Swedish expert: why lockdowns are the wrong policy

https://unherd.com/thepost/coming-up-epidemiologist-prof-johan-giesecke-shares-lessons-from-sweden/

by jamesblonde • 6 years ago

68 156 6 years ago

"The actual fatality rate of Covid-19 is the region of 0.1%"

"At least 50% of the population of both the UK and Sweden will be shown to have already had the disease when mass antibody testing becomes available"

"The results will eventually be similar for all countries"

"Covid-19 is a “mild disease” and similar to the flu, and it was the novelty of the disease that scared people."

ldng2• 6 years ago

"The actual fatality rate of Covid-19 is the region of 0.1%" Fatality rate is meaningless. Even if you don't die, you can't work when you're sick for 2 to 5 weeks. Sickness duration is relevant. Hospital bed occupancy rate and impact on hospital treating other pathologies and injuries is relevant.

"At least 50% of the population of both the UK and Sweden will be shown to have already had the disease when mass antibody testing becomes available"

It's just pure speculation at the moment. You don't take life or death decision based on such optimistic speculation. This is just irresponsible.

dehrmann2• 6 years ago

You don't take life or death decision based on such optimistic speculation. This is just irresponsible.

Not more or less irresponsible than large-scale lockdowns. Don't kid yourself and think the lockdowns were evidence-driven and accounted for knock-on effects. They were desperation moves.

jamesblonde3• 6 years ago

Actually he claimed it was based on data they had collected in the last week, but was careful to say that it may change as they collect more data. I assume it is because they are now testing all care workers and finding a large percentage of them have antibodies.

mgsouth2• 6 years ago

Sweden already has 1 death per 10,000 population (0.01% per capita, not per case) and rate is increasing. Spain is 1 per 2,500 (0.04%). NY state is 1 per 1,200, soon to be 1 per 1,000 (0.1% per capita). This is with lockdown [0]

[0] http://91-divoc.com/pages/covid-visualization/

nabla92• 6 years ago

According to Giesecke projection, the total number of deaths will be around 6000, 2-3 times the deaths from annual influenza. (currently 1,511 have died from COVID-19 in Sweden)

glofish2• 6 years ago

the whole point of the argument is that it does not matter what you do everyone will end up in the same situation

jdminhbg4• 6 years ago

The rate of deaths in Sweden is not increasing. Even accounting for reporting delays, the peak was weeks ago: https://adamaltmejd.se/covid/

gberger• 6 years ago

What is the conclusion that you make from these select quotes? Or are you just summarizing what you consider to be the most important information?

jamesblonde3• 6 years ago

Just summarizing. That's what we do on HN for those who dont want to read the whole article/interview.

SlowRobotAhead• 6 years ago

Yes, those are things from the article. Did you have some comment on them?

Are those the things you agree with most or are those things you disagree with?

adrr2• 6 years ago

Mild disease that caused of rationing of care in multiple countries. Filled up all the hospitals and stopped elective surgeries through out the world. Killed more people in the US in 1 month that the flu kills in a year even with the largest states going into full lock down to prevent spreading. What disease besides Spanish flu has caused this must disruption to our medical infrastructure?

rpiguy14• 6 years ago

Not even close. Flu killed 80K in the 2018-2019 season.

https://www.statnews.com/2018/09/26/cdc-us-flu-deaths-winter...

Projected deaths for COVID-19 are 70K through July.

nradov3• 6 years ago

All the hospitals? Most US hospitals outside a few hot spots have fewer patients right now than normal. Elective surgeries were stopped to conserve limited stocks of PPE, and prevent nosocomial infections.

klipt2• 6 years ago

"At least 50% of the population of both the UK and Sweden will be shown to have already had the disease when mass antibody testing becomes available"

They're already doing antibody testing in other countries and the numbers are much lower than 50%.

In Santa Clara county, California, the estimate is only 2.49% to 4.16%

https://www.google.com/amp/s/amp.cnn.com/cnn/2020/04/17/heal...

rpiguy14• 6 years ago

But much higher in a Chicago, as high as 50%

https://chicagocitywire.com/stories/530092711-roseland-hospi...

standardUser• 6 years ago

Sweden's deaths per capita attributed to COVID-19 is currently the 8th highest in the world (exempting a few tiny city states). That's about 20% more deaths per capita than in the US.

