Why isn’t Sweden exploding?

…Swedish state epidemiologist Anders Tegnell remains calm: he is not seeing the kind of rapid increase that might threaten to overwhelm the Swedish health service, and unlike policymakers in the UK, he has been entirely consistent that that is his main objective.

That is from a new piece by Freddie Sayers, asserting that “the jury is still out” when it comes to Sweden.  I cannot reproduce all of the graphs in that piece, but scroll through and please note that in terms of per capita deaths Sweden seems to be doing better than Belgium, France, or the United Kingdom, all of which have serious lockdowns (Sweden does not).  If you measure extant trends, Sweden is in the middle of the pack for Europe.  And here is data on new hospital admissions:

Now I understand that ideally one should compare similar “time cohorts” across countries, not absolute numbers or percentages.  That point is logically impeccable, but still as the clock ticks it seems less likely to account for the Swedish anomaly.

Of course we still need more days and weeks of data.

To be clear, I am not saying the United States can or should copy Sweden.  Sweden has an especially large percentage of people living alone, the Swedes are probably much better at complying with informal norms for social distancing, and obesity is much less of a problem in Sweden than America, probably hypertension too.

But I’d like to ask a simple question: who predicted this and who did not?  And which of our priors should this cause us to update?

I fully recognize it is possible and maybe even likely that Sweden ends up being like Japan, in the sense of having a period when things seem (relatively) fine and then discovering they are not.  (Even in Singapore the second wave has arrived, from in-migration, and may well be worse than the first.)  But surely the chance of that scenario has gone down just a little?

And here is a new study on Lombardy by Daniil Gorbatenko:

The data clearly suggest that the spread had been trending down significantly even before the initial lockdown. They invalidate the fundamental assumption of the Covid-19 epidemiological models and with it, probably also the rationale for the harshest measures of suppression.

One possibility (and I stress that word possibility) is that these Lombardy data, shown at the link, are reflecting the importance of potent “early spreaders,” often family members, who give Covid-19 to their families fairly quickly, but after which the average rate of spread falls rapidly.

I’ll stand by my claim that the pieces on this one show an increasing probability of not really adding up.  In the meantime, I am very happy to pull out and signal boost the best criticisms of these results.

Comments

Sweden has about the same number of cases as Norway and Denmark, and its caseload is rising faster. The country to focus on is Germany. Not sure why Sweden gets so much attention - different, not better.

otoh
sweden currently almost 2x as many cases as denmark and norway
Sweden currently has 3x more deaths as denmark
Sweden has 7x deaths as norway

Is the goal to "flatten the curve" and avoid overwhelming the hospital system or to avoid as many deaths as possible? Because if it's the latter, it means neverending lockdowns.

Not that simple.

Overwhelming the hospitals leads to otherwise preventable deaths. And also a high number of severe cases before we better understand treatment also leads to deaths that might be preventabe later.

"before we better understand treatment also leads to deaths that might be preventabe later"

The reason for the lockdowns is that we're hoping for better treatments in the future that will save some number of deaths?

Do you even listen to yourself when you say things? We're sacrificing trillions on the off chance that we have better treatments in the future?

Please, go in front of the public and attempt to make this case.

oh yeah, absolutely. That's the only reason we did the lockdowns. Did you miss the memo?

@estramsg - dude, it's the same thing.

I remarked several weeks ago that I thought most people don't realize that "flatten the curve" mostly likely simply means delaying when you get C-19 rather than eliminating it completely, and that the stock market still has not grasped this reality, and I stand by that assessment. I hope I'm wrong, but I have my shorts in place (DJ-30 to 15k then 10k when people like extramsg realize what flatten the curve really means).

Bonus trivia: not to hijack the thread (not), but have you read today's WaPo article on the secret 2017 US State Dept memo on Wuhan BSL-4 bioweaons lab leaking bioweapon-type viruses? Google "State Department cables warned of safety issues at Wuhan lab studying bat coronaviruses washingtonpost.com Apr 14, 2020 1:11 PM" and say "I told you so".

Still false. Many people can live through a pandemic without ever getting it, even absent a vaccine.

So herd immunity then?

You can have both. You can have people who are never exposed, and you can have recovered people who slow overall transmission through immunity.

Herd immunity does not require 100% antibody coverage.

The number is something less. Sometimes substantially so.

Becuause not every single person runs into every other single person on the planet.

Herd immunity is a strong function of R0. The higher R0 the higher fraction of people infected required to have herd immunity. That's why flu has decent herd immunity at a fraction of the population infected (I want to say 40%?) while measles requires just about everybody be vaccinated.

That's also why estimates for the required spread for COVID-19 herd immunity run high. Which is not to say there isn't large value in delaying when you get it, because technology is not static. Get it now, and you're potentially in deep trouble. Get it in the fall and you may have treatment options. Delay to next summer and a vaccine might keep you from getting it at all. Get to this fall is probably a good first goal.

@Lord Action - right, and what I'm saying is that likely with US style weak lockdowns we'll not get to R0 less than one (which is needed for C-19 to die) hence 'flatten the curve' means many if not most people will get C-19 and go to hospital (20% of infected do go say China stats). As you may know, the formulae for herd immunity is 1-1/R0, and R0 is a function of social distancing. With no social distancing, C-19 has R0 between 1.4 to 5.7 (cite: https://wwwnc.cdc.gov/eid/article/26/7/20-0282_article) For R0=5.7, you need 82% of the population to get infected. As a pessimist, I'm assuming this high number will happen in the USA (but not in Greece, South Korea, Taiwan, HK and probably Singapore).

I wouldn’t trust China’s stats (at least those from Hubei). Germany, South Korea, and Iceland have better testing regimes, and they don’t seem to have that high of a case fatality rate or that much hospitalization. I suspect R naught is above 1 but below 2 when you don’t have people crammed into stadiums, churches, or conference rooms, and that a reproductive number like that won’t overwhelm health systems in the US.

I don't trust China's stats because they are lying and are know liars. But I don't trust Germany's stats or Iceland's either because of the way testing works and Germany's desperate PR culture. South Korea might be more trustworthy, but there are reasons their experience might not be replicable.

In a world with lying governments concerned with PR, limited testing resources and policies (Do we test the dead? What goes on the death certificate of a cancer patient with COVID-19?), and flaky tests (How many of the people in the denominator of CFR calculations are false positives?), we can't trust outlier stats even if they tell us what we want to hear. Maybe especially if they tell us what we want to hear.

I still haven't seen anything convincing that shows that COVID-19 is not the R0 = 4.0, CFR = 2% monster it appears to be.

Ray, go checkout r/wallstreetbets you’ll get along with them.

Re Sweden: NO! NO! NO! lol from some Twitter thread counseling against herd immunity.

Lax Sweden has the same 10M population as lockdown Greece but 5x the C-19 cases. Do you feel lucky? C-19 will seriously impact 20% of all people, while 80% suffer nothing or just mild flu-like symptoms. But it's hard to tell which bucket you're in, even if you're young.

"Do you feel lucky? . . . Well, do you punk?"

Not per capita. Sweden has slightly fewer cumulative cases per capita than Norway and slightly more than Denmark, and about double the cumulative deaths per capita. These comparisons are sketchy because of different amounts of testing etc., but anyway for the record.

in a viral pandemic
if we are trying to define how/where/when the disease spreads
looking at absolute numbers makes more sense.
looking at per capita cases/deaths is gonna have a bigly dilutional effect

Danes and Finns don't kiss on the cheek either. Neither do Germans.

The real "sweden question" is not the success of the lockdown.

Which public health authorities will be trusted after this is over? The ones who said 500,000 will die? The ones demanding 50,000 ventilators?

You've got to take a 18 month view; this is not going away. At some point a lockdown might be useful, but for large chunks of the US and the world it isn't.

You're eating your future credibility to promises of false eradication.

So everyone now and then someone observes that the problem with effective responses to potential disasters is that some idiot will then say - “see, it was no big deal, you wasted our time”. Congratulations, you are that idiot.

Samuel - no, that's not at all what Charlie is saying, so don't call people idiots. You apparently haven't grasped the premise of "flatten the curve", which makes it funny (and ridiculous) that you're insulting other people.

