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I remember people praising Sweden's strategy for one important reason: they can do it indefinitely, while more stringent lock-down measures will fail because pe

I remember people praising Sweden's strategy for one important reason: they can do it indefinitely, while more stringent lock-down measures will fail because people will get tired of them and ignore the measures. It made perfect sense. By all indications, Sweden should have enjoyed a flat and sustainable level of infections. While this level may have been higher than neighbouring countries, the fact that it would have remained constant while other countries' would have surged as governments loosened restrictions and people stopped paying attention to them meant that Sweden's was the winning strategy for a pandemic that would be with us for several years. Why did this not pan out? Why is Sweden seeing a second wave as well? Why did the number of infections soar, while it should theoretically have remained constant?

pchristensen 6y ago
Exponential growth can get out of hand very quickly. It doesn't take too many people to mess up, break rules, or get unlucky for this virus to erupt. Also, way more people are indoors in November in Sweden than August. Many people travel to remote cabins in the summer - August in Stockholm is about as deserted as San Francisco during Burning Man. They're mostly back by September, bringing more people in proximity. I'm in Seattle and Washington is locking down again, as colder temps have brought the long predicted fall spike.
- landemva 6y ago
  "the long predicted fall spike." If those in power knew a Fall spike would likely occur, would it have made sense to encourage healthy people to seroconvert during the summer, when the flu is less prevalent? Instead, this was purposefully stretched into the flu season. Why? Who benefits from fear and lockdowns?
  - im3w1l 6y ago
    > Why? Well one part is incompetence. And the other is that a fall spike was just a hypothesis. We didn't know for sure.
    - landemva 6y ago
      Seems we can agree that it was incompetent to prevent healthy people from seroconverting last summer.
      - VectorLock 6y ago
        With even healthy people dying or having long term if not life long health impacts, was it really "incompetent" to prevent people from taking those risks?
      - tunesmith 6y ago
        There's a counterfactual logic flaw there though. How do you know ahead of time that a healthy person would recover nicely? There are plenty of counterexamples. If you respond in a utilitarian manner, well then you have to compare it with other utilitarian approaches.
      - fxtentacle 6y ago
        Your sentence makes very little sense to me because the seroconversion has a high chance of causing life-altering side effects. I'd say it would be irresponsible to suggest that to the general public.
  - Analemma_ 6y ago
    Nobody benefits from fear and lockdowns, that's why the conspiracy theories around them are so fucking stupid. We did not encourage healthy people to seroconvert during the summer because achieving the necessary numbers of infected would have caused millions of deaths. This was the UK's original plan and they backed off when they actually ran the numbers and saw how many fatalities it would require.
  - tunesmith 6y ago
    I don't understand why "fear and lockdowns" are equated here. Lockdowns aren't an agenda on their own - it's because of the virus, which exists whether you do a lockdown or not. I guess people believe that the virus is nothing to be scared of, and so then they believe that people fearmonger to whip up support for a lockdown, but this belief makes zero sense to me - why would anyone be in favor of a lockdown if the virus isn't dangerous?
    - modzu 6y ago
      it seems politically safer to do "something", than to do "nothing". if the lockdowns stop the virus you're a hero, if they dont, you're still a hero for thinking of the children... if instead you do nothing, and things get better, you're just seen as lucky, if things get worse, you get to take the blame.
  - pchristensen 6y ago
    It was predicted because the change in weather causes more people to be indoors, and poor indoor air circulation is a big contributing factor for spreading. Same with the onset of the hot weather and A/C in the US South in May, around the time cases started increasing there. Also, catching Covid sucks for a lot of people, even if they survive. Encouraging people to catch it during summer seems pretty irresponsible.
  - learnstats2 6y ago
    > encourage healthy people to seroconvert It's almost never a good medical strategy to intentionally get ill. Pox parties are extremely dangerous.
    - nradov 6y ago
      That depends which pox. For chicken pox (varicella) before we had an effective vaccine almost everyone got infected at some point. The effects were more severe for older people so it was safer to catch it as a youth.
      - deleted 6y ago
        [deleted]
  - fxtentacle 6y ago
