Just like in other EU countries, it is now the younger population which seems mostly affected, and thus the mortality is lower - which is ultimately some good news.
Summer holidays are now almost over though, so people are traveling home from vacations abroad, are going back to work, schools will start up soon and people finally get access again to health care (good luck seeing a doctor in July in Sweden). The impact remains to be seen, but it would be surprising if most other EU countries see infections increasing but not Sweden.
I remain pretty skeptical of this Swedish exceptionalism, so my guess is this blog post will not age well.
Sweden's death rate is down to zero today and has been trending down since mid April. Summer Holidays did not start until late May where deaths were already half of what they were in mid April. This post isn't aging, it's already aged.
Sweden has fairly laggy reporting of deaths, with the deaths often taking several weeks to show up in statistics, so at any given date, deaths attributed to the last few days are always dropping to close to zero.
I looked into this a bit in mid-APRIL, when somebody claimed that deaths were dropping to zero. At the time, substantial revisions occurred for about three weeks after the date, and occasional revisions for about four weeks.
(It's entirely possible that similar phenomena occur in other countries; Sweden is the only country I looked at in detail).
Several weeks is a bit of an exaggeration. Lag in reporting has been around 4-5 days on average. Lately the lag has increased somewhat as the number of reported deaths has gone down.
Any uptick at all is concerning. In fact, a flattening of the decline is concerning.
The implied thesis in the linked article is that Sweden has reached a level of herd immunity due to widespread T-cell responses, and that life in the country continues as normal.
If that is the case, then we would expect the infection curve in Sweden to follow a classic logistic model -- which is more or less symmetric. A rapid rise should be accompanied by a rapid fall.
An asymmetric curve or one that has a "second wave" of any size tends to refute this theory. It would suggest that there was in fact some meaningful intervention that changed: either the initial infection was among a different group (i.e., what the US saw with infections first dominated by New York and then later by other states) or there was an effective policy response that has begun to wane.
Logistic model? Never saw anyone use that model. Do you have reference?
What one should expect, afaik, is a Gompertz curve - the derivative of which, depending on parameters, often rises quickly and drops slowly.
Michael Levitt calibrated a Gompertz model in April based on actions taken until that day, that predicted 5000 dead by 1-jul matched reality incredibly well - whereas the WHO/Ferguson model at the same time predicted 96,000 dead by 1-jul based on the same data.
Simple mathematical models are not appropriate for a situation as nuanced and multivariate as this one.
Case count will oscillate up and down as restriction levels and individual comfort levels oscillate. As we approach herd immunity, the oscillations will dampen while following a downtrend.
The cases/day downtrend is still very much intact, and while it could reverse, it is premature to be concerned.
daily infections are irelevant if almost all of them are asymptomatic or extremely mild not requiring any hospitalization
Czechia has 200-300 daily infections and we have like 30 hospitalized patients also in country of 10.7M, so there is pretty much zero chance of dying from COVID, from those 390 people who dies in those 4 months (where usually dies around 40000 people from all causes) had other issues and coronavirus was unlikely cause of death
my guess is people who fell for this mass hysteria will be very quiet in year or two when we will look at yearly death stats and see mere blip because of COVID, where just cause of death may temporarily shift to COVID, but in the end total numbers of death will remain same. UK stats shows already for 6 weeks lower than 5 year average mortality and number of excess deaths is shrinking
> daily infections are irelevant if almost all of them are asymptomatic or extremely mild not requiring any hospitalization
In fact, more daily infections without more deaths are a good thing. It means the virus is not as dangerous as we thought and we're closer to herd immunity/the end of the pandemic.
I’m struggling to get your point about the U.K. 161 deaths below average for a week - if the trend holds for the remainder of the 22 weeks this year then that’s 3.5k deaths less which is dwarfed by the excess so far, so I can’t see that averaging out? Unless you’re point is something else?
I'm quite fed up with people counting the number of cases as if it has any value, it's like they don't want to admit we were wrong for creating such a panic. Infections are meaningless.
Let's count how many people are in ER and how many die.
The conspirationist in me can't help but think that COVID has been the scapegoat for the worst financial crisis in this century.
While we look at meaningless COVID stats and debate wether we should wear a mask, we don't look at the real culprits for the current financial crisis that will take decades to heal (if it ever heals fully).
The people who wanted power have it now, and they love wielding it. If they relent, the perception becomes that it never mattered in the first place.
Lockdown makes them heroes and wise politicians, saving you from something that we know very little about.
Heroes? Name one "powerful" person who is a hero in this pandemic. I can't think of any. Cuomo was quite effective with his daily briefings but made so many other basic mistakes before and after the core part of the NY "wave" that even that performance didn't turn him into a hero. I haven't see a single wise politician, let alone a hero, within the USA with regards to COVID19.
It's baffling that you would take this singular anecdotal factually-cherry-picked account of one doctors experience during one nations allegedly ineffective (lack of a) response to COVID as sensible advice moving forward.
For one, his per-capita-death-rates are wayyy off. (1 out of 200 dying? try around 8% in Spain and Italy...)
For 2, yes, it's precisely about slowing the spread
1) giving a chance for emergency services to handle the influx instead of being slammed in one go
2) attempting to quash a given outbreak
So many sweeping generalizations here and so little counter-point to the facts the general public have become well-acquainted with, I'm afraid our Good Doctor seems a bit eccentric and witless writing such a trivializing dismissive blog post.
Let's call him "an outlier" even for Sweden, as travel is not making his strange claims that "covid is over for Sweden" look even sillier.
Covid is not finished for "the world" at large, and it's an interconnected world, and suspicion of "t-cells bearing COVID immunity rather than antibodies" as if the PCR were just a cheap placebo test and no antibodies were detected in prior COVID sufferers (it does detect them.)... this is all making light of what deserves serious engagement.
Fire this man or get a committee investigating his various claims as flippant blogs are not the appropriate realm for such incendiary topics.
You seem overly dismissive. I mean he states "this is my experience in Sweden", so I'm not sure how death rates in Spain and Italy are relevant to his observations.
And the "T-cell immunity" is factually correct. Even the NYTimes wrote an article on how people who have never been exposed to Covid, do indeed, appear to have some level of immunity due to T-cell and likely prior infection by a related virus.[1]
> 1 out of 200 dying? try around 8% in Spain and Italy...
You have conflated the CFR and IFR, and are thereby spreading gross misinformation. From the article:
> And remember, the risk of dying is at the very most 1 in 200 if you actually do get infected.
They're talking about the risk of dying "if you actually do get infected" (i.e., IFR), not the risk of dying if you get infected and test positive (i.e., CFR). Most people infected suffer mild enough symptoms that they don't seek a test, so the CFR is much higher than the IFR. This is especially true during severe outbreaks, where people with mild symptoms are explicitly encouraged to just stay home until they get better (or worse) to avoid further stressing the medical system.
A recent meta-analysis estimates the IFR around 0.7%[1], a little higher than the Swedish doctor's numbers but pretty close. The exact number will vary dramatically with the age structure of the population, since the IFR is >100x for old people vs. young.
I sincerely hope they do so that the rate of infections in the general population is low enough that my limited exposure to other people when grocery shopping once every 2 weeks is low enough risk that I won't catch it.
This article would be banned on facebook, because the view that covid still has many millions to kill in the US (sans vaccine) is the currently allowed truth.
it would indeed, as it posits spurious claims and is factually inaccurate, ER doctor or not.
The fact is, over 150k have died in the US due to COVID, and this exceeds the US death toll from any known war, so there's no real minimizing such a figure.
It's likely precisely due to a failure to contain the spread of the causative virus, precisely due to waffling around lockdown.
"Only" 80k died from flu, without needing a shutdown, but 150k have died from covid-19 even with a shutdown, so how is that an argument against the covid-19 shutdown?
At best it's an argument that we should do more to stop flu deaths, but at worst it amounts to "If someone ever dies of any preventable cause then we should never take any measures to prevent any other death".
That is (luckily imo) only a tiny minority of Germans. I would be very interested: are the current restrictions really that bad? You need to wear a mask in supermarkets, do you think that's actually that big of a deal?
I suppose the Swedish response would be that these deaths weren't prevented, just delayed, as there'll be a second wave, third wave... and lockdowns can't continue forever.
It's the patronizing way things get pushed that is a problem. Including you pointing out someone being in the minority, followed by asking a question: the answer is kinda moot if you already established might being right as valid in your view. It's a very thin veneer of good faith, and completely transparent to the person it's done to.
If I told you to list 3 things you're grateful for each day, and hounded and sanctioned you for not doing it, if I talked about all these Nazis I know who incidentally also are not doing it, and meaningfully nodded your way every time, and made fun of you in filter bubbles... wouldn't you just do this minor thing that may actually be beneficial and is unlikely to do harm?
This is the problem, and to use a pandemic to normalize that just makes it worse, morally speaking.
>If I told you to list 3 things you're grateful for each day, and hounded and sanctioned you for not doing it, if I talked about all these Nazis I know who incidentally also are not doing it, and meaningfully nodded your way every time, and made fun of you in filter bubbles... wouldn't you just do this minor thing that may actually be beneficial and is unlikely to do harm?
The difference being that there is a strong scientific consensus that wearing a mask will save many peoples lives. I don't want to be patronizing and me pointing out that op was in a minority merely wanted to correct the "fellow germans" statement. But sometimes it's difficult not to be patronizing if you are following the strong scientific consensus on a topic. Because wearing masks shouldn't be a political issue if you can't develop a reasonable counterargument.
Listing 3 things you are grateful for each day will improve your whole life and all your relationships. As something that is likely to do good and isn't much of a sacrifice, it's the same thing, and you didn't answer the question.
> Because wearing masks shouldn't be a political issue if you can't develop a reasonable counterargument.
You are the one making it about the masks and only the masks, even the protests aren't, and I for one said IMO the pushiness is the problem, not what is being pushed.
It is not. Masks are meant to protect everybody, they are not meant to protect yourself. I'm not in favor of preventing consenting mentally stable adults from doing basically anything to themselves and – to answer your question – I would obviously object to other people forcing me into adopting any unreasonable habit. But this is about protecting society and risk groups.
> IMO the pushiness is the problem, not what is being pushed.
By "the pushiness" do you mean the laws that are in place to force people to do things? Because those are pretty common in all sorts of situations.
Or do you mean the general attitude by commentators (in the media/on twitter etc.) towards people not abiding by those laws?
I didn't say "it's the same thing", I said "As something that is likely to do good and isn't much of a sacrifice, it's the same thing"
> I would obviously object to other people forcing me into adopting any unreasonable habit.
There is nothing "unreasonable" about naming 3 things you are grateful for each day. If you did it each day, you could probably get it down to taking a few seconds.
> Or do you mean the general attitude by commentators (in the media/on twitter etc.) towards people not abiding by those laws?
I do mean the attitude, but not about not abiding to laws per se. It's just a wholesale dismissal. Like, what does "mentally stable" have to do with anything, why did you weave that in there? Because instable people are complaining about masks or think G5 causes Corona? What do, for example, arguments put forward in the OP article have to do with that?
"A large crowd of far-right groups gathered for a "sit-in" at Berlin's iconic Brandenburg Gate on Saturday to protest against the German government's coronavirus restrictions."
The same thing in the german press. the next demonstration will be on the 29. of august. It will be even bigger than the last one. You can fool some of the people some of the time. But you cant fool all the people all of the time.
I guess my question was - is that true? No doubt there were some far-right groups, but from what I've read it wasn't all of them.
It just seemed like an incredibly dismissive headline. "No worries, just crazy far-right doing their crazy stuff. We can safely ignore what they have to say."
I think we can and should safely ignore what people who protest against public health measures in a pandemic say, especially when it's rebelling against life-saving emergency measures.
Shame be upon such short-sighted folks who think that their "freedom" to not wear a mask is greater than others right to merely live.
I'll say it again: can you imagine what the survivors of World War 2 lived through? 10 years of being nervous everytime you try to go to the toilet...
and these modern crybabies and their anti-vaccine lies want you to take them seriously?
Your comments have been breaking the site guidelines. Please stop taking the thread further into flamewar.
Other commenters are expressing views that are (presumably) similar to yours in ways that stay within the guidelines. If you would please review https://news.ycombinator.com/newsguidelines.html and be like them, we'd be grateful.
I also saw US media describe a protest against the Iraq war by school children as "Hitler's Children: Pro-Saddam protesters in Munich" in the caption of a photo of a blonde kid. Yes, right-wing people are a large part of it, and too many people who are not right-wing aren't critical enough of that. But to simply paint it all with one broad brush and call it a day simply betrays an agenda rather than being an accurate description of reality.
Please don't break the site guidelines. I understand the frustration of people being wrong on the internet, but responding with name-calling ("contact with reality", "mythology you propose") only makes the thread worse. The spirit of this site means either posting corrective information (as others in this thread are doing), or resisting the temptation to post.
ah, the people that most germans refer to, poetically perhaps, as the "Covidioten".
it turns out that in Germany, as in the USA, there is a significant overlap between the Covidioten and right-wing/nationalist political groups, including even fringe groups that don't believe that the Third Reich actually ended. This gives rise to some good jokes within Germany.
You win the prize for the understatement of the century.
The ideological clarity of the covid regime is sublime. All sorts of debated matters are decided, by "science", and that is that. Whether by accident or design, the covid regime, the "new normal" that MSM has been educating us about from the very beginning, is a blueprint for a global authoritarian technocracy with its own internal logic, ethics, and mores.
I find your usage of intellectual terms employed in a very anti-intellectual effort of a very base nature.
What, pray tell, is the ideology of a virus?
Yes, the scientific method is probably a more sensible means of deciding things than "whatever gets my knickers in a bundle".
If you are suggesting that trained medical specialists shouldn't head pandemic intervention efforts, I respectfully and wholeheartedly disagree.
Your worldview elevates "the bad guys" and denigrates "the good guys" so there's your inverted logic and morality to deal with, pity, it must have been the secret chips in your childhood vaccines...
