Sweden’s herd immunity “success story”

I agree with you and that study ought to make it clear that face masks aren't going to defeat the virus on its own. Some say that the face mask is totally useless anyway and it might be true.

 

I just looked at one of the links and I see there is a "in English" button on the top right but I don't think it corresponds fully to the original version.

 

Yeh, I’ve found the basics in English but not any of the detailed statistics. I’ll keep playing with it.

 

I guess it is (as everything else in life) the question of isolation vs. resilience.

 

My friend, I know you dispute some of the statements about Sweden, but reading this might give you pause:

https://www.yahoo.com/news/swedish-government-sidelines-epidemiologist-steered-102636440.html

Sounds like the Swedish government is losing faith in the guy who sponsored their strategy. I continue to think that their strategy was boneheaded and backfired on them.

You had argued in the past for specific errors regarding protecting their elderly, being enough to explain the differences between Sweden and their neighbors...

But this new surge that is ten times worse than in Norway can't be attributed to those early mistakes.

No, it's undeniable by now that Sweden is doing much worse than its neighbors. MUCH worse.

 

I’m still researching data to respond fully to this thread. But I’ll respond with what I have so far.

To start, your quotes of Swedish officials in the yahoo piece are closer to reality than some other claims I’ve seen such as infections are 2-3 times higher now in Sweden than in the spring. I concur with the quote from your piece that infection rates are about the same now as in the spring. We really have very little idea what they were in the spring. Antibody testing data that shows infections were 21 times what official data was based on PCR up to about the end of May. So, yes, there is a second wave, but comparing this wave to the first that had basically no relevant data is not legitimate. Before June Sweden was only testing hospital admissions and some healthcare workers. Most elderly that died during this period were never admitted to a hospital.

Of course it’s indisputable Sweden is seeing higher infection and death rates than Norway for instance. But we know heterogeneity of populations must be accounted for as well as government actions, etc. Some bullet points to demonstrate.
—population density.
Sweden: 25/Sq. km
Norway: 15/sq. Km

—obesity.
Sweden: 18.6%
Norway: 12.7%

—median age.
Sweden: 40.9
Norway: 39.8

—percentage of annual deaths from coronary heart disease.
Sweden: 21.9%
Norway: 17.42%

—prevalence of diabetes.
Sweden: 6.8%
Norway: 4.7%

Not to be overlooked in the success of Norway compared to the rest of the world is their sovereign wealth fund (oil fund). Because of this over 1 trillion dollar asset they have been able to fund mitigation and not worry so much about economic decline as other nations. It’s the largest sovereign wealth fund in the world for a population just over 5 million. Pretty good lesson in saving and investing in the future for countries and individuals alike.

I’m not claiming the mitigation practices between the two countries are inconsequential. I don’t even know Norway’s policies. But I do know the above factors (and many others) are consequential. For example, Stockholm, the hardest hit area of Sweden, contains nearly half as many people as the whole country of Norway.

Another overlooked aspect of the second wave in Sweden (and other places as well) is the majority of second wave infections are in different geographical locations than the first wave. Just look at the US for a stark example. New York City in the spring vs. North Dakota this fall. A prime example in Sweden is the Tensta district of Stockholm. It’s a poorer district of mostly immigrants. In the spring infections there accounted for a large share of total Stockholm infections. Today it’s other areas of the city adding to the totals. You can see the same thing in NYC.

The point is, of course herd immunity of various growing levels is observable contrary to the opinion of even Swedish officials who now claim otherwise. In Sweden, in the US, in Italy—you just have to actually look at the data in detail instead of going off countrywide data or what a media personality says. I don’t know why people ever thought a high infection rate in one area 500 miles from somewhere else would confer herd immunity on the second location. I believe that to actually be a strawman construct by those who are unwilling to accept any observable level of herd immunity even in small localities. I’ve been very clear every time I’ve discussed this subject I don’t believe local data means states or countries surrounding those localities are in any way near herd immunity.

This is a bit off the subject, but relevant. Have you noticed countries and states always implement new mitigations such as lockdowns, mask mandates, etc. after 7 day moving averages of infection rates have peaked and are falling? I first mentioned this in our discourse about New York mask mandates in the spring being implemented after infection rates were falling but credited with the fall retroactively. I’m not bringing that up to get into effectiveness of masks (I still recognize the physical properties of them and their strengths and limitations in public use), just to reiterate that perception isn’t usually reality in these cases. In this case, if the Swede in your piece is marginalized, we will soon hear how great Sweden is doing now he’s gone. But the facts are infection rates were already falling and death rates were already falling precipitously.

