I think it is interesting that the discussions are only framed in measuring deaths, and also focus on deaths of the old.
I'm watching friends and family knocked back by this virus for weeks, and now pushing into months (36 days and 42 days since first symptoms for 2 people I know), and research in the US and China points to the increase in long term health risks in the 20 to 50 year olds that recover from this. I know people that just walk away from this with no impact, but if we only focus on death we are likely missing the bigger picture.
The "how many time the flu is this" misses how damaging this is beyond it's potential casualties, how damaging to the health care system this is and so-forth.
The thing is, I also don't think you can get away from the way that those pushing for lower-end estimates aren't arguing from pure, selfless virology. They're arguing from a "this is uncertain, so should we really risk our economy to avoid potential lives lost?" position. I can see that if you could translate the lost money directly to other lives lost. But you can't. The various state could just support people for the period of the lockdown - all the advanced nations besides the Dysfunctional US are essentially doing this. So if you phrase things in terms of just paying lives for money, I would disagree with the article, that is evil. People who actively enable that are evil. Sweden's policy looks to be baring bitter fruit and I wouldn't forgive Dr. Giesecke any blame for that if it matures. I could be wrong and I'm OK risking money on that, it's a better choice imo.
I don't really think it is about economy only. I don't see the same people pushing for help for businesses nor coming up with ideas how to make economy run as much as possible under closed conditions. The push is to make it like before and act like nothing is happening. Beyond that, there is not much.
It seems to me more of "I dont want this to be true whether for both practical or for ideological reasons, therefore it can not be true".
> The various state could just support people for the period of the lockdown
Isn't that just hiding the truth though? After all, what is the state, where does it get the funds? Whether you take my money today or tomorrow, you've still taken my money. I don't see any reason to believe that there will be a magical no-tax funding of government any time soon.
It's not really about money. Money is just bits of paper, or electronic equivalents, that can be produced in arbitrary quantities. It's about having sufficient production of food and other necessities to keep people alive, ensuring that it's distributed to everybody, and finding enough people who are willing to do enough work to keep the economy going at this level.
Right, obviously when I say money, I don't mean "paper", I mean the equivalent value that we represent by using money. We're generating a lot less value today, while spending as if we didn't. Suggestions for the state to pay people their usual salary while locked down for the next months/years do require some idea of how to pay for it (again: with value, not with paper). Magic aside, how will that happen?
What percentage of the 'working population' do you estimate is involved in necessities as opposed to conspicuous consumption, superfluous intermediating, red queen standoffs, speculation, empire building and active or collateral sabotage?
Most countries currently get loans for about zero or actual negative interest - while inflation is above zero. States can essentially borrow for more than free: Get loans for a billion, wait 10 years at 2% inflation and it's only 800M worth. Meanwhile the state used the loan to keep up demand and thus state income, commercial infrastructure and so on. This is almost guaranteed to be the least expensive way to go for every OECD country.
As someone in NY where at least 17,000 people have died of SARS2 in the last ~6 weeks including two middle aged people one older person I know personally I am absolutely certain that this is nothing, "like the flu" no matter what anyone claims. We don't get 500-1000 people dying (especially middle aged people) of the flu every day - especially when we are in virtual lockdown.
There's no question that a lot of questions remained unanswered, but one question that has a concrete answer is that this is nothing like the flu.
I think this is generally true but with two significant complications:
a) People running out of money is only the surface level problem. Money is an abstraction over value. We can and should mess with the abstraction, but we can't do anything about the underlying value in the economy going up in smoke. "Bullshit jobs" notwithstanding, the things people do at work all day do actually have a role in our collective standard of living. There is a reason we can do modern medicine while the third world can't, and we could lose it.
b) Social life seems frivolous in the small, but in the large it is not. Years without human contact will seriously fuck you up. Not only are individuals in distress, but friendships, relationships, families, communities, and society itself are all in rapid decay. Screen time can only slow that down a little.
Becoming a world of 7 billion hermits for as long as it takes carries real risks and real costs, too.
I doubt there’s a single best way of dealing with this crisis across the entirety of our planet, given the incredible diversity in demographics, cultures, population density, wealth, health care systems and dna.
EDIT: should have added politics as another differentiator
I absolutly agree, and it's something pretty much no reporter or goverment spokesperson mention. Also, even though it's talked about, there is absolutely risk of death and misery greater than the disease if economics are not considered.
and diversity in politics... don't forget politics
Korea "should" be comparable to western countries if it wasn't for politics. But they have 100x fewer deaths. They're not trying to reach herd immunity, it's a political choice.
I found an interesting article that argues exactly this. It points out that Africa is the youngest continent, and also loses the most from not being able to work to get food, etc. And that Africa should follow a different plan than other continents.
How is Giesecke's approach of "so we should do what we can to slow it so the health service can cope, but let it pass" different than what is currently happening?
As I understand it, that is what most countries do and achieve with various success. And as soon as there is any respite in the load of the hospitals, people are already pushing for a easing of restrictions in place.
A few countries have eliminated the virus entirely. Most other countries are in lockdown as more or less a desperation move and effectively have no articulated plan. Maybe they'll get infection rate down and can get testing and contact tracing working enough to do elimination in heavily effected areas but in the US, certainly, all plans are vague and the authorities seem to be reacting to events rather than planning. I think WHO articulated the elimination path but again, who knows.
But with all that, Giesecke's approach is more like getting the whole thing over with quickly, which would have brutal effect on the health care system, to say the least. IE, once this is done, all the doctors and nurses in the emergency care system are going to quit.
> But with all that, Giesecke's approach is more like getting the whole thing over with quickly, which would have brutal effect on the health care system, to say the least. IE, once this is done, all the doctors and nurses in the emergency care system are going to quit.
The point of lockdowns wasn't to stay locked until total control. That simply will not happen in the US, at this point. (And I'm not sure it's feasible anywhere other than South Korea, now.)
The point was to give everybody time to react and get ready. It's been almost 45 days since the lockdowns started--healthcare workers should have all the gowns, wipes, masks, etc. that they need, by now.
The fact that they don't is an indictment of most of the governments of most of the countries.
In my opinion, we stay locked down until healthcare workers have what they need even if a gigantic wave hits. If enough healthcare workers die, we're all in deep shit even after Covid-19 reaches herd immunity.
Want to unlock things? Start smacking some idiot leaders around about giving equipment to healthcare workers.
When I see healthcare workers saying "Please, stop, we have all the equipment we need and then some," then I'll believe we can come out of a lockdown.
The end-goal of lockdowns vary drastically by country. New Zealand just relaxed lockdown today and have declared "elimination" of all community transmission.
Most countries are seeing death rates beginning to decrease after weeks of lockdown.
I noticed the article in the WSJ about New Zealand. But I (a kiwi) haven't seen any local news indicating that the government has declared any sort of elimination. If you have seen one, could you link it? I'm currently skeptical of the WSJ article.
There were four new cases today. One confirmed by test and three presumptive cases which according to the experts probably have it. Plus there are hundreds of people in isolation/quarantine who are still sick. I wouldn't declare "elimination" just yet.
Even if new cases dwindled down to zero, that doesn't imply elimination either. There might be many asymptomatic people who are not spreading it currently because of the lockdown, but who will start spreading it once they start interacting with people outside of their bubble.
> Prime Minister Jacinda Ardern, who yesterday said the virus was "currently" eliminated, told Morning Report it was not unreasonable to use the term elimination - but that meant "zero tolerance for cases".
> In my opinion, we stay locked down until healthcare workers have what they need even if a gigantic wave hits.
Do you think that's practical? This virus has a hospitalisation rate of somewhere between 10% and 20% and an ICU rate of 4-10%, and people who are hospitalised need to be in there for 2-4 weeks. If a 'gigantic wave' is even 10% of your population (which realistically it would far exceed, given how contagious the virus is) you need 10-20 free hospital beds per 1000 population of which 4-10 are ICU beds.
The United States has 800k hospital beds of which ~100k are ICU beds, for a population of 330 million (source: https://www.aha.org/statistics/fast-facts-us-hospitals) That's 2.4 hospital beds per 1000 population, of which 0.3 are ICU beds.
You're gonna need at least 10x as many additional beds as you currently have. At least. And that's for only 10% of your population getting sick.
Edit: To be clear, I'm not saying that lockdowns are pointless. I'm saying that they need to be longer and more thorough to get to the point where the virus is entirely eliminated, or they need to remain at current levels indefinitely until an effective vaccine or other treatment is available.
I've seen a lot of discussion about a "submerged iceberg" population of asymptomatic or lightly symptomatic infections that haven't been picked up by testing, but IMO this doesn't pass the sniff test when considering populations like Australia / NZ / South Korea. Any such population should cause a steady stream of serious cases popping up that can't be traced back to known sources, along with random community testing seeing an unexpectedly high positive rate. We're seeing no such thing.
