6 ms·

Stockholm to reach herd immunity in May?

32 points by jamesblonde 7y ago

jamesblonde 7y ago
Ok, so the interview is in Swedish (and Norwegian), but it is with Sweden's state epidemiologist at the Public Health Agency. He indicates that they have been taking antibody tests the last week as the basis for his prediction of flock immunity some time in May in the Stockholm region.
- martinald 7y ago
  As far as I'm aware the antibody tests are really unreliable? At least the millions of tests the UK bought are not being used for that reason.
  - cipher_system 7y ago
    As I understand it, the quick antibody tests are the unreliable ones. For these tests, the blood will be collected at home and sent to labs where i would suppose reliable tests will be done. Also, the tests will begin next week and the results will be published end of April or beginning of May.
  - mjw1007 7y ago
    In principle even if the tests are unreliable in individual cases, if the false positive and negative rates are known sufficiently well it ought to be possible to use mass results to get an accurate estimate of the prevalence of what they're supposed to be measuring.
    - jamesblonde 7y ago
      He said they tested people for immunity (my interpretation was antibody tests, maybe i was not correct in the actual type of test - but they are testing for "immunity" (antibodies?), somehow).
nabla9 7y ago
Roughly million people live in Stockholm and 2.4 million people liven in Stockholm metropolitan area. Assuming R0 = 2.5, you need (1-1/R0) = 60% of the population to be immune for herd immunity. That would be 600,000 in Stockholm, 1.4 million people in the metropolitan area, 6 million for Sweden. Assuming the same infection fatality rate 0.002 as Finnish national health organization estimates: 1,200 deaths in Stockholm, 2,800 in the metropolitan area, 12,000 in Sweden. Currently there are just 1,400 total covid-19 deaths in Sweden.
- timClicks 7y ago
  Do you have any links/papers that explain the Finnish estimate?
  - sampo 7y ago
    > Do you have any links/papers that explain the Finnish estimate? Unfortunately the Finnish National Institute for Health and Welfare doesn't have a culture of being open about these things.
- dao- 7y ago
  The fatality rate depends on whether and how you can treat patients. The Finnish health care system has not yet reached capacity at this stage.
  - jamesblonde 7y ago
    Neither has the Stockholm health care (ICU beds) reached capacity yet.
    - dao- 7y ago
      What's your point? My point was that you can't make that calculation with a current fatality rate.
  - Gwypaas 7y ago
    Neither has the system in Stockholm, and in the rest of Sweden it barely ticks the mark. For example in Skåne, a region with a population of 1.3 million currently 16 people are in ICU care from 6 days ago. In Swedish: https://www.expressen.se/kvallsposten/sa-manga-ar-corona-smittade-ort-for-ort/ https://www.expressen.se/kvallsposten/sa-manga-ar-corona-smi...
Havoc 7y ago
They haven’t even been hit that hard. Skipping the whole infection and death stage of this process doesn’t seem particularly realistic. People forget a key element of herd immunity: the immune ones are what’s left stand after the carnage I’d expected the UK Spain and France to hit herd immunity first
- dao- 7y ago
  > I’d expected the UK Spain and France to hit herd immunity first Whoever has broad access to a vaccine first probably reaches herd immunity first. Natural herd immunity would take years to reach or massively overwhelm any health care system and kill millions.
- rumanator 7y ago
  Another important fact that is kept out of these discussions is that the whole point of social distancing and quarantines is to level the infection curve, so that health services aren't overwhelmed by epidemic cases and thus can remain functioning not only for covid19 patients but also any other type of medical care.
- maest 7y ago
  A disease can be killed off (or massively reduced) via herd immunity without requiring all individuals to have been infected.
  - nabla9 7y ago
    > killed off (or massively reduced) via herd immunity Natural herd immunity is the the end result of allowing infection to spread without limits. Only with vaccine you can create herd immunity without getting infected. For the next 12-18 months the only way to get immunity is enough people getting infected.
    - op00to 7y ago
      Yes - at a cost of many unnecessary, horribly painful and lonely deaths.
HissingMachine 7y ago
The plan might face problems from time and economic perspective. Reaching herd immunity level might take way too long, even years, during which time most other countries are opening back up using mitigation strategies. Sweden meanwhile might be under travel restrictions imposed by other countries to ward off second wave, hindering their economy far longer than other countries. It really does seem like a gamble, and I don't appreciate governments taking gambles.