Probably forgetting something but good to hear from you. Hope you and your wife are handling the stress of the “second wave” ok. Oh, you’ll be happy with me. I texted a doctor last week! I thought maybe I’d fractured a transverse process on my L5. Seems to be just muscle damage...I’m sore but thankful! I have a brother who’s a paraplegic at the moment so I was a little unnerved (pun intended LOL).

 

This I translate from another source:

“How many people die as a percentage of Corona versus the other diseases etc. that you allow yourself to be fooled by scare propaganda from the government? There are 10 million people living in Sweden of whom 243,000 are infected (not dead, only registered infected) which constitutes 0.0243% of the entire population of Sweden .... 6681 dead of Corona constitute 0.000681% … (the number 6681 from Wikipedia)”

“Since 2000, approximately 90,000 people died each year, with a peak in 2002 when just over 95,000 died. In 2019, fewer than 89,000 people died, which is the lowest number of deaths in a single year since 1977. So now explain to me how these 6681 can be life-threatening for Sweden when people here tend to live as normal ... How can the flu suddenly be ‘eradicated’ and suddenly ALL the dead are Corona victims?”

 

Run that comparison on Denmark:

Population density: 137.sq.km
Obesity: 13%ish
Median: age 41+
% Deaths from cardiovascular disease: 24%+
Diabetes: 7%+

Having done al lthat work I can't be bothered digging up COVID deaths now or in the first wave, but I know they are factors less than Sweden. The reason for that is basically the same as the reason Norway's deaths are so much lower - they decided to protect the vulnerable in their society. Does that decision alone explain every % point of difference with Sweden? No, but the scale of difference is so vast that you really are just arguing on the margins.

 

Whew, glad to know that your back problem was muscle only! Yay! Texted a doctor! Way to go! Progress!
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I hear you and as usual you bring up some very interesting points. I still think that it is very hard to walk away from this piece of data, raw as it may be, without acknowledging that Sweden is doing worse:
Deaths by million of the population - Sweden 660, Denmark 142, Finland 71, Norway 60.
Even with Sweden having a higher population density than Norway, a bit more obesity/diabetes etc., the difference is just too vast. Eleven fold!
I think your data are likely to explain some of the difference (and it's great that you think of the situation way deeper than most people) but not all of it. Sure, there are differences between the populations of these four countries in density and health indicators, but there's a great deal of similarities between them, too (all four belong to the same region of the world, are very close to each other - literally a bridge away or sharing borders - and share a lot of social, economic, and populational traits). So, there must be another strong factor, and it's just too tempting to hypothesize that the different policies of containment have to do with it, especially when their own government is now acknowledging it. It's their country; they say now that they were wrong and regret it; it counts for something, no?

I mean, the vaccines are imminent. So at some point in 2021, sooner rather than later, the Scandinavian branch of the pandemic will be over, and Sweden will be left with a much higher death toll than their neighbors. If all that we had to bring an end to the pandemic were natural herd immunity, eventually, say, in 3 or 4 years, the indexes for these four countries would equalize, and we'd say "well, Sweden by facing it with open arms just got their deaths sooner and out of the way but the other countries eventually caught up when the virus slowly made the rounds and reached their entire population despite their tougher initial containment measures." But with the vaccines being imminent, the Swedes will have to deal with the issue that their much higher death toll was unnecessary, if they had been more prudent.

Analogy: a high school soccer team in the US loses to a rival from across town (a very similar high school, with a few small differences), 11-1. The principal fires the coach. Chances are that the coach wasn't that good even if the players are a bit slower than the other team's players. Maybe with a better coach and different strategy they'd have lost by just 2-1, to account for their players being slightly worse. But 11-1? To a high school from across town? If the team they played against had been a visiting team from Brazil, I'd think that the 11-1 might have been explainable by the vast differences in soccer culture and skills between the two countries, but from across town, it's hard to attribute it to much more than the coach being no good. So if Sweden were doing 11 times worse than say, Japan, one might look deeper into the differences between these vastly different countries, but Norway? Oh, and by the way, Japan's deaths by million of inhabitants is... 16 (41.25 times smaller than Sweden's). And they have way higher density (347 inhabitants/sq.km.) and older population (4. So if these traits explained a lot of it, one would expect that the index would go the other way around, to the detriment of Japan. It is true, on the other hand, that Japan has a very small percentage of obesity and heart disease.