Granted, public health officials have been a bit cagey in how direct they've been. (It varies by country.) What most acknowledge, however, is that eradication won't happen until a vaccine is available. We can't stay locked down for over a year, so this disease is going to infect a large percentage of the population at some point before a vaccine is available. It's a question of managing the pace at which that happens and buying some time during which - maybe, no guarantees - we figure out some better medical treatments.

"eradication won't happen until a vaccine is available. We can't stay locked down for over a year, so this disease is going to infect a large percentage of the population at some point before a vaccine is available"

Depends on what you think a large % is. South Korea, Taiwan, other places are managing very well. There will be continuing infections but managable. It's not necessary to stay locked down or to have more than 10% of the population infected, you just need common sense measures. Stay 6 feet apart, avoid indoor groups, wear masks.

Those are places where it never got much of a foothold, particularly Taiwan.

It got a small foothold in South Korea, but they apparently found most (but not all) of the initial infections and plausibly may eradicate it with the measures that you've mentioned plus continuing to trace and test.

It's funny how trumpeting unfalsifiability has become a pro rather than a con over the past couple months.

If someone makes a choice that saves or loses lives, how do we prove that? I think being too technically rational and demanding rigorous proofs isn't very practical and probably impossible in most circumstances.

Here's my theory - Sweden might be free-riding on the draconian lockdowns have put in place by other countries. Severe lockdowns put in place by other European countries might have significant positive externalities on other countries by reducing infection rates. So if every country operated like Sweden then the Swedes might experience much worse outcomes.

Given that the Swedish borders are closed, why would Sweden be affected by what's going on in other countries? Or are you saying that Swedes seeing that Italy is in a hardcore lockdown are also more likely to stay away from the street voluntarily?

Mmm... If all countries went into heavy suppression and perhaps you banned entry from them to boot to be extra keen at a stage where it had not spread too much in your country, you could free ride. And possibly New Zealand and Australia free ride in such a manner. But with things where they are? Nope.

LOL.

"Why can't we all be more like Scandinavians?", COVID edition.

To be fair, the fun part of what is happening with Sweden's current non-explosion is watching the "Why can't we be more like Sweden?" and "Acshully Sweden are liberal capitalist social democrats!" crowd exploding because Sweden isn't doing some command economy shutdown and isn't exploding.

It's like oh, yeah, they are liberal capitalists who care about a capitalist economy and won't damage it for mindless reasons. Now don't you guys just love seeing it in action?

Because most of the "I'm just an aspiring Swede" crowd don't actually have any interest in a liberal pro-capitalist model. They don't actually see Sweden as a real country, just an empty vessel and totem for their fantasies of what life could be like if they didn't have these annoying small state advocates about who at least try to restrain things from incremental progress towards a total bureaucratic command economy.

Liberal capitalist social democrat?

Can you elaborate? Genuinely asking. Thanks!

"I am not saying the United States can or should copy Sweden"

Isn't the United States in some ways already a copy of Sweden in terms of openness. Our restaurants may be closed but in lots of places like Home Depot and Lowe's parking lots are full now that people have time to catch up on home improvement.

Maybe one of the more interesting things being done in Sweden is not testing symptomatic people. Instead, they're asking anyone with any symptoms to stay home and self quarantine which works in a country with generous sick leave and norms surrounding its use.

Let me check my priors crowd before commenting.

Crowding sourcing?

Swedish deaths the last three days: 17, 12, 20. Down from last week.

Jury still out, to be sure.

Well that jury, like the rest of the world, needs to get back to work.

Today, 114, equal to Sweden's worst day (on April 7). Don't know why this is. Do they perhaps report non-hospital deaths in batches, like in France, or is this a sudden surge? Don't know.

The comparison with Japan seems a little off, however. Sweden must have far more cases than Japan, based solely on the deaths per million stat.

The data of the last 3-4 days for deaths in Sweden are not definitive numbers, they are always revised upwards. I think it's non-hospital deaths that are added.

Sweden's reporting is very incomplete over the weekends which makes the first work day look much worse than it would otherwise. Easter might mean Wednesday is the first non-aberrated reporting day (This info is very valuable to inform debate and policy but Sweden can't be bothered to tally up the dead during the weekend. Sad.)

They certainly don't appear to report the same on weekends as weekdays, which does imply at least some of level of batching.

Look at the Swedish fatality data at the Worldometer site - https://www.worldometers.info/coronavirus/country/sweden/

They have declines on April 4 and 5, compared to both the preceding Friday and the following Monday. Same trend on March 28 and 29.

My understanding is that Sweden just had a 4-day holiday weekend. Good Friday and Easter Monday are both national holidays, per some quick Googling. It's therefore possible that we just had 4 straight days of underreporting and will now have a catch-up.

The lower reporting on weekends is well known and well communicated in Sweden. Anders Tegnell, the state epidemologist, pointed out before the Easter extended weekend that the figures would be lower for the four days, and then be higher on Tuesday, which was exactly what happened.

Not even the weird tinfoil hatters in Sweden consider this to be a part of some conspiracy, thankfully enough. It's generally agreed that it would be slightly better on the margin to get better daily reporting, but it's also generally agreed that this may not be on the top of anyone's list of possible improvements right now.

Gee. A country that did not lockdown is doing just as well (or better) than the ones that did.

WHAT ON EARTH COULD THIS MEAN?!?!? It's just so baffling and perplexing. There's absolutely no way to extract any kind of conclusion out of this fact!

I mean, if they had a death rate higher than everyone else, the conclusion would be very, very obvious. But what if it's the same or lower?

MY GOD PEOPLE, WHAT IF IT'S THE SAME OR LOWER?!?!?

But he did extract a conclusion"I'm not saying we should copy Sweden."

When real world data comes in but it contridicts your predictions and policy, what do you do?

Double down on the original policy.

Whoa, no need to get overexcited. The way I see it, countries that have already experienced a surge of cases are in a sort of "elimination diet" phase, basically removing all forms of social contact while we get the caseload under control, ramp up medical and testing capacity, and crucially, examine retrospectively which forms of contact actually led to clusters of cases. Once those three things are done, presumably we can resume the forms of contact that have been found to not lead to major spread. It looks like Sweden might be trying to approach this from the opposite angle, with somewhat mixed results, but not such bad ones that it's an illegitimate strategy in their situation.

Why aren't Texas and Florida exploding? They did not issue stay at home orders until April 2/3.

If the NY lockdown on March 22 is just showing up in the numbers now, as is being claimed, shouldn't we see a dramatic divergence compared to non-lockdown states?

otoh
Texas started state restrictions on March 19
the efficacy of viral control is probly gonna depend on how much virus is in the state at the time restrictions start not just the start date alone

Many large cities went before the state did (and in fact were in some cases more extreme than the state's order and were required to loosen). Dallas County March 22, the first Houston-area county March 24, Austin was also March 24.

Major metropolitan areas in Texas closed restaurants and issued their own stay at home orders earlier.

As in, early to mid March.

Yes, just looking at state information can give a false impression.

I live in Austin, and we had bars closed and restaurants dine-in only by March 16 or 17. We then gradually tightened beyond even that over the next week or so. The other biggest counties in the state: Harris (Houston), Dallas, Bexar (San Antonio), and some of the counties around them were on a similar timeline.

Statewide in Texas, bars, restaurant dine-in, gyms, and schools were all closed on March 19. There was also at that time a statewide order limiting social gatherings to 10 people.

I realize that it can be hard to follow, because some of the reporting is terrible. As late as April 4 or 5, I saw The Economist describe the Texas governor's approach as "laissez-faire".

I think there's a good chance that what we're seeing, though, is that greatly diminishing marginal returns on taking measures beyond the sort of measures that Texas took on March 19.

Wow. We're getting some bad coverage on Texas. I had pretty much thought it was business as usual until about 15 minutes ago.

Also, don't discount that the big cities locking down earlier while the rural parts of the state stayed open longer aren't totally unreasonable.

One of the nice things about the US is when the federal government fails, the states and cities are probably more likely to step up.

We're terrible at quick, broad responses, but it's not like nothing was happening across the country - by mid march a lot of areas were tightening their belts, so to speak.

