Discussion of the Sweden model

[tall73]

I see your point. However, Sweden did none of the things you mentioned. At least not to the extent of many others.

I mentioned social distancing rather than lockdown. Sweden did social distancing on a largely voluntary basis.

And guess what? None of the things happened that scientists were fearing! Frankly, what the swedish model is showing me is that all the scientists and their models were wrong and the solution to flattening the curve was more damaging than the virus itself.

Have you read the whole thread?

I think there are positives to the Sweden model. On a practical level most states are going to wind up with the Sweden model in any case because people won't remain in lockdown. Excess by some of those enforcing lockdown hasn't helped either. By working with the people voluntarily and with less authoritarian measures they have greater buy in.

Having said that, if they come up with an effective therapeutic in the next few months then it may be a large drawback that they took the hit early on in regards to fatalities. Or if this produces antibody dependent enhancement, they will be in big trouble.

Since more than likely an effective therapeutic or a vaccine are a ways off, or never coming, they may simply be acknowledging the inevitable. Once you have lost containment the virus will go through the population, slow or fast. They tried to slow it, and appear to have maintained the medical capacity.

The Sweden model was an acceptance of the notion of slowing the spread, once it was too late to stop it.

In NYC, long after they locked down, hospitalizations were still happening among those who were sheltering in place, not essential workers, etc. Everyone has to eat, and the virus finds a way in, just at a slower rate.


Cuomo says it's 'shocking' most new coronavirus hospitalizations are people who had been staying home

Most new Covid-19 hospitalizations in New York state are from people who were staying home and not venturing much outside, a "shocking" finding, Gov. Andrew Cuomo said Wednesday.

Cuomo said nearly 84% of the hospitalized cases were people who were not commuting to work through car services, personal cars, public transit or walking. He said a majority of those people were either retired or unemployed. Overall, some 73% of the admissions were people over age 51.

He said the information shows that those who are hospitalized are predominantly from the downstate area in or around New York City, are not working or traveling and are not essential employees.

Where Sweden admits they fell a bit short was in protecting nursing homes. They are trying to address that now. Since around 50 percent of deaths have been in nursing homes in Europe, so far in the USA, and slightly higher than that in Canada, many may wind up going to a program that protects nursing home facilities and the elderly, but opens up to some degree for the rest of society.

 

[rambot]

It is kinda funny to me that THIS model, the "hands off" one gets so much airplay when we don't know if it's successful. Well, that's not the funny part.

The funny part is that nobody has spent any time really parsing out the details of the countries where REALLY effective management has occurred. Where governments responded with science and listening to competent epidemiologists. I mean, those governments are PROOF that they can be helpful and do good things, but Americans don't evne give them the time of day or respect they deserve...

And an article (don't know if it's been shared yet):
Swedish antibody study shows little sign of herd immunity

 

[tall73]

The funny part is that nobody has spent any time really parsing out the details of the countries where REALLY effective management has occurred.

I spent days with our Australian friends in two threads looking at their response, and comparing it to the US response. We also looked at Taiwan, Japan, etc.

And I started another international comparison thread where we looked at the comparison between Asia and Europe.

Some of it was great response. But Germany had a great response as well and still has large community spread. Much of it came down to how much spread their was in the community (rather than contained travel cases) in the early days.

Where governments responded with science and listening to competent epidemiologists. I mean, those governments are PROOF that they can be helpful and do good things, but Americans don't evne give them the time of day or respect they deserve...

The mutation data shows community spread was established from the first case tested in Washington state, who came in on Jan. 15. There was likely additional spread from the thousands of flights that came in before the travel restrictions. Once it is out of traceable containment it is very difficult to get under control. And the manufacturing error in the CDC facility that wound up massively delaying testing pretty much sunk what chance we had after that. In the future they will likely turn to private testing sooner. They followed the model we had used with other pandemics of having the CDC develop and manufacture the initial test kits.

Our travel restrictions took place at roughly the same time as Australia, but we were further along on the curve.

It is not that the USA didn't give their methods consideration. But with the testing failures and the early community spread it was likely too late for containment.