- nabla9 7y ago
  Sweden is also using mitigation strategies, just slightly less than other countries.
  - HissingMachine 7y ago
    To me, it seems that they started to use mitigation strategies because they figured the time/economic variable that I pointed out, and realized the impossibility of their gamble.
  - WJW 7y ago
    Compared to some of the southern countries (where three generations of a family regularly live together in one house), the Swedish population was already fairly distanced. See also https://www.politico.eu/article/social-distance-swedish-style/ https://www.politico.eu/article/social-distance-swedish-styl...
cipher_system 7y ago
He is not exactly saying or promising heard immunity in May but that they do have some mathematical models that point to that. He also states the caveat that these models are only as good as their input values and he doesn't sound confident about the correctness of those.
ollysb 7y ago
Herd immunity isn't going to work if reinfection is possible https://edition.cnn.com/2020/04/17/health/south-korea-coronavirus-retesting-positive-intl-hnk/index.html https://edition.cnn.com/2020/04/17/health/south-korea-corona.... Even if there's some protection (e.g. 6 months) it will be extremely difficult to maintain herd immunity.
- thinkingemote 7y ago
  Given that we don't know if either is possible as it's too early, what should we prepare for now? It's a bit of precautionary principle, but the answer is not "plan nothing"
- goalieca 7y ago
  If reinfection is possible then vaccines are going to have a hell of a time.
sovande 7y ago
Preparing for the previous war is a classic mistake. This is irresponsible by Sweden without more data on the virus. New reports indicate that we don’t develop enough antibodies for herd immunity to be an option and it is even worrisome w/r to developing a vaccine. https://www.reuters.com/article/us-health-coronavirus-immunity/who-unsure-antibodies-protect-against-covid-little-sign-of-herd-immunity-idUSKBN21Z2XM https://www.reuters.com/article/us-health-coronavirus-immuni...
jlundborg 7y ago
Swede here. There is lots of disinformation about the Swedish approach to the epidemic. Sweden is following the same basic strategy as other countries, which is to slow down the spread by mitigating actions so the health care system can cope and to protect people in risk groups. The primary difference in Sweden compared to outher countries are: * Sweden decided early on that an evidence-based approach should be followed. Many policies that are implemented in other countries do not have a lot of evidence showing their effectiveness * Policy is still primarily dictated by the experts at Folkhälsomyndigheten (where Anders Tegnell is from), and not by politicians. Most actions taken by the Swedish government has been pretexted by "as requested by FHM we have...". State epidemiologist Anders Tegnell is generally seen as "being in charge" of the actions taken, even though technically he has very little legal authority. * Sweden has a very strong history of indepenent government bodies. In Sweden, there is specific legislation preventing government officials from intervening in specific cases if there is a government authority in charge of the issue. The legal term for this is "ministerstyre", "ministerial rule", and even if an action is not technically in violation of this legislation, it is often used if politicians try to intervene in cases without creating general legislation. * Being a high-trust society some measures that have been implemented as strict laws in countries other than Sweden are instead communicated as recommendations with a very high compliance rate.
- thinkingemote 7y ago
  Can you expand upon the policies that have little evidence of effectivness that are being done by other countries. are Swedes also aware why the other countries are doing this? Is it fear / politics / bad science etc?
  - tephra 7y ago
    I'm on mobile so can dig up links later. But one of the things I see mostly cited in foreign press is the decision to not shut down all schools. Universities and what would be equivalent to high schools are doing distance learning, but lower grades are mostly open. The department of health has mostly cited two things for not closing lower grades. 1. Little evidence that younger people are the main vectors spreading the virus. And 2. That if we shut down schools parents would need to stay home (and are encouraged to stay home via our social programs), and that would include a lot of healthcare workers placing our system under too much stress.
