Did Sweden end up taking the best approach?

260,949 Views | 1675 Replies | Last: 6 mo ago by Enzomatic
PJYoung
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AG
Texaggie7nine said:

Quote:

What percentage of the healthy population under 50 requires hospitalization. Under 1%? We can handle that.

Where are you getting that?

It's 2.9 per 100k for everybody under 50 according to this chart from the CDC

Texaggie7nine
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PJYoung said:

Texaggie7nine said:

Quote:

What percentage of the healthy population under 50 requires hospitalization. Under 1%? We can handle that.

Where are you getting that?

It's 2.9 per 100k for everybody under 50 according to this chart from the CDC


I saw you corrected. Yeah, 2.9% and 2.9 per 100k are 2 completely different things.

This chart does not really give us any percentage of how many INFECTED or known infected people 20-50 are hospitalized. I would guess that it's quite a bit higher than 2.9%
7nine
Squadron7
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PJYoung said:

Texaggie7nine said:

Quote:

What percentage of the healthy population under 50 requires hospitalization. Under 1%? We can handle that.

Where are you getting that?

It's 2.9 per 100k for everybody under 50 according to this chart from the CDC



So less than 1 in 5 over 85 years old required hospitalization?
Texaggie7nine
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Squadron7 said:

PJYoung said:

Texaggie7nine said:

Quote:

What percentage of the healthy population under 50 requires hospitalization. Under 1%? We can handle that.

Where are you getting that?

It's 2.9 per 100k for everybody under 50 according to this chart from the CDC



So less than 1 in 5 over 85 years old required hospitalization?
The chart is not narrowed down to people who are infected. It is per 100k people in our entire population.
7nine
Squadron7
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Texaggie7nine said:

Squadron7 said:

PJYoung said:

Texaggie7nine said:

Quote:

What percentage of the healthy population under 50 requires hospitalization. Under 1%? We can handle that.

Where are you getting that?

It's 2.9 per 100k for everybody under 50 according to this chart from the CDC



So less than 1 in 5 over 85 years old required hospitalization?
The chart is not narrowed down to people who are infected. It is per 100k people in our entire population.

Yeah, see that now. Thanks.
Texaggie7nine
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Yeah, it confused me to. Pretty much every link you get if you try to google "coronavirus hospitalization rate by age" you get a similar chart or numbers, all per 100k people and nothing I can find that gives percentages of infected.

What good does that chart even do except show that it affects you more the older you are?
7nine
plain_o_llama
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There is some value in showing people this if it gets across to them the differences between the total population averages and those for sub-populations. The averages for the whole population have some utility for macro policy. However with risk by age ranging over something like 3 orders of magnitude a single estimate of 0.5% IFR is of little use to an individual. Yet, some people seem to hear the population average and think it applies to them as an individual.

Just riffing.....

As for this plot, no one trusts any of the numbers for total infections. Without accurate info on infections all you can generate are curves that suggest relative risk by age group.

There are a host of plots we would like to have but can't get with our current data.

1) A plot of infections vs age.

An accurate appraisal (or even good estimates) of infections with age data lets one generate:

2) Ratio of Hospitalizations/Infections vs Age
3) Ratio of Fatalities/Infections vs Age

then there are several ways to go with comorbidities, sex, age combos.
Zobel
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The metric has been 80/15/5... 80% mild, 20% hospitalized... 15% severe, 5% ICU.

But that is of observed symptomatic cases. So, Assume 7:1 observed to not. That means if you had 80 / 20 before, it's really 780 / 20, making your total hospitalization rate around 2.5%.

This table in Imperial is probably pretty accurate, except.. make everything under 30-39 something like 0.1 to 0.5% with what we know now...

https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf
Squadron7
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Quote:

several ways to go with comorbidities, sex, age combos.

This put a picture in my mind I didn't want.




TRADUCTOR
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Looks like the best approach with hospitals not overrun and economy. Interesting data: Swedish men are getting hammered.

https://www.icuregswe.org/en/data--results/covid-19-in-swedish-intensive-care/
Zobel
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This is is the only study I've seen which looks at attack rate by age. Bottom panel.

https://www.nature.com/articles/s41591-020-0822-7.pdf


[url=https://science.sciencemag.org/content/early/2020/03/24/science.abb3221][/url]
The_Fox
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k2aggie07 said:

The metric has been 80/15/5... 80% mild, 20% hospitalized... 15% severe, 5% ICU.

But that is of observed symptomatic cases. So, Assume 7:1 observed to not. That means if you had 80 / 20 before, it's really 780 / 20, making your total hospitalization rate around 2.5%.

This table in Imperial is probably pretty accurate, except.. make everything under 30-39 something like 0.1 to 0.5% with what we know now...

https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf
So assuming around 75% get infected we are looking at roughly 6.5 million hospitalizations and 1.65 million in the ICU. What was the total hospital capacity and ICU capacity? Those numbers sound like they would overwhelm hospitals if they occurred over a very short time window.

