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

[Arcade22]

By the way, one of the reasons why there's a delay in the reporting of Swedish deaths is because they have to test those who are suspected to have been infected at the time of death. They are generally not going to prioritize the testing of the dead so there ends up being a backlog.

It's not as if they are supposed to stay as "suspected" deaths forever. They are either going to be confirmed to have been infected and then subsequently reported in to the FHM or they are confirmed not to have been infected.

The statistics show the number of people with confirmed covid-19 who have died, regardless of the cause of death.

[Skeptic Ginger]

Originally Posted by angrysoba

Hello?

You must be new here!

Welcome to the ISF.

Shh... don't scare him off. I hear icerats are an endangered species.

[Skeptic Ginger]

Originally Posted by Arcade22

Yeah, but Denmark is now talking about allowing public gatherings of up to 500 people. Apparently it's now okay if more people get infected. It's suddenly okay if more people die.

I am so confused about your position on this, but no worries, carry on.

[Skeptic Ginger]

Originally Posted by icerat

There has however been nothing at all stopping Folkhälsomyndigheten issuing "Allmänna råd" (a strange kind of "binding advice" with limited actual legal power) that simply says #STAYATHOME

They have not done that. As the Giesecke interview makes extremely clear, the strategy here is to aim for herd immunity as quickly as possible while trying to keep health care demand under control and protecting the vulnerable.

The approach assumes several things -

(a) the virus can't be stopped using suppression and mitigation ("the hammer and the dance")
(b) there will be no vaccine prior to herd immunity being achieved naturally
(c) there will be no treatment available to significantly decrease mortality until herd immunity is achieved
(d) immunity of some type is actually achievable
(e) the vulnerable can be protected

I consider this approach ethically indefensible, especially combined with the acknowledged refusal to actually model potential deaths using this approach

No one in this state is arresting or even fining anyone. The governor and mayors have announced the importance, maybe a few parking tickets were given out in closed state parks, and a cruiser might park at a crowded city beach to encourage people to stop crowding.

They did arrest a preacher in another state for holding a crowded service but he was out the next day.

You don't need to drag everyone to jail (China) or beat them back into their hovels (South Africa) to get people to comply.

[Skeptic Ginger]

Originally Posted by Arcade22

The problem here is that you ONLY compare Sweden to Scandinavian countries. That's called cherry picking.

I'm pretty sure it's called ruling out other variables, or at least trying to.

[Arcade22]

Originally Posted by Skeptic Ginger

I'm pretty sure it's called ruling out other variables, or at least trying to.

I've not seen anyone ruling out any other variables at all. The only thing people have done is fixate on one very visible difference that has been exaggerated quite heavily in foreign press.

[icerat]

Originally Posted by Arcade22

Well it must be because there's an incredible conspiracy by the FHM to deceive the government, parliament and the public.

Hanlon's razor. Or my version of it - never attribute to conspiracy that which is adequately explained by incompetence.

You did follow today's debacle?

[icerat]

Originally Posted by Arcade22

By the way, one of the reasons why there's a delay in the reporting of Swedish deaths is because they have to test those who are suspected to have been infected at the time of death.

What? They're doing post-mortem testing? Source?

[applecorped]

it lives!!!

[icerat]

Originally Posted by applecorped

it lives!!!

#fakenews

[William Parcher]

OMG, an icerat sighting. More rare than Bigfoot.

[icerat]

Originally Posted by William Parcher

OMG, an icerat sighting. More rare than Bigfoot.

and never seen together either ... make your own conclusions.

[Squeegee Beckenheim]

Originally Posted by icerat

What they neglect to mention is that the largest hospital network in Stockholm instituted a policy of not placing the elderly into ICU, and despite them being a higher percentage of reported infections in April cf March, they dropped to less than half the March rate in percent of ICU beds.

Whether this policy is (or was) wider spread is unclear, however there's been numerous media reports from people claiming it has happened to them (or their loved ones)

Is this enough to have stabilised the ICU demand? Unfortunately the data that would make it possible to analyse isn't available, but I suspect it is.

That would certainly be significant.