The few studies where a large population was tested and shown to be widely infected but largely asymptomatic seem to fall into one of two camps: They used immunological tests (which are now under serious suspicion don't seem reliable) or they tested a newly infected population after the first cases were found (before the majority of infections had time to manifest symptoms.) They've also been reported misleadingly (eg. the aircraft carrier case where it was reported "80% of the crew were infected but asymptomatic" when actually 80% of the crew who tested positive were asymptomatic.)
I'm also not asserting we know for sure that there is a 20-50x (or something along those lines) undercount in cases. Just that there is a huge amount of uncertainty with IFR and hospitalization rates, and none of your points really rule out that uncertainty.
Also true, and there's a chance I'm wrong and most people have already had a mild version and everything will be fine. There's enough evidence suggesting that the rates of severe complications and death are far higher than we're comfortable with, though, that I, for one, would prefer to err on the side of caution rather than run with "well, it might not kill 10% or more of the population."
The number of hospital and ICU beds are being increased rapidly. Medical students are now allowed to work with patients until the crisis passes ( thus increasing the healthcare capacity).
After carefuly observation the plan is to slowly reduce the stringent lock down measures and increase the infection rate, while keeping the medical staff sane.
We will get the next update in the first week of may, whether the first step of "easing" worked as intended.
I'll be interested to see how it goes. Very early on (start of March) I did some calcs for Australia and basically estimated that we'd need to be in partial lockdown for something like a decade in order to not overwhelm the health system, even assuming a significant increase in hospital beds. The numbers are a little more favourable at this point though.
This is a major issue. Most of the Fair halls (like halls where CEBIT etc take place regularly) have been converted to hospitals now.
Robert Koch Institute has asked all hospitals to build seperate wings for CoViD19 patients as the lung infections of those affected will also create after effects that will increase healthcare needs even after the disease is "eliminated".
What we are going to see is a new normal, even if we find a working vaccination soon.
> or they need to remain at current levels indefinitely until an effective vaccine or other treatment is available
It isn't quite so bad. Lockdowns are a continuum of measures, and you can modulate them over time. We're having to do such strict lockdowns because we were so slow in responding. Once the R is below 1 you can release measures to keep it at that threshold and modulate it over time to match your health care capacity. Merkel seems particularly well informed about this, having even explained what the curve of healthcare capacity versus R looks like for Germany.
This was a good discussion on this at the beginning of the lockdowns:
Oh definitely, once the number of infectious carriers is properly under control, lockdowns can be relaxed. I just meant we can't "go back to normal" until the virus is all but eradicated and no new unexplained cases are seen for at least a couple of weeks.
If you define "back to normal" as absolutely no restrictions sure. But there's a world of difference between being locked at home and having simple restrictions like no events with more than 50 people, and lower density seating at restaurants. The plan is to find a reasonable balance that's <10% of a full lockdown in terms of restriction and ride that while measuring evolution to tweak the measures. A simple control loop.
> You're gonna need at least 10x as many additional beds as you currently have. At least. And that's for only 10% of your population getting sick.
The problem is that even if we just fill the current beds we have, we STILL don't have enough equipment for the healthcare workers.
This is a major problem.
Especially so since we can substitute therapies. For example, apparently high-flow ventilation is just as good as invasive ventilation--and maybe better. The problem is that it aerosolizes the virus, so your workers need a lot more equipment.
If you don't have enough equipment for the healthcare workers, things fall apart long before you reach available system capacity.
The point of lockdowns wasn't to stay locked until total control.
I defy you to find a specific "point" of lock down. I more or less support it but I'd still claim there's not been a proactive strategy in the US even if occasionally the US uses rhetoric. So for that reason, there's no specific "point". Maybe authorities will reach sufficient clarity that they can articulate and stick to a point but not now.
But otherwise, yeah, the entire situation is a mess, an indictment of all the state involved, etc.
> A few countries have eliminated the virus entirely.
Cool. Any resources to read up on that? To my knowledge only a few countries have very few cases. But eliminated completely? Wow. I'd like to dive into this topic.
Indeed. But NZ, unlike most places on the planet, could probably live with travel restrictions for 18 months without too much problems. A big rescue program for the tourism industry would be needed, but apart from that it seems doable. If Australia could manage the same thing, then they could have a common travel area (which would also help with the tourism somewhat). People flying in from elsewhere would need a long quarantine.
Unless they believe that's sustainable for 18 months, their whole strategy of eradication wouldn't be feasible, so one would have to assume this is the plan.
"There is no widespread undetected community transmission in New Zealand. We have won that battle," Ardern said Monday. "But we must remain vigilant if we are to keep it that way."
Asked whether New Zealand had eliminated COVID-19, Ardern replied: "currently."
> But with all that, Giesecke's approach is more like getting the whole thing over with quickly,
Wait are we saying that Giesecke is arguing for an (even) more relaxed approach than is currently happening?
I assumed he was arguing for the status quo in Sweden, because hospitals are effectively at capacity now, and have been stable there for a while. A significant increase in new infections would be pretty bad so I don't think he's arguing for "business as usual".
If I understand him correctly then what he's saying is that it's not good to minimize the number of infected, but rather one should only ensure hospitals aren't overwhelmed. A good outcome is if hospitals are never overwhelmed and a significant portion (enough to make a difference) have immunity. A poor outcome would be one where either people die from lack of available care or one where the outbreak is contained through means that aren't sustainable until a vaccine is available.
Obviously if there are long term effects on the health care system from the situation where hospitals are not overwhelmed but just overworked so they quit or are burned out (e.g. many countries won't be able to give healthcare workers summer holiday this year) then that needs to be taken into account as well of course.
Being a swede it's hard but I don't know if non-swedish epidemiologists make the same mistakes and claims.
Giesecke has claimed less than two weeks ago that at least 600k people in Stockholm (pop 950k) have had it. We did viral and antibody tests that came up with 11%(and had to be retracted because it was based on blood donors and included all donors who had recovered and were specifically asked to donate plasma with antibodies, so 11% is above max) and 2.5% respectively.
This claim and Gieseckes claim that deaths are <0.1% were was then the basis of a study published to show the Swedish policy was right, which had to be retracted because it put the population of Sweden to be >3*45million.
Gieseckes claims and articles starting to disappear/overwritten on same URLs made me back up 4000 news articles yesterday. I think we are close to one of our famous overnight 180 degree public opinion turns from the media starting to question any claims at all.
A large anti body study was supposed to be released yesterday, and I'm waiting to see what it says. We seem to be very far off the herd immunity Gieseckes strategy is based on.
Where does Giesecke propose a strategy of heard immunity? Does every set of restrictions that leave out total lockdown count as a "herd immunity" strategy?
1. He's aiming for herd immunity, using the people who are the less likely to have severe cases to protect the most vulnerable
2. He believes the death toll will really not be that high to justify the actions that we are taking to prevent the virus from spreading
3. He does not care about the deaths, and the faster they die, the faster we can go back to normal
Of course I don't think he believes in number 3, which is quite horrible in my opinion.
Regarding 2, the numbers emerging of the population that has actually contracted the virus seem to be much smaller than what Giesecke was assuming. So it would seem correct to assume that the death toll is going to be much higher than he was anticipating based on a wrong hypothesis.
To me it only leaves number 1 as a potentially valid approach that does not rely on quarantine.
It wouldn't make much sense to use population who have antibodies as the main goal, and view the peak as desired but reached without further restrictions because of increased resistance in thebpopulation as an argument otherwise. He isn't arguing for lowering infection rates as long as healthcare holds, but for increased immunity. That's not something to be mad about.
Folkhälsomyndigheten has now spent over a month outright denying that the strategy is aiming for herd immunity: the strategy is purely dedicated to keeping the pressure on the health services manageable. This isn't really an issue about where you personally think it's the correct strategy, rather it's a about whether you believe what the authorities tell you.
The most credible connection to FHM this strategy has is that a former employee wrote a mail explaining the reasoning of not closing the schools to a friend who is a politician working on local school issues, the friend then (with permission) shared the text further on FB.
> Den tidigare statsepidemiologen Annika Linde hade inte tänkt ge sig in i diskussionen om Folkhälsomyndighetens strategi för att bekämpa det nya coronaviruset.
>
> – Jag halkade in på ett bananskal, säger hon.
>
> Bananskalet var en fråga den 12 mars från en lokal skolpolitiker som ville ha hjälp att förklara varför det är rätt av Sverige att inte stänga skolorna.
>
> Varför säger inte Folkhälsomyndigheten bara att flockimmunitet är planen, undrar folk i sociala medier upprört efter Lindes inlägg. Andra tycker att planen låter rimlig.
>
> – Sedan förnekade Folkhälsomyndigheten att det var tänkt så, säger Annika Linde.
>
[...]
>
> Den tidigare statsepidemiologen Annika Linde tänker inte så mycket på att hennes budskap om den svenska strategin tog sig hela vägen till Vita huset, säger hon. Däremot tänker hon fortfarande att flockimmunitet är målet för Sverige, i väntan på ett vaccin. Men hon försöker låta bli att kommentera sina efterträdares arbete.
