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The epidemiologist behind Sweden’s controversial coronavirus strategy

196 points by vanilla-almond 7y ago

bryanrasmussen 7y ago
I really think this is a case of It is difficult to get a man to understand something when his not feeling responsible for the deaths of thousands of his country people depends on him refusing to understand it.
kenneth 7y ago
It's notable as well when evaluating Sweden's number is that they are far more trustworthy than most countries. One interesting metric is excess mortality. Some places have wild unexplained excess mortality from the statistical expectation, that isn't fully explained by reported Covid-19 deaths. This suggests that Sweden is reporting deaths far more accurately than other countries, so when we evaluate the relative success of their strategy, we should keep that in mind. A chart published by the NYT: Location | % extra | excess death# | official C19 d# | unexplained difference Spain | 66% | 19,700 | 12,401 | ~ 7,300 England | 33% | 16,700 | 10,335 | ~ 6,300 NYC | 298% | 17,200 | 13,240 | ~ 4,000 France | 21% | 10,500 | 8,059 | ~ 2,500 Holland | 33% | 4,000 | 2,116 | ~ 1,900 Istambul | 29% | 2,100 | 1,006 | ~ 1,100 Jakarta | 36% | 1,000 | 84 | ~ 900 Belgium | 25% | 2,300 | 1,632 | ~ 700 Switzer. | 21% | 1,000 | 712 | ~ 300 Sweden | 12% | 1,100 | 1,160 | ~ -50
- K0nserv 7y ago
  This table is missing Norway, Denmark, and Finland which would be the most interesting to compare Sweden to.
  - goalieca 7y ago
    Sweden has a higher rate. The theory is that the bulge in death rate is bigger up front vs a prolonged one that continues for months. It will be interesting to see long term results. Sweden also seems to have the same problem with long term care homes that many other nations (France, Canada, etc) are having.
    - Ma8ee 7y ago
      I don’t think the up front deaths are in any way intentional. It’s very hard to compare strategies since there’s many other factors that control the outcome. Like Sweden had school holidays ending with a lot of people coming home from skiing in Italy just when the situation there exploded. And as you mentioned, the virus got into a lot of the nursing homes.
      - marvin 7y ago
        Just for reference, Norway's epidemic also started with a large influx of cases from Italy and Austria. But the countries have used different strategies from that point on.
    - marvin 7y ago
      Sad to say, I'm completely unsurprised that countries with rampant Covid19 spread have a lot of deaths in their retirement homes. It's practically deterministic. People are contagious in the pre-symptomatic or asymptomatic case. So all that's needed is that one employee of the retirement home gets sick and goes to work before they know, and the game is up. Dead patients everywhere. I'm sure this is discussed and considered on the highest levels of policy in the jurisdictions that have been the most proactive in getting a handle on the epidemic early, and missed in most others. I'm sure a strict face mask policy could have helped slow things down, but that's sadly been a hotly contested topic.
      - m4rtink 7y ago
        Many retirement homes here in Czech Republic have had the care takers voluntarily locking themselves up together with the people living there. Some have been there like this for many weeks, only taking in supplies in a safe way & communicating electronically. Thats some serious dedication & very prudent one, give all the tragic cases elsewhere.
  - marvin 7y ago
    Sweden: 1,937 deaths. 50 fewer seasonal deaths than expected. Norway: 187 deaths. No increase in seasonal deaths. Denmark: 384 deaths. Seasonal deaths unknown to me. Finand: 149 deaths. Seasonal deaths unknown to me. Sweden has approximately twice the population of the other Nordic countries, so per capita they have between ~2.5x and ~6x the Covid19 mortality of their neighbors, who have stricter preventive measures. Honestly, I can't see how Anders Tegnell and his colleagues can sleep at night with the uncertainties they are powering through. By rights they should be terrified that they've gotten one of their assumptions wrong.
    - henrikschroder 7y ago
      Denmark has ~2.5x the per-capita covid-19 mortality of Finland, should Danish authorities be terrified that they've gotten their assumptions wrong? The UK has ~2x the per-capita covid-19 mortality of Sweden, should English authorities be terrified that they've gotten their assumptions wrong? You are cherry-picking like crazy! There is clearly no evidence that stricter measures have any effect. If that was true, then there should at least be a linear correlation between strictness of measures vs. excess deaths, and that's simply not the case. You're extrapolating a linear correlation using a couple of data-points that happen to support your theory, i.e. Sweden vs other Nordic countries. Sweden vs. all of Europe paints a completely different picture, so you're not looking at that, because you're cherry-picking. There are so many uncertainties around this whole situation, and I think the only thing we can say with certainty is that if a country has no or a low rate of excess deaths, that country is doing "ok". Not doing great, not doing shit, just doing ok.
      - EdwardDiego 7y ago
        > There is clearly no evidence that stricter measures have any effect Working for us in NZ, although I think the timing of our national lockdown is strongly significant to our success, we managed to do so before it was widespread in the community. Our new case rate is literally bottom of the FT Covid graph: https://www.ft.com/coronavirus-latest https://www.ft.com/coronavirus-latest And we have 50% the population of Sweden, and 0.72% the deaths. If we were to be per-capita equivalent with Sweden, we'd need about another 964 people to die.
  - pvaldes 7y ago
    And Germany is another outlier
    - raphaelj 7y ago
      It looks like Germany put lockdown measures in place about a week earlier than France, Belgium or the Netherlands, if you compare the number of deaths at the time the mesures were enforced. Getting a lockdown in place a week earlier mathematically translates in a 4x reduction in deaths a few weeks later, which is more or less what we see when comparing France and Germany. Likewise the UK enforced the lockdown a few days later than France (proportionally to the state of the pendemic at the time of the measures), more or less like Spain. Looks like they are both heading towards 30k or 40k deaths until the pendemic gets under control. A few days really matter when you're fighting a pendemic that double in size every 3 days.
      - jobigoud 7y ago
        Even before the lockdons went into effect the difference between Germany and France was puzzling.
- whycombagator 7y ago
  > A chart published by the NYT: Do you have a link to the source?
  - hjnilsson 7y ago
    https://www.nytimes.com/interactive/2020/04/21/world/coronavirus-missing-deaths.html https://www.nytimes.com/interactive/2020/04/21/world/coronav...
- hcknwscommenter 7y ago
  That chart is really hard to read. Am I supposed to take away that Sweden only has about 50 or 60 more COVID deaths than the official count? This seems hard to believe. These types of numbers don't tend to have that level of quality at this stage of a disaster. I guess time will tell.
  - gok 7y ago
    No it's even weirder; the gap implies that there are 50-60 fewer non-COVID deaths in Sweden than there would be otherwise since the pandemic began.
    - omgwtfbyobbq 7y ago
      I would chalk that up to people acting a little more conservatively because of COVID-19, even if there isn't a lockdown.
    - michael-ax 7y ago
      Which isn't weird at all - if you trust that people avoiding crowds also lead to fewer having the accidents which would otherwise have gotten them dead.
      - ajross 7y ago
        Or prevents them from contracting any other disease that would have otherwise killed them. In fact even these numbers are undercounts of the "true" death total due to the pandemic, as we'd obviously expect baseline deaths to have dropped significantly over the short term. How much is for the next generation of epidemiologists to argue about. But FWIW: Sweden is absolutely an outlier here, and given the choice between "Swedish reporting is fundamentally better" and "Swedish death counts are wrong in some banal way", I'll choose the latter. Say it with me everyone: we don't make risk analysis decisions on the basis of outlier data.
        henrikschroder 7y ago
        Mortality data and excess mortality data goes back decades, it's not like we suddenly started counting these things yesterday because of the coronavirus. For Sweden's death count to be wrong now, they would also have to have been wrong going back decades, without anyone noticing. Or, the total all-cause death count would have to start being wrong about now because of unspecified reasons. That doesn't make sense.
- ajross 7y ago
  The excess mortality problem isn't about trust. No one has alleged that existing studied covid death numbers in Lombardy or New York or wherever are due to people lying. It's just that some people, in every health care system, end up dying without a test being done. It's certainly plausible that Sweden has been far more conscientious about testing unknown deaths (or testing at-risk people before symptoms, etc...). That doesn't say anything about their trustworthyness. FWIW, my money is on a bunch of these cases being discovered in Sweden too, they just didn't show up in the check the Times did. Epidemiology is just hard, and there are no magic tricks to play with the science.
  - kenneth 7y ago
    Pretty hard to hide excess death. That's precisely the point of this chart. You can miscount Covid deaths, but it's pretty hard to miscount deaths overall unless there's a fraudulent cover-up. Deaths are all recorded and tracked. Bodies don't just disappear.
- SilasX 7y ago
  It would probably help to state the unexplained difference as a percentage of official C19 death count (and narrow the columns). I took the liberty: | % | excess | official| unexplained Location | extra | death# | C19 d# | difference% -------------------------------------------------- Spain | 66% | 19,700 | 12,401 | 59 England | 33% | 16,700 | 10,335 | 61 NYC | 298% | 17,200 | 13,240 | 30 France | 21% | 10,500 | 8,059 | 31 Holland | 33% | 4,000 | 2,116 | 90 Istambul | 29% | 2,100 | 1,006 | 109 Jakarta | 36% | 1,000 | 84 | 1071 Belgium | 25% | 2,300 | 1,632 | 43 Switzer. | 21% | 1,000 | 712 | 42 Sweden | 12% | 1,100 | 1,160 | -4
- arel 7y ago
  Couldn't you in fact make the opposite case? Sweden as the outlier is not reporting accurately and others are? The UK has seen huge excess mortality above the average which is being attributed to large numbers of undiagnosed deaths in care homes and in the community. Its far too early to make any claims as to superior accuracy when almost every country is struggling with accurate testing across their entire population. In which case you'd expect Swedens numbers to get revised strongly upwards. Sweden also has no conclusive sign of flattening yet.
  - tinus_hn 7y ago
    The total number of people that have died on a certain date is not going to be revised, why would it be? The excess is that number minus a historical average which will also not be revised.
    - arel 7y ago
      Because of the huge amount of excess deaths that get assigned as probable covid cases. This is happening right now in the UK.
  - henrikschroder 7y ago
    > Sweden as the outlier is not reporting accurately and others are? Huh? If a country is in lockdown, and still experiences excess mortality, but the official covid-19 deaths aren't enough to cover that excess, then.... what the hell did people die of? The expectation is that because of lockdown, the excess mortality from non-covid-19 causes should be lower than previous years, and therefore all the actual excess, and probably more, is attributable to covid-19. Which means that countries where the official covid-19 number is lower than excess mortality, like the UK, are underreporting, while countries where the excess mortality matches the official covid-19 number, like Sweden, are not underreporting.
    - mhandley 7y ago
      I don't think you can assume that non-covid-19 causes should be lower than previous years. For example, the main cause of deaths in normal years is cardiac problems. If Covid-19 is discouraging people from seeking help, and especially from going to the emergency room when they they think something might just possibly be wrong, then you can get a big increase in cardiac deaths.
- below43 7y ago
  The excess UK deaths linked to coronavirus are likely to be currently around 43,100. For an explanation see: https://www.ft.com/content/67e6a4ee-3d05-43bc-ba03-e239799fa6ab https://www.ft.com/content/67e6a4ee-3d05-43bc-ba03-e239799fa... For today's latest numbers see: https://twitter.com/ChrisGiles_/status/1252983884284821505 https://twitter.com/ChrisGiles_/status/1252983884284821505
- pvaldes 7y ago
  The spanish case is interesting. Must be noticed that the virus hit particularly hard in the retirement homes that contribute to 12.000 of the 20.000 deaths. Some elder in retirement homes weren't hospitalised. Some people say that their parents were "rejected" by hospitals (non belonging to a prioritary group). We breath a dense fake news atmosphere in any case, so this part can be wrong. Not all people that died in retirement homes this weeks died by coronavirus necessarily. Retirement homes can not and are not designed to provide real medical care. This part has failed clearly. Some of this people could have been saved in normal circumstances. Specially if the retirement homes were more transparent about numbers and the people would had a clear protocol to follow. Another special circumstance of Spain is that we are one of the countries with more life expectancy. We have lots of elder people, therefore much more people by million falling in a high-risk category. I don't see anybody explaining that in the news, but surely must have some statistical effect. Maybe we should start adding to the charts a category of people killed by million of people over 65yo. This mean also than some countries in Africa (or Brazil) could go through this problem "relatively unscathed", just because they have lots of children and young adults. Same with poor US states that could behave different than rich states in this sense. Only time will tell us.
