
Deaths per million: 2 (Sweden: 582)
But there is another thing I haven't heard anybody talk about for months: the Chinese coronavirus dissidents, who were so interesting in February and March!
Now, I am not unaware of China's treatment of dissidents in general and coronavirus dissidents in particular back then, but I think there is a reason why we don't really hear about Chinese coronavirus dissidents anymore: People in China now know about the ****** up pandemic response in most of the rest of the world and are quite content that China's pandemic response was the way it was: carefully calculated, timely executed and effective.
I wouldn't want to live in China, but, man, I wouldn't have minded it Denmark had tackled the coronavirus the way China did!

So you are almost right when you say that I "wouldn't mind sealing people in their homes a la the Chinese in Wuhan." I was quite content not to have been sealed in my home in March and April during the Danish lockdown, but I also think that it would have helped save hundreds of lives if we had been, which would have been worth the inconvenience and would have ended the outbreak much sooner, which would have made a 'house arrest' tolerable. Denmark: 665 deaths (115 per million).

Unlike China, the only country in the world that was 100% unprepared for SARS-CoV-2, it was also easier for the Scandinavian countries to avoid "sealing people in their homes": A couple of months into the pandemic, it was already beginning to be clear how the virus spreads and how it doesn't.
China didn't know anything when the whole thing started, but we knew much more a few months later thanks to China and South Korea and were therefore never sealed in our homes.


ETA: When you call the pandemic response of countries like Australia and New Zealand tyrannical, it really spoils your credibility when you criticize China's handling of the pandemic!