I share your concerns about authoritarians using this occasion to bend things in a bad direction but are you asserting that the virus is not a real thing or that some group with authoritarian aims is behind its release? Because if the virus is a real thing then surely protesting by gathering into crowds and falling victim doesn’t harm the bad guys right? Help me understand if you don’t mind, serious questions it’s hard to word things so they don’t sound incendiary to one side or the other (or both) since the issue is so politically charged.
I think it's quite a bit more than bending in a bad direction. Many countries are still under their emergency authoritarian restrictions - to this day, troops are patrolling the streets of Melbourne to make people stay inside.
Please note I stress that I am commenting on the virus "regime".
Is the virus real? I think we should assume it is real, regardless of the facts. Let's say it is real.
Should we concern ourselves with whether it is (a) natural phenomena, or (b) man-made;
and whether regardless of its provenance, the spread of the virus was due to (a) chance events, or (b) intentional release?
Again, I say, to seriously answer any of these questions is an unreasonable burden. So, let's call it an "act of god".
Now, we are at the point to discuss sensible response, rational response, reasonable response, to a collective health issue: a virus that has reached pandemic stage and posses certain risk probabilies across various demographics.
Does the above scenario mandate that governmental norms be bent if not broken? For example, is it acceptable that from now on society will be governed by executive decrees and not legislative bodies?
How long should we tolerate such encroachments on what we know to be the basis of free societies?
Should not a health care matter of such grave import and impact on our lives be subject to the input of a wide range of experts in related subject matters?
What "authority" has designated certain institutions, such as the Imperial College as an example, as fonts of indisputable claims regarding the gravity of the situation and required remedies?
Why are dissenting experts and workers in the "frontlines" subject to media blackout, de-platforming, and loss of income?
I could go on and practically write a little book here. But that should suffice as to "why" some of us are rather concerned, to say the least.
You asked a lot of questions that seem to imply a lot of conspiracy-driven actions, but you didn't really state any definite opinions or present any evidence that supports those implications. If you're going to "write a little book here," you're going to have to say what you believe and present the evidence for why you believe it.
That is a laughable mischaracterization of the post to which you are responding.
These are legitimate questions that definitively need to be asked and answered in context of a complete workover of our societies, instead of being dishonestly dismissed.
You said you had so much information that you could write a little book. Is your book going to consist entirely of questions that appeal to thoughts of conspiracy and shadowy action by oppressing forces? Or will you simply state your opinions about how things are and support those with evidence?
That is your characterization and borderline trolling. Only a troll would claim that insisting on legislative oversight of executive, to take one item, is indicative of irrational fears.
There are a lot of highly problematic claims in the article. This one stood out to me:
>Shutting down completely in order to decrease the total number of deaths only makes sense if you are willing to stay shut down until a vaccine is available. That could take years. No country is willing to wait that long.
Actually it might very well just be half a year until we have a vaccine. Multiple candidate vaccines are in phase 3 and they are already being produced en masse, ready to be released if the vaccines prove to be successful. And it's not like other countries in Europe "shut down completely" and remain shut until today. In Germany people are leading their normal lives, the only difference being that people wear masks in super markets, register on a list when visiting a restaurant and there are no mass events/discotheques. Remaining at this status for half a year or maybe a year to prevent tens of thousands of deaths seems extremely doable.
the german gdp is down over 10 percent. A decade of growth is gone because of this failed policy. The young generation will suffer from this for a long time. Seems like the current politicians dont care about our future.
>the german gdp is down over 10 percent. A decade of growth is gone because of this failed policy.
The swedish GDP is down 9% despite them (according to the article which is misrepresenting a lot of things) not locking down at all. Even if Germany took a completely different approach (which would have led to a New York Style situation in the whole country) there would basically not be a difference in gdp numbers.
Those are preliminary flash estimates, we'll see how they hold up in a month.
Even if true, it's still less down than any other European nations, and the only one not in a recession, because you're not taking the previous quarter into account as well.
Unfortunately, it appears that a significant chunk of people are not interested in taking the vaccine. [1] If only half of Americans are going to get the vaccine (that figure is from May polling, referenced below), we can't pin all of our hopes on it.
I should note that I'm not saying it's unreasonable of people to be hesitant to take this particular vaccine, given how it is being rushed. Even scientists have said that there is not currently enough evidence of safety/efficacy that they would feel comfortable taking it or giving it to their families. [2]
I suspect once it's generally available you'll see it required at many schools, workplaces, etc. Assuming it's available next year, expect this to be a massive controversy that doesn't fall along the usual political battle lines.
Clarification: You can still get infected by viruses after you receive vaccines for them. Your severity of infection will be lower, but it's still possible to get sick even with a vaccine, just less sick than you would've.
I'm by no means anti-vaccine, but I don't have any faith in a trump-led FDA not taking shortcuts to rush a vaccine in hopes that it'll preserve trump's reign. I won't take any vaccine that hasn't been through some other country's approval process that I can trust. Most likely, I'm looking for something with EU approval.
If Covid has taught me anything, it's to stop assuming a best case scenario.
Even if a vaccine is approved in Q'21, due to manufacturing, supply chain and just general operations issues, it's going to be a while before a large part of the population is vaccinated.
I assume they'll prioritize medical workers and the elderly, then start working through the rest of the population. It wouldn't surprise me if it takes another 6 months to vaccinate less than 50% of the population (which, to be fair, may be enough).
We're probably looking at end of 2021 for enough vaccinations to happen for things to go back to "normal".
I don't think anyone involved in COVID-19 vaccination work believes the first vaccines will be more than 50% effective and that only for a short period. I believe the Oxford vaccine project is expecting 6 months of resistance to infection. This isn't good enough for things to go back to the way the way things were.
We'll be dealing with this virus permanently and it will likely be years, or decades, until there's a good enough vaccine for it to be safe for to return to the way they were.
In the mean time, things will change enough that going back to the old normal won't be an option by the time it's eventually safe enough to do it.
It's unlikely that it will be politically feasible to stop vaccinated people from going back to normal, whether or not we think it's good enough in some abstract sense.
Yeah, you're most likely right. If we have a couple vaccines fail in phase 3, add another 6 months. And there is a chance it's another year before we have a somewhat effective vaccine.
That pushes out herd immunity to late 2022.
The positive thing is there a lot of vaccine in development. I feel confident we'll find one that's at least somewhat effective.
But vaccines don't just pass or fail: likely outcomes include a lot of middle ground with partial protection or side effects that are only prohibitive for some groups (mostly age groups). Stopping fractions of infections will make it possible to lift more and more social interventions while maintaining R <= 1 suppression.
i am in the pessimists camp who believes there wont be a COVID vaccine for decades. SARS is a corona virus and no vaccine has been found in 13 years. the common cold is a corona virus and no vaccine has been found since vaccination was invented.
the new normal is going to be with us for a very long time, so adjust and plan accordingly.
The common cold is a multitude of corona viruses and a large number of other causes both viral and bacterial. There is zero business case for developing a vaccine for a single-digit percentage of common colds.
There are alot of ongoing trials and indeed unprecented global effort towards a vaccine but we can’t forget the usual time to market, and the fact that no vaccine has ever been created for a coronavirus. 6 months is very optimistic.
I donct want to be overly pessimistic but took years for Ebola. It was first discovered in the ’76 and we only have an approved vaccine for it since last year. That's 44 years.
Sweden is effectively as locked down as anywhere else. The prevalence of the virus is diminishing there because people are not going out and getting sick, rendering R_t<1. I don't participate in social distancing because my government says to, and I certainly don't stop because my government says to either.
But this is also not the case for all the other countries in Europe which (according to the author) have taken the wrong approach to COVID. The more I think about it the more this article confuses and worries me. It's a thinkpiece that is not grounded in the scientific reality.
> It's a thinkpiece that is not grounded in the scientific reality.
What does that mean? As a scientist myself, 'science' can basically never say anything definitive about reality. Not for something extremely well measured and controlled like GR, and especially not something where the evidence on the ground and influencing factors (policy, social opinion, culture) shift with a frequency on the same order of scale that our measurements can be tallied.
There are a lot of claims in the article that the current scientific consensus does not support. The T-cells claim is one of them. Of course there are no absolute truths and I agree that my choice of words was maybe unfortunate.
It means that people who have no idea what science is like to pretend they have a deeper reason for their biases other than their innate preferences. They do not like that pointed out to them and will violently react to anyone who does.
You can't have a scientific response to the virus when you don't know what the asymptomatic transmission rate is, or what the true death rate is. As can be seen here it does not go well when they are made to even consider that they don't have all the information needed for a scientific response: https://news.ycombinator.com/item?id=24077233
"I want to preface this article by stating that it is entirely anecdotal and based on my experience working as a doctor in the emergency room of one of the big hospitals in Stockholm, Sweden, and of living as a citizen in Sweden."
I mean, he mentions right at the start and several times throughout the post that it's his observations and opinion. Expecting it to be scientific reality seems a bit unfair.
Look at this paragraph. It jumped right out at me, why is nobody else commenting on this?
The next day all those patients were gone and the only thing coming in to the hospital was covid. Practically everyone who was tested had covid, regardless of what the presenting symtom was. People came in with a nose bleed and they had covid. They came in with stomach pain and they had covid.
What sort of disease has no specific symptoms at all? I thought COVID patients were presenting with an unusual form of dry pneumonia?
If you look at the history of epidemiology and virology, it is unfortunately filled with stories of misinterpreted data leading to incorrect belief that a virus was the underlying cause. For a long time diseases caused by vitamin deficiencies were blamed on viruses although none actually existed.
When you read that some doctors experience of COVID was "people turned up as normal but suddenly they were all testing positive", you do have to wonder what is going on. I thought COVID patients in hospitals were clearly COVID patients by symptoms, but the list of associated symptoms seems to keep widening. That's confusing and worrying indeed.
> I don't participate in social distancing because my government says to, and I certainly don't stop because my government says to either.
In an ideal world, the government would listen to the experts, they would reach some reality-based and science-based consensus, and then the people would follow those conclusions because it's the right thing to do.
As a trained scientist, I'm skeptical of these calls for "scientific consensus". Sure, there are many areas of science where there is clear consensus. But if you're talking about a new area of science, where we don't have much data, it's not unusual for experts to not agree on things.
And sure, one of them is likely right and one wrong, but we won't know which one until we get more data.
Trump doesn't want to reopen too fast because it won't be clear by the election (October, when mail-in voting happens) that this was a good strategy.
Democrats don't want to reopen too fast because keeping the economy shut down is bad for Trump's reelection chances.
Too cynical? Perhaps. But I do think that perspectives like the author's are dismissed too quickly because neither 'side' sees a way in which following this advice will help them in the upcoming election.
Regardless, it is a real shame that COVID has been so politicized, given the tremendous medical and economic repercussions that we are seeing.
>Trump doesn't want to reopen too fast because it won't be clear by the election (October, when mail-in voting happens) that this was a good strategy.
>Democrats don't want to reopen too fast because keeping the economy shut down is bad for Trump's reelection chances.
That's basically a conspiracy theory because the Democrats would need to coordinate this political stand and also conspire with medical health advisors. Unless you claim that every democrat has come to this conclusion by themselves.
I can't speak for the medical health advisors or their motivations. I think it would be very scary to be one of the medical folks in charge, and if I were them I would probably err on the side of medical caution. It is not their job, nor is it their expertise, to weigh medical costs against economic costs.
I don't know that Dems would all have to reach this result on their own — it's pretty clear that the Democratic party line right now (and since the beginning) has been "lock it down". Once that was established, it would have taken quite a bit of courage of convictions for a Democrat to have come out in favor of opening.
Hasn't Trump been the one flippantly saying "it's not a big deal" and "we'll be back to normal quickly" and "we'll get the kids back to school shortly"?
How could anyone view his behavior as "not wanting to reopen too fast"? It seems the exact opposite to me.
"Covid has at present killed less than 6000 in Sweden. It is very unlikely that the number of dead will go above 7,000. An average influenza year in Sweden, 700 people die of influenza."
The average number of people who die of influenza in the US is about 35,000. So we should expect 350,000 deaths and then we'll be all good?
350k deaths sounds like a huge number, but it's important to take in account how many of those would have died anyway in the next two or three years. Dying at 80 is not the same as dying at 20.
Be careful, these are years of life lost for people who died of covid. Headlines like "coronavirus can cut lifespan by 10 years or more" is just sensational - for that matter, so can bowling.
The average YLL for people infected with covid is vastly smaller. You still don't want it, but the actual number is measured in months.
> New study finds coronavirus can cut life span by 10 years or more
This is one of the worst headlines I've seen recently. The actual study measures years lost only of those that died. By that metric, if I cross the road today and get hit by a bus, the headline would be "crossing the road can cut life span by 40 years or more". There is zero valuable information in that headline.
I don't agree. The headline contains valuable information. It says that, whatever you might think is the risk of dying once you got covid-19, on average those who died have their life shortened by about ten years. Which is not the same as dying in a traffic accident or in a war, where you can safely assume average lost lifespans of 30 or 40 years.
My only issue with this title is that can- which is wrong and makes the title meaningless. The news is that on average it does cut lifespan of ten years.
Note that's quality-adjusted years of life for people who died with/from/by Covid-19, not of all those infected, because the majority of those infected lose 0 years of life so there's not much information in that metric, either.
So, yes, it does make sense to ask "how many years a person who died of Covid-19 could still enjoy had they not died of Covid-19". Just looking at how many people died of those who were infected simply ignores the fact that many people who die of Covid-19 would otherwise have gone on happily being productive and valuable members of their respective communities - and not shuffling, moaning zombies held together by arcane necromancy, waiting for a gust of wind to disintegrate. After all, while Covid-19 is very dangerous for people over 80, it is also quite dangerous for people over 50 and over 60, and those are ages where many people haven't even retired from their careers.
_____________
[1] Not a direct quote, rather one from memory. I can provide the source if needed, it's a video of an hour-long interview with Ioannidis on youtube.
It appears that Harvard study failed to adjust for comorbid conditions such as obesity, and thus I suspect it overestimates years of life lost. We know that obesity cuts several years off of life expectancy independent of COVID-19. The typical patient who dies from COVID-19 has multiple chronic comorbid conditions.