Fauci, etc. debated for some time when to go to lockdown and mitigation measures once it was clear that we couldn't contain it. I started a thread on the health expert response as well. If you want to say that the USA ignored those methods, that is not the case. All the experts were in the room early on and trying to decide when to implement travel restrictions, testing, etc.

And an article (don't know if it's been shared yet):
Swedish antibody study shows little sign of herd immunity

I referenced the study in post 82.

Their goal however, is not herd immunity, but maintaining medical capacity.

 

[tall73]

Looking at the deaths per million population over time shows which countries that initially had community spread have gotten a handle on it. Note Austria for instance. On April 22 Austria was slightly worse off than Canada. But Canada, while later on the curve than some other nations, is still going up regularly, and Austria now curbed things.

Even if comparing across nations is difficult, this allows us to compare data from within the nation itself over time.

 

[(° ͡ ͜ ͡ʖ ͡ °) (ᵔᴥᵔʋ)]

In NYC, long after they locked down, hospitalizations were still happening among those who were sheltering in place, not essential workers, etc. Everyone has to eat, and the virus finds a way in, just at a slower rate.


Cuomo says it's 'shocking' most new coronavirus hospitalizations are people who had been staying home

Yes...most of the infections were from people who were doing everything they were told to do.

 

[hedrick]

The US is definitely moving in the Swedish direction, but I'm not sure it's with as much planning. All states are now opening. But the overall US infection rate isn't decreasing very rapidly. We've stopped the steep initial rise, but we're not waiting for it to go down a lot. Maybe this is OK. A large fraction of the population is on the economic edge, and there isn't enough of a safety net to help very many of them. So a lot of people are willing to risk death.

 

[Occams Barber]

I just came across this BBC article which summarises the state of CV measures in eighteen western European countries.
How is lockdown being lifted across Europe?

I'm finding that I need to be careful about checking dates on articles since the situation is changing so rapidly. In this case the article is dated 20 May so the info should be current.

Basically, all countries are in the process of a phased lifting of restrictions.

OB

 

[hedrick]

I just came across this BBC article which summarises the state of CV measures in eighteen western European countries.
How is lockdown being lifted across Europe?

I'm finding that I need to be careful about checking dates on articles since the situation is changing so rapidly. In this case the article is dated 20 May so the info should be current.

Basically, all countries are in the process of a phased lifting of restrictions.

OB

I checked several in Worldmeter. It looks like they have had big declines for several weeks, unlike the US. After all, they started sooner

 

[Bobber]

And yet:
1) You can count them on one hand
2) Their work (none of which is recent) has been discredited as terrible science.
3) Their understanding and presentation of facts is incorrect.
4) Their word does not stand up to scrutiny.

Baloney.

 

[Occams Barber]

Slightly off topic but 'historically' interesting.

I came across this Business Insider headline dated 10 April:

US coronavirus models increase anticipated death toll to 74,000, the second increase in a week as states begin to lift stay-at-home orders
​

Back on 10 April the main US model was predicting 74,000 deaths by 4 August. For the record - today is 22 May (in the US) and the US death toll stands at 97,531.

The article goes on to talk about the variations in model predictions :

'The model from the University of Washington’s Institute for Health Metrics and Evaluation, which is used by the White House predicted over 90,000 deaths by August last week. On April 7, that number dropped to 82,000 before it decreased by around 20,000 a few days later. On April 9, the model estimated it’s the lowest death toll of 60,415 before increasing again.'
​

It seems some states were ready to declare Mission Accomplished:

'That reduction seemed to suggest that social distancing measures were working. However, some states including Georgia have begun efforts to reopen their economies and lift their lockdowns.Georgia is expected to begin relaxing stay-at-home orders on Friday.'
​

How wrong can you be?
US coronavirus models increase anticipated death toll to 74,000, the second increase in a week as states begin to lift stay-at-home orders
OB

 

[tall73]

I checked several in Worldmeter. It looks like they have had big declines for several weeks, unlike the US. After all, they started sooner

I think you have to approach the USA by state. Really it would be helpful even to approach Canada, etc. by state as well, as two provinces are driving a lot of their issues.