Obviously the number of people already infected and recovered would reduce that number. That is the real number that I would like to have already.
Knucklesammich
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HouAggie2007 said:

Knucklesammich said:

The ambassador to the most powerful country on Earth, speaking officially for his government is not advised on what he can and cannot say? When that country is taking a novel approach to handling the pandemic in their country?

Ok, you are right he just says what he wants and is totally unsupervised.



We talking Trump or the sweede?


That made me laugh well played.
plain_o_llama
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I haven't looked at this closely but it might shed some light on Italy's numbers.
Look at Table 1 and 2.
https://www.medrxiv.org/content/10.1101/2020.04.15.20067074v2.full.pdf
Squadron7
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plain_o_llama said:

Combining PFR with the Princess Diamond cruise ship IFR for ages above 70 we estimate the infection rates (IR) of regions in Italy, which peak in Lombardia at 23% (12%-41%, 95% c.l.), and for provinces in Bergamo at 67% (33%- 100%, 95% c.l.). This suggests that Bergamo may have reached herd immunity, and that the number of infected people greatly exceeds the number of positive tests, by a factor of 35 in Lombardia .
If true, this is kinda bigly big, isn't it
cone
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just look at the NYC sero data

there's a total of 40000 hospitalizations in NYC so far and the sero study predicted 1.6 MM w/ antibodies

that's 2.5% across all ages

hospitalization rate under 50 is half the total rate per 100k people

so a 2.5% hospitalization rate across full cohort would indicate 1.25% for <50

that's not accounting for comorbidities

so even if you're thinking the NYC sero study is off, it's likely the upper bound for under 50 hospitalizations is ~2%
Texaggie7nine
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cone said:

just look at the NYC sero data

there's a total of 40000 hospitalizations in NYC so far and the sero study predicted 1.6 MM w/ antibodies

that's 2.5% across all ages

hospitalization rate under 50 is half the total rate per 100k people

so a 2.5% hospitalization rate across full cohort would indicate 1.25% for <50

that's not accounting for comorbidities

so even if you're thinking the NYC sero study is off, it's likely the upper bound for under 50 hospitalizations is ~2%


I think I a more pertinent stat would be hospitalization rate for like 30-50 since 20 and under skew it so much
7nine
plain_o_llama
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Interesting to see the skew in %deaths per hospitalization vs age:

0-17 0
18-44 8.4%
45-65 18.7%
65-74 31.6%
>75 52.0%

From here, dividing deaths/hospitalizations, assuming I am reading the data correctly
https://www1.nyc.gov/site/doh/covid/covid-19-data.page
cone
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you're in luck

NYC 18-44 confirmed cases = 57462

NYC 18-44 hospitalizations = 5647

NYC total confirmed cases = 156100

NYC serology production is 25% of 8 MM = 2 MM

assume 100% over counting

1 MM infected

Potential infected:confirmed = 6.6:1

5647 / (57462 * 6.6) = 1.5%

not accounting for comorbidities

everything hinges on that sero study though. If it's overestimating off by a huge factor, then things get more grim. but the IFR is still 1% if you accept the sero study findings, which seems real.

mostly if you land in a hospital and you're older than 65, you're in bad shape
Zobel
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It's probably not off by much. Once you hit >10% the errors for the range of sensitivity and specificity we've seen matter much less.
cone
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agree

just keeping my powder dry

good news - hospitals don't seem like as much of a bottle neck especially for non-epidemic areas

bad news - people die at home
PJYoung
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https://www.cnn.com/2020/04/28/europe/sweden-coronavirus-lockdown-strategy-intl/index.html

Quote:

Denmark and Norway are now beginning to ease their lockdowns, with children returning to school in the past 10 days, in smaller classes with markers to help keep them two meters apart. Salons and other businesses with one-to-one contact will reopen in Norway from Monday. Finland has extended its restrictions until May 13.



Quote:

Albert believes that Sweden's healthcare system is coping, as does Peter Lindgren, managing director at the Swedish Institute for Health Economics (IHE). Lindgren told CNN that the number of people treated in intensive care units over several weeks had been stable, "so in that aspect it has to be successful."

But he added: "What it failed at, I think, is that there has been disease transmitted into elderly care facilities. We have deaths occurring as a consequence of that."

Hallengren, the Swedish health minister, told CNN: "One of the main concerns now in Sweden is to strengthen the protection for those living in care homes for older people."