Sure, on average. But there seems to be a lot of people in nursing homes that are dying of covid, and I assume that population likely has a lower life expectancy than the average.
The same argument is made by the Swedish ER doctor in the linked article:
“Considering that 70% of those who have died of covid are over 80 years old, quite a few of those 6,000 would have died this year anyway. That makes covid a mere blip in terms of its effect on mortality.”
It’s just empirically true that dying at 80 is different from dying at 20 if you’re assessing the impact of a pandemic. I guess it needs to be pointed out that “different” has a distinct meaning from “way less tragic.”
The Swedish doctor also has a remarkably cavalier attitude about mortality and
I'm willing to bet quite a large sum that he wouldn't be so gung-ho about it
if he were 80 years old himself.
It is surprising to hear someone who is supposed to care about the bodies and
minds of people be such a cowboy when it comes to their lives. If it's not a
big deal for people over 80 to die because "quite a few [of them] would have
died this year anyway", maybe we should stop admitting people over 80 to
hospitals and save the costs of their care? Does that really sound like a
sensible proposition?
I am reminded of the Italian scientist, Rita Levi-Montalcini who receivead a
Nobel prize in physiology of medicine at 77 and continued to work and make
contributions well into her last years of life until she died at 103 [1]. Of
course there are exceedingly few such exceptional people, but my point is that
it is perfectly possible for someone to enjoy many years of a productive life
after their 80'th birthday and perhaps we should be doing more to ensure that
this is not such a rare occurrence, rather than assuming that all those old
fossils are dying anyway and leave them to it because them young 'uns wants to
go out dancin' and drinkin'.
After all, most people plan to grow old anyway. How many of us are comfortable
with the idea that, in our old age, priority will be given to "the economy",
not to mention the very economy we worked our arse off to keep going while we
were young? What is this economy anyway, Moloch?
> If it's not a big deal for people over 80 to die because "quite a few [of them] would have died this year anyway"
This is miles from what he says. He is arguing for the adjustment of a statistic. He is arguing that Covid has had a minimal affect on the death rate and even smaller when you adjust for how many of the dead would already have been included in the much larger baseline number of expected annual deaths because they are over 80 and X% of those over 80 die each year even with no Covid.
I’m not even sure I agree with him on this or other arguments but it’s clear he values the life of the elderly. As an ER doctor he probably treats many (and many with Covid) each day. I think he’s earned the benefit of the doubt on valuing life, more than most of us here who treat and save no one.
>> “Considering that 70% of those who have died of covid are over 80 years old, quite a few of those 6,000 would have died this year anyway. That makes covid a mere blip in terms of its effect on mortality
My comment:
>> If it's not a big deal for people over 80 to die because "quite a few [of them] would have died this year anyway".
Though I should perhaps not have paraphrased, I believe my comment captures the feeling of the doctor's statement well. Yes, he is making a point about mortality rates. Also, he's making the point that 6,000 people dead is a mere blip on mortality because most of them would be dying anyway. His entire post is a declaration that Covid-19 and the deaths from it are not a big deal because most were very old and on their way out anyway.
The economy is not some abstract separate thing. It is all of us producing the goods and services which make life possible, or at least worth living. We do not have infinite resources. In my old age I hope those resource allocation decisions will focus on giving my children and grandchildren a decent life rather than keeping me alive for a few more months.
Not everyone has children and grandchildren. How does the dreadful arithmetic change for those people? Do they want to be kept alive for a few more months and if so, should they? And who gets to decide?
I think his point is you can't compare the impact of the flu because 1) it hits every year (versus a quick outbreak) and 2) many people are vaccinated.
Don't forget the '17 flu seasons was 65k deaths in the US. So we're at a little under 3x right now. So yes, Covid is worse, but we don't bat an eye at 65k deaths due to the flu.
Consider that recovery from coronaplague is lengthy and that a good amount of those discharged form hospital are looking at permanently reduced lung function. Death isn't the best metric here.
I hear this a lot, but I've never seen this claim put in context of a comparison to lung function following viral pneumonia from viruses other than SARS-CoV-2.
How many? I'm all for some variant of the precautionary principle, but we should be getting better data about long(er) term effects now that this has been ongoing for 6+ months. Can you put some actual concrete numbers to this?
This is simply not true in general. The vast majority of people who come down with covid have a minor illness, and many of them do not even realise what it was. I have three friends who had positive tests and no symptoms beyond those of the common cold. All of the available data supports this being the normal case, and serious complications being either a rare case of bad luck, or a result of underlying illnesses.
> a good amount of those discharged form hospital are looking at permanently reduced lung function
If you have any respiratory infection serious enough to put you in the hospital, you're probably looking at a longer recovery and possibly at long-term reduced lung function. But the relatively young & healthy mostly don't end up in hospital with covid, just as they don't end up in hospital when they get the flu.
Selecting only the most serious cases (hospital admissions) and talking about their outcomes is not useful for drawing general conclusions about the pandemic or the way countries have chosen to respond to it.
> So yes, Covid is worse, but we don't bat an eye at 65k deaths due to the flu.
1) Only as long as they are old people. The moment flu kills even a couple children, everybody goes apoplectic.
2) I suspect that one of the takeaways from Covid is going to be that viruses (even flu) cause a lot more long-term damage than we give them credit for. Nobody was funding brain or circulatory scans for flu patients--we're going to get some of that data as a side benefit of all the Covid analysis.
During the 2017-2018 flu season, an estimated 115 children under 4 years old died. And almost 700 if you count those under 18.[1] That's more than I've seen reported for Covid so far.
And the flu certainly can cause long-term damage.
"Other possible serious complications triggered by flu can include inflammation of the heart (myocarditis), brain (encephalitis) or muscle (myositis, rhabdomyolysis) tissues, and multi-organ failure (for example, respiratory and kidney failure). Flu virus infection of the respiratory tract can trigger an extreme inflammatory response in the body and can lead to sepsis, the body’s life-threatening response to infection."[2]
> Don't forget the '17 flu seasons was 65k deaths in the US. So we're at a little under 3x right now. So yes, Covid is worse, but we don't bat an eye at 65k deaths due to the flu.
How can we compare Covid numbers to the flu when the US has gone into lockdown, schools closed, everyone that can is WFH. No concerts or sporting events
totally different circumstances
Sweden might be a more accurate comparison since they didn’t go into full lockdown and it’s at 10x
The comparison is fraught with problems due to the lack of immunity for COVID.
The "with shutdowns, masks and closed schools" line also assumes the effectiveness of all those measures, and ignores the glaring problem that they simply kick the can down the road -- there is no appetite for shutdowns and closed schools until the end of 2021, but a vaccine could easily take that long (if not longer) to be generally available -- assuming any of the current vaccine candidates work well. So what, exactly, is the plan?
You're counting flu and covid-19 deaths differently.
For flu you're using sophisticated statistical modelling of excess death combined with community surveillance of use of primary and secondary care. This will tend to overcount.
For covid-19 you're using "died after testing positive for covid, or with covid mentioned as the cause on the death certificate". This will tend to undercount (even when taking into account the slight overcount involved in people who die from other things after a +ve test).
>> The average number of people who die of influenza in the US is about 35,000.
What Covid-19 made me realise is that there are tens of thousands of lives we could be saving each year by adopting some simple behavioural rules that definitely do not need to harm the economy. For example, stay home when you have flu-like symptoms, don't touch your face, wash your hands thoroughly, sneeze into your elbow or a handkerchief and get rid of it immediately and so on. No need for lockdowns or anything- just keep in the front of peoples' minds the fact that diseases can be carried around, are carried around, by people doing normal people things all together in a big place with lots of people.
In fact, I believe I've seen signs advising such measures to curb the spread of disease around the London Underground and I think also the Paris Metró, but I've always, until now, ignored them. When I had flu-like symptoms I've always soldiered on and went to work because that was expected of me and that's what my coleagues also did- and more than once I actually got sick after noticing someone sick at work [1].
Well, no more. Not for me anyway. I had no idea. But now I do.
___________
[1] And one time I got a real nasty stomach bug after I used the toilets after a coleague who had just recovered from a similar infection. I do always wash my bloody hands after, but it seems he didn't and well, there was one door handle in the loo. Yeeew dude. Yeew.
We track Calicivirus seasons in Sweden, I'm still waiting for the final report on that, but there are indications that the Corona scare basically killed the season almost 10 weeks early.
This doctor[1] is basically claiming that all of Sweden, or the vast bulk, have had SARS-CoV-2 and are now immune. This goes completely contrary to every medical authority, and is the sort of claim that generally gets something removed as disinformation. Disinformation does well on HN.
Of course you get to the article's slant when it claims that Sweden is "normal" right now, which is an outrageous lie.
Virtually all events are cancelled. Social engagements are non-existent. Streets are empty. Huge percentages of people work from home. Bars and restaurants were closed for a period of time in hot areas, and regardless have operated under a significantly reduced capacity. Sweden's summer school break began at the PEAK of their outbreak, and we'll see what happens when they return in a little over a week.
Sweden's societal reaction to COVID-19 is basically optimal as a general society, and some parts of the US that are "locked down" have much higher social engagement. Either we've redefined normal to be "completely and absolutely unlike the before times", or this guy is just twisting reality pretty generously because he likes the views, particularly among a certain conspiratorial segment of the US population (a Swedish MD whose blog is in English).
[1] An MD who has extraordinarily little expertise in virology or immunology. Yet he discounts immunity tests. This is like a JavaScript developer telling you why Metal is better than Vulkan.
First paragraph - "Unlike other countries, Sweden never went in to complete lockdown. Non-essential businesses have remained open, people have continued to go to cafés and restaurants, children have remained in school, and very few people have bothered with face masks in public."
Sweden has adopted virtually every recommendations without it being mandated. This is an enormous difference from some Florida Man arguing why lockdowns are unnecessary. As much as people focus on face masks, in Sweden the sparsity of people given their response makes it much less of a necessity.
There you go -- read about Swedes talking about their COVID-19 experience. It is a universe removed from normal, or what Florida-man-using-Sweden-as-their-no-biggie-example claims.
Someone had an ill considered party. Despite the amazing herd immunity nonsense this guy is arguing (again, contrary to the entire expert community), most of the partiers got COVID. Ooops!
Swedish schools closed for the summer break just as COVID was peaking. They return in just over a week. Businesses are sparse because few people are shopping. Restaurants and bars were closed, and other than that have strict reduced occupancy.
But Florida man is sure that Everything Is Normal. It's hilarity. That "look they didn't close their schools"...when they were closed regardless. Hurr.
"And masks aren't mandated, but most people are wearing them?"
Masks are necessary when you're in close proximity to other people. Swedes aren't getting in close proximity to other people. Are you getting this?
The Cult of Idiocy that has overtaken the US isn't there in Sweden. Florida in their highest level of lockdown has dramatically more social interaction than Sweden minus it.
"Now, increasing numbers of workers are also coming forward to criticise regional healthcare authorities for protocols which they say discourage care home workers from sending residents into hospital, and prevent care home and nursing staff from administering oxygen without a doctor's approval, either as part of acute or palliative (end-of-life) services.
"'We were told not to send them in'
"They told us that we shouldn't send anyone to the hospital, even if they may be 65 and have many years to live. We were told not to send them in," says Latifa Löfvenberg, a nurse who worked in several care homes around Gävle, north of Stockholm, at the beginning of the pandemic.
""Some can have a lot of years left to live with loved ones, but they don't have the chance... because they never make it to the hospital," she says. "They suffocate to death. And it's a lot of panic and it's very hard to just stand by and watch."" (https://www.bbc.com/news/world-europe-52704836)
My understanding is that Sweden avoided overcrowded hospitals by only offering palliative care (which doesn't include oxygen) to the elderly.
The author doesn't state (and I don't know the real-time info) about whether the country is locked down and social distancing/masks, etc.
If so, it's not like their laissez-faire attitude (the previous months) is the success he's making it out to be. They only have stabilized because they adopted the recommended measures finally, if that's true.
The Swedish government never locked down or encouraged any sort of social distancing. Their plan was herd immunity and they appear to have gotten it right.
Excess mortality is the best measure, because it accounts for the impact of the disease, as well as the impact of actions taken to fight it (not all of which will be good).
Looking only at covid deaths is therefore misleading, as it only optimizes for that one thing. Looking at the big picture is the better way to make policy.
Your Finland comparison misses the author's argument. His claim is not that they haven't had many more deaths than Finland, but that Finland will catch up with Sweden. His theory seems to be that there will be a more-or-less fixed number of deaths per million, unless countries are willing to wait for a vaccine (which he thinks they won't do).
Delusional. For that, ~2700 more people would need to die in Finland. 14 people have died in Finland since June 1st and they're typically reporting 0 now. In Sweden, 40 people died ON June 1st.
Both countries have it under control now. But it's clear Finland's shutdown saved lives.
Perhaps! I'm not an expert on COVID, and I've not been following trends in Europe. His claim would only make sense if Finland's low current rates are due to lockdown, and Sweden's low current rates are not because of lockdown but because COVID is no longer spreading much due to prior spread.
Finland has it under control for now, but they should expect to see future waves of infection, since nearly every country that did a hard lockdown has. So the question is, will they be able to do the same severe response 2, 3, 4 times before they get the required supply of vaccines?
It's not clear anything is saving lives. Once everything opens up we could be right where we started. Also we've said basically that people with coronavirus matter more than other illnesses. There will be millions of deaths around the world because of shutdown. Things like AIDs medicine. Then thousands due to lack of treatment of cancers and people not going to doctor(England did a study on this). Then you'll have the domestic violence, murder rate increase. Then the negative effects on children decades later. It's only a trade off of lives, not a net saving of lives. If you think it's "clear" that any lives are being saved then I would challenge you to think more critically.
The shutdown will be looked back on in 10 years as one of the worst mistakes the world has ever made.
I know you live in a tech bubble, but people still have to physically go to a thing called work. You're telling me that some car accidents go down that will offset aids, tuberculosis, malaria. Not to mention cancer treatments, cancer not getting caught early, etc. You really do live in a bubble. While we cry about not having internet or that a face mask isn't covering someones nose completely, millions of people die around the world due to very preventable or treatable diseases.
