A Swedish doctor's perspective on Covid • Hacker News Board

Re: A Swedish doctor's perspective on Covid

#301

Post by anoncake » Sat, Aug 08, 2020, 3:18 PM UTC

williamstein wrote: post #63

Udik wrote: post #39

Earlier quoted context omitted.

350k deaths sounds like a huge number, but it's important to take in account how many of those would have died anyway in the next two or three years. Dying at 80 is not the same as dying at 20.

Unfortunately, it turns out that the estimate of the years of life lost due to Covid per person is significantly larger than "two or three years". For example, "New study finds coronavirus can cut life span by 10 years or more" (see https://thehill.com/changing-america/well-being/longevity/49... ), and there are other more recent studies that go into more detail in the US looking at populations ( https://www.hsph.har…

The number of years of life lost due to Covid is much lower. Assuming

- 60% of the population get it - the IFR is 0.6% - Everyone who dies loses on average 10 years

it's 60% × 0.6% × 10yr = 0.036yr. That's less than two weeks. How much more are you willing to sacrifice for less than two weeks of lifespan?

Re: A Swedish doctor's perspective on Covid

#302

Post by henrikschroder » Sat, Aug 08, 2020, 3:20 PM UTC

microtherion wrote: post #285

henrikschroder wrote: post #222

Earlier quoted context omitted.

> 10 QALY lost per death Average age of the covid-19 dead in Sweden is 82, average life expectancy is 83. The majority of the deaths also occurred at elder care homes where the expected survival time is less than two years. And, just like everywhere else, the covid-19 dead are much more likely to belong to certain risk groups associated with earlier deaths as well. 10 QALY lost per death sounds way, way too high to m…

> Average age of the covid-19 dead in Sweden is 82, average life expectancy is 83. That's life expectancy at BIRTH. It would seem to me that the relevant statistic in the case of an 80 year old dying is the average life expectancy they had at 80, which is considerably more than 3 years.

You're right, but it's actually even more specific than that, you have to look at the life expectancy of a frail 80-year old living at an elder care facility suffering from diabetes/hypertension/heart problems. Not that of a random, healthy, 80-year old.

The biggest disingeniousness of the people talking about the covid-19 specific death toll is that the assumption is that if not for covid-19, everyone would have lived forever and ever, and that's simply not true. Looking at the demographics of the dead, for many, covid-19 is what happened to push them over. If not for covid-19, something else would have done it in a similar timeframe, especially since the flu seasons of 2018/19 and 2019/20 were so mild.

Yes, there are people who died significantly before their time, but they're a small minority of the dead. So 10 QALY lost per dead is way too much. 1 QALY lost per dead is too little, I agree. The truth is probably somewhere in between.

Re: A Swedish doctor's perspective on Covid

#303

Post by ghaff » Sat, Aug 08, 2020, 3:31 PM UTC

rightbyte wrote: post #297

ghaff wrote: post #293

Earlier quoted context omitted.

In general, any photo you see anywhere is going to be cherry-picked. Of course, that only goes so far. If you have a crowded school corridor with almost no one wearing masks, well--that happened. But it's hard to draw broad conclusions generally because of what seems like a somewhat crowded restaurant or an empty street. A lot of people also bring their own beliefs about what is appropriate to the interpretation and…

Ye, I agree. As a note, schools up to 15 y.o:s were open so photos of those should show a lot of pupils.

Although lots of promises in many places about distancing and masks and so forth that no one who has ever been or ever been around anyone from Kindergarten kids to college students actually really believed.

