
The epidemiologist behind Sweden’s controversial coronavirus strategy - vanilla-almond
https://www.nature.com/articles/d41586-020-01098-x
======
kqr
One thing is missing from this discussion that needs to be understood: the
Swedish government and related agencies generally _do not do things based on
common sense_.

This may sound ridiculous, but in most cases, it's not. Common sense is wrong
so often. The view of the Swedish government is that they are not more
intelligent than the citizens. Unless things can be scientifically proved, the
individual rights of citizens should not be restricted.

This permeates a lot of public policy in Sweden; I recently had reason to
investigate to what extent maternal/neonatal care followed the best of our
scientific knowledge and it was extremely close. If you think that's a given,
think again. Many countries base their maternal/neonatal care on common sense
and old wives' tales instead.

Both approaches are valid, but they are different. With policy based on common
sense, you accept that you occasionally (often?) force something wrong on the
public, potentially against their better knowledge. With policy based on
strong evidence, you are more rarely wrong, but you also get way fewer
opportunities to force things on the public, simply because there are so few
things we truly know to be true. Doubly so during a novel pandemic.

~~~
marvin
There is a dark side to this. Scientific consensus follows certain rituals and
heuristics. Even if you can assume that the scientific consensus is the
closest to truth you can get (this is debatable), the approach will fail in
some situations.

In particular, in war-like situations where there is little published science,
data is scarce, data changes fast and there are policy considerations to be
made across a multitude of disparate fields - fields that can not all be
quickly evaluated with the scientific method.

IMHO, as I've been saying throughout this crisis, many institutions that do
well in peace-time are in a terribly dangerous situation when they follow
their normal heuristics and routines today. Strong top leadership (political
or otherwise) can mitigate this danger.

~~~
s1artibartfast
Given that Scientific consensus has limitations, what do you propose is better
in situations where data is scarce?

How does a strong leader mitigate this danger? Is the leader making choices by
following their intuition? Does the leader make choices based on public
sentiment?

~~~
hansvm
One possible mechanism by which strong leadership could be more effective is
that inaction and uncoordinated action can be less effective than any
coordinated decision, regardless of whether that decision happened to be
optimal.

I don't know how often this happens in a pandemic or in a political setting,
but as an example from software engineering bikeshedding seems somewhat common
-- it probably doesn't matter whether curly braces get a new line, but there's
probably a benefit to only doing it one way in a codebase. Not that strong
leadership is the only path to resolution either, even accepting that some
cohesive decision needs to be made, but it does solve that class of problems.

~~~
cycomanic
Strong leadership and science are orthogonal dimensions. You can have strong
leadership that makes decisions based on evidence and scientific arguments, or
not. I would argue the first is always better than the second.

Again in the current crisis the decisions based on scientific evidence
(pandemic models developed previously) was to act early and quickly with lots
of testing. Most countries did not follow this, but I would say this had
nothing to do with what the "scientific approach" was.

Somehow people here conflate scientific with need to wait/establish all
information.

However in the end science is a method to establish truth/knowledge about the
world around us. It can guide our decisions, but it's not a decision making
method.

------
kenneth
It's notable as well when evaluating Sweden's number is that they are far more
trustworthy than most countries. One interesting metric is excess mortality.
Some places have wild unexplained excess mortality from the statistical
expectation, that isn't fully explained by reported Covid-19 deaths. This
suggests that Sweden is reporting deaths far more accurately than other
countries, so when we evaluate the relative success of their strategy, we
should keep that in mind.

A chart published by the NYT:

    
    
        Location | % extra | excess death# | official C19 d# | unexplained difference
        Spain    |  66%    | 19,700        | 12,401          | ~ 7,300
        England  |  33%    | 16,700        | 10,335          | ~ 6,300
        NYC      | 298%    | 17,200        | 13,240          | ~ 4,000
        France   |  21%    | 10,500        |  8,059          | ~ 2,500
        Holland  |  33%    |  4,000        |  2,116          | ~ 1,900
        Istambul |  29%    |  2,100        |  1,006          | ~ 1,100
        Jakarta  |  36%    |  1,000        |     84          | ~   900
        Belgium  |  25%    |  2,300        |  1,632          | ~   700
        Switzer. |  21%    |  1,000        |    712          | ~   300
        Sweden   |  12%    |  1,100        |  1,160          | ~   -50

~~~
K0nserv
This table is missing Norway, Denmark, and Finland which would be the most
interesting to compare Sweden to.

~~~
goalieca
Sweden has a higher rate. The theory is that the bulge in death rate is bigger
up front vs a prolonged one that continues for months. It will be interesting
to see long term results. Sweden also seems to have the same problem with long
term care homes that many other nations (France, Canada, etc) are having.

~~~
marvin
Sad to say, I'm completely unsurprised that countries with rampant Covid19
spread have a lot of deaths in their retirement homes. It's practically
deterministic.

People are contagious in the pre-symptomatic or asymptomatic case. So all
that's needed is that _one_ employee of the retirement home gets sick and goes
to work before they know, and the game is up. Dead patients everywhere.

I'm sure this is discussed and considered on the highest levels of policy in
the jurisdictions that have been the most proactive in getting a handle on the
epidemic early, and missed in most others.

I'm sure a strict face mask policy could have helped slow things down, but
that's sadly been a hotly contested topic.

~~~
m4rtink
Many retirement homes here in Czech Republic have had the care takers
voluntarily locking themselves up together with the people living there. Some
have been there like this for many weeks, only taking in supplies in a safe
way & communicating electronically.

Thats some serious dedication & very prudent one, give all the tragic cases
elsewhere.