jpxw 7y ago
Here are the issues with the herd immunity strategy: - The R0 of this virus is higher than we once thought. The median R0 reported here is 5.7. https://wwwnc.cdc.gov/eid/article/26/7/20-0282_article https://wwwnc.cdc.gov/eid/article/26/7/20-0282_article - This means that some 80% of the population would need to be infected before reaching herd immunity - This also means the peak of infections would be far more concentrated. - Even with R=2.5, the number of hospitalisation necessary in an unmitigated peak would utterly overwhelm any health system - This overwhelming situation would mean a lot of people who otherwise would survive with medical treatment (oxygen etc) would end up dying
imartin2k 7y ago
German here who moved to Sweden in 2006. Since January, state epidemiologist Anders Tegnell has constantly made claims which turned out to be inaccurate, misleading or at least overly optimistic. Among the more devastating ones is that he in an interview on February 8 stated that "there is absolutely no risk for coronavirus when traveling to skiing vacations in the Alps/Southern Europe". To me, such a lack of foresight as an epidemiologist alone disqualifies him from the heavy role he has. Therefore, I don't take any claim he makes seriously. Sadly, he loves media appearance and seems to be giving interviews all day long, every day. So it's totally impossible to escape those claims. They are everywhere. Shockingly, his display of (partial?) incompetence has hardly impacted the credibility he enjoys among large parts of the Swedish society. In fact, many people totally love him. That's something I just cannot comprehend. To me, it looks like mass hypnosis. My personal stance by now is that I'm not following the Swedish Health Agency's recommendations, but the German authorities', which I consider more trustworthy and competent (based on the absence of a track record of false predictions, a respect of cautionary principles, and an absence of exaggerated self-assurance). However, I don't like feeling that way. Usually I'm "emotionally" only reverting back to my native country when it comes to the Football World Cup :)
- jlundborg 7y ago
  I think this is decidedly unfair critizism, and is based on cherrypicking statements out of context especially regarding timing. The statement about the Alps/Southern europe has for sure been shown to be false in retrospect, but when it was made nobody knew there was an outbreak brewing there, so it was very much based on what was known at the time. I don't think any epidemiologist could have predicted the big outbreak in the alps/northern Italy specifically, and as far as I know, the advise from Tegnell was not different from that of the German authorities at the time. Basing your judgement of Tegnell only on this statement seems very ill-advised.
  - imartin2k 7y ago
    "nobody knew there was an outbreak brewing there" How do you know that? It's 2020, a globalized world, heavy exchanges between China and Italy, supercomputers, complex models. Wouldn't one expect from experts in virology that they actually do have means to foresee these scenarios? I personally do. I was monitoring the coronavirus situation at that time due to personal travel plans. And by mid February I saw a high probability (70 % - 80 %) that we would have significant outbreaks in Europe. Thus, I do expect more from a state epidemiologist than such a display of false certainty. Apart from that, Tegnell has been wrong in so many regards (how often hasn't he claimed that the outbreak is near a peak, or that there is reason for optimism??! I don't have enough fingers to count that). One would rather have to cherrypick in order to find a specific prediction/claim/statement which turned out to be correct. In the end, it comes down to what we expect from our leading experts. The experts who in fact decide about many people's lives, in this case. Particularly in a country in which most people follow the state experts' recommendations without any questions asked.
jerng 7y ago
Herd immunity implies herd infection. I am sure you are already aware of the mortality rates for infected citizens. All the best to this test. You are taking one for the global team. #forscience
tomohawk 7y ago
As much criticism as has been leveled at the approach in Sweden, you would think Sweden would be doing far worse than other countries. It appears actually to be doing better than average. https://ourworldindata.org/grapher/new-covid-deaths-per-million?tab=chart&time=2020-03-08..&country=BEL+FRA+ITA+ESP+SWE+GBR+USA https://ourworldindata.org/grapher/new-covid-deaths-per-mill... So, the approach appears no worse than what others are doing, and likely has fewer side effects.

