Sweden fact of the day

Cases in the Nordic country have declined sharply over the past few days and on Tuesday only 283 new cases were recorded.

That contrasts with a torrid month of June when daily numbers ran as high as 1,800, eclipsing rates across much of Europe, even as deaths and hospitalisations continued to decline from peaks in April.

At the same time:

…weekly numbers for tests have more than doubled since late May, putting the country in the same bracket as extensively testing nations such as Germany.

Here is the full article.  Who again has the best model of this?  Anyone?  How about no one?  Here is a NYT piece on Sweden, dated July 7, it doesn’t even mention any of this.

Here is the steadily declining Swedish death rate.  No need to point out that Denmark and Norway, with their early and swift responses, did much better yet.  I am interested in what is the best way to model why Sweden is not doing much worse.

Comments

One of the fascinating aspects of this disease is the way increased information translates to reduced certainty.

Maybe better put, the uninformed certainty falls apart. There never was any certainty, simply possibilities.

Could it be that the virus that is spreading right now is not the same as was spreading two months ago?

"Could it be that the virus that is spreading right now is not the same as was spreading two months ago?"

Yes. It is also possible it is the same virus, but with additional information. Better information. Better data.

In the US? If you mean mutation, the one spreading in the US came from Europe rather than the first cases which was the original one from China.

https://www.scripps.edu/news-and-events/press-room/2020/20200612-choe-farzan-coronavirus-spike-mutation.html

Has anybody yet calculated the Disability-Adjusted Life Years lost per average death in Sweden?

Fatal traffic accidents tend to cost, say, 30 or 40 years of Quality-Adjusted Life Years per death. What's the number per CV death in Sweden?

Nextstrain.org tracks the virus by mutation (as well as several other viruses). If you peruse their pretty beautiful charts you can see how the virus has developed into many strains over time.

The two major divisions are the original virus from China and the virus that developed in Italy. The Italy strain has more 'spikes' and they are more stable making them better at infecting people.

https://nextstrain.org/ncov/europe?f_region=Europe

Am confused by Tyler’s confusion.

Social distancing in Sweden decreased reproductive value of virus below 1, thus the virus cases will exponentially fall.

Looking at case numbers, as a raw number, gives an incomplete view. Testing % positive, or the positive test rate, is a better indicator. Though of course not ideal.

All of the data you discuss are entirely in line with expectations.

What I find exhausting is that this was explained in your comments section weeks and months ago. By myself and others.

Forget it, Bob - it's Tylertown...

“Social distancing in Sweden decreased reproductive value of virus below 1, thus the virus cases will exponentially fall.“

That’s your “Model?” Just a blanket conclusory statement? Forgive my suspicion, but how exactly do you have such clear insight to Sweden’s social distancing practices to begin with?

Perhaps more concerning is how you make no mention of the very different levels of health the average Swede ( (less Relevant comorbidities) deals with than say the average American or living the differences in living arrangements.

>> Forgive my suspicion, but how exactly do you have such clear insight to Sweden’s social distancing practices to begin with?

Covid data provides all the information on social distancing you need. With a time lag, of course :)

Pretty much, which is why Sweden looks like a typical Western European country in that regard. There is a link below to a 14 minute video from Johan Carlson, Director General of the Public Health Agency of Sweden explaining it,

The 'in English, with English subtitles' seems to be missing.

Yep, there was the question of whether voluntary and even natural social distancing and traditional mitigation measures would work close to as well in Sweden to drop R0, as "lockdowns".

They of course seem to have done, and would have done anywhere within Western Europe or the USA (contrary to the claims of those that thought only compulsory shelter in place orders worked, perhaps because of the USA's unique culture or somesuch, that meant the recalcitrant deplorable Trump voting hordes and so on had to be coerced by their betters).

Kudos if you called this one back as early as April; I can't remember exactly where I was on that. Probably there by late April, but not 100% sure on that.

I expect that we'll see a similar effect from voluntary and natural social distancing in the states of the US that currently seem to be peaking, and that as we see elsewhere, reduction in R0 will chime with when public become aware of large numbers of cases (largely a function of effective media and testing data) and change behaviour, and not really match up with when any shutdown orders are reimposed.

I agree that natural social distancing measures were enough in Sweden and perhaps other parts of Europe, but clearly they were not so in the USA, as our case count never got down to low levels like Europe’s and is now spiking back up again. In my area new daily cases are now higher than their record during the lockdown period and even though there has been no new lockdown, a couple of restaurants closed permanently this week as the spiking virus cases (mostly caused by young people bringing it back from vacations in hotspots) make people afraid to go out. It is very frustrating because it feels like the lockdowns were all for nothing and now we are getting both the economic damage, the political damage, and the health damage.

And it is very regional. While blue states made significant policy errors like around nursing homes that red states did not, blue areas (at least the professional-class blue areas) also had significantly higher voluntary compliance with masking and social distancing, signifying more European levels of cultural capital.

That may be the narrative but it’s completely wrong.

California is exploding in cases, as is Washington state.

That the “lockdowns” were bottom up phenomena, and not ordered from on high, was observed in March, not April.

As for “calling it,” the question is about the model, not necessarily predictions. If-then statements, etc.

>this was explained in your comments section weeks and months ago.