    Seroconversion was avoided because it's potentially deadly. And while you're waiting for a vaccine to get ready, it kind of makes sense to spread things out. Who benefits from fear? I'd guess weapons companies. Who benefits from lockdowns? No idea. Pro gamers? I can't really decide if you're posting here to stir up a reaction or if you are strongly convinced that seroconversion is a good idea. But just for the sake of discussion, you should consider that the chance of side effects is high enough that many people would actively resist seroconversion. So my guess would be that people who consider that to be a great idea are a 5% minority. That's why governments will likely not do it.
    - landemva 6y ago
      "That's why governments will likely not do it." Japan did it. Japan learned from the docking of the Princess cruise there and the results from each passenger. Those results were quite interesting. And death rates by age group are revealing. The young without co-morbidities have great prospects. September Tokyo study said, "Boston Children’s Hospital and Beth Israel Deaconess Medical School, Boston, say their study suggests that seroprevalence for SARS-CoV-2 rose to almost 50% ..." https://www.news-medical.net/news/20200924/Tokyo-citizens-may-have-developed-COVID-19-herd-immunity-say-researchers.aspx https://www.news-medical.net/news/20200924/Tokyo-citizens-ma... These are mainstream medical professionals from USA making findings that Tokyo is at herd immunity.
      - fxtentacle 6y ago
        That study uses seroconversion in the meaning that a previous infection becomes measurable. But when people suggest active seroconversion they usually mean that you start infecting otherwise healthy individuals deliberately to increase herd immunity. So while both groups use the same word, they mean quite different things.
mrkwse 6y ago
What makes you think the number of infections should remain constant? Studies suggest up to 20% of Covid cases are asymptomatic - those people wouldn't know to follow any guidance/regulations on isolation. The basic R0 is believed to be around 5.7, so even with precautions such as social distancing, masks, and hand washing (which won't be followed flawlessly), it's still trying to mitigate something outstandingly infectious. You need to bring the R0 to 1.0 for the number of cases to only increase at a constant rate, as for anything above 1 every 10 cases will lead to more than 10 new cases, which compounds as it spreads.
landemva 6y ago
The focus on rate of infection, as if that should be minimized, is misplaced. It would be reasonable to protect the vulnerable and focus on allowing healthy people to seroconvert to move the overall population to herd immunity. The virus is in cats, so it is not going away.
- fxtentacle 6y ago
  Seroconversion has a high risk of side effects. That's why nobody is doing it.
- ska 6y ago
  You seem to be fixated on intentional seroconversion as an effective strategy we somehow "missed", but the experts (i.e. epidemiologists) seem to be pretty consistent that this is a poor strategy. Why are you convinced otherwise?
gotaran 6y ago
This doesn't answer your question, but it's worth pointing out that what "worked" for Sweden wouldn't necessarily work or flatten the curve elsewhere. Sweden has a healthy population, tons of spare healthcare capacity, inexpensive healthcare, a high propensity to social distance, an outdoorsy culture, low socioeconomic disparity, and very few people living in multi-generational households. The US, sadly, has none of that. Also, Sweden did have a few restrictions in place. They shut down high schools and universities, and strongly encouraged WFH if possible. Arguably, most of red state US had even looser restrictions than that. HN's perspective on lockdowns might be skewed by the fact that most of us here live in places that actually did have a good faith reasonable response to COVID, but it didn't really work in the absence of a coordinated nationwide response.
- flubert 6y ago
  >HN's perspective on lockdowns might be skewed by the fact that most of us here live in places that actually did have a good faith reasonable response to COVID, but it didn't really work in the absence of a coordinated nationwide response. ...care to expand on this hypothesis? I've heard variations on a theme around this. I live in an area which seems to have close to 100% mask compliance for the last several months as near as I can tell, and we still have cases increasing. I guess I'm having a hard time believing that it is visitors from Texas (or where ever) coming in and spreading coronavirus. What it seems to indicate to me, is that public shopping, etc. isn't a driver behind the spread.
resoluteteeth 6y ago
> Why did this not pan out? Why is Sweden seeing a second wave as well? Why did the number of infections soar, while it should theoretically have remained constant? I have no idea whether this is actually the case in Sweden or not, but it seems like one possibility could be that people/businesses were originally taking additional measures beyond what was legally required but then stopped.
AntiImperialist 6y ago