It also has one of the lowest testing rates in the Western world at 0.7%, compared to around 2% in Spain, Italy and Germany.

nabla92• 6 years ago

That's not counterargument against Swedish strategy.

Year from now we will see the total number of deaths from different strategies and the thing is settled by then.

yxhuvud• 6 years ago

It also doesn't help that different countries count differently.

rossdavidh• 6 years ago

Also lower than the UK, Netherlands, France, Italy, Spain, i.e. a lot of their neighbors.

bosie• 6 years ago

Counting spain, UK, italy, france as sweden's neighbor is a bit odd. why not compare it to their actual neighbors, rather than tourism hotspots with lots of transit?

asjw• 6 years ago

Yeah close doesn't mean neighbors

I'm from Rome, Italy, and Stockholm is farther away from it than Cairo in Egypt

flatline• 6 years ago

Yes but we cannot function as a society like this, indefinitely on lockdown. The proposals to test, track, and isolate sound good but are preposterous in terms of logistics - funding, manufacturing, personnel, accountability. It will optimistically be 12-18 months till we “have a vaccine” - but I suspect it will be 4-5 years more realistically till we have applied it planet-wide sufficiently to eradicate the disease. So, I don’t think Sweden is totally crazy, we have to find some way to live with the disease, and that still means a lot of people are going to die.

rpiguy14• 6 years ago

People really haven’t really woken up to the reality that contact tracking, forced testing, and eventually vaccination will NEVER happen in the US, at least not in a consistent and effective way.

A significant portion of the population won’t stand for it, and given the current make up of the Supreme Court any mandatory citizen tracking, or job based discrimination based on mandatory testing will not pass muster. Nor will forced vaccinations. We can’t get people to vaccinate against measles and whooping cough, which spread faster and kill more people (including children).

Civil liberty practically ensures that in most places tracking and vaccination will have to be optional.

Whether we like it or not we are heading toward a herd immunity strategy.

If this were killing 30% of the general population, like smallpox could, people would fall in line. But I can’t see it happening for something as comparatively mild as COVID-19.

BurningFrog• 6 years ago

It's early in this marathon race.

It's not uninteresting who's in the lead now. But it's the goal line standings that matter.

AzzieElbab2• 6 years ago

It is scary how confident people are when discussing the unknown.

throwlaplace• 6 years ago

indeed. here and elsewhere in the blagosphere people have taken this opportunity to opine at length on everything from epidemiology to virology to welfare economics. it's been the case for a long time that people online have had very little sense of humility about their opinions but somehow experiencing a pandemic has given them even less pause to consider what they're ignorant of.

lordnacho• 6 years ago

I think the Internet makes it worse, but it's not as if it was hard to find someone who was too confident in their layman's opinion in the real world. Witness any sports event. How often do your friends say "favorite will definitely win" when it's been known that they lose now and again?

Same with the stock market, predictions about the house market, the weather, political events, and so on.

Overconfidence is the rule, not the exception.

I'm certain of it.

tehjoker• 6 years ago

Consider how ill informed and criminally stupid the US administration is and I would suggest that people discussing things and coming to their own conclusions, while a messy process, is at least one that might reach the correct conclusion in the face of being lied to by authority figures.

EDIT: As a recent example, consider the lies we were told by the administration about the effectiveness of surgical masks in preventing spread. While this lie was told in service of keeping the supply prioritized for health care workers, it caused vulnerable people to not wear them and discouraged people from wearing home made masks that might help prevent asymptomatic spread. We have only overcome this lie through public discussion and eventual acknowledgement by the CDC.

AzzieElbab2• 6 years ago

I wasn't thinking about the internet. I meant the "experts", you can't be an expert on the unknown.

kbr2000• 6 years ago

True, but it's probably not so important. After all, it's just more human centered talk. It might be useful now for everyone to take a step back, consider we share this planet with other living things, and maybe someone is brave enough to look at things from a perspective of non-human being. Who's the pandemic now? ;)

Besides, the planet doesn't care about our little problems: https://www.youtube.com/watch?v=uHgJKrmbYfg

rpiguy14• 6 years ago

It the product of evolution. As a species we have to make decisions on imperfect and limited information all the time. If we were programmed to wait to figure everything out we would have died off ages ago.

downerending2• 6 years ago

No it isn't! :-)

meerita• 6 years ago

I live in Spain. It's about one month and 7 days of lockdown and the official data isn't realistic. Although we are having lower numbers, it will take many months of lockdown to stop having deaths. I don't think this strategy of full lockdown will help, to be honest, we should lockdown risk factor people.

m3kw94• 6 years ago

Once proper contact tracing is out, the lock down can ease. Otherwise the fire will spread uncontrollably and govt won’t take anymore risks

TheChaplain• 6 years ago

It's not about stopping deaths completely, it's about not putting more strain on an already overworked health care system.