Re: A Swedish doctor's perspective on Covid

#304

Post by doodlebugging » Sat, Aug 08, 2020, 3:47 PM UTC

greenyoda wrote: post #233

doodlebugging wrote: post #139

Is this guy an undertaker or a urologist? His tag seems to have both words but I do not speak Swedish. Anyway it may not be a perfect extrapolation or comparison but if you take his numbers, 6000 dead in a country of 100 million people and you adjust that to the US population don't you come out with 330 million people and 198000 dead? We are not far from that now and if the trend continues we will blow past that in a…

> Is this guy an undertaker or a urologist? His tag seems to have both words but I do not speak Swedish. His name tag says "Underläkare", which is a title meaning "assistant physician". The term is defined in this Swedish Wikipedia article: https://sv.wikipedia.org/wiki/Underl%C3%A4kare Google translates it as follows: "Assistant physician in Sweden is a title for all the doctors on duty who do not have specialist co…

Thank you for the interpretation of the name tag. I appreciate the effort. I should've made the same effort myself.

In fact, in rereading my own comment I notice that I fat-fingered a number in the comparison I was trying to make. Where I show their Dead vs Population size as 6000 / 100 million that should've been 6000 / 10 million. I had one too many zeroes on their population figure.

Not my finest hour and a real drag for me personally since I have spent so much of my career QC'ing other people's work and pointing out their defects. I need to pay closer attention to my own output since I obviously am not perfect either.

Re: A Swedish doctor's perspective on Covid

#305

Post by tripletao » Sat, Aug 08, 2020, 3:50 PM UTC

henrikschroder wrote: post #302

microtherion wrote: post #285

Earlier quoted context omitted.

> Average age of the covid-19 dead in Sweden is 82, average life expectancy is 83. That's life expectancy at BIRTH. It would seem to me that the relevant statistic in the case of an 80 year old dying is the average life expectancy they had at 80, which is considerably more than 3 years.

You're right, but it's actually even more specific than that, you have to look at the life expectancy of a frail 80-year old living at an elder care facility suffering from diabetes/hypertension/heart problems. Not that of a random, healthy, 80-year old. The biggest disingeniousness of the people talking about the covid-19 specific death toll is that the assumption is that if not for covid-19, everyone would have liv…

I said ten years from a study[1] adjusting for age and comorbidities of the patients, which got 13 and 11 years for men and women respectively. That study doesn't adjust for the severity of the comorbidities, so I agree it's probably an overestimate. I'd like to see a study that predicts life expectancy using more factors (e.g., long-term care residency), but I'm not aware of one.

As to masks, I also agree correct use is a problem. Here (SF Bay Area) the East Asian population seems to use them competently and consistently, but everyone else is hit or miss. I would have liked to see more public education, rather than just the unexplained mandate; but the probability that masks primarily explain East Asia's success in containing the virus seems high enough, and the cost seems low enough, that they seem like a favorable bet to me. I do also think it's quite possible that other factors (e.g., different degrees of pre-existing T cell immunity from other coronaviruses) will turn out to explain that big difference though.

1. https://wellcomeopenresearch.org/articles/5-75

Re: A Swedish doctor's perspective on Covid

#306

Post by lsllc » Sat, Aug 08, 2020, 4:11 PM UTC

beagle3 wrote: post #271

lsllc wrote: post #217

Earlier quoted context omitted.

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.

Yes, whilst normal life goes on now in NZ, they're stuck there and one of the main industries tourism is almost completely shuttered -- I think the fatigue will be economic.

Re: A Swedish doctor's perspective on Covid

#307

Post by lsllc » Sat, Aug 08, 2020, 4:16 PM UTC

foogazi wrote: post #239

lsllc wrote: post #155

Earlier quoted context omitted.

The UK, France, Spain, India and Australia who all shutdown (to varying degrees) are now experiencing significant upticks in cases. Even Vietnam is now fighting hard to tamp down a resurgence of C19 despite impressive initial measures to try to stop it. You'd have to be completely sure that during your lockdown, the virus burned itself out inside each household. You'd have to have a really strict lockdown (e.g. troop…

Have not heard about India’s shut down I know the UK was going for herd immunity at first and then switched Spain did lockdown drastically once things got pretty bad My next question would be on Sweden’s case: is herd immunity real? Or as the virus spreads it reinfects ?