The previous strategy was to "flatten the curve" and nothing else. There was no vaccine or very effective treatment and this could go on for a very long time. The previous strategy was optimal for that problem. Now that multiple vaccines are around the corner, minimizing infections can most definitely save lives. Would they have done better if they had been stricter? Yes. But there was no way to know this back then. Imagine that there was no vaccine and the pandemic became an endemic that nobody could escape... and the only viable option was herd immunity. Had that happened, the Swedish strategy would have put them ahead of most. They would have taken a smaller hit to the economy while not losing that many more lives in a given period (do note that, in that case, the period would have been much longer and most of those who died last year had pre-existing conditions and something else would have most likely killed them within the next few years anyway).
nradov 6y ago
The null hypothesis is that the differences in death rates between countries are mostly a matter of luck and timing rather than caused by pandemic control measures (or lack thereof). Only a few countries have successfully contained the virus: mainly New Zealand, Vietnam, and possibly Taiwan, China, and Australia. For other countries which still have widespread community transmission we may see the per capita death rates gradually converge (after adjusting for population demographics). To be clear I'm not claiming that all pandemic control measures are ineffective. We just don't have strong scientific evidence that they are effective at the national level over long periods. Sometimes things just happen randomly. Is it possible that Sweden just flipped the coin to heads a bunch of times in al row and now it finally came up tails?
- sampo 6y ago
  > Only a few countries have successfully contained the virus Every country that has chosen suppression as their strategy, has been able to do it. Australia, China, Laos, Mongolia, New Zealand, Nigeria, Ruanda, South Korea, Taiwan, Vietnam. https://ourworldindata.org/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&country=LAO~MNG~RWA~NGA~CHN~NZL~AUS~KOR~TWN~VNM&region=World&casesMetric=true&interval=smoothed&perCapita=true&smoothing=7&pickerMetric=total_cases&pickerSort=desc https://ourworldindata.org/coronavirus-data-explorer?zoomToS...
  - mixedCase 6y ago
    Explain Argentina
  - nradov 6y ago
    I should have included South Korea in my list. But for those other developing countries we don't have enough data to conclude whether their containment efforts have been successful or not. They generally haven't done a lot of widespread random population testing. And their population demographics would lead to low per capita death rates even absent any pandemic control measures.
checkyoursudo 6y ago
As a person who lives in Sweden, here is my best guess. While we did not have mandated lockdowns, there was relatively effective, voluntary limitation of indoor social gatherings throughout the summer, which limited the spread of covid19. Sure, businesses mostly stayed open, but Swedes tend to try to avoid each other to begin with. Asking some Swedes to stand 2m apart in a store would be asking them to stand closer together than they would prefer. Swedes spend a lot of time outdoors, especially in the summer. (Not suggesting more than elsewhere; most places seemed to have better numbers in the summer.) Now that the weather is turning less pleasant, more people spend more time indoors. Therefore, transmission is rising again. > Sweden should have enjoyed a flat and sustainable level of infections. So I think therefore that this didn't really happen, which means now we get our second wave. In some places, such as the nearby town of a few thousand, we are actually only starting to get a first wave as we never really had a first wave yet. Still almost no mask wearing, though. Not sure when or if masks will happen here, although I have seen packs of them at the market now. Again, I am no expert and I have not looked at actual transmission numbers throughout the summer etc. This is just my best guess. Edit: What I mean is, I don't think most regions of Sweden had sustained levels of transmission during the summer, in case that wasn't clear.
sampo 6y ago
> Why is Sweden seeing a second wave as well? Why did the number of infections soar, while it should theoretically have remained constant? I think we can now conclude that covid19 behaves seasonally, just like other respiratory viruses. But nobody knows exactly why. There are many theories, but none universally accepted: Summertime higher vitamin D levels from sunlight, maybe this gives better immune defense. Sunlight disinfects surfaces. Colder air is dry, respiratory droplets stay afloat longer and spread better in dry air. People's mucous membranes stay healthier in more humid air, maybe they are more susceptible for virus attacks in dry air. Maybe the patterns of how much people meet each other indoors is different in cold weather.
- PowerBar 6y ago
  > I think we can now conclude that covid19 behaves seasonally, just like other respiratory viruses. I don't know how you can possibly establish a seasonal trend before we've even observed it for a single seasonal rotation. https://xkcd.com/605/ https://xkcd.com/605/

