
Stockholm to reach herd immunity in May? - jamesblonde
https://www.nrk.no/urix/tegnell_-_-det-kan-bli-flokkimmunitet-i-stockholm-i-mai-1.14984679
======
jlundborg
Swede here. There is lots of disinformation about the Swedish approach to the
epidemic. Sweden is following the same basic strategy as other countries,
which is to slow down the spread by mitigating actions so the health care
system can cope and to protect people in risk groups. The primary difference
in Sweden compared to outher countries are:

* Sweden decided early on that an evidence-based approach should be followed. Many policies that are implemented in other countries do not have a lot of evidence showing their effectiveness

* Policy is still primarily dictated by the experts at Folkhälsomyndigheten (where Anders Tegnell is from), and not by politicians. Most actions taken by the Swedish government has been pretexted by "as requested by FHM we have...". State epidemiologist Anders Tegnell is generally seen as "being in charge" of the actions taken, even though technically he has very little legal authority.

* Sweden has a very strong history of indepenent government bodies. In Sweden, there is specific legislation preventing government officials from intervening in specific cases if there is a government authority in charge of the issue. The legal term for this is "ministerstyre", "ministerial rule", and even if an action is not technically in violation of this legislation, it is often used if politicians try to intervene in cases without creating general legislation.

* Being a high-trust society some measures that have been implemented as strict laws in countries other than Sweden are instead communicated as recommendations with a very high compliance rate.

~~~
thinkingemote
Can you expand upon the policies that have little evidence of effectivness
that are being done by other countries. are Swedes also aware why the other
countries are doing this?

Is it fear / politics / bad science etc?

~~~
jlundborg
I think the most obvious examples are:

* Closing borders when we already have a pandemic in all countries. Swedish borders are still open.

* Closing schools when most evidence shows that it is not effective. Swedish schools are still open.

There is of course lots of debate about this in Sweden, some are worried that
Sweden is not taking enough decisive action. There is however a wide-spread
general support that the more measured approach in Sweden is a good one.
Anders Tegnell has become a very popular public figure for his low-key
bureaucratic but yet humoristic way of explaining the uncertainties involved
and why Sweden is doing things this way.

I believe that the reasons these measures are taken in other countries is
because it is a way to show strong political leadership in a time of crisis. I
think this approach works less well in Sweden because people have very high
trust in experts and (well-managed) authorities.

~~~
marxama
Aren't high schools and universities still closed in Sweden?

Edit: Run remotely, to be clear.

~~~
yesbabyyes
There is a strong recommendation that high schools and universities handle
their education remotely.

This recommendation is followed. The Swedish government cannot order schools
to be closed (a law was quickly put in place in the case that this be
necessary. I'm not sure that it pertains to universities, though).

------
imartin2k
German here who moved to Sweden in 2006. Since January, state epidemiologist
Anders Tegnell has constantly made claims which turned out to be inaccurate,
misleading or at least overly optimistic. Among the more devastating ones is
that he in an interview on February 8 stated that "there is absolutely no risk
for coronavirus when traveling to skiing vacations in the Alps/Southern
Europe". To me, such a lack of foresight as an epidemiologist alone
disqualifies him from the heavy role he has. Therefore, I don't take any claim
he makes seriously. Sadly, he loves media appearance and seems to be giving
interviews all day long, every day. So it's totally impossible to escape those
claims. They are everywhere.

Shockingly, his display of (partial?) incompetence has hardly impacted the
credibility he enjoys among large parts of the Swedish society. In fact, many
people totally love him. That's something I just cannot comprehend. To me, it
looks like mass hypnosis.

