Update on Coronavirus in Sweden
I posted one week ago about Sweden’s response to COVID 19. For those unaware, they have taken a different approach than most of the world, and kept much of the lockdown approaches elsewhere to a minimum. They have banned crowds over 50, and closed high schools/universities. But non-essential businesses are continuing to operate, public spaces/restaurants remain open, and the restrictions are substantially less than other countries.
There was a lot of arguing over the ethics and morality in the thread which is not really my intention. Sweden is doing this regardless of our opinions, all we can do is look at the data reach our own conclusions.
As I said in the other thread, I give more credence to deaths per capita than the death per known positive test. Testing varies wildly and is thus an unreliable statistic to compare countries. For instance, I could tell you the death rate for known Covid cases is substantially lower in NBA athletes and US celebrities than Manhattan, but that is a completely irrelevant conclusion about this disease.
Where they stand now:
Finland: 15 deaths per million
Norway: 29 deaths per million
Denmark: 58 deaths per million
Sweden: 139 death per million population
In comparison to other selected European countries and USA
Germany: 49 deaths/mil
USA: 105 Deaths/mil
Sweden: 139 death per million population
UK: 215 deaths/mil
Italy: 367 Deaths/mil
Spain: 413 deaths/mil
Daily New Cases graph in Sweden:
https://portal.icuregswe.org/siri/report/corona.vtfstart
Daily ICU Cases in Sweden
https://portal.icuregswe.org/siri/report/corona.covid-dagligen
Daily Deaths in Sweden
https://twitter.com/gryningsrad/status/1251005288838242304
Some data still to come in on the last couple days, but it looks promising that Sweden may be in/approaching a plateau.
People were arguing on the last thread that Sweden’s population is irrelevant because they are so spread out. I think at least the population centers are relevant, Stockholm (which has 1 million residents and accounts for half of the cases in Sweden) has a population density of 13k/square mile. That would be the fourth most densely populated large city in America after NYC, Boston and SF.
Other reports from health minister:
ICU beds are at 75% capacity and has been stable at that level. 50% for COVID patients 25% for non covid related illness
Unemployment
Hard to find much in the way of concrete data this early, but Sweden's unemployments rates are thus far faring better than their neighbors.
Sweden: ~5%, Norway ~14 %
https://twitter.com/leadlagreport/status/1251142132682850304/photo/1
Denmarks unemployment rate has nearly doubled, https://www.statista.com/statistics/1110143/number-of-individuals-unemployed-after-the-coronavirus-outbreak-in-denmark/
This is still all new and too early to reach any conclusions, but TO DATE, Sweden’s approach has not overwhelmed their health system and they are possibly reaching a plateau with their quasi- social distancing approach. They are faring way worse than their scandanavian neighbors in death toll, but far better than the hardest hit countries globally. Economic impact is going to be the last known entity, but thus far the Swedes have suffered less lost jobs.
April 17th, 2020 at 10:41 AM ^
VERT DER FERK?
April 17th, 2020 at 10:47 AM ^
In regards to health system toll, I would be interested to know how well equipped Sweden’s health system was with regards to beds, ventilators, PPE, etc in respect to their population and how that compares to other countries.
April 17th, 2020 at 10:52 AM ^
With regards to bed, this paper breaks it down by European countries. Looks like Sweden is around 5 beds per 100,000 whereas German is close to 30 per 100,000
April 17th, 2020 at 11:00 AM ^
Is there anything on respirators or treatments they may be using (anti-virals)?
April 17th, 2020 at 11:04 AM ^
Really curious how their health system is not getting overwhelmed. Early action to shelter the most at-risk? Seems doubtful bc it's impossible to completely shelter them - nursing home staff, sharing housing, etc.
More healthy population leading to lower hospitalizations? Probably helps.
April 17th, 2020 at 12:57 PM ^
There's so much variability in world-wide reporting, comparing country to country is a challenge I believe.
Considering how contagious this thing is, if they're near the top of deaths per rate but Sweden isn't being overwhelmed, that tells me the proper story isn't being communicated.