------
salimmadjd
There is a lengthier interview by UnHeard with Professor Johan Giesecke
(another experienced epidemiologist) of Sweden on YouTube [0]. It’s worthwhile
listening to their perspective.

One of the comments he made was that no lockdown would work in democratic
countries and the real test will be fatality rates between Sweden and others
in 1 year. He believed it’ll be very little difference between those countries
that have implement the lockdown and those that haven’t

I had watched the simulation of covid19 infection by 1blue3brown[1] and some
of his modeling appeared to me (maybe I misunderstood them) to confirm Swede’s
point of view.

Ultimately the same number of people got infected albeit in a “flatter” rate.
However one counter point by Johan Giesecke was that these flattening the
curve is motivated by the assumption of a static capacity of ER rooms to deal
with this pandemic and he pointed out they have increased capacity. Overall I
found listening to his side very informative, at least it gave me a different
view of looking at from their view.

[0] [https://youtu.be/bfN2JWifLCY](https://youtu.be/bfN2JWifLCY)

[1] [https://youtu.be/gxAaO2rsdIs](https://youtu.be/gxAaO2rsdIs)

~~~
bryanrasmussen
well when I look at Sweden
[https://www.worldometers.info/coronavirus/#countries](https://www.worldometers.info/coronavirus/#countries)
it has 16,004 total cases, 13,517 active cases, 550 total recovered, 515
serious/critical, total deaths 1,937

and Denmark has 7,912 total cases, 2,441 active cases, 5,087 recovered, 80
serious critical, total death 384

So what does that tell me?

1\. They have slightly over 12% death rate currently and Denmark has slightly
over 4%.

2\. They have very many active cases and no recovered cases yet so this makes
me think like all these people that have it right have just barely gotten it.
So it is a little bit early to talk about how successful it is (otherwise it
is time to talk about why is it taking so long to recover in Sweden if they
have had it a long time)

If indeed my supposition that they have just barely gotten all these cases and
have not had the time to let anyone recover so that means they don't know how
many of the people they have right now will actually recover or how many will
get critical and have life long complications or die and they are already at a
12% death rate with another 3.2% currently critical === HOLY HELL WTF!!

on edit: of course percentage death rate only for symptomatic cases we know
have it, there should be much larger portion of population that has it.

~~~
viceroyalbean
>They have very many active cases and no recovered cases yet so this makes me
think like all these people that have it right have just barely gotten it. So
it is a little bit early to talk about how successful it is (otherwise it is
time to talk about why is it taking so long to recover in Sweden if they have
had it a long time)

I'm struggling to find a good source on this, ([1] is the best I could find,
though it's in Swedish) but Sweden doesn't track recovered cases so that
number is meaningless.

[1] [https://www.mabra.com/halsa/friskforklarad-fran-
coronavirus/](https://www.mabra.com/halsa/friskforklarad-fran-coronavirus/)

~~~
bryanrasmussen
Ok, then less holy hell wtf. Although I think though most of the cases they
have are still relatively recent because I could swear I remember Sweden
having less numbers of people than Denmark with it about a month ago.

When I look at this chart of death rates they had 451 dead on April 2
[https://www.statista.com/statistics/1105753/cumulative-
coron...](https://www.statista.com/statistics/1105753/cumulative-coronavirus-
deaths-in-sweden/)

which argues a much lower number of cases back then (haven't been able to find
how many active cases they had then though, so I may be wrong)

I think this article is right on target

[https://www.project-syndicate.org/commentary/swedish-
coronav...](https://www.project-syndicate.org/commentary/swedish-coronavirus-
no-lockdown-model-proves-lethal-by-hans-bergstrom-2020-04)

on edit: added "then Denmark"

------
thawaway1837
The whole thing is clearly an attempt at a graceful exit.

The original strategy was herd immunity. The argument being made was that
Sweden was gonna get infected anyways, so better to get it out of the way
sooner rather than later, while protecting the at risk. And this would reduce
economic harm as well.

However, the Swedish decision makers seemed completely unaware of asymptomatic
carriers, which led to the at risk (largely old people) being heavily exposed
anyways due to the asymptomatic younger workers around them infecting them.

Further, the Swedish people, reflecting normal human behavior, shut down
economic activity anyways.

The result was a slight linear short term economic benefit but an exponential,
potentially long term, downwards public health situation whose economic
effects itself will likely dwarf the direct economic benefit anyways.

So now that their plan has failed both in concept and execution they are
changing their story saying that it was a Swedish cultural thing, where they
trusted individual Swedes to take personal responsibility, because of the
exceptional Swedish character.

~~~
deft
This is pretty much the opposite of what's happening. The herd immunity
strategy is working, antibody testing shows around 30% of Stockholm is already
immune, with their mortality rate comparable to many other countries and lower
than a few too.

The media that wants to paint this strategy as terrible and ineffective
(despite all evidence to the contrary) is now scrambling to come up with an
alternative explanation that allows them to say "but it wouldn't have worked
here". A special culture is the perfect explanation.

~~~
viceroyalbean
>The herd immunity strategy is working, antibody testing shows around 30% of
Stockholm is already immune

This isn't true (or, at least, isn't supported by studies). There was indeed a
report [1] published that claimed that 30% of Stockholm has been infected, but
it was a mathematical model and not antibody testing.

A study was recently published that showed that 11% of people in Stockholm had
antibodies, but that was retracted [2] (only have Swedish sources for this,
sorry) because the researchers didn't think that it was good enough.

[1]
[https://www.medrxiv.org/content/10.1101/2020.04.15.20066050v...](https://www.medrxiv.org/content/10.1101/2020.04.15.20066050v1)
[2] [https://www.svt.se/nyheter/inrikes/nya-antikroppstestet-
base...](https://www.svt.se/nyheter/inrikes/nya-antikroppstestet-baserat-pa-
osakert-underlag)

~~~
matthewdgreen
It was 11 out of 100 people, using an antibody test that's known to have some
false positives. So the error bars are huge. (The fact that this result has
metastasized into obvious nonsense is exactly why people should be careful
publishing incomplete scientific results.)

~~~
Kiro
This new test from Karolinska Institute cannot have false positives, only
false negatives. However, the way the test was conducted was indeed incorrect
(they accidentally included people who gave blood because they were infected
so it was not random). They will conduct a new test so let's see what that
says.