In the same way community spread started on the west coast pretty early in the USA. Most of the cases from NY though, and probably the East coast generally, appear to be from Italy and Europe, based on mutation data. That is part of why NY's curve was behind Italy and Spain.

The trends by state look quite a bit different, and since measures often go down to the county level, each region may have its own trends. It took some time for the virus to even make its way to every state, as we tracked in our (now) 50 states thread.

And some never locked down but didn't face nearly the issue so far as NY, NJ, IL, LA, etc.

I will update these numbers eventually, but as of May 15 here are the deaths per million population by state, compared to various nations:

Deaths per million population:

15-May
New York 1,410
New Jersey 1,120
Connecticut 903
Massachusetts 795
Belgium 773
Spain 587
Louisiana 520
Italy 519
UK 495
Michigan 479
Rhode Island 442
France 420
Sweden 361
Pennsylvania 335
Netherlands 329
Maryland 316
Illinois 310
Ireland 305
Delaware 267
Indiana 244
Switzerland 217
Colorado 189
Mississippi 161
Georgia 146
Canada 145
Ohio 131
Washington 130
Minnesota 119
Portugal 117
New Mexico 115
Virginia 114
New Hampshire 111
Nevada 110
Iowa 101
Alabama 96
Germany 95
Denmark 93
Missouri 92
Florida 87
Arizona 86
Vermont 85
California 77
Wisconsin 75
Kentucky 73
South Carolina 72
Oklahoma 72
Austria 70
Kansas 66
North Carolina 61
Nebraska 58
Finland 53
North Dakota 52
Maine 51
South Dakota 49
Norway 43
Texas 43
Tennessee 42
Idaho 40
West Virginia 35
Arkansas 32
Oregon 32
Utah 23
Montana 15
Alaska 14
Wyoming 12
Hawaii 12
Japan 6
South Korea 5
Australia 4
New Zealand 4

 

[hedrick]

I think you have to approach the USA by state. Really it would be helpful even to approach Canada, etc. by state as well, as two provinces are driving a lot of their issues.

I agree. But still, a lot of our states aren't significantly below their peaks. Some are, such as NY, but many look a lot like the overall US curve. They do have very different absolute numbers, though. A curve that's hanging out at the peak, but with a few people a day dying is a lot different than one that's staying near the peak with over a hundred a day (NJ, where I live, though we're no longer at the peak).

I'm depending upon curves from the NY Times. Unfortunately they give cases and deaths only. NJ is using hospitalizations for most decisions, because it's the most likely to be accurate and up to date. Cases rise as testing increases. Deaths lag by weeks, and delay in reporting from onset is quite variable.

The most publicized numbers are cases. It could be that their failure to fall is due at least in part to increased testing. But some of it may be the limitations in the data. For NJ, the peak of both cases and deaths (from New Jersey Coronavirus Map and Case Count) had a broad 2-week plateau. But the hospitalization rate didn't. It reached a peak and immediately started down. (New Jersey COVID-19 Information Hub)

 

[pitabread]

I think you have to approach the USA by state. Really it would be helpful even to approach Canada, etc. by state as well, as two provinces are driving a lot of their issues.

Mainly just Quebec. As a province they account for almost 2/3 of the deaths from COVID-19, but they represent less than 25% of Canada's total population.

 

[tall73]

NJ is using hospitalizations for most decisions, because it's the most likely to be accurate and up to date. Cases rise as testing increases. Deaths lag by weeks, and delay in reporting from onset is quite variable.

I agree that hospitalization is a key metric, especially since it is capacity that is the main point of slowing the spread. New infections are helpful, but some are not detected until they become a hospitalization.

And as you mentioned, New York down from its peak is a lot worse than a state that never had many cases or deaths to start with, even if they are flat or just down from the peak. If the purpose is maintaining capacity, then a state or even county has to look at total beds, ICU beds, ventilators, cases, hospitalizations, etc.

A number of states now have dashboards that track this, and some counties as well.

