4 ms·

> I'm starting to think it was the right decision Sweden is #6 by deaths/population according to this page: https://www.worldometers.info/coronavirus/ https://

by kanox 6y ago

> I'm starting to think it was the right decision Sweden is #6 by deaths/population according to this page: https://www.worldometers.info/coronavirus/ https://www.worldometers.info/coronavirus/ This would indicate that the swedish response is among the worst. Several countries with comparable health systems have a death rate which is many times lower, for example Germany. This saved many thousands of lives. What am I missing?

marcusverus 6y ago
If the pandemic is expected to continue for many months, isn't it a bit premature to talk about current death rates as a metric for success? Given Sweden's 'herd immunity' plan, higher death rates at the beginning would seem to be a given. They didn't flatten their curve. But as they approach something like herd immunity, the number of possible carriers should plummet permanently (assuming immunity is a thing with COVID), and infections and deaths would permanently decline. Nations which have held down infection numbers with shutdowns have, of course, flattened their curves. But they may well suffer from second/third waves which will hike up their total numbers.
- kingkawn 6y ago
  Herd immunity cannot be considered the plan given that herd immunity has not been proven to be possible
  - noodlenotes 6y ago
    Indefinite lockdowns, vaccines haven't been "proven possible" either. At some point you have to make a plan with the best information you have. The fact that spread in New York has slowed down compared to other states that weren't initially hit hard implies that there's some immunity effect going on.
  - tripletao 6y ago
    Herd immunity is certainly possible--we could hold a parade, and spray it with cultured virus. Obviously no one is doing that, because no one actually wants natural herd immunity. Sweden just thinks the cost to control the epidemic to the point that it doesn't end in that way is unacceptably high. If a treatment is discovered next month that cuts the IFR by a factor of ten, then Sweden was wrong. If no safe and effective vaccine is ever developed and treatment never improves, then Sweden was right. Reality will fall somewhere between those two unlikely extremes, and we don't know where. Fewer infected is always good news[1], in Sweden or anywhere else--it means fewer dead now, more infections pushed until later when treatment will probably be better, etc. It's weird to see low infection rates twisted around as if they were bad, "evidence that herd immunity may not be possible". This is particularly true when the prevalence is compared to herd immunity from a model assuming a well-mixed, homogeneous population, which we know overestimates the herd immunity threshold (though not by how much, since estimates of the heterogeneity of the coronavirus are even more uncertain than those of R0). Finally, herd immunity is a gradual process. Even in a crude homogeneous SIR model, you may approach it asymptotically but never get there. This is good--the only case where a disease "burns itself out" abruptly is when there's big overshoot, which implies many avoidable deaths. Perhaps that kind of overshoot could be desirable in a population of young people, if the small excess mortality in the young people were more than offset by their decreased ability to spread it later; but that's a narrow needle to thread. For the avoidance of doubt, I believe Sweden did a bad job protecting elder care facilities (though many places that locked down did too), and I disagree with their position on masks. Their response otherwise seems reasonable to me, not obviously better than stricter approaches but also not obviously worse. 1. Unless you know the death count and you're looking for the denominator for your IFR, since more infected then means lower IFR. That was true early in the epidemic, before the first high-quality serosurveys, but not anymore.
- kalleboo 6y ago
  > They didn't flatten their curve They did flatten the curve[0], they kept their cases within hospital capacity (by banning gatherings over 50, reducing restaurant capacity, having people work from home, etc) What they never did was crush the curve, which is the strategy most other countries switched to once they realized it was feasible [0] https://static01.nyt.com/images/2020/03/22/science/11SCI-VIRUS-CURVE1/11SCI-VIRUS-TRACKER1-mediumSquareAt3X.jpg https://static01.nyt.com/images/2020/03/22/science/11SCI-VIR...
martindbp 6y ago
Simple: it's not over yet, but it might be for some hard hit areas of Sweden. We'll see. Then there is another question whether it was worth it to shut down the world economy over a 0.05% death rate, or a few years worth of flu at once. I'd say probably no. We didn't know this back in Feb/March, which is why I was very much for a quarantine then, but not now. I don't think the powers that be would have done a complete shutdown if they'd known what they know now.
- tomjakubowski 6y ago
  > it might be for some hard hit areas of Sweden The long-term success of Sweden's approach appears to hinge on this question. What evidence is there which supports that their hardest hit locales have achieved herd immunity?
  - wk_end 6y ago
    Numbers and projections show things slowing down in Sweden [1]. The obvious explanation for this would be that herd immunity is kicking in, isn't it? [1] https://covid19.healthdata.org/sweden https://covid19.healthdata.org/sweden
  - martindbp 6y ago
    My own observeration from Stockholm is: beaches crowded during heatwave, public transit is crowded as usual. Lots of movement of people, travel within Sweden etc. Practically nobody is wearing a mask. People are still generally careful, washing hands, keeping the distance in lines etc, but I don't think this can explain the cases going down. In March-April, I think people were the most careful, when hundreds were dying every day. Since then people have gradually become more relaxed, but the numbers keep going down. Of course, it could be that these rather small measures have pushed r0 a bit under 1 ever since March. But there have also been reports that for each person tested with antibodies, two more are actually immune, which would put the immunity at maybe 30% two weeks ago. At least it's in the right ball-park, as some have proposed that herd immunity could be reached at much lower percentages than previously thought.
drewg123 6y ago
The same data source also shows that Sweden's per-capita death rates are lower than Spain and Italy, which had full scale lockdowns.
- watwut 6y ago
  They had lockdowns after country systems were completely overwhelmed. Up to inability to handle dead people in some places. Their situations was strong argument for other countries to lock down much sooner.
  - SpicyLemonZest 6y ago
    The question is whether locking down sooner actually solves the problem. As Melbourne heads into another 6 weeks of lockdown, I'm growing skeptical.
deleted 6y ago
[deleted]

by kanox 6y ago

marcusverus 6y ago

If the pandemic is expected to continue for many months, isn't it a bit premature to talk about current death rates as a metric for success? Given Sweden's 'herd immunity' plan, higher death rates at the beginning would seem to be a given. They didn't flatten their curve. But as they approach something like herd immunity, the number of possible carriers should plummet permanently (assuming immunity is a thing with COVID), and infections and deaths would permanently decline. Nations which have held down infection numbers with shutdowns have, of course, flattened their curves. But they may well suffer from second/third waves which will hike up their total numbers.

