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A Swedish doctor's perspective on Covid

sebastianrushworth.com

271–280 of 340 posts

Re: A Swedish doctor's perspective on Covid

#271
post #217

Earlier quoted context omitted.

New Zealand apparently had police on the streets.

I think given the circumstances, NZ did the right thing and they did it with the support & cooperation of their citizens. They had the distinct advantages of being a remote island with very few cases to begin with and relatively little international traffic compared to most of the rest of the world which was easily shutdown. They had a really good chance to beat it, they took it and they succeeded -- but I think it w…

And if it takes a year or two to come under control in the rest of the world, they may have a fatigue and reintroduction. Too early in the game to label winners or losers.

Re: A Swedish doctor's perspective on Covid

#272

Earlier quoted context omitted.

Yes, the charts are pretty stark and show that Sweden has fared worse than the other nordic countries: https://ig.ft.com/coronavirus-chart/?areas=swe&areas=nor&are... or compare excess mortality between Sweden and other nordic countries in the charts halfway down https://www.ft.com/content/a2901ce8-5eb7-4633-b89c-cbdf5b386... I'm surprised the myth of Sweden doing well is still being bruited about.

Sweden chart is going downhill at the same rate as other countries with strict lockdown. There is a significant gap in mortality but I think the point is that people initially thought they would explode with COVID cases like early days in Wuhan (i.e. graph will go up, not down). Now it looks like they either have already hit zero new cases or going to hit them very soon. I think this is important fact worthy of study…

Sweden's infection stats going down is completely consistent with the ten weeks nationwide summer vacation where they'd disperse into the vast forests anyways, pandemic or not. The curve flattened the moment schools closed (and all workplaces drop to the absolute minimal staffing because parents tend to sync vacation days with school vacations) and then collapsed once intra-family infection chains played out. Schools will reopen less than two weeks from now, another two weeks later we will have a clear answer.

Re: A Swedish doctor's perspective on Covid

#273

Earlier quoted context omitted.

Maybe it was based on seeing what happened in other countries, ie. Spain and Italy? I can say for sure that the impact in the health care system here in Spain was very significant.

It's hard to disentangle cause and effect though. Countries that were very hard hit also had the most extreme government reactions to it. This can compromise the efficiency of the healthcare system, for example, I've read that in Spain at the peak of the epidemic many nurses and doctors were self-isolating because they'd tested positive, so there was a huge loss of healthcare capacity. Then later on it was discovered…

> "Then later on it was discovered that a lot of positive tests are asymptomatic and asymptomatic people don't transmit the disease, so this just hurt healthcare capacity for no reason"

I think it makes sense to isolate anyone who tests PCR positive for coronavirus, right?

Also, is it 100% sure that asymptomatic people will not transmit the disease? What if they are just pre-symptomatic? Where do you establish the cut-off?

Re: A Swedish doctor's perspective on Covid

#274

Earlier quoted context omitted.

Sweden chart is going downhill at the same rate as other countries with strict lockdown. There is a significant gap in mortality but I think the point is that people initially thought they would explode with COVID cases like early days in Wuhan (i.e. graph will go up, not down). Now it looks like they either have already hit zero new cases or going to hit them very soon. I think this is important fact worthy of study…

Check the charts I shared. They did explode initially, with far higher rates than similar countries, and they have taken much longer than similar countries to bring their death rates down. The earlier poster suggesting over 5000 more dead as a direct result of the policy is borne out by all cause mortality comparisons with similar countries. Now possibly all these countries will be able to keep their low rates, but I…

Every "minor second wave" rise I have seen seems to be followed by a much smaller (if any!) rise in deaths than the waves in the first half of the year, at least in countries were the health system isn't completely overrun. It might be improved testing capacity and strategies leaving a smaller fraction of infections undiscovered but I doubt that: we are less and to predict test outcome now that the virus is everywhere a little instead of concentrated in few, intensive clusters and capacity hasn't improved that much. Another explanation that I often hear is that somehow spread has now shifted to younger people but why would that be? Older people tend to be less mobile, aren't socializing as widely, in short: they are more likely to be dead-ends for the virus than the young. Is expect the elderly to be just as much receivers infection chains spread by the young in March as in July.