This is one reason you need to look at all cause mortality. Another is that COVID specific counts don't catch all related deaths and include possible unrelated deaths.
I'm aware of excess death or all cause. This doesn't take in account the delay of deaths we're going to have. So we need to look at all cause globally in a year or two or ten
I don't think we're going to know in just 10 years. Maybe 50, or 100.
For myself, I definitely sense that we (collectively, or nation by nation) could have followed various pathways (and to some extent, we did). The "right" answer was (and is) not known, and we had a choice between erring on the side of caution over the damage caused by the disease versus that caused by economic disruption.
For now, I'm still in favor of erring in the direction of caution over the disease impact, but will concede that history may judge things quite differently.
The really thorny issues is that erring on the side of caution over the disease impact means that we are avoiding COVID cases at the expense of millions of undiagnosed / later-diagnosed cancer cases, and many other diseases.
That’s just a piece of the all cause mortality due to the COVID response.
And then after accepting all that direct cost, then you can start evaluating the economic damage on top (which to some extent is unavoidable regardless of lockdown policy).
Even though recessions cause loss of lives(as they always do), I'm not arguing we value the economy over lives. The economy will bounce back as it always does. I'm arguing that we should value all lives. We're only valuing covid lives over other lives right now. Meaning we're valuing our grandmother and great grandmothers lives over our brothers, sister, mothers, fathers even children. To be frank we have to look at average years of life loss with Covid. Let's call it how it is: The quarantine should just be called the life exchange.
Economies do not always "bounce back". In fact, after the major economic impacts of the 20th century, most economies worldwide required gigantic public policies targetting their rebuilding to reemerge, and even that tended to take many, many years.
But we didn't remove the requirement to pay rent/mortgages on the real estate used by the businesses that shut down, or make the loan payments on the loans that they took out. Consequently, oodles of small business are simply going to fail.
I'd love to believe that you're right (and 3 months ago, I felt the same way). But I just don't.
If and only if there is an effective vaccine within a year or two.
Sweden didn’t make this bet. Finland, Norway, and New Zealand did.
Sustained lockdown and lack of travel will be very costly if it has to be maintained for two years; and the fatigue from maintaining it will undo all of the supposed success.
This is not decidable at this point in time, and likely not within the next 5 years.
At $100k per quality-adjusted life-year and 10 QALY lost per death, those 5k deaths are $5B, about 1% of Sweden's GDP. So by the same math used to determine if medical treatments are cost-effective, it's breakeven if that GDP difference persists for about four months. We should also account for QALY lost due to people who get severely ill but recover, but I'd guess the net result is surprisingly close to breakeven. Perhaps this means the policymakers just chose different but roughly equivalent (by that math) options, or perhaps that's just chance.
Of course you could say that math is horrible and inhumane, and any equation involving dollars and human lives will feel that way. But the point is that health care spending is already rationed by something like that standard, and every dollar of GDP that disappears is a dollar that's unavailable to spend in other ways (including medical treatments that are cost-effective by that standard).
To be clear, I think Sweden erred by not mandating masks, which seem cost-effective to me by that standard. Their response otherwise seems reasonable to me, not obviously better than stricter approaches but not obviously worse.
Plausible long-term damage to the brain of a significant percentage of COVID patients, in both severe and non-severe cases—-according to a Lancet paper—should change the QALY-based calculation by a great deal.
Perhaps the cost-benefit analysis should also include improvements in the technology to develop vaccines as a benefit? There's a good chance that the injection of resources into the development of COVID-19 vaccines will put us in a better position to respond to the next pandemic.
That is an incredibly bad paper. They have gone on a fishing expedition across dozens of algorithmically detected differences, barely adjusted their statistical significance thresholds to make up for the fact that they're searching for something that might be "significant", and even then, the best they can do is come up with...50% of people have something. A coin toss.
This is the medical literature version of the xkcd green M&M comic:
Average age of the covid-19 dead in Sweden is 82, average life expectancy is 83. The majority of the deaths also occurred at elder care homes where the expected survival time is less than two years. And, just like everywhere else, the covid-19 dead are much more likely to belong to certain risk groups associated with earlier deaths as well.
10 QALY lost per death sounds way, way too high to me.
> To be clear, I think Sweden erred by not mandating masks, which seem cost-effective to me by that standard.
The reasoning behind this, which is the same in the rest of the Nordics and the Netherlands, is that a general mask mandate is counter-productive. No-one is arguing that medical grade face masks properly handled, worn, and disposed of help prevent the spread. The problem, and this should be obvious if you live in a place where masks are mandated, is that people don't have proper masks and don't wear them properly. So masks can create a sense of false security, and make people slack off on their distancing, which means a mask mandate can result in a net negative result.
Right or wrong, I don't know, and I don't know if we'll ever know, but that's at least the reasoning behind it. And it definitely sounds plausible to me.
I'm in Hawaii which has had a mask mandate for months now, and the way regular people are actually handling their masks in the real world is very, very far from the way trained medical professionals handle their masks.
> Average age of the covid-19 dead in Sweden is 82, average life expectancy is 83.
That's life expectancy at BIRTH. It would seem to me that the relevant statistic in the case of an 80 year old dying is the average life expectancy they had at 80, which is considerably more than 3 years.
You're right, but it's actually even more specific than that, you have to look at the life expectancy of a frail 80-year old living at an elder care facility suffering from diabetes/hypertension/heart problems. Not that of a random, healthy, 80-year old.
The biggest disingeniousness of the people talking about the covid-19 specific death toll is that the assumption is that if not for covid-19, everyone would have lived forever and ever, and that's simply not true. Looking at the demographics of the dead, for many, covid-19 is what happened to push them over. If not for covid-19, something else would have done it in a similar timeframe, especially since the flu seasons of 2018/19 and 2019/20 were so mild.
Yes, there are people who died significantly before their time, but they're a small minority of the dead. So 10 QALY lost per dead is way too much. 1 QALY lost per dead is too little, I agree. The truth is probably somewhere in between.
I said ten years from a study[1] adjusting for age and comorbidities of the patients, which got 13 and 11 years for men and women respectively. That study doesn't adjust for the severity of the comorbidities, so I agree it's probably an overestimate. I'd like to see a study that predicts life expectancy using more factors (e.g., long-term care residency), but I'm not aware of one.
As to masks, I also agree correct use is a problem. Here (SF Bay Area) the East Asian population seems to use them competently and consistently, but everyone else is hit or miss. I would have liked to see more public education, rather than just the unexplained mandate; but the probability that masks primarily explain East Asia's success in containing the virus seems high enough, and the cost seems low enough, that they seem like a favorable bet to me. I do also think it's quite possible that other factors (e.g., different degrees of pre-existing T cell immunity from other coronaviruses) will turn out to explain that big difference though.
you are missing the point and should look at yearly death stats from all causes
so yes, temporarily Sweden stats may look worse because people who would die this or next year died in short time window in these few months, but those people will be missing in stats down the road
it's already happening in UK, for 6 consecutive weeks they have lower than 5yr average death toll and excess deaths are shrinking because oft his
> "it is nonsensical to compare covid to other major pandemics […] Covid will never even come close to those numbers. And yet many countries have shut down their entire economies"
> "That makes covid a mere blip in terms of its effect on mortality."
This sounds wrong to me for several reasons. First of all, it's silly assuming that other countries are shutting down their economies without a very good reason for doing so. As I understood it, the "good reason" for doing so was that the infection & death rate was growing so fast, that it was putting hospitals & morgues way beyond their capacity. At the same time, the situation was keeping non-COVID, hospital-worthy visits out of the healthcare system, thus creating a massive public health problem.
(Let's not forget the improvised hospitals, improvised morgues, etc. These were very real.)
It'd be interesting knowing why somehow the COVID cases 'vanished' from this doctor's hospital. But instead of looking into why this happened, this doctor is just saying "turns out that the problem went away, so in the end it was good that we didn't bother too much about it".
And the thing is - we're not through it yet. Thankfully the death rate seems not being as bad as we thought it could be, but this could very well be down to current measures such as isolating elder people, testing at-risk populations, higher awareness levels, and the fact that the average infection age is now much lower than it was in March. So, now, healthcare systems are not collapsing.
There's a myriad of variables that likely affect the virus spread and outcome. For example, the age and characteristics of the populations where the virus is spreading, how population is distributed around the territory (and its density), how frequently this population "comes together" (social behavior - ever seen a swede profusely hugging and kissing?, public transportation, remote working…), and so on.
And when it comes to the healthcare system capacity debate: Sweden frequently put elder, infected people straight in palliative care (http://archive.is/VC5vb), bypassing hospitals. Other countries did admit elder people into hospitals, thus putting more strain into the healthcare system, which later on prompted a lockdown to prevent said system from collapsing.
> First of all, it's silly assuming that other countries are shutting down their economies without a very good reason for doing so.
I certainly wouldn't want to assume that governments only ever do the correct thing, or the thing that is in my best interests, so I think it's reasonable to ask questions.
> As I understood it, the "good reason" for doing so was that the infection & death rate was growing so fast, that it was putting hospitals & morgues way beyond their capacity. At the same time, the situation was keeping non-COVID, hospital-worthy visits out of the healthcare system, thus creating a massive public health problem.
The UK enlisted the army to build enormous field hospitals and staffed them with doctors and nurses from other hospitals. Most of them closed after seeing only a few patients, since all other hospitals were operating far below capacity. Emergency rooms were ghost towns. Meanwhile, all elective surgery was cancelled, reducing the quality of life for thousands of people while doctors stood around waiting for the promised influx that never happened.
It seems to me that the response in the West has been largely reactionary, driven by fear and public opinion, and disconnected from any real analysis of what genuinely works and what the long-term plan is -- with the possible exception of Sweden, who despite all the "they don't care" rhetoric you see in other comments, not only put a lot of analytical care into their approach, but discussed that analysis openly.
Maybe it was based on seeing what happened in other countries, ie. Spain and Italy? I can say for sure that the impact in the health care system here in Spain was very significant.
It's hard to disentangle cause and effect though. Countries that were very hard hit also had the most extreme government reactions to it. This can compromise the efficiency of the healthcare system, for example, I've read that in Spain at the peak of the epidemic many nurses and doctors were self-isolating because they'd tested positive, so there was a huge loss of healthcare capacity. Then later on it was discovered that a lot of positive tests are asymptomatic and asymptomatic people don't transmit the disease, so this just hurt healthcare capacity for no reason.
Many countries had problems with care home workers abandoning their jobs, for example to return to their home countries before borders closed. There are some quite horrific stories of the terrible conditions created in care homes in some of the places with excess death spikes.
The imagery of ice-rink morgues etc had a similar effect. There was no real demand surge for morgue space, but undertakers were refusing to work until they were supplied with ample PPE because they thought they would be infected by the bodies with a killer virus. Same story in Bergamo. So then a sudden shortfall in PPE was converted into a shortfall in funeral capacity, even though at that point there was no sudden tsunami of bodies. This then led to more panic especially amongst health system workers.
It's very hard to disentangle what really went on here.
> "Then later on it was discovered that a lot of positive tests are asymptomatic and asymptomatic people don't transmit the disease, so this just hurt healthcare capacity for no reason"
I think it makes sense to isolate anyone who tests PCR positive for coronavirus, right?
Also, is it 100% sure that asymptomatic people will not transmit the disease? What if they are just pre-symptomatic? Where do you establish the cut-off?
No. Why would it? Given how mild almost all infections are, and that doctors/nurses can routinely save lives from much more serious conditions, it's a strange cost/benefit analysis that assumes it's better to lose huge chunks of healthcare capacity than for some people to get COVID.
Asymptomatic is being used as a different classification than pre-symptomatic in the literature. Asymptomatic means you never develop symptoms. Pre-symptomatic means you haven't yet but will. Pre-symptomatic phase is not long though. Typically just 1-3 days, I think, from the latest literature.
Given the tiny window of time that exists when people are infectious and might not know it, and given the very low likelyhood of a PCR test being done in exactly that time, and given that PCR testing has a lot of problems (e.g. triggers even if your body has destroyed the virus), and given that nurses and doctors are pretty important, I can't see it being useful to actively test in hospitals. It's everywhere by now anyway.
Given that we apparently can't give up on hydroxychloroquine without a large scale randomized trial, exactly what information do you claim to find in this article?
"Sebastian Rushworth M.D." clearly states at the beginning of his internet post that it's anecdotal, even though his bio suggests he's trying to correct internet misinformation with "science". It absolutely shouldn't be censored. I mean, if I was considering taking this guy's medical advice - I'd want to know about this.
I agree with most of the things in this article, but it smells an awful lot like a planted piece.
The name is very unusual for a Swedish person, I can only find three people with that last name in Sweden, and none of them has the first name Sebastian.
The image of him in a gas mask is vague enough that you can't identify the person based on that.
The blog is a hosted wordpress that only has a couple of articles going back a few days.
The English is very good, I didn't see a single Swedishism, which makes it less likely the writer is actually Swedish.
The article talks about other kinds of deaths that are also bad, and mentions opioid deaths. That is a cause of death that is extremely rare in Sweden, but which would be familiar to an American audience. Using that as an example while talking about Swedish deaths is very odd.
I would love it if Sweden was right and tackled this in a way that does look like a seasonal flu, but I think the science is still out on that. It does seem the science points mildly towards it being quite as deadly as initially thought, but I would not the Swedish death rate a total win.
<snark>
Forget all that Sweden is the best approach, we should copy it in America especially the very solid social health care system :)
</snark>
* It was solved at a greater expense of human life, its easy to say "those people would have died" but that is harder to prove ethically. Could the excess deaths have lived on _longer than a flu season_?
* Is there a good argument that it is in fact over in Sweden?
* Are there other variables that might have made Covid-19 not so bad in Sweden?
If I was to take more direct counters to the article:
> I am willing to bet that the countries that have shut down completely will see rates spike when they open up. If that is the case, then there won’t have been any point in shutting down in the first place, because all those countries are going to end up with the same number of dead at the end of the day anyway.