April 17th, 2020 at 10:53 AM ^
Also relevant would be the average health of their population. According to this site (https://www.nationmaster.com/country-info/compare/Sweden/United-States/Health) they have 1/3 the obesity rate, which seems relevant.
April 17th, 2020 at 11:03 AM ^
Obesity (i.e. BMI > 30) is a huge (pardon the pun) factor in how this disease impacts people who are infected. The NYU Langone Health study of hospitalized patients found that two factors: age and obesity, were most closely associated with the likelihood of hospitalization.
In looking into the lab results and other factors among the patients in those studies, the authors found that inflammation markers in the blood (such as C-Reactive Protein) were much higher among obese people. Inflammation, in turn, leads to blood clots, particularly in the cardiovascular and pulmonary arteries.
April 17th, 2020 at 11:13 AM ^
This seems like a solvable problem. If the US can mandate a lockdown, we should be able to temporarily mandate daily exercise as well.
Also, if obesity is a significant risk factor, the media should make it very clear that obese people will be some of the last people allowed out of lockdown. That alone should motivate more obese people to start exercising.
April 17th, 2020 at 11:21 AM ^
It is not the government's job to incentivise people to lose weight, especially with the threat of imprisonment
April 17th, 2020 at 11:28 AM ^
I'm all for promoting health. When I visit America, it's seriously the biggest culture shock by far. Get out of an airplane in Korea and everyone just walks off. Get out of an airplane in America and there's an army of people ready with wheelchairs. It's insane how normalized it is to be severely overweight.
Having said that, this is some crazy dystopian shit you're talking about. There are much better ways to promote health. None of what you're talking about exists in much healthier countries (i.e., the rest of the world).
April 17th, 2020 at 11:37 AM ^
Not sure if serious...
April 17th, 2020 at 12:52 PM ^
1. Age/racial demographics. Looking at deaths per capita is good start, but it would be cool to see the breakdown by age as well. If Sweden has a younger and healthier population, those are confounding factors.
2. Travel is another factor I think has to be accounted for. I am not sure the analysis has been done for this yet, but I think countries with high tourism and international travel, especially from China, in the early part of the outbreak are going to fare worse in this pandemic. USA, Italy, UK, France, and Spain are all countries that see significant international business and/or tourism travel. I don't know how Sweden measures in international travel, but I would guess they are much more closed off than those countries. Detroit/Michigan became a hotspot for this reason.
Sweden does not appear here, but France, Spain, USA, and Italy are all in the top 5 of world tourism rankings. It's not scientific, but it does imply that it didn't face the same travel risk factor that the USA and those other countries have had to deal with.
https://en.wikipedia.org/wiki/World_Tourism_rankings
Sweden and other Nordic countries don't even rank in the top 10 in Europe. Assuming their population and risk factors are similar to the other Nordic countries, it is clear Sweden is an outlier there. And the other European countries like Spain, UK, and Italy that fared worse were slow to implement mitigation strategies. The UK was originally going to follow a model similar to Sweden until they realized it was not working for them. I also think it would be worth looking at how Germany fares as they have done almost the complete opposite of Sweden and may be faring better.
April 17th, 2020 at 10:54 AM ^
Wishing Sweden well!
April 17th, 2020 at 11:52 AM ^
No internet disinformation campaigns against the Swedes? Vlad, you're getting soft.
April 17th, 2020 at 10:59 AM ^
This is excellent. It provides a view of what early return to work effects may be in the US. I know unreasonable people on one side of the political spectrum have trumpeted Sweden as proof that the US quarantine is extreme, which causes unreasonable people on the other side to attack it.
There's no need to do this. The world is large and different cultures are taking different approaches and that's actually really good for the human response to this pandemic. Sweden isn't a weapon for one side nor a foe of the other, they're a people we should watch very closely for what we may be able to learn.
(I realize this may sound like a lecture, and maybe no one will display the tribalism I describe above, if so please neg this comment to oblivion)
April 17th, 2020 at 11:27 AM ^
Excellent points and very well said Bodogblog. Couldn't agree more.