Quote:

Personally i think the biggest argument is treatment improvements rather than a vaccine. Potential treatments can be in place orders of magnitude faster than a vaccine, and there are several extremely promising ones already on the horizon.

Sure, either way. The point is that I think for it to be demonstrated that Sweden's policy is wrong it'd need to be established that the net loss of life (or harm to life, including long-term decreased quality of life) is greater.

[dann]

Originally Posted by Arcade22

I mean that is what you are alleging is occurring, because on one hand "the Swedish strategy" is supposedly about infecting as many people as possible and get herd immunity and yet they are calling on people to "stay at home at the slightest sign of illness, keep away from others and being careful about hand hygiene". That damn Anders and his conspiratorial co-conspirators are subjecting Sweden to a terrifying experiment and they are not even honest about it!

This call was excusable at the time when it was assumed that the stage of contagion was when people were showing symptoms of Covid-19. At this point, it is well known that people infected with the virus are actually contagious even in the early stage when they don't yet show any symptoms at all - and that some people never show any symptoms, which doesn't prevent them from passing the infection on to others.
That is also why the testing of people (and not just the ones showing symptoms), isolating those tested positive, and tracing down and testing people they had come into contact with has been the most successful approach to slowing down (or even putting a stop to!) the spreading of the disease: Færøerne!
So you are right about the dishonesty of Anders Tegnell and his co-conspirators. At the beginning of the pandemic, they could be excused. Now they no longer can.


ETA: And even after the symptoms have disappeared, there is no reason to assume that you are no longer contageous. Only testing can tell: COVID-19 Coronavirus: How Long Are You Contagious And Do Symptoms Last? (Forbes, April 21, 2020)

[bruto]

Originally Posted by dann

This call was excusable at the time when it was assumed that the stage of contagion was when people were showing symptoms of Covid-19. At this point, it is well known that people infected with the virus are actually contagious even in the early stage when they don't yet show any symptoms at all - and that some people never show any symptoms, which doesn't prevent them from passing the infection on to others.
That is also why the testing of people (and not just the ones showing symptoms), isolating those tested positive, and tracing down and testing people they had come into contact with has been the most successful approach to slowing down (or even putting a stop to!) the spreading of the disease: Færøerne!
So you are right about the dishonesty of Anders Tegnell and his co-conspirators. At the beginning of the pandemic, they could be excused. Now they no longer can.


ETA: And even after the symptoms have disappeared, there is no reason to assume that you are no longer contageous. Only testing can tell: COVID-19 Coronavirus: How Long Are You Contagious And Do Symptoms Last? (Forbes, April 21, 2020)

Unless that recommendaton was made a long time ago, I have to question this a little, since it seems to have been known for quite a long time that one can be an asymptomatic carrier.

[dann]

Originally Posted by bruto

Unless that recommendaton was made a long time ago, I have to question this a little, since it seems to have been known for quite a long time that one can be an asymptomatic carrier.

It wasn't. That's my point!

Latest news from Sweden:

Quote:

Sverige har så mange døde, at de er nødt til at hævde, at de var tæt på målet om flokimmunitet, lyder kritikken fra dansk professor.
Sverige trækker to corona-rapporter tilbage: De retfærdiggjorde deres strategi, siger dansk professor (TV2.da, April 22, 2020)

Swede has so many deaths that they had to claim that they were close to the goal of herd immunity, says a Danish professor criticizing the reports.
Sweden withdraws two coronavirus reports: They justified their strategy, Danish professor says

Quote:

Adspurgt om hvorvidt den svenske strategi har resulteret i ekstraordinært mange dødsfald, siger han:
- Det er et svært spørgsmål, og jeg har ikke svaret, og jeg ved ikke, om vi nogensinde får svaret.
Svensk epidemiolog erkender fejlvurdering af dødstal – men forsvarer strategien (TV2.da, April 24, 2020)

Asked about if the Swedish strategy has resulted in an extraordinary number of deaths, he says:
- That is a difficult question, and I don’t have the answer, and I don’t know if we will ever have the answer.
Swedish epidemiologist acknowledges false estimate of the number of deaths – but defends the strategy
= I don’t want to know the answer, and I will continue to dispute the obvious answer!