pchristensen 6y ago

Exponential growth can get out of hand very quickly. It doesn't take too many people to mess up, break rules, or get unlucky for this virus to erupt. Also, way more people are indoors in November in Sweden than August. Many people travel to remote cabins in the summer - August in Stockholm is about as deserted as San Francisco during Burning Man. They're mostly back by September, bringing more people in proximity. I'm in Seattle and Washington is locking down again, as colder temps have brought the long predicted fall spike.

landemva 6y ago
"the long predicted fall spike." If those in power knew a Fall spike would likely occur, would it have made sense to encourage healthy people to seroconvert during the summer, when the flu is less prevalent? Instead, this was purposefully stretched into the flu season. Why? Who benefits from fear and lockdowns?
- im3w1l 6y ago
  > Why? Well one part is incompetence. And the other is that a fall spike was just a hypothesis. We didn't know for sure.
  - landemva 6y ago
    Seems we can agree that it was incompetent to prevent healthy people from seroconverting last summer.
    - VectorLock 6y ago
      With even healthy people dying or having long term if not life long health impacts, was it really "incompetent" to prevent people from taking those risks?
    - tunesmith 6y ago
      There's a counterfactual logic flaw there though. How do you know ahead of time that a healthy person would recover nicely? There are plenty of counterexamples. If you respond in a utilitarian manner, well then you have to compare it with other utilitarian approaches.
    - fxtentacle 6y ago
      Your sentence makes very little sense to me because the seroconversion has a high chance of causing life-altering side effects. I'd say it would be irresponsible to suggest that to the general public.
- Analemma_ 6y ago
  Nobody benefits from fear and lockdowns, that's why the conspiracy theories around them are so fucking stupid. We did not encourage healthy people to seroconvert during the summer because achieving the necessary numbers of infected would have caused millions of deaths. This was the UK's original plan and they backed off when they actually ran the numbers and saw how many fatalities it would require.
- tunesmith 6y ago
  I don't understand why "fear and lockdowns" are equated here. Lockdowns aren't an agenda on their own - it's because of the virus, which exists whether you do a lockdown or not. I guess people believe that the virus is nothing to be scared of, and so then they believe that people fearmonger to whip up support for a lockdown, but this belief makes zero sense to me - why would anyone be in favor of a lockdown if the virus isn't dangerous?
  - modzu 6y ago
    it seems politically safer to do "something", than to do "nothing". if the lockdowns stop the virus you're a hero, if they dont, you're still a hero for thinking of the children... if instead you do nothing, and things get better, you're just seen as lucky, if things get worse, you get to take the blame.
- pchristensen 6y ago
  It was predicted because the change in weather causes more people to be indoors, and poor indoor air circulation is a big contributing factor for spreading. Same with the onset of the hot weather and A/C in the US South in May, around the time cases started increasing there. Also, catching Covid sucks for a lot of people, even if they survive. Encouraging people to catch it during summer seems pretty irresponsible.
- learnstats2 6y ago
  > encourage healthy people to seroconvert It's almost never a good medical strategy to intentionally get ill. Pox parties are extremely dangerous.
  - nradov 6y ago
    That depends which pox. For chicken pox (varicella) before we had an effective vaccine almost everyone got infected at some point. The effects were more severe for older people so it was safer to catch it as a youth.
    - deleted 6y ago
      [deleted]
- fxtentacle 6y ago
  Seroconversion was avoided because it's potentially deadly. And while you're waiting for a vaccine to get ready, it kind of makes sense to spread things out. Who benefits from fear? I'd guess weapons companies. Who benefits from lockdowns? No idea. Pro gamers? I can't really decide if you're posting here to stir up a reaction or if you are strongly convinced that seroconversion is a good idea. But just for the sake of discussion, you should consider that the chance of side effects is high enough that many people would actively resist seroconversion. So my guess would be that people who consider that to be a great idea are a 5% minority. That's why governments will likely not do it.
  - landemva 6y ago
    "That's why governments will likely not do it." Japan did it. Japan learned from the docking of the Princess cruise there and the results from each passenger. Those results were quite interesting. And death rates by age group are revealing. The young without co-morbidities have great prospects. September Tokyo study said, "Boston Children’s Hospital and Beth Israel Deaconess Medical School, Boston, say their study suggests that seroprevalence for SARS-CoV-2 rose to almost 50% ..." https://www.news-medical.net/news/20200924/Tokyo-citizens-may-have-developed-COVID-19-herd-immunity-say-researchers.aspx https://www.news-medical.net/news/20200924/Tokyo-citizens-ma... These are mainstream medical professionals from USA making findings that Tokyo is at herd immunity.
    - fxtentacle 6y ago
      That study uses seroconversion in the meaning that a previous infection becomes measurable. But when people suggest active seroconversion they usually mean that you start infecting otherwise healthy individuals deliberately to increase herd immunity. So while both groups use the same word, they mean quite different things.