32 points by jamesblonde 7y ago

Ok, so the interview is in Swedish (and Norwegian), but it is with Sweden's state epidemiologist at the Public Health Agency. He indicates that they have been taking antibody tests the last week as the basis for his prediction of flock immunity some time in May in the Stockholm region.

martinald 7y ago
As far as I'm aware the antibody tests are really unreliable? At least the millions of tests the UK bought are not being used for that reason.
- cipher_system 7y ago
  As I understand it, the quick antibody tests are the unreliable ones. For these tests, the blood will be collected at home and sent to labs where i would suppose reliable tests will be done. Also, the tests will begin next week and the results will be published end of April or beginning of May.
- mjw1007 7y ago
  In principle even if the tests are unreliable in individual cases, if the false positive and negative rates are known sufficiently well it ought to be possible to use mass results to get an accurate estimate of the prevalence of what they're supposed to be measuring.
  - jamesblonde 7y ago
    He said they tested people for immunity (my interpretation was antibody tests, maybe i was not correct in the actual type of test - but they are testing for "immunity" (antibodies?), somehow).

nabla9 7y ago

Roughly million people live in Stockholm and 2.4 million people liven in Stockholm metropolitan area. Assuming R0 = 2.5, you need (1-1/R0) = 60% of the population to be immune for herd immunity. That would be 600,000 in Stockholm, 1.4 million people in the metropolitan area, 6 million for Sweden. Assuming the same infection fatality rate 0.002 as Finnish national health organization estimates: 1,200 deaths in Stockholm, 2,800 in the metropolitan area, 12,000 in Sweden. Currently there are just 1,400 total covid-19 deaths in Sweden.

timClicks 7y ago
Do you have any links/papers that explain the Finnish estimate?
- sampo 7y ago
  > Do you have any links/papers that explain the Finnish estimate? Unfortunately the Finnish National Institute for Health and Welfare doesn't have a culture of being open about these things.
dao- 7y ago
The fatality rate depends on whether and how you can treat patients. The Finnish health care system has not yet reached capacity at this stage.
- jamesblonde 7y ago
  Neither has the Stockholm health care (ICU beds) reached capacity yet.
  - dao- 7y ago
    What's your point? My point was that you can't make that calculation with a current fatality rate.
- Gwypaas 7y ago
  Neither has the system in Stockholm, and in the rest of Sweden it barely ticks the mark. For example in Skåne, a region with a population of 1.3 million currently 16 people are in ICU care from 6 days ago. In Swedish: https://www.expressen.se/kvallsposten/sa-manga-ar-corona-smittade-ort-for-ort/ https://www.expressen.se/kvallsposten/sa-manga-ar-corona-smi...

Havoc 7y ago

They haven’t even been hit that hard. Skipping the whole infection and death stage of this process doesn’t seem particularly realistic. People forget a key element of herd immunity: the immune ones are what’s left stand after the carnage I’d expected the UK Spain and France to hit herd immunity first

dao- 7y ago
> I’d expected the UK Spain and France to hit herd immunity first Whoever has broad access to a vaccine first probably reaches herd immunity first. Natural herd immunity would take years to reach or massively overwhelm any health care system and kill millions.
rumanator 7y ago
Another important fact that is kept out of these discussions is that the whole point of social distancing and quarantines is to level the infection curve, so that health services aren't overwhelmed by epidemic cases and thus can remain functioning not only for covid19 patients but also any other type of medical care.
maest 7y ago
A disease can be killed off (or massively reduced) via herd immunity without requiring all individuals to have been infected.
- nabla9 7y ago
  > killed off (or massively reduced) via herd immunity Natural herd immunity is the the end result of allowing infection to spread without limits. Only with vaccine you can create herd immunity without getting infected. For the next 12-18 months the only way to get immunity is enough people getting infected.
  - op00to 7y ago
    Yes - at a cost of many unnecessary, horribly painful and lonely deaths.