Maybe, but that could also be a case of thinking that the death rate is a fairly simple linear model, which would fly in the face of the various epidemiological models that we use (not just for covid but since the 1920s)
> No, because influenza has been around for centuries while covid is completely new. In an average influenza year most people already have some level of immunity because they’ve been infected with a similar strain previously, or because they’re vaccinated.
Is Covid-19 completely new? By this reasoning it would as stated be more infectious due to a lack of known immunity. With this line of reasoning why wouldn't a _different_ cornovirus also give a more uniform immunity? Why would a novel Cornovirus strain have a greater impact over a novel Influenza strain?
I could go one but I feel like I am sniping.
Personally I dont think the world wide response has been great, I do think we have overreacted but I also would argue that its not just another influenza and should be ignored as such.
Plus, just because some policy works for some country (for some specific time period) it doesn't mean it will work for another. There are way too many differences in factors that affect virus propagation for the same policy to be effective in most other places, healthcare being, like you mentioned, just one of them.
NYC is a good case study since it's one of the first place hit and is now more or less "done" with covid in the same sense used in this article (it had a peak and is now on the right tail).
States with aggressive reopening policies like Florida/Louisana/Arizona etc had spikes recently but are also coming back down. They are sitting at around 2-3k cases per 100k (deaths will lag).
Even if the reason why those states "peaked" is because of herd immunity, it seems like it still requires at least 3k cases per 100k. That would translate to 300k cases for a population of 10 million but Sweden is only at 80k right now.
I think we really are losing sight of the before versus now comparison. NYC is an absolutely ghost town compared to how it was. Everyone stays remarkably limited in their social contact. Professional sports are a ghost of what they were, running in an incredibly limited fashion. Travel is rare.
The same is true of Sweden as well, of course. Social interaction has collapsed to very close to nil, and any article that claims that things are "normal" is lying to push an agenda.
How are sports teams a ghost of what they were? NHL playoffs are incredible right now. European soccer is wrapping up and play is great. NBA is just getting started. Most of them just canceled games or took a break, which, for example, the NHL used to do every 4 years for the Olympics. The only sport that seems to be having real trouble is the MLB, who just had a terrible plan. I admit, I have no belief the NFL has any chance due to team and personal size but that is just life. Not to mention esports which has barely slowed down after the first few months where they had to cancel in person events.
And I was talking about NYC. Zero NBA or NHL games are taking place in NYC.
In an average month in NYC, pre-COVID, there are dozens of enormous sports events. Hundreds of concerts. Tens of thousands of significant parties. If social interaction were on a scale from 0 to 100, and 100 was the before, right now NYC is at a less than 1. So when someone looks at NYCs current infection rate and presumes that means there is some herd immunity or the like, I don't think they're fully taking into account the reality on the ground.
Looks useless to me; dropping R to below (but not much below l) 1 means a super-slow decline; you might need years with such a regime to eliminate the virus. And it doesn’t actually provide herd immunity, just a slow die-off.
Which leaves most of the population vulnerable, and re-introduction a possibility.
You have to get R significantly below 1 and the whole ecosystem (for the US: the whole world) to do it.
Or, you need herd immunity compatible with the R that you can maintain indefinitely - which la likely >2 so immunity needs to be >60%.
Any other way leaves you with the possibility of reintroduction as far as I understand.
I'm not sure how playing in a bubble without fans means they are a ghost. Honestly I wish fans didn't come back to live sports. Hearing the game and player noise makes everything much more enjoyable. I think most pro-sports are currently doing great besides missing ticket revenue, especially compared to a few months ago when they weren't going at all.
Anyways, I don't think measuring recovery in the number of events and parties is a very good metric. Though I agree without that there probably isn't going to be true herd immunity for this and I wish people would stop throwing around the term.
a) The context is specifically in relation to communicability
b) Further, it was about New York City!
Extremely few sports are taking place in NYC, and even if we discount that, from the overarching context those sports having a tiny, tiny fraction of the communicability potential.
25% percent of NYC was seropositive in May. So that works out to about 25k per 100k people.
The reported cases have always been just the tip of the iceberg. And we never knew how big the underwater part was. We still down't.
Take the current situation, is the disease penetration larger than that in March/April? Most likely not, not even close, yet the reported new cases are about 5x larger.
I don't care how big the underwater part is though. I am just using the case rate as a proxy for when states seem to hit their peak (yes, extremely handwavy).
As long at the confirmed cases is within some constant fraction of true number, it will be a decent proxy. This makes sense to me since some x% of the people who get infect will need hospitalization so they will get counted towards the statistics.
The most recent, randomized studies of the NYC metro area finds SARS-CoV-2 antibodies in about 14% of participants when they randomly solicit people directly. Prior studies put out ads looking for participants, naturally drawing in people who "had that unexplained thing a few months back".
Even when directly appealing to people the participation rate is likely higher among people who suspect they may have had it.
We know that testing was very limited early in the outbreak, when NYC was hit, and that it caught only a fraction of the people infected. But all metrics are that there is still a huge victim base in the area.
Good to know. My 25% numbers were from an announcement by Cuomo where the report claimed that the sample collection and data processing (corrections) were statistically sound.
Even at 14% seropositivity the true number of people that had the virus is likely larger. There are reports that some (many?) people that recover do so without needed antibodies.
Working backwards, taking the fairly accepted value of 0.6% fatality rate, the 30K deaths in NYC would indicate around 5 million infections. Now the the NYC fatality rate is likely higher due to Cuomo's mind boggling order regarding nursing homes.
Regardless I think it is fair to estimate that the true number of cases in NYC is likely to fall between the reported 400k and the upper limit of 5 million. At 25% seropositivity would be around 2 million, to me sounds believable.
2 separate studies are pointing to herd immunity being impossible because SARS-CoV-2 antibodies disappear over time and previous carriers could become infected again.
There haven’t been any cases of reinfection afaik but we’ll see in due time.
Right, but antibodies often are transient for some diseases. Once the infection disappears, the antibody levels drop. But if post-infection there are T-cells that recognize the virus, then future exposure to the virus results in a rapid and robust immune response.
Proving herd immunity impossible is a rather bold claim and the threshold for that has simply not been met.
We do have a rather large confidence that this virus isn’t going anywhere and will be endemic. It will join the 200+ Cold viruses that hit us every year.
i don't know what is the actual truth and we probably won't know which way was the "correct" decision until well after this pandemic is over (assuming it ends). i think the biggest issue with the US response is the bad messaging and iffy attempts at lockdown and reopening.
taiwan didn't go into lockdown but the country respects social distancing and masks and is very adamant about quarantining, tracing and cleaning.
do you think the average american citizen will adhere to any of that? forced quarantine for 14 days if you are infected or fly-in while a phone app afterward traces your movements to make sure future outbreaks can be traced? will people wear masks? will people maintain the social good over the individual? (answer for the US is apparently not)
i don't know culturally how sweden viewed these things but from what i can tell most people at least tried to maintain some form of social distancing. some swede can chime in here and correct me on that.
but what they've said about the nordic countries though, is that sweden's economy has shrank the same size as denmark's[0], while denmark which went into lockdown, suffered 8x fewer deaths, 5x fewer by percentage of population. that is the effect no lockdown has had on sweden.
also as a discussion to that both sweden and denmark's new cases are slowly creeping up, but denmark's is at about a quarter (~100/day) compared to sweden (~400/day).
Yes you are correct during the worst part of corona my experience is not the same as the doctor from the article. Many people strictly kept away from places with large amount of people close together. A lot of employers changed to work from home. My employer says we will continue WFH until end of year. That said people still socialised, though outside and in smaller groups.
In the end our high mortality rate can't be overlooked. We need to change our strategy for future similar pandemics. That said, I think the most interesting stats to look at when deciding what we should have done differently is the breakdown of deaths per age-group. Less than 100 deaths are among people younger than 50. So almost all of our ~6000 deaths were among the elderly. That is what needs to change. Next time we need to be quicker at protecting the old. Otherwise our strategy could have worked, the rest seem to be able to build up their defences to the virus.
1) I'm glad I don't have this guy as a doctor.
2)If it's not a big deal, why is he wearing a mask in the picture? Catch covid-19, rub some dirt on it, and move on. If you die, you were going to anyway.
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[ 3.0 ms ] story [ 409 ms ] threadJust like in other EU countries, it is now the younger population which seems mostly affected, and thus the mortality is lower - which is ultimately some good news.
Summer holidays are now almost over though, so people are traveling home from vacations abroad, are going back to work, schools will start up soon and people finally get access again to health care (good luck seeing a doctor in July in Sweden). The impact remains to be seen, but it would be surprising if most other EU countries see infections increasing but not Sweden.
I remain pretty skeptical of this Swedish exceptionalism, so my guess is this blog post will not age well.
Sweden's death rate is down to zero today and has been trending down since mid April. Summer Holidays did not start until late May where deaths were already half of what they were in mid April. This post isn't aging, it's already aged.
https://www.statista.com/statistics/525353/sweden-number-of-...
Worse than 2019, which was an exceptionally good year, but most probably below the ten-year average. Might even land below the five-year average.
No, it isn't.
Sweden has fairly laggy reporting of deaths, with the deaths often taking several weeks to show up in statistics, so at any given date, deaths attributed to the last few days are always dropping to close to zero.
I looked into this a bit in mid-APRIL, when somebody claimed that deaths were dropping to zero. At the time, substantial revisions occurred for about three weeks after the date, and occasional revisions for about four weeks.
(It's entirely possible that similar phenomena occur in other countries; Sweden is the only country I looked at in detail).
Don’t take my word for it, see for yourself at https://morberg.github.io/covid-notebook/covid.html
GitHub repo here: https://github.com/morberg/covid-notebook
https://91-divoc.com/pages/covid-visualization/?chart=countr...
Downtrend in average deaths per day continues, currently at 6/day.
https://91-divoc.com/pages/covid-visualization/?chart=countr...
Any uptick at all is concerning. In fact, a flattening of the decline is concerning.
The implied thesis in the linked article is that Sweden has reached a level of herd immunity due to widespread T-cell responses, and that life in the country continues as normal.
If that is the case, then we would expect the infection curve in Sweden to follow a classic logistic model -- which is more or less symmetric. A rapid rise should be accompanied by a rapid fall.
An asymmetric curve or one that has a "second wave" of any size tends to refute this theory. It would suggest that there was in fact some meaningful intervention that changed: either the initial infection was among a different group (i.e., what the US saw with infections first dominated by New York and then later by other states) or there was an effective policy response that has begun to wane.
What one should expect, afaik, is a Gompertz curve - the derivative of which, depending on parameters, often rises quickly and drops slowly.
Michael Levitt calibrated a Gompertz model in April based on actions taken until that day, that predicted 5000 dead by 1-jul matched reality incredibly well - whereas the WHO/Ferguson model at the same time predicted 96,000 dead by 1-jul based on the same data.
Annual lockdown month happened:
https://hejsweden.com/en/swedish-holiday-dont-work-in-july/
Schools even close for ten weeks, and those will be over soon.
Case count will oscillate up and down as restriction levels and individual comfort levels oscillate. As we approach herd immunity, the oscillations will dampen while following a downtrend.
The cases/day downtrend is still very much intact, and while it could reverse, it is premature to be concerned.
Czechia has 200-300 daily infections and we have like 30 hospitalized patients also in country of 10.7M, so there is pretty much zero chance of dying from COVID, from those 390 people who dies in those 4 months (where usually dies around 40000 people from all causes) had other issues and coronavirus was unlikely cause of death
my guess is people who fell for this mass hysteria will be very quiet in year or two when we will look at yearly death stats and see mere blip because of COVID, where just cause of death may temporarily shift to COVID, but in the end total numbers of death will remain same. UK stats shows already for 6 weeks lower than 5 year average mortality and number of excess deaths is shrinking
https://twitter.com/EdConwaySky/status/1290568780251308032
In fact, more daily infections without more deaths are a good thing. It means the virus is not as dangerous as we thought and we're closer to herd immunity/the end of the pandemic.
Let's count how many people are in ER and how many die.
The conspirationist in me can't help but think that COVID has been the scapegoat for the worst financial crisis in this century.
While we look at meaningless COVID stats and debate wether we should wear a mask, we don't look at the real culprits for the current financial crisis that will take decades to heal (if it ever heals fully).
For one, his per-capita-death-rates are wayyy off. (1 out of 200 dying? try around 8% in Spain and Italy...)
For 2, yes, it's precisely about slowing the spread 1) giving a chance for emergency services to handle the influx instead of being slammed in one go 2) attempting to quash a given outbreak
So many sweeping generalizations here and so little counter-point to the facts the general public have become well-acquainted with, I'm afraid our Good Doctor seems a bit eccentric and witless writing such a trivializing dismissive blog post.
Let's call him "an outlier" even for Sweden, as travel is not making his strange claims that "covid is over for Sweden" look even sillier.
Covid is not finished for "the world" at large, and it's an interconnected world, and suspicion of "t-cells bearing COVID immunity rather than antibodies" as if the PCR were just a cheap placebo test and no antibodies were detected in prior COVID sufferers (it does detect them.)... this is all making light of what deserves serious engagement.
Fire this man or get a committee investigating his various claims as flippant blogs are not the appropriate realm for such incendiary topics.
And the "T-cell immunity" is factually correct. Even the NYTimes wrote an article on how people who have never been exposed to Covid, do indeed, appear to have some level of immunity due to T-cell and likely prior infection by a related virus.[1]
[1]https://www.nytimes.com/2020/08/06/health/coronavirus-immune...
You have conflated the CFR and IFR, and are thereby spreading gross misinformation. From the article:
> And remember, the risk of dying is at the very most 1 in 200 if you actually do get infected.
They're talking about the risk of dying "if you actually do get infected" (i.e., IFR), not the risk of dying if you get infected and test positive (i.e., CFR). Most people infected suffer mild enough symptoms that they don't seek a test, so the CFR is much higher than the IFR. This is especially true during severe outbreaks, where people with mild symptoms are explicitly encouraged to just stay home until they get better (or worse) to avoid further stressing the medical system.