- DavidVoid 7y ago
  Reddit user /u/Anaemix made a nice graph of the Swedish stats [1]. Döda per dag translates to deaths per day. [1] https://i.imgur.com/oXyrncm.png https://i.imgur.com/oXyrncm.png
- abacadaba 7y ago
  Could reduced deaths from driving etc. also be significant in this analysis?
- robhunter 7y ago
  Do you have a link to this?
- misun78 7y ago
  Super interesting, thanks. Do you know if anyone has graphed the excess mortality on a month by month basis? That data would be invaluable in understand the timelines of actual spikes in excess mortality, irrespective of covid-19 testing and diagnosis. For example, did it spike up in March in NYC compared to Jan or Feb?
  - viceroyalbean 7y ago
    The New York Times article mentioned has more complete data, including the graphs you want. https://www.nytimes.com/interactive/2020/04/21/world/coronavirus-missing-deaths.html https://www.nytimes.com/interactive/2020/04/21/world/coronav...
juiyout 7y ago
> We are in the middle of the epidemic and, in my view, the science shows that closing schools at this stage does not make sense. You have to shut down schools fairly early in the epidemic to get an effect. Could anyone shed some light on why Sweden chooses not to close down schools fairly early?
- deleted 7y ago
  [deleted]
vondur 7y ago
On the face of it, the numbers don't look too good for Sweden. Compared to the Los Angeles area (LA county and Orange County) we see 1937 deaths in Sweden vs 697 in the LA Area. The population is also about 18% higher in the LA area vs all of Sweden. We are assuming the numbers reported in the LA area are accurate, which they may not be.
- Ma8ee 7y ago
  I don’t think these kind of comparisons are meaningful until we are out of it. It all depends on exactly when the outbreaks started at the different places and what the long term infection rate will be.
  - rolandog 7y ago
    These uncoordinated set of strategies by different countries seem to me like battles in RPGs; Sweden's probably opting to take less economic damage and instead take a x2 damage on health points. The Netherlands is switching strategies, thinking that Sweden's strategy is cool, but they're dipping their toes first by sending in teachers and children to see if they take a great amount of damage.
    - microtherion 7y ago
      > Sweden's probably opting to take less economic damage In all the discussion so far, I haven't seen any documentation of just how much "economic damage" the various countries are taking. I suppose there is little such data at sufficiently fine granularity to compare internationally. It's entirely plausible that Sweden's voluntary measures vs other countries' stricter approach don't make as much economic difference as many people seem to take for granted.
    - Ma8ee 7y ago
      My impression is that they actually haven’t considered the economy much at all when they have decided the strategy. More important is that that the strategy is feasible in the long run. You can close everything for a few weeks, but this is going to continue for many months still, maybe even years. Also, the social costs of isolation must also be taken into consideration. All the kids where the school is the only stable point in their life. Domestic abuse, alcohol and drug abuse are all going up a lot when people are isolated.
divan 7y ago
Is it just me or his answers are super vague and uncertain? I've expected some irrefutable arguments and unshakable confidence, but it's mostly "I think", "I [don't] believe" and "hard to know". Zero proofs or data, mostly his opinions.
- Entalpi 7y ago
  Well, its an informal interview. As the dude say, in the mornings they review data and do an analysis with experts.
- glofish 7y ago
  everything is an opinion and estimate at this point - the transmission rates in the population with respect of their way of living, the sensibility to infection of different ages, races etc I salute Sweden for not giving in to the lockdown hysteria and trusting that people can and will act cautiously without the threats and mandates.
- CuriousSkeptic 7y ago
  Perhaps a cultural difference. Swedes tend to respect a bit of humility. Especially if you can pull it of with confidence ;) To us Americans f.ex. can seem way to confident and boasting. If I generalize a bit. At the extreme we have things like this https://en.m.wikipedia.org/wiki/Law_of_Jante https://en.m.wikipedia.org/wiki/Law_of_Jante
golemiprague 7y ago
There are so many parameters that even in a year from now we will never know what is the best way to deal with it. Different way of measurement, different amount of measurement, different quality of measurement, different population density country wide and in the cities, different culture when it comes to adherence to government directions, different culture of "touchiness", different culture of how much you meet your family and friends, different weather, different exposure to people from other countries, different strain of the virus. That's just off the top of my head, I am sure there are more. It actually starts to make me wonder also about global warming, not about the warming per se but about predicting the outcome of it all many years from now and the assumption there is only one way to deal with it.
kqr 7y ago
One thing is missing from this discussion that needs to be understood: the Swedish government and related agencies generally do not do things based on common sense. This may sound ridiculous, but in most cases, it's not. Common sense is wrong so often. The view of the Swedish government is that they are not more intelligent than the citizens. Unless things can be scientifically proved, the individual rights of citizens should not be restricted. This permeates a lot of public policy in Sweden; I recently had reason to investigate to what extent maternal/neonatal care followed the best of our scientific knowledge and it was extremely close. If you think that's a given, think again. Many countries base their maternal/neonatal care on common sense and old wives' tales instead. Both approaches are valid, but they are different. With policy based on common sense, you accept that you occasionally (often?) force something wrong on the public, potentially against their better knowledge. With policy based on strong evidence, you are more rarely wrong, but you also get way fewer opportunities to force things on the public, simply because there are so few things we truly know to be true. Doubly so during a novel pandemic.
- tpmx 7y ago
  [Am Swedish and not a fan of the current policy] This evidence-driven decision making process (which is indeed the default here) works remarkably well when things are moving slowly. It kills bullshit beautifully. This is normally something I'm quite proud about. However, it breaks down so badly when you're suddenly facing a one in a hundred years pandemic and you can't act decisively 3-4 months into the pandemic because there's no evidence yet. Sweden is "peace-damaged". We haven't really had to deal with any national-level crises the since the spanish flu about 100 years ago. The last war was in 1814. 500 soldiers died. Note that the above mostly applies to national governance - this is the stuff that really gets set into code and culture over time. At a local e.g. hospital/research unit/private company level, there's fantastic innovation happening on a daily basis, just as in the rest of the world.
  - davidw 7y ago
    This whole thing is kind of like driving a car, except that when you turn the steering wheel, nothing happens, and then two weeks later the wheels start to turn.
bigf4k332 7y ago
protip: none of you commenting know shit about anything health related so shut up you are turning this into a dystopia there were 34k deaths last year of 'flu' and we are at 46k this year, of course - that is if you believe the numbers which are FALSE
bigf4k332 7y ago
covid is scam! OPEN THE COUNTRY!
zwaps 7y ago
I do like the reliance on the high trust society in Sweden, but I also feel like a wider circle of experts could be consulted for such a decision. Even if it may not be a good model of human behavior, it's sometimes useful to consider "rational behavior" - if only to judge the resilience of certain mechanisms. In this case, "social" behavior is in a sense very altruistic. If I am young and healthy, recent media reports (accurate or not) would suggest that limiting myself to staying inside, practicing more hygiene and such, is costly but doesn't significantly reduce my own risk. At the same time, isolating risk-groups may not be sufficient, and younger people may genuinely be at risk. So, it would be desirable if everyone practices social isolation. If that is true, social behavior is a collective good: The more people stay inside, the easier it is for myself to go outside and, say, enjoy the sun in a park or have fun in a club. Thus, my incentives are not aligned with the goals of these recommendations. And if everyone thinks that way, social distancing will not be achieved in a "decentralized" fashion. Indeed if everyone is that rational, such a decentralized but workable "recommendation" does not exist. Now, I stress that people do not fit this model, especially in Sweden. But in situations of anonymity, e.g. with many people involved, it has sometimes proven useful to check the robustness of one's decisions against the case where people act rationally. In that case, laws and regulation do make sense.
EmilioMartinez 7y ago
Each nation's strategy seems to come about due to its very specific circumstances. Leaders will defend (to death) their bullshit ideologies and false securities, and stick to a plan made in the heat of the moment. Perhaps this mechanism is the great randomizer that ensures that every combination is tested, some risk distribution strategy.
int_19h 7y ago
This is one of those cases where a single day in the media cycle makes for a very big difference: https://www.forbes.com/sites/davidnikel/2020/04/22/sweden-health-agency-withdraws-controversial-coronavirus-report/#6b6795114349 https://www.forbes.com/sites/davidnikel/2020/04/22/sweden-he...
jnbiche 7y ago
I don't understand why certain media are lauding Sweden's strategy. It's not succeeding by any objective standard. For example, if you filter out tiny countries like Andorra (which result in statistical aberrations), Sweden has the 5th highest death rate in the world (per million population). And it's increasing, having gained several spots in the past 5 days. It may turn out be that Sweden's right in that closing borders, schools, and businesses doesn't have much of an effect, although there's significant evidence for the effectiveness of closing schools in respiratory illnesses. But Sweden's strategy is not working as a public health strategy.
- seunosewa 7y ago
  If they had sufficient testing and encouraged the use of face masks to slow the spread, it would probably have worked.
pengaru 7y ago
This was the most sane and reasonable thing I've read about handling the pandemic, and I'm super bummed it's not regarding my home country.
newcrobuzon 7y ago
Sweden is starting to see sharp increase in daily deaths - 172 yesterday and 185 the day before - which for a country of 10 million is a lot. For instance Czechia with roughly same population introduced lock down very early on and now their total is 210 - while Sweden's is 1937...
- tome 7y ago
  Where are you getting those numbers from? They're much higher than suggested by this graph: https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_Sweden#History https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_S...
DeathArrow 7y ago
I think Sweden did it wrong, valuing the economy more than the lives of people. I think there are some political ideologies at work, but I don't want to get into these. In my country we have 3x less cases and 8x less deaths per million people. I do think that quarantine payed off. We can recover the economy but we can't recover lives.
DeathArrow 7y ago
It was a cynical decision, disguised as "we don't want to impact people's freedoms" and "we follow the scientific truth". Sweden's progressive government hates older people which they perceive as more conservative. So they decided to let them die. If the epidemy would affect younger people as much as older people, Sweden would take the same actions other countries had and limit the number of deaths.
- SahAssar 7y ago
  Are you seriously saying that the government is on purpose making their strategy kill old people? Because that is some grade-a conspiracy paranoia.
buboard 7y ago
While their strategy seems to not have led to disaster, it's not certain whether one would call it success. Shutdowns clearly didnt work well in some countries (france,spain,italy,uk) but they seem to work well in most eastern europe countries and germany. People are not being infected at large . Some of his remarks are generally questionable and worth a second thoughts > Closing borders, in my opinion, is ridiculous, because COVID-19 is in every European country now. There are many countries with very few COVID cases, and some of them are summertime destinations for swedes (like greece). It's certainly dangerous to open borders with a highly infected country like sweden without rigorous checks. Europe is big. > Each country has to reach ‘herd immunity’ in one way or another Not all countries are looking to get there fast. In fact countries that delay the spread are hoping for a potential cure/treatment that will make herd immunity much less painful. Herd immunity isnt even necessary - plenty of diseases don't need immunity/vaccines. Also, while it's nice that sweden chose a relaxed, voluntary approach, the lockdown measures have wide support in many countries. He s right that governments should be measuring the impact of measures though. Sweden should be doing so too, it would be very useful to know which are the most important infection routes, now that other countries are opening up