mrkwse 6y ago

What makes you think the number of infections should remain constant? Studies suggest up to 20% of Covid cases are asymptomatic - those people wouldn't know to follow any guidance/regulations on isolation. The basic R0 is believed to be around 5.7, so even with precautions such as social distancing, masks, and hand washing (which won't be followed flawlessly), it's still trying to mitigate something outstandingly infectious. You need to bring the R0 to 1.0 for the number of cases to only increase at a constant rate, as for anything above 1 every 10 cases will lead to more than 10 new cases, which compounds as it spreads.

landemva 6y ago

The focus on rate of infection, as if that should be minimized, is misplaced. It would be reasonable to protect the vulnerable and focus on allowing healthy people to seroconvert to move the overall population to herd immunity. The virus is in cats, so it is not going away.

fxtentacle 6y ago
Seroconversion has a high risk of side effects. That's why nobody is doing it.
ska 6y ago
You seem to be fixated on intentional seroconversion as an effective strategy we somehow "missed", but the experts (i.e. epidemiologists) seem to be pretty consistent that this is a poor strategy. Why are you convinced otherwise?

gotaran 6y ago

This doesn't answer your question, but it's worth pointing out that what "worked" for Sweden wouldn't necessarily work or flatten the curve elsewhere. Sweden has a healthy population, tons of spare healthcare capacity, inexpensive healthcare, a high propensity to social distance, an outdoorsy culture, low socioeconomic disparity, and very few people living in multi-generational households. The US, sadly, has none of that. Also, Sweden did have a few restrictions in place. They shut down high schools and universities, and strongly encouraged WFH if possible. Arguably, most of red state US had even looser restrictions than that. HN's perspective on lockdowns might be skewed by the fact that most of us here live in places that actually did have a good faith reasonable response to COVID, but it didn't really work in the absence of a coordinated nationwide response.

flubert 6y ago
>HN's perspective on lockdowns might be skewed by the fact that most of us here live in places that actually did have a good faith reasonable response to COVID, but it didn't really work in the absence of a coordinated nationwide response. ...care to expand on this hypothesis? I've heard variations on a theme around this. I live in an area which seems to have close to 100% mask compliance for the last several months as near as I can tell, and we still have cases increasing. I guess I'm having a hard time believing that it is visitors from Texas (or where ever) coming in and spreading coronavirus. What it seems to indicate to me, is that public shopping, etc. isn't a driver behind the spread.

resoluteteeth 6y ago

> Why did this not pan out? Why is Sweden seeing a second wave as well? Why did the number of infections soar, while it should theoretically have remained constant? I have no idea whether this is actually the case in Sweden or not, but it seems like one possibility could be that people/businesses were originally taking additional measures beyond what was legally required but then stopped.