~~~
esailija
There is no such thing as test without false positives so that's your clue.
Especially antibody tests typically have 4% false positive, just a day ago
there was news that revealed 4% false positive for a test claimed to have
0.5%.

~~~
Kiro
My clue for what? I'm not the one who is saying this, it's Karolinska
Institute saying their new antibody test has no false positives:
[https://www.svt.se/nyheter/inrikes/11-procent-av-
stockholmar...](https://www.svt.se/nyheter/inrikes/11-procent-av-
stockholmarna-har-antikroppar-mot-covid-19)

------
etrevino
I'm an American, so the usual caveats apply, but I think more should be made
of this statement from the interview:

"The Swedish laws on communicable diseases are mostly based on voluntary
measures — on individual responsibility. It clearly states that the citizen
has the responsibility not to spread a disease. This is the core we started
from, because there is not much legal possibility to close down cities in
Sweden using the present laws. Quarantine can be contemplated for people or
small areas, such as a school or a hotel. But [legally] we cannot lock down a
geographical area."

If we take that as a given then the approach used in, say, Italy isn't doable.
Why not put that out there and let there be a public debate about the issue?
Is there a sense that this isn't the time?

Maybe there is a debate. I'm not exactly in touch with Swedish politics, so if
someone knows, I'd love to hear about it.

~~~
SketchySeaBeast
Isn't this whole process of debate and individual responsibility basically
irrevocably tainted in the age of mass misinformation? I don't know where we
get if we walk down this train of thought, probably nowhere good, but when a
not inconsiderable portion of the population has been directly targeted to
cause them to believe the whole thing is just Bill Gates fault, who magically
caused the Coronavirus and is holding back a cure, does debate have value?

This might be a good time when a representative democracy, composed of people
who are willing to listen to experts and make the hard, unpopular, decisions,
would be the best choice.

~~~
Hermel
Misinformation is nothing new and just as the amount of misinformation has
increased, the amount of information has increased too. I would bet that the
average citizen is better informed overall today than say 50 years ago.

~~~
deegles
Probably, but the core issue (at least in the US) is that a large fraction of
informed citizens have moved to coastal cities, leaving the less informed
citizens with more voting power. This means that misinformed citizens are
gaining _more_ influence over time, not less.

~~~
WalterBright
> but the core issue (at least in the US) is that a large fraction of informed
> citizens have moved to coastal cities, leaving the less informed citizens
> with more voting power

Every person imagines they are better informed than those they disagree with,
especially when it comes to politics.

There are exceptions to this rule. For example, I am better informed than
those who disagree with me.

------
chasd00
go here and scroll down to Cases by Country, normalized by country population
then highlight Sweden. Across the different metrics Sweden seems to be doing
about average.

[http://91-divoc.com/pages/covid-
visualization/](http://91-divoc.com/pages/covid-visualization/)

here's projections for Sweden but given how wildly these projections have
fluctuated i'm not sure how valuable it is

[https://covid19.healthdata.org/sweden](https://covid19.healthdata.org/sweden)

~~~
f38zf5vdt
Cases are a poor metric because they're a function of per-capita testing,
which is variable across nations. You have to go by deaths. In that case you
can see that they're much worse than their neighbors Norway and Finland, and
that they're closer to regions with catastrophic death rates like Switzerland.

The earlier lockdown measures are imposed, the greater the impact, hence the
comparatively excellent numbers from Finland. Sweden has long held denial of
asymptomatic transmission (especially by Tegnell, even in this article), which
we've learned is categorically wrong. The IHME model has been considered
notoriously optimistic, as the US number of deaths has been rising but the US
peak is reported as 1 week ago. The IHME model assumes a full lockdown in the
US until August, which has already been violated by a number of US states this
week.

~~~
yoden
To back this up with some data, this article has information about tests per
capita: [https://www.thelocal.se/20200414/understanding-swedens-
figur...](https://www.thelocal.se/20200414/understanding-swedens-figures-on-
the-coronavirus)

If Sweeden had been testing at the rate of Norway or Germany, they would not
be in the middle of that cases per capita graph. This is despite Sweeden's
infection growth being ~15 days behind Italy's, e.g. enough time for a
lockdown to have almost entirely prevented it.

So it seems clear that Sweeden's policies have made infections worse. The
questions that remain are: 1) Will their peak infection rate go over hospital
capacity? 2) Will they have economic benefits from having population immunity
faster?

~~~
senderista
As Tegnell points out, the relevant comparison is death rates after the
epidemic has run its course, say after a year or so. Lockdown just delays some
of the infections to buy time for additional mitigations which will hopefully
decrease the total number of deaths. The virus will still eventually spread
through the population until herd immunity is reached.

~~~
cycrutchfield
This ignores hospital capacity, which is the most important consideration when
projecting out fatality rates. Lockdowns are not just about buying time for
additional mitigations.