My personal stance by now is that I'm not following the Swedish Health
Agency's recommendations, but the German authorities', which I consider more
trustworthy and competent (based on the absence of a track record of false
predictions, a respect of cautionary principles, and an absence of exaggerated
self-assurance). However, I don't like feeling that way. Usually I'm
"emotionally" only reverting back to my native country when it comes to the
Football World Cup :)

~~~
jlundborg
I'm very sorry to hear you are not following the recommendations of Swedish
authorities, I would strongly recommend you do, because they are contrary to
what you claim here, not actually based on Tegnells personal whims or vanity,
but based on the many experts employed at the agency, and more importantly
adapted to local circumstances in Sweden, such as the current stage of the
epidemic, which areas are most affected and so on. As long as the German
recommendations are stricter this is of course not that problematic, but it
could mean you pay less attention to things that are more urgent to adress in
Sweden.

~~~
notacoward
> based on the many experts employed at the agency

How can you make an appeal to authority while denying any non-Swedish
authority? Are Swedish authorities just better then those anywhere else? Hm.

------
nabla9
Roughly million people live in Stockholm and 2.4 million people liven in
Stockholm metropolitan area.

Assuming R0 = 2.5, you need (1-1/R0) = 60% of the population to be immune for
herd immunity. That would be 600,000 in Stockholm, 1.4 million people in the
metropolitan area, 6 million for Sweden.

Assuming the same infection fatality rate 0.002 as Finnish national health
organization estimates: 1,200 deaths in Stockholm, 2,800 in the metropolitan
area, 12,000 in Sweden. Currently there are just 1,400 total covid-19 deaths
in Sweden.

~~~
hedgew
I wouldn't place too much trust in the Finnish IFR estimate. Their IFR
estimate a month ago was 0.05% - 0.1%. At the time there was no data to
support that, and it turns out that they had simply taken their estimates from
a ten year old pandemic preparedness plan, which was designed for an influenza
pandemic.

It was basically the same mistake UK did. Now they have very slowly begun to
adjust away from the misleading path they originally set on.

The Finnish national health organization has been subject to severe budget
cuts for the past ten years. They are still saying that masks do more harm
than good, and that it's absolutely impossible to stop the virus, despite
South-Korea having done so for almost 50 days already.

~~~
nabla9
Their updated estimate is similar to ones from Iceland (mass testing) and
others. More people than expected go trough the disease without symptoms. At
least 50%.

The math goes as follows:

\- 60% need to be infected for herd immunity.

\- At least 50% of infected show no symptoms.

\- CFR is 0.7%.

0.6×0.5×0.007 = 0.002

(This math assumes that everyone without symptoms is a diagnosed case, so
overestimte)

------
Havoc
They haven’t even been hit that hard. Skipping the whole infection and death
stage of this process doesn’t seem particularly realistic. People forget a key
element of herd immunity: the immune ones are what’s left stand after the
carnage

I’d expected the UK Spain and France to hit herd immunity first

~~~
stock_toaster
> People forget a key element of herd immunity: the immune ones are what’s
> left stand after the carnage

Has it been concluded that people do actually retain longterm immunity? I was
reading[1][2] previously that there isn't proof yet that immunity afterwards
is retained for long. Seems still too early to tell.

ref:

[1]: [https://abcnews.go.com/Health/questions-remain-
covid-19-reco...](https://abcnews.go.com/Health/questions-remain-
covid-19-recovery-guarantee-immunity-reinfection/story?id=70085581)

[2]: [https://www.theguardian.com/world/2020/apr/17/coronavirus-
fi...](https://www.theguardian.com/world/2020/apr/17/coronavirus-five-months-
on-what-scientists-now-know-about-covid-19)

~~~
homarp
one more: [https://www.scmp.com/week-asia/health-
environment/article/30...](https://www.scmp.com/week-asia/health-
environment/article/3080251/poor-immunity-or-mutations-south-korea-
investigates)

------
HissingMachine
The plan might face problems from time and economic perspective. Reaching herd
immunity level might take way too long, even years, during which time most
other countries are opening back up using mitigation strategies. Sweden
meanwhile might be under travel restrictions imposed by other countries to
ward off second wave, hindering their economy far longer than other countries.