HissingMachine 7y ago

The plan might face problems from time and economic perspective. Reaching herd immunity level might take way too long, even years, during which time most other countries are opening back up using mitigation strategies. Sweden meanwhile might be under travel restrictions imposed by other countries to ward off second wave, hindering their economy far longer than other countries. It really does seem like a gamble, and I don't appreciate governments taking gambles.

nabla9 7y ago
Sweden is also using mitigation strategies, just slightly less than other countries.
- HissingMachine 7y ago
  To me, it seems that they started to use mitigation strategies because they figured the time/economic variable that I pointed out, and realized the impossibility of their gamble.
- WJW 7y ago
  Compared to some of the southern countries (where three generations of a family regularly live together in one house), the Swedish population was already fairly distanced. See also https://www.politico.eu/article/social-distance-swedish-style/ https://www.politico.eu/article/social-distance-swedish-styl...

cipher_system 7y ago

He is not exactly saying or promising heard immunity in May but that they do have some mathematical models that point to that. He also states the caveat that these models are only as good as their input values and he doesn't sound confident about the correctness of those.

ollysb 7y ago

Herd immunity isn't going to work if reinfection is possible https://edition.cnn.com/2020/04/17/health/south-korea-coronavirus-retesting-positive-intl-hnk/index.html https://edition.cnn.com/2020/04/17/health/south-korea-corona.... Even if there's some protection (e.g. 6 months) it will be extremely difficult to maintain herd immunity.

thinkingemote 7y ago
Given that we don't know if either is possible as it's too early, what should we prepare for now? It's a bit of precautionary principle, but the answer is not "plan nothing"
goalieca 7y ago
If reinfection is possible then vaccines are going to have a hell of a time.

sovande 7y ago

Preparing for the previous war is a classic mistake. This is irresponsible by Sweden without more data on the virus. New reports indicate that we don’t develop enough antibodies for herd immunity to be an option and it is even worrisome w/r to developing a vaccine. https://www.reuters.com/article/us-health-coronavirus-immunity/who-unsure-antibodies-protect-against-covid-little-sign-of-herd-immunity-idUSKBN21Z2XM https://www.reuters.com/article/us-health-coronavirus-immuni...

jlundborg 7y ago

Swede here. There is lots of disinformation about the Swedish approach to the epidemic. Sweden is following the same basic strategy as other countries, which is to slow down the spread by mitigating actions so the health care system can cope and to protect people in risk groups. The primary difference in Sweden compared to outher countries are: * Sweden decided early on that an evidence-based approach should be followed. Many policies that are implemented in other countries do not have a lot of evidence showing their effectiveness * Policy is still primarily dictated by the experts at Folkhälsomyndigheten (where Anders Tegnell is from), and not by politicians. Most actions taken by the Swedish government has been pretexted by "as requested by FHM we have...". State epidemiologist Anders Tegnell is generally seen as "being in charge" of the actions taken, even though technically he has very little legal authority. * Sweden has a very strong history of indepenent government bodies. In Sweden, there is specific legislation preventing government officials from intervening in specific cases if there is a government authority in charge of the issue. The legal term for this is "ministerstyre", "ministerial rule", and even if an action is not technically in violation of this legislation, it is often used if politicians try to intervene in cases without creating general legislation. * Being a high-trust society some measures that have been implemented as strict laws in countries other than Sweden are instead communicated as recommendations with a very high compliance rate.

thinkingemote 7y ago
Can you expand upon the policies that have little evidence of effectivness that are being done by other countries. are Swedes also aware why the other countries are doing this? Is it fear / politics / bad science etc?
- tephra 7y ago
  I'm on mobile so can dig up links later. But one of the things I see mostly cited in foreign press is the decision to not shut down all schools. Universities and what would be equivalent to high schools are doing distance learning, but lower grades are mostly open. The department of health has mostly cited two things for not closing lower grades. 1. Little evidence that younger people are the main vectors spreading the virus. And 2. That if we shut down schools parents would need to stay home (and are encouraged to stay home via our social programs), and that would include a lot of healthcare workers placing our system under too much stress.