As I explained yesterday, there is nothing Tyler hates more than being taught something new.

Sweden's unremarkable all-cause mortality for the year also needs modeled --> https://softwaredevelopmentperestroika.wordpress.com/2020/07/07/guest-blogger-haraldofw-all-you-ever-wanted-to-know-about-corona-sweden/.

'why Sweden is not doing much worse'

Deaths per million -
Sweden - 539 (more than France or the Netherlands, and only 10% less than Italy's 577)
Norway - 46
Denmark - 105
Finland - 59

It takes a special kind of economist to consider a difference of 5x or 10x than peer nations as not doing much worse at this point in the pandemic. On the plus side of the ledger, always nice to have further confirmation how utterly worthless the NYT remains.

What did Denmark do that was 2X worse than Norway in terms of deaths per million?

What did New York do that was 17X worse than Texas in terms of deaths per million?

Be less isolated than Norway comes to mind, as Denmark shares a major border with a country with an equally high death rate and rate of infection.

It seems a bit early to make a NYC/Texas comparison, at least until the rise in new Texas cases is clearly over.

Texas isn't through yet. You can't draw conclusions until then.

And Norway, Denmark, and Finland are "through"? I'm not sure anyone is "through" yet, which is precisely what Sweden's approach acknowledges.

Well, Norway, Denmark, Sweden and Finland are all clearly finished with their first pandemic wave. One could reasonably say the same thing about NYC.

Texas, on the other hand, hasn't even reached the peak of its first wave yet. And the better comparison would be to Houston and NYC, or NY and Texas.

Hardly. Norway, Denmark and Finland have not had a first pandemic wave, just like Texas and California have not yet had a first pandemic wave. All of the latter have simply had ripples, which means their populations are completely exposed to the yet to come first wave (unless they achieve absolute containment, of course).

Guess we need to define first wave. My definition would be a sustained difference between peak and trough that is at least 10x (more like 20x, 30x or even 100x), using new cases.

Finland - 267 on April 4, yesterday 5
Denmark - 390 on April 7, 10 (Denmark's case numbers are a bit weird)
Norway - 399 on March 27, 11
Sweden is a bit later on its curve - 1806 on June 24, 57 yesterday (though like with Denmark, yesterday's number looks a bit off)

You are welcome to say that all three had waves more like a ripple if you wish, but all three countries have case rates in a pattern that ends with Denmark fully comparable to Germany's 2,368.
Finland - 1,311
Norway - 1,650
Denmark - 2,227

The above comment is an example of lack of perspective.

What if the numbers were 54, 5, 11, and 6? Same relative performance, right? In any case, it is 539 per million, or 0.0539% of the population- a number, by the way that is less than 10% of the number of Swedes who have died this year from all other causes.

And, finally, I will point out once again- the virus is still out there in Denmark, Norway, and Finland, just waiting for them to behave the exact same way Sweden has done from the start.

This video from July 2 makes its fairly plain that it is now Sweden acting like Denmark, Norway, and Finland.

www.folkhalsomyndigheten.se/the-public-health-agency-of-sweden/communicable-disease-control/covid-19--the-swedish-strategy/

In the film below Johan Carlson, Director General of the Public Health Agency of Sweden, talks about how Sweden has adapted society and implemented social distancing to minimise the spread of the new coronavirus. The film is introduced by Lena Hallengren, Minister for Health and Social Affairs.

Right, Sweden has 40% more deaths than the US, and we are clearly one of worst at handling this thing. I don't get the debate here.

Because
1. Sweden is much closer to herd immunity (Over 25% of people in Stockholm.
2. Because Sweden's minimised the economic and social impact

Tegnell expected 40% by the end of May. So sure, Sweden may be closer to herd immunity, but its epidemiologists have proven to be quite inaccurate also.

And in reply to Jan, Sweden in no way has 40% more deaths than the U.S. -
Sweden deaths per million - 539
America's - 405

No one got it right but Sweden has not done badly at all and a modified Swedish model is probably the only one that can work if a vaccine is not imminent.

Precisely right, and the modified Swedish model is likely to look pretty much like most of Western Europe's.

Effective social distancing is the key, regardless of how it is achieved. The part that is a bit less clear is how to respond to local clusters. Local lockdowns may be the best answer there, as seen now that Gütersloh is no longer under lockdown after a major cluster at a local meat packing plant (larger than what is currently happening Melbourne). There is basically no evidence of community spread apart from the employees at that plant, meaning that a 2 week lockdown in combination with broad testing, extensive contact tracing and isolation/quarantine is effective.

No if a vaccine is not imminent we should ony be social distancing from the vulnerable. Everyone else should be going about their daily life and exposing themsleves to it.

"1. Sweden is much closer to herd immunity (Over 25% of people in Stockholm."

Is this true? The U.S. is probably around 10% nationwide, with over 25% of people in NYC.

25% in Stockholm is a defensible number, though on the higher end based on Swedish antibody studies.

Here's a better chart of deaths over time in Sweden, by date of death rather than date the death gets reported: https://adamaltmejd.se/covid/

Bizarre TC post. Sweden is in fact a basket case, a certified failure by any metric (deaths per million, cases per capita, etc etc etc)

See more here: https://www.thestreet.com/mishtalk/economics/swedens-covid-experiment-is-now-a-certified-failure

("Sweden's Covid Experiment is Now a Certified Failure" - written 7/8/2020)

Covid-19 deaths per million people in Sweden, rolling seven day average, is about the same as in the USA.