April 17th, 2020 at 12:41 PM ^
Appreciate that, friend. Have you tried the daily stretching for 5-10 minutes? Curious if you ever started that
April 17th, 2020 at 11:55 AM ^
Are you serious? America learning from someone else? That's against the Constitution. It's in there somewhere. I think.
April 17th, 2020 at 11:56 AM ^
Agree, this is really interesting. I think it will be important to look back at this in 9 months to a year, not just now. If Sweden's per capita death toll is high now, but ends up being lower than most after a second and third wave hit countries that Sweden doesn't get, it might look like this was a better option even if the death toll is high now. Hopefully the world will be able to critically evaluate the different tactics and have a playbook ready for the next one.
April 17th, 2020 at 12:01 PM ^
Yes, I don't know why people insist on weaponizing doing things differently on both sides, but they insist on doing so. I'd say 6 months, minimum is the return time on understanding whose approach may be ideal. And even then ideal may not apply equally.
Brazil is another outlier, as is Mexico. Getting reliable data out of either of those places is another thing entirely. On the other end of the spectrum most Asian countries have instituted virtual lockdowns; again, reliable data from some of them may be problematic.
I'm very curious on how the still "3rd World" countries handle all this. In theory, they should handle it poorly, with lower access to care. However, in general, they have a much younger average age, so perhaps it could be widespread and nobody would even notice.
Hilarious they're pointing to Sweden as the example. Yes I agree let's be more like Sweden. I'll take universal healthcare too. Also free school ...
April 17th, 2020 at 11:00 AM ^
Thanks for the per-capita numbers. I've been using the bing tracking dashboard and have found their raw numbers to be less than optimal. It's hard to see how various approaches compare when none of the numbers are adjusted for population size.
I'd go a step farther and say that an even more interesting statistic would be the change in overall death rate. That is, if we normally have 8000 people die per day and now we're seeing 9000 people die per day, then our death rate has increased by 12.5%. Public health is affected by way more than just this one disease. If we're enforcing a lockdown for public health, we need to look at the state of public health in aggregate and not just the health of people who have tested positive for the disease.
April 17th, 2020 at 11:18 AM ^
We also need to adjust for when the virus started spreading. I like the LA Times coverage of California because it tracks cases by county starting from the 10th recorded case. I don’t like their coverage because they are just reporting raw numbers, not per capita.
April 17th, 2020 at 11:23 AM ^
https://www.worldometers.info/coronavirus/
I think this is the best site for numbers.
April 17th, 2020 at 11:38 AM ^
I like it for a current update but have been frustrated because I haven’t been able to find much historical data beyond their one day look back. Am I missing something obvious (or even not obvious).
April 17th, 2020 at 11:54 AM ^
Well if you click on the country you can see daily new cases and deaths for each day.
April 17th, 2020 at 11:01 AM ^
I've felt as though the social distancing orders need to be individualized for locations that are seeing higher infection rates, although better (more) testing would be needed in order to more accurately determine these locations. The major thing that strikes me is while flattening the curve has been widely accepted as necessary to prevent an overload on the health system many people fail to recognize that not everyone's curve is going to line up. Some locations may not see an overwhelming burden on the health care system due to lower population densities. And some locations that began following the social distancing orders may see there curve accelerate after the stay at home order is lifted and will likely go through another round of social distancing.
The other concern I have is that flattening the curve excessively does not provide any net benefit. Total number infected will be the same and deaths will be close to the same. But a flatter curve lengthens the time to a conclusion and requires those who are most at risk to be isolated from society for longer.
April 17th, 2020 at 11:09 AM ^
My one quibble:
Flattening the curve excessively (or at least enough to prevent overwhelming a hospital) does result in fewer deaths. People are able to receive care and that will help some people survive, including those in the hospital for reasons other than covid-19.
To be clear, the above is not a commentary on what policy should be taken or even how much social distancing is required in order to avoid overwhelming hospitals.