~~~
CuriousSkeptic
And the ICU load has hovered around 80% the last couple of weeks. Which was
the goal of the chosen strategy. Current goal is to keep things below that
while things develop

------
starvingbear
Some countries in martial law some shut down a massive portion of their
economy. The controversial approach is relying on individual citizen
responsibility. Fascinating times

~~~
ajsnigrutin
If it was something that affected only those individuals, noone would care.
The problem is, that someone else can be irresponsible, and you die because of
that.

~~~
FpUser
Why is that suddenly a problem? We always had it. Most people posing danger to
others in one or the other way. Driving a car is the most obvious example but
there are countless other

~~~
matthewdgreen
That's why we have drivers' licenses and manslaughter charges for negligent
homicide. We don't just shrug our shoulders at the risks.

~~~
SpicyLemonZest
We take reasonable, targeted measures to mitigate the risks. What we don't do
is embark on a grand social program to eradicate freeway crashes, because such
a program would involve banning or heavily restricting cars and we feel cars
are too important for that.

~~~
greedo
The car/cancer/heart-disease analogies are inherently flawed because they're
not communicable. If my road rage started a chain reaction across the
Interstate causing 45K people to die in a month, I think we'd stop driving
until we figured out what was going on.

------
alfiedotwtf
My money is within a month Sweden going into full lockdown, and regretting
their decision.

If it weren't for the states closing down here, Australia's death toll could
have been much worse given the Federal wanted to keep everything open.

~~~
Hurdy
People have been saying that about Sweden for a long time. My money is on all
other countries doing something closer to the swedish model when the next wave
hits in winter.

~~~
klmadfejno
I think this is accurate. Fears of medical systems being overrun are generally
overstated. The threat to doctors is already maximal, and by extending the
length of the epidemic we're just extending the time they're at maximal risk.
There's an argument towards buying time for more PPE availability but I think
that's a bad bet. Lockdowns lifted before something like herd immunity is
reached isn't going to help. If less than 10% of the population is immune,
then you're in the same boat when the lockdown is lifted and you've achieved
basically nothing but buying time. I don't think anybody would say we can
endure a lockdown FOREVER. I think it's naive to think we can endure a
lockdown for even one year without economic devastation causing far more harm
than the virus, let alone the ambiguous timeline towards a vaccine.

A lot of people are going to die. More people will die if the lockdown is
lifted, and many of those who would have died anyway will die sooner. But
famine, crime, war, and authoritarianism will cost more. On a global scale I
have no doubt that disease is less harmful than poverty in terms of happiness
or lives lost. The same for any given country as a whole. For wealthy
communities perhaps not.

It is frustrating to me that saying such things comes off as right wing or
anti-science. I feel the calls to keep the lockdown going are a thing of
entitlement from those who can afford to do so. There's a middleground where
you lockdown those at risk, reduce travel, and encourage sanitation practices
but open things up.

~~~
greedo
I live in a small Midwestern state. A friend's mother is going through
oncology, and is having complications due to the treatment regimen. Yesterday
she had to be put in ICU for a day because every other bed in the facility was
being used for COVID-19.

This isn't in the local news, nor regional news. It's almost like it's a dirty
secret.

You may not consider this "overrun" but I do. I sure hope I don't have
appendicitis or a stroke because it'll be an issue...

~~~
klmadfejno
That is an issue, but its a separate issue. The concern that COVID is going to
drastically overrun hospitals to the point at which we simply cannot take in
more people and cause even the young to die is mostly not an accurate
depiction of how hospitals and their capacity works.

It's true, a prolonged lockdown could potentially keep hospital usage low
enough that things like this aren't happening, but only temporarily, and not
in a way that meaningfully diminishes the threat of the virus and similar
hospital burdens occurring later. You can't slowly let everyone acquire
immunity. The disease either exponentially spreads to a sufficient scale or it
spreads too slowly to build up a community resistance that permits a lockdown
to end without consequence.

I really do empathize with people who are suffering, but what do you do if 6
months from now the disease is still here, we don't have a vaccine, and the
economic situation is worse? You either release it, and put us back at the
beginning with these same woes we're encountering now, or we keep holding the
lockdown for short term loss of life avoidance at significant economic cost.

~~~
DiogenesKynikos
The hospitals were overloaded in Lombardy, in exactly the way you're saying
will not happen.

~~~
klmadfejno
From everything I've read, the hospitals in Lombardy could have surged even
higher. Hospitals, in general, can expand care to many more people than
they're scoped to handle. It means that each person gets worse quality care,
but for an untreatable disease, there's little you can do to treat it anyway.
Ventilator mortality is extremely high. My sense is ballpark 80% mortality
rate, and that's just an average. With ventilator + age + pre-existing
conditions assessment there's a large number of people that have extremely low
chances of survival. At the level of triage decisions being made, I'd expect
very few additional lives to have been lost.

I get that this is tragic. I get that people are dying. I get that this is an
enormous mental and emotional toll on doctors. I get that we should be
cautious and avoid needless exposure, especially to vulnerable populations or
with unnecessary large social gatherings. But the lockdown is not saving
lives. It's delaying inevitable deaths, at an economic cost which could kill
even more people!

------
jon889
It sounds exactly what the UK was going to do until Imperial released a report
that said it wouldn’t work.

~~~
dijit
And Anders "debunked" imperials study because it was not yet peer reviewed[0].
While continuing with his "Scientific" gut feeling.