Alarming lack of perspective by pro-Sweden admirers.

19 deaths per million. Per million... With cases leveling and even falling. The "failure" is not grasping this most important metric and instead comparing it to others.

@Patrick - Read the below. Do you want to catch this? I don't think so...
7/8/20- MarketWatch- "On a Facebook Live event, Fauci said the lower death rate is a reflection of an improvement in treatments, especially for patients with more severe forms of the disease, and the uptick in cases involving younger people. But young people can have horrifying symptoms and suffer long-term effects.
A group of U.K. neurologists on Wednesday published details of more than 40 COVID-19 patients who suffered complications from the illness that included brain damage, including brain inflammation, delirium/psychosis and stroke.
Other recovered COVID-19 patients have been left with symptoms including breathlessness, fatigue, numbness, a loss of taste and smell, memory problems and even paranoia".

We’re months into this now, do we have any actual figures on ‘young people can have horrifying symptoms and suffer long-term effects’. Millions of young people have been infected, are there hundreds of thousands of them so suffering? I have seen only anecdotal reports.

The previous excitement over young children experiencing some kind of severe reaction disappeared with cases in the tens. So far I am not seeing anything to make me thing the young people with horrifying symptoms won’t end up the same way.

Lars Christensen (the market monetarist) did appear to predict this

He said John Cochranes SIR model is a good one to explain what is going on.

Also, maybe Alex Berenson? He didn't model anything but seemed to correctly predict that much of the reporting is quite wrong.

Yeah, Lars has been sticking to his guns on Twitter. Quite the contrarian. We'll see how it all comes out.

Sweden has less deaths per capita than Italy, Spain, etc. It is now rapidly declining. It suffered no lock-down, no privation of freedom. It is a great success, and the model TC is looking for is "herd immunity". How can you guys can be so ideologically blinded?

If you like being compared to Italy or Spain. But compared to France, Sweden did worse - deaths per million in France are 459, while in Sweden the figure is 539. Making the difference between France and Sweden twice as great as the difference between Sweden and Italy at 577.

The Swedish model was basically a dud, measured be its own standards. It has not till now matched Tegnell's forecasts in terms of projected infection rates, and one assumes that he did not intend to have Sweden end up with a higher death rate than France.

Tegnell did not "intend" any death rates or "herd immunity" at all. He simply did what was in line with and constrained by Swedish law and by science, rather than attempt to get politicians to remake the law on the back of the aim of achieving shutdowns which were of dubious scientific merit and benefit then in reducing the spread of the infection, and which still are.

And again of course, the calculation of "Any higher death rate from covid means Sweden 'did worse'" is the absolute nadir of reductive stupidity on this topic. What we want to really know is many other, more sophisticated questions, such as ("Economic Cost In Lost Growth and GDP"/"Years Lost From Excess All Cause Mortality At 2020 End"), the loss of QALYs from people being locked in homes more than they would prefer against loss of QALYs from excess death, etc. Was extra loss of GDP and extra increase of debt from lockdown polices really worth the lives saved? Was extra loss of people's life experiences for those months from lockdown really worth the life experiences that were saved?

Nothing was said about herd immunity, which is a red herring when talking about Tegnell anyways.

'is the absolute nadir of reductive stupidity on this topic' Tell that to Tegnell -
Now he has told Swedish public radio: "If we were to encounter the same disease again, knowing exactly what we know about it today, I think we would settle on doing something in between what Sweden did and what the rest of the world has done."

When asked if too many people had died too soon, Dr Tegnell said, "Yes, absolutely."

Sometimes, one could get the impression that no one actually pays attention to what Tegnell says.

'Was extra loss of GDP and extra increase of debt from lockdown polices really worth the lives saved?'
The Danes would say yes, since the current EU economic forecasts show that there is no difference between the two peer countries - Sweden -5.3 and Denmark -5.2. The forecast for 2021 is obviously less certain, but it seems as if the Danes are unlikely to complain there either, with 4.3 growth compared to Sweden's 3.1. Comparisons between countries will always be imperfect, but Sweden and Denmark are much, much more comparable than between Greece and the UK, or Poland and Portugal.

More moronic prior approval comments; cherry picking Denmark as comparison country, supposing lockdown and not timing of interventions only difference. Dumb partisan comments.

You are suggesting that Denmark and Sweden are not similar Scandinavian countries? Seriously?

Skål

What's infuriating about the Sweden-bashers is that, somehow, Sweden has only 3 "peer countries"; Denmark, Norway, and Finland, but that no other Western European country is. Will they respond that Czechia, Austria, Portugal and Germany, are "peer countries" but Belgium, Netherlands, Italy, Spain and the UK are not? The comparison is unquestionably cherry-picking.

People politely leave out Iceland, because those are the four true Scandinavian countries. And obviously, Iceland as an island fits into a significantly different category than the other three in terms of how it handled the pandemic. However, the Icelanders Norwegians, Danes, and Swedes consider themselves to be similar in an even tighter fashion than Germany and Austria consider themselves to be 'peers' (obviously, Germany is much bigger since the end of WWI). Another example of peer countries would be Czechia and Slovakia (with the ever superior Czechs a bit insulted at the very idea).

