8 ms·

I would love it if we could get such clear-cut results from the numbers, and just be able to say “this strategy is good, if we do that everything will be fine”

I would love it if we could get such clear-cut results from the numbers, and just be able to say “this strategy is good, if we do that everything will be fine” (not saying you're saying that), but I really don't think that's the case. Here in Switzerland, we had plenty of lockdowns, followed the scientific wisdom and so on, and we're at 1375 deaths per million. The UK has shifted strategies around a bunch, but they have one of the highest vaccination rates, and have had multiple lockdowns, but are still at a very high 2119 deaths per million. I'm not trying to say this or that approach is good or bad, and I'm happy we've had lockdowns here in Switzerland. I'm just saying that correlating the number of deaths with the implementation of lockdowns definitely does not fully explain what we've seen so far. There are so many other factors, such as excess mortality, compliance with measures, psychological impacts on both mental and physical health, international travel, local variants, and a lot of factors we don't even know exist yet.

inpdx 5y ago
While I agree comparing countries can be apples and oranges, it makes sense to compare the Scandinavian countries. That Norway and Finland were much lower strongly suggests Sweden's strategies worsened things.
- yxhuvud 5y ago
  Only if you assume the countries are similar in every other way that matter. But that is not the case, Sweden is for example by far the most urbanized country in Scandinavia - the share of people living in big or medium sized cities is 10% higher than other Scandinavian countries. Countries with high level of urbanisation have (so far, and especially early on) been hit way harder than more rural countries.
  - hedora 5y ago
    I’d be interested in seeing a scatter plot of excess mortality vs urbanization, income, single family housing, etc, etc. in one of these articles. Without that, they seem pretty lazy, or designed to drive a political point regardless of the evidence.
- wk_end 5y ago
  What’s frustrating is that the people who insist you should only compare Sweden to its Scandinavian peers are the same who insist that the US or Europe should use have used remote islands in the Pacific as their pandemic model. This goes the other way too, of course - people who are keen to compare Sweden to the UK instead of Denmark cry foul whenever New Zealand is brought up. The problem though is that there’s no bulletproof explanation for why lockdowns were so effective in the rest of Scandinavia and less so elsewhere in Europe (or many American states for that matter). Without that, the counterfactual is still a bit of a question mark. If Sweden had adopted Denmark’s strategy, maybe they would’ve indeed come out looking like Denmark - or maybe they would’ve come out looking like the UK. Vaguely gesturing towards “they’re all Scandinavian” doesn’t have much explanatory power.
- xorcist 5y ago
  What you say makes sense when we think of geographic locality. But is that really what should guide the pandemic response? Sweden is much more like UK, the Netherlands and Germany than it is like Norway or Finland when we look at things like urbanisation, demographic diversity and immigration. In part because much more of the population is centralized to a few areas. The organization of public health care, especially that of old people's homes, is completely different between those countries. If we look at the regional differences, you'd see that the areas of Sweden which demographically is similar to Norway indeed followed the pandemic outbreak of Norway very closely, with a very low incidence for the longest time, and then scattered outbreaks with increasing magnitude. During those first crucial months, the pandemic outbreak in Sweden almost exlusively took place in the two most populous and urbanized areas. The rest of the country was pretty much spared. With the differently implemented lockdown in place, it was interesting to compare incidence in smaller geographic areas separated by the border but otherwise much more similar than the countries are. It is quite clear that any correlation can not be substantiated by data.
api 5y ago
Age of population is a huge factor that must be included but I seldom see it mentioned. Another one we don’t even understand at all yet is genetic makeup of the population. We know that with other diseases there are genetic markers that increase of decrease susceptibility. There probably are here too but we don’t know what they are. Differences in distribution of those markers could totally confound studies. The best comparisons right now are going to be within more genetically and demographically similar populations. Here in Ohio we have seen that the vaccine is over 90% effective at preventing severe COVID and death but far less effective at simply stopping transmission. (Ohio has used the mRNA Pfizer/Moderna one almost exclusively.) But we already know it does not sterilize. Not sure about masks and lockdowns. Have to look that up. There are even more confounders there like what masks are being used (N95 vs KN95 vs thin cloth junk) and uneven compliance that nobody is able to track.
NoPie 5y ago