(No, I'm not making any of what I said up or being hyperbolic[1])

The serious lack of testing and fact that many doctors are saying they cannot
attach COVID-19 as a cause of death unless it is a direct cause and has been
tested for, give me pause to the numbers Sweden is putting out.[2] Since if
you arrive to the hospital already dead then they will not "waste a test" on
you confirming cause of death. I would much rather look at the Swedish death
rate comparative to last year instead[3]

[0]: [https://www.theguardian.com/world/2020/mar/28/as-the-rest-
of...](https://www.theguardian.com/world/2020/mar/28/as-the-rest-of-europe-
lives-under-lockdown-sweden-keeps-calm-and-carries-on)

[1]:
[https://twitter.com/bjornsing/status/1252888065959436288](https://twitter.com/bjornsing/status/1252888065959436288)

[2]: [https://www.thelocal.se/20200414/understanding-swedens-
figur...](https://www.thelocal.se/20200414/understanding-swedens-figures-on-
the-coronavirus)

[3]: [https://www.scb.se/en/finding-statistics/statistics-by-
subje...](https://www.scb.se/en/finding-statistics/statistics-by-subject-
area/population/population-composition/population-statistics/)

~~~
senderista
Agree, excess deaths over a suitably long period is the only metric I trust at
this point, and the only one that will be able to settle the debate over the
effectiveness of lockdowns.

~~~
SahAssar
Although very early data (as it is everywhere) does it not look like the stats
for excess deaths and the reported COVID-19 deaths for sweden line up pretty
well?

[https://www.nytimes.com/interactive/2020/04/21/world/coronav...](https://www.nytimes.com/interactive/2020/04/21/world/coronavirus-
missing-deaths.html)

------
vondur
On the face of it, the numbers don't look too good for Sweden. Compared to the
Los Angeles area (LA county and Orange County) we see 1937 deaths in Sweden vs
697 in the LA Area. The population is also about 18% higher in the LA area vs
all of Sweden. We are assuming the numbers reported in the LA area are
accurate, which they may not be.

~~~
Ma8ee
I don’t think these kind of comparisons are meaningful until we are out of it.
It all depends on exactly when the outbreaks started at the different places
and what the long term infection rate will be.

~~~
rolandog
These uncoordinated set of strategies by different countries seem to me like
battles in RPGs; Sweden's probably opting to take less economic damage and
instead take a x2 damage on health points.

The Netherlands is switching strategies, thinking that Sweden's strategy is
cool, but they're dipping their toes first by sending in teachers and children
to see if they take a great amount of damage.

~~~
microtherion
> Sweden's probably opting to take less economic damage

In all the discussion so far, I haven't seen any documentation of just how
much "economic damage" the various countries are taking. I suppose there is
little such data at sufficiently fine granularity to compare internationally.

It's entirely plausible that Sweden's voluntary measures vs other countries'
stricter approach don't make as much economic difference as many people seem
to take for granted.

------
juiyout
> We are in the middle of the epidemic and, in my view, the science shows that
> closing schools at this stage does not make sense. You have to shut down
> schools fairly early in the epidemic to get an effect.

Could anyone shed some light on why Sweden chooses not to close down schools
fairly early?

------
wannabag
I live in Stockholm, Sweden, so while I acknowledge my bias I'd bet my money
on the fact that other countries will change their approach rather than Sweden
starting to follow others.

While there are some undeniable social (think multiple generations in a
household), geographical and cultural (swedes are notorious in keeping their
distance from other swedes) differences at play here, other European countries
have gone for a "people can't be trusted so we must restrict individual
freedom". While there is certainly some good reasons to think that this will
work the means used to implement this have some really sad consequences. Look
at France, people are getting fined and in some cases brutalized; protests are
sparking in places where strict measures have been implemented, not because
they are unfair but because they affect people unfairly! Easy for well-off
people to "leave early, far and for a long time" but far from everyone has
that luxury (oh if you understand French, check out Twitter on the "lockdown
diaries" parodies and compare that to how people in the suburbs of Paris are
being treated!). This is without even starting to talk about how the economic
impacts will be spread amongst social classes. To me Sweden has chosen the
most socially (in this case as opposed to morally) fair route to handle this
crisis.

That being said, it's morally very difficult to defend this strategy in the
face of a higher death toll amongst seniors in care homes. I cannot come up
with a single argument that I don't know will get shot down immediately and
that is a good sign that it's probably not morally optimal. We live in a time
of humanism and human life comes first, rightly so but even with that said, it
shouldn't hide the picture and justify every consequence out there. The
approaches in many countries are incredibly reactive and short sighted in that
regard.

~~~
nollbit
To be honest, I'd like somebody to explain to me how a lockdown would have
prevented more deaths in elder care facilities in Sweden.

~~~
kzrdude
I'd expect that better working conditions would have been a much bigger help.

These workers would like to follow the general guidelines and stay home if
they have any symptoms, but they generally work hours, not salary jobs, and
can't miss too much work.

If they had the flexibility and leisure a lot of the swedish middle class
experience at their office jobs, being able to call in sick, then more of the
care workers could have obeyed the recommendation by the health authority.

But for now it's a low-wage, high pressure sector with less than ideal working
conditions.

To add to that, the same patients meet very many different caregivers during a
week due to the same working conditions, and this is also not good for
preventing transmission.

~~~
CuriousSkeptic
I suspect that in the aftermath of this. There’s are the things that will have
had the biggest impact on outcomes. The pre-conditions at the start. Not
differences in response strategies.

------
zwaps
I do like the reliance on the high trust society in Sweden, but I also feel
like a wider circle of experts could be consulted for such a decision.

Even if it may not be a good model of human behavior, it's sometimes useful to
consider "rational behavior" \- if only to judge the resilience of certain
mechanisms.