Further, the Danes and Germans are almost identical in cases and deaths, yet no one suggests they are peers the way they suggest it about Denmark and Sweden. Likely because Germany and Denmark basically share no language, history, or many cultural similarities. A statement that does not apply to Sweden and Denmark.

Maybe it would help to stop thinking everyone talking about Sweden is bashing it? Otherwise, you end up with Tegnell being a Swedish model basher, in light of how he has said that Sweden could have done better, particularly in preventing deaths.

We will all know in a couple of years how Sweden stacks up.

I'm not sure the virus cares which countries have cultural similarities, and the expectation that countries with cultural similarities *should* have similar outcomes in respect of deaths from a pathogen seems a stretch.

I agree that the virus is uninterested in politics, but with so many people endlessly pointing out all the differences between country A and country B, having two countries that share similar cultures, genetics, climates, health cares systems, economic systems and so on is useful (I'm sure you could come up with a few similarities easily - drinking culture and diet, education, etc.)

The Swedish model is long term - let's compare Denmark and Sweden in a year, as they do make a fairly close pair with fewer differences than most European countries. Notice I am making no predictions, mainly because I prefer to see what the facts are.

And if there is an effective vaccine in 5 months, that is certainly not a reason to disparage the Swedish model. They had a strategy, and nobody knows what the future will be when facing a previously unknown pandemic virus. You handle a pandemic with the strategy you have, not the one you develop with 20/20 hindsight. And the Swedes got the single most important point completely right from the start - do not let your health system get overwhelmed.

Why is herd immunity a red herring? I would say on the contrary, the unknown herd immunity number is one of the few reasons to think Sweden did well. Since it's unknown, we don't know whether Sweden did well or if they didn't. We also don't know when the vaccine will be available which will create herd immunity. We also don't know how well Sweden's GDP will do on a cumulative basis between now and when the vaccine is available.

It is summertime. Everyone in Sweden is outside and enjoying 18 hours of sunshine and vitamin D. What if it really is that simple?

Isn't it weird that every place where vitamin D levels are improving (Canada, Sweden, Northern Europe) is seeing lighter than expected outbreaks, while every place where they're getting worse (Argentina, South Africa, Southern Australia) is seeing big outbreaks?

The evidence that vitamin D helps is a lot stronger than the evidence that cloth masks help:

https://shotwell.ca/posts/masks_and_vitamin_d/

Thanks, that was a good link.

Sorry, Tyler. I'm laughing at your ignorance and confusion. You have written hundreds of posts about the virus, the disease, and the pandemic around the world. Your posts, however, are just a random collection of random ideas and very preliminary conclusions from self-appointed experts claiming to be searching for knowledge, although most struggling for a new social position.

Yes, the supply side of the "knowledge" industry that is supposed to meet the demands of all of us struggling to adjust to the "false alarm" of an existential threat is failing us. You are still pretending to intermediate as a filter of relevant and reliable knowledge (the mass and social media platforms are full of fake and failed intermediaries, but you are a survivor). But any filter is condemned to fail because there are too much noise and no skill to model adjustment and adaptation at the global level.

I'd say that we have been looking for ideas and models where the lamp is because all over the world politicians and bureaucrats as decisionmakers are struggling to survive and willing to pay to too much to the few that may come with a "vaccine" --it doesn't matter if a real or a fake one, what matters is one that they can sell to keep their positions (as Gordon Tullock had said, the default solution to keep power is Xi's, but I'd add that today it's not reliable). Indeed, long ago we learned that adjustment and adaptation rarely are expeditious processes at the local level, and never at larger ones (I still recommend starting with Sowell's Knowledge and Decisions).

Do you have an answer to the question?

"You have written hundreds of posts about the virus, the disease, and the pandemic around the world. "

I doubt this

On whether all the Emergent Ventures/Fast Grants PR counts.

I know we do not have real time GDP data, but why do we never see ANY kind of mention of relative economic performance in these comparisons.

April 2016 Swedish authorities issued my mother a driver license that would have expired when she was 103 years of age. Asking about the wisdom of such thing, I was told that in Sweden the Swedes were supposed to know when they were fit to drive or not.
That goes for coronavirus too

Who will pay the most and for the longest the economic costs of the lockdown? The younger.
Who are at most risk because of coronavirus/COVID19? The older
Is this adequately reflected in current policies around the world? NO!

If at the end of the day Sweden took the right approach handling the pandemic, you can bet that the evidence of that will not be allowed to surface.

I love how being a lefty these days means that you have to rip Sweden!

Sweden had a strategy, they followed it, and it turns out to be in no way better than Denmark's in terms of economic performance.

The Swedish health authorities are fully open about how they could have done better, which makes sense, since only over 7% of Swedes have been infected according to antibody tests. They know that their strategy to have a larger percentage of the population infected by this point did not work out as planned till now, and are already working on taking that into account for how they will continue to deal with a pandemic that is not even a year old.

Probably because the Swedish health authorities will do anything to keep Trump from being elected.

Better management of the virus at nursing home (e.g. frequent testing of staff and isolating infected), would likely have cut Sweden's total death toll from coronavirus in half. That is the mistake they acknowledged. The rest of the strategy, as far as I'm aware, they're not apologizing for.