mamon 7y ago
So far the net result of Sweden's strategy is that they have 2,021 coronaviris deaths, more than 4x more than Poland, which also has almost 4x bigger population - so Sweden has 16x more deaths per 1M of citizens than Poland.
mensetmanusman 7y ago
Sweden’s approach is an optimization of how to respond to the epidemic and how to respond to the general life disruption. The optimal response to the epidemic is everyone stays in their house for 1 month with no human contact. In that scenario, the virus is stopped and everyone dies because no one works the food chain, etc. The world’s current response is heavily weighed towards optimizing the response toward the epidemic, but the potentially fatal assumption to this approach is that a vaccine will soon be developed. If a vaccine is not soon developed, the same amount of people will still get sick, people will still die, but additional people will die due to life disruption.
option_behavior 7y ago
It will be interesting checking back in 2-3 years and evaluating the efficacy of approaches by different countries. As referenced in the interview, each country has to eventually reach herd immunity. For the majority of the world this will be when 60-80% of the population has antibodies through the natural spread of the virus. Assuming healthcare systems are not at overcapacity, our resources will best be spent protecting at risk groups. These are mainly old people, given that the average life expectancy of those who have died is just over a decade. I'm confused why so many people are extraordinarily emotional and passionate about shelter-in-place. We should be focused on increasing healthcare capacity, and more importantly securing the safety of at-risk populations which are primarily composed of old people. This is where honest and effective communication over the objective risks for different groups is essential. If you are under 30 with no pre-existing conditions, the odds of dying are < 1/100,000. The numbers are commensurately promising for those without underlying health conditions in their 30s, 40s, and even 50s. It is silly to prioritize shelter-in-place going forward, across most of the developed and developing world. The costs are tremendously high, as we actually want most relatively young and healthy people to be exposed to the virus to protect at-risk populations. There was even a recent study published that revealed if we intentionally infected young and healthy people, death rates from C-19 would nearly halve. A solution could turn out to be staggering payments to very low risk groups to get infected, taking into account people's various living situations. Unfortunately, I think most governments would prefer 2x,3x,4x, etc. death rates over paying people to infect themselves. I believe many people will look back and admire the Swedish model for their practical and effective approach. Excessive shelter-in-place has tremendous costs, with minimal benefits once healthcare systems are stabilized. Hopefully nations around the world accept this reality and act accordingly.
eveningcoffee 7y ago
There is no controversy. They just messed up and are now saving their faces blabbing about herd immunity and hoping that the spread will stop magically. I do not have hopes up yet.
butler14 7y ago
"We are in the middle of the epidemic" I'd love to know what metric he's basing that statement on
- bigf4k332 7y ago
  "pandemic" is liberalism for "i'm going to fuck your economy over until you give me what i want" liberalism is the real pandemic
- prophesi 7y ago
  That's probably the least controversial statement in the interview.
  - erikrothoff 7y ago
    Curious to hear what you think were the most controversial statements were?
    - butler14 7y ago
      "Closing borders, in my opinion, is ridiculous, because COVID-19 is in every European country now" has to be up there Closing borders seems like a perfectly reasonable step for a great many countries. Particularly those that are vastly more connected via land-based mass transit (often directly into cities that have higher populations than the entire country of Sweden)
      - Zenbit_UX 7y ago
        Ironically, if all other borders are closed around you, then yours are effectively closed too.
        Lewton 7y ago
        Interestingly enough, you're wrong. Denmark has closed it's border But Danes can go to Sweden, because Swedens border are open. And while Denmarks borders are closed, danes are always allowed to return home. Quite a few irresponsible danish people are going on vacations in Sweden these days
etrevino 7y ago
I'm an American, so the usual caveats apply, but I think more should be made of this statement from the interview: "The Swedish laws on communicable diseases are mostly based on voluntary measures — on individual responsibility. It clearly states that the citizen has the responsibility not to spread a disease. This is the core we started from, because there is not much legal possibility to close down cities in Sweden using the present laws. Quarantine can be contemplated for people or small areas, such as a school or a hotel. But [legally] we cannot lock down a geographical area." If we take that as a given then the approach used in, say, Italy isn't doable. Why not put that out there and let there be a public debate about the issue? Is there a sense that this isn't the time? Maybe there is a debate. I'm not exactly in touch with Swedish politics, so if someone knows, I'd love to hear about it.
- tomcooks 7y ago
  > I'm an American, so the usual caveats apply What do you mean with usual caveats?
  - etrevino 7y ago
    Just that since I don't live there and know the society/culture I may be asking a dumb question. I probably should have said something like "I don't know much about Sweden, so I'm asking from a position of genuine ignorance."
    - tomcooks 7y ago
      Ah thanks, I assumed it was an HN inside joke and I was a bit lost Cheers
- ilamont 7y ago
  That quote stood out to me, too. It's hard to lock down an area in the U.S., too, but some states and cities have enacted nonessential business, school, and transportation closures that have been quite effective at flattening the curve without a geographic quarantine. Maybe another question to ask: Can Sweden enact emergency facility and public transportation closures for other reasons? For instance, for a flood or some other disaster?
jon889 7y ago
It sounds exactly what the UK was going to do until Imperial released a report that said it wouldn’t work.
- jeltz 7y ago
  For now Sweden has slightly fewer deaths per capita than the UK, so their last minute change does not seem to have helped much. While I was and still am in favor of a harsher lockdown the Swedish strategy does not seem to perform that badly. There are countries with harsh lockdown doing both doing way worse and way better, so other factors may matter more.
  - jon889 7y ago
    I think the reason for that is that British people are less trusting of the government and will generally ignore rules if it doesn’t make sense to them unless they’re mandatory. Even the prime ministers dad said he’d still go to the pub just before the lockdown.
- dijit 7y ago
  And Anders "debunked" imperials study because it was not yet peer reviewed[0]. While continuing with his "Scientific" gut feeling. (No, I'm not making any of what I said up or being hyperbolic[1]) The serious lack of testing and fact that many doctors are saying they cannot attach COVID-19 as a cause of death unless it is a direct cause and has been tested for, give me pause to the numbers Sweden is putting out.[2] Since if you arrive to the hospital already dead then they will not "waste a test" on you confirming cause of death. I would much rather look at the Swedish death rate comparative to last year instead[3] [0]: https://www.theguardian.com/world/2020/mar/28/as-the-rest-of-europe-lives-under-lockdown-sweden-keeps-calm-and-carries-on https://www.theguardian.com/world/2020/mar/28/as-the-rest-of... [1]: https://twitter.com/bjornsing/status/1252888065959436288 https://twitter.com/bjornsing/status/1252888065959436288 [2]: https://www.thelocal.se/20200414/understanding-swedens-figures-on-the-coronavirus https://www.thelocal.se/20200414/understanding-swedens-figur... [3]: https://www.scb.se/en/finding-statistics/statistics-by-subject-area/population/population-composition/population-statistics/ https://www.scb.se/en/finding-statistics/statistics-by-subje...
starvingbear 7y ago
Some countries in martial law some shut down a massive portion of their economy. The controversial approach is relying on individual citizen responsibility. Fascinating times
- ajsnigrutin 7y ago
  If it was something that affected only those individuals, noone would care. The problem is, that someone else can be irresponsible, and you die because of that.
  - Zenbit_UX 7y ago
    Yes, we all get that, it's been rammed down our throats for months.
  - FpUser 7y ago
    Why is that suddenly a problem? We always had it. Most people posing danger to others in one or the other way. Driving a car is the most obvious example but there are countless other
    - matthewdgreen 7y ago
      That's why we have drivers' licenses and manslaughter charges for negligent homicide. We don't just shrug our shoulders at the risks.
      - SpicyLemonZest 7y ago
        We take reasonable, targeted measures to mitigate the risks. What we don't do is embark on a grand social program to eradicate freeway crashes, because such a program would involve banning or heavily restricting cars and we feel cars are too important for that.
        ajsnigrutin 7y ago
        But we do just that. Every car has to pass a bunch of certifications to be legal to drive on the road. It has to pass a (4-, 2- or 1-)yearly checkup, has to be registered, insurance has to be paid, road tax, etc. Also the driver has to pass a theoretical and a practical exam, has to be of certain age, not be under influence of any of many substances, has to obey a bunch of traffic laws, etc. And we also have check for all that, from police controls, to speed cameras, alco-testers, etc.
alfiedotwtf 7y ago
My money is within a month Sweden going into full lockdown, and regretting their decision. If it weren't for the states closing down here, Australia's death toll could have been much worse given the Federal wanted to keep everything open.
- D_Alex 7y ago
  I agree. It seems extraordinarily risky to let another disease spread among the world population. - What if there are long term effects? - What if it becomes a seasonal disease? - What if the next mutation is more severe? Each country should b a good global citizen, and put in its best effort to make sure the spread is as limited as possible.
- DavidVoid 7y ago
  The mortality rate has been stable for a while now so I doubt that that will happen any time soon [1]. If people in Stockholm don't follow the recommendations then they might set up some more restrictions though. [1] https://i.imgur.com/xJ16VGd.png https://i.imgur.com/xJ16VGd.png
- Hurdy 7y ago
  People have been saying that about Sweden for a long time. My money is on all other countries doing something closer to the swedish model when the next wave hits in winter.
  - gvjddbnvdrbv 7y ago
    Why do you think the next wave will be in the winter?
    - baq 7y ago
      not OP but: 1) there won't be a vaccine - even if there will be, you won't be able to vaccinate everybody 2) the virus spreads fast but due to lockdowns not fast enough for herd immunity to prevent spread 3) lockdowns will be relaxed when new cases stop being found 4) all of it assuming immunity lasts for a few years, which it should, but it isn't a certainty 5) 3) will lead directly to asymptomatic cases causing flare-ups a few weeks after lockdowns are relaxed (see Singapore, Japan) 6) if 4) isn't true, we're toast
notacoward 7y ago
When a future article is written about the dangers of being contrarian to get attention, that same picture of Anders Tegnell will be just below the headline. His parents should have spent more time with him.
- dang 7y ago
  Please don't post nasty, empty things to HN. We've already had to ask you not to do this kind of thing. Maybe you don't owe Swedish epidemiologists in Nature any better, but you owe this community better when you're posting here. Please stick to https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html.
  - notacoward 7y ago
    > We've already had to ask you not to do this kind of thing. When did it become HN policy to cherry-pick long ago examples from among a plethora of highly-regarded comments like that? Pretty clearly other users think I've paid any debt to this community since whatever incident you're referring to (and I don't remember any) many times over. Bringing it up like this seems pretty empty and nasty in itself.
  - deleted 7y ago
    [deleted]
matwood 7y ago
Some southern states are about to try the same strategy so we'll see how it works out.
thawaway1837 7y ago