In this case, "social" behavior is in a sense very altruistic. If I am young
and healthy, recent media reports (accurate or not) would suggest that
limiting myself to staying inside, practicing more hygiene and such, is costly
but doesn't significantly reduce my own risk. At the same time, isolating
risk-groups may not be sufficient, and younger people may genuinely be at
risk. So, it would be desirable if everyone practices social isolation.

If that is true, social behavior is a collective good: The more people stay
inside, the easier it is for myself to go outside and, say, enjoy the sun in a
park or have fun in a club. Thus, my incentives are not aligned with the goals
of these recommendations. And if everyone thinks that way, social distancing
will not be achieved in a "decentralized" fashion. Indeed if everyone is that
rational, such a decentralized but workable "recommendation" does not exist.

Now, I stress that people do not fit this model, especially in Sweden. But in
situations of anonymity, e.g. with many people involved, it has sometimes
proven useful to check the robustness of one's decisions against the case
where people act rationally. In that case, laws and regulation do make sense.

------
epr
Is there a pronounced difference between coronavirus cases in Sweden vs
neighboring countries? On a per population basis I'm seeing very similar
numbers (links below). Anecdotal evidence is one thing, but these charts don't
seem to tell that story. That being said, it's unclear to me the degree to
which coronavirus statistics provided by different countries can be compared
meaningfully, or if this is an apples and oranges situation (for any number of
reasons).

[https://www.worldometers.info/coronavirus/country/sweden/](https://www.worldometers.info/coronavirus/country/sweden/)
[https://www.worldometers.info/coronavirus/country/norway/](https://www.worldometers.info/coronavirus/country/norway/)
[https://www.worldometers.info/coronavirus/country/finland/](https://www.worldometers.info/coronavirus/country/finland/)
[https://www.worldometers.info/coronavirus/country/denmark/](https://www.worldometers.info/coronavirus/country/denmark/)

Population numbers:

Sweden: 10.2 million

Norway: 5.4 million

Finland: 5.5 million

Denmark: 5.8 million

~~~
joshuahedlund
Cases are an unreliable metric because Sweden has done less testing per capita
than Norway/Finland/Denmark. However, its deaths per capita is notably higher
(and rising - from 14th global rank to 10th in the last couple weeks)

Sweden: 192 per million

Denmark: 66 per million

Norway: 34 per million

Finland: 27 per million

~~~
epr
That does not look good for Sweden. I was just thinking that it would be
interesting to compare total deaths per year for 2020 at years end to
eliminate differences in methodology. It's a crude measurement, but if the
coronavirus death toll becomes large enough compared to total population then
it should give us a general idea considering how slowly death rates change in
general. That could at least point us to who did things right, and hopefully
some guidance for future policy.

~~~
epr
Hold that thought. They probably have deaths by week already.

~~~
henrikschroder
[https://euromomo.eu/](https://euromomo.eu/)

[https://www.nytimes.com/interactive/2020/04/21/world/coronav...](https://www.nytimes.com/interactive/2020/04/21/world/coronavirus-
missing-deaths.html)

------
option_behavior
It will be interesting checking back in 2-3 years and evaluating the efficacy
of approaches by different countries. As referenced in the interview, each
country has to eventually reach herd immunity. For the majority of the world
this will be when 60-80% of the population has antibodies through the natural
spread of the virus.

Assuming healthcare systems are not at overcapacity, our resources will best
be spent protecting at risk groups. These are mainly old people, given that
the average life expectancy of those who have died is just over a decade.

I'm confused why so many people are extraordinarily emotional and passionate
about shelter-in-place. We should be focused on increasing healthcare
capacity, and more importantly securing the safety of at-risk populations
which are primarily composed of old people.

This is where honest and effective communication over the objective risks for
different groups is essential. If you are under 30 with no pre-existing
conditions, the odds of dying are < 1/100,000. The numbers are commensurately
promising for those without underlying health conditions in their 30s, 40s,
and even 50s.

It is silly to prioritize shelter-in-place going forward, across most of the
developed and developing world. The costs are tremendously high, as we
actually want most relatively young and healthy people to be exposed to the
virus to protect at-risk populations.

There was even a recent study published that revealed if we intentionally
infected young and healthy people, death rates from C-19 would nearly halve. A
solution could turn out to be staggering payments to very low risk groups to
get infected, taking into account people's various living situations.
Unfortunately, I think most governments would prefer 2x,3x,4x, etc. death
rates over paying people to infect themselves.

I believe many people will look back and admire the Swedish model for their
practical and effective approach. Excessive shelter-in-place has tremendous
costs, with minimal benefits once healthcare systems are stabilized. Hopefully
nations around the world accept this reality and act accordingly.

------
divan
Is it just me or his answers are super vague and uncertain?

I've expected some irrefutable arguments and unshakable confidence, but it's
mostly "I think", "I [don't] believe" and "hard to know". Zero proofs or data,
mostly his opinions.

~~~
glofish
everything is an opinion and estimate at this point -

the transmission rates in the population with respect of their way of living,

the sensibility to infection of different ages, races etc

I salute Sweden for not giving in to the lockdown hysteria and trusting that
people can and will act cautiously without the threats and mandates.

------
jnbiche
I don't understand why certain media are lauding Sweden's strategy. It's not
succeeding by any objective standard.

For example, if you filter out tiny countries like Andorra (which result in
statistical aberrations), Sweden has the 5th highest death rate in the world
(per million population). And it's increasing, having gained several spots in
the past 5 days.

It may turn out be that Sweden's right in that closing borders, schools, and
businesses doesn't have much of an effect, although there's significant
evidence for the effectiveness of closing schools in respiratory illnesses.
But Sweden's strategy is not working as a public health strategy.