>
> – Det finns något som kallas ”lösa kanoner på däck”. De skjuter lite hit och dit och kan träffa skeppet och sänka det helt och hållet och sedan inte ha något ansvarstagande. Så jag nöjer mig numera med att svara på enstaka frågor, som nu från dig om att jag inte höll tyst där i början.
https://www.dn.se/nyheter/sverigebilden-under-coronakrisen/
> A large anti body study was supposed to be released yesterday, and I'm waiting to see what it says.
Also be aware that there are false positives, especially significant with these antibody tests, so with the low numbers of positives it's extremely important to evaluate if the claimed values are more than noise artifacts of the tests themselves. It is also important to be aware of the scenarios for which the use of the apparent test results is not reasonable.
Moreover, here's what happened in the UK a few weeks ago:
"John Newton, Public Health England’s director of health improvement, said:"
"A number of companies were offering us these quick antibody tests, and we were hoping that they’d be fit for purpose, but when they got to test, they all worked but were just not good enough to rely on.
“The judgment was made [that] it’s worth taking the time to develop a better antibody test before rolling it out, and that is what the current plan is.”"
"Newton told the committee that the tests trialled so far had lacked sufficient sensitivity to identify people who had been infected. “We set a clear target for tests to achieve, and none of them frankly were close.”"
Are you sure there are false positives with the serological tests they're using? As far as I've read, there are tests with only false negatives, and if I don't misremember they were the ones used for the Swedish statistical study released (and retracted) last week.
> Swedish statistical study released (and retracted) last week
I don't know any details about that specific study, or why it was retracted etc, so any links to more info appreciated!
I was writing about the general problems existing when there are little actual positives, and also about the known or maybe somewhere less mentioned issues.
I've only read about it in Swedish, but here's [1] a Reddit post discussing it in English (with the top-comment referencing a later news article which says the study was retracted).
"Uncertain conclusions of the new antibody test -- Updated April 22, 2020 Published April 21, 2020"
"The assignment was presented in yesterday's News by Jan Albert, professor of clinical microbiology and chief physician. Now the researchers are withdrawing the report - because it may be based on uncertain evidence."
"The study already used existing tests from healthy blood donors as a basis.
The preliminary results showed that 11 out of 100 bar on antibodies to the coronavirus in Stockholm. Today, the group behind the research has gone out with information that this is not true - they have used unsafe evidence."
"Thus, there may be fewer than 11 out of 100 infected, but how many can not say until they have done the study. In the coming weeks, they will start over from the beginning. The tests already done will be scrapped."
I also share your concern about claims made by Gieseke.
The article quotes Gieseke as saying "The real death toll, he suggested, will be in the region of a severe influenza season — maybe double that at most".
Sweden's official death toll was 2270 yesterday (2020-04-28). The three worst influenza seasons in Sweden since 1969 killed 807, 674 and 652 people[1]. So we've already passed his "at most" claim. The only way I can see that working out is if he feels that none of the influenza seasons in the past 50 years count as "severe".
[1]: numbers taken from the Swedish wikipedia entry on influenza. I didn't bother to check wikipedia's source. An average Swedish influenza season kills about 200.
But the excess death data will also be tainted because people, especially older people, avoid going to hospitals out of fear of catching covid19. Cancer screenings are way down, and fewer people go to the ER with heart attacks and the like. This will inevitably lead to excess mortality down the road --even among otherwise healthy people--, but it will be very hard to determine the magnitude of this second-order effect.
Of course it's also very hard to distinguish between people dying with covid19 and dying because of it. And we've never even made a serious effort to track the cause of death of the elderly.
Meaning we don't know how many people die each year from the flu, and we don't know how many people are dying of covid19. When you add it all up, it will be very difficult to learn the right lessons from this pandemic.
That's not what excess mortality means. They don't say "this many extra people died, I guess it must be covid" -- they're not fucking idiots.
When cancer patients die because their cancer treatment was cancelled they die of a cancer related cause, and that's how their death will be recorded, and that's how their death will be reported.
> And we've never even made a serious effort to track the cause of death of the elderly.
It's hard to understand your "we" here. Which country doesn't try to track cause of death for elderly people?
> Meaning we don't know how many people die each year from the flu,
But we can count the deaths the same way. We can look at deaths of people confirmed to have the disease, we can look at death certificates, we can look at excess mortality combined with community surveillance. The errors for all three are going to be similar for flu and covid-19.
When person in an elderly care facility dies we don't do a forensic investigation. We just shrug and say "I guess it was their time". So we don't have an accurate mortality baseline to do any comparison against. And that's assuming we are accurately distinguishing between those who died of covid19 and those who died with covid19, which we don't.
I'm not suggesting that people who draw conclusions from incomplete data are idiots, I'm pointing out that the data we have is completely insufficient to make an accurate assessment of covid19 mortality.
I think this is why excess all cause deaths will be the best evaluation. Lots of people who die from Covid in care homes are people who would have died from this years flu anyway. They aren't excess deaths, they are the baseline deaths.
I agree that 'excess all cause deaths' is an important metric, but we still have to correct for clear biases in both directions. E.g. fewer traffic deaths because of a lockdown.
> When person in an elderly care facility dies we don't do a forensic investigation. We just shrug and say "I guess it was their time".
This ("we just shrug and say "I guess it was their time"") is untrue. It's okay that you don't know, but you should stop spreading this misinformation.
> Significant discrepancies between the two documents were observed in 50% of patients. In 25%, the immediate cause of death was incorrectly stated on the certificate, having been assigned to a different organ system in the majority of those cases. In 33%, there was disagreement on major disease other than the immediate cause of death.
Anecdotally, elderly people I've lost had completely wrong death certificates. When common sense, anecdotal evidence, and a cursory review of the scientific literature point in the same direction I'm going to assume that's the way it is.
Also, try to be kinder in the way you communicate.
The UK made SARS-CoV-2 a "notifiable disease" which means by law any death from it must be reported to central government and it must be allocated to that death when present.
But there’s another, potentially even more serious problem: the way that deaths are recorded. If someone dies of a respiratory infection in the UK, the specific cause of the infection is not usually recorded, unless the illness is a rare ‘notifiable disease’. So the vast majority of respiratory deaths in the UK are recorded as bronchopneumonia, pneumonia, old age or a similar designation. We don’t really test for flu, or other seasonal infections. If the patient has, say, cancer, motor neurone disease or another serious disease, this will be recorded as the cause of death, even if the final illness was a respiratory infection. This means UK certifications normally under-record deaths due to respiratory infections.
Now look at what has happened since the emergence of Covid-19. The list of notifiable diseases has been updated. This list — as well as containing smallpox (which has been extinct for many years) and conditions such as anthrax, brucellosis, plague and rabies (which most UK doctors will never see in their entire careers) — has now been amended to include Covid-19. But not flu. That means every positive test for Covid-19 must be notified, in a way that it just would not be for flu or most other infections.
1) Death certificates rely on doctors using their best knowledge and experience to say what the patient died of, and what the patient died with. Flu and other respiratory illness is mentioned on many death certificates. See 5.4 here: https://assets.publishing.service.gov.uk/government/uploads/...
2) A notifiable illness has no meaning for death certificates.
3) We don't routinely test for flu. That's why all cause mortality is the preferred statistic for flu deaths, and also for covid-19 deaths.
You're not arguing with the Spectator, they're just acting as a publisher. You're arguing with in his words, "a recently-retired Professor of Pathology and NHS consultant pathologist". So you're claiming a professional British pathologist doesn't understand how British death certificates work, and you know better. Bold move.
Especially so because you seem to actually be agreeing with what he wrote, which is weird. For instance your claim (3) exactly matches his claim that:
"the vast majority of respiratory deaths in the UK are recorded as bronchopneumonia, pneumonia, old age or a similar designation. We don’t really test for flu, or other seasonal infections."
You say flu appears on many death certificates. Yes and he never argued otherwise. He said despite that it's sometimes mentioned it's actually under-reported because testing isn't really done much for it - as you agreed with!
That leaves the question of notifiability. The rules say that COVID-19 must be mentioned on a death certificate if testing was done at all, even if negative (which is new to me, I wonder what that does to the widely cited stat of "number of certificates that mention COVID"). But the point is that relative to flu, testing deaths for COVID is enormous, practically blanket at this point. If you test a lot and you insist that every case is reported to central government it will cause a flood of reports to arrive on the desks of decision makers, who will then feel it's much worse than flu. But it's not, it's just a reporting artifact.
That difference seems to arise because the report you cite uses a broad definition of influenza deaths. Page 2 says they're counting patients who "have influenza as a contributing or underlying cause of death, plus patients who received specialist care with an influenza diagnosis who subsequently died within 30 days".
In any case, boosting the number to 685 still isn't enough so that covid is "double at most", and boosting it to 1100 isn't enough either.