That leaves us with improved treatment. We clearly don't have a miracle drug, but my impressive is that doctors know much better now than a few months ago what actually causes Covid-deaths and that they are now far beyond just supplying oxygen according to treatment recipes for completely different illnesses and hoping for the best. I expect the implications of this to become the center of heated debates any day now.

Re: A Swedish doctor's perspective on Covid

#275

Sweden didn’t go into total lockdown but still did a lot. In the grocery store the cashiers are in a plastic bubble. Wherever there is a line there are marks on the floor to show where to wait to keep distance. Nobody shakes hands for quite some time. Yes, people go to Cafes/restaurants but restaurants have been assessed and assigned covid-friendly seating layouts. There are many more things that clearly separate tod…

But people still don't socially distance in stores. I have had people walk so close they are touching my hands, thst never happens usually.

My experience is that most people do keep their distance. But even if 90% do, you'll be getting way too close to a couple of people when say shopping for groceries. Fuck those people.

Re: A Swedish doctor's perspective on Covid

#276

Earlier quoted context omitted.

Average new cases per day has dropped from about 1200/day in late June to less than 300/day now. There's a slight uptick over the past week. https://91-divoc.com/pages/covid-visualization/?chart=countr... Downtrend in average deaths per day continues, currently at 6/day. https://91-divoc.com/pages/covid-visualization/?chart=countr...

> There's a slight uptick over the past week. Any uptick at all is concerning. In fact, a flattening of the decline is concerning. The implied thesis in the linked article is that Sweden has reached a level of herd immunity due to widespread T-cell responses, and that life in the country continues as normal. If that is the case, then we would expect the infection curve in Sweden to follow a classic logistic model --…

> It would suggest that there was in fact some meaningful intervention that changed

Annual lockdown month happened:

https://hejsweden.com/en/swedish-holiday-dont-work-in-july/

Schools even close for ten weeks, and those will be over soon.

Re: A Swedish doctor's perspective on Covid

#277
post #49

"COVID is over in Sweden" is a pretty bold claim with ~400 daily infections, and increasing again as per https://experience.arcgis.com/experience/09f821667ce64bf7be6... Just like in other EU countries, it is now the younger population which seems mostly affected, and thus the mortality is lower - which is ultimately some good news. Summer holidays are now almost over though, so people are traveling home from vacation…

https://www.google.com/search?q=sweden+covid+deathrate&oq=sw... Sweden's death rate is down to zero today and has been trending down since mid April. Summer Holidays did not start until late May where deaths were already half of what they were in mid April. This post isn't aging, it's already aged.

> Sweden's death rate is down to zero today

No, it isn't.

Sweden has fairly laggy reporting of deaths, with the deaths often taking several weeks to show up in statistics, so at any given date, deaths attributed to the last few days are always dropping to close to zero.

I looked into this a bit in mid-APRIL, when somebody claimed that deaths were dropping to zero. At the time, substantial revisions occurred for about three weeks after the date, and occasional revisions for about four weeks.

(It's entirely possible that similar phenomena occur in other countries; Sweden is the only country I looked at in detail).

Re: A Swedish doctor's perspective on Covid

#278
post #244

"In total covid has killed under 6,000 people in a country of ten million. A country with an annual death rate of around 100,000 people." This is basically deliberate disinformation. In April and early May Sweden had 30-50% excess mortality. And this was despite actually stopping the virus through soft lockdown. What the full count would have been had they let the virus rage unchecked is hard to say, but he's compari…

May be it's more fair to count for the months of COVID, March-July. So normal deaths would have been 42,000 during this period but COVID roughly added 10%. While this is still high and non-trivial amount, the fascinating thing is that almost everyone thought they will turn into Wuhan with dead bodies on roads and overflowing hospitals. For virus spread, soft lockdown was considered inconsequential back in March and a…

Yeah the projections from respected institutions like the IHME showed that with Swedens minor interventions, they should have had 80,000 deaths. This was later revised down to 18,000 deaths with better models.