~~~
seunosewa
If they had sufficient testing and encouraged the use of face masks to slow
the spread, it would probably have worked.

------
matwood
Some southern states are about to try the same strategy so we'll see how it
works out.

------
DeathArrow
It was a cynical decision, disguised as "we don't want to impact people's
freedoms" and "we follow the scientific truth".

Sweden's progressive government hates older people which they perceive as more
conservative. So they decided to let them die.

If the epidemy would affect younger people as much as older people, Sweden
would take the same actions other countries had and limit the number of
deaths.

~~~
SahAssar
Are you seriously saying that the government is on purpose making their
strategy kill old people?

Because that is some grade-a conspiracy paranoia.

------
int_19h
This is one of those cases where a single day in the media cycle makes for a
very big difference:

[https://www.forbes.com/sites/davidnikel/2020/04/22/sweden-
he...](https://www.forbes.com/sites/davidnikel/2020/04/22/sweden-health-
agency-withdraws-controversial-coronavirus-report/#6b6795114349)

------
DeathArrow
I think Sweden did it wrong, valuing the economy more than the lives of
people. I think there are some political ideologies at work, but I don't want
to get into these.

In my country we have 3x less cases and 8x less deaths per million people. I
do think that quarantine payed off. We can recover the economy but we can't
recover lives.

------
EmilioMartinez
Each nation's strategy seems to come about due to its very specific
circumstances. Leaders will defend (to death) their bullshit ideologies and
false securities, and stick to a plan made in the heat of the moment.

Perhaps this mechanism is the great randomizer that ensures that every
combination is tested, some risk distribution strategy.

------
newcrobuzon
Sweden is starting to see sharp increase in daily deaths - 172 yesterday and
185 the day before - which for a country of 10 million is a lot. For instance
Czechia with roughly same population introduced lock down very early on and
now their total is 210 - while Sweden's is 1937...

~~~
tome
Where are you getting those numbers from? They're much higher than suggested
by this graph:

[https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_S...](https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_Sweden#History)

------
mamon
So far the net result of Sweden's strategy is that they have 2,021 coronaviris
deaths, more than 4x more than Poland, which also has almost 4x bigger
population - so Sweden has 16x more deaths per 1M of citizens than Poland.

------
eveningcoffee
There is no controversy. They just messed up and are now saving their faces
blabbing about herd immunity and hoping that the spread will stop magically. I
do not have hopes up yet.

------
pengaru
This was the most sane and reasonable thing I've read about handling the
pandemic, and I'm super bummed it's not regarding my home country.

------
mensetmanusman
Sweden’s approach is an optimization of how to respond to the epidemic and how
to respond to the general life disruption.

The optimal response to the epidemic is everyone stays in their house for 1
month with no human contact. In that scenario, the virus is stopped and
everyone dies because no one works the food chain, etc.

The world’s current response is heavily weighed towards optimizing the
response toward the epidemic, but the potentially fatal assumption to this
approach is that a vaccine will soon be developed. If a vaccine is not soon
developed, the same amount of people will still get sick, people will still
die, but additional people will die due to life disruption.

------
buboard
While their strategy seems to not have led to disaster, it's not certain
whether one would call it success. Shutdowns clearly didnt work well in some
countries (france,spain,italy,uk) but they seem to work well in most eastern
europe countries and germany. People are not being infected at large .

Some of his remarks are generally questionable and worth a second thoughts

> Closing borders, in my opinion, is ridiculous, because COVID-19 is in every
> European country now.

There are many countries with very few COVID cases, and some of them are
summertime destinations for swedes (like greece). It's certainly dangerous to
open borders with a highly infected country like sweden without rigorous
checks. Europe is big.

> Each country has to reach ‘herd immunity’ in one way or another

Not all countries are looking to get there fast. In fact countries that delay
the spread are hoping for a potential cure/treatment that will make herd
immunity much less painful. Herd immunity isnt even necessary - plenty of
diseases don't need immunity/vaccines.

Also, while it's nice that sweden chose a relaxed, voluntary approach, the
lockdown measures have wide support in many countries.

He s right that governments should be measuring the impact of measures though.
Sweden should be doing so too, it would be very useful to know which are the
most important infection routes, now that other countries are opening up

------
russellbeattie
Even if you assume 100% of the population will eventually be infected, the
final percentage will have a much easier time and chance of recovery than the
first ones because of what we've learned as time goes on, even without a
vaccine. In fact, they're _already_ learning better ways to treat the disease.

The stupidity of saying, "We really can't do much right now, so fuck it" is
unbelievably irresponsible. If you knew you were definitely going to get the
virus, when would you rather it happen, right now or a year from now? Sweden
is essentially saying it doesn't matter.

~~~
war1025
> We really can't do much right now, so fuck it"

For many people it's more of "I can take my chances relying on the government
when I'm not allowed to work" or "I can take my chances catching a virus that
is probably coming for me anyway"

Locking down doesn't terribly help vulnerable populations. It's only advantage
is that it keeps people who were less likely to catch it to begin with from
catching it, and as a result reduces the hospital load.

Here in Iowa the majority of outbreaks are either in nursing homes or meat
packing plants. Locking down does nothing to help them. We could shut down the
meat packing plants, but then we kill the food supply chain, which is a
disaster for everyone. Nursing homes are basically sitting ducks no matter
what.

If it's a fire we can't put out except by letting it burn through, then our
best choice is to open up to the point that we are burning at maximum
capacity. Hospitals here are laying off workers because they aren't allowed to
do anything except wait for a crash of Covid-19 patients that so far hasn't
come.

If the bottleneck is the hospitals like people have been saying all along,
then hospitals being so empty they can't even pay their staff means we have
gone to far.