The whole thing is clearly an attempt at a graceful exit. The original strategy was herd immunity. The argument being made was that Sweden was gonna get infected anyways, so better to get it out of the way sooner rather than later, while protecting the at risk. And this would reduce economic harm as well. However, the Swedish decision makers seemed completely unaware of asymptomatic carriers, which led to the at risk (largely old people) being heavily exposed anyways due to the asymptomatic younger workers around them infecting them. Further, the Swedish people, reflecting normal human behavior, shut down economic activity anyways. The result was a slight linear short term economic benefit but an exponential, potentially long term, downwards public health situation whose economic effects itself will likely dwarf the direct economic benefit anyways. So now that their plan has failed both in concept and execution they are changing their story saying that it was a Swedish cultural thing, where they trusted individual Swedes to take personal responsibility, because of the exceptional Swedish character.
- tinus_hn 7y ago
  There are a number of options: * lockdown until there is a vaccine or treatment * slow down the spread * do nothing A vaccine or treatment is at least half a year away so unless your country is exceptionally rich the first option is not feasible. Slowing down the spread can help making sure the demands to healthcare are met. This is not an issue in Sweden. It can help because treatment right now is better than treatment a month ago. And in theory at a certain moment there might be herd immunity. Or there may not be. Ultimately either a large amount of people or everyone will get ill anyway and then they will get better and immune or die. Doing nothing means a lot of people get ill and then get better and immune or die and the country keeps running. Sweden chose the last option because the first option is not realistic and the advantages of the second option are, in their opinion, not worth it. In my opinion this is at least a defensible position to take. If a country does not have enough healthcare capacity the second option has to be chosen for as long as necessary. The first option, barring exceptional circumstances (your country is a self sustaining island that can handle losing all tourism and trade) is not viable. I’m not sure what you mean by a downwards public health situation whose economic effects will dwarf the direct benefits. It’s terrible if a lot of old people die but realistically the economy will get over it rather quickly.
chasd00 7y ago
go here and scroll down to Cases by Country, normalized by country population then highlight Sweden. Across the different metrics Sweden seems to be doing about average. http://91-divoc.com/pages/covid-visualization/ http://91-divoc.com/pages/covid-visualization/ here's projections for Sweden but given how wildly these projections have fluctuated i'm not sure how valuable it is https://covid19.healthdata.org/sweden https://covid19.healthdata.org/sweden
- f38zf5vdt 7y ago
  Cases are a poor metric because they're a function of per-capita testing, which is variable across nations. You have to go by deaths. In that case you can see that they're much worse than their neighbors Norway and Finland, and that they're closer to regions with catastrophic death rates like Switzerland. The earlier lockdown measures are imposed, the greater the impact, hence the comparatively excellent numbers from Finland. Sweden has long held denial of asymptomatic transmission (especially by Tegnell, even in this article), which we've learned is categorically wrong. The IHME model has been considered notoriously optimistic, as the US number of deaths has been rising but the US peak is reported as 1 week ago. The IHME model assumes a full lockdown in the US until August, which has already been violated by a number of US states this week.
  - deleted 7y ago
    [deleted]
  - yoden 7y ago
    To back this up with some data, this article has information about tests per capita: https://www.thelocal.se/20200414/understanding-swedens-figures-on-the-coronavirus https://www.thelocal.se/20200414/understanding-swedens-figur... If Sweeden had been testing at the rate of Norway or Germany, they would not be in the middle of that cases per capita graph. This is despite Sweeden's infection growth being ~15 days behind Italy's, e.g. enough time for a lockdown to have almost entirely prevented it. So it seems clear that Sweeden's policies have made infections worse. The questions that remain are: 1) Will their peak infection rate go over hospital capacity? 2) Will they have economic benefits from having population immunity faster?
epr 7y ago
Is there a pronounced difference between coronavirus cases in Sweden vs neighboring countries? On a per population basis I'm seeing very similar numbers (links below). Anecdotal evidence is one thing, but these charts don't seem to tell that story. That being said, it's unclear to me the degree to which coronavirus statistics provided by different countries can be compared meaningfully, or if this is an apples and oranges situation (for any number of reasons). https://www.worldometers.info/coronavirus/country/sweden/ https://www.worldometers.info/coronavirus/country/sweden/ https://www.worldometers.info/coronavirus/country/norway/ https://www.worldometers.info/coronavirus/country/norway/ https://www.worldometers.info/coronavirus/country/finland/ https://www.worldometers.info/coronavirus/country/finland/ https://www.worldometers.info/coronavirus/country/denmark/ https://www.worldometers.info/coronavirus/country/denmark/ Population numbers: Sweden: 10.2 million Norway: 5.4 million Finland: 5.5 million Denmark: 5.8 million
- joshuahedlund 7y ago
  Cases are an unreliable metric because Sweden has done less testing per capita than Norway/Finland/Denmark. However, its deaths per capita is notably higher (and rising - from 14th global rank to 10th in the last couple weeks) Sweden: 192 per million Denmark: 66 per million Norway: 34 per million Finland: 27 per million
  - epr 7y ago
    That does not look good for Sweden. I was just thinking that it would be interesting to compare total deaths per year for 2020 at years end to eliminate differences in methodology. It's a crude measurement, but if the coronavirus death toll becomes large enough compared to total population then it should give us a general idea considering how slowly death rates change in general. That could at least point us to who did things right, and hopefully some guidance for future policy.
    - epr 7y ago
      Hold that thought. They probably have deaths by week already.
salimmadjd 7y ago
There is a lengthier interview by UnHeard with Professor Johan Giesecke (another experienced epidemiologist) of Sweden on YouTube [0]. It’s worthwhile listening to their perspective. One of the comments he made was that no lockdown would work in democratic countries and the real test will be fatality rates between Sweden and others in 1 year. He believed it’ll be very little difference between those countries that have implement the lockdown and those that haven’t I had watched the simulation of covid19 infection by 1blue3brown[1] and some of his modeling appeared to me (maybe I misunderstood them) to confirm Swede’s point of view. Ultimately the same number of people got infected albeit in a “flatter” rate. However one counter point by Johan Giesecke was that these flattening the curve is motivated by the assumption of a static capacity of ER rooms to deal with this pandemic and he pointed out they have increased capacity. Overall I found listening to his side very informative, at least it gave me a different view of looking at from their view. [0] https://youtu.be/bfN2JWifLCY https://youtu.be/bfN2JWifLCY [1] https://youtu.be/gxAaO2rsdIs https://youtu.be/gxAaO2rsdIs
- f38zf5vdt 7y ago
  With such an enormously high r0 as currently predicted, completely stopping the virus once firmly established is an impossibility, but many examples e.g. Finland and Korea have shown that you can seriously reduce infections and deaths. There's no reason a lockdown followed by extensive testing shouldn't work, and indeed it _has_ worked in countries such as Korea and Taiwan. In fact, it worked in Hong Kong and Canada during the original SARS epidemic. There has to be a willingness to act early and responsibly, closing your borders, attempting to isolate highly infected areas, and slowing the spread of the disease as you dramatically ramp up testing. It seems as if the Western world has complete amnesia of previous events like SARS and is throwing caution to the wind as they assert that nothing could have been done to prevent this.
  - hcknwscommenter 7y ago
    It's a policy choice to allow all of the reaction to work through the private sector instead of just deploying a national response strategy. In the U.S., the CDC tried to take the lead on testing (good) and essentially banned any other testing infrastructure (bad) and fell on its face with contamination issues (very bad), and pivoting to opening the testing infrastructure was a good policy choice. But the real answer has always been: DO BOTH. The CDC could be doing a million tests a day right now. Why don't they? It's madness.
wannabag 7y ago
I live in Stockholm, Sweden, so while I acknowledge my bias I'd bet my money on the fact that other countries will change their approach rather than Sweden starting to follow others. While there are some undeniable social (think multiple generations in a household), geographical and cultural (swedes are notorious in keeping their distance from other swedes) differences at play here, other European countries have gone for a "people can't be trusted so we must restrict individual freedom". While there is certainly some good reasons to think that this will work the means used to implement this have some really sad consequences. Look at France, people are getting fined and in some cases brutalized; protests are sparking in places where strict measures have been implemented, not because they are unfair but because they affect people unfairly! Easy for well-off people to "leave early, far and for a long time" but far from everyone has that luxury (oh if you understand French, check out Twitter on the "lockdown diaries" parodies and compare that to how people in the suburbs of Paris are being treated!). This is without even starting to talk about how the economic impacts will be spread amongst social classes. To me Sweden has chosen the most socially (in this case as opposed to morally) fair route to handle this crisis. That being said, it's morally very difficult to defend this strategy in the face of a higher death toll amongst seniors in care homes. I cannot come up with a single argument that I don't know will get shot down immediately and that is a good sign that it's probably not morally optimal. We live in a time of humanism and human life comes first, rightly so but even with that said, it shouldn't hide the picture and justify every consequence out there. The approaches in many countries are incredibly reactive and short sighted in that regard.
- logicchains 7y ago
  >That being said, it's morally very difficult to defend this strategy in the face of a higher death toll amongst seniors in care homes. I cannot come up with a single argument that I don't know will get shot down immediately and that is a good sign that it's probably not morally optimal. It's easier if rather than "lives saved", you look at "life years saved". In this sense, somebody in their 80s who only has a couple of years left dying early is equivalent to the situation of a young adult being pushed into poverty by the lockdowns and never managing to recover a middle-class lifestyle, so they die a couple years earlier (I'm not sure about Sweden, but in English speaking countries poor people on average die a few years earlier). A 20-year-old commiting suicide due to sudden poverty, or depression from being locked inside, is equivalent to twelve 80-year-olds who have five years to live dying early.
russellbeattie 7y ago
Even if you assume 100% of the population will eventually be infected, the final percentage will have a much easier time and chance of recovery than the first ones because of what we've learned as time goes on, even without a vaccine. In fact, they're already learning better ways to treat the disease. The stupidity of saying, "We really can't do much right now, so fuck it" is unbelievably irresponsible. If you knew you were definitely going to get the virus, when would you rather it happen, right now or a year from now? Sweden is essentially saying it doesn't matter.
- war1025 7y ago
  > We really can't do much right now, so fuck it" For many people it's more of "I can take my chances relying on the government when I'm not allowed to work" or "I can take my chances catching a virus that is probably coming for me anyway" Locking down doesn't terribly help vulnerable populations. It's only advantage is that it keeps people who were less likely to catch it to begin with from catching it, and as a result reduces the hospital load. Here in Iowa the majority of outbreaks are either in nursing homes or meat packing plants. Locking down does nothing to help them. We could shut down the meat packing plants, but then we kill the food supply chain, which is a disaster for everyone. Nursing homes are basically sitting ducks no matter what. If it's a fire we can't put out except by letting it burn through, then our best choice is to open up to the point that we are burning at maximum capacity. Hospitals here are laying off workers because they aren't allowed to do anything except wait for a crash of Covid-19 patients that so far hasn't come. If the bottleneck is the hospitals like people have been saying all along, then hospitals being so empty they can't even pay their staff means we have gone to far.
  - kyawzazaw 7y ago
    Wouldn't a lockdown translate to limiting the nursing homes' exposure to the virus?
    - war1025 7y ago
      That's the theory, but it has proved pretty ineffective in practice. Nurses don't live onsite, so there is no actual way to seal the residents off from the outside world. Once it gets in you're no better off than had there not been a lockdown in place.