As far as I know they have an even broader definition of corona deaths in Sweden.
My point is more that statistics is hard. You tried to debunk someones "dodgy" statistics with your own numbers that can be twisted to be even more off than the person you tried dismiss.
I'm afraid nobody and everybody will be right after this is over. People will always find statistics to prove their points and that they where right and the other people where wrong.
> Sweden's official death toll was 2270 yesterday (2020-04-28). The three worst influenza seasons in Sweden since 1969 killed 807, 674 and 652 people[1]. So we've already passed his "at most" claim. The only way I can see that working out is if he feels that none of the influenza seasons in the past 50 years count as "severe".
> [1]: numbers taken from the Swedish wikipedia entry on influenza. I didn't bother to check wikipedia's source. An average Swedish influenza season kills about 200.
Sorry, but you can't just throw around numbers without explaining exactly what they mean or where they come from. The numbers you're quoting is most likely deaths that has been diagnozed as influenza. To get the full picture you need to look at excess mortality (which is reported by EuroMOMO[1]) and possibly adjust the numbers to pick out the influenza-related excess (FluMOMO[2] is the model most countries use).
If you look at the 2016/2017 season in Sweden [3, figure 17, page 46] you will see that the excess mortality as reported by FluMOMO goes way beyond ~600 for a season. In the peak season we see that it was ~300 per week. There are of course uncertainties in these numbers (which is why you won't see any official "x number of people died of influenza" figures), but it was probably closer to thousands than hundreds in 2016/2017.
> you can't just throw around numbers without explaining exactly what they mean or where they come from.
In the interview, Gieseke says influenza kills 1000 to 2000 people per year in Sweden, it's part of the exchange starting at 24:16. He doesn't explain exactly what those numbers mean or where they come from.
A minute or two later, he guards his 'double' comment by saying it's not going to be 10x.
One interpretation of the exchange is that he's predicting 2000-4000 deaths in Sweden, and definitely not 20000.
> Giesecke has claimed less than two weeks ago that at least 600k people in Stockholm (pop 950k) have had it
Stockholm has 2.34 million inhabitants. (Stockholm in this context is always stockholm area, not the city). That makes a 600k estimate much less outlandish although still optimistic (25%). Self-selecting hospital workers showed 20% in yesterdays publication, which seems like it should be an upper bound for the general population.
It's also important to remember that when people make the claim that "X had it" they also simultaneously estimate that perhaps X/2 would show up as positive in serological tests (because the rate of infection and delay of antibodies would create a lag) so a person claiming 20% having been infected isn't contradicted by a serological result of 10% positive.
> Stockholm has 2.34 million inhabitants. (Stockholm in this context is always stockholm area, not the city).
I agree, counting only Stockholm city isn't reasonable. But I've found the 'Metropolitan Stockholm' number is seldom used as well, but looking at the definitions it should be more common.
What is more commonly used is the number for the Stockholm urban area (I'll link the Swedish wiki article since it contains a lot more data, https://sv.wikipedia.org/wiki/Stockholm_(tätort) ).
It's interesting to compare the metropolitan areas. In Stockholm is stretches so far that it includes areas that feed to (and somewhat off) some of the other large cities (mostly Uppsala I guess), but in Skåne the metropolitan area only covers a few municipalities although commuting by car is more commonplace and there seems to be a lot more commuting by train from Helsingborg and Kristianstad to Malmö (it's also extremely handy by train) than from Uppsala to Stockolm (no hard numbers, but I commuted Uppsala -> Stockholm for five years and Helsingborg -> Malmö for a while).
So it does make more sense to use the 'Greater' areas for all the major cities.
> But I've found the 'Metropolitan Stockholm' number is seldom used as well, but looking at the definitions it should be more common.
The county (region, or formerly "län") is the area responsible for healthcare so it's natural that this area is used for all things healthcare related.
Yes. For Stockholm "Stockholmare" is used for multiplex definitions when for Malmö you have "Malmöiter" and "Skåningar" where the first is specifically the urban area and the latter for the region (healthcare) but an area greater than the metropolitan area.
The problem with the Giesecke approach is that it relies on 2 assumptions being true. 1) that infection brings long term immunity to the currently circulating strains. 2) that covid-19 will not mutate into a new strain with equivalent pathogenicity to which those with immunity to the current strain are no longer immune.
If either of these are false then you will not get a meaningful form of immunity in the population. Currently we don't have any evidence that either assumption is true so pursuing this approach carries an increased risk for very little benefit.
Regarding point 2 - it is more likely that mutations would actually cause sars-cov-2 to be less pathogenic. Futher if you judge merits of approach solely by looking at death counts you miss the bigger picture: what is the total cost of the approach when you include economy and other indirect impacts, eg. mental issues caused by more severe isolation.
This is wrong. The concept Giesecke has not considered this is a little bizarre.
We have studied corona viruses before so we have information about mutations and immunity. We have also been watching covid-19 for these for 4 months.
So this is 100% untrue - "Currently we don't have any evidence that either assumption is true"
"for very little benefit." - We are talking millions of millions of lives, so I'm not sure why you'd say this. The lockdowns are killing millions, a lot of them are the very poor.
We need to plan for the fact it might mutate or we are not seeing immunity stick. But that's different to throwing out Giesecke approach because we don't know something with certainty.
To clarify, the Giesecke approach is merely to use the clearer goal of keeping the case load manageable to the health services.
I don't know who came up with the idea that the goal would be heard immunity. Arguably, a "lockdown until vaccine" strategy is more clearly focused on (artificially) reaching herd immunity.
The lockdowns were sold on “flatten the curve” — which they have done, dramatically so, if we take ex ante predictions as accurate. They were not supposed to be the new normal.
True, my mistake. In my defence, there is a lot of "reasons" for the lockdowns floating around in the global conversation.
This particular error on my part I regarding the reasons for the lockdown I attribute to Tomas Pueyo and his hammer-and-dance amateur epidemiology blog.
Every approach to Covid-19 relies on certain assumptions, so this is hardly unique to Giesecke. For example, most lockdown approaches assume we will have a vaccine in 12-18 months, and/or that we will be able to suppress secondary outbreaks after lockdown ends (via test and trace or other methods). Neither of these assumptions are guaranteed either.
On the other hand, if we don't get long term immunity from the virus we wont get it from a vaccine either. In my opinion there is three paths through this. Two of them depends on immunity.
1. Slow down the spread with soft lockdown, let it pass and get immunity. Will take a long time.
2. Try to severly limit spread with hard lockdown. Either to open up and do lockdown again as necessary or stay in lockdown. Untill vaccine. This is a long road. Optimistic figures is a vaccine somewhere second half of next year.
3. Contact tracing and severe quarantine for infected and contacts until the virus is eradicated. Quick, only possible if the spread is limited. You can't open your country to others until they have done the same or a vaccine is here. The unicorn exit is of course every county doing this and a total eradication of the virus.
A country could possibly change track from strategy 2 to 3 if the spread is down really low and contact tracing is in place. Testing without tracing wont do it.
So soft lockdown in maybe a year or more, deaths will be in the 0,5% vicinity, more in some countries, less in some.
Hard lockdown in the same timespan as above. Less deaths but will you have any society to return to? If you do hard lockdown for a while and then lighten up you're in situation 1 basically or forced to lock down soon again.
Number three is very attractive. Had we all been prepared and had plans for this like South Korea and being island nations with easily shut borders like NZ it would have been simpler. But most countries were not and are not any of that.
South Korea is effectively a island nation in this context: ain't nothing much passing over their land border unless something goes severely wrong in North Korea.
To point 1, you’re right we don’t know for sure, but past experience with Coronaviruses (4 are endemic plus SARS and MERS) suggests that 0.5-3 years is not unreasonable. Past that the question becomes how much immunity, I.e. even if not completely immune, do you get a milder illness. Again we don’t know for sure but it’s a good Bayesian prior to assume yes, recovering from a legitimate SARS-COV-2 infection yields useful immunity for a meaningful period.
For 2, it’s unlikely to mutate to the point of not being recognized within a relevant timeframe. We can track how fast it’s mutating reliably, and it’s not dangerously quick. The good news is if we have immunity, it should last for several years if considering only what we can see about the mutations. Follow the NextStrain project and Trevor Bedford on Twitter for a smarter analysis than I can provide here.
There's a third assumption that I find particularly pernicious: that the long-term health effects of getting and surviving COVID-19 don't need to be part of the equation. We're learning more every day about how the disease not only affects the lungs but also the heart, the brain, the kidneys, and so on. Treatments, unlike vaccines, are likely to be mere months away, and don't just include drugs. We're already learning about better ways to deal with the oxygen starvation that is COVID-19's hallmark.
Every person who merely delays getting COVID-19 until better treatment is available is a win. Even if it succeeds by other metrics, the Swedish approach will fail (has already failed) by this one.