And don't forget about having a little bit of luck, too. NYC was likely to be one of the worst hit. Big cities in Texas aren't anywhere nearly as dense as on the east coast, either, so the spread is likely to be slower.

Jeff - the federal government will pretty much always "fail" at things like the emergency closures we've seen in different states and cities. Governors and mayors have the legal authority to impose those measures, and the federal government doesn't.

At most, the federal government can provide information and recommendations for those measures. (It can also, of course, provide various forms of relief and support for healthcare systems.)

Scoop - yes, that is bad coverage.

Here was the situation in terms of a state-wide order on March 19 - https://www.houstonpublicmedia.org/articles/news/texas/2020/03/19/364739/gov-abbott-closes-schools-bars-and-restaurants-limits-gatherings-amid-covid-19-outbreak/

It ratcheted up to a statewide "shelter-in-place" in all but name on March 31 - https://www.texastribune.org/2020/03/31/greg-abbott-texas-executive-order-closures/

I'll also add that as far back as March 19 and a bit earlier, there was pretty strong messaging to the population in general and employers of "work from home if you can, and don't go out to public places except when you really need to do so (get food, go to the gas station).

As one anecdote on that point: I live in downtown Austin. I was out walking somewhere at what I distinctly remember as about 5 pm Monday, March 16, and the level of pedestrian and vehicle traffic was what I'd normally associate with 9 am on a Sunday morning. So that was what the central business district of one of the larger Texas cities was like almost one month ago. I'm sure that some people were still going to offices, but employers who could have people work from home - which covers most downtown offices - were doing so without any government order requiring it.

It's been a frustrating part of much of the media coverage: the idea that anything other than a state government matching the strictest order of some other state government means "business as usual".

Florida also had a patchwork of county- and citywide regulations before the governor abrogated them through his statewide order. Some were more draconian than others. Hillsborough County (home of Tampa) just instituted a 9 PM to 5 AM curfew this Monday.

Sweden is a very different proposition. Homeownership is structured very differently. For example single occupant homes are the biggest segment as I recall. Working from memory here. There are not a lot of elder younger households. Their healthcare system is better too. Lots of those kinds of factors.

I mean, in most of America people aren't living with their parents or grandparents either. Does this mean lockdowns can be improved in all states where housing prices are sufficiently low for young people to be able to afford one?

*to be clear I AM saying we should copy Sweden.

That's what the data says. It's not what is apparently politically correct to say in Academia.

Sweden has a large welfare state, central government takes Quality of Life quite seriously. There's more emphasis on a rather centrist "Folkhemmet", yet it's still in the spirit of bipartisanship: https://www.thenation.com/article/archive/sweden-welfare-state-benefits-popular/
*philosophy trivia: Swedenbourg was considered a mystic!

In terms of R0 the virus does not “care” about most political philosophies. It “cares” about specific social practices: Swedes are less likely to be obese, have more single family dwellings, and are less prone to Italian style intimacy/familiarity etc. (I.e. already practice a form of social distancing.)

No the virus does not "care" about anything for that matter! But if you have a strong central infrastructure that cares about specific spheres of human life in the context EQUALITY and justice, then you may expect a uniform approach towards a pandemic, rather than endless political factions. These expectations are guided by the values, goals and socio-cultural landscape that is Sweden, in fact, Scandinavia. And, G-d forbid, if some of that is shaped by deeper philosophical subtext!

you go, girlfriend

The data definitely does not say that

From what I can tell, all native Swedes born between 1940 and 1975 were given the BCG anti-tuberculosis vaccine, which some studies are showing is correlated with a big reduction (83%?) in the severity of the coronavirus. (Nowhere near my field of expertise, but it is worth a look.) I could see how that could reduce fatalities, but I don't think it would have a huge effect on the number of cases.

Yes, it is the mass BCG vaccinations. Look at the infection and death numbers between Spain and Portugal, two adjoining countries. Key difference? Portugal mass vaccinates its population with BCG, while Spain does not.

Then why is France doing poorly? Also (although this is weaker) why is Iran doing worse than its neighbors?

France, Italy, UK do not have a universal BCG vaccination program. The vaccine is not currently part of the routine childhood immunisation schedule.

I guess whether a program is current or not that would change infection rates, but all that should matter a lot for the real IFR and the acceleration of deaths is what was the case when the old folk (who present the 90% of deaths) were immunized.

This is actually probably a pretty good test of the theory. If past BCG immunization programmes matter, look at the timing and whether that has any effect on demographic slope of deaths.

Those countries where immunization happened decades ago, but doesn't now, should have some measurable excess of young:old deaths compared to those that never had it, or have continuously had it. If that doesn't happen and they have the same age->probability of death slope (the same distribution of fatalities adjusted to the age distribution of the country), then BCG immunization doesn't matter.

It would be interesting to see what percentage of the Swedish deaths had the vaccine, as opposed to the percentage of urban population over 55 that had the vaccine. Perhaps just using "native born" would be a reasonable proxy. In any case, if this indeed is a major factor, all the fulminations about whether we should adopt Swedish policies is a little late in the day. The policies we should have followed are 55 years old. (Seriously, I think it is perfectly understandable that Sweden stopped requiring the vaccine. When it came to eradicating TB, Sweden was not a "free rider.")

I think you might need a bit more of an age control, as the risks are still pretty non-equal beyond age 55 (so if you had lots of dead who were 85 and didn't get it because less vaccination then, that would skew things if comparable sample had more age 55s who did, etc.).

The basic principle of whether dead had much higher / lower vaccination rate than age matched slice of local population seems basically sound though, so that could be another way to do it.

According to wikipedia France had mass bcg vaccination between 1950 and 2007. So that has to be explained away before bcg vaccinations make sense as an explanation.

That does seem to be a good counterargument. There could be other factors, such as (he says unconvincingly) 1). There do seem to be over 10 substrains of BCG used in different countries and perhaps some are better than others. 2) France certainly has a number of immigrants who are now old enough to die and may not have had the vaccine. But I will concede the point until better evidence emerges.

I wish someone did a direct study of that - it should not be that difficult to get the vaccination data on patients.

This article tries to put BCG hopes in perspective: https://www.forbes.com/sites/madhukarpai/2020/04/12/bcg-against-coronavirus-less-hype-and-more-evidence-please/#385e5bbe6b4f. Read it for a good background on how the BCG interest for COVID-19 started. The ecological studies that offered the hope were far from conclusive and did not account for a multitude of variables (testing levels, where countries are in their exposure to coronavirus...).
It in turn references this recent WHO brief, https://www.who.int/news-room/commentaries/detail/bacille-calmette-gu%C3%A9rin-(bcg)-vaccination-and-covid-19, which states:
"There is no evidence that the Bacille Calmette-Guérin vaccine (BCG) protects people against infection with COVID-19 virus. Two clinical trials addressing this question are underway, and WHO will evaluate the evidence when it is available. In the absence of evidence, WHO does not recommend BCG vaccination for the prevention of COVID-19."

Thank you for posting this and not shutting down debate and learning in your editorial decisions. This is one reason I keep coming back.

"To be clear, I am not saying the United States can or should copy Sweden."

Didn't you and others want us to copy South Korea and other Asian nations with mass testing? People didn't seem too bothered by the fact that we aren't South Korea, either. I seriously doubt our citizens would have been nearly as compliant.

Wouldn't most Americans jump at the chance for free testing? Right now you mostly need a doctor's note.

South Korea's testing isn't quite as "mass" as some people think.

Look at Worldometer stats. South Korea has cumulatively performed 10,288 tests per 1 million people. The U.S. cumulative number is at 9,172 tests per 1 million people.

Where South Korea really shined was in initially ramping up testing really quickly and then testing contacts of confirmed cases.

South Korea has not, as I understand it, ever been that just anyone in the country (or even a metro area) can get a free test. It's closer to the model of a "doctor's note", which has included public health officials in South Korea essentially demanding that someone get tested.

