GAC06 said:

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https://unherd.com/thepost/swedish-doctor-t-cell-immunity-and-the-truth-about-covid-19-in-sweden/

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"Intensive care units are getting empty, the wards are getting empty, we are really seeing a decrease and that despite that people are really loosening up. The beaches are crowded, social distancing is not kept very well but still the numbers are really decreasing. That means that something else is happening we are actually getting closer to herd immunity. I can't really see another reason."

"We found that if you have a mild case you can be negative for antibodies afterwards in those almost all of them had strong T-cell activity. This study says that there are cases that you can have a strong T-cell response even though you have not had antibodies, meaning that you have encountered the virus and built up immunity."

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https://www.roswellpark.org/newsroom/202004-roswell-park-catholic-health-university-buffalo-unite-answer-question-who-will

Interesting study to look at T cell and B cell response, hoping to identify markers for who will have a mild case and who could be in trouble.

DadHammer said:

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Lowest weekly average for new infections since April 2nd. Things are looking up in Sweden.lowest weekly 7 day average for deaths since March 21st.

It's just about over for real in Sweden. That's great news. No reinfections after months so some type of herd immunity is being reached.

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Just like New York state a month ago. Except somehow NY had 3x the deaths per million residents. Good news for Sweden.

DadHammer said:

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https://www.usnews.com/news/world/articles/2020-07-07/swedens-daily-tally-of-new-covid-19-cases-falls-to-lowest-since-may

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Falling to the lowest tally really isn't an argument relative to the thread title, although I am very happy to see it reported in Sweden or anywhere. But nyc, Italy, China, UK all have hit lowest tallies before since they let it spike and get out of control previously. Texas will be there at some point, I think in 4-8 weeks based on my non medical opinion also based solely on web data to date.

A place that never has a huge uptick, or no highs to have fallen from, and can mean tin that and economic stability until such time as a vaccine is ready would be a real winner

Great info thank you

I unfortunately question how well his plan would work here.

It would require a ton of voluntary compliance, and that's not something the US tends to do well.

The effect of public healthcare also has to be considered I think.

You may be right, the outliers might be coloring my view a bit.

I think it's tough to make a call on any of this until we're looking back on it and can fairly evaluate all the different factors (public health, economic, etc.) but it definitely looks like their approach had some success.

fig96 said:

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I unfortunately question how well his plan would work here.

It would require a ton of voluntary compliance, and that's not something the US tends to do well.

The effect of public healthcare also has to be considered I think.

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All he asked for was social distancing for a time.....nothing else. If you read, their beaches are packed and there's not much social distancing going on.

They did it right (though in hindsight quarantining NH/LTC facilities would have been productive).

Until they mandated masks by law, lots of people didn't wear them. No way in hell would enough people in the US comply with instructions that are voluntary. Too many people here with the mentality that they don't want to be told what to do, along with many that distrust authority/government. Basically the opposite of Swedish people.

Keller6Ag91 said:

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fig96 said:

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I unfortunately question how well his plan would work here.

It would require a ton of voluntary compliance, and that's not something the US tends to do well.

The effect of public healthcare also has to be considered I think.

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All he asked for was social distancing for a time.....nothing else. If you read, their beaches are packed and there's not much social distancing going on.

They did it right (though in hindsight quarantining NH/LTC facilities would have been productive).

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That's not really accurate. While things there are more open now, early on they implemented remote working, social distancing, online learning, limited restaurants and bars, and maybe most importantly recognized the danger to their older population.

From the doctor himself:

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That's not to say the country hasn't been proactive at all. The policy in effect in Sweden is similar to what had been implemented in much of the United States before shelter-in-place orders were issued and the one that will soon be in place in states that reopen. The Swedish government has recommended that people wash their hands frequently, maintain social distance, work from home if they can, and those who are elderly or more susceptible to Covid-19 stay home. The government recommended that universities switch to online teaching; they quickly followed course. Social distance is required by law in restaurants, and bar service is banned. The government changed its sick leave rules to encourage anyone who is feeling symptoms to stay home. "Instead of saying 'close down all of society,' we have looked at society and closed down aspects of society," where the disease is most likely to spread, Anders Tegnell, the epidemiologist at Sweden's Public Health Agency in charge of recommending policy to the government, told The Daily Show. "I think that's had a great effect."

