Nils Karlson on the Swedish strategy (from an email forwarded to me)

Dear [redacted],

The strategy chosen by Sweden is of course discussed, but I would still say that there is a broad consensus across the political spectrum viewing the strategy, at least so far, as being wise.

I think this can be explained by at least the following five factors:

1. The high horizontal trust and the high vertical trust in Swedish society. In Swedish culture we usually trust that our peers will behave a responsible way and respect the integrity of others. Moreover, we usually trust our authorities, not only politicians but also the public administration. As a consequence “recommendations” for how to behave in regards to Covid-19 has so far been enough.

2. The long tradition of administrative independence. Since the 17th century we have an administrative system where the central governmental agencies such as the National Health Agency is independent. It is a quiet unique system of division of power, where the implementation of laws and regulations is entrusted to the bureaucracies rather than the politicians. As a result the experts rather the politicians have the say, make recommendations and the like, even in a situation like this. And their recommendation has been to not close down the whole society, but to avoid social contacts and to totally refrain from interact with people older than 70 years.

3. An attempt to reach group or mass immunity. As I interpret these experts the attempt is to reach group or mass immunity, 60 – 70 percent, of the population without reaching the limits of intensive care and by protecting the elderly. Also the ambition is to have the staff at hospitals on the job. Hence, child care and schools for children up to high school s still open as usual, shops, restaurants are still open, even if I many of them have very few customers.

4. As strong belief across the political parties to keep the economy going. There is wide consensus in Sweden about the value of work and to have jobs available, and in particular to keep the important export sector intact. I think especially the experience of the deep crisis we had in the early 1990s is important here. But perhaps also that the current prime minister has a back ground as the chairman of the metal workers union.

5. A long tradition of peace. A last factor I believe is that Sweden has stayed out of wars for over 200 years, Hence, we really do not think that disaster can happen to us. This in contrast to for example Denmark, Norway and Finland, who in fact have chosen very different strategies.

More generally, here is Dan Klein on Sweden.  Rolander and Daly (Bloomberg) wonder if Sweden will reverse its experiment.


I have a question for,our Swedish friends : is the media in Sweden as sensationalist as in the west?

Follow up : are our level headed Nordic friends contemptuous of the rabble rousing media?

In general less sensationalist. There's both state owned and free media in Sweden, and the state owned media is structured in a way where leadership positions are appointed by our parliament, or "riksdag". By all indications there's *some* political bias in the state media corps, but there's also a clear mission statement to remain neutral. Public service is criticized by some for failing to remain neutral, and whether or not there's truth to that the narratives are nowhere near as polarizing as like FOX or MSNBC. In light of this mission statement of neutrality, and their watchful critics who are looking for any opportunity to indict them, the news probably will tend towards being pretty tame and non-sensationalist.

RE: attitude towards rabble rousing media. I haven't particularly noticed that, but I've seen a lot of people grow aggitated over experts disagreeing over how to deal with COVID-19. But I think that looks more like a feature of pandemics being inherently difficult to predict, and not so much the media acting inconsistently.

Bravo on taming the media. I don’t know exactly how you did it. I read through it’s history and I’m still confused.

It would be unthinkable in the rest of the west to take the path Sweden has taken. The media would stir up so much Ill sentiment that the politicians would have no choice but to change course.

You’re doing exactly the correct thing. We’ll bring you down with us, since we’re crashing the world, but you won’t go to the depths we’re headed.

As I interpret these experts the attempt is to reach group or mass immunity, 60 – 70 percent, of the population without reaching the limits of intensive care and by protecting the elderly.
This is the plan the docs had from the beginning, it is the definition of curve flattening.

The quoted herd immunity ratio too high. Herd immunity should be closer to 90%. if it is seasonal immunity and remission time is two weeks.

I hear a lot of pundits believe we will kill off the virus and none of the medical docs plan on that until 18 moinths when we get a vaccine; way past herd immunity.