They also freely acknowledge their milestones concerning infection rates were mistaken too. Around 7% total, and maybe 25% in Stockholm around mid-June, where the Stockholm rate was expected to be at 40% by the end of May. And they further acknowledge they needed to learn how to do social distancing better than at first.

The Swedes are taking a long term approach, and we will be better able to judge in a year or two. Why they have any need to apologize escapes me completely, to be honest.

Which is fascinating because it is the single most salient thread that binds all of the western world - if only old folks homes had been better managed, casualties would be far lower.

Except your wrong Sweden has done better economically than it's neighbours so far and is forecast too as well:

https://fee.org/articles/sweden-sees-economic-growth-in-1st-quarter-despite-global-pandemic/

An article from May 30 looking back at the first quarter is not exactly all that up to date nor relevant.

Here is a Danish source from July 7th (you can decide whether they play up being second, or being better than third) - "Denmark’s economy is forecast to be the second best performer as the EU emerges from the Coronavirus Crisis, according to the European Commission.

The commission’s Summer 2020 Economic Forecast released on Tuesday said that the economy will contract by 5.2 percent this year but rise by 4.3 percent in 2021.

This puts the Scandinavian nation in second place among EU members, next only to Poland whose GDP is forecast to shrink by 4.6 percent in 2020 and increase by 4.3 percent next year.

Sweden third place
The decrease of 5.2 percent of GDP means Denmark will face its largest economic decline since the 2008 global financial crisis when the economy was down 4.9 percent, according to TV2.

Yet Denmark fares slightly better than its neighbour, Sweden, whose economy is forecast to be the third best performer in the EU. The commission said that the Swedish economy will contract by 5.3 percent this year and grow by 3.1 percent next year." cphpost.dk/?p=115843

The may article is more relevant than a forecast as it shows what actually has occurred.

Do the forecasts take into account the long term impact on society of literally all of its young children missing critical early school years, not to mention the effects on development that isolation from other children may have at early stages of development?

Sticking just with Denmark, they had a 6 week or so school pause (older students a bit longer). Does not seem all that tragic in any sense, unless you have a problem with a typical 6 week summer break too.

And it is very likely that the Danes were watching the Swedes very carefully before making their decision. Most countries do not have the hysterical overreaction that seems to be an integral part of all these crazy, overwhelmingly American, discussions. I certainly think that any normal country will be having an essentially normal school year next fall.

Swedes are conformist as compared to, say, Americans; it's the heterogeneity in America (I can't resist). In America, everything is political, even mask-wearing and social distancing. Here's a very good summary of the different studies of America's descent into partisanship and polarization: https://www.nytimes.com/2020/07/08/opinion/trump-politics-psychology.html The convergence of culture, race, and religion, three things that separately are trouble but when combined are toxic. The "good" news is that it's not about ideology (one can be both libertarian and authoritarian without suffering a mental breakdown). Much of this is based on the moral foundations theory popularized by Cowen's friend Jonathan Haidt, but the findings of studies not so based have coalesced around it. Again, it's culture, race, and religion, the three pillars of human conflict and misery.

By the way, Gunnar Myrdal was a Swede. It's no coincidence that he wrote An American Dilemma.

I don't know about Sweden, but in Denmark maskwearing is non-existent precisely because it's so conformist.

Waiting for Tyler and other geniuses to realize that no one knows anything about anything and that no amount of sifting through garbage data is going to help them figure out how the world works.

Maybe somebody should gin up some data on UVC lamps per capita. Since transmission is primarily indoors, the money spent on testing would probably have a greater impact financing production of these virus destroyers, especially ion Northern latitudes where windows are going start being shut and the prophylaxis of good outdoor air circulation is lost. Far-UVC lamps are demonstrated safe to humans and just as effective at destroying the virus. With support, a program for mass production of far-UVC lamps could be up and running and able to put a lamp in every home before winter sets in at a per unit cost far cheaper than tests. Of course the lamps would protect people confined to air conditioned space as well.

Don't conflate official policy with the actions of actual people. Perhaps Swedes, seeing disaster in the making and not being total fools, simply began to act in ways that better protected themselves.
Specific human interactions change the spread rate, official policy is unknown to the virus.

Congrats to Sweden. This suggests that voluntary social distancing and mask wearing is effective at getting the virus to controllable levels—if people do it. The problem is that when significant segments of society do not do it or stop doing it, as we are seeing in the US, it does not work and the virus continues to explode, with all the disruptions to normal life that entails.

I agree with you. If we all drive safely, the probability of a crash is much lower than driving recklessly. Now, the relevant question is how we respond to the cost of driving recklessly (research on this question can be found in law&econ textbooks and journals). And then, ask yourself how most people would respond if they were told that the rules and standards to drive safely had been wrong.

BTW, I live in Chile and I follow the news from the 10 countries where I used to live or work (including China and HK), and I still read about people that don't comply with rules and don't take warnings seriously. Before you compare a large country like the U.S. with other countries (in particular much smaller countries), please look at their records of law compliance and government willingness and ability to recourse to force. In addition, I have been following the U.S. (I lived there 15 years of my last 55 years) long enough to know about the increasing differences in those records within the U.S.