It really does seem like a gamble, and I don't appreciate governments taking
gambles.

~~~
nabla9
Sweden is also using mitigation strategies, just slightly less than other
countries.

~~~
WJW
Compared to some of the southern countries (where three generations of a
family regularly live together in one house), the Swedish population was
already fairly distanced. See also [https://www.politico.eu/article/social-
distance-swedish-styl...](https://www.politico.eu/article/social-distance-
swedish-style/)

------
ollysb
Herd immunity isn't going to work if reinfection is possible
[https://edition.cnn.com/2020/04/17/health/south-korea-
corona...](https://edition.cnn.com/2020/04/17/health/south-korea-coronavirus-
retesting-positive-intl-hnk/index.html). Even if there's some protection (e.g.
6 months) it will be extremely difficult to maintain herd immunity.

~~~
thinkingemote
Given that we don't know if either is possible as it's too early, what should
we prepare for now?

It's a bit of precautionary principle, but the answer is not "plan nothing"

------
cipher_system
He is not exactly saying or promising heard immunity in May but that they do
have some mathematical models that point to that. He also states the caveat
that these models are only as good as their input values and he doesn't sound
confident about the correctness of those.

------
tomohawk
As much criticism as has been leveled at the approach in Sweden, you would
think Sweden would be doing far worse than other countries. It appears
actually to be doing better than average.

[https://ourworldindata.org/grapher/new-covid-deaths-per-
mill...](https://ourworldindata.org/grapher/new-covid-deaths-per-
million?tab=chart&time=2020-03-08..&country=BEL+FRA+ITA+ESP+SWE+GBR+USA)

So, the approach appears no worse than what others are doing, and likely has
fewer side effects.

------
jamesblonde
Ok, so the interview is in Swedish (and Norwegian), but it is with Sweden's
state epidemiologist at the Public Health Agency. He indicates that they have
been taking antibody tests the last week as the basis for his prediction of
flock immunity some time in May in the Stockholm region.

~~~
martinald
As far as I'm aware the antibody tests are really unreliable? At least the
millions of tests the UK bought are not being used for that reason.

~~~
mjw1007
In principle even if the tests are unreliable in individual cases, if the
false positive and negative rates are known sufficiently well it ought to be
possible to use mass results to get an accurate estimate of the prevalence of
what they're supposed to be measuring.

~~~
jamesblonde
He said they tested people for immunity (my interpretation was antibody tests,
maybe i was not correct in the actual type of test - but they are testing for
"immunity" (antibodies?), somehow).

------
jerng
Herd immunity implies herd infection. I am sure you are already aware of the
mortality rates for infected citizens. All the best to this test. You are
taking one for the global team. #forscience

------
jpxw
Here are the issues with the herd immunity strategy:

\- The R0 of this virus is higher than we once thought. The median R0 reported
here is 5.7.
[https://wwwnc.cdc.gov/eid/article/26/7/20-0282_article](https://wwwnc.cdc.gov/eid/article/26/7/20-0282_article)
\- This means that some 80% of the population would need to be infected before
reaching herd immunity \- This also means the peak of infections would be far
more concentrated. \- Even with R=2.5, the number of hospitalisation necessary
in an unmitigated peak would utterly overwhelm any health system \- This
overwhelming situation would mean a lot of people who otherwise would survive
with medical treatment (oxygen etc) would end up dying

------
sovande
Preparing for the previous war is a classic mistake. This is irresponsible by
Sweden without more data on the virus. New reports indicate that we don’t
develop enough antibodies for herd immunity to be an option and it is even
worrisome w/r to developing a vaccine. [https://www.reuters.com/article/us-
health-coronavirus-immuni...](https://www.reuters.com/article/us-health-
coronavirus-immunity/who-unsure-antibodies-protect-against-covid-little-sign-
of-herd-immunity-idUSKBN21Z2XM)