Quote:

– Det är absolut inte så att vi ser någon nedgång, säger Anders Wallensten, biträdande statsepidemiolog, under torsdagens presskonferens.
Över 2 000 coronasmittade döda i Sverige (SVT.se, April 23, 2020)

- We are definitely not seeing the numbers go down, says Anders Wallensten, deputy national epidemiologist, in the press briefing on Thursday.
[url=https://www.svt.se/nyheter/inrikes/folkhalsomyndigheten-3]More than 2,000 corona-infected have died in Sweden[/urll]


Folkshälsomyndigheten drar tillbaka rapport (SVT.se, April 22, 2020)
Public Health Agency of Sweden withdraws report

Quote:

SVT har frågat över 100 kommuner om de informerar anhöriga om coronaviruset sprids på det äldreboende där deras närstående bor. Nästan 16 procent svarar att de inte informerar boende och anhöriga. Lika många svarar att de inte vet.
Stor oro när kommuner inte informerar om corona på boenden (SVT.se, April 24, 2020)

SVT asked more than 100 municipalities if they inform relatives about coronavirus spreading at the nursing home where their elderly relatives live. Almost 16 percent answer that they inform neither the elderly themselves nor their relatives. The same number answer that they don’t know.
Much concern when municipalities don’t inform about coronavirus at nursing homes

[angrysoba]

There was a BBC report on this in which the reporter spoke to politicians and to Anders Tegnell about this policy. He also talks to the critics of the policy.

It seems everything thinks they called it correctly (although Anders does admit that maybe more have died than should have done):

YouTube Video This video is not hosted by the ISF. The ISF can not be held responsible for the suitability or legality of this material. By clicking the link below you agree to view content from an external website.

I AGREE

[angrysoba]

And yet Sweden is most similar - from what I can see - to Japan. Maybe the two big differences with Sweden and Japan is that Japan has closed schools and just about everybody wears face masks.

I took a bike ride round the town today (first time in a few weeks although I usually walk around the neighbourhood with my son on his bicycle). I went to pick up lunch today from MacDonalds (we ordered online, received a number on a smartphone and just turned up to pick it up off the counter).

I would say that most shops appeared to be open. Clothes shops, hairdressers, bakeries, convenience stores, fast food restaurants, a coffee shop, a shoe shop, drugstores, electronic goods shops, etc... Some had created "social distancing theatre" with people on the door admitting customers in sporadically, although the cash registers still had lines of people that doubled back on themselves as they snaked to the front with very little consideration for how the customers could keep themselves apart. There are see-through plastic curtains at the cash registers of some shops, and most shops have doors open to get the air to circulate.

Overall, though, Japan is far less locked down than most European countries as far as I know with the possible exception of Sweden. Japan now has around 300 deaths, so things are still growing here, but not at a breakneck speed.

I think it remains pretty mysterious why things are not worse here yet.

[Squeegee Beckenheim]

For those who are interested, the podcast The Bunker Daily yesterday was talking about Sweden's approach to this. I didn't actually listen to much of it because, well, some guests are more interesting than others, but anybody particularly interested in the subject might find it worth listening to.

[dann]

Originally Posted by icerat

What? They're doing post-mortem testing? Source?

I don't have a source for you about testing in Sweden, but the first death from coronavirus in Denmark was discovered post mortem.

[dann]

Originally Posted by dann

What are you talking about? Even if we look at per capita deaths (i.e. per million), we get this result:
Sweden: 176
USA: 129
Denmark: 64
Norway: 34

Sweden is now on the Top 10 of Covid-19 deaths.

Deaths per millon (TV2, April 24, 2020)
Sweden: 214 (total 2,152)
USA: 152 (total 50,114)
Denmark: 70 (total 403)
Norway: 37 (total 199)

[Skeptic Ginger]

Originally Posted by angrysoba

...

I think it remains pretty mysterious why things are not worse here yet.

Are most people wearing some kind of mask?

Because if they are then for the most part, they are not spreading the virus to others.

