
Sweden's unusual response to coronavirus - imartin2k
https://www.bbc.com/news/world-europe-52076293
======
alkonaut
The reports of “business as usual in Sweden” are exaggerated. The end results
are pretty similar across Scandinavia despite approaches being officially
different. Streets are mostly empty. People do walk outside as there is no
lockdown or shelter-in-place, but restaurants are mostly empty or closed, ski
resorts are closing, travel is “not recommended” even domestically and so on.
The restrictions are based on recommendations and personal responsibility.
Trust in authorities is high.

You’ll always be able to find people that won’t follow recommendations (So
taking clickbait pictures of people drinking isn’t difficult).

I think the gradual approach might mean we are always “one step behind” since
the idea is to introduce measures as they are needed, which you notice two to
three weeks after you need them. That’s my fear, at least.

On the other hand I think we’ll se authorities facing the opposite problem in
Italy and elsewhere when lockdown needs to continue for longer than people
accept (already reports of this). In the end I think we’ll see that
differences will be small between countries despite varying policy, and that
policy will converge to the successful ones.

I hope authorities will be quick to introduce further restrictions _if_ and
when they are needed. More importantly I hope people are doing this _before_
authorities require it, if reports of healthcare overload appear.

Looking at the curves now, I’m pretty satisfied, but again if they start to
point north further restrictions need to be introduced two weeks back in time,
which is difficult even for our trusted authorities.

~~~
jariel
This is really interesting.

It could be that Swedes are following the norms established everywhere else,
even if 'lockdown' orders are not that hard.

In Quebec, restaurants started to empty out long before they were ordered
closed.

I can absolutely see information workers working from home without the order.

So it may be the the 'de-facto' situation in Sweden is quite similar to that
of other places on soft lock down.

~~~
reaperducer
_It could be that Swedes are following the norms established everywhere else,
even if 'lockdown' orders are not that hard._

Or it could be, as the article noted, that more than 50% of households are
just one person.

~~~
alkonaut
And no households consist of elderly living with younger relatives. That at
least helps isolate the old from the rest.

------
Hokusai
Sweden is quite different from other countries, that explains the slow spread
of the virus.

Many companies allow employees to stay home for minor flu symptoms of the
employee or their children. You will be fired in countries like Spain if you
remained home so often. (update: I mean that you can do this always, not just
now because the new virus)

Stockholm, the "big" city, has 2.5 million habitants in its extended
metropolitan area. So, not so big. Swedish are not in love of big gatherings.
Cultural behaviour than is the opposite than that of Italy or Spain.

All my friends at companies like Electronic Arts, Epic, King, Klarna... are
already working from home. Stockholm is a technological hub. Office work has
been moved home fast and eficciently thank to the tradition of “VAB'ing”. In
any given meeting some one is working from home, anyway. The subway is emptier
than ever. Many companies have shut down offices and operations continue from
home. But, that is something that you do not read in the news.

The virus growth is exponential, we may not need complete isolation just yet.
Probably it is just a matter of time. So, getting to conclusions right now is
premature.

~~~
Symbiote
Denmark is roughly the same, culturally and regarding worker's rights, yet had
a very strong response from around 12 March.

~~~
hedgew
Finland and Norway have also had much stronger responses than Sweden.

~~~
EmilStenstrom
What does "strong" mean in this case? The health care department issues
statements in Norway that politicians were not acting on their
recommendations, but rather that they were making "political decisions". I
guess they want their population to look at them as strong leaders. We should
not confuse that kind of strong, with measures that elicit a strong decline in
cases. We only need the latter right now.

~~~
scandinavegan
Same thing with Denmark. Their Ministry of Health said that closing the
borders was a political decision and not based on public health.

Sweden has stayed consistent with what experts have been saying. There's no
use in closing the borders when the virus is already in the country.

Same thing with outlawing movement in and out of Stockholm. There's already a
very clear recommendation and instruction to avoid travel within the country
to avoid spreading the virus. There's no real way of enforcing a full
quarantine unless you divert police officers who could be doing other things,
or the military which we are reluctant to do (see Ådalen 1931, which is a
reason why you don't want armed military to interact with citizens).

~~~
Dahoon
>Sweden has stayed consistent with what experts have been saying

Letting up to 499 people gather freely is not what experts will tell you is
the way to stop this, so clearly they have not. If anything Sweden is among
those that have listened least to medical experts. Norway and Denmark is
following the advice much closer, closing borders or not.

~~~
otippat
The maximum number of invidivuals allowed in public gatherings has been
lowered to 50, after being requested to do so by the Swedish public health
agency.

------
hedgew
All the Nordic countries underestimated the pandemic. Norway switched their
goal from mitigation to suppression a few days ago, Finland is still teetering
somewhere in between, and Sweden is solidly in the mitigation camp. Government
officials in these countries seemed incapable of accepting just how horrible
the situation is, so they only created optimistic models of the pandemic.
Finland and Norway have released more and more pessimistic models each week,
while Sweden has kept theirs secret for some reason.

I fear Sweden is still basing their approach on those optimistic models, that
likely don't apply to this particular pandemic. They seem to be making the
same mistake UK did, except they haven't changed paths yet. They say they are
only doing what is "scientifically proven", without realizing that peer review
and randomized controlled trials alone are not enough for situations where
decisions need to be made in short time with imperfect information.