A recent meta-analysis estimates the IFR around 0.7%[1], a little higher than the Swedish doctor's numbers but pretty close. The exact number will vary dramatically with the age structure of the population, since the IFR is >100x for old people vs. young.
1. https://www.medrxiv.org/content/10.1101/2020.05.03.20089854v...
Eg. They don't have to keep working or risk not having healthcare.
The US needs the big government sponsored lockdown because otherwise US companies will force people to go to work when it's not safe
The fact is, over 150k have died in the US due to COVID, and this exceeds the US death toll from any known war, so there's no real minimizing such a figure.
It's likely precisely due to a failure to contain the spread of the causative virus, precisely due to waffling around lockdown.
US deaths in WWII: 419k (https://en.wikipedia.org/wiki/World_War_II_casualties)
At best it's an argument that we should do more to stop flu deaths, but at worst it amounts to "If someone ever dies of any preventable cause then we should never take any measures to prevent any other death".
That is (luckily imo) only a tiny minority of Germans. I would be very interested: are the current restrictions really that bad? You need to wear a mask in supermarkets, do you think that's actually that big of a deal?
I suppose the Swedish response would be that these deaths weren't prevented, just delayed, as there'll be a second wave, third wave... and lockdowns can't continue forever.
If I told you to list 3 things you're grateful for each day, and hounded and sanctioned you for not doing it, if I talked about all these Nazis I know who incidentally also are not doing it, and meaningfully nodded your way every time, and made fun of you in filter bubbles... wouldn't you just do this minor thing that may actually be beneficial and is unlikely to do harm?
This is the problem, and to use a pandemic to normalize that just makes it worse, morally speaking.
The difference being that there is a strong scientific consensus that wearing a mask will save many peoples lives. I don't want to be patronizing and me pointing out that op was in a minority merely wanted to correct the "fellow germans" statement. But sometimes it's difficult not to be patronizing if you are following the strong scientific consensus on a topic. Because wearing masks shouldn't be a political issue if you can't develop a reasonable counterargument.
> Because wearing masks shouldn't be a political issue if you can't develop a reasonable counterargument.
You are the one making it about the masks and only the masks, even the protests aren't, and I for one said IMO the pushiness is the problem, not what is being pushed.
It is not. Masks are meant to protect everybody, they are not meant to protect yourself. I'm not in favor of preventing consenting mentally stable adults from doing basically anything to themselves and – to answer your question – I would obviously object to other people forcing me into adopting any unreasonable habit. But this is about protecting society and risk groups.
> IMO the pushiness is the problem, not what is being pushed.
By "the pushiness" do you mean the laws that are in place to force people to do things? Because those are pretty common in all sorts of situations.
Or do you mean the general attitude by commentators (in the media/on twitter etc.) towards people not abiding by those laws?
> I would obviously object to other people forcing me into adopting any unreasonable habit.
There is nothing "unreasonable" about naming 3 things you are grateful for each day. If you did it each day, you could probably get it down to taking a few seconds.
> Or do you mean the general attitude by commentators (in the media/on twitter etc.) towards people not abiding by those laws?
I do mean the attitude, but not about not abiding to laws per se. It's just a wholesale dismissal. Like, what does "mentally stable" have to do with anything, why did you weave that in there? Because instable people are complaining about masks or think G5 causes Corona? What do, for example, arguments put forward in the OP article have to do with that?
"A large crowd of far-right groups gathered for a "sit-in" at Berlin's iconic Brandenburg Gate on Saturday to protest against the German government's coronavirus restrictions."
It just seemed like an incredibly dismissive headline. "No worries, just crazy far-right doing their crazy stuff. We can safely ignore what they have to say."
Shame be upon such short-sighted folks who think that their "freedom" to not wear a mask is greater than others right to merely live.
I'll say it again: can you imagine what the survivors of World War 2 lived through? 10 years of being nervous everytime you try to go to the toilet... and these modern crybabies and their anti-vaccine lies want you to take them seriously?
It's not right.
Other commenters are expressing views that are (presumably) similar to yours in ways that stay within the guidelines. If you would please review https://news.ycombinator.com/newsguidelines.html and be like them, we'd be grateful.
It's such a pity that you have Trumpelstiltskins over there too. I had thought you smarter...
Just curious - what do you thing will happen in the long run if the whole world chooses to live according to some mythology, as you propose?
https://news.ycombinator.com/newsguidelines.html
it turns out that in Germany, as in the USA, there is a significant overlap between the Covidioten and right-wing/nationalist political groups, including even fringe groups that don't believe that the Third Reich actually ended. This gives rise to some good jokes within Germany.
Such as: https://pbs.twimg.com/media/EeQm7ecXYAYv_ni.jpg
The ideological clarity of the covid regime is sublime. All sorts of debated matters are decided, by "science", and that is that. Whether by accident or design, the covid regime, the "new normal" that MSM has been educating us about from the very beginning, is a blueprint for a global authoritarian technocracy with its own internal logic, ethics, and mores.
does it aid conditions of "foaming at the mouth"?
I find your usage of intellectual terms employed in a very anti-intellectual effort of a very base nature.
What, pray tell, is the ideology of a virus?
Yes, the scientific method is probably a more sensible means of deciding things than "whatever gets my knickers in a bundle".
If you are suggesting that trained medical specialists shouldn't head pandemic intervention efforts, I respectfully and wholeheartedly disagree.
Your worldview elevates "the bad guys" and denigrates "the good guys" so there's your inverted logic and morality to deal with, pity, it must have been the secret chips in your childhood vaccines...
Please note I stress that I am commenting on the virus "regime".
Is the virus real? I think we should assume it is real, regardless of the facts. Let's say it is real.
Should we concern ourselves with whether it is (a) natural phenomena, or (b) man-made;
and whether regardless of its provenance, the spread of the virus was due to (a) chance events, or (b) intentional release?
Again, I say, to seriously answer any of these questions is an unreasonable burden. So, let's call it an "act of god".
Now, we are at the point to discuss sensible response, rational response, reasonable response, to a collective health issue: a virus that has reached pandemic stage and posses certain risk probabilies across various demographics.
Does the above scenario mandate that governmental norms be bent if not broken? For example, is it acceptable that from now on society will be governed by executive decrees and not legislative bodies?
How long should we tolerate such encroachments on what we know to be the basis of free societies?
Should not a health care matter of such grave import and impact on our lives be subject to the input of a wide range of experts in related subject matters?
What "authority" has designated certain institutions, such as the Imperial College as an example, as fonts of indisputable claims regarding the gravity of the situation and required remedies?
Why are dissenting experts and workers in the "frontlines" subject to media blackout, de-platforming, and loss of income?
I could go on and practically write a little book here. But that should suffice as to "why" some of us are rather concerned, to say the least.
These are legitimate questions that definitively need to be asked and answered in context of a complete workover of our societies, instead of being dishonestly dismissed.
>Shutting down completely in order to decrease the total number of deaths only makes sense if you are willing to stay shut down until a vaccine is available. That could take years. No country is willing to wait that long.
Actually it might very well just be half a year until we have a vaccine. Multiple candidate vaccines are in phase 3 and they are already being produced en masse, ready to be released if the vaccines prove to be successful. And it's not like other countries in Europe "shut down completely" and remain shut until today. In Germany people are leading their normal lives, the only difference being that people wear masks in super markets, register on a list when visiting a restaurant and there are no mass events/discotheques. Remaining at this status for half a year or maybe a year to prevent tens of thousands of deaths seems extremely doable.
The swedish GDP is down 9% despite them (according to the article which is misrepresenting a lot of things) not locking down at all. Even if Germany took a completely different approach (which would have led to a New York Style situation in the whole country) there would basically not be a difference in gdp numbers.
Even if true, it's still less down than any other European nations, and the only one not in a recession, because you're not taking the previous quarter into account as well.
> Swedish GDP is up this quarter, as about the only nation in Europe
so... is it possible to talk about the estimated gdp right now or not? Because those two statements don't fit together.
You're casually talking about the deaths of hundreds of thousands, maybe a million people.
_Of course_ your government cares. They _also_ care about needless death. They're trying to walk the tightrope.
If you want a look at a country that just goes: Eh, whatever - check out sweden, and the US.
Which have at least as much economic damage, if not far more.
You couldn't be more wrong.
I should note that I'm not saying it's unreasonable of people to be hesitant to take this particular vaccine, given how it is being rushed. Even scientists have said that there is not currently enough evidence of safety/efficacy that they would feel comfortable taking it or giving it to their families. [2]
1: https://www.npr.org/sections/coronavirus-live-updates/2020/0...
2: https://www.nytimes.com/2020/08/03/opinion/sunday/coronaviru...
Even if a vaccine is approved in Q'21, due to manufacturing, supply chain and just general operations issues, it's going to be a while before a large part of the population is vaccinated.
I assume they'll prioritize medical workers and the elderly, then start working through the rest of the population. It wouldn't surprise me if it takes another 6 months to vaccinate less than 50% of the population (which, to be fair, may be enough).
We're probably looking at end of 2021 for enough vaccinations to happen for things to go back to "normal".
That's another year.
We'll be dealing with this virus permanently and it will likely be years, or decades, until there's a good enough vaccine for it to be safe for to return to the way they were.
In the mean time, things will change enough that going back to the old normal won't be an option by the time it's eventually safe enough to do it.
In my eyes, that is the best case scenario.
That pushes out herd immunity to late 2022.
The positive thing is there a lot of vaccine in development. I feel confident we'll find one that's at least somewhat effective.
the new normal is going to be with us for a very long time, so adjust and plan accordingly.
it has already been half a year.
Is that true? Are all the schools closed? Are most people working from home? Are most businesses shutdown?
That's not what I've read (outside this article).
What does that mean? As a scientist myself, 'science' can basically never say anything definitive about reality. Not for something extremely well measured and controlled like GR, and especially not something where the evidence on the ground and influencing factors (policy, social opinion, culture) shift with a frequency on the same order of scale that our measurements can be tallied.
You can't have a scientific response to the virus when you don't know what the asymptomatic transmission rate is, or what the true death rate is. As can be seen here it does not go well when they are made to even consider that they don't have all the information needed for a scientific response: https://news.ycombinator.com/item?id=24077233
"I want to preface this article by stating that it is entirely anecdotal and based on my experience working as a doctor in the emergency room of one of the big hospitals in Stockholm, Sweden, and of living as a citizen in Sweden."
Look at this paragraph. It jumped right out at me, why is nobody else commenting on this?
The next day all those patients were gone and the only thing coming in to the hospital was covid. Practically everyone who was tested had covid, regardless of what the presenting symtom was. People came in with a nose bleed and they had covid. They came in with stomach pain and they had covid.
What sort of disease has no specific symptoms at all? I thought COVID patients were presenting with an unusual form of dry pneumonia?
If you look at the history of epidemiology and virology, it is unfortunately filled with stories of misinterpreted data leading to incorrect belief that a virus was the underlying cause. For a long time diseases caused by vitamin deficiencies were blamed on viruses although none actually existed.
When you read that some doctors experience of COVID was "people turned up as normal but suddenly they were all testing positive", you do have to wonder what is going on. I thought COVID patients in hospitals were clearly COVID patients by symptoms, but the list of associated symptoms seems to keep widening. That's confusing and worrying indeed.
https://www.gstatic.com/covid19/mobility/2020-08-04_SE_Mobil...
In an ideal world, the government would listen to the experts, they would reach some reality-based and science-based consensus, and then the people would follow those conclusions because it's the right thing to do.
But that's an ideal world.
And sure, one of them is likely right and one wrong, but we won't know which one until we get more data.
Now, as for the current pandemic, data is plenty already.
Trump doesn't want to reopen too fast because it won't be clear by the election (October, when mail-in voting happens) that this was a good strategy.
Democrats don't want to reopen too fast because keeping the economy shut down is bad for Trump's reelection chances.
Too cynical? Perhaps. But I do think that perspectives like the author's are dismissed too quickly because neither 'side' sees a way in which following this advice will help them in the upcoming election.
Regardless, it is a real shame that COVID has been so politicized, given the tremendous medical and economic repercussions that we are seeing.
>Democrats don't want to reopen too fast because keeping the economy shut down is bad for Trump's reelection chances.
That's basically a conspiracy theory because the Democrats would need to coordinate this political stand and also conspire with medical health advisors. Unless you claim that every democrat has come to this conclusion by themselves.
I don't know that Dems would all have to reach this result on their own — it's pretty clear that the Democratic party line right now (and since the beginning) has been "lock it down". Once that was established, it would have taken quite a bit of courage of convictions for a Democrat to have come out in favor of opening.
Hasn't Trump been the one flippantly saying "it's not a big deal" and "we'll be back to normal quickly" and "we'll get the kids back to school shortly"?
How could anyone view his behavior as "not wanting to reopen too fast"? It seems the exact opposite to me.
https://news.ycombinator.com/newsguidelines.html
The average number of people who die of influenza in the US is about 35,000. So we should expect 350,000 deaths and then we'll be all good?
The average YLL for people infected with covid is vastly smaller. You still don't want it, but the actual number is measured in months.
This is one of the worst headlines I've seen recently. The actual study measures years lost only of those that died. By that metric, if I cross the road today and get hit by a bus, the headline would be "crossing the road can cut life span by 40 years or more". There is zero valuable information in that headline.
My only issue with this title is that can- which is wrong and makes the title meaningless. The news is that on average it does cut lifespan of ten years.
Note that's quality-adjusted years of life for people who died with/from/by Covid-19, not of all those infected, because the majority of those infected lose 0 years of life so there's not much information in that metric, either.
So, yes, it does make sense to ask "how many years a person who died of Covid-19 could still enjoy had they not died of Covid-19". Just looking at how many people died of those who were infected simply ignores the fact that many people who die of Covid-19 would otherwise have gone on happily being productive and valuable members of their respective communities - and not shuffling, moaning zombies held together by arcane necromancy, waiting for a gust of wind to disintegrate. After all, while Covid-19 is very dangerous for people over 80, it is also quite dangerous for people over 50 and over 60, and those are ages where many people haven't even retired from their careers.
_____________
[1] Not a direct quote, rather one from memory. I can provide the source if needed, it's a video of an hour-long interview with Ioannidis on youtube.
