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Some discussion about Sweden and their results

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Marc_G

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Hi folks,

In a now-closed thread about HQ, @steveh.jae posted some thoughts about Sweden's results, as follows:

He said:
"Here’s some ‘anecdotal data’ from Sweden ... the ‘herd immunity’ approach their scientific advisors recommended and implemented (with minimal impact on their daily lives compared to ours) seems to have produced a linear hard crash in the descending limb of the death trajectory. Just sayin’ "
In the event the pasted Sweden daily deaths graph from Worldometers.org doesn't show well, it shows a spike of daily deaths per day of more than 50 and up to around 100 deaths per day through April, with recovery and sustained downward trend beginning in the first half of May. Sweden currently has very few deaths on a daily basis at this point.

I call this out for discussion because there has been a lot of discussion on some right wing forums I frequent (somewhat at my emotional peril) about Sweden as a great example of letting people live their lives and having a good outcome. Typically the conversations drift to: "Why don't (or, why didn't) we do that? We could have saved our economy and been in a better health position because what Sweden is doing clearly works!"

My statement is that if we had done what Sweden did, we would probably be well over 1M deaths in the USA by now. I detailed the reasons why on the other forum, but will excerpt from that over here for your review and commentary. I think this is an interesting discussion topic and opened this thread to explore arguments pro and con to what @steveh.jae was saying over here in this topic. Let's try to stay fact based and not force a thread closure.

In a few minutes I will reply with some comments once I lift them from another forum and adjust them for context here. Stand by.
 
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Marc_G

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I've been interested in Sweden since the beginning.

FOR THE RECORD: I think it's important that different countries try different strategies because that way we can compare notes later and figure out what worked best. So I'm glad that Sweden tried something different, but of course I'm sad that the results were so poor.

It's easy to look at their graph and come to a conclusion that "no lockdown" is a better strategy than "lockdown," particularly given our curve is going up and Sweden's is going down. If we scale Sweden's results up to our population level, you only get a 20% increase over our own death rate/numbers, and the benefit is that they currently are not in an upward swing: they had a spike, and are largely through it, per the deaths graph.

So, why do I say we would have so many more deaths than that if we didn't lock down?

The answer (part 1) is that Sweden is nothing like the United States. Baked into their death rate is essentially their way of life which is different from ours in lots of ways. For example, their population density is very low when you factor the "inhabited" areas of the country. They spread out much more than we do. They have many nice cities but only one has more than a million people living there. Here's from Wikipedia a list of their 10 biggest cities showing populations, showing only three cities with more than 200k people:

1596415390179.png


So, a major point is that because their way of life is very spread out, in this way the virus has a bit harder time spreading. Makes sense, right? Now, that's not to say that Swedes don't group together: for example, they are much more likely than a lot of Americans to take public transportation, particular in their "big cities."
You could also look at obesity rates (here) since obesity is a major contributor to death susceptibility with COVID-19. The US is much fatter than Sweden. Funny side note: I'm eating a brownie for dessert as I write this message about us being fat. Maybe not so funny, because while I have flirted with weight issues for the last 15 years, the "quarantine 15" is a real thing for me. I've started cutting back and exercising more. But damn these are good brownies.

(stand by, more coming)
 

Marc_G

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So, a better comparison is between Sweden and its Nordic neighbors Finland and Norway, as they all share a similar way of life.

Here is such a comparison:

Sweden is Europe's disaster scenario, pretty much, due to lack of formal lockdowns. It's coming under control now due to the ramping up of restrictions and controls along with strong urging by the government for people to adjust their lifestyles. People there actually largely do what the government asks, rather than saying face masks violate the constitution or some such. The fact that things are getting better there now is great but it has been a long time coming.

Let's look at the numbers. Sweden is a Nordic country with a way of life very similar to its neighbors Finland and Norway. So direct comparison with those countries makes sense. Norway and Finland had moderately strong lockown measures and strong compliance with the request by their government for people to distance. So, how did they do comparatively?

Deaths per million people:

Norway: 47 deaths per million people
Finland: 59 deaths per million people
Sweden: 568 deaths per million people.

You can look at overall cases per/million people, and again Sweden is much higher in terms of cases per million, but it's the deaths that tell the biggest story.
SWEDEN, BY NOT LOCKING DOWN FORMALLY, SACRIFICED 10X AS MANY PEOPLE PER CAPITA, THAN ITS NORDIC NEIGHBORS.