~~~
Hokusai
> All the Nordic countries underestimated the pandemic.

All countries underestimated the pandemic. From China to the United Kingdom,
USA or Italy, every country underestimated it. The main difference is the
attitude once lock downs are needed.

Maybe South Korea was the exception. But, South Korea is a high-income country
in a permanent war with its north brother. The country is probably prepared
for a biological attack similar to a pandemic. And, even South Korea seems to
have lowered its standards and cases are growing up.

> I fear Sweden is still basing their approach on those optimistic models

Yes. It is surprising how everybody is blinded by exponential growth. "It is
just 10 cases, it is just 50 cases, it is just 125 cases, it is just ... oh
shit!"

~~~
gurkendoktor
There is at least one country that didn't underestimate the virus - Taiwan,
which was way ahead of the WHO at every step: warned about human-to-human
transmission at the end of 2019(!), quickly ramped up travel restrictions,
immediately mobilized to mass-produce masks.

The vast majority of new cases in Taiwan are imported now, and everyone coming
back has to self-quarantine for 14 days.

~~~
tooltalk
how about Vietnam (174 cases and no death so far)? It shares physical border
with China and the country's health system, much less response to the
pandemic, threadbare; yet they have fewer cases than Taiwan.

IMO, I think it's very difficult to draw any important lessons from countries
that are warmer climate like Taiwan, Singapore, Vietnam, or Thailand.

~~~
gurkendoktor
The grandparent was talking about taking the risk seriously - you can say that
about Taiwan no matter its climate.

My gut feeling is that the culture of wearing masks, not shaking hands etc. is
just as important of a factor as the climate. I guess we'll find out by
observing cooler Japan.

------
tobr
> After a long winter, it's just become warm enough to sit outside in the
> Swedish capital

A “long” winter? It‘s been a record-breakingly mild winter. It felt like we
went from autumn, through a weekend of snow, directly to spring.

~~~
eMSF
Disregarding Leap Day, it's been the same amount of days since last September
as every other year, and while there has been little snow or freezing
temperatures, it was still rather too cold to comfortably sit outside all
winter (winter Sun intensity plays a role too).

~~~
cjblomqvist
Meteorologically, there's a definition of when winter starts and ends.
According to that definition it was one of the shortest one in Sweden in a
long time.

------
BaronSamedi
I think that in hindsight Sweden's approach will look reasonable. The data we
have now, imperfect as it is, shows that the elderly are the main risk group
and therefore the ones needing special protection. The South Koreans have very
good data and publish it daily. Their recent CFR numbers by age group are:

80+ 17.51%

70-79 6.77%

60-69 1.74%

50-59 0.56%

40-49 0.08%

30-39 0.10%

0-29 0%

The data from other countries matches this distribution. Keep in mind that the
CFR is what we have but not the number we want. The one we want is the
infection fatality rate (IFR). This is the number of deaths divided the total
number of cases (not just the reported ones). The IFR numbers are likely to be
lower due to the fact that widespread testing is not in place in many
countries.

~~~
ricardobeat
Only if you ignore the overloaded-healthcare-system factor, which is the main
reason for lockdowns, not the number of deaths.

~~~
BaronSamedi
Not ignored, I just cannot find any good data on hospitalization rates by age
group nor the associated stats. These figures also do not take into account
pre-existing conditions which greatly influence the CFR.

------
aazaa
Looks like Sweden doesn't stand out much in its case growth compared to
neighbors:

[https://aatishb.com/covidtrends/?country=Finland&country=Ger...](https://aatishb.com/covidtrends/?country=Finland&country=Germany&country=Norway&country=Sweden)

~~~
user_50123890
Don't look at case growth. That is limited by testing capacity/policy. Look at
deaths.

~~~
dijit
And Sweden is not testing people either.

The way it’s being communicated to me is that by testing people they will
bring more people together and thus spread the virus.

~~~
Gwypaas
Yes, from what the government agencies communicate they most closely look at
the number being admitted to ICUs per day, which has actually been declining.

------
paul_f
Honestly, while it's wouldn't be my choice, I am glad someone is running this
test

------
listsfrin
When I was in med school you didn't die because of the flu. People died
because they had diabetes or HTA which got some complications like low
immunity, a failing kidney and so on.