- 60% of the population get it - the IFR is 0.6% - Everyone who dies loses on average 10 years
it's 60% × 0.6% × 10yr = 0.036yr. That's less than two weeks. How much more are you willing to sacrifice for less than two weeks of lifespan?
“Considering that 70% of those who have died of covid are over 80 years old, quite a few of those 6,000 would have died this year anyway. That makes covid a mere blip in terms of its effect on mortality.”
It’s just empirically true that dying at 80 is different from dying at 20 if you’re assessing the impact of a pandemic. I guess it needs to be pointed out that “different” has a distinct meaning from “way less tragic.”
It is surprising to hear someone who is supposed to care about the bodies and minds of people be such a cowboy when it comes to their lives. If it's not a big deal for people over 80 to die because "quite a few [of them] would have died this year anyway", maybe we should stop admitting people over 80 to hospitals and save the costs of their care? Does that really sound like a sensible proposition?
I am reminded of the Italian scientist, Rita Levi-Montalcini who receivead a Nobel prize in physiology of medicine at 77 and continued to work and make contributions well into her last years of life until she died at 103 [1]. Of course there are exceedingly few such exceptional people, but my point is that it is perfectly possible for someone to enjoy many years of a productive life after their 80'th birthday and perhaps we should be doing more to ensure that this is not such a rare occurrence, rather than assuming that all those old fossils are dying anyway and leave them to it because them young 'uns wants to go out dancin' and drinkin'.
After all, most people plan to grow old anyway. How many of us are comfortable with the idea that, in our old age, priority will be given to "the economy", not to mention the very economy we worked our arse off to keep going while we were young? What is this economy anyway, Moloch?
________
[1] https://en.wikipedia.org/wiki/Rita_Levi-Montalcini
This is miles from what he says. He is arguing for the adjustment of a statistic. He is arguing that Covid has had a minimal affect on the death rate and even smaller when you adjust for how many of the dead would already have been included in the much larger baseline number of expected annual deaths because they are over 80 and X% of those over 80 die each year even with no Covid.
I’m not even sure I agree with him on this or other arguments but it’s clear he values the life of the elderly. As an ER doctor he probably treats many (and many with Covid) each day. I think he’s earned the benefit of the doubt on valuing life, more than most of us here who treat and save no one.
>> “Considering that 70% of those who have died of covid are over 80 years old, quite a few of those 6,000 would have died this year anyway. That makes covid a mere blip in terms of its effect on mortality
My comment:
>> If it's not a big deal for people over 80 to die because "quite a few [of them] would have died this year anyway".
Though I should perhaps not have paraphrased, I believe my comment captures the feeling of the doctor's statement well. Yes, he is making a point about mortality rates. Also, he's making the point that 6,000 people dead is a mere blip on mortality because most of them would be dying anyway. His entire post is a declaration that Covid-19 and the deaths from it are not a big deal because most were very old and on their way out anyway.
Don't forget the '17 flu seasons was 65k deaths in the US. So we're at a little under 3x right now. So yes, Covid is worse, but we don't bat an eye at 65k deaths due to the flu.
This is simply not true in general. The vast majority of people who come down with covid have a minor illness, and many of them do not even realise what it was. I have three friends who had positive tests and no symptoms beyond those of the common cold. All of the available data supports this being the normal case, and serious complications being either a rare case of bad luck, or a result of underlying illnesses.
> a good amount of those discharged form hospital are looking at permanently reduced lung function
If you have any respiratory infection serious enough to put you in the hospital, you're probably looking at a longer recovery and possibly at long-term reduced lung function. But the relatively young & healthy mostly don't end up in hospital with covid, just as they don't end up in hospital when they get the flu.
Selecting only the most serious cases (hospital admissions) and talking about their outcomes is not useful for drawing general conclusions about the pandemic or the way countries have chosen to respond to it.
1) Only as long as they are old people. The moment flu kills even a couple children, everybody goes apoplectic.
2) I suspect that one of the takeaways from Covid is going to be that viruses (even flu) cause a lot more long-term damage than we give them credit for. Nobody was funding brain or circulatory scans for flu patients--we're going to get some of that data as a side benefit of all the Covid analysis.
And the flu certainly can cause long-term damage.
"Other possible serious complications triggered by flu can include inflammation of the heart (myocarditis), brain (encephalitis) or muscle (myositis, rhabdomyolysis) tissues, and multi-organ failure (for example, respiratory and kidney failure). Flu virus infection of the respiratory tract can trigger an extreme inflammatory response in the body and can lead to sepsis, the body’s life-threatening response to infection."[2]
[1]https://www.cdc.gov/flu/about/burden/2017-2018.htm [2]https://www.cdc.gov/flu/symptoms/symptoms.htm#complications
How can we compare Covid numbers to the flu when the US has gone into lockdown, schools closed, everyone that can is WFH. No concerts or sporting events
totally different circumstances
Sweden might be a more accurate comparison since they didn’t go into full lockdown and it’s at 10x
In the last ten years we (in the US) have lost +500,000 people to the flu.
For some reason the people that died from the flu must be lesser in value because nobody did anything about it.
You would think that a single year of 65k deaths would be enough for everybody to wear masks the following flu season. And yet?
No economic shutdowns. No masks. No restrictions on schools. Literally nothing other than vaccines that mostly don’t work.
How is that an argument for less-drastic measures?
The "with shutdowns, masks and closed schools" line also assumes the effectiveness of all those measures, and ignores the glaring problem that they simply kick the can down the road -- there is no appetite for shutdowns and closed schools until the end of 2021, but a vaccine could easily take that long (if not longer) to be generally available -- assuming any of the current vaccine candidates work well. So what, exactly, is the plan?
For flu you're using sophisticated statistical modelling of excess death combined with community surveillance of use of primary and secondary care. This will tend to overcount.
For covid-19 you're using "died after testing positive for covid, or with covid mentioned as the cause on the death certificate". This will tend to undercount (even when taking into account the slight overcount involved in people who die from other things after a +ve test).
I think this so called Doctor is just trying to push a narrative and links to no research or sources for any of his assumptions or data.
This article has no credibility.
What Covid-19 made me realise is that there are tens of thousands of lives we could be saving each year by adopting some simple behavioural rules that definitely do not need to harm the economy. For example, stay home when you have flu-like symptoms, don't touch your face, wash your hands thoroughly, sneeze into your elbow or a handkerchief and get rid of it immediately and so on. No need for lockdowns or anything- just keep in the front of peoples' minds the fact that diseases can be carried around, are carried around, by people doing normal people things all together in a big place with lots of people.
In fact, I believe I've seen signs advising such measures to curb the spread of disease around the London Underground and I think also the Paris Metró, but I've always, until now, ignored them. When I had flu-like symptoms I've always soldiered on and went to work because that was expected of me and that's what my coleagues also did- and more than once I actually got sick after noticing someone sick at work [1].
Well, no more. Not for me anyway. I had no idea. But now I do.
___________
[1] And one time I got a real nasty stomach bug after I used the toilets after a coleague who had just recovered from a similar infection. I do always wash my bloody hands after, but it seems he didn't and well, there was one door handle in the loo. Yeeew dude. Yeew.
See "Figur 1" https://www.folkhalsomyndigheten.se/contentassets/0ad710ef37...
Of course you get to the article's slant when it claims that Sweden is "normal" right now, which is an outrageous lie.
Virtually all events are cancelled. Social engagements are non-existent. Streets are empty. Huge percentages of people work from home. Bars and restaurants were closed for a period of time in hot areas, and regardless have operated under a significantly reduced capacity. Sweden's summer school break began at the PEAK of their outbreak, and we'll see what happens when they return in a little over a week.
Sweden's societal reaction to COVID-19 is basically optimal as a general society, and some parts of the US that are "locked down" have much higher social engagement. Either we've redefined normal to be "completely and absolutely unlike the before times", or this guy is just twisting reality pretty generously because he likes the views, particularly among a certain conspiratorial segment of the US population (a Swedish MD whose blog is in English).
[1] An MD who has extraordinarily little expertise in virology or immunology. Yet he discounts immunity tests. This is like a JavaScript developer telling you why Metal is better than Vulkan.
If so, they've only stabilized because they adopted the recommended measures finally.
https://www.reddit.com/r/sweden/comments/i58jjj/helgtr%C3%A5...
There you go -- read about Swedes talking about their COVID-19 experience. It is a universe removed from normal, or what Florida-man-using-Sweden-as-their-no-biggie-example claims.
Here you go - https://www.svt.se/nyheter/lokalt/vast/nastan-alla-fick-coro...
Someone had an ill considered party. Despite the amazing herd immunity nonsense this guy is arguing (again, contrary to the entire expert community), most of the partiers got COVID. Ooops!
And although non-essential businesses aren't closed, Swedes aren't going to those stores?
And masks aren't mandated, but most people are wearing them?
Swedish schools closed for the summer break just as COVID was peaking. They return in just over a week. Businesses are sparse because few people are shopping. Restaurants and bars were closed, and other than that have strict reduced occupancy.
But Florida man is sure that Everything Is Normal. It's hilarity. That "look they didn't close their schools"...when they were closed regardless. Hurr.
"And masks aren't mandated, but most people are wearing them?"
Masks are necessary when you're in close proximity to other people. Swedes aren't getting in close proximity to other people. Are you getting this?
The Cult of Idiocy that has overtaken the US isn't there in Sweden. Florida in their highest level of lockdown has dramatically more social interaction than Sweden minus it.
https://news.ycombinator.com/newsguidelines.html
My understanding (based on what I've heard) is that that was indeed the situation at least during the peak; not sure if that's still the case.
"Now, increasing numbers of workers are also coming forward to criticise regional healthcare authorities for protocols which they say discourage care home workers from sending residents into hospital, and prevent care home and nursing staff from administering oxygen without a doctor's approval, either as part of acute or palliative (end-of-life) services.
"'We were told not to send them in' "They told us that we shouldn't send anyone to the hospital, even if they may be 65 and have many years to live. We were told not to send them in," says Latifa Löfvenberg, a nurse who worked in several care homes around Gävle, north of Stockholm, at the beginning of the pandemic.
""Some can have a lot of years left to live with loved ones, but they don't have the chance... because they never make it to the hospital," she says. "They suffocate to death. And it's a lot of panic and it's very hard to just stand by and watch."" (https://www.bbc.com/news/world-europe-52704836)
My understanding is that Sweden avoided overcrowded hospitals by only offering palliative care (which doesn't include oxygen) to the elderly.
If so, it's not like their laissez-faire attitude (the previous months) is the success he's making it out to be. They only have stabilized because they adopted the recommended measures finally, if that's true.
Excess mortality is the best measure, because it accounts for the impact of the disease, as well as the impact of actions taken to fight it (not all of which will be good).
Looking only at covid deaths is therefore misleading, as it only optimizes for that one thing. Looking at the big picture is the better way to make policy.
https://ourworldindata.org/excess-mortality-covid
Hope those 5000+ unnecessary deaths were worth 3.3%.
"Considering that 70% of those who have died of covid are over 80 years old, quite a few of those 6,000 would have died this year anyway."
Wow.
Both countries have it under control now. But it's clear Finland's shutdown saved lives.
The shutdown will be looked back on in 10 years as one of the worst mistakes the world has ever made.
https://www.nytimes.com/2020/08/03/health/coronavirus-tuberc...
https://www.thelancet.com/journals/lanonc/article/PIIS1470-2...
For myself, I definitely sense that we (collectively, or nation by nation) could have followed various pathways (and to some extent, we did). The "right" answer was (and is) not known, and we had a choice between erring on the side of caution over the damage caused by the disease versus that caused by economic disruption.
For now, I'm still in favor of erring in the direction of caution over the disease impact, but will concede that history may judge things quite differently.
That’s just a piece of the all cause mortality due to the COVID response.
And then after accepting all that direct cost, then you can start evaluating the economic damage on top (which to some extent is unavoidable regardless of lockdown policy).
I'd love to believe that you're right (and 3 months ago, I felt the same way). But I just don't.
Sweden didn’t make this bet. Finland, Norway, and New Zealand did.
Sustained lockdown and lack of travel will be very costly if it has to be maintained for two years; and the fatigue from maintaining it will undo all of the supposed success.
This is not decidable at this point in time, and likely not within the next 5 years.
Of course you could say that math is horrible and inhumane, and any equation involving dollars and human lives will feel that way. But the point is that health care spending is already rationed by something like that standard, and every dollar of GDP that disappears is a dollar that's unavailable to spend in other ways (including medical treatments that are cost-effective by that standard).
To be clear, I think Sweden erred by not mandating masks, which seem cost-effective to me by that standard. Their response otherwise seems reasonable to me, not obviously better than stricter approaches but not obviously worse.
https://mobile.twitter.com/yaneerbaryam/status/1290916583137...
This is the medical literature version of the xkcd green M&M comic:
https://xkcd.com/882/
Average age of the covid-19 dead in Sweden is 82, average life expectancy is 83. The majority of the deaths also occurred at elder care homes where the expected survival time is less than two years. And, just like everywhere else, the covid-19 dead are much more likely to belong to certain risk groups associated with earlier deaths as well.
10 QALY lost per death sounds way, way too high to me.
> To be clear, I think Sweden erred by not mandating masks, which seem cost-effective to me by that standard.
The reasoning behind this, which is the same in the rest of the Nordics and the Netherlands, is that a general mask mandate is counter-productive. No-one is arguing that medical grade face masks properly handled, worn, and disposed of help prevent the spread. The problem, and this should be obvious if you live in a place where masks are mandated, is that people don't have proper masks and don't wear them properly. So masks can create a sense of false security, and make people slack off on their distancing, which means a mask mandate can result in a net negative result.
Right or wrong, I don't know, and I don't know if we'll ever know, but that's at least the reasoning behind it. And it definitely sounds plausible to me.
I'm in Hawaii which has had a mask mandate for months now, and the way regular people are actually handling their masks in the real world is very, very far from the way trained medical professionals handle their masks.
That's life expectancy at BIRTH. It would seem to me that the relevant statistic in the case of an 80 year old dying is the average life expectancy they had at 80, which is considerably more than 3 years.