I really think this is a case of It is difficult to get a man to understand something when his not feeling responsible for the deaths of thousands of his country people depends on him refusing to understand it.

kenneth 7y ago

It's notable as well when evaluating Sweden's number is that they are far more trustworthy than most countries. One interesting metric is excess mortality. Some places have wild unexplained excess mortality from the statistical expectation, that isn't fully explained by reported Covid-19 deaths. This suggests that Sweden is reporting deaths far more accurately than other countries, so when we evaluate the relative success of their strategy, we should keep that in mind. A chart published by the NYT: Location | % extra | excess death# | official C19 d# | unexplained difference Spain | 66% | 19,700 | 12,401 | ~ 7,300 England | 33% | 16,700 | 10,335 | ~ 6,300 NYC | 298% | 17,200 | 13,240 | ~ 4,000 France | 21% | 10,500 | 8,059 | ~ 2,500 Holland | 33% | 4,000 | 2,116 | ~ 1,900 Istambul | 29% | 2,100 | 1,006 | ~ 1,100 Jakarta | 36% | 1,000 | 84 | ~ 900 Belgium | 25% | 2,300 | 1,632 | ~ 700 Switzer. | 21% | 1,000 | 712 | ~ 300 Sweden | 12% | 1,100 | 1,160 | ~ -50

K0nserv 7y ago
This table is missing Norway, Denmark, and Finland which would be the most interesting to compare Sweden to.
- goalieca 7y ago
  Sweden has a higher rate. The theory is that the bulge in death rate is bigger up front vs a prolonged one that continues for months. It will be interesting to see long term results. Sweden also seems to have the same problem with long term care homes that many other nations (France, Canada, etc) are having.
  - Ma8ee 7y ago
    I don’t think the up front deaths are in any way intentional. It’s very hard to compare strategies since there’s many other factors that control the outcome. Like Sweden had school holidays ending with a lot of people coming home from skiing in Italy just when the situation there exploded. And as you mentioned, the virus got into a lot of the nursing homes.
    - marvin 7y ago
      Just for reference, Norway's epidemic also started with a large influx of cases from Italy and Austria. But the countries have used different strategies from that point on.
  - marvin 7y ago
    Sad to say, I'm completely unsurprised that countries with rampant Covid19 spread have a lot of deaths in their retirement homes. It's practically deterministic. People are contagious in the pre-symptomatic or asymptomatic case. So all that's needed is that one employee of the retirement home gets sick and goes to work before they know, and the game is up. Dead patients everywhere. I'm sure this is discussed and considered on the highest levels of policy in the jurisdictions that have been the most proactive in getting a handle on the epidemic early, and missed in most others. I'm sure a strict face mask policy could have helped slow things down, but that's sadly been a hotly contested topic.
    - m4rtink 7y ago
      Many retirement homes here in Czech Republic have had the care takers voluntarily locking themselves up together with the people living there. Some have been there like this for many weeks, only taking in supplies in a safe way & communicating electronically. Thats some serious dedication & very prudent one, give all the tragic cases elsewhere.
- marvin 7y ago
  Sweden: 1,937 deaths. 50 fewer seasonal deaths than expected. Norway: 187 deaths. No increase in seasonal deaths. Denmark: 384 deaths. Seasonal deaths unknown to me. Finand: 149 deaths. Seasonal deaths unknown to me. Sweden has approximately twice the population of the other Nordic countries, so per capita they have between ~2.5x and ~6x the Covid19 mortality of their neighbors, who have stricter preventive measures. Honestly, I can't see how Anders Tegnell and his colleagues can sleep at night with the uncertainties they are powering through. By rights they should be terrified that they've gotten one of their assumptions wrong.
  - henrikschroder 7y ago
    Denmark has ~2.5x the per-capita covid-19 mortality of Finland, should Danish authorities be terrified that they've gotten their assumptions wrong? The UK has ~2x the per-capita covid-19 mortality of Sweden, should English authorities be terrified that they've gotten their assumptions wrong? You are cherry-picking like crazy! There is clearly no evidence that stricter measures have any effect. If that was true, then there should at least be a linear correlation between strictness of measures vs. excess deaths, and that's simply not the case. You're extrapolating a linear correlation using a couple of data-points that happen to support your theory, i.e. Sweden vs other Nordic countries. Sweden vs. all of Europe paints a completely different picture, so you're not looking at that, because you're cherry-picking. There are so many uncertainties around this whole situation, and I think the only thing we can say with certainty is that if a country has no or a low rate of excess deaths, that country is doing "ok". Not doing great, not doing shit, just doing ok.
    - EdwardDiego 7y ago
      > There is clearly no evidence that stricter measures have any effect Working for us in NZ, although I think the timing of our national lockdown is strongly significant to our success, we managed to do so before it was widespread in the community. Our new case rate is literally bottom of the FT Covid graph: https://www.ft.com/coronavirus-latest https://www.ft.com/coronavirus-latest And we have 50% the population of Sweden, and 0.72% the deaths. If we were to be per-capita equivalent with Sweden, we'd need about another 964 people to die.
- pvaldes 7y ago
  And Germany is another outlier
  - raphaelj 7y ago
    It looks like Germany put lockdown measures in place about a week earlier than France, Belgium or the Netherlands, if you compare the number of deaths at the time the mesures were enforced. Getting a lockdown in place a week earlier mathematically translates in a 4x reduction in deaths a few weeks later, which is more or less what we see when comparing France and Germany. Likewise the UK enforced the lockdown a few days later than France (proportionally to the state of the pendemic at the time of the measures), more or less like Spain. Looks like they are both heading towards 30k or 40k deaths until the pendemic gets under control. A few days really matter when you're fighting a pendemic that double in size every 3 days.
    - jobigoud 7y ago
      Even before the lockdons went into effect the difference between Germany and France was puzzling.
whycombagator 7y ago
> A chart published by the NYT: Do you have a link to the source?
- hjnilsson 7y ago
  https://www.nytimes.com/interactive/2020/04/21/world/coronavirus-missing-deaths.html https://www.nytimes.com/interactive/2020/04/21/world/coronav...
hcknwscommenter 7y ago
That chart is really hard to read. Am I supposed to take away that Sweden only has about 50 or 60 more COVID deaths than the official count? This seems hard to believe. These types of numbers don't tend to have that level of quality at this stage of a disaster. I guess time will tell.
- gok 7y ago
  No it's even weirder; the gap implies that there are 50-60 fewer non-COVID deaths in Sweden than there would be otherwise since the pandemic began.
  - omgwtfbyobbq 7y ago
    I would chalk that up to people acting a little more conservatively because of COVID-19, even if there isn't a lockdown.
  - michael-ax 7y ago
    Which isn't weird at all - if you trust that people avoiding crowds also lead to fewer having the accidents which would otherwise have gotten them dead.
    - ajross 7y ago
      Or prevents them from contracting any other disease that would have otherwise killed them. In fact even these numbers are undercounts of the "true" death total due to the pandemic, as we'd obviously expect baseline deaths to have dropped significantly over the short term. How much is for the next generation of epidemiologists to argue about. But FWIW: Sweden is absolutely an outlier here, and given the choice between "Swedish reporting is fundamentally better" and "Swedish death counts are wrong in some banal way", I'll choose the latter. Say it with me everyone: we don't make risk analysis decisions on the basis of outlier data.
      - henrikschroder 7y ago
        Mortality data and excess mortality data goes back decades, it's not like we suddenly started counting these things yesterday because of the coronavirus. For Sweden's death count to be wrong now, they would also have to have been wrong going back decades, without anyone noticing. Or, the total all-cause death count would have to start being wrong about now because of unspecified reasons. That doesn't make sense.
ajross 7y ago
The excess mortality problem isn't about trust. No one has alleged that existing studied covid death numbers in Lombardy or New York or wherever are due to people lying. It's just that some people, in every health care system, end up dying without a test being done. It's certainly plausible that Sweden has been far more conscientious about testing unknown deaths (or testing at-risk people before symptoms, etc...). That doesn't say anything about their trustworthyness. FWIW, my money is on a bunch of these cases being discovered in Sweden too, they just didn't show up in the check the Times did. Epidemiology is just hard, and there are no magic tricks to play with the science.
- kenneth 7y ago
  Pretty hard to hide excess death. That's precisely the point of this chart. You can miscount Covid deaths, but it's pretty hard to miscount deaths overall unless there's a fraudulent cover-up. Deaths are all recorded and tracked. Bodies don't just disappear.
SilasX 7y ago
It would probably help to state the unexplained difference as a percentage of official C19 death count (and narrow the columns). I took the liberty: | % | excess | official| unexplained Location | extra | death# | C19 d# | difference% -------------------------------------------------- Spain | 66% | 19,700 | 12,401 | 59 England | 33% | 16,700 | 10,335 | 61 NYC | 298% | 17,200 | 13,240 | 30 France | 21% | 10,500 | 8,059 | 31 Holland | 33% | 4,000 | 2,116 | 90 Istambul | 29% | 2,100 | 1,006 | 109 Jakarta | 36% | 1,000 | 84 | 1071 Belgium | 25% | 2,300 | 1,632 | 43 Switzer. | 21% | 1,000 | 712 | 42 Sweden | 12% | 1,100 | 1,160 | -4
arel 7y ago
Couldn't you in fact make the opposite case? Sweden as the outlier is not reporting accurately and others are? The UK has seen huge excess mortality above the average which is being attributed to large numbers of undiagnosed deaths in care homes and in the community. Its far too early to make any claims as to superior accuracy when almost every country is struggling with accurate testing across their entire population. In which case you'd expect Swedens numbers to get revised strongly upwards. Sweden also has no conclusive sign of flattening yet.
- tinus_hn 7y ago
  The total number of people that have died on a certain date is not going to be revised, why would it be? The excess is that number minus a historical average which will also not be revised.
  - arel 7y ago
    Because of the huge amount of excess deaths that get assigned as probable covid cases. This is happening right now in the UK.
- henrikschroder 7y ago
  > Sweden as the outlier is not reporting accurately and others are? Huh? If a country is in lockdown, and still experiences excess mortality, but the official covid-19 deaths aren't enough to cover that excess, then.... what the hell did people die of? The expectation is that because of lockdown, the excess mortality from non-covid-19 causes should be lower than previous years, and therefore all the actual excess, and probably more, is attributable to covid-19. Which means that countries where the official covid-19 number is lower than excess mortality, like the UK, are underreporting, while countries where the excess mortality matches the official covid-19 number, like Sweden, are not underreporting.
  - mhandley 7y ago
    I don't think you can assume that non-covid-19 causes should be lower than previous years. For example, the main cause of deaths in normal years is cardiac problems. If Covid-19 is discouraging people from seeking help, and especially from going to the emergency room when they they think something might just possibly be wrong, then you can get a big increase in cardiac deaths.
below43 7y ago
The excess UK deaths linked to coronavirus are likely to be currently around 43,100. For an explanation see: https://www.ft.com/content/67e6a4ee-3d05-43bc-ba03-e239799fa6ab https://www.ft.com/content/67e6a4ee-3d05-43bc-ba03-e239799fa... For today's latest numbers see: https://twitter.com/ChrisGiles_/status/1252983884284821505 https://twitter.com/ChrisGiles_/status/1252983884284821505
pvaldes 7y ago
The spanish case is interesting. Must be noticed that the virus hit particularly hard in the retirement homes that contribute to 12.000 of the 20.000 deaths. Some elder in retirement homes weren't hospitalised. Some people say that their parents were "rejected" by hospitals (non belonging to a prioritary group). We breath a dense fake news atmosphere in any case, so this part can be wrong. Not all people that died in retirement homes this weeks died by coronavirus necessarily. Retirement homes can not and are not designed to provide real medical care. This part has failed clearly. Some of this people could have been saved in normal circumstances. Specially if the retirement homes were more transparent about numbers and the people would had a clear protocol to follow. Another special circumstance of Spain is that we are one of the countries with more life expectancy. We have lots of elder people, therefore much more people by million falling in a high-risk category. I don't see anybody explaining that in the news, but surely must have some statistical effect. Maybe we should start adding to the charts a category of people killed by million of people over 65yo. This mean also than some countries in Africa (or Brazil) could go through this problem "relatively unscathed", just because they have lots of children and young adults. Same with poor US states that could behave different than rich states in this sense. Only time will tell us.
DavidVoid 7y ago
Reddit user /u/Anaemix made a nice graph of the Swedish stats [1]. Döda per dag translates to deaths per day. [1] https://i.imgur.com/oXyrncm.png https://i.imgur.com/oXyrncm.png
abacadaba 7y ago
Could reduced deaths from driving etc. also be significant in this analysis?
robhunter 7y ago
Do you have a link to this?
misun78 7y ago
Super interesting, thanks. Do you know if anyone has graphed the excess mortality on a month by month basis? That data would be invaluable in understand the timelines of actual spikes in excess mortality, irrespective of covid-19 testing and diagnosis. For example, did it spike up in March in NYC compared to Jan or Feb?
- viceroyalbean 7y ago
  The New York Times article mentioned has more complete data, including the graphs you want. https://www.nytimes.com/interactive/2020/04/21/world/coronavirus-missing-deaths.html https://www.nytimes.com/interactive/2020/04/21/world/coronav...