If we don't get a vaccine soon then the Swedish approach is FAR superior to ALL others, including Denmark and Norway.

Consider

1. Somewhere between 20-30% of Swedes in the stockholm have antibodies so herd immunity at least in the capital is achievable

2. It's economy has and is performing better than it's locked down neighbours. This will likely continue for logical reasons

3. Lockdown is not sustainable and there is no exit strategy for countries that can't eliminate the virus entirely. And those that can eliminate the virus domestically have to lockdown the borders.

See the link above. The Danes are not exactly shy about beating Sweden in this regard.

As to 'and there is no exit strategy for countries that can't eliminate the virus entirely,' also see above.

what link? as I said, if there is no vaccine then a country has two choices manage your way to herd immunity or permnent low level lockdown.

This is perhaps what is most infuriating. This virus has many unknowns. However, the one thing we know with a fairly high degree of certainty is that there will be no effective and widely deployed vaccine *soon* (if at all).

And worse, there is some unfortunate evidence that immunity after infection may be short lived. We will know more in the future.

"If we don't get a vaccine soon then the Swedish approach is FAR superior to ALL others, including Denmark and Norway."

I think this it True, but it is fundamentally a hypothetical, that assumes no quick vaccine and that we have further waves of Covid19. Absent those two conditions, the Swedish approach appears to be worse.

I'm not critical of Sweden here, they tried something different. But It probably didn't work in their favor.

True but it is logical that where lockdowns are relaxed, temperature conditions are suitable, and where there is no herd immunity the virus returns. This also seems to be happening

I actually wrote about the Swedish conondrum a month ago on our blog. Unfortunately, it's in Danish, but other people may be able to read the table in the blog post: http://punditokraterne.dk/2020/06/08/nedlukningen-ingen-effekt-2/
The basic take-away from estimating weekly deaths in Southern Sweden and parts of Denmark - the entire country (DK), the eastern parts with Copenhagen (SH) and the Western half (JF) - the last three years with week, year and region fixed effects is that the Danish lockdown (in Danish: Nedlukning) is associated with_more_deaths. You might argue that Southern Sweden is not representative of the entire country, which is of course isn't. But the whole point of the exercise was to assess the effects of the Danish lockdown relative to part of Sweden that is geographically, culturally and historically most similar to Denmark. And the results certainly do not support a story of great and effective policy-making in Denmark,

Interesting, seeing as how Denmark and Germany are almost identical in terms of death and infection rates.

Luck obviously plays a role.

"Luck obviously plays a role."

+1, people continue to ignore that

Here are a few hypotheses.

1) What if herd immunity actually happens after a low percentage of the population has antibodies, like 25 to 50%?

2) What if private citizens take personal responsibility for social distancing, mask wearing, hand washing, or whatever actually reduces R, regardless of government policies?

3) What if we have learned how to reduce the death rate with better techniques in hospitals?

Sometimes when data is difficult to understand, there is more than one cause of the thing you are trying to predict. There is usually a Pareto of causes. If the Pareto is rather flat, then you need to understand multiple causes.

In the case of Covid, many countries have R near 1. The difference between 0.8, 1.0, and 1.2 is small but it multiplies the number of cases.

In 5 years, after many papers are written, we will understand half of the things that can move R by 0.2.

We already know about social distancing, masks, and outdoor vs indoor. We may learn about vitamin D, ambient temperature and humidity, aerosols, gut bacteria, diet, and other factors.

Other good posts here have mentioned vitamin D, Jason Y on nursing homes and nosocomial transmission, very different tendencies to give or receive Covid with some super spreaders and other vulnerable people, and Scott Sumner’s observation that actual behaviors are similar in similar countries.

We might expect to discover 10 or more factors that can move R by 0.2.

*many* of those most likely to die from covid have correlated infection probabilities, e.g., nursing home populations and those who are sick and receiving treatment at hospitals

there will be a spike(s) in deaths as covid enters and works its way through those sub-graphs of the social graph. those spikes will be large and happen quickly because their infections are correlated. if you read the article, again over half of the deaths occurred in nursing homes/at-home care. how many occurred among those seeking treatment at hospitals? we'll never know, but i bet nosocomial infections account for ~25-50% of the non-nursing home deaths.

as those populations are harvested, death rates will fall. they won't drop to zero because there are high risk individuals scattered throughout the social graph, but they will fall as individuals mitigate their risk and Reff drops.

fatality rates conditional on age and comorbidities are more or less the same everywhere. what differs regionally is: a) the age distribution; b) the prevalence of comorbidities; c) the probability an outbreak has occurred within nursing homes and hospital patient/staff pops due to policy differences and randomness.

most everything else is the equivalent of a rounding error. that's deliberate overstatement, but it isn't far off. i said this in march btw and it's still true.

most models make the mistake of forgetting that we are dealing with a social graph: people do not mix randomly or even randomly within age-stratified populations. it matters.

they also make the mistake of just ignoring the fatality rates by age and comorbidities. there is more careful analysis of eFG% vs FG% in NBA data crunching than Covid fatality rates, which is.. frightening.

you might get the impression from above that i am a Covid truther or something, but i am not: it is a pretty serious thing and lots of people have died and will die. that's a very bad thing.

but with simpler models and common sense policies, we probably could have done much better at a fraction of the cost.

it is a shame that the *most effective* policies were off the table from the get-go: travel bans and strict screening at border checkpoints.