We don't even know why covid has a seasonality. Obviously it has a physical cause but the interplay of all factors is so complicated that no one can really explain why peaks come and go, and at different times in each place.
- kyrra 5y ago
  Best guess I've seen on hit this has to do with how much time people are spending inside due to weather. See the screenshot of covid positivity rates at two different dates. https://mobile.twitter.com/EricTopol/status/1457438899580456968 https://mobile.twitter.com/EricTopol/status/1457438899580456... The screenshot is from the NYTimes covid tracker. The guess was that more people were inside in the south the summer when it was hot, and they were running air conditioning. Now that the South has more reasonable temperatures, people are spending more time outside. While the north is starting to get colder and people are spending more time inside. This also seems to apply to California which has relatively stable temperatures all year, so they haven't been hit by either spike yet. Though the part that doesn't fit in here is the northeast corridor is not being hit as hard. My only guess is they were the ones hit hardest when covid started, so maybe they won't get as big of a spike now.
  - mdp2021 5y ago
    Not only that (rate of interaction spent outdoors), also an effect of UV was observed. Not massive but significant. I cannot find the original material that informed me, but I see there was a research effort last year, described at https://bren.ucsb.edu/news/seasonal-uv-light-exposure-affects-covid-19-spread https://bren.ucsb.edu/news/seasonal-uv-light-exposure-affect... > The authors then used a dataset of meteorological conditions with daily resolution ... analyz[ing] how four variables — UV radiation, temperature, humidity and precipitation — correlated with the daily growth rate of COVID-19 cases ... [and] found evidence that a location’s UV exposure significantly affects COVID-19 transmission. A change in UV exposure by 1 standard deviation (roughly equal to the difference in UV between May and June in Los Angeles) reduced the growth rate of new cases by around 1 percentage point over the following two weeks and a more recent one, described at https://eos.org/research-spotlights/scientists-uncover-the-seasonality-of-covid-19 https://eos.org/research-spotlights/scientists-uncover-the-s... > The seasonal values of ultraviolet (UV) radiation and ADC, however, were consistent with fluctuations in COVID-19 prevalence across all five countries
chli 5y ago
I hope you're kidding with respect to Switzerland's handling of covid... We have the worst vaccine coverage of western Europe. The government didn't take the necessary measures in September/October last year which lead to thousands of unnecessary deaths. Most schools have no mitigation in place, no CO2 meter, no filtering, no mask, no testing. The largest political party (SVP/UDC) has systematically downplayed the pandemic. Etc.
- vladharbuz 5y ago
  > We have the worst vaccine coverage of western Europe. You're right, I hadn't realised this. Still, all countries in Western Europe are within ~10% of each other when it comes to the percentage of the population that's fully vaccinated. More generally, I definitely don't think Switzerland's handling of the pandemic was perfect, but it currently seems to me that Switzerland did mostly follow the advice of the scientific community.
amelius 5y ago
The problem is that it's not black/white. Close all roads to normal traffic and you'll have near-zero mortality from traffic accidents. But does that make it a smart policy?
- convolvatron 5y ago
  no. but at least you have a framework to reason about the tradeoffs. with covid its all been a bunch of speculation and shouting
  - skeeter2020 5y ago
    Even then it's not an issue-free baseline. How many people died because they couldn't use the roads, either directly (get to help) or indirectly (delivery of inputs that prevented a death)? Covid is even harder to measure. One Example: You shut down elementary schools to prevent kids from getting infected; how many were pushed back into broken homes from the only safe space they had? How many will have long-term pain from learning , nutrition, physical abuse, mental health? Most policy can be reduced to "Better safe than sorry" which completely ignores the direct and indirect costs of any action.
    - xorcist 5y ago
      > How many will have long-term pain from learning , nutrition, physical abuse, mental health? We know that. Not exact numbers, but at least there are rough estimates. It's been an active area of research for quite some time, so there's a lot of data. Statistically speaking, we know how childhood poverty or a missed school year means for average lifespan. It's been theoreticized that a reason for the differences in pandemic response when it comes to Sweden are down to the fact that they recently unified all their people health issues, that is not only medical issues but also social ones, under one government agency. That broader mandate is generally more data driven and needs to take longer term effects of missing school into account. > Most policy can be reduced to "Better safe than sorry" That's not all there is to it. Strictly following that reasoning would emphasize known risks against unknown risks. That does not explain the policy making that dominated during the pandemic.
deleted 5y ago
[deleted]