The comment misses one point, which may mean nothing, climate. I would like to know if cold weather helps or hurts. The docs are nuts, they use giinea pigs to test the passage of virus through air:
Influenza virus transmission is dependent on humidity and temperature.
Using the then newly developed guinea pig model of influenza virus transmission (4), we tested directly the impact of ambient temperature and relative humidity (RH) on the efficiency of viral spread between hosts. When inoculated and exposed guinea pigs were housed in separate cages, transmission was found to be dependent on both temperature and RH (5, 6). Transmission was highly efficient at 5°C but was blocked or inefficient at 30°C. Dry conditions (20% and 35% RH) were also found to be more favorable for spread than either intermediate (50% RH) or humid (80% RH) conditions (Fig. 1A).

OK, grab a physicist, use clean air and filter traps do an actual distribution of flow. We gonna use X rays to test gravity by throwing ginea pigs off a cliff?

But I digress, use the numbers above, they are good enough and one can see we want to hide out in hot humid pl;aces. We have hot in Fresno, come on down.

Why hot air? Dunno, talk to the gas physicists. Probably because the bulk of the virus get hotter and floats upward relative to ambient particles.

Why not air? Because hot air has higher *absolute humidity* than cold air at the same level of relative humidity. Absolute humidity matters because the air we breathe gets heated up close to body temperature anyway, and that is where the humidity matters. In fact, it’s not the virus that cares about humidity, but our throat whose self-cleaning functions work better at higher levels of humidity.

Related to that, it also helps a little to breathe through your nose and not through your mouth.

Fascinating. Thank you.

I wish them well and hope it works for them. It will be interesting to hear a few years from now how they cope with knowing their choice killed many thousands that didn't need to die. Please follow up with that story. My guess will be denial.

We would rather ruin the economy because we don't want to wash our hands and have everybody buy a neti pot and a common textile mask. We can't humidify homes and workplaces.

Over the years I've talked to 3 doctors about sinusitis . I've received the skin prick test and a recommendation to get a regime of injections. I also received pharma prescriptions from a specialist. The other doctor even mooted the idea of surgery. The cure I found myself was the squeeze version of the neti pot. I don't even remember why I tried it. Google perhaps.

There's no money to be made by business in home made masks and the neti pot cost very little. Hand soap is low profit margin. Americans will choose the most expensive solution because if it costs more "it must be better".

Sweden has been under exponential growth for most of a month. I don't see a likelihood of a sudden burst of infection and death in the data I am looking at. They may see a long tail of 30-70 deaths a day over the next 2 months.

But, sure, they will probably abandon the strategy under pressure from all sides.

Death rate per million -
Germany - 17
Austria - 21
Sweden - 37

It took them just a month to achieve that, it seems. Maybe number 6 is that the Swedes accept death among their elderly more easily. They do still have quite a ways to go to catch up to the death rate in most other European countries.

You should not compare death rates from countries with mild supression strategies: Spain and Italy have now strict lockdown strategies and death rates well over 200

Basically all of Europe has lockdowns that are more comparable to Spain and Italy than whatever chaotic situation exists in the U.S.

And are you honestly missing the cause and effect? Germany and Austria have lower death rates in part because of their suppression strategies being successful, not because they are stupid enough to act like the Swedes currently.

Though there is absolutely zero evidence of this, pretend that Italy or Spain or France or Germany have an infected rate of 10%, which is causing problems for medical care that are undeniable. If only due totally overloaded morgues leading to temporary arrangements to handle a flood of infectious bodies as a sign of something completely out of the ordinary in three of those countries.

So the Swedes think 20% or 30% would be better? Yes, there likely will be pressure to change. Equally likely, it will not be especially possible by that point.

Are they testing aggressively, or just as people walk in?

Doesn't seem that different from Japan, who apparently moved quicker than Sweden (closing schools?) and has a tiny death toll.

Looking at deaths, I think it's too early to declare Sweden out of the "exponential woods" just yet, but there are grounds for hope. If things go sideways, they could lockdown quickly and still probably avoid a Spain/Italy scenario.

