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

https://www.reuters.com/article/us-health-coronavirus-sweden-strategy-idUSKCN24M25L

by mrfusion • 6 years ago

92 257 6 years ago

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?

lbeltrame5• 6 years ago

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.

Ovah• 6 years ago

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

TheSpiceIsLife2• 6 years ago

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?

matz13• 6 years ago

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

johnnyo• 6 years ago

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?

ceejayoz15• 6 years ago

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...

ginko2• 6 years ago

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

jjuel2• 6 years ago

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.

Kiro5• 6 years ago

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

KingOfCoders• 6 years ago

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).

madspindel• 6 years ago

21 new deaths today:

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

ginko2• 6 years ago

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/

glofish8• 6 years ago

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.

s9w2• 6 years ago

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

glofish8• 6 years ago

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.

gridlockd6• 6 years ago

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.

l33tman2• 6 years ago

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).

jordanbeiber• 6 years ago

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...

hedora4• 6 years ago

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.

XyC0• 6 years ago

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.

ceejayoz15• 6 years ago

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

matsemann5• 6 years ago

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

welterde• 6 years ago

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..).

gpm2• 6 years ago

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).

basch2• 6 years ago

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.

Viliam12344• 6 years ago

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?

ArkVark• 6 years ago

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-...

jug• 6 years ago

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.

zosima3• 6 years ago

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?

nprz• 6 years ago

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.

bluGill5• 6 years ago

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.

m0llusk• 6 years ago

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.

lsllc5• 6 years ago

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...

rumanator6• 6 years ago

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."

mantap• 6 years ago

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

viklove• 6 years ago

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.

Khaine3• 6 years ago

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]

sdinsn2• 6 years ago

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?

postcynical• 6 years ago

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

mixmastamyk6• 6 years ago

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.

anoraca• 6 years ago

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

reportgunner3• 6 years ago

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

Pfhreak2• 6 years ago

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.

hkeide7• 6 years ago

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

Pfhreak2• 6 years ago

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.

dariosalvi787• 6 years ago

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

_lbaq3• 6 years ago

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.

reportgunner3• 6 years ago

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

SaltyLemonZest• 6 years ago

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".

tharne3• 6 years ago

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.

Kiro5• 6 years ago

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...

dgellow3• 6 years ago

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.

tharne3• 6 years ago

Fair enough. The American left worships Sweden.

raxxorrax• 6 years ago

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.

dgut2• 6 years ago

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...

glofish8• 6 years ago

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.

ceejayoz15• 6 years ago

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...

Kiro5• 6 years ago

For a contrary view regarding the economy:

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

DangerousPie3• 6 years ago

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.

hkeide7• 6 years ago

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.

matsemann5• 6 years ago

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

dgut2• 6 years ago

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.

mubar• 6 years ago

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.

matsemann5• 6 years ago

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

hkeide7• 6 years ago

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?

tgb2• 6 years ago

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.

DangerousPie3• 6 years ago

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.

oxymoron2• 6 years ago

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.

dariosalvi787• 6 years ago

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

Kiro5• 6 years ago

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

tgb2• 6 years ago

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

dariosalvi787• 6 years ago

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

gridlockd6• 6 years ago

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.

DangerousPie3• 6 years ago

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.

cblconfederate• 6 years ago

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

dariosalvi787• 6 years ago

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

mhandley• 6 years ago

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.

dariosalvi787• 6 years ago

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.

glofish8• 6 years ago

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.

dominik3• 6 years ago

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.

w0utert• 6 years ago

> 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?

bluGill5• 6 years ago

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

raziel2p• 6 years ago

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.

jeltz• 6 years ago

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.

dgellow3• 6 years ago

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?

dariosalvi787• 6 years ago

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

m12k• 6 years ago

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.

iantrt• 6 years ago

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.

qqqwerty• 6 years ago

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.

dmurray4• 6 years ago

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/

glofish8• 6 years ago

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.

dmurray4• 6 years ago

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.

RobertoG• 6 years ago

"[..] 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?

matsemann5• 6 years ago

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.

dmurray4• 6 years ago

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.

vilhelm_s• 6 years ago

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...

dmurray4• 6 years ago

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...

noelsusman• 6 years ago

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.

imartin2k2• 6 years ago

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.

manojlds• 6 years ago

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.

black_puppydog2• 6 years ago

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.

makomk2• 6 years ago

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).

imartin2k2• 6 years ago

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).

basch2• 6 years ago

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.

addicted5• 6 years ago

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.

black_puppydog2• 6 years ago

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?

l33tman2• 6 years ago

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.

cies2• 6 years ago

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.

ceejayoz15• 6 years ago

Sorry, which countries ditched their constitutions during COVID?

rumanator6• 6 years ago

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".

vmchale• 6 years ago

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

mamon2• 6 years ago

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

YeGoblynQueenne• 6 years ago

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...

viburnum2• 6 years ago

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

beagle33• 6 years ago

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)

gknapp• 6 years ago

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.

viburnum2• 6 years ago

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

h3ll0k4ll3• 6 years ago

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...

_lbaq3• 6 years ago

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.

reportgunner3• 6 years ago

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/

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

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