~~~
greedo
Do you have any links to reports of hospital layoffs? I too live in the
Midwest and haven't seen any, though midwestern news sites are atrocious
unless it has to do with football.

~~~
war1025
There have been several stories, including one just yesterday where one of the
main hospital groups in the state (Unity Point Health) is laying off /
furloughing employees.

Here is a story directly related to it though [1].

"""

"The loss of revenue over the last few weeks due to the inability to provide
non-emergency care is destabilizing core health services in rural America,"
the NRHA said.

"""

[1] [https://www.iowapublicradio.org/post/small-town-hospitals-
ar...](https://www.iowapublicradio.org/post/small-town-hospitals-are-closing-
just-coronavirus-arrives-rural-america)

Edit:

Here [2] is a link to a "live blog" post, so it's sort of a moving target, but
under "11:00 am Tuesday" there is this headline:

"UnityPoint Health announces cuts to staff hours and pay"

[2] [https://www.iowapublicradio.org/post/liveblog-tyson-foods-
su...](https://www.iowapublicradio.org/post/liveblog-tyson-foods-suspends-
waterloo-operations-iowa-bars-and-restaurants-project-closures)

~~~
greedo
Okay, you said "Hospitals here are laying off workers because they aren't
allowed to do anything except wait for a crash of Covid-19 patients that so
far hasn't come." You're in Iowa, yet the first link is an extremely small
hospital in Tennessee. The second link refers to a Unitypoint Health which has
operations in several states.

Hospitals are losing revenue for elective surgery. UP Health is cutting
doctors pay 15%, and furloughing some other employees. Not sure if those are
medical providers or administrative staff.

And saying that we're waiting for "a crash of Covid-19 patients that so far
hasn't come." is not factually accurate, even in the Midwest. I can name
several hospitals in Nebraska that are so full, they're using the ER for non-
COVID patients since the COVID patients have filled entire wings.

Here's an article about Grand Island, one of Nebraska's hotspots. The article
is 8 days old, and the situation has become worse.

[https://www.omaha.com/livewellnebraska/our-resources-are-
bei...](https://www.omaha.com/livewellnebraska/our-resources-are-being-tested-
grand-island-hospitals-icu-is-filling-up-
fast/article_b2d1cf40-c2b1-5688-8059-af65a0cdd330.html)

For Omaha/Bellevue, Bellevue Medical Center is using the ER due to a lack of
rooms.

~~~
war1025
Here is another article about hospital layoffs [1]

As to the number of patients, it is highly regional. This is the official
state of Iowa Coronavirus info page [2].

My coworker's wife is a doctor here in Story county. My neighbor is a nurse at
the clinic across the street from my house. Both have said business is way
down and they are having trouble finding enough work to fill their time.

My mom is recently retired from the hospital in Mitchell county. She fills in
for people in her old department when they are short staffed. She said last
week what would normally have been a ten hour day for her took two hours to
complete.

We are strangling the majority of hospitals because the minority are overrun.
That isn't sustainable.

[1] [https://www.vox.com/2020/4/8/21213995/coronavirus-us-
layoffs...](https://www.vox.com/2020/4/8/21213995/coronavirus-us-layoffs-
furloughs-hospitals)

[2] [https://coronavirus.iowa.gov/](https://coronavirus.iowa.gov/)

------
bryanrasmussen
I really think this is a case of It is difficult to get a man to understand
something when his not feeling responsible for the deaths of thousands of his
country people depends on him refusing to understand it.

------
butler14
"We are in the middle of the epidemic"

I'd love to know what metric he's basing that statement on

~~~
scythe
The day with the most COVID-19 deaths [so far] in Sweden was yesterday. Sounds
like the middle to me. Or maybe the upswing.

~~~
viceroyalbean
Where are you getting that from? FHM's Covid-19 tracker [1] shows the most
deaths occurring on 8/4\. Of course, because there's a lag in the reporting
that is likely to change over time. Either way, the data for yesterday is too
incomplete to make any statements about yet.

[1]
[https://fohm.maps.arcgis.com/apps/opsdashboard/index.html#/6...](https://fohm.maps.arcgis.com/apps/opsdashboard/index.html#/68d4537bf2714e63b646c37f152f1392)

~~~
kzrdude
Two different ways to present the deaths: attributed to the date of death, or
attributed to the date they were reported by FHM.

~~~
viceroyalbean
That makes sense, though I would advice against the latter way since it will
show massive dips and spikes due to variation in reporting. Notably, the
reports dip every weekend and there was a huge dip over Easter that took ages
to get caught up.

------
notacoward
When a future article is written about the dangers of being contrarian to get
attention, that same picture of Anders Tegnell will be just below the
headline. His parents should have spent more time with him.

~~~
dang
Please don't post nasty, empty things to HN. We've already had to ask you not
to do this kind of thing.

Maybe you don't owe Swedish epidemiologists in Nature any better, but you owe
this community better when you're posting here. Please stick to
[https://news.ycombinator.com/newsguidelines.html](https://news.ycombinator.com/newsguidelines.html).

~~~
notacoward
> We've already had to ask you not to do this kind of thing.

When did it become HN policy to cherry-pick long ago examples from among a
plethora of highly-regarded comments like that? Pretty clearly other users
think I've paid any debt to this community since whatever incident you're
referring to (and I don't remember any) many times over. Bringing it up like
this seems pretty empty and nasty in itself.