rich_sasha 5y ago
> The UK has shifted strategies around a bunch, but they have one of the highest vaccination rates, and have had multiple lockdowns, but are still at a very high 2119 deaths per million. Another reason why such comparisons are hard: UK aggressively cleared hospitals in early 2020, in anticipation of case rises, and discharged whoever they could home. This lead to thousands of old people being discharged to care homes, as it turns out frequently with Covid, with care home staff having not even the basic protective gear. IIRC 25% of first wave deaths were attributed to care homes, and due to various quirks of the number, this may well be an underestimate. I guess you’ll see other cases where the general policy was good/bad but external forces skewed the result. Poland do basically no protective steps until Autumn 2020, and despite that was totally spared the pandemic. Then later shit hit the fan pretty badly...
irthomasthomas 5y ago
UK is a bad example to choose. They used the highest possible sensitivity setting on the PCR test, to the degree that no meaningful information could be extracted from them. In addition, anyone who died, for any reason, at any time after a positive test, was recorded as a covid death. Even if they died in a car accident months after they had the test. Sources: Covid-19: The problems with case counting: "What is a case? One issue in trying to interpret numbers of detected cases is that there is no set definition of a case. At the moment it seems that a polymerase chain reaction (PCR) positive result is the only criterion required for a case to be recognised. In any other disease we would have a clearly defined specification that would usually involve signs, symptoms, and a test result, .... “We are moving into a biotech world where the norms of clinical reasoning are going out of the window. A PCR test does not equal covid-19; it should not, but in some definitions it does." http://www.bmj.com/content/370/bmj.m3374.full http://www.bmj.com/content/370/bmj.m3374.full Why no one can ever recover from COVID-19 in England: "A Department of Health and Social Care source said: ‘You could have been tested positive in February, have no symptoms, then hit by a bus in July and you’d be recorded as a COVID death.’” https://web.archive.org/web/20201012190837/https://www.cebm.net/covid-19/why-no-one-can-ever-recover-from-covid-19-in-england-a-statistical-anomaly/ https://web.archive.org/web/20201012190837/https://www.cebm.... And my favourite... Sir Humphrey responds to the allegation of test inaccuracy... "Positive test results at the limit of detection that occur late in the cycle of infection represent individuals with a low or very low risk of transmission, as a result of the decline in infectious virus production or remnants of viral RNA in respiratory secretions. The clinical significance of these positive results, at the limit of detection of the assay, are difficult to interpret in the absence of a clinical history and context. Possible reasons for the non-repeatability of these results include stochastic effects at the limit of detection of the assay, true prolonged low level detection of the virus, and very rarely, analytical errors in sample handling." https://www.gov.uk/government/publications/sars-cov-2-rna-testing-assurance-of-positive-results-during-periods-of-low-prevalence/assurance-of-sars-cov-2-rna-positive-results-during-periods-of-low-prevalence https://www.gov.uk/government/publications/sars-cov-2-rna-te...
- JoeAltmaier 5y ago
  "A source said" isn't the same as data. People are saying a thousand accusatory things. Let's quit spreading the gossip.
mdp2021 5y ago
> There are so many other factors What about "whether people observe care or not"? Because I have seen (also not far away from the poster, and not even in a single "culture") that a large amount of people seemed to be completely oblivious and irresponsible - and I am very sure that factor has been and is being critical. Extreme lack of contextual awareness - in general and in specific occasions, day by day and moment by moment. Incidentally: never received so many invitations to "go out and meet and do" like in the past two years. (And of course, never been so glad of cheap communication tech being available.) Attention is everything.
tchalla 5y ago
> Here in Switzerland, we had plenty of lockdowns, followed the scientific wisdom and so on, and we're at 1375 deaths per million. You can compare the number of days of lockdown to deaths per million. You should also compare at what point of time the lockdowns were undertaken. There's plenty of research that shows Non Pharmaceutical Initiatives are very effective in stopping the spread of virus.
- ed25519FUUU 5y ago
  You really would not be able to tell this by looking at a state-by-state map of deaths in the USA, which have had various (sometimes opposing) views of “Non Pharmaceutical initiatives” https://www.statista.com/statistics/1109011/coronavirus-covid19-death-rates-us-by-state/ https://www.statista.com/statistics/1109011/coronavirus-covi...
  - tchalla 5y ago
    Yes, and this is why you don't look at one state-by-state map graphic but rely on quality research to understand the benefits of them.
h0nd 5y ago
You should not compare the numbers of deaths that may or may not be caused by covid, but the absolute number of deaths.