AntiImperialist 6y ago

The previous strategy was to "flatten the curve" and nothing else. There was no vaccine or very effective treatment and this could go on for a very long time. The previous strategy was optimal for that problem. Now that multiple vaccines are around the corner, minimizing infections can most definitely save lives. Would they have done better if they had been stricter? Yes. But there was no way to know this back then. Imagine that there was no vaccine and the pandemic became an endemic that nobody could escape... and the only viable option was herd immunity. Had that happened, the Swedish strategy would have put them ahead of most. They would have taken a smaller hit to the economy while not losing that many more lives in a given period (do note that, in that case, the period would have been much longer and most of those who died last year had pre-existing conditions and something else would have most likely killed them within the next few years anyway).

nradov 6y ago

The null hypothesis is that the differences in death rates between countries are mostly a matter of luck and timing rather than caused by pandemic control measures (or lack thereof). Only a few countries have successfully contained the virus: mainly New Zealand, Vietnam, and possibly Taiwan, China, and Australia. For other countries which still have widespread community transmission we may see the per capita death rates gradually converge (after adjusting for population demographics). To be clear I'm not claiming that all pandemic control measures are ineffective. We just don't have strong scientific evidence that they are effective at the national level over long periods. Sometimes things just happen randomly. Is it possible that Sweden just flipped the coin to heads a bunch of times in al row and now it finally came up tails?

sampo 6y ago
> Only a few countries have successfully contained the virus Every country that has chosen suppression as their strategy, has been able to do it. Australia, China, Laos, Mongolia, New Zealand, Nigeria, Ruanda, South Korea, Taiwan, Vietnam. https://ourworldindata.org/coronavirus-data-explorer?zoomToSelection=true&time=2020-03-01..latest&country=LAO~MNG~RWA~NGA~CHN~NZL~AUS~KOR~TWN~VNM&region=World&casesMetric=true&interval=smoothed&perCapita=true&smoothing=7&pickerMetric=total_cases&pickerSort=desc https://ourworldindata.org/coronavirus-data-explorer?zoomToS...
- mixedCase 6y ago
  Explain Argentina
- nradov 6y ago
  I should have included South Korea in my list. But for those other developing countries we don't have enough data to conclude whether their containment efforts have been successful or not. They generally haven't done a lot of widespread random population testing. And their population demographics would lead to low per capita death rates even absent any pandemic control measures.

checkyoursudo 6y ago

As a person who lives in Sweden, here is my best guess. While we did not have mandated lockdowns, there was relatively effective, voluntary limitation of indoor social gatherings throughout the summer, which limited the spread of covid19. Sure, businesses mostly stayed open, but Swedes tend to try to avoid each other to begin with. Asking some Swedes to stand 2m apart in a store would be asking them to stand closer together than they would prefer. Swedes spend a lot of time outdoors, especially in the summer. (Not suggesting more than elsewhere; most places seemed to have better numbers in the summer.) Now that the weather is turning less pleasant, more people spend more time indoors. Therefore, transmission is rising again. > Sweden should have enjoyed a flat and sustainable level of infections. So I think therefore that this didn't really happen, which means now we get our second wave. In some places, such as the nearby town of a few thousand, we are actually only starting to get a first wave as we never really had a first wave yet. Still almost no mask wearing, though. Not sure when or if masks will happen here, although I have seen packs of them at the market now. Again, I am no expert and I have not looked at actual transmission numbers throughout the summer etc. This is just my best guess. Edit: What I mean is, I don't think most regions of Sweden had sustained levels of transmission during the summer, in case that wasn't clear.

sampo 6y ago

> Why is Sweden seeing a second wave as well? Why did the number of infections soar, while it should theoretically have remained constant? I think we can now conclude that covid19 behaves seasonally, just like other respiratory viruses. But nobody knows exactly why. There are many theories, but none universally accepted: Summertime higher vitamin D levels from sunlight, maybe this gives better immune defense. Sunlight disinfects surfaces. Colder air is dry, respiratory droplets stay afloat longer and spread better in dry air. People's mucous membranes stay healthier in more humid air, maybe they are more susceptible for virus attacks in dry air. Maybe the patterns of how much people meet each other indoors is different in cold weather.

PowerBar 6y ago
> I think we can now conclude that covid19 behaves seasonally, just like other respiratory viruses. I don't know how you can possibly establish a seasonal trend before we've even observed it for a single seasonal rotation. https://xkcd.com/605/ https://xkcd.com/605/