[dann]

Är Sverige på väg mot en katastrof? (Aftonbladet.se, April 25, 2020)
Is Sweden headed for a disaster?


All kinds of graphs and curves comparing Sweden with countries like Spain, Italy and the USA - and towards the end with the other Nordic countries.

[dann]

Har Island nedkæmpet coronavirus? Prognose viser nul smittede i slutningen af måneden (TV2.dk, April 25, 2020)
Has Iceland defeated the coronavirus? Prognosis says nobody with infections by the end of this month

Iceland’s strategy has been 1) testing, 2) quarantine and self-isolation, 3) tracking down.
A taskforce of 60 managed to trace 92% of all cases. A large number of the people tested positive were people who had already been quarantined on suspicion alone.
For a couple of days, they have registered no new infections. And the vast majority of those infected have now recovered. See graphs in the article.

Tegnell: Enögt att enbart se till dödstalen (SVT.se, April 25, 2020)
Tegnell: One-eyed to look only at the number of deaths

Deaths per 100,000
Sweden: 214 (total 2,152)
USA: 158 (total 51,949)
Denmark: 70 (total 418)
Norway: 37 (total 199)
Finland: 32 (total 177)
Iceland: 30 (total 10)

[dann]

Frontberetning fra Sverige: - Det er kaos (TV2.dk, April 25, 2020)
Report from the frontline in Sweden: - It’s chaos

Quote:

Dr. Mike Ryan, Executive Director of the WHO's Health Emergencies Programs, said recently that a good benchmark is to have at least 10 negative cases for every one positive case confirmed. That means if a state or country carries out testing and comes back with positive cases of around 9% or under, then it's likely that it is testing well.
The US has a positive result rate of 18.8%, going by the COVID Tracking Project's figures cited by JHU.
(…)
France and Sweden are also performing tests below the WHO benchmark.
Lifting lockdowns safely relies on effective testing. Germany surges ahead, but US states are flying blind (CNN, April 25, 2020)

[Klimax]

You can still do better than that:
Czech Republic: 21,8 (218)

[Childlike Empress]

I have taken some time today to research the situation in Belarus where we have heard that Uncle Luka has categorized this as a "mass psychosis". Numbers of infected seem to grow in recent days from a low basis while they do a lot of testing, but there are demonstrations (funnily allowed in the "last dictatorship in Europe" while they are banned everywhere else), and a petition signed by 150K people (of a bit under 10 million Belarussians) that demand to be locked down like in "the West" (or Russia).

Here is an interesting op-ed on one of the two sites I added to my news feeds while researching.

Originally Posted by belarusfeed

[...] the president said that the media artificially inflated the hype and the global drug manufacturers who make money off of panic are behind all this. It seems that Lukashenko sincerely believes that coronavirus panic is the work of the enemy, and he should keep people calm and don’t frighten them with any drastic measures.

The problem is that when the main enemy is not a virus, but a panic, it creates dangerous incentives for the entire power vertical. And now, any official or high-ranking doctor who sees that the situation is getting out of control will think twice before demanding the authorities to impose strict quarantine or cancel a mass event.

After all, it is him who will look like an alarmist arguing with the president. In the end, it may turn out that due to the system’s paralysis, fear of escalating panic, we will miss the point of no return. Politically, this is one of Lukashenko’s most risky experiments in his career.

If his bid pays off, Belarus does not become a leader of the region with sad statistics, and does not kill the economy, the president will get out of the situation in triumph. But if events take a different course, it won’t be possible to shift responsibility to someone else. The author of the unique Belarusian way took it upon himself.

(I don't think there is enough interest for a "how Belarus does it" thread as I seem to be the first who was curious enough to look it up at all. If the mods disagree please do a sensible split)

[Klimax]

Originally Posted by Childlike Empress

I have taken some time today to research the situation in Belarus where we have heard that Uncle Luka has categorized this as a "mass psychosis". Numbers of infected seem to grow in recent days from a low basis while they do a lot of testing, but there are demonstrations (funnily allowed in the "last dictatorship in Europe" while they are banned everywhere else), and a petition signed by 150K people (of a bit under 10 million Belarussians) that demand to be locked down like in "the West" (or Russia).
...