The biggest disingeniousness of the people talking about the covid-19 specific death toll is that the assumption is that if not for covid-19, everyone would have lived forever and ever, and that's simply not true. Looking at the demographics of the dead, for many, covid-19 is what happened to push them over. If not for covid-19, something else would have done it in a similar timeframe, especially since the flu seasons of 2018/19 and 2019/20 were so mild.
Yes, there are people who died significantly before their time, but they're a small minority of the dead. So 10 QALY lost per dead is way too much. 1 QALY lost per dead is too little, I agree. The truth is probably somewhere in between.
As to masks, I also agree correct use is a problem. Here (SF Bay Area) the East Asian population seems to use them competently and consistently, but everyone else is hit or miss. I would have liked to see more public education, rather than just the unexplained mandate; but the probability that masks primarily explain East Asia's success in containing the virus seems high enough, and the cost seems low enough, that they seem like a favorable bet to me. I do also think it's quite possible that other factors (e.g., different degrees of pre-existing T cell immunity from other coronaviruses) will turn out to explain that big difference though.
1. https://wellcomeopenresearch.org/articles/5-75
As did Peru. Despite following WHO globalist advice to the letter.
Why is your cherry pick right and mine wrong?
so yes, temporarily Sweden stats may look worse because people who would die this or next year died in short time window in these few months, but those people will be missing in stats down the road
it's already happening in UK, for 6 consecutive weeks they have lower than 5yr average death toll and excess deaths are shrinking because oft his
https://twitter.com/EdConwaySky/status/1290568780251308032
so while you may pat yourself on shoulders how good you done without spike in the end you both reach pretty much same result spike or not
> "That makes covid a mere blip in terms of its effect on mortality."
This sounds wrong to me for several reasons. First of all, it's silly assuming that other countries are shutting down their economies without a very good reason for doing so. As I understood it, the "good reason" for doing so was that the infection & death rate was growing so fast, that it was putting hospitals & morgues way beyond their capacity. At the same time, the situation was keeping non-COVID, hospital-worthy visits out of the healthcare system, thus creating a massive public health problem.
(Let's not forget the improvised hospitals, improvised morgues, etc. These were very real.)
It'd be interesting knowing why somehow the COVID cases 'vanished' from this doctor's hospital. But instead of looking into why this happened, this doctor is just saying "turns out that the problem went away, so in the end it was good that we didn't bother too much about it".
And the thing is - we're not through it yet. Thankfully the death rate seems not being as bad as we thought it could be, but this could very well be down to current measures such as isolating elder people, testing at-risk populations, higher awareness levels, and the fact that the average infection age is now much lower than it was in March. So, now, healthcare systems are not collapsing.
There's a myriad of variables that likely affect the virus spread and outcome. For example, the age and characteristics of the populations where the virus is spreading, how population is distributed around the territory (and its density), how frequently this population "comes together" (social behavior - ever seen a swede profusely hugging and kissing?, public transportation, remote working…), and so on.
And when it comes to the healthcare system capacity debate: Sweden frequently put elder, infected people straight in palliative care (http://archive.is/VC5vb), bypassing hospitals. Other countries did admit elder people into hospitals, thus putting more strain into the healthcare system, which later on prompted a lockdown to prevent said system from collapsing.
I certainly wouldn't want to assume that governments only ever do the correct thing, or the thing that is in my best interests, so I think it's reasonable to ask questions.
> As I understood it, the "good reason" for doing so was that the infection & death rate was growing so fast, that it was putting hospitals & morgues way beyond their capacity. At the same time, the situation was keeping non-COVID, hospital-worthy visits out of the healthcare system, thus creating a massive public health problem.
The UK enlisted the army to build enormous field hospitals and staffed them with doctors and nurses from other hospitals. Most of them closed after seeing only a few patients, since all other hospitals were operating far below capacity. Emergency rooms were ghost towns. Meanwhile, all elective surgery was cancelled, reducing the quality of life for thousands of people while doctors stood around waiting for the promised influx that never happened.
It seems to me that the response in the West has been largely reactionary, driven by fear and public opinion, and disconnected from any real analysis of what genuinely works and what the long-term plan is -- with the possible exception of Sweden, who despite all the "they don't care" rhetoric you see in other comments, not only put a lot of analytical care into their approach, but discussed that analysis openly.
Many countries had problems with care home workers abandoning their jobs, for example to return to their home countries before borders closed. There are some quite horrific stories of the terrible conditions created in care homes in some of the places with excess death spikes.
The imagery of ice-rink morgues etc had a similar effect. There was no real demand surge for morgue space, but undertakers were refusing to work until they were supplied with ample PPE because they thought they would be infected by the bodies with a killer virus. Same story in Bergamo. So then a sudden shortfall in PPE was converted into a shortfall in funeral capacity, even though at that point there was no sudden tsunami of bodies. This then led to more panic especially amongst health system workers.
It's very hard to disentangle what really went on here.
I think it makes sense to isolate anyone who tests PCR positive for coronavirus, right?
Also, is it 100% sure that asymptomatic people will not transmit the disease? What if they are just pre-symptomatic? Where do you establish the cut-off?
Asymptomatic is being used as a different classification than pre-symptomatic in the literature. Asymptomatic means you never develop symptoms. Pre-symptomatic means you haven't yet but will. Pre-symptomatic phase is not long though. Typically just 1-3 days, I think, from the latest literature.
Given the tiny window of time that exists when people are infectious and might not know it, and given the very low likelyhood of a PCR test being done in exactly that time, and given that PCR testing has a lot of problems (e.g. triggers even if your body has destroyed the virus), and given that nurses and doctors are pretty important, I can't see it being useful to actively test in hospitals. It's everywhere by now anyway.
It's important information that I don't think should be censored, but it goes contrary to WHO.
The name is very unusual for a Swedish person, I can only find three people with that last name in Sweden, and none of them has the first name Sebastian.
The image of him in a gas mask is vague enough that you can't identify the person based on that.
The blog is a hosted wordpress that only has a couple of articles going back a few days.
The English is very good, I didn't see a single Swedishism, which makes it less likely the writer is actually Swedish.
The article talks about other kinds of deaths that are also bad, and mentions opioid deaths. That is a cause of death that is extremely rare in Sweden, but which would be familiar to an American audience. Using that as an example while talking about Swedish deaths is very odd.
So all in all this piece smells off.
I found him on LinkedIn as well, so, ok, it's a real person.
This is a weird coincidence: https://www.couchsurfing.com/people/sebrushworth
Same age. But switched to medicine?
I have now tried to contact him by Facebook Messenger, where he has had an account for many years. I asked if he wrote those texts on Wordpress.
https://www.medrxiv.org/content/10.1101/2020.05.10.20096909v...
https://covid19-projections.com/denmark vs https://covid19-projections.com/sweden
Its also possible Sweden just got lucky with the prevalent strain https://www.biorxiv.org/content/10.1101/2020.08.03.233866v1....
I would love it if Sweden was right and tackled this in a way that does look like a seasonal flu, but I think the science is still out on that. It does seem the science points mildly towards it being quite as deadly as initially thought, but I would not the Swedish death rate a total win.
<snark> Forget all that Sweden is the best approach, we should copy it in America especially the very solid social health care system :) </snark>
I guess my counter would be:
* It was solved at a greater expense of human life, its easy to say "those people would have died" but that is harder to prove ethically. Could the excess deaths have lived on _longer than a flu season_?
* Is there a good argument that it is in fact over in Sweden?
* Are there other variables that might have made Covid-19 not so bad in Sweden?
If I was to take more direct counters to the article:
> I am willing to bet that the countries that have shut down completely will see rates spike when they open up. If that is the case, then there won’t have been any point in shutting down in the first place, because all those countries are going to end up with the same number of dead at the end of the day anyway.
Maybe, but that could also be a case of thinking that the death rate is a fairly simple linear model, which would fly in the face of the various epidemiological models that we use (not just for covid but since the 1920s)
> No, because influenza has been around for centuries while covid is completely new. In an average influenza year most people already have some level of immunity because they’ve been infected with a similar strain previously, or because they’re vaccinated.
Is Covid-19 completely new? By this reasoning it would as stated be more infectious due to a lack of known immunity. With this line of reasoning why wouldn't a _different_ cornovirus also give a more uniform immunity? Why would a novel Cornovirus strain have a greater impact over a novel Influenza strain?
I could go one but I feel like I am sniping.
Personally I dont think the world wide response has been great, I do think we have overreacted but I also would argue that its not just another influenza and should be ignored as such.
NYC is at 2716 cases per 100k and 281 deaths per 100k: https://www.cdc.gov/covid-data-tracker/#cases
States with aggressive reopening policies like Florida/Louisana/Arizona etc had spikes recently but are also coming back down. They are sitting at around 2-3k cases per 100k (deaths will lag).
Even if the reason why those states "peaked" is because of herd immunity, it seems like it still requires at least 3k cases per 100k. That would translate to 300k cases for a population of 10 million but Sweden is only at 80k right now.
I highly doubt they have herd immunity.
The same is true of Sweden as well, of course. Social interaction has collapsed to very close to nil, and any article that claims that things are "normal" is lying to push an agenda.
No fans. Playing in two bubble cities in Canada.
"NBA is just getting started"
No fans. Playing in one bubble city.
And I was talking about NYC. Zero NBA or NHL games are taking place in NYC.
In an average month in NYC, pre-COVID, there are dozens of enormous sports events. Hundreds of concerts. Tens of thousands of significant parties. If social interaction were on a scale from 0 to 100, and 100 was the before, right now NYC is at a less than 1. So when someone looks at NYCs current infection rate and presumes that means there is some herd immunity or the like, I don't think they're fully taking into account the reality on the ground.
Both are equally important pieces of the puzzle. They work together to get R below 1.
https://twitter.com/trvrb/status/1291860668342079490?s=21
Which leaves most of the population vulnerable, and re-introduction a possibility.
You have to get R significantly below 1 and the whole ecosystem (for the US: the whole world) to do it.
Or, you need herd immunity compatible with the R that you can maintain indefinitely - which la likely >2 so immunity needs to be >60%.
Any other way leaves you with the possibility of reintroduction as far as I understand.
Anyways, I don't think measuring recovery in the number of events and parties is a very good metric. Though I agree without that there probably isn't going to be true herd immunity for this and I wish people would stop throwing around the term.
b) Further, it was about New York City!
Extremely few sports are taking place in NYC, and even if we discount that, from the overarching context those sports having a tiny, tiny fraction of the communicability potential.
25% percent of NYC was seropositive in May. So that works out to about 25k per 100k people.
The reported cases have always been just the tip of the iceberg. And we never knew how big the underwater part was. We still down't.
Take the current situation, is the disease penetration larger than that in March/April? Most likely not, not even close, yet the reported new cases are about 5x larger.
As long at the confirmed cases is within some constant fraction of true number, it will be a decent proxy. This makes sense to me since some x% of the people who get infect will need hospitalization so they will get counted towards the statistics.
You should care. The disease propagation is all about the "unseen" part.
Otherwise the numbers are not comparable at all. Back then we caught 10% of cases, today perhaps 50%
Thus you can't extrapolate from old numbers into the new.
if anything you'd need to triple the numbers or more
Even when directly appealing to people the participation rate is likely higher among people who suspect they may have had it.
We know that testing was very limited early in the outbreak, when NYC was hit, and that it caught only a fraction of the people infected. But all metrics are that there is still a huge victim base in the area.
The drop is more likely entirely behavioral.
Even at 14% seropositivity the true number of people that had the virus is likely larger. There are reports that some (many?) people that recover do so without needed antibodies.
Working backwards, taking the fairly accepted value of 0.6% fatality rate, the 30K deaths in NYC would indicate around 5 million infections. Now the the NYC fatality rate is likely higher due to Cuomo's mind boggling order regarding nursing homes.
Regardless I think it is fair to estimate that the true number of cases in NYC is likely to fall between the reported 400k and the upper limit of 5 million. At 25% seropositivity would be around 2 million, to me sounds believable.
There haven’t been any cases of reinfection afaik but we’ll see in due time.
https://www.medrxiv.org/content/10.1101/2020.07.09.20148429v...
https://www.nejm.org/doi/full/10.1056/NEJMc2025179
Proving herd immunity impossible is a rather bold claim and the threshold for that has simply not been met.
We do have a rather large confidence that this virus isn’t going anywhere and will be endemic. It will join the 200+ Cold viruses that hit us every year.
taiwan didn't go into lockdown but the country respects social distancing and masks and is very adamant about quarantining, tracing and cleaning.
do you think the average american citizen will adhere to any of that? forced quarantine for 14 days if you are infected or fly-in while a phone app afterward traces your movements to make sure future outbreaks can be traced? will people wear masks? will people maintain the social good over the individual? (answer for the US is apparently not)
i don't know culturally how sweden viewed these things but from what i can tell most people at least tried to maintain some form of social distancing. some swede can chime in here and correct me on that.
but what they've said about the nordic countries though, is that sweden's economy has shrank the same size as denmark's[0], while denmark which went into lockdown, suffered 8x fewer deaths, 5x fewer by percentage of population. that is the effect no lockdown has had on sweden.
also as a discussion to that both sweden and denmark's new cases are slowly creeping up, but denmark's is at about a quarter (~100/day) compared to sweden (~400/day).
[0]: 4.5 for sweden, 4.1 for denmark. https://www.nytimes.com/2020/07/07/business/sweden-economy-c...
In the end our high mortality rate can't be overlooked. We need to change our strategy for future similar pandemics. That said, I think the most interesting stats to look at when deciding what we should have done differently is the breakdown of deaths per age-group. Less than 100 deaths are among people younger than 50. So almost all of our ~6000 deaths were among the elderly. That is what needs to change. Next time we need to be quicker at protecting the old. Otherwise our strategy could have worked, the rest seem to be able to build up their defences to the virus.
1) I'm glad I don't have this guy as a doctor. 2)If it's not a big deal, why is he wearing a mask in the picture? Catch covid-19, rub some dirt on it, and move on. If you die, you were going to anyway.