Governmental response to Covid-19, Sweden, etc

(Bunny) #244

What if these Doctors are wrong?

#245

Bunny, I’m not sure I understand your post, but based on how the virus has played out in a few places without/before shutdowns, it looks like we might not actually need anywhere near 80% of people to actually get the virus.

(Bunny) #246

This is just speculation but what if 50% of the population already had the virus and by creating a shut down (stay home, wear masks and face shields if you do go out) we just interfered with it and increased the viral load exposure and death rate by doing so and not letting it reach its 80% peak.

Seemingly Sweden had the right idea to begin with, I’m not saying it would be a pleasant event or situation but that’s how viral-load-herd-immunity really works and when humans interfere with Mother Nature’s machinery the consequences will be worse and much more severe?

Could you see animals wearing face masks and face shields in a pandemic? (not natural?)

I’m not saying don’t wear a face mask or face shield, I do think it is safer to do so. (…and forget I ever wrote this post…lol)

I think that it is magical thinking if we think this virus is just going to go away by trying to create a sterile environment (makes it much worse) without letting it takes it’s natural course.

#247

Yes, unfortunately I think you’re right. I’m happy to wear a mask but the endless shutdowns seem misguided, and most of our attempts to stop the curve have been a mess. (With some exceptions! New Zealand seems to be doing well, but I’m not sure what the long-term vision is - just stay closed to outsiders forever? lockdown again as soon as there’s a new case? hope for the perfect vaccine to show up soon?)

I think that Sweden actually had lower than normal mortality (all-cause mortality) after its COVID peak in the spring, which means that a percentage of the population who would have died in May and June died a month or two earlier.

It seems brutal to talk about death in these terms - these are human lives! - but policy makers need do this all the time (55mph or 65 mph? a highway on ramp here or there? etc) and we’re just not used to thinking in this way. If we handled driving the way we handle COVID in the news, you’d have public outrage, voters clamoring for change. Imagine if every day we were greeted with headlines of year-to-date highway fatalities, stories of family tragedies, mangled lives. We may well come to the conclusion that we clearly need to make the speed limit 12 miles per hour.

Or heart disease, diabetes - – both of them kill so many people (and are responsible for so many COVID deaths). Why aren’t we talking about them all the time instead?

(Ron) #248

Sweden is not much of an example to follow… in deaths per million population they are 8th highest death rate out of 215 countries/islands being tracked globally.

Sweden is doing worse than US, France, Mexico, etc… and almost 10x worse than neighboring Finland.

(bulkbiker) #249

But they are also far better than Belgium and the UK, Spain and Italy who all had major lockdowns so…

.https://twitter.com/HaraldofW/status/1290265363259617280

(Elmo) #250

Here we are 3 months later. Not much change for my relatives - the younger ones are getting out more, but still strict with social distancing (I know of no place in the US where this would be expected to occur, frankly). For the ‘family’ as a whole, there has been some relaxation, if only in attitude. Less concern about getting the virus from surfaces, the same or more concern about it being airborne. Nobody I know there has had the virus yet.

We got 20% off for two months, New Jersey, US (the company is Progressive).

I commonly see people treating Sweden as a total outlier, when it’s really not. This isn’t at all directed at you, Bob M - you’re more familiar with Sweden than most, by far. In Sweden the epidemic is not all that far along. They’ve only tested 8% or 9% of the population, and thus far less than 1% has been positive. Even allowing for asymptomatic cases, it’s not like the virus has yet “gone through the population.”

The Swedish government is NOT actively pursuing “herd immunity.” Sweden’s “voluntary” measures have been stricter (and much better adhered to) than in some countries with firm gov’t dictates. While technically only “suggestions,” they are not optional for the populace (as odd as that sounds).

The Public Health Agency of Sweden is more independent of the government than most people on this forum are used to, i.e. those in the UK, Australia, US, etc. It does not have the power to make law, but there is a recognized obligation on the part of private citizens to participate in halting the spread of an infectious disease, per The Swedish Communicable Diseases Act.

I think it’s a relatively ‘fuzzy’ concept, certainly at least compared to the US. The gov’t doesn’t push things too much, but the people don’t either. If “push comes to shove…” - it doesn’t get that far. (If it did, there really isn’t a mechanism in place to punish those who don’t follow the recommendations.)

I contrast this with the US, where so many people either think “the gov’t should do more” or “the gov’t should do less.”

Most Swedes would disagree. There’s still a mix of opinion, i.e. more/less restrictions, but it’s shifted some more toward feeling the gov’t should have clamped down harder. Merely being “a little better than the worst in the world” isn’t really saying much. The comparison isn’t with mainland Europe - Swedes will roll their eyes at you if you start in on that - different timing of the virus outbreak, much denser populations, etc. Finland and Norway are the obvious comparisons.

If there never would be a vaccine, and if medical treatment for the disease never improved, then Sweden’s actions would be bolstered. Worst-case for public opinion would be a vaccine appearing tomorrow, i.e. “We could have had per-capita deaths like Finland or Norway, but here we are with 9.5 times as many as Finland, and 12+ times as many as Norway.”

Where did that come from? Here in New Jersey we’ve been having 500-600 fatalities per year, for the past 10+ years. This year, we’ve had 303 traffic deaths thus far. We’ve also had 10-20 single days when Covid-19 killed more people than that. This isn’t like “traffic accidents.”