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https://gen.medium.com/what-americans-need-to-understand-about-the-swedish-coronavirus-experiment-50417cc20994

george07 said:

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Until they mandated masks by law, lots of people didn't wear them. No way in hell would enough people in the US comply with instructions that are voluntary. Too many people here with the mentality that they don't want to be told what to do, along with many that distrust authority/government. Basically the opposite of Swedish people.

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Respectfully, I just don't agree with that.

Keller6Ag91 said:

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Fantastic news for Sweden. I figured they'd be proven as making the right decision.

So how much of this will by covered by the US media?

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None.

On March 5th, Tegnell predicted that the peak in Sweden was going to be on March 9th or 10th (see https://www.aftonbladet.se/nyheter/a/9vdbWd/tegnell-backar-coronakulmen-pa-mandag-eller-tisdag ). On March 10th, Sweden had a cumulative case count of 355. Now it has had 78,166 confirmed cases. He was clearly way off in his understanding of the risks posed by the disease. Way off.

Denmark+Norway combined population of about as many people as Sweden (and a similar density). They are similar countries in many respects. Stockholm is bigger than Copenhagen or Oslo, but each of these 3 cities have populations under 1 million. London's population is almost 9 million. It's way off-base for Tegnell to try to say that the UK is the appropriate comparison.

At the time Tegnell made that prediction Sweden had 94 confirmed cases. On that day, the Denmark+Norway case count was (10+87 = 97). If you fast forward 2 weeks from then, to March 19, the death counts were 11 for Sweden and 13 (6+7) for Denmark+Norway. So, in terms of surveillance, it looks like the level of surveillance failure for Sweden was pretty similar as its two closest neighbors. I don't really see evidence that they were treating the disease much different before this point. And the Denmark+Norway combo vs Sweden seem to have done similarly poorly in terms of early detection.

In early March, Sweden's strategy diverged from the rest of Europe. Since then Sweden has had about 5,300 deaths, while Denmark+Norway have added another 870. Sweden is in the "top 5" per capita death rates for countries with over 1 million people (there is a lot of scatter in data from tiny countries; Andorra and San Marino both have higher death rates than Sweden now, according to Worldometer, making Sweden 7th out of the 215 countries they track).

It's great that the number of cases and deaths in Sweden are low now. I hope those trends hold.

It would be great if there was some pre-existing immunity that lowers the herd immunity threshold. Evidence for that still seems pretty thin, but I hope that it pans out.

It's possible that the rest of Scandinavia will catch up with Sweden in terms of deaths per capita eventually. But at their current death rates, it would take years even if Sweden has no more deaths. Given the improvements in treatments, delaying infection can save a lot of lives. So, it seems to me that Norway and Denmark have done a much better job (but as for the "best approach" in the thread title, it seems like South Korea or New Zealand are the obvious candidates).

Note: I used numbers from John Hopkins above. If you compare to excess deaths (https://ourworldindata.org/excess-mortality-covid ) the picture doesn't change appreciably:

Sweden (3/17 - 6/22) 5,334 reported COVID-19 deaths; 5,322 excess deaths.
Denmark (3/24 - 6/8) 561 reported COVID-19 deaths; 259 excess deaths.
Norway (3/31 - 6/22) 220 reported COVID-19 deaths; -134 excess deaths.

(Note: the excess mortality data lags. And these #'s are not over exactly the same time frame, but they are close).

Edit: Typos "too" -> "two" and "a years" -> "years" fixed. "770" -> "870" for the D+N deaths. "D+S" -> "D+N"

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Stockholm is bigger than Copenhagen or Oslo, but each of these 3 cities have populations under 1 million.