 

Thanks for the comparison. Yes, you are correct Sweden did not protect their vulnerable. As I said, very few Covid deaths in the aged were even hospitalized initially. There are probably hundreds of reasons for the differences. My point is the only reason isn’t Sweden’s lack of authoritarian mandates.

I find it interesting people get there panties in a wad over Sweden allowing citizens to make their own decisions but don’t bat an eyelash at letting older folks die without even admitting them to a hospital. It’s weird. Why do you think that is?

 

Because the death of an old man is never a tragedy?

Because quality of life for those still living is important?

 

Sure, they made some big mistakes their neighbors didn’t. Probably the biggest was not closing their borders. All three Nordic neighbors did so early. Same with schools I believe. Look at countries etc. that closed borders hard early, especially countries that are islands or well isolated. Japan as you bring up, Australia, New Zealand, even Hawaii. In fact, not closing borders is the biggest mistake every hard hit country made in my opinion. I’m not trying to argue Sweden didn’t mess up. I’m pointing out their main mess up wasn’t not failing to go full authoritarian on their citizens. It bothers me to see most people blame lack of domestic authoritarianism alone for differences when it’s actually only a small part of the difference. I think you and I agree protecting borders is not overreach by government, but instead one of government’s few legitimate functions.

I don’t think they would ever equalize. The early death rate from not treating elderly early would still stand out as well as the problems with immigrant neighborhoods like Tensta that I mentioned earlier. Just like NYC death rate isn’t ever going to equalize with my state. Heterogeneity that affects infection rates will affect death rates as well as errors in treatment of cases. There are factors I’ve yet to detail here that could be huge in determining IFR of C19 in different demographics. One of which is T cell regulation development from childhood exposure to pathogens. Even use of antibiotics in the first 5 years of life is linked to T cell regulation problems later in life. Yet the only things ever mentioned in relation to success or failure of countries or states with C19 is mask usage, political persuasion, or some metric of authoritarianism. To be clear again, my point isn’t to excuse incompetence where it’s occurred. It’s to point out attributing heterogeneity of results that are unrelated to that incompetence is disingenuous and dangerous because it shuts off the thinking process. Attributing all results to one or two causes in situations like pandemics is not wise as it ends our ability to learn about the factors we can’t or won’t acknowledge. Not learning about those metrics will have negative consequences in the future.

I love analogy and you are skilled at creating them. This one makes a good point. But I would add, the team from across town could be made up of immigrants who have been steeped in soccer for generations and the losing team may be made up of 10th generation US kids who are playing soccer just because they aren’t big enough for football. We don’t know that. Same as we don’t know all the reasons some places have more C19 deaths than others. Take my state of Nebraska compared to Michigan. Lots of differences I’m sure. The only one emphasized it seems is how great Michigan was at mandating behavior. Yet Nebraska with comparatively minuscule restrictions from the state has about half the deaths per capita. And almost half the unemployment rate as well. We can find numerous examples where one or two mitigation practices seems to have worked and numerous examples where the same things did not work regardless of the coach.

Japan and other Asian countries are interesting. I’m pretty convinced an infected mask wearer in Japan is much less likely to infect someone else than an infected American mask wearer. I don’t think most Americans have the patience, attention to detail, or knowledge/understanding of systems approach to problem solving to wear masks effectively no matter how draconian the penalties for non compliance. And again, closed borders on island nations is certainly one key to success in pandemics.

To speak to Japan specifically, who is aware most mitigation there is voluntary? Who was aware Japan has done practice runs of social distancing and cessation of unnecessary activities?

This cultural voluntary cessation of normal life was practiced in 2011 after the tsunami and was called for in the spring to deal with Covid.

Also, Japanese culture is a bit different than say Italian culture in respect to distancing and spit swapping. But of course, what do we hear is solely responsible for Japan’s success? Masks that aren’t even mandated there.

When all is said and done, I think the failure of the US will be because we were too narrowly focused on certain factors while ignoring others. That’s just my opinion based on observations.