Even dictatorships occasionally allow mass gatherings and token demonstrations. To demonstrate "people" part of name.

Also dictatorships often like to pretend there is no problem until it explodes in their face. In this regard Belarus is following in excellent footsteps of China, Russia and co...

[icerat]

Originally Posted by angrysoba

And yet Sweden is most similar - from what I can see - to Japan. Maybe the two big differences with Sweden and Japan is that Japan has closed schools and just about everybody wears face masks.

Both big differences.

German study finds schools are major hubs for infection transmission

Masks alone could stop the epidemic

[elgarak]

Originally Posted by icerat

Both big differences.

German study finds schools are major hubs for infection transmission

Masks alone could stop the epidemic

These are based on models, though.

The problem is that one cannot model human behavior properly. That's the big problem we here in Germany are facing right now with loosening restrictions. Yes, masks show a potential of being very effective. But there are some effects that could counter effect them, like people not using them correctly, or people getting feeling safe and stepping closer to others (that's actually happening).

For instance, explaining how it works and appeals alone did not work here. Only after it was made mandatory, with police checks and (at least publishing a list of) fines people took it seriously and actually DID do something.

Models can give you an idea what restrictions to employ or to loosen up. But then you have to wait, see how the people actually react (which may not be as intended), and how the numbers develop. Which means waiting at least something like two weeks to see the real effects.

[icerat]

Originally Posted by elgarak

These are based on models, though.

It was my understanding the first model used actual data from an outbreak. Looking for clarification.

Quote:

The problem is that one cannot model human behavior properly. That's the big problem we here in Germany are facing right now with loosening restrictions. Yes, masks show a potential of being very effective. But there are some effects that could counter effect them, like people not using them correctly, or people getting feeling safe and stepping closer to others (that's actually happening).

Ha, tell me about it. The guy running the show in Sweden was asked about masks for aged care workers and he essentially answered "we don't know how well they work yet so until we get a better understanding we're not recommending them"

Quote:

For instance, explaining how it works and appeals alone did not work here. Only after it was made mandatory, with police checks and (at least publishing a list of) fines people took it seriously and actually DID do something.

Yes, knowledge almost always changes behaviour for only a small time, if it all, for most people

Models can give you an idea what restrictions to employ or to loosen up. But then you have to wait, see how the people actually react (which may not be as intended), and how the numbers develop. Which means waiting at least something like two weeks to see the real effects.[/quote]

[Skeptic Ginger]

Originally Posted by icerat

...
Ha, tell me about it. The guy running the show in Sweden was asked about masks for aged care workers and he essentially answered "we don't know how well they work yet so until we get a better understanding we're not recommending them"

I hope when the acute phase of this pandemic passes we can go back and string some of these people up (figuratively of course). There are dozens of them in this country that deserve it.

[Baylor]

Originally Posted by Arcade22

I've not seen anyone ruling out any other variables at all. The only thing people have done is fixate on one very visible difference that has been exaggerated quite heavily in foreign press.

So you're saying people who don't live in your country fail to put things into context and are drawing histrionic and erroneous conclusions based off what they read from the foreign press. Wow, I have no idea what that must be like.

[dann]

Originally Posted by Klimax

EAlso dictatorships often like to pretend there is no problem until it explodes in their face.

Like in the USA?! American democracy doesn't seem to have stopped the virus from exploding.

[dann]

Anders Tegnell seems to be (deliberately) incapable of understanding the difference between his own pandemic response, i.e. business as (almost) usual until the majority of the population has been infected, and the response in other countries where they chose to lock down major parts of social life until the spread of the virus had been slowed down enough to start slowly and cautiously opening up again:

Sveriges statsepidemiolog: Danmark begynder at rette sig efter den svenske vej (DR.dk, April 26, 2020)
Sweden’s national epidemiologist: Denmark is beginning to follow the Swedish strategy

[Klimax]

Originally Posted by dann

Like in the USA?! American democracy doesn't seem to have stopped the virus from exploding.