Good post, and pairs well with mine below about non-susceptible populations, spreading behavior, and the immunity threshold.

Michael Levitt has *a* model of this, so not "no one," for sure. Whether it's the best, too early to say, I think.

His Twitter feed @MLevitt_NP2013 is quite interesting on this.

I think we have a very plausible explanation that has already been clearly set out by a few people, perhaps the best being Friston's post about different types of immunity:

https://medium.com/@karlfriston/immunological-dark-matter-b48e20bba9ea

There are several ways that someone can be "non-susceptible" to coronavirus. They have had an infection, and they now have strong antibodies. Or, they were exposed, and t-cell responses fought off the virus easily. Or, they have such strong natural immunity that even with exposure the infection never takes hold, even if a PCR test might at the right time might detect some dead/shattered virus particles. With high testing rates, it seems about 80% of positive tests are asymptomatic, and very mild or asymptomatic cases often don't produce antibody responses.

All of this means that a population might reach "herd immunity" at a point when only 10-20% of the population show positive in serological antibody tests, especially when taking into account the distribution of spreading behavior across the non-susceptible population. Note that there aren't really "second waves", where local places with very bad waves are having a resurgence. Rather, large countries may seem to have "second waves" because regions that were not badly hit the first time are getting a first wave,. Places that have had bad first waves, like Spain, France, Italy, New York, London, and Sweden now have very few cases, because a population immunity threshold has been reached.

The analogy with fire is a good one. Yes, it is possible that a new outbreak can start if a spark lands on a patch of dry unburned population, but the more burning you've had so far, the less likely that is. And by now, most places are mostly burned out, at least in Europe and the east coast.

My two cents, granted somewhat speculative.

1. Sweden by nature practices a lot of social distancing. 40% of households have only a single person in them.

2. Outside of Stockholm, it's very rural as well.

3. It has done 'lockdown lite' banning larger gatherings (50 people I believe, nursing home visits are also banned).

4. People have pulled back regardless of what the gov't wants. Despite the pictures you see of people eating at cafes, I bet there's more working from home, more wearing masks, more opting not to go out to close social events.

So what happened? The fire burned dramatically initially but now simmers very slowly because of all these factors. But Sweden has killed a lot of people for little gain and is still killing people. Consider:
https://www.statista.com/statistics/1115707/sweden-number-of-deaths-per-week/

Sweden began the year well below their 2015-19 trend in deaths per week. Then they shot way up and have now come down to a bit above trend line. This implies if Covid never happened Sweden would have been enjoying a year where average deaths were about 10% less. Now 'success' is being 3-5% more, after the massive surge.

+1 on items 1 through 3.

But 4 is a classical statistical fallacy. Even without Covid19, Sweden was statistically likely to return to the norm, absent any significant death negating changes.

They rolled a 1 on a six sided die 3 years in a row, it doesn't make them more likely to have rolled a 1 this year.

Possibly except deaths are not a toss of a die. They are a toss of a die weighted by factors like demographics, healthcare etc. For example, if Sweden had a small population spurt of older people there were dying out at the turn of the century then they might have had a higher rate of weekly deaths that would gradually dropped as that blip becomes a smaller and smaller part of their population. Then again you might be right and they simply tossed a 'heads' at the beginning of the year and were under their trend and now have tossed 'tails'.

I suppose one way to tease this out might be to look at the individual years that make up the average and see if they are marching in one direction but I'm not going to pay for whatever service that site wants to promote.

You cited a trend from 2015-2019. That's not a long term trend. Sure it's possible there was a huge change in Swedish longevity that kicked in 5 years ago, but didn't happen anywhere else in the world, but it seems really unlikely.

The more likely explanation was that it was just normal statistical variation.

I cited a possible trend. I don't have the data for each year so I don't know so you are correct this may just be a roll of the dice. I suspect death rates are normally driven by age so even 5 years might be more than enough if you have a large cohort of very old people who are exiting the population (and by large I don't mean like the Baby Boom but just a 'bulge' in the population). The risk of death after 75 looks like it is nearly 10% (http://www.bandolier.org.uk/booth/Risk/dyingage.html) in any given year. A bulge of 75 yr olds in 2015 will add a lot of death each year but by 2020 will only be 40% or so smaller.

If I had to place bets I'd say your explanation of simple luck would be 75% and I'd hold out 25% for a possible trend that's been thrown overboard by Covid-19. Has anyone run the numbers on what would happen to US society if the virus ends up doing a herd immunity route and infecting 60-80% of us given the death rates are much higher for those over 65?

Re; last paragraph, the Oxford Centre for Evidence Based Medicine has covered that - https://www.cebm.net/covid-19/thoughts-on-estimating-excess-mortality-from-covid-19/

But their conclusion is opposite yours; if excess were down at the beginning of year (mild flu season or such), that probably would shift to middle of year.

So it's likely having a mild beginning of year would have made subsequent excess mortality artificially appear higher, and Sweden did better than we think, not worse.

While I cannot be certain, it seems like the most likely answer to Tyler's question is that the results in Sweden are no longer much different from Sweden's neighbors because the policies in Sweden are no longer much different from their neighbors.