What about the relative spike mentioned by many, where much of Europe is seeing a surge? Norway and Finland are seeing just a handful of new cases each day, and zero or one deaths per day. Things are fine there, not spiking much if at all. Sweden is still seeing hundreds of new cases per day though their death rate is now quite low, a few a day to match their neighbors. Let's review, keeping in mind that Sweden has almost twice as many people living there (10.1M) than either Finland (5.5M) or Norway (5.4M):




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Everything I have read suggests Sweden's economy took a similar hit to its neighbors, despite the drastic increase in death toll comparatively.

So, in which Nordic country would you prefer to live? For me, it would not be Sweden.

(yet more coming)
 

Marc_G

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The answer (part 2) is that Sweden did lock down, sort of, eventually.

While Sweden started off pretty blase about the whole pandemic thing, they eventually realized they were headed for disaster and reversed course.

While they didn't do a government-directed lockdown, the Swedish people did all manner of things on a voluntary basis to promote distancing. They as a people are good at conforming for the greater social good.

Here is an article from early April about what they were doing to reduce infections:
https://www.thelocal.se/20200401/what-you-need-to-know-about-swedens-new-social-distancing-guidelines

And keep in mind some of this was compulsory, such as distancing in bars:
Sweden is shutting down bars and restaurants where people defied social distancing guidelines (apologies for sloppy links due to copy/paste issues)
Swedish officials said that five bars and restaurants in Stockholm ignored social distancing guidelines over the weekend.


Here's an article from June about the problems with their voluntary approach:

Five Problems With the Swedish Approach to COVID-19 | Think Global Health
As herd immunity remains elusive, Sweden’s experience seems to be a cautionary tale—Norway and Denmark have fared better

Also, remember, you couldn't travel freely for a while there. It wasn't all up to people's good nature:

Social distancing and markedly reduced travel in Sweden
Swedes are largely following the government agencies’ advice and recommendations. This has been shown through surveys and data concerning movement...

But their approach did ultimately bring it under control, this recent article describes the distancing measures in good detail:

Swedish Covid Infections Drop After Steady Distancing Patterns
The rate of Covid-19 infections is declining in Sweden, which health authorities said is thanks to citizens voluntarily adhering to social distancing guidelines.

Sweden isn't the success story of the region; other nordic nations that did more and locked down had much lower mortality rates (by 10x fold).

Meanwhile in the US we have people trying to assert that being forced to wear a mask somehow violates their civil rights:


1595363805425.png



Europeans by and large just wear them because it is the right thing to do, as do most Asian folks.

So, @steveh.jae I'm not sure where you are going with you post. Are you suggesting we just let the virus run its course? Bad call.

Really, they did quite a lot and locked down much travel, reduced density indoors at places like bars and restaurants, and asked their citizenry to restrict interactions. They got a late start, which is why they had a huge (per capita) spike, but they worked at it and citizens complied pretty well, and they are out of the woods more or less now.

So, Sweden's "no lockdown" strategy evolved into a "lockdown guidance, with some compulsory bits" strategy. Again I reinforce that their citizens generally respect the government and generally comply with reasonable requests in a time of crisis. Like, if the government says to wear a mask, they wear a mask during the pandemic and argue about it later, right? They don't go around talking about how it's a violation of their civil rights, with pretty few exceptions. Masking isn't political for the most part there, like it became here. Anyway, they took increasingly strong measures, turned the tide against coronavirus, and now things are looking good and they are relaxing some of the stricter parts of their strategy while watching for hot spots.
 
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Marc_G

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And the last in my copy / paste saga:


The answer (part 3) is that in the US, we were heading for a collapse of the health system, and only the lock down averted a complete disaster. Stick with me here, I know this sounds like some liberal exaggeration, so let me back it up with some facts.

The first fact is a very important one: even before lock downs were implemented, the R value for the virus was dropping here in the US, by different amounts state by state. People were scared and listening to authorities to take precautions to some extent, so the "doubling every 2.5 days" of cases had dropped, but in much of the country (not just New York and Michigan!) it was still doubling every 4-6 days.

You can get R values over time from several places but the reality is that most places still had a mushrooming number of infections/day until after the lock downs started. Many places, including Indiana where I live, were very close to exceeding their ICU capacity. Indiana was on average days to a week away from having to turn people away from the hospitals. We maxed out with room for around 2x as many COVID-19 patients as we had. That's basically one doubling, for us probably 5-6 days at the time in question. And because of the lag between "infections" becoming "cases" becoming "hospital admissions" we would have been over the redline of infections before we knew we were cooked. This was happening in a lot of cities around the country, some more than others, and not so much in the rural areas (with exceptions like meat packing plant locations).