juiyout 7y ago

> We are in the middle of the epidemic and, in my view, the science shows that closing schools at this stage does not make sense. You have to shut down schools fairly early in the epidemic to get an effect. Could anyone shed some light on why Sweden chooses not to close down schools fairly early?

deleted 7y ago
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vondur 7y ago

On the face of it, the numbers don't look too good for Sweden. Compared to the Los Angeles area (LA county and Orange County) we see 1937 deaths in Sweden vs 697 in the LA Area. The population is also about 18% higher in the LA area vs all of Sweden. We are assuming the numbers reported in the LA area are accurate, which they may not be.

Ma8ee 7y ago
I don’t think these kind of comparisons are meaningful until we are out of it. It all depends on exactly when the outbreaks started at the different places and what the long term infection rate will be.
- rolandog 7y ago
  These uncoordinated set of strategies by different countries seem to me like battles in RPGs; Sweden's probably opting to take less economic damage and instead take a x2 damage on health points. The Netherlands is switching strategies, thinking that Sweden's strategy is cool, but they're dipping their toes first by sending in teachers and children to see if they take a great amount of damage.
  - microtherion 7y ago
    > Sweden's probably opting to take less economic damage In all the discussion so far, I haven't seen any documentation of just how much "economic damage" the various countries are taking. I suppose there is little such data at sufficiently fine granularity to compare internationally. It's entirely plausible that Sweden's voluntary measures vs other countries' stricter approach don't make as much economic difference as many people seem to take for granted.
  - Ma8ee 7y ago
    My impression is that they actually haven’t considered the economy much at all when they have decided the strategy. More important is that that the strategy is feasible in the long run. You can close everything for a few weeks, but this is going to continue for many months still, maybe even years. Also, the social costs of isolation must also be taken into consideration. All the kids where the school is the only stable point in their life. Domestic abuse, alcohol and drug abuse are all going up a lot when people are isolated.

divan 7y ago

Is it just me or his answers are super vague and uncertain? I've expected some irrefutable arguments and unshakable confidence, but it's mostly "I think", "I [don't] believe" and "hard to know". Zero proofs or data, mostly his opinions.

Entalpi 7y ago
Well, its an informal interview. As the dude say, in the mornings they review data and do an analysis with experts.
glofish 7y ago
everything is an opinion and estimate at this point - the transmission rates in the population with respect of their way of living, the sensibility to infection of different ages, races etc I salute Sweden for not giving in to the lockdown hysteria and trusting that people can and will act cautiously without the threats and mandates.
CuriousSkeptic 7y ago
Perhaps a cultural difference. Swedes tend to respect a bit of humility. Especially if you can pull it of with confidence ;) To us Americans f.ex. can seem way to confident and boasting. If I generalize a bit. At the extreme we have things like this https://en.m.wikipedia.org/wiki/Law_of_Jante https://en.m.wikipedia.org/wiki/Law_of_Jante

golemiprague 7y ago

There are so many parameters that even in a year from now we will never know what is the best way to deal with it. Different way of measurement, different amount of measurement, different quality of measurement, different population density country wide and in the cities, different culture when it comes to adherence to government directions, different culture of "touchiness", different culture of how much you meet your family and friends, different weather, different exposure to people from other countries, different strain of the virus. That's just off the top of my head, I am sure there are more. It actually starts to make me wonder also about global warming, not about the warming per se but about predicting the outcome of it all many years from now and the assumption there is only one way to deal with it.

kqr 7y ago

One thing is missing from this discussion that needs to be understood: the Swedish government and related agencies generally do not do things based on common sense. This may sound ridiculous, but in most cases, it's not. Common sense is wrong so often. The view of the Swedish government is that they are not more intelligent than the citizens. Unless things can be scientifically proved, the individual rights of citizens should not be restricted. This permeates a lot of public policy in Sweden; I recently had reason to investigate to what extent maternal/neonatal care followed the best of our scientific knowledge and it was extremely close. If you think that's a given, think again. Many countries base their maternal/neonatal care on common sense and old wives' tales instead. Both approaches are valid, but they are different. With policy based on common sense, you accept that you occasionally (often?) force something wrong on the public, potentially against their better knowledge. With policy based on strong evidence, you are more rarely wrong, but you also get way fewer opportunities to force things on the public, simply because there are so few things we truly know to be true. Doubly so during a novel pandemic.

tpmx 7y ago
[Am Swedish and not a fan of the current policy] This evidence-driven decision making process (which is indeed the default here) works remarkably well when things are moving slowly. It kills bullshit beautifully. This is normally something I'm quite proud about. However, it breaks down so badly when you're suddenly facing a one in a hundred years pandemic and you can't act decisively 3-4 months into the pandemic because there's no evidence yet. Sweden is "peace-damaged". We haven't really had to deal with any national-level crises the since the spanish flu about 100 years ago. The last war was in 1814. 500 soldiers died. Note that the above mostly applies to national governance - this is the stuff that really gets set into code and culture over time. At a local e.g. hospital/research unit/private company level, there's fantastic innovation happening on a daily basis, just as in the rest of the world.
- davidw 7y ago
  This whole thing is kind of like driving a car, except that when you turn the steering wheel, nothing happens, and then two weeks later the wheels start to turn.

bigf4k332 7y ago

protip: none of you commenting know shit about anything health related so shut up you are turning this into a dystopia there were 34k deaths last year of 'flu' and we are at 46k this year, of course - that is if you believe the numbers which are FALSE

bigf4k332 7y ago

covid is scam! OPEN THE COUNTRY!

zwaps 7y ago

I do like the reliance on the high trust society in Sweden, but I also feel like a wider circle of experts could be consulted for such a decision. Even if it may not be a good model of human behavior, it's sometimes useful to consider "rational behavior" - if only to judge the resilience of certain mechanisms. In this case, "social" behavior is in a sense very altruistic. If I am young and healthy, recent media reports (accurate or not) would suggest that limiting myself to staying inside, practicing more hygiene and such, is costly but doesn't significantly reduce my own risk. At the same time, isolating risk-groups may not be sufficient, and younger people may genuinely be at risk. So, it would be desirable if everyone practices social isolation. If that is true, social behavior is a collective good: The more people stay inside, the easier it is for myself to go outside and, say, enjoy the sun in a park or have fun in a club. Thus, my incentives are not aligned with the goals of these recommendations. And if everyone thinks that way, social distancing will not be achieved in a "decentralized" fashion. Indeed if everyone is that rational, such a decentralized but workable "recommendation" does not exist. Now, I stress that people do not fit this model, especially in Sweden. But in situations of anonymity, e.g. with many people involved, it has sometimes proven useful to check the robustness of one's decisions against the case where people act rationally. In that case, laws and regulation do make sense.

EmilioMartinez 7y ago

Each nation's strategy seems to come about due to its very specific circumstances. Leaders will defend (to death) their bullshit ideologies and false securities, and stick to a plan made in the heat of the moment. Perhaps this mechanism is the great randomizer that ensures that every combination is tested, some risk distribution strategy.

int_19h 7y ago

This is one of those cases where a single day in the media cycle makes for a very big difference: https://www.forbes.com/sites/davidnikel/2020/04/22/sweden-health-agency-withdraws-controversial-coronavirus-report/#6b6795114349 https://www.forbes.com/sites/davidnikel/2020/04/22/sweden-he...

jnbiche 7y ago

I don't understand why certain media are lauding Sweden's strategy. It's not succeeding by any objective standard. For example, if you filter out tiny countries like Andorra (which result in statistical aberrations), Sweden has the 5th highest death rate in the world (per million population). And it's increasing, having gained several spots in the past 5 days. It may turn out be that Sweden's right in that closing borders, schools, and businesses doesn't have much of an effect, although there's significant evidence for the effectiveness of closing schools in respiratory illnesses. But Sweden's strategy is not working as a public health strategy.

seunosewa 7y ago
If they had sufficient testing and encouraged the use of face masks to slow the spread, it would probably have worked.

pengaru 7y ago

This was the most sane and reasonable thing I've read about handling the pandemic, and I'm super bummed it's not regarding my home country.

newcrobuzon 7y ago

Sweden is starting to see sharp increase in daily deaths - 172 yesterday and 185 the day before - which for a country of 10 million is a lot. For instance Czechia with roughly same population introduced lock down very early on and now their total is 210 - while Sweden's is 1937...

tome 7y ago
Where are you getting those numbers from? They're much higher than suggested by this graph: https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_Sweden#History https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_S...

DeathArrow 7y ago

I think Sweden did it wrong, valuing the economy more than the lives of people. I think there are some political ideologies at work, but I don't want to get into these. In my country we have 3x less cases and 8x less deaths per million people. I do think that quarantine payed off. We can recover the economy but we can't recover lives.

DeathArrow 7y ago

It was a cynical decision, disguised as "we don't want to impact people's freedoms" and "we follow the scientific truth". Sweden's progressive government hates older people which they perceive as more conservative. So they decided to let them die. If the epidemy would affect younger people as much as older people, Sweden would take the same actions other countries had and limit the number of deaths.