kingkawn 6y ago
Herd immunity cannot be considered the plan given that herd immunity has not been proven to be possible
- noodlenotes 6y ago
  Indefinite lockdowns, vaccines haven't been "proven possible" either. At some point you have to make a plan with the best information you have. The fact that spread in New York has slowed down compared to other states that weren't initially hit hard implies that there's some immunity effect going on.
- tripletao 6y ago
  Herd immunity is certainly possible--we could hold a parade, and spray it with cultured virus. Obviously no one is doing that, because no one actually wants natural herd immunity. Sweden just thinks the cost to control the epidemic to the point that it doesn't end in that way is unacceptably high. If a treatment is discovered next month that cuts the IFR by a factor of ten, then Sweden was wrong. If no safe and effective vaccine is ever developed and treatment never improves, then Sweden was right. Reality will fall somewhere between those two unlikely extremes, and we don't know where. Fewer infected is always good news[1], in Sweden or anywhere else--it means fewer dead now, more infections pushed until later when treatment will probably be better, etc. It's weird to see low infection rates twisted around as if they were bad, "evidence that herd immunity may not be possible". This is particularly true when the prevalence is compared to herd immunity from a model assuming a well-mixed, homogeneous population, which we know overestimates the herd immunity threshold (though not by how much, since estimates of the heterogeneity of the coronavirus are even more uncertain than those of R0). Finally, herd immunity is a gradual process. Even in a crude homogeneous SIR model, you may approach it asymptotically but never get there. This is good--the only case where a disease "burns itself out" abruptly is when there's big overshoot, which implies many avoidable deaths. Perhaps that kind of overshoot could be desirable in a population of young people, if the small excess mortality in the young people were more than offset by their decreased ability to spread it later; but that's a narrow needle to thread. For the avoidance of doubt, I believe Sweden did a bad job protecting elder care facilities (though many places that locked down did too), and I disagree with their position on masks. Their response otherwise seems reasonable to me, not obviously better than stricter approaches but also not obviously worse. 1. Unless you know the death count and you're looking for the denominator for your IFR, since more infected then means lower IFR. That was true early in the epidemic, before the first high-quality serosurveys, but not anymore.
kalleboo 6y ago
> They didn't flatten their curve They did flatten the curve[0], they kept their cases within hospital capacity (by banning gatherings over 50, reducing restaurant capacity, having people work from home, etc) What they never did was crush the curve, which is the strategy most other countries switched to once they realized it was feasible [0] https://static01.nyt.com/images/2020/03/22/science/11SCI-VIRUS-CURVE1/11SCI-VIRUS-TRACKER1-mediumSquareAt3X.jpg https://static01.nyt.com/images/2020/03/22/science/11SCI-VIR...

martindbp 6y ago

Simple: it's not over yet, but it might be for some hard hit areas of Sweden. We'll see. Then there is another question whether it was worth it to shut down the world economy over a 0.05% death rate, or a few years worth of flu at once. I'd say probably no. We didn't know this back in Feb/March, which is why I was very much for a quarantine then, but not now. I don't think the powers that be would have done a complete shutdown if they'd known what they know now.

tomjakubowski 6y ago
> it might be for some hard hit areas of Sweden The long-term success of Sweden's approach appears to hinge on this question. What evidence is there which supports that their hardest hit locales have achieved herd immunity?
- wk_end 6y ago
  Numbers and projections show things slowing down in Sweden [1]. The obvious explanation for this would be that herd immunity is kicking in, isn't it? [1] https://covid19.healthdata.org/sweden https://covid19.healthdata.org/sweden
- martindbp 6y ago
  My own observeration from Stockholm is: beaches crowded during heatwave, public transit is crowded as usual. Lots of movement of people, travel within Sweden etc. Practically nobody is wearing a mask. People are still generally careful, washing hands, keeping the distance in lines etc, but I don't think this can explain the cases going down. In March-April, I think people were the most careful, when hundreds were dying every day. Since then people have gradually become more relaxed, but the numbers keep going down. Of course, it could be that these rather small measures have pushed r0 a bit under 1 ever since March. But there have also been reports that for each person tested with antibodies, two more are actually immune, which would put the immunity at maybe 30% two weeks ago. At least it's in the right ball-park, as some have proposed that herd immunity could be reached at much lower percentages than previously thought.

drewg123 6y ago

The same data source also shows that Sweden's per-capita death rates are lower than Spain and Italy, which had full scale lockdowns.

watwut 6y ago
They had lockdowns after country systems were completely overwhelmed. Up to inability to handle dead people in some places. Their situations was strong argument for other countries to lock down much sooner.
- SpicyLemonZest 6y ago
  The question is whether locking down sooner actually solves the problem. As Melbourne heads into another 6 weeks of lockdown, I'm growing skeptical.

deleted 6y ago

[deleted]