 

[tall73]

Mainly just Quebec. As a province they account for almost 2/3 of the deaths from COVID-19, but they represent less than 25% of Canada's total population.

Agreed, they are outsized in their footprint. And much of that stemmed from their understaffed nursing homes rotating fill in staff between locations, which spread it to more nursing facilities. Other provinces announced early on this would not be done.

It is a case where specific decisions really had a bad impact. Last I heard around 80 percent of deaths in Canada were in nursing homes.

 

[pitabread]

It is a case where specific decisions really had a bad impact. Last I heard around 80 percent of deaths in Canada were in nursing homes.

Correct. It's been an incredible tragedy and really exposed some issues in the way we manage long-term senior care up here. I'm hoping this will spark some change, but the cynic in me doubts it.

 

[tall73]

Correct. It's been an incredible tragedy and really exposed some issues in the way we look after long-term senior care up here. I'm hoping this will spark some change, but the cynic in me doubts it.

To be fair we have many of the same problems. It is just our percentage is less because we have so many other deaths as well. Even so around 40-60 percent of our deaths are believed to be from nursing homes, and many feel that is under counted.

 

[hedrick]

Slightly off topic but 'historically' interesting.

I came across this Business Insider headline dated 10 April:

US coronavirus models increase anticipated death toll to 74,000, the second increase in a week as states begin to lift stay-at-home orders
​

Back on 10 April the main US model was predicting 74,000 deaths by 4 August. For the record - today is 22 May (in the US) and the US death toll stands at 97,531.

The article goes on to talk about the variations in model predictions :

'The model from the University of Washington’s Institute for Health Metrics and Evaluation, which is used by the White House predicted over 90,000 deaths by August last week. On April 7, that number dropped to 82,000 before it decreased by around 20,000 a few days later. On April 9, the model estimated it’s the lowest death toll of 60,415 before increasing again.'
​

It seems some states were ready to declare Mission Accomplished:

'That reduction seemed to suggest that social distancing measures were working. However, some states including Georgia have begun efforts to reopen their economies and lift their lockdowns.Georgia is expected to begin relaxing stay-at-home orders on Friday.'
​

How wrong can you be?
US coronavirus models increase anticipated death toll to 74,000, the second increase in a week as states begin to lift stay-at-home orders
OB

You’re referring to the IHME model. It was never a model. They thought we didn’t have enough information to model, so they did curve fitting. They used a normal curve, which goes up then down the same, though with some modifications based on Chinese data. Watching my state of NJ, they kept predicting that deaths would start going down rapidly starting the day after the model was done. In fact it didn’t work that way.

It was about the best that could be done. They didn’t predict just one number, but a range. The figures we’re seeing now are within the range. People seem to have quoted only the center of the range, without warning that there was a large degree of uncertainty.

The projections also end Aug 1, so the numbers are not totals, but only projections for the first phase.

 

[variant]

Looking at the deaths per million population over time shows which countries that initially had community spread have gotten a handle on it. Note Austria for instance. On April 22 Austria was slightly worse off than Canada. But Canada, while later on the curve than some other nations, is still going up regularly, and Austria now curbed things.

Even if comparing across nations is difficult, this allows us to compare data from within the nation itself over time.

View attachment 277371

It's going to be hard to make proper comparisons because you have to factor in things like population density, the amount of mass transit use, exactly what precautions were taken and when these places were actually exposed. Things like that.

Thankfully we have professionals who do that sort of thing for a living. Unfortunately, that kind of study takes time and effort.

 

[tall73]

It's going to be hard to make proper comparisons because you have to factor in things like population density, the amount of mass transit use, exactly what precautions were taken and when these places were actually exposed. Things like that.

Thankfully we have professionals who do that sort of thing for a living. Unfortunately, that kind of study takes time and effort.

Agreed, we were discussing some of those factors in the international comparison thread, and in the threads comparing the Australian response to the US.

It is also why it varies so much by state and county in the USA which has many different areas with differences in populations.

However, as noted, the value in that chart is seeing how they have done in comparison to their earlier state. Either they have managed to slow it or they haven't, given their setting.