SahAssar 7y ago
Are you seriously saying that the government is on purpose making their strategy kill old people? Because that is some grade-a conspiracy paranoia.

buboard 7y ago

While their strategy seems to not have led to disaster, it's not certain whether one would call it success. Shutdowns clearly didnt work well in some countries (france,spain,italy,uk) but they seem to work well in most eastern europe countries and germany. People are not being infected at large . Some of his remarks are generally questionable and worth a second thoughts > Closing borders, in my opinion, is ridiculous, because COVID-19 is in every European country now. There are many countries with very few COVID cases, and some of them are summertime destinations for swedes (like greece). It's certainly dangerous to open borders with a highly infected country like sweden without rigorous checks. Europe is big. > Each country has to reach ‘herd immunity’ in one way or another Not all countries are looking to get there fast. In fact countries that delay the spread are hoping for a potential cure/treatment that will make herd immunity much less painful. Herd immunity isnt even necessary - plenty of diseases don't need immunity/vaccines. Also, while it's nice that sweden chose a relaxed, voluntary approach, the lockdown measures have wide support in many countries. He s right that governments should be measuring the impact of measures though. Sweden should be doing so too, it would be very useful to know which are the most important infection routes, now that other countries are opening up

mamon 7y ago

So far the net result of Sweden's strategy is that they have 2,021 coronaviris deaths, more than 4x more than Poland, which also has almost 4x bigger population - so Sweden has 16x more deaths per 1M of citizens than Poland.

mensetmanusman 7y ago

Sweden’s approach is an optimization of how to respond to the epidemic and how to respond to the general life disruption. The optimal response to the epidemic is everyone stays in their house for 1 month with no human contact. In that scenario, the virus is stopped and everyone dies because no one works the food chain, etc. The world’s current response is heavily weighed towards optimizing the response toward the epidemic, but the potentially fatal assumption to this approach is that a vaccine will soon be developed. If a vaccine is not soon developed, the same amount of people will still get sick, people will still die, but additional people will die due to life disruption.

option_behavior 7y ago

It will be interesting checking back in 2-3 years and evaluating the efficacy of approaches by different countries. As referenced in the interview, each country has to eventually reach herd immunity. For the majority of the world this will be when 60-80% of the population has antibodies through the natural spread of the virus. Assuming healthcare systems are not at overcapacity, our resources will best be spent protecting at risk groups. These are mainly old people, given that the average life expectancy of those who have died is just over a decade. I'm confused why so many people are extraordinarily emotional and passionate about shelter-in-place. We should be focused on increasing healthcare capacity, and more importantly securing the safety of at-risk populations which are primarily composed of old people. This is where honest and effective communication over the objective risks for different groups is essential. If you are under 30 with no pre-existing conditions, the odds of dying are < 1/100,000. The numbers are commensurately promising for those without underlying health conditions in their 30s, 40s, and even 50s. It is silly to prioritize shelter-in-place going forward, across most of the developed and developing world. The costs are tremendously high, as we actually want most relatively young and healthy people to be exposed to the virus to protect at-risk populations. There was even a recent study published that revealed if we intentionally infected young and healthy people, death rates from C-19 would nearly halve. A solution could turn out to be staggering payments to very low risk groups to get infected, taking into account people's various living situations. Unfortunately, I think most governments would prefer 2x,3x,4x, etc. death rates over paying people to infect themselves. I believe many people will look back and admire the Swedish model for their practical and effective approach. Excessive shelter-in-place has tremendous costs, with minimal benefits once healthcare systems are stabilized. Hopefully nations around the world accept this reality and act accordingly.

eveningcoffee 7y ago

There is no controversy. They just messed up and are now saving their faces blabbing about herd immunity and hoping that the spread will stop magically. I do not have hopes up yet.

butler14 7y ago

"We are in the middle of the epidemic" I'd love to know what metric he's basing that statement on

bigf4k332 7y ago
"pandemic" is liberalism for "i'm going to fuck your economy over until you give me what i want" liberalism is the real pandemic
prophesi 7y ago
That's probably the least controversial statement in the interview.
- erikrothoff 7y ago
  Curious to hear what you think were the most controversial statements were?
  - butler14 7y ago
    "Closing borders, in my opinion, is ridiculous, because COVID-19 is in every European country now" has to be up there Closing borders seems like a perfectly reasonable step for a great many countries. Particularly those that are vastly more connected via land-based mass transit (often directly into cities that have higher populations than the entire country of Sweden)
    - Zenbit_UX 7y ago
      Ironically, if all other borders are closed around you, then yours are effectively closed too.
      - Lewton 7y ago
        Interestingly enough, you're wrong. Denmark has closed it's border But Danes can go to Sweden, because Swedens border are open. And while Denmarks borders are closed, danes are always allowed to return home. Quite a few irresponsible danish people are going on vacations in Sweden these days

etrevino 7y ago

I'm an American, so the usual caveats apply, but I think more should be made of this statement from the interview: "The Swedish laws on communicable diseases are mostly based on voluntary measures — on individual responsibility. It clearly states that the citizen has the responsibility not to spread a disease. This is the core we started from, because there is not much legal possibility to close down cities in Sweden using the present laws. Quarantine can be contemplated for people or small areas, such as a school or a hotel. But [legally] we cannot lock down a geographical area." If we take that as a given then the approach used in, say, Italy isn't doable. Why not put that out there and let there be a public debate about the issue? Is there a sense that this isn't the time? Maybe there is a debate. I'm not exactly in touch with Swedish politics, so if someone knows, I'd love to hear about it.

tomcooks 7y ago
> I'm an American, so the usual caveats apply What do you mean with usual caveats?
- etrevino 7y ago
  Just that since I don't live there and know the society/culture I may be asking a dumb question. I probably should have said something like "I don't know much about Sweden, so I'm asking from a position of genuine ignorance."
  - tomcooks 7y ago
    Ah thanks, I assumed it was an HN inside joke and I was a bit lost Cheers
ilamont 7y ago
That quote stood out to me, too. It's hard to lock down an area in the U.S., too, but some states and cities have enacted nonessential business, school, and transportation closures that have been quite effective at flattening the curve without a geographic quarantine. Maybe another question to ask: Can Sweden enact emergency facility and public transportation closures for other reasons? For instance, for a flood or some other disaster?

jon889 7y ago

It sounds exactly what the UK was going to do until Imperial released a report that said it wouldn’t work.

jeltz 7y ago
For now Sweden has slightly fewer deaths per capita than the UK, so their last minute change does not seem to have helped much. While I was and still am in favor of a harsher lockdown the Swedish strategy does not seem to perform that badly. There are countries with harsh lockdown doing both doing way worse and way better, so other factors may matter more.
- jon889 7y ago
  I think the reason for that is that British people are less trusting of the government and will generally ignore rules if it doesn’t make sense to them unless they’re mandatory. Even the prime ministers dad said he’d still go to the pub just before the lockdown.
dijit 7y ago
And Anders "debunked" imperials study because it was not yet peer reviewed[0]. While continuing with his "Scientific" gut feeling. (No, I'm not making any of what I said up or being hyperbolic[1]) The serious lack of testing and fact that many doctors are saying they cannot attach COVID-19 as a cause of death unless it is a direct cause and has been tested for, give me pause to the numbers Sweden is putting out.[2] Since if you arrive to the hospital already dead then they will not "waste a test" on you confirming cause of death. I would much rather look at the Swedish death rate comparative to last year instead[3] [0]: https://www.theguardian.com/world/2020/mar/28/as-the-rest-of-europe-lives-under-lockdown-sweden-keeps-calm-and-carries-on https://www.theguardian.com/world/2020/mar/28/as-the-rest-of... [1]: https://twitter.com/bjornsing/status/1252888065959436288 https://twitter.com/bjornsing/status/1252888065959436288 [2]: https://www.thelocal.se/20200414/understanding-swedens-figures-on-the-coronavirus https://www.thelocal.se/20200414/understanding-swedens-figur... [3]: https://www.scb.se/en/finding-statistics/statistics-by-subject-area/population/population-composition/population-statistics/ https://www.scb.se/en/finding-statistics/statistics-by-subje...

starvingbear 7y ago

Some countries in martial law some shut down a massive portion of their economy. The controversial approach is relying on individual citizen responsibility. Fascinating times

ajsnigrutin 7y ago
If it was something that affected only those individuals, noone would care. The problem is, that someone else can be irresponsible, and you die because of that.
- Zenbit_UX 7y ago
  Yes, we all get that, it's been rammed down our throats for months.
- FpUser 7y ago
  Why is that suddenly a problem? We always had it. Most people posing danger to others in one or the other way. Driving a car is the most obvious example but there are countless other
  - matthewdgreen 7y ago
    That's why we have drivers' licenses and manslaughter charges for negligent homicide. We don't just shrug our shoulders at the risks.
    - SpicyLemonZest 7y ago
      We take reasonable, targeted measures to mitigate the risks. What we don't do is embark on a grand social program to eradicate freeway crashes, because such a program would involve banning or heavily restricting cars and we feel cars are too important for that.
      - ajsnigrutin 7y ago
        But we do just that. Every car has to pass a bunch of certifications to be legal to drive on the road. It has to pass a (4-, 2- or 1-)yearly checkup, has to be registered, insurance has to be paid, road tax, etc. Also the driver has to pass a theoretical and a practical exam, has to be of certain age, not be under influence of any of many substances, has to obey a bunch of traffic laws, etc. And we also have check for all that, from police controls, to speed cameras, alco-testers, etc.

alfiedotwtf 7y ago

My money is within a month Sweden going into full lockdown, and regretting their decision. If it weren't for the states closing down here, Australia's death toll could have been much worse given the Federal wanted to keep everything open.

D_Alex 7y ago
I agree. It seems extraordinarily risky to let another disease spread among the world population. - What if there are long term effects? - What if it becomes a seasonal disease? - What if the next mutation is more severe? Each country should b a good global citizen, and put in its best effort to make sure the spread is as limited as possible.
DavidVoid 7y ago
The mortality rate has been stable for a while now so I doubt that that will happen any time soon [1]. If people in Stockholm don't follow the recommendations then they might set up some more restrictions though. [1] https://i.imgur.com/xJ16VGd.png https://i.imgur.com/xJ16VGd.png
Hurdy 7y ago
People have been saying that about Sweden for a long time. My money is on all other countries doing something closer to the swedish model when the next wave hits in winter.
- gvjddbnvdrbv 7y ago
  Why do you think the next wave will be in the winter?
  - baq 7y ago
    not OP but: 1) there won't be a vaccine - even if there will be, you won't be able to vaccinate everybody 2) the virus spreads fast but due to lockdowns not fast enough for herd immunity to prevent spread 3) lockdowns will be relaxed when new cases stop being found 4) all of it assuming immunity lasts for a few years, which it should, but it isn't a certainty 5) 3) will lead directly to asymptomatic cases causing flare-ups a few weeks after lockdowns are relaxed (see Singapore, Japan) 6) if 4) isn't true, we're toast

notacoward 7y ago

When a future article is written about the dangers of being contrarian to get attention, that same picture of Anders Tegnell will be just below the headline. His parents should have spent more time with him.

dang 7y ago
Please don't post nasty, empty things to HN. We've already had to ask you not to do this kind of thing. Maybe you don't owe Swedish epidemiologists in Nature any better, but you owe this community better when you're posting here. Please stick to https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html.
- notacoward 7y ago
  > We've already had to ask you not to do this kind of thing. When did it become HN policy to cherry-pick long ago examples from among a plethora of highly-regarded comments like that? Pretty clearly other users think I've paid any debt to this community since whatever incident you're referring to (and I don't remember any) many times over. Bringing it up like this seems pretty empty and nasty in itself.
- deleted 7y ago
  [deleted]

matwood 7y ago

Some southern states are about to try the same strategy so we'll see how it works out.