What do you think the goal is of any strategy? Minimizing deaths from Covid-19 in the 2020 spring season? Minimizing deaths from Covid-19 overall (until the disease is "over")? Minimizing all-cause deaths this year? Minimizing some more abstract thing like "quality adjusted lives lost" over many years ahead?
I'll let you know which one it isn't: the first one.
Currently all that is certain is the Swedish gov has gambled with their citizens lives and in doing so they've done horribly in contrast with comparable countries. And the number of fatalities continues to grow.
How is Sweden in any better position to minimise total (lifetime) C19 deaths? Or all-cause deaths this year?
> How is Sweden in any better position to minimise total (lifetime) C19 deaths? Or all-cause deaths this year?
One strategy is ensuring you have some protection from immunity in the population (e.g. 20%) when the first wave is over, so that together with other measures (testing, contact tracing, quarantines) you have a chance to control the virus until a vaccine is found in say 18 months, while also allowing the economy to function. That is to say: flatten the curve but not too much. You want some percentage of immunity too.
The effects on deaths from the economy will take years to manifest. What quality of cancer care can be offered in a country in 5 or 10 years can definitely depend on how this situation is managed now.
To which ever rational scientist downvoted me, here are the good doctors' claims from 26th [1] :
"So if you look at California—these numbers are from yesterday—we have 33,865 COVID cases, out of a total of 280,900 total tested. That’s 12% of Californians were positive for COVID. So we don’t, the initial—as you guys know, the initial models were woefully inaccurate. They predicted millions of cases of death—not of prevalence or incidence—but death. That is not materializing. What is materializing is, in the state of California is 12% positives. You have a 0.03 chance of dying from COVID in the state of California."
Even a child can figure out why this is not even wrong.
An interesting aspect is that the authority where the Swedish State Epidemologist works is the "public health agency". That is: the agency responsible for the health of the whole population. That's not irrelevant here.
Their mission is always the long term health of the population. They are not in a position to recommend actions that they belive will reduce deaths from Covid if they simultaneously believe that e.g the economic effects on the healthcare system will mean it is a net negative for the public health long term.
Meanwhile in other countries perhaps some authorities are working from shorter term ethical guidelines.
Using different views and optimizing for different goals isn't necessarily wrong. There is no "right" here. Everyone realizes that thousands will die in the coming years from things we can afford to treat today, but that we won't be able to afford if we have 15% unemployment. Whether that's part of the equation or not varies between countries and experts. In many places these decisions aren't even left to relevant expert authorities but rather to politicians who have an additional set of concerns (such as popularity) to deal with.
Note: Johan Giesecke is no longer working as State Epidemologist but his views are rather consistent with those of the current authority and the current State Epidemologist Dr Tegnell, so his views are probably shaped in this framework.
A lot of these discussions also sound like lockdown measures are "free". But in reality it's about balancing two unknowns.
On the one hand we don't know how dangerous the virus actually is. If you look around you can find very serious scientists calculating the risks both as very low and very high. There are a number of various complicating factors (like comorbidity, or lockdown measures) to take into consideration.
On the other hand we have some idea that lockdown is going to be really bad. We are likely to face a huge economic crisis, except a lot of the outlets for negative emotion have been cut off. That is going to have a very real death toll as well. But again, we don't know how bad this is going to be. Will it cause wars? Perhaps. Will it cause suicides? Definitely.
I am personally fairly surprised that the Giesecke view isn't more popular around the world. Having a bit more scepticism about the virus before one decides to also sacrifice a lot of people's livelihoods seems prudent to me.
The tail risk angle is pretty interesting. We have a pretty good idea of the upper bound of mortality of the virus, and we also know that with some basic precautions the worst case scenario can be avoided. It's worse than the flu, but not 10 times worse. On the other hand we have no clue what the end result will be of mass unemployment and food insecurity for millions who used to be middle class, on top of unprecedented central bank policy. It's pretty reckless to shut down the world economy and hope it will turn out OK.
We don't know that it's not 10 times worse. Data is confusing and sketchy, but there are many datapoints that indicate that the IFR is over 1%, and maybe as high as 2%.
The UK budget watchdog estimates that 6 months of lockdown will lead to national debt increase of about 25% GDP [1] - an unthinkably huge number in a world where 5% GDP debt increase is a huge amount, in normal times. UK's current debt-to-GDP ratio is something like 80%.
Assuming an optimistic "vaccine" scenario of 1 year of lockdown, universal vaccine, then immediate bounce-back, and extrapolating the debt figures, that's 50% GDP new debt; and in reality, I expect that the longer the lockdown, the more expensive it is. I can well imagine the casualties of such a scenario to be worse than the pessimistic Coronavirus numbers. Public health funding collapsing, God knows what about schools, social spending etc., and yes, perhaps even societal collapse.
I'd love to be proved wrong, but the UK government at least doesn't see it as necessary to even share its thinking of the financial consequences of lockdown, or even acknowledge that there is a trade-off.
Yes, exactly. If the lockdown and the subsequent recession decreases the life expectancy of the average person by 0.5%, then the policy is already a net negative. Add the massive wealth destruction on top of that and the picture becomes even murkier. We, sadly, live in a world where lives can be saved with relatively little effort. Clean water, malaria nets, nutrition. If we wanted to prevent those unnecessary deaths we easily could. And now we're settings trillions on fire without even thinking carefully about the humanitarian consequences.
The issue is that it is a false dichotomy. You can't just "reopen" the economy and everything goes back to normal.
Sweden has effectively voluntarily shutdown with >80% reductions in hospitality spending, etc.
Until a region effectively eradicates the disease (elimination, vaccination or haphazard herd immunity) there is no option of returning to normality.
Modern pandemic response analysis is of course not weighing pro's and cons of lockdown, but instead anticipating outcomes from different scenarios and mitigation strategies.
Ie. What may be the outcomes of not locking down by any measure, and is this response in any way realistically viable? The deeper reflections are missing from public discourse.
The problem is that scenario analysis cannot really be open to the public, and is also highly complex where "small" variables may turn out to have high impacts.
I take the editorial stance that we should only use "believe" in a religious context, so that we tag the thought as something subjective and unprovable in the mathematical sense.
Instead put a Figure of Merit against the idea.
I 30% buy off that covid-19 is a nasty virus that one Does Not Want, and that precautions are in order to protect those with compromised immune systems (my wife).
I 70% think that a variety of leaders on all levels and parties are not "letting a crisis go to waste" here, and purging the backlog of items that they don't care to discuss in detail.
"Whether you’re more Giesecke or Ferguson, it’s time to stop pretending that our response to this threat is simply a scientific question, or even an easy moral choice between right and wrong. It’s a question of what sort of world we want to live in, and at what cost."
That right there is the thing. I think there are a lot of questions that fall into this catagory. People want them to be questions of science but they are fundamentally political questions. You can use science - in ways that are fair or unfair - but at heart science can't answer them.
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[ 3.1 ms ] story [ 220 ms ] threadI'm watching friends and family knocked back by this virus for weeks, and now pushing into months (36 days and 42 days since first symptoms for 2 people I know), and research in the US and China points to the increase in long term health risks in the 20 to 50 year olds that recover from this. I know people that just walk away from this with no impact, but if we only focus on death we are likely missing the bigger picture.
The thing is, I also don't think you can get away from the way that those pushing for lower-end estimates aren't arguing from pure, selfless virology. They're arguing from a "this is uncertain, so should we really risk our economy to avoid potential lives lost?" position. I can see that if you could translate the lost money directly to other lives lost. But you can't. The various state could just support people for the period of the lockdown - all the advanced nations besides the Dysfunctional US are essentially doing this. So if you phrase things in terms of just paying lives for money, I would disagree with the article, that is evil. People who actively enable that are evil. Sweden's policy looks to be baring bitter fruit and I wouldn't forgive Dr. Giesecke any blame for that if it matures. I could be wrong and I'm OK risking money on that, it's a better choice imo.
It seems to me more of "I dont want this to be true whether for both practical or for ideological reasons, therefore it can not be true".
Isn't that just hiding the truth though? After all, what is the state, where does it get the funds? Whether you take my money today or tomorrow, you've still taken my money. I don't see any reason to believe that there will be a magical no-tax funding of government any time soon.
There's no question that a lot of questions remained unanswered, but one question that has a concrete answer is that this is nothing like the flu.
a) People running out of money is only the surface level problem. Money is an abstraction over value. We can and should mess with the abstraction, but we can't do anything about the underlying value in the economy going up in smoke. "Bullshit jobs" notwithstanding, the things people do at work all day do actually have a role in our collective standard of living. There is a reason we can do modern medicine while the third world can't, and we could lose it.
b) Social life seems frivolous in the small, but in the large it is not. Years without human contact will seriously fuck you up. Not only are individuals in distress, but friendships, relationships, families, communities, and society itself are all in rapid decay. Screen time can only slow that down a little.
Becoming a world of 7 billion hermits for as long as it takes carries real risks and real costs, too.