For India, it started back in March. It seems it was quite strict, there are youtube videos of violators getting beaten by the police (which may just have been isolated incidents).

https://en.wikipedia.org/wiki/COVID-19_pandemic_lockdown_in_...

However, since they opened back up, they've seen a fairly large resurgence in cases:

https://www.npr.org/sections/coronavirus-live-updates/2020/0...

Re: A Swedish doctor's perspective on Covid

#308

Post by lsllc » Sat, Aug 08, 2020, 4:18 PM UTC

mhh__ wrote: post #248

foogazi wrote: post #239

Earlier quoted context omitted.

Have not heard about India’s shut down I know the UK was going for herd immunity at first and then switched Spain did lockdown drastically once things got pretty bad My next question would be on Sweden’s case: is herd immunity real? Or as the virus spreads it reinfects ?

Is there a citation for herd immunity and the UK? It was bandied around by the left wing press when they were looking for blood but I never saw any concrete evidence beyond it apparently being mentioned in passing.

https://www.nationalgeographic.com/science/2020/03/uk-backed...

Re: A Swedish doctor's perspective on Covid

#309

Post by Barrin92 » Sat, Aug 08, 2020, 4:30 PM UTC

throwaway202020 wrote: post #256

gyger wrote: post #238

Earlier quoted context omitted.

Also Stockholm in summer is empty. People leave the town and go on holiday, retract to the country side. I also don't understand when he says there is/was no social distancing. That is totally not my experience here, a lot of people were working from home and commuter trains were quite empty.

What about the photos of people happily seating in groups in restaurants and even attending sports events? I never seen anyone in those photos with masks. Also, I believe schools were kept open at least before summer vacations? I am not living there but very curious about how the life was during COVID period there.

>What about the photos of people happily seating in groups in restaurants and even attending sports events?

they obviously don't distance (by definition), but economic indicators suggest that Swede's do behave similar to countries that went into formal lockdowns. GDP in the second quarter was down 8.5%, which is not far off from the 10% in Germany or the US.

Re: A Swedish doctor's perspective on Covid

#310

Post by YeGoblynQueenne » Sat, Aug 08, 2020, 5:35 PM UTC

_-___________-_ wrote: post #208

williamstein wrote: post #63

Earlier quoted context omitted.

Unfortunately, it turns out that the estimate of the years of life lost due to Covid per person is significantly larger than "two or three years". For example, "New study finds coronavirus can cut life span by 10 years or more" (see https://thehill.com/changing-america/well-being/longevity/49... ), and there are other more recent studies that go into more detail in the US looking at populations ( https://www.hsph.har…

> New study finds coronavirus can cut life span by 10 years or more This is one of the worst headlines I've seen recently. The actual study measures years lost only of those that died. By that metric, if I cross the road today and get hit by a bus, the headline would be "crossing the road can cut life span by 40 years or more". There is zero valuable information in that headline.

I haven't read the article above, however there's a double standard here. I've heard, e.g. John Ioannidis (one of my personal Heroes of Science©) say that Covid-19 is not that bad because the majority of the people who die of it didn't have many quality-adjusted years of life left anyway [1].

Note that's quality-adjusted years of life for people who died with/from/by Covid-19, not of all those infected, because the majority of those infected lose 0 years of life so there's not much information in that metric, either.

So, yes, it does make sense to ask "how many years a person who died of Covid-19 could still enjoy had they not died of Covid-19". Just looking at how many people died of those who were infected simply ignores the fact that many people who die of Covid-19 would otherwise have gone on happily being productive and valuable members of their respective communities - and not shuffling, moaning zombies held together by arcane necromancy, waiting for a gust of wind to disintegrate. After all, while Covid-19 is very dangerous for people over 80, it is also quite dangerous for people over 50 and over 60, and those are ages where many people haven't even retired from their careers.

_____________

[1] Not a direct quote, rather one from memory. I can provide the source if needed, it's a video of an hour-long interview with Ioannidis on youtube.