Are some folks seeing the image of Jesus in their mashed potatoes? Maybe. It's true that in Sweden the confirmed inspection rate is relatively low? Is that because there is relatively little testing in Sweden? It's true that Sweden has a relatively low infection rate even in the absence of an official lock-down. Is that because Swedes have taken it own their own to impose a voluntary lock-down, with public transit ridership down over 50%, many employers voluntarily choosing to have their employees work from home, and universities voluntarily choosing to close. It's a cultural thing: PM Stefan Löfven admonished that "Us adults need to be exactly that: adults. Not spread panic or rumours. No one is alone in this crisis, but each person carries a heavy responsibility." Compare that to Trump's statements. Although Sweden has a relatively low official infection rate, Sweden has a relatively high death rate (as a percentage of the official infection rate). Is that because the official infection rate understates the actual infection rate (due to little testing) and because those most at risk are the ones being infected? Am I seeing the image of Jesus in my mashed potatoes?

From what I've read and seen on the news, Stockholm has had most people staying inside but not other cities and towns, which weren't changing their behavior much. At least that was true in early April.

"Is that because the official infection rate understates the actual infection rate (due to little testing)?"

The official infection rate understates the actual infection rate basically everywhere. The question is by how much. The most likely answers are various versions of "dramatically": i.e., actual infections being at least 10x greater than confirmed cases seems likely in most countries.

(Perhaps not so much in South Korea. But even they had several weeks - from about March 10 to April 5 - of finding another 100 or so cases each day, which has since dropped to more like 20 or 30. So even they pretty clearly haven't ever found everybody who has the virus.)

Cowen should start following Gelman (or rather https://statmodeling.stat.columbia.edu/):

https://statmodeling.stat.columbia.edu/2020/04/13/considerate-swedes-only-die-during-the-week/

This is a pretty naive criticism. Here is a site that breaks down Swedish deaths by date reported and date of death, and provides an estimate for current days based on reporting delays: https://adamaltmejd.se/covid/

The "weekend effect" simply isn't big enough to account for the lack of the predicted explosion in cases.

Singapore also thought they were doing great without a lock down. They totally reversed course a week ago as daily new cases kept increasing.

I fully recognize it is possible and maybe even likely that Sweden ends up being like Japan, in the sense of having a period when things seem (relatively) fine and then discovering they are not.

Japan's had about 140 deaths from this. They're in satisfactory shape no matter how many times you lie about it.

Lying is the new accepted mode of discourse these days. Just ask the president.

I, for one, am thrilled to be alive in the time of the first president to lie.

Also the first president to cheat on his wife, the first to express belief in ethnic stereotypes, and the first to make promises he knows he cannot keep. An unrepentant reprobate.

He's still at it. He just endorsed Biden, saying things everyone knows is complete BS.

Yeah, don’t know why he’s always rooting for Japan to fail. It’s weird.

It may be that Japanese culture is "too different" to emulate, but they have had 140 deaths in total, while Sweden had 112 today, so unless Japan is outright lying, they are the star pupil. Even South Korea has more deaths. Very weird Tyler. Maybe because Japan is a standing reproach to the globalist, integrationist vision.

Steve Jackman, a westerner living in Japan, thinks the Japanese government is orchestrating a cover up.
See the comment section of Japan Times coronavirus article.

https://www.japantimes.co.jp/community/2020/04/01/general/japan-culture-low-covid-19-numbers/#.XpZH0_JKg3F

Japan is deliberately under-testing for the coronavirus and rolling its excess coronavirus deaths into pneumonia deaths.
Japan only does autopsies in 10% of suspicious deaths and a pneumonia death is not suspicious.
The Ministry of Health, Labor and Welfare only issues pneumonia death numbers [in a comprehensive survey] every three years.

So what about year-over-year comparisons of total deaths in Japan to see if there are excess deaths this year? I see Steve Jackman claiming that the government only reports total pneumonia deaths every few years, but what about just total deaths (from all causes).

It also seems telling if, without extreme measures, they've apparently avoided having hordes of patients who are in hospitals, outstripping ICU capacity.

Yes ICU's filled to capacity would be hard to air brush out. It is quite interesting how people use straw clutching arguments like giant conspiracies to save their theory.

"Japan is a standing reproach to the globalist, integrationist vision."

Proud member of the TPP Japan, you say? Your stereotypes about Japanese immigration levels are also several decades off as well, I reckon.

As recently as 2016, Japan only had about 100,000 permanent immigrants per year - https://data.oecd.org/chart/5StJ

That's in a country of 120+ million people. It's roughly the same number of permanent immigrants as Belgium, which has slightly less than 10% of the population of Japan.

I don't think it's fair to just look at Lombardy and then conclude that the lockdown wasn't useful. It may be that the new cases and deaths in Lombardy already had a negative second derivative before the lock down. However, the lock down helped confine most of the cases to Lombardy. I don't think there's evidence of a nation-wide negative second derivative before the lock down.

This argument is kind of like looking at the location where a forest fire started and concluding that evacuating nearby areas doesn't make sense because the fire is already dying down in its initial location...

Travel restrictions can be a part of a lockdown, but don't have to be the only lockdown measure. Authorities could've banned traveling in/out of Lombardy without mandating a strict quarantine within Lombardy.

In principle travel restrictions without a lockdown could have the same effect, but I doubt that it'd work in practice. If the only restriction is no travel into or out of Lombardy, then it only takes one infected person leaving to render it useless.

Back to the fire analogy, you can't just build a fire break in a forest fire's path and then leave; even if a single ember crosses the break, you're back to square one...

That article looks like garbage to me. Just look at the plot. There's like 20 data points and they look like random noise and then the guy says "clearly it was trending down" which is just not the case at all.

The "new" study on Lombardia is a blog post from March 19, and looks at data only up to March 3. It's hard to tell for sure (you have to dig through salute.it.gov), but it sure looks like the growth rate in deaths accelerated substantially again after the time period considered.

One of the problems I've been noticing is that lack of accountability for the various models out there. Everything is a projection forward. I look at the University of Washington's models regularly and there's no way to assess how effective they've been because they're always updated to look forward. But if we really wanted to assess them, we would need to be able to see an overlay between what they would have predicted on a previous date compared to what the actual numbers are now. Granted, it would mean being able to contextualize, knowing that, eg, on a certain date a state or country may have instituted a lockdown. But it would make the models and their architects more transparent and accountable.

Here’s a paper assessing the IMHE model: https://arxiv.org/abs/2004.04734

In short: it’s really useless. Less than half of states fall within their “95%” confidence interval day-to-day.

I'm a Swede, and just like major swaths of the population I have a fair amount of trust in the direction the public health agency has staked out. Mainly because the government is actually letting the experts take the lead where politicians in our neighboring countries have often prioritized being seen as resolute over heeding the recommendations of their expert agencies (whose recommendations are largely in line with Sweden's).

However, which countries will end up looking good at the end of this will largely be decided ex-post with information no party can possibly forecast right now. If no short-term treatments are found to work at scale and herd immunity ends up being the only feasible near-term solution, Sweden may come off excellently by swiftly achieving a largely immune population, closely tracking but not overloading ICU capacity and keeping the economy running throughout. If on the other hand one of the treatments now tested turn out to work effectively and is widely adopted within the next few months, Sweden will come across as having gambled with thousands of lives while countries opting for complete lockdowns will be seen as prophetic.

Unfortunately the judgment will be passed by commentators with 20/20 hindsight and no recollection of how certain everything looked at this point in time.

how uncertain* everything looked at this point in time.

"However, which countries will end up looking good at the end of this will largely be decided ex-post with information no party can possibly forecast right now."

+1

+1. Thread winner.

Gambled with thousands of lives for a gain of about a hundreds of billions.

That’s clearly a bet that a rational person should take.