EDIT: should have added politics as another differentiator
Korea "should" be comparable to western countries if it wasn't for politics. But they have 100x fewer deaths. They're not trying to reach herd immunity, it's a political choice.
Agreed and I amended my comment accordingly - and thanks for pointing out my oversight!
https://mg.co.za/article/2020-04-08-is-lockdown-wrong-for-af...
> it’s like a tsunami sweeping across Europe.” The real death toll, he suggested, will be in the region of a severe influenza season
>UK fatality rate of Covid-19 is likely to be 0.8-0.9%,
As I understand it, that is what most countries do and achieve with various success. And as soon as there is any respite in the load of the hospitals, people are already pushing for a easing of restrictions in place.
But with all that, Giesecke's approach is more like getting the whole thing over with quickly, which would have brutal effect on the health care system, to say the least. IE, once this is done, all the doctors and nurses in the emergency care system are going to quit.
The point of lockdowns wasn't to stay locked until total control. That simply will not happen in the US, at this point. (And I'm not sure it's feasible anywhere other than South Korea, now.)
The point was to give everybody time to react and get ready. It's been almost 45 days since the lockdowns started--healthcare workers should have all the gowns, wipes, masks, etc. that they need, by now.
The fact that they don't is an indictment of most of the governments of most of the countries.
In my opinion, we stay locked down until healthcare workers have what they need even if a gigantic wave hits. If enough healthcare workers die, we're all in deep shit even after Covid-19 reaches herd immunity.
Want to unlock things? Start smacking some idiot leaders around about giving equipment to healthcare workers.
When I see healthcare workers saying "Please, stop, we have all the equipment we need and then some," then I'll believe we can come out of a lockdown.
Most countries are seeing death rates beginning to decrease after weeks of lockdown.
There were four new cases today. One confirmed by test and three presumptive cases which according to the experts probably have it. Plus there are hundreds of people in isolation/quarantine who are still sick. I wouldn't declare "elimination" just yet.
Even if new cases dwindled down to zero, that doesn't imply elimination either. There might be many asymptomatic people who are not spreading it currently because of the lockdown, but who will start spreading it once they start interacting with people outside of their bubble.
https://www.rnz.co.nz/news/national/415278/covid-19-new-zeal...
Do you think that's practical? This virus has a hospitalisation rate of somewhere between 10% and 20% and an ICU rate of 4-10%, and people who are hospitalised need to be in there for 2-4 weeks. If a 'gigantic wave' is even 10% of your population (which realistically it would far exceed, given how contagious the virus is) you need 10-20 free hospital beds per 1000 population of which 4-10 are ICU beds.
The United States has 800k hospital beds of which ~100k are ICU beds, for a population of 330 million (source: https://www.aha.org/statistics/fast-facts-us-hospitals) That's 2.4 hospital beds per 1000 population, of which 0.3 are ICU beds.
You're gonna need at least 10x as many additional beds as you currently have. At least. And that's for only 10% of your population getting sick.
Edit: To be clear, I'm not saying that lockdowns are pointless. I'm saying that they need to be longer and more thorough to get to the point where the virus is entirely eliminated, or they need to remain at current levels indefinitely until an effective vaccine or other treatment is available.
Part of the reason there is even a debate is because we don't know this for sure.
The few studies where a large population was tested and shown to be widely infected but largely asymptomatic seem to fall into one of two camps: They used immunological tests (which are now under serious suspicion don't seem reliable) or they tested a newly infected population after the first cases were found (before the majority of infections had time to manifest symptoms.) They've also been reported misleadingly (eg. the aircraft carrier case where it was reported "80% of the crew were infected but asymptomatic" when actually 80% of the crew who tested positive were asymptomatic.)
The number of hospital and ICU beds are being increased rapidly. Medical students are now allowed to work with patients until the crisis passes ( thus increasing the healthcare capacity).
After carefuly observation the plan is to slowly reduce the stringent lock down measures and increase the infection rate, while keeping the medical staff sane.
We will get the next update in the first week of may, whether the first step of "easing" worked as intended.
What we are going to see is a new normal, even if we find a working vaccination soon.
It isn't quite so bad. Lockdowns are a continuum of measures, and you can modulate them over time. We're having to do such strict lockdowns because we were so slow in responding. Once the R is below 1 you can release measures to keep it at that threshold and modulate it over time to match your health care capacity. Merkel seems particularly well informed about this, having even explained what the curve of healthcare capacity versus R looks like for Germany.
This was a good discussion on this at the beginning of the lockdowns:
https://medium.com/@tomaspueyo/coronavirus-the-hammer-and-th...
The problem is that even if we just fill the current beds we have, we STILL don't have enough equipment for the healthcare workers.
This is a major problem.
Especially so since we can substitute therapies. For example, apparently high-flow ventilation is just as good as invasive ventilation--and maybe better. The problem is that it aerosolizes the virus, so your workers need a lot more equipment.
If you don't have enough equipment for the healthcare workers, things fall apart long before you reach available system capacity.
I defy you to find a specific "point" of lock down. I more or less support it but I'd still claim there's not been a proactive strategy in the US even if occasionally the US uses rhetoric. So for that reason, there's no specific "point". Maybe authorities will reach sufficient clarity that they can articulate and stick to a point but not now.
But otherwise, yeah, the entire situation is a mess, an indictment of all the state involved, etc.
Cool. Any resources to read up on that? To my knowledge only a few countries have very few cases. But eliminated completely? Wow. I'd like to dive into this topic.
Unless they believe that's sustainable for 18 months, their whole strategy of eradication wouldn't be feasible, so one would have to assume this is the plan.
Asked whether New Zealand had eliminated COVID-19, Ardern replied: "currently."
[1] https://www.npr.org/sections/coronavirus-live-updates/2020/0...
Wait are we saying that Giesecke is arguing for an (even) more relaxed approach than is currently happening?
I assumed he was arguing for the status quo in Sweden, because hospitals are effectively at capacity now, and have been stable there for a while. A significant increase in new infections would be pretty bad so I don't think he's arguing for "business as usual".
If I understand him correctly then what he's saying is that it's not good to minimize the number of infected, but rather one should only ensure hospitals aren't overwhelmed. A good outcome is if hospitals are never overwhelmed and a significant portion (enough to make a difference) have immunity. A poor outcome would be one where either people die from lack of available care or one where the outbreak is contained through means that aren't sustainable until a vaccine is available.
Obviously if there are long term effects on the health care system from the situation where hospitals are not overwhelmed but just overworked so they quit or are burned out (e.g. many countries won't be able to give healthcare workers summer holiday this year) then that needs to be taken into account as well of course.
Giesecke has claimed less than two weeks ago that at least 600k people in Stockholm (pop 950k) have had it. We did viral and antibody tests that came up with 11%(and had to be retracted because it was based on blood donors and included all donors who had recovered and were specifically asked to donate plasma with antibodies, so 11% is above max) and 2.5% respectively.
This claim and Gieseckes claim that deaths are <0.1% were was then the basis of a study published to show the Swedish policy was right, which had to be retracted because it put the population of Sweden to be >3*45million.
Gieseckes claims and articles starting to disappear/overwritten on same URLs made me back up 4000 news articles yesterday. I think we are close to one of our famous overnight 180 degree public opinion turns from the media starting to question any claims at all.
A large anti body study was supposed to be released yesterday, and I'm waiting to see what it says. We seem to be very far off the herd immunity Gieseckes strategy is based on.
1. He's aiming for herd immunity, using the people who are the less likely to have severe cases to protect the most vulnerable
2. He believes the death toll will really not be that high to justify the actions that we are taking to prevent the virus from spreading
3. He does not care about the deaths, and the faster they die, the faster we can go back to normal
Of course I don't think he believes in number 3, which is quite horrible in my opinion.
Regarding 2, the numbers emerging of the population that has actually contracted the virus seem to be much smaller than what Giesecke was assuming. So it would seem correct to assume that the death toll is going to be much higher than he was anticipating based on a wrong hypothesis.
To me it only leaves number 1 as a potentially valid approach that does not rely on quarantine.
The most credible connection to FHM this strategy has is that a former employee wrote a mail explaining the reasoning of not closing the schools to a friend who is a politician working on local school issues, the friend then (with permission) shared the text further on FB.