Finland and Norway are the similar countries. Actually, I think Sweden will get passed in per-capita deaths by a substantial number countries in the end, worldwide. Sweden’s low population density, excellent medical care, and the effective measures they have taken (it’s not remotely a lockdown/no lockdown situation) cannot be matched by many. Sweden blew by France, but Peru ran down Sweden… Brazil and the US are coming.

#251

@ElmosUzi Thanks so much for such a thoughtful post!

There’s one question to me in it. Re highway fatalities: I wasn’t comparing traffic deaths and COVID in terms of numbers but in terms of focus and policy. We make our peace with policies re: highways and speed limits that will result in a certain number of people killed and maimed year after year. We could say “one death is too many” but we don’t.

I’m not suggesting that we don’t take measures to save as many lives as possible. In fact, I really wish we had much more targeted policy for those with compromised immunity and more effective quarantines for those who are sick. However, I’m hearing a lot of rhetoric about any one death being the fault of particular policies, and I thought I saw today that some folks were advocating for a goal of zero COVID cases. That just doesn’t make sense to me.

#252

I enjoyed this podcast about COVID-19 asymptomatic homeless people in Boston. None came down with symptoms. The postulated reason is one we all know.

#253

Great radio. Thanks for the link.

(Elmo) #255

I think it’s “of course we don’t say one death is too many.” There is a point of diminishing returns, and it’s not worth it to us to take traffic deaths to zero. Across all fifty US states, the average is 2 traffic deaths per day, per state. There are many larger, more pressing problems. From your earlier post:

I really don’t think so. Highway deaths have gone down a lot - on a per capita basis they’ve declined 50%-60% over the past 50 years (in the US). They’re not even in the top ten causes of death.

And, we already do get greeted with news of horrible crashes, etc. You’ve likely heard the old saying about TV news - “If it bleeds, it leads.”

I think we’re back to numbers - state by state, with that average of 2 deaths per day, Mr & Mrs are sitting in front of the TV and seeing that one or two people in their town got killed in a motor vehicle accident. Or, it happened on the far side of the state and doesn’t even make the news. Contrast that with Covid-19 deaths, which in 7 or 8 weeks went from 0 to over 500 per day here in New Jersey. That’s going to raise a few eyebrows.

On the rhetoric - so what? Anybody can say anything. There are endless “what ifs” - and often a given death could have been prevented by a nearly unlimited number of happenings. “Zero Covid cases” - so, total virus suppression; a worthy goal but obviously not possible in many places around the world (it’s too late).

Another sort of “invisible” thing is the nature of immunity, here. In our old friend Sweden, it was discovered that even if Covid-19 antibodies are not found, a prior virus exposure may have resulted in the presence of B-cells and T-cells from the individual’s immune system, which can fight the virus during subsequent contacts.

(Doug) #256

That’s kind of weird - the longer things go, the better Sweden looks. While the situation will have to be an amalgam (they’re not going to do ‘nothing’ and they’re not going to lock down hard like a totalitarian state can), I do think they screwed up by just going on assumption, early on, before they knew what was happening.

(Polly) #257

This is an interesting and informative blog by a Swedish Doctor who works in the Emergency Department in Stokholm Hospital.

#258

But isn’t that everyone did? (had to do!) We don’t know the full physical and mental health effects of a lockdown just as we don’t know the full repercussions of a partial (or no) lockdown.
And in Sweden’s defense, there has been plenty of science available to make some educated guesses about the herd immunity implications of exposure to previous corona viruses.

That said - there’s a lot in all this that I’ve been critical of but honestly I don’t think I would want to be a policy maker right now. It’s really hard to make a good decision with imperfect and incomplete data and so many different needs and perspectives…

(Doug) #259

No - some countries clamped down hard enough that to this day they have exceedingly few deaths, by comparison. They protected the vulnerable people. “Educated guesses about herd immunity” - I think that even right now in August there’s still so much to learn that that’s hardly true.

#260

I mean that everyone had to make a guess by going on an assumption - some assumption - as you said: “before they knew what was happening”. That’s what everyone had to do. We’ll find out in hindsight which assumptions were correct.

(Doug) #261

The people behind Sweden’s policy have already admitted they did wrong - they failed to protect the vulnerable, especially the elderly. There was no reason to assume that “not worrying about it,” to the extent that Sweden did, was the right thing to do. It wouldn’t have taken a “long” lockdown to reveal a lot more of what was really going on - it was clear by April. After that, hey, knock yourself out with the other stuff.

I know there’s no “perfect” response but the real-time prevention of deaths goes a long way, versus assumptions about the harmful effects of lockdowns.

(Ron) #262

Common sense (to me) would dictate in the beginning of the unknown , it would be the safest approach to protect human life as much as possible by erring on the side of caution as apposed to throwing caution to the wind.

(Doug) #263

I agree Ron. And I’m not singling Sweden out in this - I’d say more countries than not erred on the side of inadequate caution.

#264

There have been a lot of folks interviewed. Just like in NY, there wasn’t enough protection of the elderly. Otherwise, there’s definitely not a consensus among leaders in Sweden (US headlines notwithstanding).

I know suicidal teens in NYC right now as well as a family friend whose spring death came after weeks of spiraling downward from her complete isolation (yes, I know, anecdotal - but those are not unusual). I think we took a huge gamble with our assumptions about lockdowns. Maybe it will be worth it, but I don’t think we know yet.