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How do you account for density?

I would also call your attention to the euromomo data. Specifically, the z-score by age.

https://www.euromomo.eu/graphs-and-maps

Sweden shows no difference in the under 65 demographics. Other "hard hit" Euro countries do. Even in 65-74, Sweden is not prominent in comparison to Spain, France, Netherlands, Belgium, UK, etc.

Where Sweden stands out is the 75-84 and, particularly, the 85+ demographic.

This suggests a lot of "death shifting" of the old and frail, and Sweden will probably see below expected mortality in the next year, especially relative to its neighbors.

googling indicates that Copenhagen has about 6800 people per square km. Stockholm around 4800 and Oslo less dense 1532. Overall country density: Sweden is larger in area than Norway+Denmark. And the population of Sweden is about the same as Norway+Denmark

I think that it is clear that a broad swath of western Europe (and the US) had massive surveillance failures. So that when they realized they had a problem, there was a world of pain "baked in" to their situation: e.g. hospitals so crowded that there were almost certainly many deaths that could have been prevented if the surveillance had been adequate to slow down the onslaught of cases. For example: Northern Italy, NYC, Spain, France, Belgium, etc

It is certainly fair to point out those failures and criticize those governments/public health officials. I have no problem with people saying there was a massive failure.

But if you look at where Europe was mid-March... Switzerland and Germany looked like they were in real trouble. There was no reason to think that Scandinavia was going to be hit hard.

However, in the "dealing with the COVID now that we know we have a problem" stage of public health response : Sweden turned a average case into a "top 5 deaths per capita" case. The rest of Scandinavia did basically fine. Switzerland and Germany turned things around and really limited their deaths.

wrt the Z scores link. There are always lots of transformations of data that change the rankings. You can play around with looking through the infinite set of transformations if you like. I tend to focus on death per capita as delaying death is a the main target of public health. Deaths per capita can be unhelpful if 2 countries have really different age structures to their population, but that is not the case with the intra-Scandinavian country comparisons.

Edit: word left out "a" -> "is a"

Skane County in Sweden, directly adjacent to Copenhagen, has a population of 1.4 million and 258 COVID fatalities.

That's probably the best apples-to-apples comparison to Copenhagen.

They have the same density?

I definitely agree that deaths are not the only thing that matters. My last comment was unclear; sorry about that confusion. I just meant to convey that when looking at the mortality figures, I tend think per capita death rate (while paying attention to age structure) gets you most of the info - rather than trying to find lots of fine-grained transformations of slices of the data.

In mid-March, I thought Sweden's approach of keeping schools for the younger kids was risky given what we didn't know about the virus. But I agree that that decision appears to not be a problem for them. On the other hand, Norway controlled the virus and opened at least some (most? all? I don't know) of their schools again in late April. So, I don't think they paid a huge price for being cautious.

A lot of people have advocated not worrying much about spread SARS-CoV-2 in the population and just focus on protecting the at risk (elderly + folks with co-morbidities). Sweden seemed to be the poster-child of that approach. That sounds great in theory. But the epidemiologists I read (e.g., I think Natalie Dean of UF has been very informative) warned that if the disease gets prevalent it is going to be very hard to keep it away from the vulnerable among us. I think the high mortality of elderly in Sweden shows that these skeptics were right.

Some truth to the harder to isolate vulnerable when it is very prevalent. However, Sweden acknowledged that they should have done a better job of isolating the elder care facilities earlier. So hard to tell if the high death rate of elderly in facilities was do to it being inevitable or just a failure early on of Sweden healthcare.

twk said:

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By looking exclusively at covid deaths, you're only looking at half the balancing equation. The other half includes impact on the economy, other health impacts (people not seeing to other medical conditions), and the impact of keeping children out of school. You can argue about whether Sweden should be compared to Norway and Denmark, or whether the UK and Belgium are valid comparisons, but if that's all you look at, you're missing the forest for the trees.

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Very good post.