> Den tidigare statsepidemiologen Annika Linde hade inte tänkt ge sig in i diskussionen om Folkhälsomyndighetens strategi för att bekämpa det nya coronaviruset. > > – Jag halkade in på ett bananskal, säger hon. > > Bananskalet var en fråga den 12 mars från en lokal skolpolitiker som ville ha hjälp att förklara varför det är rätt av Sverige att inte stänga skolorna. > > Varför säger inte Folkhälsomyndigheten bara att flockimmunitet är planen, undrar folk i sociala medier upprört efter Lindes inlägg. Andra tycker att planen låter rimlig. > > – Sedan förnekade Folkhälsomyndigheten att det var tänkt så, säger Annika Linde. > [...] > > Den tidigare statsepidemiologen Annika Linde tänker inte så mycket på att hennes budskap om den svenska strategin tog sig hela vägen till Vita huset, säger hon. Däremot tänker hon fortfarande att flockimmunitet är målet för Sverige, i väntan på ett vaccin. Men hon försöker låta bli att kommentera sina efterträdares arbete. > > – Det finns något som kallas ”lösa kanoner på däck”. De skjuter lite hit och dit och kan träffa skeppet och sänka det helt och hållet och sedan inte ha något ansvarstagande. Så jag nöjer mig numera med att svara på enstaka frågor, som nu från dig om att jag inte höll tyst där i början. https://www.dn.se/nyheter/sverigebilden-under-coronakrisen/
Also be aware that there are false positives, especially significant with these antibody tests, so with the low numbers of positives it's extremely important to evaluate if the claimed values are more than noise artifacts of the tests themselves. It is also important to be aware of the scenarios for which the use of the apparent test results is not reasonable.
Moreover, here's what happened in the UK a few weeks ago:
https://www.theguardian.com/world/2020/apr/09/uk-government-...
"None of 3.5m home tests ordered have so far been accurate enough to detect coronavirus immunity"
UK got 3.5 million(!) unusable antibody tests.
https://www.bmj.com/content/369/bmj.m1449
"John Newton, Public Health England’s director of health improvement, said:"
"A number of companies were offering us these quick antibody tests, and we were hoping that they’d be fit for purpose, but when they got to test, they all worked but were just not good enough to rely on.
“The judgment was made [that] it’s worth taking the time to develop a better antibody test before rolling it out, and that is what the current plan is.”"
"Newton told the committee that the tests trialled so far had lacked sufficient sensitivity to identify people who had been infected. “We set a clear target for tests to achieve, and none of them frankly were close.”"
I don't know any details about that specific study, or why it was retracted etc, so any links to more info appreciated!
I was writing about the general problems existing when there are little actual positives, and also about the known or maybe somewhere less mentioned issues.
1: https://www.reddit.com/r/COVID19/comments/g4znbg/at_least_11...
https://www.svt.se/nyheter/inrikes/nya-antikroppstestet-base...
"Uncertain conclusions of the new antibody test -- Updated April 22, 2020 Published April 21, 2020"
"The assignment was presented in yesterday's News by Jan Albert, professor of clinical microbiology and chief physician. Now the researchers are withdrawing the report - because it may be based on uncertain evidence."
"The study already used existing tests from healthy blood donors as a basis.
The preliminary results showed that 11 out of 100 bar on antibodies to the coronavirus in Stockholm. Today, the group behind the research has gone out with information that this is not true - they have used unsafe evidence."
"Thus, there may be fewer than 11 out of 100 infected, but how many can not say until they have done the study. In the coming weeks, they will start over from the beginning. The tests already done will be scrapped."
The article quotes Gieseke as saying "The real death toll, he suggested, will be in the region of a severe influenza season — maybe double that at most".
Sweden's official death toll was 2270 yesterday (2020-04-28). The three worst influenza seasons in Sweden since 1969 killed 807, 674 and 652 people[1]. So we've already passed his "at most" claim. The only way I can see that working out is if he feels that none of the influenza seasons in the past 50 years count as "severe".
[1]: numbers taken from the Swedish wikipedia entry on influenza. I didn't bother to check wikipedia's source. An average Swedish influenza season kills about 200.
Or that he doesn't think deaths in past influenza seasons were all attributed to influenza but rather just "normal" deaths.
The excess all-cause deaths will be the figure to look at, but it will take quite a while before those numbers are reliable.
Of course it's also very hard to distinguish between people dying with covid19 and dying because of it. And we've never even made a serious effort to track the cause of death of the elderly.
Meaning we don't know how many people die each year from the flu, and we don't know how many people are dying of covid19. When you add it all up, it will be very difficult to learn the right lessons from this pandemic.
When cancer patients die because their cancer treatment was cancelled they die of a cancer related cause, and that's how their death will be recorded, and that's how their death will be reported.
> And we've never even made a serious effort to track the cause of death of the elderly.
It's hard to understand your "we" here. Which country doesn't try to track cause of death for elderly people?
> Meaning we don't know how many people die each year from the flu,
But we can count the deaths the same way. We can look at deaths of people confirmed to have the disease, we can look at death certificates, we can look at excess mortality combined with community surveillance. The errors for all three are going to be similar for flu and covid-19.
When person in an elderly care facility dies we don't do a forensic investigation. We just shrug and say "I guess it was their time". So we don't have an accurate mortality baseline to do any comparison against. And that's assuming we are accurately distinguishing between those who died of covid19 and those who died with covid19, which we don't.
I'm not suggesting that people who draw conclusions from incomplete data are idiots, I'm pointing out that the data we have is completely insufficient to make an accurate assessment of covid19 mortality.
This ("we just shrug and say "I guess it was their time"") is untrue. It's okay that you don't know, but you should stop spreading this misinformation.
The accuracy of death certificates. Implications for health statistics. https://www.ncbi.nlm.nih.gov/pubmed/1871957
> Significant discrepancies between the two documents were observed in 50% of patients. In 25%, the immediate cause of death was incorrectly stated on the certificate, having been assigned to a different organ system in the majority of those cases. In 33%, there was disagreement on major disease other than the immediate cause of death.
Anecdotally, elderly people I've lost had completely wrong death certificates. When common sense, anecdotal evidence, and a cursory review of the scientific literature point in the same direction I'm going to assume that's the way it is.
Also, try to be kinder in the way you communicate.
We know that death rates with the disease vary a lot due to attribution.
We really can't get a good comparison as influenza isn't usually attributed as the main cause of death but coronavirus is.
We can only look at all cause mortality rates which is quite the lagging indicator.
https://www.euromomo.eu/graphs-and-maps/
The best we have.
What makes you say this?
https://www.spectator.co.uk/article/The-evidence-on-Covid-19...
But there’s another, potentially even more serious problem: the way that deaths are recorded. If someone dies of a respiratory infection in the UK, the specific cause of the infection is not usually recorded, unless the illness is a rare ‘notifiable disease’. So the vast majority of respiratory deaths in the UK are recorded as bronchopneumonia, pneumonia, old age or a similar designation. We don’t really test for flu, or other seasonal infections. If the patient has, say, cancer, motor neurone disease or another serious disease, this will be recorded as the cause of death, even if the final illness was a respiratory infection. This means UK certifications normally under-record deaths due to respiratory infections.
Now look at what has happened since the emergence of Covid-19. The list of notifiable diseases has been updated. This list — as well as containing smallpox (which has been extinct for many years) and conditions such as anthrax, brucellosis, plague and rabies (which most UK doctors will never see in their entire careers) — has now been amended to include Covid-19. But not flu. That means every positive test for Covid-19 must be notified, in a way that it just would not be for flu or most other infections.
1) Death certificates rely on doctors using their best knowledge and experience to say what the patient died of, and what the patient died with. Flu and other respiratory illness is mentioned on many death certificates. See 5.4 here: https://assets.publishing.service.gov.uk/government/uploads/...
2) A notifiable illness has no meaning for death certificates.
3) We don't routinely test for flu. That's why all cause mortality is the preferred statistic for flu deaths, and also for covid-19 deaths.
You're not arguing with the Spectator, they're just acting as a publisher. You're arguing with in his words, "a recently-retired Professor of Pathology and NHS consultant pathologist". So you're claiming a professional British pathologist doesn't understand how British death certificates work, and you know better. Bold move.
Especially so because you seem to actually be agreeing with what he wrote, which is weird. For instance your claim (3) exactly matches his claim that:
"the vast majority of respiratory deaths in the UK are recorded as bronchopneumonia, pneumonia, old age or a similar designation. We don’t really test for flu, or other seasonal infections."
You say flu appears on many death certificates. Yes and he never argued otherwise. He said despite that it's sometimes mentioned it's actually under-reported because testing isn't really done much for it - as you agreed with!
That leaves the question of notifiability. The rules say that COVID-19 must be mentioned on a death certificate if testing was done at all, even if negative (which is new to me, I wonder what that does to the widely cited stat of "number of certificates that mention COVID"). But the point is that relative to flu, testing deaths for COVID is enormous, practically blanket at this point. If you test a lot and you insist that every case is reported to central government it will cause a flood of reports to arrive on the desks of decision makers, who will then feel it's much worse than flu. But it's not, it's just a reporting artifact.
Source: https://www.socialstyrelsen.se/globalassets/sharepoint-dokum...
In any case, boosting the number to 685 still isn't enough so that covid is "double at most", and boosting it to 1100 isn't enough either.
My point is more that statistics is hard. You tried to debunk someones "dodgy" statistics with your own numbers that can be twisted to be even more off than the person you tried dismiss. I'm afraid nobody and everybody will be right after this is over. People will always find statistics to prove their points and that they where right and the other people where wrong.
> [1]: numbers taken from the Swedish wikipedia entry on influenza. I didn't bother to check wikipedia's source. An average Swedish influenza season kills about 200.