April 17th, 2020 at 11:35 AM ^
No I agree. But the once the curve is flattened to the point where health care systems are not overwhelmed, flattening beyond that does not really benefit anyone. Edit: As someone pointed out below being at the point of full beds and ventilators probably lessens the care to other patients and possibly limits beds for other patients. Obviously patient care is at its best when there are as few people in the hospital as can be, but that's not entirely realistic either.
April 17th, 2020 at 11:22 AM ^
Definitely. The problem with that is if you don't have a robust testing system and contact tracing, which the US absolutely does not have, you can't provide targeted responses.
April 17th, 2020 at 11:30 AM ^
If you’ve read any of my posts you know I’m a pretty strong advocate of pretty strong social distancing, but I too wonder about how we could have better tailored social distancing requirements. As you note, it is hard to do without data.
I think one lesson we can all agree on is that better early monitoring could have made a very big difference. While it raises significant privacy concerns I wonder about the use of big data to augment more traditional testing, especially early on when you are just gearing up. There has been some interesting stuff on how google searches are a good indicator of spikes in both the flu and covid-19. There are also more intrusive measures like heart rate data from smart watches.
Knowing more about the effectiveness of different levels of social distancing would also be helpful. In a large urban area like NYC, Boston or DC, I suspect that there is a much greater portion of people who can reasonably easily work from home. Would early institution of this had any significant impact on NYCs peak?
As to your last point, avoiding peaks and pushing cases in the future seems to have very important potential net benefits. First, I presume that patient care is better without peaks such that outcomes should be better. Second, peaks must take a tremendous toll on our health care workers. I imagine that there will likely be some long term impact. Third, delaying cases provides more time for effective treatments to be found. I suspect outcomes for similar cases in November will be better than they are now. Treatments may also allow us to more easily withstand peaks and lower need for extreme social distancing. If treatments can meaningfully shorten hospital stays or even better avoid them altogether, there would be much less concern about the impact of a peak on a hospital system
April 17th, 2020 at 11:34 AM ^
Flattening the curve has another clear benefit: treatable non-covid deadly illness can be treated in hospitals that aren't at capacity.
So while deaths of covid may be stretched out, there won't be as much collateral deaths from heart attacks, pneumonia, etc. if the hospital isn't overrun with covid.
Spreading the covid deaths out gives infected persons a greater chance at recovery for both covid and other issues.
April 17th, 2020 at 11:03 AM ^
Sweden, doing much worse than their closet counterparts but when compared to other countries they share very little in common with doing great. It doesn't make sense to compare Sweden to the UK or Germany both in terms of negative or positive responses, those countries have very different demographics, cultures, multiple major population areas with higher density, etc. If you want to conduct a natural experiment the places to compare them to are Norway, Denmark, and Finland who share much more in common in terms of international travel, population density, cultural norms, and timeline. They are doing much worse in comparison. Also the idea that Sweden has reached plateau is not clear. They had their third highest day of new cases yesterday and passed that today. They've had their two worst days of death totals in the previous two days. Yesterday a group of leading scientists in the country posted on open letter calling on their health ministry to take further action based on their results compared to their peer countries.
April 17th, 2020 at 11:10 AM ^
Depends what your goal is.
If your goal is to have the least death, then Sweden's method will not work.
If your goal is to "flatten the curve" as to not overwhelm the health system while minimizing impact to the economy, Sweden's method may work.
I'm not here to debate the ethics and morality of a government's decisions, but it's clear they are going for the latter.
April 17th, 2020 at 11:41 AM ^
You should still only compare them to their peers. A strategy that works in Sweden wouldn't work in Germany or the UK because population density can lead to systems getting over whelmed by big spikes. There's a reason such a high percentage of the deaths have come from Stockholm.For literally any comparison for a natural experiment it only makes sense to look at countries with as many other factors controlled as possible since any deviation makes your natural experiment less valuable. Sweden compared to Finland? Fantastic natural experiment. Sweden compared to Italy? Pretty mediocre. Sweden compared to the US or South Korea, moderately useless
You’re cherry picking by implying I only compared to Italy. Literally, an entire multi page post with a tiny footnote data point that has Italy and you choose to grasp on that and only that and ignore the rest.