Did these things change in current medicine?

~~~
DanBC
Covid-19 seems to hit a population by first of all killing all the people who
are pretty ill even without covid-19. Lots of people die from covid-19, but
those people would probably have died later that year anyway, so there's not
much excess mortality.

Then, like all winter time respiratory illness it kills people who have
comorbidities that probably wouldn't have killed them without covid-19. The
people with moderate but well controlled asthma or diabetes -- the chronic
conditions that we don't think of as life-ending.

Then the ICUs start feeling pretty overwhelmed, and the ages of the people
dying gets lower, and they have fewer and less severe comorbidities. Maybe
only a small percentage of these people die, but covid-19 infects so many
people that this small percentage of a very large number ends up being pretty
large.

This is the point healthcare systems start building field hospitals in sports
halls or convention centres. It's when they requisition ice rinks to act as
temporary morgues. They start locking down movement just to try to reduce this
very large number of people getting infected.

ICU doctors and nurses are now overwhelmed, and they're improvising PPE out of
binbags. They're reusing PPE using weird new sterilisation techniques. Other
HCPs have less access to PPE, because it's all been used up. Where they would
have had FPP3 and eye-shields they now have a plastic apron and a loop
surgical mask.

And they're faced with something they feel like they should be familiar with
(pneumonia is pretty common) but which doesn't act like other types of
pneumonia. Here's one example, but there are loads more:
[https://twitter.com/iamyourgasman/status/1241267189048578048](https://twitter.com/iamyourgasman/status/1241267189048578048)

> When I was in med school you didn't die because of the flu.

The real situation is a bit more complicated than that, isn't it? Plenty of
people die from flu, and it's the flu that kills them, and we have medical
statisticians who can tell us what the excess mortality is each year.

~~~
jariel
"Lots of people die from covid-19, but those people would probably have died
later that year anyway, so there's not much excess mortality."

This is simply false.

The most extensive research here, posted in HN yesterday indicated that Corona
represents about '1 year of living' worth of risk for individuals.

It's killing a lot of people with 'conditions' who would otherwise live a long
time.

~~~
DanBC
Did you ignore the rest of my post, where I spend a lot of time talking about
all the other people who also die from covid-19?

------
tinyhouse
Someone told me old people in Scandinavia not going to the doctor when they
are sick (unless it's very bad). It's a cultural thing. I guess it helps when
there's a pandemic like this.

------
100-xyz
Looks like even Batman is affected :-)

[https://toonclip.com/player?key1=4de7921623](https://toonclip.com/player?key1=4de7921623)

------
rasz
UK had the same "unusual" approach, and look at them now after two weeks.

------
gregoriol
Since the travels from abroad are all stopped now, there is less chance for
the virus to get there. Maybe they'll be lucky enough to be the last ones
without the large outbreak, and all the others being locked down won't bring
it there?

~~~
digikata
I think there is little "getting lucky". If they also run an intense detect,
test, and trace capability it might be effective. If they rely only on border
lockdowns, or lockdown and lackadaisical test/trace then it would likely be
insufficient.

------
jdjriekfkf
Everybody's brave until the deaths start to mount. Let's check again in two
weeks.

~~~
martinhath
We don't need to wait two weeks; Sweden has significantly more deaths (110)
than any of it's neighboring countries: Norway (25), Denmark (72), and Finland
(11).

[0]: [https://www.corona.cloud/](https://www.corona.cloud/)

~~~
wodenokoto
Swedens population is almost twice of Denmarks, so I am not sure saying 110 is
signifcantly more than 72.

~~~
martinhath
Denmark is also about 5 times as dense, so one could easily attribute the
death number to that.

~~~
Gwypaas
I think the numbers are within margin if you measure what actually matters;
urbanization. The huge swaths of empty forests up north in Sweden makes the 5
times number look ridiculous but doesn't carry any meaning.

Looking at urbanization:

Denmark: 87.5% [0]

Sweden: 87.4% [1]

Another statistic is Copenhagen Metropolitan area compared to Stockholm, which
both is about 2.5 million. Though Copenhagen jumps to 4 million if you go by
the Öresund region including parts of Sweden. [2]

[0]: [https://www.statista.com/statistics/455812/urbanization-
in-d...](https://www.statista.com/statistics/455812/urbanization-in-denmark/)

[1]: [https://www.statista.com/statistics/455935/urbanization-
in-s...](https://www.statista.com/statistics/455935/urbanization-in-sweden/)

[2]:
[https://en.wikipedia.org/wiki/%C3%98resund_Region](https://en.wikipedia.org/wiki/%C3%98resund_Region)

------
dmh2000
Sweden's mortality rate (2.97) is significantly higher than Germany (0.78),
South Korea (1.59) and the US (1.75) among others. As of 3/29/2020
[https://www.statista.com/statistics/1105914/coronavirus-
deat...](https://www.statista.com/statistics/1105914/coronavirus-death-rates-
worldwide/)

~~~
Gwypaas
Sweden has since March 13th stopped testing except those who requires hospital
care, so the numbers are not comparable in any way.

~~~
lawn
The government announced today they want to increase the testing again, but
how much or when is yet undecided.

~~~
Gwypaas
Wasn't the government generally simply approving of more tests as long as it
doesn't implicate the care?

The push was launched by the main opposition party to be able to open the
economy earlier.

~~~
lawn
As I understood it the government tasked Folkhälsomyndigheten to hurriedly
create a plan for how testing could be increased.