Sorry, but you can't just throw around numbers without explaining exactly what they mean or where they come from. The numbers you're quoting is most likely deaths that has been diagnozed as influenza. To get the full picture you need to look at excess mortality (which is reported by EuroMOMO[1]) and possibly adjust the numbers to pick out the influenza-related excess (FluMOMO[2] is the model most countries use).
If you look at the 2016/2017 season in Sweden [3, figure 17, page 46] you will see that the excess mortality as reported by FluMOMO goes way beyond ~600 for a season. In the peak season we see that it was ~300 per week. There are of course uncertainties in these numbers (which is why you won't see any official "x number of people died of influenza" figures), but it was probably closer to thousands than hundreds in 2016/2017.
[1]: https://www.euromomo.eu/ [2]: https://www.euromomo.eu/how-it-works/flumomo [3]: https://www.folkhalsomyndigheten.se/publicerat-material/publ...
In the interview, Gieseke says influenza kills 1000 to 2000 people per year in Sweden, it's part of the exchange starting at 24:16. He doesn't explain exactly what those numbers mean or where they come from.
A minute or two later, he guards his 'double' comment by saying it's not going to be 10x.
One interpretation of the exchange is that he's predicting 2000-4000 deaths in Sweden, and definitely not 20000.
Stockholm has 2.34 million inhabitants. (Stockholm in this context is always stockholm area, not the city). That makes a 600k estimate much less outlandish although still optimistic (25%). Self-selecting hospital workers showed 20% in yesterdays publication, which seems like it should be an upper bound for the general population.
It's also important to remember that when people make the claim that "X had it" they also simultaneously estimate that perhaps X/2 would show up as positive in serological tests (because the rate of infection and delay of antibodies would create a lag) so a person claiming 20% having been infected isn't contradicted by a serological result of 10% positive.
I agree, counting only Stockholm city isn't reasonable. But I've found the 'Metropolitan Stockholm' number is seldom used as well, but looking at the definitions it should be more common.
What is more commonly used is the number for the Stockholm urban area (I'll link the Swedish wiki article since it contains a lot more data, https://sv.wikipedia.org/wiki/Stockholm_(tätort) ).
It's interesting to compare the metropolitan areas. In Stockholm is stretches so far that it includes areas that feed to (and somewhat off) some of the other large cities (mostly Uppsala I guess), but in Skåne the metropolitan area only covers a few municipalities although commuting by car is more commonplace and there seems to be a lot more commuting by train from Helsingborg and Kristianstad to Malmö (it's also extremely handy by train) than from Uppsala to Stockolm (no hard numbers, but I commuted Uppsala -> Stockholm for five years and Helsingborg -> Malmö for a while).
So it does make more sense to use the 'Greater' areas for all the major cities.
The county (region, or formerly "län") is the area responsible for healthcare so it's natural that this area is used for all things healthcare related.
https://en.wikipedia.org/wiki/Regions_of_Sweden
https://en.wikipedia.org/wiki/Stockholm_County
We have studied corona viruses before so we have information about mutations and immunity. We have also been watching covid-19 for these for 4 months.
So this is 100% untrue - "Currently we don't have any evidence that either assumption is true"
"for very little benefit." - We are talking millions of millions of lives, so I'm not sure why you'd say this. The lockdowns are killing millions, a lot of them are the very poor.
We need to plan for the fact it might mutate or we are not seeing immunity stick. But that's different to throwing out Giesecke approach because we don't know something with certainty.
I don't know who came up with the idea that the goal would be heard immunity. Arguably, a "lockdown until vaccine" strategy is more clearly focused on (artificially) reaching herd immunity.
This particular error on my part I regarding the reasons for the lockdown I attribute to Tomas Pueyo and his hammer-and-dance amateur epidemiology blog.
So soft lockdown in maybe a year or more, deaths will be in the 0,5% vicinity, more in some countries, less in some. Hard lockdown in the same timespan as above. Less deaths but will you have any society to return to? If you do hard lockdown for a while and then lighten up you're in situation 1 basically or forced to lock down soon again. Number three is very attractive. Had we all been prepared and had plans for this like South Korea and being island nations with easily shut borders like NZ it would have been simpler. But most countries were not and are not any of that.
For 2, it’s unlikely to mutate to the point of not being recognized within a relevant timeframe. We can track how fast it’s mutating reliably, and it’s not dangerously quick. The good news is if we have immunity, it should last for several years if considering only what we can see about the mutations. Follow the NextStrain project and Trevor Bedford on Twitter for a smarter analysis than I can provide here.
Every person who merely delays getting COVID-19 until better treatment is available is a win. Even if it succeeds by other metrics, the Swedish approach will fail (has already failed) by this one.
Deaths are almost an order of magnitude higher in Sweden v the rest of Scandinavia: https://ourworldindata.org/grapher/covid-daily-deaths-trajec...
I'll let you know which one it isn't: the first one.
How is Sweden in any better position to minimise total (lifetime) C19 deaths? Or all-cause deaths this year?
One strategy is ensuring you have some protection from immunity in the population (e.g. 20%) when the first wave is over, so that together with other measures (testing, contact tracing, quarantines) you have a chance to control the virus until a vaccine is found in say 18 months, while also allowing the economy to function. That is to say: flatten the curve but not too much. You want some percentage of immunity too.
The effects on deaths from the economy will take years to manifest. What quality of cancer care can be offered in a country in 5 or 10 years can definitely depend on how this situation is managed now.
https://calmatters.org/health/2020/04/debunking-bakersfield-...
"So if you look at California—these numbers are from yesterday—we have 33,865 COVID cases, out of a total of 280,900 total tested. That’s 12% of Californians were positive for COVID. So we don’t, the initial—as you guys know, the initial models were woefully inaccurate. They predicted millions of cases of death—not of prevalence or incidence—but death. That is not materializing. What is materializing is, in the state of California is 12% positives. You have a 0.03 chance of dying from COVID in the state of California."
Even a child can figure out why this is not even wrong.
[1] https://www.aier.org/article/open-up-society-now-say-dr-dan-...
Meanwhile in other countries perhaps some authorities are working from shorter term ethical guidelines.
Using different views and optimizing for different goals isn't necessarily wrong. There is no "right" here. Everyone realizes that thousands will die in the coming years from things we can afford to treat today, but that we won't be able to afford if we have 15% unemployment. Whether that's part of the equation or not varies between countries and experts. In many places these decisions aren't even left to relevant expert authorities but rather to politicians who have an additional set of concerns (such as popularity) to deal with.
Note: Johan Giesecke is no longer working as State Epidemologist but his views are rather consistent with those of the current authority and the current State Epidemologist Dr Tegnell, so his views are probably shaped in this framework.
On the one hand we don't know how dangerous the virus actually is. If you look around you can find very serious scientists calculating the risks both as very low and very high. There are a number of various complicating factors (like comorbidity, or lockdown measures) to take into consideration.
On the other hand we have some idea that lockdown is going to be really bad. We are likely to face a huge economic crisis, except a lot of the outlets for negative emotion have been cut off. That is going to have a very real death toll as well. But again, we don't know how bad this is going to be. Will it cause wars? Perhaps. Will it cause suicides? Definitely.
I am personally fairly surprised that the Giesecke view isn't more popular around the world. Having a bit more scepticism about the virus before one decides to also sacrifice a lot of people's livelihoods seems prudent to me.
Assuming an optimistic "vaccine" scenario of 1 year of lockdown, universal vaccine, then immediate bounce-back, and extrapolating the debt figures, that's 50% GDP new debt; and in reality, I expect that the longer the lockdown, the more expensive it is. I can well imagine the casualties of such a scenario to be worse than the pessimistic Coronavirus numbers. Public health funding collapsing, God knows what about schools, social spending etc., and yes, perhaps even societal collapse.
I'd love to be proved wrong, but the UK government at least doesn't see it as necessary to even share its thinking of the financial consequences of lockdown, or even acknowledge that there is a trade-off.
[1] https://www.bbc.co.uk/news/business-52393472
Until a region effectively eradicates the disease (elimination, vaccination or haphazard herd immunity) there is no option of returning to normality.
Ie. What may be the outcomes of not locking down by any measure, and is this response in any way realistically viable? The deeper reflections are missing from public discourse.
The problem is that scenario analysis cannot really be open to the public, and is also highly complex where "small" variables may turn out to have high impacts.
Instead put a Figure of Merit against the idea.
I 30% buy off that covid-19 is a nasty virus that one Does Not Want, and that precautions are in order to protect those with compromised immune systems (my wife).
I 70% think that a variety of leaders on all levels and parties are not "letting a crisis go to waste" here, and purging the backlog of items that they don't care to discuss in detail.
That right there is the thing. I think there are a lot of questions that fall into this catagory. People want them to be questions of science but they are fundamentally political questions. You can use science - in ways that are fair or unfair - but at heart science can't answer them.