This always feels like a Sisyphean task to point out, but the fact is that they were never very different. The Swedish, Danish and Norwegian public health agencies have all publically acknowledged this.

Basically all three of them laid out the same coronavirus policy from the get-go. The Danish government chose to impose additional restrictions (border and school closings) against the recommendation of their public health agency, prompting Norway to go the same way to avoid looking feeble.

This led Sweden to differ on two points: schools (which are generally agreed not to be a big infection driver) and borders (which were unilateraly closed by neighbors anyway so does not make much of a difference). Some relevant context which foreign media rarely picks up is that Sweden has a pretty unique model of public governance dating back to Axel Oxenstierna in the 17th century: the government is constitutionally prevented from asserting political influence over government agencies. This means what happened in Norway and Denmark would be seen as "minister rule" in Sweden, a scandal capable of effectively ending a political career.

And now Denmark and Norway are gradually loosening the additional restrictions they had, wiping out the last traces of differences in coronavirus policy. But Sweden is stilled viewed as an "experiment" for some reason.

It's not until you take all this into account you can start asking the right questions about what went wrong. One answer is that the winter school holidays timed exceptionally badly - 10% of Swedes were abroad when European outbreaks started, many skiing in the Italian Alps. Norwegians had their winter break the week before, meaning right before the first outbreaks. Also Sweden likely has been terrible at keeping hygiene and safety routines at elderly homes which merits a major investigation in itself.

But putting this down to a lockdown vs. no lockdown dichotomy will lead us nowhere.

I'm not sure how accurate the introverted Swede stereotype is but I'd imagine it could have something to do with it.

It is my understanding that for practical reasons all Nobel Prizes except the Peace Prize will be awarded to Swedes this year.

Too many comments about the level when the post is about the decline.

Interesting timing for this post. The NYT disagrees.

"They literally gained nothing."

"In short, Sweden suffered a vastly higher death rate while failing to collect on the expected economic gains."

https://www.nytimes.com/2020/07/07/business/sweden-economy-coronavirus.html

NYT is paywelled, so no idea if they actually have any evidence. But strongly suspect that their measures will have preserved economy to some extent relative to compulsory closures, furloughing, etc. Once this is all done and analysed. GDP data to date that I have seen generally confirm that.

"Exact same economic damage" is not gonna be correct, just as "many, many more deaths was not correct". (Unfortunately for those Progs who are really bullish that There Is No Alternative to doing exactly what they say, there will remain, as there always have, multiple options tradeoffs, with the preferred Proggy options not particularly attractive or compelling.)

When we look back on this in the future, I see three ways in which a country could be defined as having failed (obviously they are a bit reductive):

1) ICU cases significantly breaching capacity, meaning that a way higher share of infections lead to deaths (and more ancillary deaths due to crowd-out) than a slow spread of similar magnitude would have led to.

2) Enforcing long lockdowns without finding a cure or managing to eradicate the virus, thus ending up in the same mortality end state but with incurring more overall damage to people's well-being and livelihoods in the process.

3) Allowing the virus to apread in a controlled manner (i.e. within ICU capacity), but discovering later that a treatment or vaccine was arrived at earlier than expected. Meaning unnecessary deaths that more cautious countries could have avoided.

In my view Sweden has managed to avoid failures of the category 1 or 2 type (ICU load is greatly reduced, never breached capacity and there is no indication of a second wave). The third type of failure could definitely still be a possible path to failure and hindsight is 20-20.

What irks me is that so many people focus only on the third type which is still largely a hypothetical situation. The NYT article seems entirely uninterested in the fact that very few western countries have found a solution that does not entail lockdown in perpetuity.

Is it possible that it is simply impossible to discern cause-and-effect when it comes to the spread and impact of this disease, and the various efforts to mitigate its spread and impact?

I don’t want to be pessimistic exactly. But it seems to me that a given disease will have a wide range of impact on a given population – some people will get sick, some people will not get sick, some people will have peculiar reactions, some people will have very predictable reactions, and so on. There are “things” that contribute to each of those outcomes of exposure to the virus – people’s underlying health, the amount of virus they’re exposed to, the conditions of exposure. And timing delays between exposure and onset further complicate the picture.

Even if you had perfect knowledge of all of these factors, my guess is that it would be difficult to discern cause-and-effect, and then design some sort of scheme to optimally protect the health of a community.

But we don’t have perfect knowledge. Even assuming incredibly competent health organizations around the world, the task of collecting information in real time in a consistent and reliable manner would be nearly impossible. And we can probably assume we do not have “incredibly competent health organizations”.

Add to this the various criteria that public health officials are using to set policy, and that individuals are using to regulate their own behavior.

How could you ever know what’s is truly going on? How could you know which policies led to which outcomes?

As a bit of a related aside, I remember an article many years ago about breast cancer “hot spots”. These are areas where there were unusually high concentrations of breast cancer cases. The people who lived in those areas were convinced it was... the water, the food, the you-name-it. But if you assumed a random distribution of cases across the country, what you’d find is that these “hotspots” were perfectly explainable *and expected* based on probability. If enough people are flipping coins, someone will come up heads every time.

Of course, we can’t give up the attempt to understand “what’s special about Sweden.” But we also need to be humble and understand that it may just be that they’re lucky.

Comments for this post are closed