 

I'm aware that in Japan the government simply ASKED the people to wear masks. 97% did.
You are aware that I am for educational campaigns (we had none that I know of) rather than authoritarian measures.
I also do firmly believe, with good and solid scientific evidence, that the right kinds of maks worn properly do decrease the relative risks of transmitting and catching the disease.
You are right that the analogy shouldn't blame the coach by default and not look into skilled players attending the other high school. But I did say, the HS that fired the coach only had kids slightly slower than the other school. That was meant to mean that they were similar in skills, slightly worse for the losing school, to account in the analogy for your indexes of slightly higher density, diabetes, heart disease.

 

Yes, when it’s all reduced in the bottom of the pan we agree on the basics—from masks to authoritarianism. I believe we discussed educational campaigns in relation to vaccines as well. And that isn’t happening either as far as I know. But I don’t consume much media so could be ignorant on the matter.

 

No educational campaigns at all.
I suspect that Trump will want credit for the vaccines but won't want the pandemic to actually end, because he is practicing a scorched earth strategy and wants to sabotage the Biden administration. So I don't expect any educational campaign while he is in office.

 

I’m surprised he has such strict control over state and local health departments. He’s usually criticized for being too “hands off”. You would think some state or locality would think of using some of that CARES act money they can’t figure out what to do with for an educational campaign.

 

I'm not one of those people, so I can't help you.

Maybe you can help me - why do people continually feel the need to defend a failed strategy in Sweden that has unnecessarily cost thousands of lives when there are MUCH more successful examples of how to handle the pandemic literally right next door? Can you give me some insight into the logic there, because defending failure while ignoring success makes zero logical sense to me.

 

That is false on SARS.

2003: SARS
First identified in 2003 after several months of cases, Severe Acute Respiratory Syndrome is believed to have possibly started with bats, spread to cats and then to humans in China, followed by 26 other countries, infecting 8,096 people, with 774 deaths.

SARS is characterized by respiratory problems, dry cough, fever and head and body aches and is spread through respiratory droplets from coughs and sneezes.

Quarantine efforts proved effective and by July, the virus was contained and hasn’t reappeared since. China was criticized for trying to suppress information about the virus at the beginning of the outbreak.
https://www.history.com/topics/middle-ages/pandemics-timeline

 

https://www.worldometers.info/coronavirus/

I don't see where Sweden is worse or better for what they did to the pandemic fight.

They are 42 in total cases per 1M pop.
They are 22 in total deaths per 1M pop.

USA is about 10th in both categories.
Per the above link.

 

Yes, one would think so but apparently nobody is interested. Half the country thinks that it's a hoax. I'm appalled. When I watch international TV I see NUMEROUS public health announcements teaching the population. Nothing, here. It's preposterous. All these governors issue these mandates, nobody thinks of, instead, trying to educate the population.

 

I’m not one of those people so I can’t help you. I’m only interested in truth and facts. When I see misinformation I attempt to correct it. I’ve never defended Sweden, just corrected a few of the lies told about Sweden. I know I’m a rare bird, caring about correct information as opposed to accepting popular narratives based on falsehoods. But that’s who I am.

If you actually read my posts you will see I pointed out Sweden’s failures and the neighbor’s successes. Ones you were never even aware of. I’m here to educate, not regurgitate media narratives.

 

Absolutely. Missouri is going to spend a bunch of CARES money on promoting tourism. I **** you not. Have to get rid of it somewhere or you can’t keep it. Many states are giving a lot to higher education. Fine. That’s cool. But none that I can see spent on educating the general public.

 

What's to educate? Wear a mask, and social distance. Even a 5 year old should be able to get it. Problem is(69% of people have reported wearing a mask) is that it's a virus, not a choice. Sometimes, stuff just happens and you end up getting sick anyway.

 

Specifically we were referring to vaccination, but from what I’ve seen the few times I’ve been in public very few are wearing a mask properly in conjunction with social distancing. On average masks are causing people to not social distance much at all. The amount of misinformation I see here at PF makes me think states and local health departments could certainly provide a valuable service in information campaigns. More local is better in my opinion. Few trust the federal government anymore for good reason.

 

Finally! Here is what Alex Azar said today:

"We have got a very large public affairs campaign in the works. I hope we'll be on radio this week and getting on TV soon thereafter to help educate people about these vaccines," Azar said. "One interesting thing: we actually had to go back to the, as we call it, white-boarding on these campaigns, because the Moderna and Pfizer vaccines are so highly effective in these clinical trials, we've actually had to make some edits to our campaign materials to take account of that."