Their daily cases are dropping. There is reason to believe that 5-10% are already infected/immune.
It means that the social spreaders (super spreaders) are already immune. These are mainly young people living alone and they infected other young people or people like them. Ro is dropping towards 1 and the 10% is helping towards herd immunity.
The rest of the population which is quite compliant is more cautious. There are quite a few billboards telling you to stay home if you’re sick.
The hospitals are not overwhelmed and that puts them in the middle of the pack
They also benefited from less worldwide travel even if it wasn’t explicitly their policy.
https://www.svt.se/nyheter/inrikes/ny-studie-2-5-av-stockholmarna-bar-pa-viruset

Actually 5-10% refers to the public health agency's estimate of active infections in Stockholm (based on a sampling with a 2.5% positive rate a few days prior). The share of the population having had an infection at some point would be significantly higher, but of course these are numbera for Stockholm and not the country as a whole.

yes, you have to add the ( unknown) already immune to this tally, but it was probably small, based on the the infectious period ( ~ 2 weeks) , it might have been another 2.5%. Community transmission was detected on March 9.
Stockholm has more infections/illnesses than the rest of Sweden: 10% of the population but 35-50% of the cases/illnesses.

What makes you think that things have gone wrong in Japan? They are still below 200 deaths, which is remarkable given how early the virus was introduced.

Yes, they have announced a state of emergency, but that could easily be a result of social pressures.

He’s been unfairly assessing Japan the whole time. I honestly don’t know why.

Japan's not sold on the idea of MOAR immigration.

I’m here for these LOLs. Japan data today and yesterday looks a lot like Sweden. They just went over 100 deaths since early February. This blogger has implied that he has insider information that he knows they are hiding their official data from the world instead of publishing it daily like everyone else. Frankly I think the Japanese are trying to do a lock down as late as possible to placate public fear rather than try to stop anything to do with the virus because it could very well be bad policy. Remember when there’s a lot of deaths, saturation is in less than 2 weeks after.

Japan looks nothing like Sweden, which if the size of the U.S. would currently have around 25,000 deaths.

Why isn't Sweden exploding?
Why is England exploding?
Why did Italy go off a cliff?
Why did New York get hit so hard?
Why did Colorado get hit early and then slow down?
What's California's story?
What about Spain?

What are you only asking about the cases that seem to confirm your bias?

What is Tyler's bias?

Seriously, people seem to be using their own bias to project things onto Tyler that aren't obvious and probably don't exist.

They've spent a lot of ink here induling in the overreaction spin that seems to be taking form as the central talking point from the Trump side.

The blame-the-forecasters thing is tiresome. Especially from someone whose business is the utterly failed and disgraced dismallness of economics.

Blaming forecasters isn't enough. Starve the WHO!

Not going to click because I’m positive it’s some insane culture war tweet. How the hell did the WHO’s incompetence become a culture war issue?

The WHO:

1/14: There is no human to human transmission of the novel Corona virus

3/30: Taiwan? Doesn’t exist

For serious people,

https://twitter.com/mims/status/1250200002951106562?s=19

Whatever.

It doesn't refute Skeptical's basic point: the WHO has shown itself to be a hopelessly politicized organization that bends over backwards to placate mainland China.

There's a decent argument that right now isn't the correct time to stop WHO funding, but the idea that they've done a good job is ridiculous.

I see that the second tweet is from someone who works as a reporter for Nature. She should spend more time worrying about why her employer publishes editorials pushing back against the idea of referring to this virus as China's fault - https://www.nature.com/articles/d41586-020-01009-0. Because, the spread of this virus undoubtedly *is* the fault of various levels of the Chinese government.

Also, Amy Maxmen conspicuously ignores WHO statements such as its director saying, on February 3, that here was no need for measures that “unnecessarily interfere with international travel and trade” - https://www.reuters.com/article/us-china-health-who/who-chief-says-widespread-travel-bans-not-needed-to-beat-china-virus-idUSKBN1ZX1H3

By "serious people", do you mean lackeys of and apologists for the Chinese Communist Party?

I mean the red under your bed

+1

And, the premise is also that Sweden is doing nothing, or that, notwithstanding the government pronouncement, most people are taking actions to protect themselves.

"So far, Sweden has banned gatherings larger than 50 people, closed high schools and universities, and urged those over 70 or otherwise at greater risk from the virus to self-isolate."

And while most businesses in Sweden are still operating, the economic cost of the pandemic is already being felt. Last week, 25,350 Swedes registered as unemployed, according to the Stockholm Chamber of Commerce — a larger increase than during the 2008 financial crisis.

Yosemite National Park during the time of coronavirus Covid 19 Los
In contrast, just across a narrow strip of sea, neighboring Denmark is talking about reopening society after having imposed a much stricter lockdown four weeks ago, closing borders, schools and businesses. This week, the prime minister said that by acting early, Denmark averted the tragedy that struck hard-hit nations such as Italy and Spain, which together have seen at least 37,000 virus-related deaths, and will be ready after Easter for a slow return to normal life that starts with reopening preschools and primary schools."
For weeks, the numbers of COVID-19 cases and fatalities were proportionally similar between Sweden and Denmark, but while the economic results of the strict isolation are being felt in Denmark, Sweden’s mortality rate has reached more than 88 dead per million, compared with around 47 dead per million in Denmark.

Sweden, with a population of 10 million, has registered 899 deaths, while Denmark, with 5.8 million people, has 273 deaths."

Here is the link: https://www.latimes.com/world-nation/story/2020-04-13/as-virus-deaths-rise-sweden-sticks-to-low-scale-lockdown

Hey wait, that doesn't fit the narrative!

Neither does the UK. You'll note that many of those people who were complaining a few weeks ago that we should be more like the UK, have quietly drifted away from that train-wreck and gravitated to mythologizing Sweden and to blaming forecasters.

Is the UK a train wreck?

My money is on more than 30% of the UK already having been infected already.

By train wreck I refer to the headfake on quarantine, culminating in a hasty retreat from their previously cavaleir posture. I mean the comparative high mortality to infection ratio (i know, I know). I mean the PM may have almost died.

If they end up with a high rate of natural immunity, it was by accident, and costly.

Tyler, you put the same picture twice

1. V-shaped recovery seems increasingly likely.

2. What’s one step below herd immunity? CV seems a bit weak at bridging gaps bigger than full churches and full houses. Call it “mid-distance immunity”.

3. Why does it seem that despite virus onset differing across regions that we all are coming down the curve roughly simultaneously?

To answer point 3:

I think it's that measures to limit spread - both individual behavior and government actions - are often based on what's observed elsewhere.

As a slight tangent, there's probably too much emphasis on the latter and not enough on the former. "Individual" here can include corporate actions: retailers closing before mandated to do so, employers telling people to work from home before mandated to do so.

There's also probably too much emphasis on government "stay-at-home, only essential trips" versus other measures (closing bars, gyms, and dine-in restaurants, limits on large gatherings) that result in a very large percentage of that impact.

You are doing abstract three ala Fama, creating a model of an information processor and noting that uncertainty levels tend to equalize everywhere. I am sending you a Nobel Banana and 1.5 million micro cents.

Perhaps all of this covid comparison stuff on this site is an attempt to divert attention to all the money going out the door under the stimulus program.

There is no discussion on this site of the stimulus program.

If you go back and look at how stimulus was discussed in 2008 on this site and compare that to the lack of any discussion on this topic you would think you were living in a different universe.

While comparing social distancing regimes is relevant for both economic effects and disease spread, there is no discussion of economics, nor of stimulus programs.

As an analytical exercise, compare the discussion of stimulus programs in 2008 on this site to the discussion of stimulus programs in 2020. What changed: Political affiliation.

Start discussing the economic stimulus program.

After 2008 we have herd immunity to bailout outrage.

Besides this time around, they got smart and actually dropped a couple helicopter loads in the direction of actual working people. Or promised to anyway.

The charts say 2001.

In this thread Bill compares the government boosting unemployment benefits and lending money to businesses during an obligatory government shutdown to shoveling $831 billion to rent seekers.

Unless we're here to champion the extra $25 per week in unemployment benefits of the stimulus bill in 2009.

In his reply, Skeptical relies on you knowing nothing or forgetting the past or both. You know enough to make your own judgment.

Those are very good questions. I think Sweden will do fine but in many cases lockdown is the best thing to do.

I give some examples of effectiveness of the lockdown from Italy.

The first Italian cluster was in Lodi province. A very hard lockdown (including stopping all economic activity) was quickly imposed in the area, which is currently doing fine (relatively speaking of course). The second cluster was near Bergamo. Due to a combination of factors not worth discussing in this context, no lockdown was imposed for a few days, and when it was done, industrial activity was kept running. Reliable estimates say 0.5% of the population died in one month, and the epidemic is not over yet.