inpdx 5y ago

While I agree comparing countries can be apples and oranges, it makes sense to compare the Scandinavian countries. That Norway and Finland were much lower strongly suggests Sweden's strategies worsened things.

yxhuvud 5y ago
Only if you assume the countries are similar in every other way that matter. But that is not the case, Sweden is for example by far the most urbanized country in Scandinavia - the share of people living in big or medium sized cities is 10% higher than other Scandinavian countries. Countries with high level of urbanisation have (so far, and especially early on) been hit way harder than more rural countries.
- hedora 5y ago
  I’d be interested in seeing a scatter plot of excess mortality vs urbanization, income, single family housing, etc, etc. in one of these articles. Without that, they seem pretty lazy, or designed to drive a political point regardless of the evidence.
wk_end 5y ago
What’s frustrating is that the people who insist you should only compare Sweden to its Scandinavian peers are the same who insist that the US or Europe should use have used remote islands in the Pacific as their pandemic model. This goes the other way too, of course - people who are keen to compare Sweden to the UK instead of Denmark cry foul whenever New Zealand is brought up. The problem though is that there’s no bulletproof explanation for why lockdowns were so effective in the rest of Scandinavia and less so elsewhere in Europe (or many American states for that matter). Without that, the counterfactual is still a bit of a question mark. If Sweden had adopted Denmark’s strategy, maybe they would’ve indeed come out looking like Denmark - or maybe they would’ve come out looking like the UK. Vaguely gesturing towards “they’re all Scandinavian” doesn’t have much explanatory power.
xorcist 5y ago
What you say makes sense when we think of geographic locality. But is that really what should guide the pandemic response? Sweden is much more like UK, the Netherlands and Germany than it is like Norway or Finland when we look at things like urbanisation, demographic diversity and immigration. In part because much more of the population is centralized to a few areas. The organization of public health care, especially that of old people's homes, is completely different between those countries. If we look at the regional differences, you'd see that the areas of Sweden which demographically is similar to Norway indeed followed the pandemic outbreak of Norway very closely, with a very low incidence for the longest time, and then scattered outbreaks with increasing magnitude. During those first crucial months, the pandemic outbreak in Sweden almost exlusively took place in the two most populous and urbanized areas. The rest of the country was pretty much spared. With the differently implemented lockdown in place, it was interesting to compare incidence in smaller geographic areas separated by the border but otherwise much more similar than the countries are. It is quite clear that any correlation can not be substantiated by data.

api 5y ago

Age of population is a huge factor that must be included but I seldom see it mentioned. Another one we don’t even understand at all yet is genetic makeup of the population. We know that with other diseases there are genetic markers that increase of decrease susceptibility. There probably are here too but we don’t know what they are. Differences in distribution of those markers could totally confound studies. The best comparisons right now are going to be within more genetically and demographically similar populations. Here in Ohio we have seen that the vaccine is over 90% effective at preventing severe COVID and death but far less effective at simply stopping transmission. (Ohio has used the mRNA Pfizer/Moderna one almost exclusively.) But we already know it does not sterilize. Not sure about masks and lockdowns. Have to look that up. There are even more confounders there like what masks are being used (N95 vs KN95 vs thin cloth junk) and uneven compliance that nobody is able to track.