Markoff4• 6 years ago

we will really only know when looking at yearly stats or even bigger stats, it's possible it may slightly increase yearly death toll but nothing close to those crazy numbers reported now when just cause of death shift towards virus from other causes

if your system is not overloaded or kills almost only the people who would die anyway soon

I feel pity for Spain, their economy was F up prior this virus, can't imagine what it's gonna be after virus

erdos4d2• 6 years ago

Thank goodness at least someone with credentials is saying what is obvious. The lockdown approach is not sustainable for much longer out of basic economic concerns and the virus will absoluteley start spreading again when the masses break and go back to work. Protecting the most vulnerable while the rest of the society works to support them is the only sensible approach and should have been the plan all along. I'm personally very sad that so many will sustain great economic damage on top of this reality, but this is what happens when people run scared. I just hope this reality is recognized and accepted before even more damage is done.

DennisP4• 6 years ago

If you use your lockdown time to set up solid testing and tracing, it can work out pretty well.

jdminhbg4• 6 years ago

That’s a theory, but nothing more. Nobody has successfully done that yet. The testing and tracing success stories started before they needed to lock anything down.

usaar333• 6 years ago

start spreading again when the masses break and go back to work

I don't see why this must be true. R before the lockdown in northern CA and WA (heavy voluntary measures but people "working") was ~1.45. [source: https://www.medrxiv.org/content/10.1101/2020.04.12.20062943v...]. SoCal was higher at R=2.1, possibly due to less voluntary restrictions.

Add on a functional testing and contact tracing (built up during the lockdown) and you should be at r < 1.

_vertigo• 6 years ago

You’re ignoring the possibility that the lockdown bought us time to prepare a more effective strategy we can implement as we open society again.

Also, there are still a lot of unknowns about this virus.

* It has been reported to cause long term organ damage. How common is that? How severe is it?

* It has killed lots of people who are not frail.

* We don’t have a good idea of how widespread it is, so we don’t know what the true death rate is. The Santa Clara serological study suggested that 48k residents have been infected. Santa Clara currently only has 73 deaths, which gives a death rate of .15%. We only had access to this serological data yesterday, so how would we have made decisions using it last month? And even if the death rate is low, that’s the death rate with a health care system that’s not at capacity thanks to social distancing and lockdown measures.

* We don’t know how effective a policy of “protect the old and frail” would be because it’s never been tried.

* etc etc

All of these unknowns together should give you pause. It’s tiring to hear people confidently promoting their unfounded opinions on the virus grounded in nothing more than a know-it-all attitude and a generous helping of Dunning-Kruger.

erdos4d2• 6 years ago

What have we accomplished in this time? We know basically what we knew a month ago, we have no vaccine or treatment, and we know very well that the old and compromised are at much higher risk than the young. We also know that every passing day gives those with capital to withstand this more leverage within the society as more businesses go under and more people are thrown to the dole. This we can be certain of, especially in the US, where it seems to be repugnant to provide serious assistance to the poor. Maybe you are one of those with great wealth, but the rest of us would be happy to put grandma in an empty house somewhere and get back to work, before there is no work to be had. I personally feel this way and am happy to take my chances with the virus rather than the "goodwill" of the rich. I suspect mine is rapidly becoming a majority opinion as savings dwindle and businesses go under.

jfoster4• 6 years ago

These seem like made-up statistics:

1. "The actual fatality rate of Covid-19 is the region of 0.1%"

2. "At least 50% of the population of both the UK and Sweden will be shown to have already had the disease when mass antibody testing becomes available"

alharith• 6 years ago

1. It's about as made up as the WHO's 3.4% figure.

2. Most thinkers I know and follow widely believe this to be the case as well, it also passes the common sense test.

(OK, 3.4% of reported cases, my point is they have thrown out death rates as well, all of them can be considered fantasy because we have zero clue what the denominator is)

esoterica2• 6 years ago

The WHO never said the infection fatality rate is 3.4%. Here's the actual transcript the number is taken from:

https://www.who.int/dg/speeches/detail/who-director-general-...