I knew somebody will try to include USA. But then they still have state governments and they took varying actions independent of federal government. So not correct example to include. Trump might like to pretend to be big dog, but ultimately he has not as much power as Lukašenko and co. (One of main differences between presidential republic and dictatorship - limit on power)

[uke2se]

Dann, a question for a Dane:

I am active in a national health related organization who's sphere of interest includes geriatric care. My counter part in Denmark is telling me that Denmark isn't counting Covid19 deaths at geriatric homes. I wouldn't put much stock in such a rumor normally, but considering the source, I thought I'd check with a second opinion. What does Danish media say?

[dann]

Denmark counts all corona deaths. Could it be that your Danish source thinks that there are no separate statistics for deaths in nursing homes? You should ask them to provide a link of some kind.
I assume that the vast majority of deaths (maybe all deaths) from Covid-19 are in ICUs. I can't imagine that any difference is made between where people were before they were transferred to a hospital and then to an ICU and placed on ventilators/respirators.
I very recently saw the definition of what counts as a death from the virus, and I think it was anyone who dies from whatever cause if that person has been tested positive for the virus in the last two months. And then, of course, there are the post-mortem tests. The first registered Covid-19 death in Denmark was a patient who died from a heart condition but was tested positive for the virus post mortem.
I'll try to find the official defintion of Covid-19 deaths in Denmark.

In the meantime:

Deaths per million (total) (TV2.dk, April 29, 2020)
Sweden: 235 (2,355)
USA: 177 (58,355)
Denmark: 75 (434)
Norway: 38 (206)
Finland: 36 (199)
Iceland: 30 (10)

Percentage of population tested - Percentage of positive tests
Sweden: 0.7 – 14.1
Finland: 1.1 – 6.5
Denmark: 1.7 – 7.8
Norway: 2.7 – 4.9

Denmark cases of hospitalizations and deaths peaked April 1 or April 2:
Denmark: April 1 or 2 --> April 28
Hospitalized: 535 --> 284
In ICU: 153 --> 66
On ventilators/respirators: 138 --> 50
Deaths per day: 20 --> 6

[uke2se]

Originally Posted by dann

Denmark counts all corona deaths. Could it be that your Danish source thinks that there are no separate statistics for deaths in nursing homes? You should ask them to provide a link of some kind.
I assume that the vast majority of deaths (maybe all deaths) from Covid-19 are in ICUs. I can't imagine that any difference is made between where people were before they were transferred to a hospital and then to an ICU and placed on ventilators/respirators.
I very recently saw the definition of what counts as a death from the virus, and I think it was anyone who dies from whatever cause if that person has been tested positive for the virus in the last two months. And then, of course, there are the post-mortem tests. The first registered Covid-19 death in Denmark was a patient who died from a heart condition but was tested positive for the virus post mortem.
I'll try to find the official defintion of Covid-19 deaths in Denmark.

In the meantime:

Deaths per million (total) (TV2.dk, April 29, 2020)
Sweden: 235 (2,355)
USA: 177 (58,355)
Denmark: 75 (434)
Norway: 38 (206)
Finland: 36 (199)
Iceland: 30 (10)

Percentage of population tested - Percentage of positive tests
Sweden: 0.7 – 14.1
Finland: 1.1 – 6.5
Denmark: 1.7 – 7.8
Norway: 2.7 – 4.9

Denmark cases of hospitalizations and deaths peaked April 1 or April 2:
Denmark: April 1 or 2 --> April 28
Hospitalized: 535 --> 284
In ICU: 153 --> 66
On ventilators/respirators: 138 --> 50
Deaths per day: 20 --> 6

Thank you. It sounded wrong to me, and I'm glad it was cleared up. It's possible that he was talking about separate statistics.

[dann]

Lande opgør antallet af døde forskelligt: Der kan være et mørketal - også i Danmark (TV2.dk, March 31, 2020)

This one is as offical as it gets, and it contains ”Tal og fakta om COVID-19 på plejehjem”: Udbrud med COVID-19 (Statens Serum Institut)

This is their report from yesterday: COVID-19 (Statens Serum Institut, April 28, 2020)