NoPie 5y ago

We don't even know why covid has a seasonality. Obviously it has a physical cause but the interplay of all factors is so complicated that no one can really explain why peaks come and go, and at different times in each place.

kyrra 5y ago
Best guess I've seen on hit this has to do with how much time people are spending inside due to weather. See the screenshot of covid positivity rates at two different dates. https://mobile.twitter.com/EricTopol/status/1457438899580456968 https://mobile.twitter.com/EricTopol/status/1457438899580456... The screenshot is from the NYTimes covid tracker. The guess was that more people were inside in the south the summer when it was hot, and they were running air conditioning. Now that the South has more reasonable temperatures, people are spending more time outside. While the north is starting to get colder and people are spending more time inside. This also seems to apply to California which has relatively stable temperatures all year, so they haven't been hit by either spike yet. Though the part that doesn't fit in here is the northeast corridor is not being hit as hard. My only guess is they were the ones hit hardest when covid started, so maybe they won't get as big of a spike now.
- mdp2021 5y ago
  Not only that (rate of interaction spent outdoors), also an effect of UV was observed. Not massive but significant. I cannot find the original material that informed me, but I see there was a research effort last year, described at https://bren.ucsb.edu/news/seasonal-uv-light-exposure-affects-covid-19-spread https://bren.ucsb.edu/news/seasonal-uv-light-exposure-affect... > The authors then used a dataset of meteorological conditions with daily resolution ... analyz[ing] how four variables — UV radiation, temperature, humidity and precipitation — correlated with the daily growth rate of COVID-19 cases ... [and] found evidence that a location’s UV exposure significantly affects COVID-19 transmission. A change in UV exposure by 1 standard deviation (roughly equal to the difference in UV between May and June in Los Angeles) reduced the growth rate of new cases by around 1 percentage point over the following two weeks and a more recent one, described at https://eos.org/research-spotlights/scientists-uncover-the-seasonality-of-covid-19 https://eos.org/research-spotlights/scientists-uncover-the-s... > The seasonal values of ultraviolet (UV) radiation and ADC, however, were consistent with fluctuations in COVID-19 prevalence across all five countries

chli 5y ago

I hope you're kidding with respect to Switzerland's handling of covid... We have the worst vaccine coverage of western Europe. The government didn't take the necessary measures in September/October last year which lead to thousands of unnecessary deaths. Most schools have no mitigation in place, no CO2 meter, no filtering, no mask, no testing. The largest political party (SVP/UDC) has systematically downplayed the pandemic. Etc.

vladharbuz 5y ago
> We have the worst vaccine coverage of western Europe. You're right, I hadn't realised this. Still, all countries in Western Europe are within ~10% of each other when it comes to the percentage of the population that's fully vaccinated. More generally, I definitely don't think Switzerland's handling of the pandemic was perfect, but it currently seems to me that Switzerland did mostly follow the advice of the scientific community.

amelius 5y ago

The problem is that it's not black/white. Close all roads to normal traffic and you'll have near-zero mortality from traffic accidents. But does that make it a smart policy?

convolvatron 5y ago
no. but at least you have a framework to reason about the tradeoffs. with covid its all been a bunch of speculation and shouting
- skeeter2020 5y ago
  Even then it's not an issue-free baseline. How many people died because they couldn't use the roads, either directly (get to help) or indirectly (delivery of inputs that prevented a death)? Covid is even harder to measure. One Example: You shut down elementary schools to prevent kids from getting infected; how many were pushed back into broken homes from the only safe space they had? How many will have long-term pain from learning , nutrition, physical abuse, mental health? Most policy can be reduced to "Better safe than sorry" which completely ignores the direct and indirect costs of any action.
  - xorcist 5y ago
    > How many will have long-term pain from learning , nutrition, physical abuse, mental health? We know that. Not exact numbers, but at least there are rough estimates. It's been an active area of research for quite some time, so there's a lot of data. Statistically speaking, we know how childhood poverty or a missed school year means for average lifespan. It's been theoreticized that a reason for the differences in pandemic response when it comes to Sweden are down to the fact that they recently unified all their people health issues, that is not only medical issues but also social ones, under one government agency. That broader mandate is generally more data driven and needs to take longer term effects of missing school into account. > Most policy can be reduced to "Better safe than sorry" That's not all there is to it. Strictly following that reasoning would emphasize known risks against unknown risks. That does not explain the policy making that dominated during the pandemic.