Asked when the worst day of the outbreak will be, Dr. Deborah Birx, the White House coronavirus response coordinator, talked about the three hotspots being watched most closely: Detroit, Louisiana and New York. She said each are on the upside of their curve of mortality, and that officials anticipate them hitting their peaks in the next six to seven days.

"The next two weeks are extraordinarily important," said Birx. "This is the moment to not be going to the grocery store, not going to the pharmacy, but doing everything you can to keep your family and your friends safe and that means everybody doing the six-feet distancing, washing their hands."
Talking phase two when we are running up the peak.

One can intelligently shop if you wait for the odd hours get in and out quickly and avoid the counter until there are no customers. Wear a mask. Then beware the wrappers.

Here we have the people expecting one rule fits all. It doesn't, various regions are phased different and some do not have the sharp peaks like NYC. A lot of folks are intelligent about getting around and a lot of folks are not, if you have judgement you can use it.

But the timeline is right, the next two weeks will be a triage moment like the civil war in full battle. Expect tent wards.

Today's Wapo - "More than 15 city, state and federal agencies — ranging from military engineers to Javits Center carpenters — built the initial 1,000-bed hospital from scratch inside of a week. On Thursday night they finished with a second wing holding 2,000 additional beds. By Tuesday, they project to have finished the third and final phase, adding 1,000 more. Other convention centers in Detroit and Miami have been calling for advice — how do you build a hospital in a place that wasn’t designed for it? — as this brutal disease spreads.

The plan until Wednesday had been to keep the Javits New York Medical Station, or JNYMS as they’re calling it, free of covid-19. The station was to take on “low acuity” patients, those recovering from surgery or with diabetes flare-ups who could be released in a few days, to relieve hospitals citywide, where the crush of thousands of covid-19 patients has left no capacity for treating other ailments.

By Thursday, however, amid an outcry from hospital administrators incredulous that the Javits Center was sitting near-empty while their doctors and nurses were being overwhelmed, Gov. Andrew M. Cuomo (D) announced that he’d requested, and that President Trump had granted, permission for the convention hall to assume a new mission. The makeshift medical station that was supposed to be covid-free is now covid-only.'

* The first tent wards were set up more than a week ago in Central Park.

here's the playbook...doctors make dire predictions re. deaths and infections...when neither reach those depths politicians take the credit for "saving everyone and thing" get every time

Do you think that the Italian or Spanish doctors were publicly predicting such a death toll back on March 15, and that Italian or Spanish politicians are going to take credit for not saving ten thousands of lives? This applies a bit more to Spain, where there was less excuse for delaying action.

Or do you think that the American projections from public health experts are completely ignoring what has been going on in Italy, Spain, France, the Netherlands, the Uk, Switzerland .... ?

Shouldn't we start counting the cost in lives of coronavirus as including the statistically certain deaths that result from each percentage point drop in GDP? Wouldn't that give us a better idea of the correct policy response?

Number five is the sort of insight that is rare these days. It might not just be war, as Spain (and France to a lesser extent) experienced terrorists attacks over decades. Further, in countries like France, Italy, and Germany, a brutal overflow of victims is a hallmark of both a pandemic and warfare since the start of the 20th Century.

The counterexample is Switzerland, which was in fairly close proximity to WWII warfare.

1. Trust is not observable.

2. Sure hope the admins get it right, on average.

3. Herd immunity. Sure, everyone's wish. Problem is the path.

4. Glad that trade-offs between hospitalizations and economic activity are recognized in Sweden, too.

5. Peace? Sweden and Denmark participated actively in European wars. They merely lost. Later, Finland resisted the Soviet Union and then attempted to regain its losses by force of arms. Or is it meant that Sweden was not occupied by Germany, whereas Denmark and Norway were? Neither was Finland.

Only No. 2 is important. The rest isn't even wrong.

Sweden did not have any active participation in 20th century wars, and did not have the sort of front row seat to WWII strategic bombing (with bombs that occasionally fell in Switzerland around Lake Constance) and modern combat that the Swiss did.