Globally, about 3.4% of reported COVID-19 cases have died.

They said that 3.4% of REPORTED cases had died, which was true at that point.

Most thinkers I know and follow widely believe this to be the case as well, it also passes the common sense test.

0.015% of the Swedish population has died so far from the coronavirus. On the other hand ~0.15% of NYC has already died from the coronavirus. If the majority of the Swedish population is already infected, why is the death rate only 1/10th that of NYC? How does that pass the "common sense test"?

iforgotpassword2• 6 years ago

Most thinkers I know

I hope that doesn't translate to "people in the same Facebook groups like me", i.e. the typical echo chamber effect.

It's amazing how there can be a hundred experts plus hard figures, studies, whatnot, which then get strictly ignored by those "just the flu" folks, which forward the same handful of interviews with some doctor or virologist on WhatsApp or Facebook claiming we're overreacting, it's just a slightly more aggressive kind of flu, mass panic, coming up with excuses why Wuhan, Italy and NY don't quite fit what they're saying, but no convincing counter argument yet.

Sure it would be the more convenient truth, or you just feel woke, but there are more and more places on this planet that simply show this is not true.

bobcostas55• 6 years ago

The first one is trivially wrong. In NYC more than 0.1% of the _population_ (not the infected) has died already.

The second is less trivially wrong, but there's a lot of evidence against it: tests from Wuhan[0], Denmark[1], the Netherlands[2] all show very low infection rates, around 3-4%.

[0] https://www.wsj.com/articles/wuhan-starts-testing-to-determi...

[1] https://nyheder.tv2.dk/samfund/2020-04-17-stor-screening-vis...

[2] https://nltimes.nl/2020/04/16/3-dutch-blood-donors-covid-19-...

fouc2• 6 years ago

17,671 deaths / 8,398,748 population * 100% = 0.21%

esoterica2• 6 years ago

The second one is also trivially wrong - if Sweden had a majority of the population infected we would be seeing similar or higher death rates than NYC there (which we don't yet).

Jeema101• 6 years ago

Also bears pointing out that that the real number of deaths in NYC is higher since some have died in their homes or before they could be tested.

jfoster4• 6 years ago

The second one is trivially wrong as well. The allegation is that 50% of Sweden has had it and recovered but this would require antibody tests to prove. On which date is it proposed that Sweden passed that halfway mark and had sufficient time to recover?

March 31st deaths from Covid-19 in Sweden: 180

April 17th deaths from Covid-19 in Sweden: 1400

It has been > 7x deaths just within April.

cameldrv2• 6 years ago

There was a town in Italy that actually had 70% positive antibodies among blood donors. The only problem is 1.4% of the population of the town died in March.

rpiguy14• 6 years ago

Antibody tests in Chicago show as high as 50%

https://chicagocitywire.com/stories/530092711-roseland-hospi...

eloff2• 6 years ago

Yeah, I maintain that whenever you allow your mental model of the world to drift away from reality, there's a price to be paid. There's a cost to being wrong and people should put more effort into challenging their beliefs.

riffraff3• 6 years ago

I think NYC is already at the "hospital collapse" level tho.

The quoted figure would be for a situation with hospitals in perfect operational state.

So the Sweden reasoning is: we will stay within normal capacity even at peak, and everything will be ok.

If infection rate is actually slow, that may work, but it's not obvious this is true.

fiter2• 6 years ago

The recent study in Santa Clara County suggests it may be between 0.12 and 0.20 though it suggests only a couple percent have had it there: https://www.sfgate.com/news/editorspicks/article/Santa-Clara...

generalpass• 6 years ago

That isn't a random sample, so they had to massage the numbers.

m3kw94• 6 years ago

Is 0.1 when the ventilators/hospital treatments are used? If the spike happens and people that needs it but don’t have it, how would deaths look like?not sure if he took that into account with the 0.1, otherwise he is not much of an epidemiologist

safog• 6 years ago

I agree. I have several objections to this line of thought. Of course Sweden might want to risk its entire population on made up data but I don't think that's a prudent approach.