Other example: the rest of Italy. Despite having already some spread, plus a very large number of imported cases escaping from Lombardy just before the lockdown was imposed, the situation is under control everywhere and pretty good in the south. If you think the lockdown did not make a difference, you are basically saying that temperature and pollution account for order of magnitudes of difference in the number of deaths.

What about Sweden then? In addition to what you said:
1) Sweden effectively did test and trace in the early phases of the epidemic. They eventually were not able to keep up, but the uncontrolled spread started quite late.
2) They used the time to equip properly their health care personnel, which limited hospital spread.
3) They imposed mild measures, but relatively speaking they imposed them very early - before the start of uncontrolled spread in the country. As if Italy had imposed them in early February.

Conclusion:
managing well the early phases of the epidemic is crucial. Milder measures may be enough if imposed early (relatively to contagion). If you have wide spread, however, you have to bring down the contagion rate hard.

+1 Thanks for the information and data.

The 'why is X country doing so well' flavour of articles are interesting. They all say the same things. Country X closed the schools and banned all gatherings. They shut down non-essential businesses and ramped up testing. But Italy closed schools and quarantined cities on Feb 22(ish) when they had only 100 cases. And nearly every country has followed more or less the Italian model.

Sweden has done worse in terms of the death rate, just not abysmally worse. My hunch: responsible voluntary preventative measures, and modest government restrictions (eg banning gatherings over 500) get you 90% of the way there. Most people have been saying they would rather over-react. It looks like they've done just that. Might be sensible too. Let Sweden be the Guinea pig. (or is it Hamster. I recall reading somewhere that hamsters were desirable for medical testing because they have a human-like immune system)

What is the mix of a population is as follows:

50% can't catch or are highly resistant to it.
20% can catch it, but will largely be asymptomatic.
10% can catch it and will get sick
10% can catch it and will get very sick
4% can catch it and will get so sick they need ICU
~1% can catch it and will die

In other words, what if there is a huge chunk of the population is largely immune for reasons not yet understood? In that case, the burnout would happen sooner than anyone expects (as we're seeing) regardless of distancing.

When the plague hit, some were completely immune. Ditto with HIV.

The last three seem mostly correct in total, about 15% of us suffer sever reaction. I got this from a doc who estimated how many people just have severe allergy to other corona virus.

The last one is off by an order of magnitude.

17% of NY pregnant women giving birth had it. 5/6 of them had no symptoms. That means under-reporting from the current 10,000/M in NY to about 170,000/M.

At least.

Because that's just the woman who had a high enough viral load to detect.

> The last one is off by an order of magnitude.

Sorry, I was trying to propose the first one as a curiousity. Everyone seems surprised this is burning out the way it is everywhere, whether social distancing is being done or not. One explanation for that is that a large % of the population is immune and can't catch it all. No antibodies. No symptoms, Their system just rejects the virus as it does zillions of other viruses.

Have you seen any writings or discussions on the size of a group that is immune? The plague had a sizable group, and there is a very, very small % of folks that cannot catch HIV.

As above said, a ratio of 24:1 of sick:deaths looks off.

A good guess at the moment (best studied guess) seems to be we can be fairly confident that, of those patients who get sick enough to be classified as symptomatic, over US age demographics, probably only 10% actually need hospitalization, and would only 1.8% die. So that's the max, if there are no asymptomatic patients. More like 50:1 sick:dead.

If symptomatic:asymptomatic / v.v. mild is only 1:1, then 5% hospitalization and 0.9% IFR.

If symptomatic:asymptomatic / v.v. mild is 1:4 (as suggested by the study of the pregnant women), then IFR around hospitalization is 1% and 0.36% IFR.

That is still high enough to yield many deaths if all are susceptible (hundreds of thousands in the US, still). But if some % non-susceptible (simply immune) then total possible fatalities are lower.

(Some share of population "simply immune" was one of Michael Levitt's proposals based on his reading of Chinese data, back before all this kicked off in the West. Some claim that this is implausible on the basis of small case control scenarios though - e.g. there was no a large share "simply immune" in care homes / Diamond Princess, etc.)

And real fatalities and stress on hospitals in a given time frame would be lower, as, even if you don't get to total "herd immunity" transmission slows a lot when there is substantial immunity and people are mostly socializing with a fixed pool of people.

> there was no a large share "simply immune" in care homes

Maybe there's an age component (which we know there already is). But for example, in population under 40, a certain sizable % cannot catch it or they need a very intense exposure for the virus to get a foothold. But over 60, you don't need much (poker players).

In short, I'll be the reasons the models are all so wrong is that viruses seldom have an equal chance of infecting everyone, and sars-cov is maybe even more specialized in this metric.

Hospitalization rates among 18-49 year old was roughly 2.5 per 100K, 7.4 for those 50 to 64 years, to 17 per 100K for those aged 85.

In other words, it's 42X more resource intensive (ICU demand) to infect an 85 year old than it is to infect a 30 year old.

We should have had the college kids remain at college, and sweat this out in their dorm room.

Could be. Care home evidence is hard to check as mortality is super high anyway - https://academic.oup.com/ageing/article/42/2/209/27127 - "Results: a total of 2,558 (26.2%) care home and 11,602 (3.3%) community residents died within 1 year. The age and sex standardised mortality ratio for nursing homes was 419 (95% CI: 396–442) and for residential homes was 284 (266–302)."

There were some reports today that in Scotland, care home deaths were 1/4 of recorded Covid19 related deaths. Since care home residents only make up 16% at most even of the comparable age groups, that's quite something.

My pet hypothesis is that it takes a very small viral load to set up an infection in those who are susceptible and thankfully, very few are susceptible. So, what happened is that social distancing was not nearly severe enough to do much. The people who could get it, got it. Ones, who because of weak immune systems or the bad luck to be a suitable receptor got noticeably and sometimes severely ill.

Here in MA, we are in our 5th week of socially isolating and given the incubation times and disease progression, deaths should have dropped to near zero by the end of week three. My hypothesis fits the fact pattern better than the idea that social distancing does very much.

Yes. 113 deaths today (or yesterday, but reported today) in MA, for a total of 957, which means an increase of the number of deaths of 13%.

Here in MA, we are in our 5th week of socially isolating and given the incubation times and disease progression, deaths should have dropped to near zero by the end of week three.

Median lapse of time between infection and symptoms is 5 days. Median lapse of time between illness onset and death is 18 days. The stay-at-home advisory was issued in Massachusetts on 24 March. Twenty-three days later would be 16 April.

Despite the Governor's orders, everybody was locked down since the point at which Trump declared a national emergency. I've (and everyone I know) been working from home since the 14th, some people plus or minus a day or two.

Yes, it is quite possible, as something like this happens for many other infectious diseases.

In this case, the first 50% will probably not carry the antibodies
even if they have been attacked by the Coronavirus, so they will be completely undetected by our tests, but for all practical purposes, they are in the same group as people who have been infected and have recovered.

This was an answer to dbp above.

To Phinton, I meant. Sorry.

How about the explanation that people have taken it upon themselves to social distance, without any government order? Consistent with your other comments on "social choice." The Google mobility data supports this theory: https://www.gstatic.com/covid19/mobility/2020-04-05_SE_Mobility_Report_en.pdf. Correlating this mobility data with new case data across countries might help identify the R0 heterogeneity among different activities, so that we may intelligently relax lock downs.

+1 People take it upon themselves and social signaling. One aspect of government regulation, though, is to avoid someone holding large parties and destroying your effort to reduce the neighborhood risks by increasing with their actions.

Coordination problem and incentive to defect if others defect.

Compare Austin South by Southwest to New Orleans Mardi Gras.

People are still holding parties in Seattle where I live. Nothing huge, just 6-10 people gathering in apartments for drinks quietly. The curve is still flat regardless.

And that proves (1) everyone is holding parties, (2) parties or assembly of more than 10 persons should be regulated, but not less than 10 or (3) this is not representive across a large population.