He literally said that Denmark, Norway and Finland were *not* used to peace, and that Sweden was. Sweden hasn't fought a war since 1814. If anything Swedish industry has enjoyed an absolute advantage in industry owing to basically every other modern economy except the US being in shambles resulting in WW2.

Ooops! I got that wrong.

Sweden has almost twice the density, they will have a steeper curve. They will take a big hit in Stockholm, then a set of smaller cities of a 100,000 people at a much slower rate.

Twice the density of Norway or Sweden, that is.

But, obviously the spread is mapped by large cities at the moment.

The spread in southern German regions is just that - regional, and not particularly based in cities (of which apart from Munich, there really aren't any bigger than Fresno anyways). The virus remains completely uninterested in what people think about it.

And the worst hit German region - by far - is Heinsberg. It has no cities, and a population density of 1,000/sq mile. The town of Heinsberg with around 40,000 inhabitants has a density of 1200/sq mile. Fresno city has a density of 4,562.76/sq mile. There is not really a lack of data - Heinsberg has been a major focus of covid19 research even before the German shutdown. A shutdown based in no small part from what was being observed there. You might want to stop wasting your time with theories, and spend more time actually trying to learn about a virus which we have a half year's experience of.

Perhaps offer this:

This has been mentioned a couple of times in the comments here, but the whole point of an effective public health system is to collect data on which to base decision making. The Swedes will make an interesting counterpoint, assuming they continue their policies for several more weeks.

God himself aborts lots of embryos during the first trimester, leading to miscarriages. Take this as a hint that the soul does not enter the body before week 12 or so and that early abortions for good reasons are acceptable from a religious point of view.

Lol, about to say. God is the biggest aborter ever. About 70% of all conceptions are believed to lead to miscarriage - which is another way of saying that Jesus himself will be digging through ya womb with his proverbial coat hanger.

You think the virus cares about your "long tradition of peace"? lol. Sweden is doomed by their virtue signaling and moral posturing.

If the strategy turns out to work, then they're not doomed are they? And they'll come out the other end with an economy in much better condition. I think it sounds like Sweden has done the math, and they've found out what the opportunity cost in terms of foregone GDP is with shutting down the economy. Remember their long tradition of peace, and how Sweden capitalized on supplying Europe with goods when Europe was in ruins after WW2? The virus might not care about Sweden's tradition of peace, but your falling GDP doesn't care about your feelings either.

If I piss into your soup and you don't get sick, then it's all good right? You don't make plans assuming unicorns will always fart rainbows out their asses. Bad thing will happen.

"3. An attempt to reach group or mass immunity. As I interpret these experts the attempt is to reach group or mass immunity, 60 – 70 percent, of the population without reaching the limits of intensive care and by protecting the elderly. "

If we assume Sweden is only confirming 10% of actual cases through their testing, then at this point well less than 1% of their population has contracted the illness. This virus is more infectious than the typical flu, so heard immunity is not going to be strong at 60% immune, and of course it may turn out that immunity doesn't last more than a year or two.

It doesn't require complicated math to see that this is never going to happen. This is yet another example of invoking "herd immunity" when they mean to say "we want to keep doing what we've been doing, and are looking for a fig leaf to justify that."

And even immunity is hard to quantity so early in the course of a pandemic, which has not even completed a full seasonal cycle. Well those infected this spring still possess immunity next winter?

Yes, it is sad to see how many people are complacent, and don't want to change anything, even in the face of a pandemic.

I'm currently living in Prague. The Czech Republic and Sweden are both about 10 million people. Both had cases early March/late Feb. Czech has had very strict measures--quarantine, mask-wearing, etc.

Czech death total deaths = 62
Sweden total deaths = 373

Czech # in intensive care = 86
Sweden # in intensive care = 379 (some estimates 520)

Sweden seems to be tracking 5x worse on these metrics. Clearly, there are a host of other factors that may go into this, but I'd be curious to know what people think are the reasons, aside from the different approaches.

Wait until this is over. By definition, things should go much faster in Sweden but possibly with similar total number of deaths and a tremendously lower impact on lifes and the economy.