deleted 5y ago

[deleted]

rich_sasha 5y ago

> The UK has shifted strategies around a bunch, but they have one of the highest vaccination rates, and have had multiple lockdowns, but are still at a very high 2119 deaths per million. Another reason why such comparisons are hard: UK aggressively cleared hospitals in early 2020, in anticipation of case rises, and discharged whoever they could home. This lead to thousands of old people being discharged to care homes, as it turns out frequently with Covid, with care home staff having not even the basic protective gear. IIRC 25% of first wave deaths were attributed to care homes, and due to various quirks of the number, this may well be an underestimate. I guess you’ll see other cases where the general policy was good/bad but external forces skewed the result. Poland do basically no protective steps until Autumn 2020, and despite that was totally spared the pandemic. Then later shit hit the fan pretty badly...

irthomasthomas 5y ago

UK is a bad example to choose. They used the highest possible sensitivity setting on the PCR test, to the degree that no meaningful information could be extracted from them. In addition, anyone who died, for any reason, at any time after a positive test, was recorded as a covid death. Even if they died in a car accident months after they had the test. Sources: Covid-19: The problems with case counting: "What is a case? One issue in trying to interpret numbers of detected cases is that there is no set definition of a case. At the moment it seems that a polymerase chain reaction (PCR) positive result is the only criterion required for a case to be recognised. In any other disease we would have a clearly defined specification that would usually involve signs, symptoms, and a test result, .... “We are moving into a biotech world where the norms of clinical reasoning are going out of the window. A PCR test does not equal covid-19; it should not, but in some definitions it does." http://www.bmj.com/content/370/bmj.m3374.full http://www.bmj.com/content/370/bmj.m3374.full Why no one can ever recover from COVID-19 in England: "A Department of Health and Social Care source said: ‘You could have been tested positive in February, have no symptoms, then hit by a bus in July and you’d be recorded as a COVID death.’” https://web.archive.org/web/20201012190837/https://www.cebm.net/covid-19/why-no-one-can-ever-recover-from-covid-19-in-england-a-statistical-anomaly/ https://web.archive.org/web/20201012190837/https://www.cebm.... And my favourite... Sir Humphrey responds to the allegation of test inaccuracy... "Positive test results at the limit of detection that occur late in the cycle of infection represent individuals with a low or very low risk of transmission, as a result of the decline in infectious virus production or remnants of viral RNA in respiratory secretions. The clinical significance of these positive results, at the limit of detection of the assay, are difficult to interpret in the absence of a clinical history and context. Possible reasons for the non-repeatability of these results include stochastic effects at the limit of detection of the assay, true prolonged low level detection of the virus, and very rarely, analytical errors in sample handling." https://www.gov.uk/government/publications/sars-cov-2-rna-testing-assurance-of-positive-results-during-periods-of-low-prevalence/assurance-of-sars-cov-2-rna-positive-results-during-periods-of-low-prevalence https://www.gov.uk/government/publications/sars-cov-2-rna-te...

JoeAltmaier 5y ago
"A source said" isn't the same as data. People are saying a thousand accusatory things. Let's quit spreading the gossip.

mdp2021 5y ago

> There are so many other factors What about "whether people observe care or not"? Because I have seen (also not far away from the poster, and not even in a single "culture") that a large amount of people seemed to be completely oblivious and irresponsible - and I am very sure that factor has been and is being critical. Extreme lack of contextual awareness - in general and in specific occasions, day by day and moment by moment. Incidentally: never received so many invitations to "go out and meet and do" like in the past two years. (And of course, never been so glad of cheap communication tech being available.) Attention is everything.

tchalla 5y ago

> Here in Switzerland, we had plenty of lockdowns, followed the scientific wisdom and so on, and we're at 1375 deaths per million. You can compare the number of days of lockdown to deaths per million. You should also compare at what point of time the lockdowns were undertaken. There's plenty of research that shows Non Pharmaceutical Initiatives are very effective in stopping the spread of virus.

ed25519FUUU 5y ago
You really would not be able to tell this by looking at a state-by-state map of deaths in the USA, which have had various (sometimes opposing) views of “Non Pharmaceutical initiatives” https://www.statista.com/statistics/1109011/coronavirus-covid19-death-rates-us-by-state/ https://www.statista.com/statistics/1109011/coronavirus-covi...
- tchalla 5y ago
  Yes, and this is why you don't look at one state-by-state map graphic but rely on quality research to understand the benefits of them.

h0nd 5y ago

You should not compare the numbers of deaths that may or may not be caused by covid, but the absolute number of deaths.