jpxw 7y ago

Here are the issues with the herd immunity strategy: - The R0 of this virus is higher than we once thought. The median R0 reported here is 5.7. https://wwwnc.cdc.gov/eid/article/26/7/20-0282_article https://wwwnc.cdc.gov/eid/article/26/7/20-0282_article - This means that some 80% of the population would need to be infected before reaching herd immunity - This also means the peak of infections would be far more concentrated. - Even with R=2.5, the number of hospitalisation necessary in an unmitigated peak would utterly overwhelm any health system - This overwhelming situation would mean a lot of people who otherwise would survive with medical treatment (oxygen etc) would end up dying

imartin2k 7y ago

German here who moved to Sweden in 2006. Since January, state epidemiologist Anders Tegnell has constantly made claims which turned out to be inaccurate, misleading or at least overly optimistic. Among the more devastating ones is that he in an interview on February 8 stated that "there is absolutely no risk for coronavirus when traveling to skiing vacations in the Alps/Southern Europe". To me, such a lack of foresight as an epidemiologist alone disqualifies him from the heavy role he has. Therefore, I don't take any claim he makes seriously. Sadly, he loves media appearance and seems to be giving interviews all day long, every day. So it's totally impossible to escape those claims. They are everywhere. Shockingly, his display of (partial?) incompetence has hardly impacted the credibility he enjoys among large parts of the Swedish society. In fact, many people totally love him. That's something I just cannot comprehend. To me, it looks like mass hypnosis. My personal stance by now is that I'm not following the Swedish Health Agency's recommendations, but the German authorities', which I consider more trustworthy and competent (based on the absence of a track record of false predictions, a respect of cautionary principles, and an absence of exaggerated self-assurance). However, I don't like feeling that way. Usually I'm "emotionally" only reverting back to my native country when it comes to the Football World Cup :)

jlundborg 7y ago
I think this is decidedly unfair critizism, and is based on cherrypicking statements out of context especially regarding timing. The statement about the Alps/Southern europe has for sure been shown to be false in retrospect, but when it was made nobody knew there was an outbreak brewing there, so it was very much based on what was known at the time. I don't think any epidemiologist could have predicted the big outbreak in the alps/northern Italy specifically, and as far as I know, the advise from Tegnell was not different from that of the German authorities at the time. Basing your judgement of Tegnell only on this statement seems very ill-advised.
- imartin2k 7y ago
  "nobody knew there was an outbreak brewing there" How do you know that? It's 2020, a globalized world, heavy exchanges between China and Italy, supercomputers, complex models. Wouldn't one expect from experts in virology that they actually do have means to foresee these scenarios? I personally do. I was monitoring the coronavirus situation at that time due to personal travel plans. And by mid February I saw a high probability (70 % - 80 %) that we would have significant outbreaks in Europe. Thus, I do expect more from a state epidemiologist than such a display of false certainty. Apart from that, Tegnell has been wrong in so many regards (how often hasn't he claimed that the outbreak is near a peak, or that there is reason for optimism??! I don't have enough fingers to count that). One would rather have to cherrypick in order to find a specific prediction/claim/statement which turned out to be correct. In the end, it comes down to what we expect from our leading experts. The experts who in fact decide about many people's lives, in this case. Particularly in a country in which most people follow the state experts' recommendations without any questions asked.

jerng 7y ago

Herd immunity implies herd infection. I am sure you are already aware of the mortality rates for infected citizens. All the best to this test. You are taking one for the global team. #forscience

tomohawk 7y ago

As much criticism as has been leveled at the approach in Sweden, you would think Sweden would be doing far worse than other countries. It appears actually to be doing better than average. https://ourworldindata.org/grapher/new-covid-deaths-per-million?tab=chart&time=2020-03-08..&country=BEL+FRA+ITA+ESP+SWE+GBR+USA https://ourworldindata.org/grapher/new-covid-deaths-per-mill... So, the approach appears no worse than what others are doing, and likely has fewer side effects.