Re: A Swedish doctor's perspective on Covid

#279
According to the comments the article was cross-posted to a UK doctor's blog, Dr. Kendrick's blog (which I haven't visited). So I'd like to comment on this article from the point of view of a UK resident, as I am.

The first thing to note is that in the UK, with a supposed lockdown imposed (now lifted), the number of deaths from Covid-19 so far is 46,596 [1]. That's in a country of almost 70 million [2]. The article above reports about 6,000 deaths in Sweden so far. We can look at different ratios and statistics, like per capita death rate (for the entire country) or case fatality ratio, etc, and we must of course accept that "death from Covid-19" sometimes means "death with Covid-19" and sometimes "death by Covid-19". Finally, we can note that the majority of the people who died were of a certain age and had underlying issues so they may have been dying already anyway.

The fact remains that more than 45,000 people is a big number of people to die within a couple of months. It's a much larger number of deaths than 7,000 and it's not a number that justifies sitting around doing nothing. Not for policy makers, not for doctors, not for the general population.

Of course the article makes the point that the situation in Sweden is now much better than in other places, because Sweden did not impose a lockdown like those other countries. So, in theory, without a lockdown the UK would have many fewer infections thanks to heard immunity. But, what would be the cost of acquiring this herd immunity? If more than 45,000 people died under lockdown, how many would have died without it? Of course this is a difficult question to answer- but it stands to reason that we would see more deaths, perhaps many more [4]. How many peoples' lives saved justify a lockdown? 50,000? 100,000? 10,000?

To be honest, I can't get my head around this dreadful arithmetic. Epidemiologists and perhaps some doctors also are used to thinking of case fatality rates and population-level statistics, but the fact still remains that even a thousand people dead from a single, possibly preventable cause, is something that the majority of the population of any country would accept as intolerable. See for instance the recent explosion in Beirut which killed "only" 135 people (last I looked). And yet, this seems to be considered by everyone as a great tragedy (certainly by the press, always obsessed with body counts, but by everone else also). If we accept that everything should be done to avoid losing 135 people in an explosion, shouldn't everything be done to avoid losing more than 45,000 people in a disease outbreak?

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[1] https://coronavirus.jhu.edu/map.html

[2] https://en.wikipedia.org/wiki/United_Kingdom reports a 2020 estimate of 67,886,004.

[3] This all is before looking at excess deaths in the UK in the months of the lockdown, which I won't do because I find the way these are measured and reported a bit confusing (e.g. I've found excess mortality plots for the last five years - but that's a short time and there may be much more variation over 10 years, say, or 35, so I'm not sure we learn much by looking at those plots).

[4] Again I'm not going to try to quantify "how many more would have died without lockdown" because we simply don't have the data for accurate estimates. Some estimates have been derived, notably the estimates from the Imperial Colledge modelling team, but there's no way to rely on them with any certainty.

Re: A Swedish doctor's perspective on Covid

#280
post #187

Earlier quoted context omitted.

> We're probably looking at end of 2021 for enough vaccinations to happen for things to go back to "normal". In my eyes, that is the best case scenario.

Yeah, you're most likely right. If we have a couple vaccines fail in phase 3, add another 6 months. And there is a chance it's another year before we have a somewhat effective vaccine. That pushes out herd immunity to late 2022. The positive thing is there a lot of vaccine in development. I feel confident we'll find one that's at least somewhat effective.

But vaccines don't just pass or fail: likely outcomes include a lot of middle ground with partial protection or side effects that are only prohibitive for some groups (mostly age groups). Stopping fractions of infections will make it possible to lift more and more social interventions while maintaining R <= 1 suppression.
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