So, (second fact) we didn't have good testing then (we still have systemic testing problems: my wife's test took 13 days to give a result, in JULY!!!) so we didn't really know how much infection there was, nor did we understand at what rate it would convert into hospitalizations. Locking down was the answer because we weren't doing enough to slow the spread and get to a less-than-1.0-R-value which is needed to shrink infections. It would have gotten worse and worse, and the hospitals would have been unable to accommodate all the sick and dying, and we would have had much more death in April and May than we saw.
And (third fact) the deaths would have been in part due to Corona, in part due to other health conditions like heart attacks and pregnancy complications and all sorts of other things usually treated well (or at least adequately) by our health system.

Next (fourth fact) infectious diseases don't infect everybody. 70% is a typical figure tossed about. Not 330M would get the virus. But maybe 200M might get it.
If it got really bad, there would have been mass riots about the poor response and the $hit might have hit the fan, for real. That's on the outside edge for sure. Might not have happened. But it might have. In this case it could add millions more as the government tried to reassert control.

So, if the thing kept spreading we would have had a worst case scenario with something like 200M infections (most of which would be sub-clinical), 20M "cases" needing clinical care, all in a couple months. Our case fatality rate started out around 6-7%; now it's around 4% last time I looked, but given the strain on our system by such a surge as we would have seen, I'm sticking with 6% deaths. This gives us 1.2M deaths. There would also have been a lot of collateral death, due to the things I mentioned above. So, probably closer to 2M deaths. Keep in mind, people "don't die a lot" due to interventions by our health system. If it got overwhelmed by COVID-19, there would have been a huge surge of people dying for stupid reasons.

That's my reasoning in response to looking at Sweden's approach as some sort of example the US should follow. The numbers are estimates open to interpretation. Keep in mind in the US we generally don't comply so well. Here in Indiana, before the recent mask mandate, if I went to the grocery store I would see MAYBE 75% masked and maybe 60% properly masked (no nose sticking out). Today I went to several stores and there was 100% mask compliance and nearly nobody poking their nose out. :) So, for us at least, we need strong direction to do things for our own good. Sad, but true.
 

afadeev

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I call this out for discussion because there has been a lot of discussion on some right wing forums I frequent (somewhat at my emotional peril) about Sweden as a great example of letting people live their lives and having a good outcome. Typically the conversations drift to: "Why don't (or, why didn't) we do that? We could have saved our economy and been in a better health position because what Sweden is doing clearly works!"
I've stopped responding to such "what about XXX" threads on TRF and alt-blah forums, since discussion there rarely follows basic rules of logic.
Before Sweden, folks there (and on TRF) where trying to worship Israel and UK. Once Covid-19 situation gets out of control at one "whatabout XXX" location, they pick another one.
Ignoring the cultural, population density, and data integrity considerations, one can sort the data based on Deaths / population ratio.

In descending order of Deaths / population: San Marino, Belgium and UK come in as 1-2-3.
Sweden is #8.
US is #10, for now.

Personally, if I wanted to construct a "whatabout" argument, I would have picked a country with lower Deaths / pop ratio than the US.
Just saying.
But that's me being logical, and that wont get me far on those forums.

Sweden's economy also took an 8.6% dive in Q2 and their unemployment rate rose to 9.4% in June, so they have hardly done well, economically speaking:

If you look at large enough countries with 100+M in total population, and skipping those who are known to distort data (China and Russia) all of the following are doing better than the US right now: Mexico, Egypt, India, Pakistan, Bangladesh, Philippines, Indonesia, Japan, Nigeria, and Ethiopia.

Problem with all of those - one can't worship them and be casually racist at the same time. ;)
So back to the Sweden we go.

If nothing else, Sweden has this going for it, which pretty much trumps all logical arguments:
 
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Steven

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I've simply been throwing everyone's 'facts' and 'figures' into a hat and pulling one out. After reading it, I chuck it back into the hat and throw the whole mess out. Still alive and doing well.
 

Ez2cDave

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Let's try to stay fact based and not force a thread closure.
No one respected my request to do the same in my thread, the one you are referencing ( which I requested to be closed because of that ) . . . Why should you be any different ?

Dave F.
 

steveh.jae

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No one respected my request to do the same in my thread, the one you are referencing ( which I requested to be closed because of that ) . . . Why should you be any different ?

Dave F.
“Knowledge is the barrier which prevents learning” Frank Herbert

There’s too many ‘rocket scientist’ ‘know it alls’ with axes to grind here for me get anything but heartburn out of the noise. You guys have fun.
 
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Marc_G

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No one respected my request to do the same in my thread, the one you are referencing ( which I requested to be closed because of that ) . . . Why should you be any different ?

Dave F.
The result may not be different. But maybe my tolerance for the crap is higher. Time will tell!
 
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