Or they will have a very high spike that when all is said and done will have been worse than more patient social distancing. See the graph of Philadelphia here vs Minneapolis.

Digression: the folks I see advocating for a Philadelphia type response aren’t the ones who’d likely die. Skin in the game?

We could, theoretically, adopt economy-destroying public health measures every year to save the same few hundred lives from succumbing to the seasonal flu. The question is should we.

Pr we could just use a flu vaccine. Which we already do.

Let us know when there is a vaccine for a novel pandemic virus that hasn't even existed for 6 months.

It is both surprising and depressing to see those who endorse the extreme measures adopted for suppression of this novel virus do so without even acknowledging that a cost-benefit analysis is just as necessary here as it is for every other problem, ever.

Its's not like the Swedish aren't practicing social distancing, they are just using a less extreme form-- mostly comparable to what the US cities that flattened the curve in the 1918 Spanish Flu epidemic did.

Opposite cherry-picking:
Belgium's population is just a little larger, and its deaths are 3x Sweden's.
Netherlands, France, Italy.
Even among the Nordics: Denmark per capita deaths only a little lower than Sweden's, so far.

It seems like "how hard/early was a country hit?" is an important variable in addition to response.

Something like Italy, Spain, Switzerland, Benelux, France, and out from there.

What Sweden is trying would almost surely not have worked in those countries.

5x as bad will probably look really good to the Swedes in a couple of weeks.

Has there been a strong debate in Sweden over policy? Is there anything we can read in translation to see the arguments on both sides?

Debate is a step toward dissent, which Swedish culture strongly discourages. Hence #5, a default to not doing things as a nation, and #2, an expectation that problems will be handled out of public view.

6. Sweden is a death cult.

How has no one pointed out that this is the country of death metal, death cleaning, and Midsommar?

Those are just fantasies we live out to compensate for our obsession with safety; think Volvo

“We don’t have a choice, we have to close Stockholm right now,” Cecilia Soderberg-Naucler, Professor of Microbial Pathogenesis at the Karolinska Institute, told Reuters.

She is one of around 2,300 academics who signed an open letter to the government at the end of last month calling for tougher measures to protect the healthcare system.

I thought counter-measures to stop ("slow"?) the spread of the coronavirus were intended to protect the people generally, not the "healthcare system."

Everyone else will, sweeping their decisions and actions under the most convenient carpet they can find.

Then when they think people have forgotten (Epstein of the 5000 American dead, tops being a bellwether), they will again start offering their opinions as if they were shown to be hopelessly incompetent.

My mother was from Sweden. On March 14, I tweeted
Again, I visited Churchill War Rooms in London
Reading UK’s plans of building up herd immunity against coronavirus, I wonder whether Winston would not have agreed with such stiff upper lip policy “I've nothing to offer but coughing, fever, chills and shortness of breath”

From the Bloomberg article: "But with much of the rest of the world going into lockdown, Sweden’s efforts to keep its economy open aren’t doing much to shield it from recession."

I've noticed something similar in downtown Boston. Even though all restaurants are allowed to serve take-out, many have closed anyways for lack of customers. Many of those restaurants depend on workday lunch customers, and workplaces are closed.

So, not self-isolating is claimed to cause externalities when one becomes infected oneself and increases the risk that the disease spreads to others. Similarly, privately shutting down imposes externalities on those that don't shut down by reducing commerce generally. One of these externalities is frequently cited.

there is no need to BUILD 'extra" hospitals, how many rural hospitals have closed in the last 2 years, that are empty, how may DOD hospitals were changed from acute care to clinic only and only using one floor of the hospital, I worked with the Med Reserve Corp after Katrina we brought back 2 closed VA Med Centers that were running clinics to back to use if needed, they were used as shelters but same could be done use them as medical shelters in the old TB hospital sense, 2-week quarantine, , it could be done without having to build tent citys.

Here in Spain, and in the UK I think, part of the initial advice was to sneeze into your elbow and not your hand. The Swedes do this already as a matter of course. No idea what other Scandinavian countries do or whether it would make a big difference to transmission rates.

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