I went out and talked to a neighbor today within 5 feet of him. And, went to a store to buy groceries two days ago. That proves....

I would be more impressed had you shown Google social mobility data pre and post.

I didn't realize how easy it was to find Google mobility data for Seattle:

"Seattle-area residents are taking Washington state’s social distancing mandate seriously. They have dramatically reduced trips to work, retail and restaurants, and transit stations, according to Google data. But Seattleites love their parks and that doesn’t appear to be changing.

Google’s new COVID-19 Mobility Reports provide county-level data on how people are moving around. Google customers who have opted in to sharing their location history with the tech giant provide the underlying data. The mobility report compares trends for the past few days with a baseline, measured by the median value for the corresponding day of the week from Jan. 3 – Feb. 6." Here is the link:https://www.geekwire.com/2020/google-location-data-seattle-shows-decline-work-transit-retail-trips-not-park-visits/

That is my hypothesis as well. Could it be that government edicts are not an essential part of social distancing? Perhaps firms and organizations are capable of evolving distancing regimes that work effectively without dictates from the state? Maybe the existence of externalities doesn't dominate the advantages of allowing spontaneous solutions in this case much more than they do in other circumstances where we ignore them, e.g. allowing firms to set their own prices.

Just a hypothesis! :)

Right. For example, movie theaters are not officially closed in Sweden, but total box office in Sweden had dropped to $18,000 by the weekend of March 20. Most chains shut themselves down. The one chain that stayed open forecast on April 1 that it would shut down in mid-April for lack of popular new movies to screen due to movie studios delaying releases.

It's because of herd immunity. They got through it relatively quickly, and are in a much better position to avoid a second wave than the other countries that imposed lockdowns and social distancing. All while not destroying their economy completely, which should result in fewer recession or economic depression-related illnesses and deaths. That's the big one that people like Tyler and Alex are not factoring in.

Exactly.
And which epidemiologist predicted it?
Many, and Prof. Knut Wittkowski: https://m.youtube.com/watch?v=lGC5sGdz4kg

You can't escape the virus. Herd immunity is the only way.

Very premature to say "they got through it"

Swedes do not kiss on the cheek when greeting. Unlike Spain, France, and Italy.

https://somethingswedish.wordpress.com/2013/08/22/meeting-and-greeting-in-sweden-handshake-hug-or-kisses/

Also supports my prior observation that cheek kissing is more acceptable as a greeting in New York than other parts of the US.

Interesting. Here's a test. Map of France by how many greeting kisses given:

https://cms.qz.com/wp-content/uploads/2019/10/kiss_chart.png?w=620&h=620&crop=1&strip=all&quality=75

Map of French virus cases:

https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_France#/media/File:COVID-19_Outbreak_Hospitalized_in_France_13_Regions_&_DomTom.svg

I don't see much of a pattern.

Number of kisses is probably not the issue. One is probably sufficient to transmit enough virus.

As another thought, it could be the cheek kissing makes it *especially* contagious because the virus can be transmitted not just to one person, but to everyone who subsequently kisses the cheek of the same person.

I.e. Patient 0 kisses Patient A and B and leaves a little virus on A and B's face. C and D kiss A, and subsequently E and F kiss B, causing the virus to be transmitted to the lips of C, D, E, and F. And so forth.
In a small group setting the virus can easily get directly onto the lips of every person in the room.

https://matadornetwork.com/abroad/8-ways-humiliate-sweden/

"4. Hug someone you’ve just met for the first time
A handshake is more than enough, so keep your physical interaction with strangers to a minimum. Hugs are for friends you have known for years and the cheek-kissing thing, well, let’s not even go there."

Swede here:

Swedens actual death figures are exploding. The reason you don't see that in this graph is that the figures are only registered days later, they often don't register deaths during weekends.

(Cases are useless, Sweden doesnt test)

Sweden, Norway and Denmark registered their first death within one day of each other. As of todays probably underetimated numbers:

Sweden: 1033 (per million 100)
Norway: 139 (per million 22)
Denmark: 299 (per million 52)

Never, under any circumstances, rely on Swedish numbers for that day, it takes 2 weeks for deaths to be registered and trickle in, use reported figures until that day, not those registered that day.

Yeah it's really hard to figure out their numbers. Good explanation here:

https://www.thelocal.se/20200414/understanding-swedens-figures-on-the-coronavirus

One of the authorities' objections to the letter by 22 Swedish scientists that their strategy has failed is that they cherry picked a midweek three day period when deaths from the previous weekend were bunched in.

Here is a graph where deaths have been matched to the actual day of death.

I don't see a clear explosion (but no turning down either).

https://adamaltmejd.se/covid/

Good graph. Based on that, Sweden is per capita adjusted for time far above Denmark, Norway and Finland, and not far from Italy at this point.

If Sweden is not exploding, one must argue Italy did not explode.

Tomorrow's report will be central. I don't see an "explosion" in the sense of continuing exponential growth. But the deaths are on a high level for sure.

And yes, Sweden is above Denmark, Norway, and Finland. A key question is whether they will succeed with long-run containment or not. If they do, Sweden will be much worse than them even in the long-run. If they will also go for herd immunity in the end, the relative deaths will be determined by the quality of protecting risk groups (especially nursing homes), and will have little to do with mortality at this stage, because they will have postponed the epidemic until later by their strong measures.

(Interestingly enough, the Norwegian CDC does not seem to believe in the suppression strategy of the Norwegian government, but rather think in terms of flatting the curve. From their latest report:

"Responsen mot epidemien må være dynamisk og om nødvendig geografisk variert med mål om å ha et sett av tiltak som holder epidemien innenfor helsetjenestens kapasitetsgrense, men uten noen nullvisjon for smittespredningen."

https://www.fhi.no/contentassets/c9e459cd7cc24991810a0d28d7803bd0/notat-om-risiko-og-respons-2020-04-05.pdf

)

A possibility is that outside of households this only spreads through mass events where people are in close quarters for a long time. Once large church services, parties, cruises, spectator sports, funerals etc. cease you're doing 90% of what is necessary and will see a result in deaths two weeks down the road. Sweden seems to have curtailed a lot more of this than you'd think from the headlines a few weeks ago. It's not workplace transmission, it's social gatherings.

https://www.theguardian.com/world/2020/apr/09/the-cluster-effect-how-social-gatherings-were-rocket-fuel-for-coronavirus

The way a lot of countries have handled it is to wait till just before mass death occurs, then do the above too late, then lurch into more destructive shutdowns when the death rate jumps and assume that's what flattened it. Of course none of this explains Tokyo subway commuters not getting sick. Maybe the masks really are that important.

As an adjunct to this Australia and NZ moved on lock downs at a very similar time, with NZ adopting far stricter measures (ie no food delivery services, all non essential retail banned, etc.). On a per capita basis, the impact of these harsher measures on incremental infections and deaths has been zero.

We don't have enough information yet to know if Australia would have benefited from from New Zealand type 1 restrictions early on, but we can say Australian restrictions are working in Australia. Personally, I would have gone for Australian restrictions + face masks. Whatever their disadvantages of basic cloth masks, I'm sure they don't outweigh the positives and we have a vast amount of manufacturing capacity in this area called grandmas.

I also would have introduced a host of things such as a small discount on supermarket items that are delivered instead of bought in store. Higher temperatures in supermarkets etc. Lots of public education on how to use face masks correctly and general information on avoiding infection. I'd also make the fines for not obeying restrictions small because we want people to believe they are taking precautions because they are good people and not because they are forced to. This will put us in a better position to deal with the next pandemic/emergency.

Garbage in, garbage out.

Presumably lock down strategies are part of a continuum. "Highest risk" individuals (ie those with most interactions or highest infection risk interactions - commonly known as super spreaders) are infected first. This suggests a negative observed R_0 over time. As awareness builds, public behaviour switches to biasing away from high risk actions (eg travel, unnecessary interactions) and toward better hand hygiene, staying home if sick, etc. Governments have supplemented this with varying forms of lock down, vulnerable shielding, etc.

All of these will have the effect of reducing observed R_0 over time, but there are too many confounding factors to undertake a proper country vs country comparison (cultural, timing of infection, etc.). Ultimately, true infection fatality rate is the holy grail for informing policy and only proper randomised testing will deliver this unless we wait until it is over to learn it.