1. When we put in these lockdown measures, we basically had very little science behind the disease. Not locking down and hoping things generalize from very small sample sized studies coming out of Italy (which did enter lockdown at that point) is not prudent policy.

2. The only clean room evidence we have even now is the US Naval carrier that was exposed to COVID. It turned out that amongst those infected, 30% of the sailors were just asymptomatic. Previous modeling assumptions that US policy is driven off of were using 15-20% are asymptomatic. Okay, fine our initial assumptions were off a little, but not orders of magnitude off.

3. The other problem with the Swedish approach is that you can't simply isolate old people in isolation from younger people - healthcare workers, nursing home workers etc. are all fairly young and can be asymptomatic COVID carriers.

4. Even if the mortality for younger folks is ~0.1% the toll that COVID is taking on the lungs of even recovered patients is pretty brutal (anecdotal evidence, needs more study). Especially, if you're an athlete or want 100% lung capacity for the rest of your life, it's a bit iffy at this point if you'll actually get it. It also looks like it's hitting multiple organs and not just lungs, again we don't have much science here at this point.

5. I was hoping we could do antibody testing as a way to judge who can safely go out, but I was watching a Bill Gates interview yesterday and it looks like the testing is not good enough yet to make that call - it still has too high a false positive rate, people with antibodies still can get reinfected if their viral load the first time was enough to only trigger a mild infection.

shalmanese• 6 years ago

I can't believe we're still having this debate in April when it should have been settled in Feb. After Wuhan got hit, a bunch of countries repatriated their citizens and tested every single person.

From Reddit:

South Korea: 802 imported cases, 17 from China, 389 from Europe, 306 from Americas. Taiwan: evacuated 975 from Wuhan so far, only 1 tested positive. 728 evacuated from Wuhan since March 10th, 0 positives. Singapore: ~80% of 800 cases imported, 24 from China. Ontario (Province of Canada): 968 imported cases, US 318, UK 101, Mexico 49, Spain 46, Germany 34... China 5. HK 1 - HK has 200x less population than China.

It was clear Wuhan was hit by something incredibly deadly that had only barely started inching its way through the population.

South Korea is one of the most comprehensively tested nations on the planet and their death rate right now is 2%.

People are still desperately clinging onto a narrative that this thing is way less deadly than it appears and twisting and distorting all sorts of stats to get them there but it just plain is vanishingly unlikely to be true.

This virus started with Westerners assuming that they were somehow exceptionally different from Asians and did not need to learn from their experience and it will end with Westerners assuming that they are exceptionally different from Asians and do not need to learn from their experiences.

Markoff4• 6 years ago

those numbers are not really comparable if you don't factor demographics like proportion of age groups in population, average life expectancy, how overloaded or capable is the health system, how are deaths counted and social habits like cogenerational living (IT/ES) vs most single person households at least in Europe (SE) or even how people socialize with greetings (FR, ES, IT), how common is social distancing

many of these would explain why SoKo, Japan and Sweden fare well without lockdown

elesbao• 6 years ago

Good that Sweden is using the same rational inside that they applied to other countries during WWII, cruelly neutral wrt w/death toll. https://en.wikipedia.org/wiki/Swedish_neutrality

simonsaidit5• 6 years ago

“The correct policy is to protect the old and the frail only.”

How is it working out with that. Last I heard old people in Sweden don’t go to the ICU but is left to die and they have a large spread in care homes for elderly. And as if their economy is in a vacuum they think they won’t be struggling with the same recession as the rest of us

toomuchtodo3• 6 years ago

The old and frail will die eventually. It’s reasonable to discuss how much we’re willing to sacrifice for the additional time afforded them in aggregate.

This is not to sound cold or callus. I’ll be old one day (but am also not going to expect extraordinary resources to live a few extra months). These are necessary discussions in a finite world.

maxerickson2• 6 years ago

It's likely enough that lockdowns are the better strategy for the economy. If that is the case, it's not even a sacrifice.