She said it was still "far too early to draw any firm conclusions as to the effectiveness of the measures taken in Sweden."
HotardAg07
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Squadron7
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HotardAg07 said:



Isn't this to be expected, though? The question can't be answered until we get to a point where we can measure the area under the curve. And, again, if hospitals are not currently overwhelmed in Sweden then will still can't say that theirs is not the better way to herd immunity.
ETFan
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cone said:

just look at the NYC sero data

there's a total of 40000 hospitalizations in NYC so far and the sero study predicted 1.6 MM w/ antibodies

that's 2.5% across all ages

hospitalization rate under 50 is half the total rate per 100k people

so a 2.5% hospitalization rate across full cohort would indicate 1.25% for <50

that's not accounting for comorbidities

so even if you're thinking the NYC sero study is off, it's likely the upper bound for under 50 hospitalizations is ~2%


If hospitalization rate is 2.5% I think the shutdown and slow opening are completely justified. Just some quick math:

US Adults: 209M
Let 25% become infected quickly: 52M infected
2.5% hosp. rate: 1,300,000 that need the hospital

Don't we only have ~1M total beds in the entire US? Assume we need half for other illnesses and... yikes. That's at 25% infection.
HotardAg07
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Squadron7 said:

HotardAg07 said:



Isn't this to be expected, though? The question can't be answered until we get to a point where we can measure the area under the curve. And, again, if hospitals are not currently overwhelmed in Sweden then will still can't say that theirs is not the better way to herd immunity.
Isn't it too early to say?

All we can conclude is that so far the more aggressive shelter at home orders did have a stronger effect at flattening the curve rather than the more loose social distancing guidelines Sweden has been using, but that seems like a pretty logical conclusion.

Sweden has such a small population, so it's hard to compare, but they have a higher per capita death total than the US right now (175 per mm). If we had their per capita death total, we would have 20,000 more dead people.

I personally think the best response was by far South Korea. The started their growth on a similar path to Italy, aggressively implemented social distancing, testing, and contact tracing. They have 244 deaths total in a country 5 times more populous than Sweden and also more population density. They also were able to limit cases so aggressively (yesterday they had 10 new cases and 1 new death) they could resume normal life faster. I'm not really sure Sweden is the model of best economic response or viral response.
Squadron7
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Quote:

If we had their per capita death total, we would have 20,000 more dead people.

I think this has been asked before...but why would per capita death totals be so different before any hospitals are overrun there? For that matter....why are they so different between states here?
The_Fox
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Squadron7 said:

Quote:

If we had their per capita death total, we would have 20,000 more dead people.

I think this has been asked before...but why would per capita death totals be so different before any hospitals are overrun there? For that matter....why are they so different between states here?
Because the virus has spread though more of the population already? Front loaded deaths versus steady stream of deaths with a long tail?
Squadron7
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The_Fox said:

Squadron7 said:

Quote:

If we had their per capita death total, we would have 20,000 more dead people.

I think this has been asked before...but why would per capita death totals be so different before any hospitals are overrun there? For that matter....why are they so different between states here?
Because the virus has spread though more of the population already? Front loaded deaths versus steady stream of deaths with a long tail?
Probably. What is Sweden's estimated IFR again?
HotardAg07
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Squadron7 said:

Quote:

If we had their per capita death total, we would have 20,000 more dead people.

I think this has been asked before...but why would per capita death totals be so different before any hospitals are overrun there? For that matter....why are they so different between states here?
I can only speculate.
  • Where hospitals have been overrun, they have been in highly localized hot spots where the infection rate spiked (Lombardy, NYC, etc.). Perhaps Sweden's deaths have been more spread out as the country is more spread out?
  • Perhaps hospitalizations and ICU requirements have gone down over time due to improved anti-viral and IL-6 inhibitor treatments? In NYC it is a ratio of 3.5 hospitalizations to deaths, but from what I understand initially it was expected to be much higher from what was coming out of Italy. My grand aunt was infected in NYC, had to go to the hospital, but was released after 1 day with oxygen and a pulse ox meter to monitor herself at home. From what I understand, that is a new tactic being used to save hospital beds in NY, but it could be contributing.

Either way, I am looking forward to May 1st when Texas goes under a Sweden-like social distancing scenario, so obviously I don't have a big issue with it. I just think that they probably aren't the example of the BEST response, I think that would be South Korea.
cone
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not everyone gets sick at the same time and people were already paranoid before the lockdowns

and some parts of the population are more vulnerable, require stricter lockdown

it's all about if working age can produce and consume without extreme paranoia

lockdowns bought us time and took us off the total back foot. they were necessary.
PJYoung
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Squadron7 said:

The_Fox said:

Squadron7 said:

Quote:

If we had their per capita death total, we would have 20,000 more dead people.

I think this has been asked before...but why would per capita death totals be so different before any hospitals are overrun there? For that matter....why are they so different between states here?
Because the virus has spread though more of the population already? Front loaded deaths versus steady stream of deaths with a long tail?
Probably. What is Sweden's estimated IFR again?

12%? (this chart is a few days old)

NASAg03
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I don't believe Sweden is emphasizing testing the public at large, which skews the IFR.
Mike Shaw - Class of '03
Squadron7
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NASAg03 said:

I don't believe Sweden is emphasizing testing the public at large, which skews the IFR.

Skews it upward.
plain_o_llama
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A reminder for those not following this closely.... (not Squadron7)

The IFR is based on the number of actual infections across the whole population and is exceedingly
difficult to determine. It is not the same as the CFR which is based on the cases of infection that have been identified. More confusing, differences between countries and states in testing procedures and availability skew the CFR in ways that are difficult to reconcile for comparison purposes.

Conflating these two ideas is rather unhelpful for developing policy.
 
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