Cowen wrote: (Even in Singapore the second wave has arrived, from in-migration, and may well be worse than the first.)"

Nothing much has happened in the data with Singapore.
The increase in Singapore's coronavirus cases:

March 14 to March 25: 10% increase a day
March 26 to April 8 : 7% increase a day
April 9 to April 14: 13% increase a day

There has been no "second wave" in Singapore and 10 people have died giving a mortality rate of 0.3%

https://www.sun-sentinel.com/coronavirus/fl-ne-dying-together-coronavirus-20200414-atv34aun7fhf7atucntor63jee-story.html#rt=chartbeat-flt

A decade ago, eight retirees with ties to New York City became fast friends over their love of poker, running into each other over and over in South Florida casinos. Before long, they started their own poker game in the card room of an Aventura condominium that became something of a ritual.

The players convened every Sunday to Thursday for raucous games over pots less than $100. Over the years, they traveled together on cruises and swapped stories about grandchildren. Harriet Molko, who sat at the table every week with her husband, Ronald Molko, said the group was, in many ways, a family.

They all played together for the last time on March 12. In a matter of weeks, coronavirus claimed the lives of three members of that poker family and debilitated the other five.

----
A measured parameter. Three days, three hours a day, four old people. The transmission will be fairly constant in the one room. How many millions of Yorkers had regular parties up to the pandemic outbreak?

Likely almost half did the equivalent of it.

This virus seems to be spread by Good Clean Fun: by people talking animatedly, laughing, singing, etc.

You cite a "new study" but it's just a blog entry on Medium written by yet another cryptocurrency blockchain tout.

+1
But that is par for the course here at MR during the pandemic.

TC is signal boosting. Which is hilarious, but sounds so much better than pushing a narrative.

NYC has "found" another 3800 deaths that are Coronavirus.

More garbage into the models.

Germany is doing triage at day 3 or 4 and taking action sooner. Their numbers look good

The docs at MedCram have been looking at old methods used during the 1918 pandemic that were abandoned after medicinal treatments were developed in later decades. There's fairly strong evidence that old-school hydrotherapy (essentially, sauna) are actually very effective in triggering a strong immune response in the early stages of viral infection. Those treated with hydrotherapy in 1918 were significantly less likely to develop pneumonia. If true, the answer to the question, "Why isn’t Sweden exploding?" may well be: the Scandinavian sauna.

Coronavirus Pandemic Update 46: Can Hot/Cold Therapy Boost Immunity?
https://www.youtube.com/watch?v=EFRwnhfWXxo
Coronavirus Pandemic Update 47: Searching for Immunity Boosters & Possible Lessons From Spanish Flu
https://www.youtube.com/watch?v=H1LHgyfPPQ8

His updates have been fantastic. I loved 34 and 35.

The Germans are finding that quarantine may have actually caused more harm that good in spreading the disease. https://www.youtube.com/watch?v=VP7La2bkOMo Basically spending a lot of time close to someone is the root of the spread.

That line of thinking is very much in line with basically every countries cases. Everyone who hunkered down with a sick person got sick too even if there were no symptoms. Every single country exploded when they locked down. Every single one. Sweden has been sporadic.

The German findings jibe with the known mass spread events. They always involve a bunch of people in close quarters for an extended time. Usually they are social, not commercial, the American meat packing plants being the exceptions that prove the rule because they are unusually close quarter jobs.

You wrote:

"I fully recognize it is possible and maybe even likely that Sweden ends up being like Japan, in the sense of having a period when things seem (relatively) fine and then discovering they are not."

This is a mischaracterization of how it has gone here in Japan.

Things were fine, and while they were fine the prime minister caved to hysterical public pressure to do more and declared an emergency, and now things remain fine, with barely more than 100 Covid-19 deaths nationwide.

Please see my 6-min video, "Japan's Coronavirus Emergency Declaration Was a Mistake" at:

https://youtu.be/dCIgrBqRGy8

Sweden is, however, doing considerably worse than its immediate peer Nordic neighbors. What this suggests to me is that there are some other factors that Sweden shares with its neighbors- whether things mentioned in your post like compliance with social distancing or low obesity, or other possible factors with at least moderate evidence such as weather (the virus likely performs best at a moderate temperature), genetic predisposition including blood types, air pollution, smoking rates, etc.

Note that this virus appears to be virulent enough that even if weather, for example, has a significant dampening on the exponent growth, that can still lead to an exponent over 1 and exponential growth rather than decay and suppression (unlike seasonal flu in the summer.) Hence places might be better than you expect based on behavior alone but still have uncontrolled outbreaks (similarly, Florida does not seem as bad as one might think).

Similarly, it's not the case that Japan has quite the exponential growth in cases that you would expect given their lack of social distancing so far; exponential to be sure, but not as high an exponent as one would think so the same question as Sweden would apply. Their weather would appear to be in the optimum range, so the likely explanation is a strong culture of mask wearing (they have had some distancing, like cancelling school, but not much.)

No countries have gotten an uncontrolled outbreak in control and into exponential decay without wearing masks (and they have been effective in Central and Eastern Europe, like in Czechia and Austria); Singapore in fact does not encourage masks and does not have universal mask wearing, the government being silly enough as to believe the WHO, and their recent failure thus only increases the likelihood that masks are an important element. At the same time, masks alone are not enough; it takes several protective factors (possibly including the luck of temperature) to get the exponential below one.

Sweden's fortune is thus due to the factors it shares with its neighbors, and the failings of its strategy is seen in how poorly it compares to them.

Anyone who believes the US based research suggesting that air pollution makes it worse must also believe that weather has an effect, or else it is mighty difficult to explain why Thai isn't worse off, especially with all the Chinese tourists they got including at the beginning of the outbreak.

That Lombardy graph and the subsequent conclusions seem pretty fishy to me. Here's why:
* For the first week or so, there are only a handful of deaths a day (1, 1, 4, 3, 0, 5, 3,), making the initial growth rates very noisy. The first few data points are important to giving the impression of a negative slope, so this is especially problematic.
* The author assumes a median of 24 days from infection to death. That assumes a median six day incubation period and 18 days to death after the incubation period. Then he asserts a minimum of 20 days until death. I have no data or expertise here, but it seems implausible to me that the distribution would have so a tight variance that one could assume near zero deaths would occur before 20 days when the median is 24 days.

If one ignores the first few data points, I think you can see a relatively flat growth rate until sometime between 3/8 and 3/15, which is about when you’d expect to see the effects of lockdown starting assuming a reasonable variance on time to death from infection.

(To get the raw death numbers, I’m looking at the data provided on the IMHE model site. Except for the first two days, 3/22-3/23, the data is consistent with the graph. For 3/22-3/23 the IMHE data shows zero deaths, and for 3/24 it shows 6. I inferred that the graph assumed 1, 1, and 4 deaths for 3/22-3/24.)

The IHME model that the White House relies on projects 18,000 Swedish deaths by August 4.

That’s 18,000 deaths in a country of 10 million.

By comparison, this exceeds the projections for France with 60 million and Spain with 40 million.

I don't see how Sweden gets to 18,000 deaths by August 4 when there have so far been 1,000 deaths and the increase in cases per day is at 4% while the increase in deaths per day is 6%. Those are down from 7% and 16% from a week ago.

Tyler mentioned how little obesity there is in Sweden, 15% of adults, but that isn't too much lower than Italy where 21% of adults are obese, about the same as Germany.

Of course South Korea has also not locked down and although intially was hit hard, things are improving steadily without it. We will look back in 5 years and kick ourselves...

We will look back in 5 years and kick ourselves ... for not using the WHO test.

Sweden testing has been at 54,700 for the last week. No testing no cases. I have been watching it daily.

Wow, so we crippled the economy for nothing

Fuck

People are going to twist into a the craziest pretzel in order to protect their egos on this deal

Maybe Sweden is not really different. Just different testing and reporting strategy: https://www.independent.co.uk/news/world/europe/sweden-coronavirus-lockdown-doctor-death-certificates-latest-a9462796.html

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