Severe infection and death rates are still quite high among people that are not especially old or frail; and then it sort of depends a lot of whether 'frail' is an apt description of the people that are more susceptible.

stOneskull• 6 years ago

I wouldn't want to take people's freedoms away to protect me a little bit. Why live longer anyway without freedoms.

lymeeducator• 6 years ago

It's unknown how long symptoms typically last. I am pushing 4+ weeks with mild symptoms I have never experienced with the flu. My doctor indicates 4+ weeks until ~mostly recovered based on her patients. How does this deplete nutrients necessary for continued immune function relative to the flu? We need more data and that Swede doesn't have it.

iso16314• 6 years ago

In the UK, week ending April 3rd, rather than the expected 10k deaths there were a (preliminary) 16k deaths. 60% above background level

Stats for week ending April 10th aren't out yet, however they are alluded to in https://assets.publishing.service.gov.uk/government/uploads/... at being over 20k deaths, twice the number.

(The week 15 report predicted 5k excess deaths for week ending apr3, more concrete figures had it at 6k. Week 16 predicts about 12k excess deaths for w/e april 10.

60% extra deaths isn't "slightly above background level"

If covid is burning itself out then that's great, we'd be looking at a total 100k excess deaths, or 20% above background level for the year.

However there is no evidence that we're anywhere near 20% of the country having had it, let alone 70%.

Those dying in week ending april 10th will likely have contracted covid before lockdown

  w/e | reported covid deaths | actual excess deaths
  w/e mar 27 | 842 | 1.5k
  w/e apr 3 | 3294 | 6k
  w/e apr 10 | 5562 | 10-15k
  w/e apr 17 | 5589 |

So we're likely looking at 30k excess deaths in the last month, or about 80%, but that's because we locked down in mid-end march and the number of deaths 3 weeks later hasn't increased at the non-lockdown rate we'd expect.

Tobacco kills an average 2k per week in the UK, covid is killing 5 times as many, and that's with all the controls.

Cars kill an average 30 per week

rpiguy14• 6 years ago

This is a stunning difference. In the US we had no excess mortality in March, in fact total deaths from all causes were down year over year.

Cases didn’t peak in NY until April so we may see some increase after this month.

I realize the U.K. locked down later than many countries, but there must be other factors driving mortality as there are other countries that did not lock down and aren’t being ravaged quite the same.

What is it? Level of care in the NHS? Higher prevalence of secondary conditions like diabetes? Hygiene? Crowding?

iso16314• 6 years ago

We didn't really have any excess mortality in March either - total deaths in 4 weeks upto 27th march was 43,406. 5 year average for that 4 week period is 43,700.

We're slightly ahead of New York state in covid breakout too (about 4-5 days at the occurrence of both 10th and 100th death)

I suspect that the excess numbers are undiagnosed covid cases - especially those dying in care homes.

In w/e 3rd april compared with the week before

  Place      | Excess Deaths | Excess covid deaths
  Home       | 1079          | 105
  Care Home  | 1280          | 175
  Hospital   | 2779          | 2609

Tests in the UK are almost entirely to people going into hospital.

Where are the stats for deaths in New York? UK (Or rather England and Wales, but that's 90% of the population of the UK) are at https://www.ons.gov.uk/peoplepopulationandcommunity/birthsde...

m3kw94• 6 years ago

He is of course inclined to say what he thinks is right because he suggested such a plan.

lazylizard• 6 years ago

Sweden is the only country that has a scientist in charge of covid response? All other countries have politicians in charge? I'm not sure that they're definitely wrong?

nradov3• 6 years ago

Why is this flagged? The interview is intellectually interesting. Prof. Johan Giesecke literally wrote the book on infectious disease epidemiology, and works as a senior advisor to the WHO and Swedish government.

specialbat• 6 years ago

Agree, he is not some crank. I don't understand the flagging system on this site at all

Markoff4• 6 years ago

I agree with most of the things besides 50% of infected population, in Czech 250+ branches (that's at least 5000 people) of Lidl they had only 4 confirmed infected until now, in Globus supermarket chain out of 5000 workers only 2. yes, Czechia is enforcing mandatory masks (although like 90% of population wear only cloth masks due to lack of access to medical masks and respirators) but still you would expect, if it would be that contagious through surfaces and other ways as some scare, there would be much more infected in these busiest businesses right now

Swedish expert: why lockdowns are the wrong policy

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