thawaway1837 7y ago

The whole thing is clearly an attempt at a graceful exit. The original strategy was herd immunity. The argument being made was that Sweden was gonna get infected anyways, so better to get it out of the way sooner rather than later, while protecting the at risk. And this would reduce economic harm as well. However, the Swedish decision makers seemed completely unaware of asymptomatic carriers, which led to the at risk (largely old people) being heavily exposed anyways due to the asymptomatic younger workers around them infecting them. Further, the Swedish people, reflecting normal human behavior, shut down economic activity anyways. The result was a slight linear short term economic benefit but an exponential, potentially long term, downwards public health situation whose economic effects itself will likely dwarf the direct economic benefit anyways. So now that their plan has failed both in concept and execution they are changing their story saying that it was a Swedish cultural thing, where they trusted individual Swedes to take personal responsibility, because of the exceptional Swedish character.

tinus_hn 7y ago
There are a number of options: * lockdown until there is a vaccine or treatment * slow down the spread * do nothing A vaccine or treatment is at least half a year away so unless your country is exceptionally rich the first option is not feasible. Slowing down the spread can help making sure the demands to healthcare are met. This is not an issue in Sweden. It can help because treatment right now is better than treatment a month ago. And in theory at a certain moment there might be herd immunity. Or there may not be. Ultimately either a large amount of people or everyone will get ill anyway and then they will get better and immune or die. Doing nothing means a lot of people get ill and then get better and immune or die and the country keeps running. Sweden chose the last option because the first option is not realistic and the advantages of the second option are, in their opinion, not worth it. In my opinion this is at least a defensible position to take. If a country does not have enough healthcare capacity the second option has to be chosen for as long as necessary. The first option, barring exceptional circumstances (your country is a self sustaining island that can handle losing all tourism and trade) is not viable. I’m not sure what you mean by a downwards public health situation whose economic effects will dwarf the direct benefits. It’s terrible if a lot of old people die but realistically the economy will get over it rather quickly.

chasd00 7y ago

go here and scroll down to Cases by Country, normalized by country population then highlight Sweden. Across the different metrics Sweden seems to be doing about average. http://91-divoc.com/pages/covid-visualization/ http://91-divoc.com/pages/covid-visualization/ here's projections for Sweden but given how wildly these projections have fluctuated i'm not sure how valuable it is https://covid19.healthdata.org/sweden https://covid19.healthdata.org/sweden

f38zf5vdt 7y ago
Cases are a poor metric because they're a function of per-capita testing, which is variable across nations. You have to go by deaths. In that case you can see that they're much worse than their neighbors Norway and Finland, and that they're closer to regions with catastrophic death rates like Switzerland. The earlier lockdown measures are imposed, the greater the impact, hence the comparatively excellent numbers from Finland. Sweden has long held denial of asymptomatic transmission (especially by Tegnell, even in this article), which we've learned is categorically wrong. The IHME model has been considered notoriously optimistic, as the US number of deaths has been rising but the US peak is reported as 1 week ago. The IHME model assumes a full lockdown in the US until August, which has already been violated by a number of US states this week.
- deleted 7y ago
  [deleted]
- yoden 7y ago
  To back this up with some data, this article has information about tests per capita: https://www.thelocal.se/20200414/understanding-swedens-figures-on-the-coronavirus https://www.thelocal.se/20200414/understanding-swedens-figur... If Sweeden had been testing at the rate of Norway or Germany, they would not be in the middle of that cases per capita graph. This is despite Sweeden's infection growth being ~15 days behind Italy's, e.g. enough time for a lockdown to have almost entirely prevented it. So it seems clear that Sweeden's policies have made infections worse. The questions that remain are: 1) Will their peak infection rate go over hospital capacity? 2) Will they have economic benefits from having population immunity faster?

epr 7y ago

Is there a pronounced difference between coronavirus cases in Sweden vs neighboring countries? On a per population basis I'm seeing very similar numbers (links below). Anecdotal evidence is one thing, but these charts don't seem to tell that story. That being said, it's unclear to me the degree to which coronavirus statistics provided by different countries can be compared meaningfully, or if this is an apples and oranges situation (for any number of reasons). https://www.worldometers.info/coronavirus/country/sweden/ https://www.worldometers.info/coronavirus/country/sweden/ https://www.worldometers.info/coronavirus/country/norway/ https://www.worldometers.info/coronavirus/country/norway/ https://www.worldometers.info/coronavirus/country/finland/ https://www.worldometers.info/coronavirus/country/finland/ https://www.worldometers.info/coronavirus/country/denmark/ https://www.worldometers.info/coronavirus/country/denmark/ Population numbers: Sweden: 10.2 million Norway: 5.4 million Finland: 5.5 million Denmark: 5.8 million

joshuahedlund 7y ago
Cases are an unreliable metric because Sweden has done less testing per capita than Norway/Finland/Denmark. However, its deaths per capita is notably higher (and rising - from 14th global rank to 10th in the last couple weeks) Sweden: 192 per million Denmark: 66 per million Norway: 34 per million Finland: 27 per million
- epr 7y ago
  That does not look good for Sweden. I was just thinking that it would be interesting to compare total deaths per year for 2020 at years end to eliminate differences in methodology. It's a crude measurement, but if the coronavirus death toll becomes large enough compared to total population then it should give us a general idea considering how slowly death rates change in general. That could at least point us to who did things right, and hopefully some guidance for future policy.
  - epr 7y ago
    Hold that thought. They probably have deaths by week already.

salimmadjd 7y ago

There is a lengthier interview by UnHeard with Professor Johan Giesecke (another experienced epidemiologist) of Sweden on YouTube [0]. It’s worthwhile listening to their perspective. One of the comments he made was that no lockdown would work in democratic countries and the real test will be fatality rates between Sweden and others in 1 year. He believed it’ll be very little difference between those countries that have implement the lockdown and those that haven’t I had watched the simulation of covid19 infection by 1blue3brown[1] and some of his modeling appeared to me (maybe I misunderstood them) to confirm Swede’s point of view. Ultimately the same number of people got infected albeit in a “flatter” rate. However one counter point by Johan Giesecke was that these flattening the curve is motivated by the assumption of a static capacity of ER rooms to deal with this pandemic and he pointed out they have increased capacity. Overall I found listening to his side very informative, at least it gave me a different view of looking at from their view. [0] https://youtu.be/bfN2JWifLCY https://youtu.be/bfN2JWifLCY [1] https://youtu.be/gxAaO2rsdIs https://youtu.be/gxAaO2rsdIs

f38zf5vdt 7y ago
With such an enormously high r0 as currently predicted, completely stopping the virus once firmly established is an impossibility, but many examples e.g. Finland and Korea have shown that you can seriously reduce infections and deaths. There's no reason a lockdown followed by extensive testing shouldn't work, and indeed it _has_ worked in countries such as Korea and Taiwan. In fact, it worked in Hong Kong and Canada during the original SARS epidemic. There has to be a willingness to act early and responsibly, closing your borders, attempting to isolate highly infected areas, and slowing the spread of the disease as you dramatically ramp up testing. It seems as if the Western world has complete amnesia of previous events like SARS and is throwing caution to the wind as they assert that nothing could have been done to prevent this.
- hcknwscommenter 7y ago
  It's a policy choice to allow all of the reaction to work through the private sector instead of just deploying a national response strategy. In the U.S., the CDC tried to take the lead on testing (good) and essentially banned any other testing infrastructure (bad) and fell on its face with contamination issues (very bad), and pivoting to opening the testing infrastructure was a good policy choice. But the real answer has always been: DO BOTH. The CDC could be doing a million tests a day right now. Why don't they? It's madness.

wannabag 7y ago

I live in Stockholm, Sweden, so while I acknowledge my bias I'd bet my money on the fact that other countries will change their approach rather than Sweden starting to follow others. While there are some undeniable social (think multiple generations in a household), geographical and cultural (swedes are notorious in keeping their distance from other swedes) differences at play here, other European countries have gone for a "people can't be trusted so we must restrict individual freedom". While there is certainly some good reasons to think that this will work the means used to implement this have some really sad consequences. Look at France, people are getting fined and in some cases brutalized; protests are sparking in places where strict measures have been implemented, not because they are unfair but because they affect people unfairly! Easy for well-off people to "leave early, far and for a long time" but far from everyone has that luxury (oh if you understand French, check out Twitter on the "lockdown diaries" parodies and compare that to how people in the suburbs of Paris are being treated!). This is without even starting to talk about how the economic impacts will be spread amongst social classes. To me Sweden has chosen the most socially (in this case as opposed to morally) fair route to handle this crisis. That being said, it's morally very difficult to defend this strategy in the face of a higher death toll amongst seniors in care homes. I cannot come up with a single argument that I don't know will get shot down immediately and that is a good sign that it's probably not morally optimal. We live in a time of humanism and human life comes first, rightly so but even with that said, it shouldn't hide the picture and justify every consequence out there. The approaches in many countries are incredibly reactive and short sighted in that regard.

logicchains 7y ago
>That being said, it's morally very difficult to defend this strategy in the face of a higher death toll amongst seniors in care homes. I cannot come up with a single argument that I don't know will get shot down immediately and that is a good sign that it's probably not morally optimal. It's easier if rather than "lives saved", you look at "life years saved". In this sense, somebody in their 80s who only has a couple of years left dying early is equivalent to the situation of a young adult being pushed into poverty by the lockdowns and never managing to recover a middle-class lifestyle, so they die a couple years earlier (I'm not sure about Sweden, but in English speaking countries poor people on average die a few years earlier). A 20-year-old commiting suicide due to sudden poverty, or depression from being locked inside, is equivalent to twelve 80-year-olds who have five years to live dying early.

russellbeattie 7y ago

Even if you assume 100% of the population will eventually be infected, the final percentage will have a much easier time and chance of recovery than the first ones because of what we've learned as time goes on, even without a vaccine. In fact, they're already learning better ways to treat the disease. The stupidity of saying, "We really can't do much right now, so fuck it" is unbelievably irresponsible. If you knew you were definitely going to get the virus, when would you rather it happen, right now or a year from now? Sweden is essentially saying it doesn't matter.

war1025 7y ago
> We really can't do much right now, so fuck it" For many people it's more of "I can take my chances relying on the government when I'm not allowed to work" or "I can take my chances catching a virus that is probably coming for me anyway" Locking down doesn't terribly help vulnerable populations. It's only advantage is that it keeps people who were less likely to catch it to begin with from catching it, and as a result reduces the hospital load. Here in Iowa the majority of outbreaks are either in nursing homes or meat packing plants. Locking down does nothing to help them. We could shut down the meat packing plants, but then we kill the food supply chain, which is a disaster for everyone. Nursing homes are basically sitting ducks no matter what. If it's a fire we can't put out except by letting it burn through, then our best choice is to open up to the point that we are burning at maximum capacity. Hospitals here are laying off workers because they aren't allowed to do anything except wait for a crash of Covid-19 patients that so far hasn't come. If the bottleneck is the hospitals like people have been saying all along, then hospitals being so empty they can't even pay their staff means we have gone to far.
- kyawzazaw 7y ago
  Wouldn't a lockdown translate to limiting the nursing homes' exposure to the virus?
  - war1025 7y ago
    That's the theory, but it has proved pretty ineffective in practice. Nurses don't live onsite, so there is no actual way to seal the residents off from the outside world. Once it gets in you're no better off than had there not been a lockdown in place.