I literally gave a comparison of Sweden to its neighbors in the first data I listed.
And then I listed the hardest hit countries to show what the current worst case scenarios, with some other countries that we can trust accurate data. Some have fared better, some worse
April 17th, 2020 at 11:45 AM ^
It may work in some parts of the country, but is there a credible case that it would have worked in NY/NJ? I also suspect that as others have pointed out, the underlying health of a given country may play a big role. What works in a healthier country, may not work as well in a less healthy country.
April 17th, 2020 at 12:12 PM ^
The reason Sweden should be compared to its immediate neighbors is that the Nordic countries in general are relatively isolated from the rest of Europe - less so for Denmark (which shares a land border with Germany) but definitely the others.
An example: ski resorts in the Alps were major vectors of the virus in February and a lot of British/German/Dutch/Belgian people brought the virus from there when they returned from their ski trips. This happened much less to Nordic residents because Norway/Sweden have their own ski resorts. Denmark doesn't, though, and some Danes did go to the Alps, and this may explain why their country initially had the worst COVID outbreak in the Nordic region before they went to a hard lockdown.
There really was no reason for Sweden to have the worst death rate in the region. We can conclude that it was due to policy decisions.
April 17th, 2020 at 11:06 AM ^
https://www.worldometers.info/world-population/sweden-population/
https://www.worldometers.info/world-population/us-population/
Some additional comparisons for the US and Sweden
- Somewhat more Swedes (88.2%) live in urban areas as compared to US (82.8%)
- Swedish population density is less at 64 pers square mile as compared to 94 in the US
- Swedish average age is older than US at 41.1 to 38.3
- Sweden fares better in a number of health metrics including life expectancy (83.33 years to 79.11 years)
- US population is obviously much bigger 330 million to 10 million (9 US states have a greater population than Sweden)
April 17th, 2020 at 12:21 PM ^
By all means, Sweden should be doing a lot better against this virus than we are. We have a much less healthy population, including a significant number of people who haven't seen a doctor in ages due to a lack of insurance. It's quite shocking that more Swedes have died per capita than Americans - which is not the case for any of the other Nordic countries.
I also think it's misleading to say Stockholm would be in the top 5 of densest American cities. America has a lot more population centers with large suburbs that are densely packed. It really depends how you define it, strictly within city limits or the metro area? And how large does the city have to be before it counts, over 500k people?
April 17th, 2020 at 11:06 AM ^
the Scandinavian countries are often the harder areas to achieve wide spread infection in Europe playing Plague Inc---game developers must have done their research.
April 17th, 2020 at 11:51 AM ^
Greenland is really hard to infect too. And hey, Greenland seems to have gotten away unscathed again!
April 17th, 2020 at 11:19 AM ^
They just hit their spike early. They will be fine after the initial wave. We will be fighting this for awhile. We are only prolonging the inevitable.
April 17th, 2020 at 12:02 PM ^
Why will they be fine? Do you think they've achieved herd immunity already? That's pretty doubtful.
April 17th, 2020 at 11:19 AM ^
One problem with just saying that places are open for business is that Swedes aren't going to those businesses for the most part. It's not at all the case that Swedes are packing bars and restaurants while America shuts them down. I'll try to find the info I saw but anything like restaurants, theaters, etc. may as well be closed anyway in Sweden. The same thing happened in America actually. You can see before mandatory stay-at-home orders, business plummeted. Also, I'm not sure banning crowds, high schools, and universities is much of a minimum. They're still doing a lot. So yes, they're not dying in droves but they do also have a lot more deaths. And it's early.
Also it's misleading to talk about how they're doing better than Italy or the UK. Italy did absolutely nothing before it was way too late. That's what no restrictions really looks like. The UK also very notably took a laissez-faire attitude, including Boris Johnson, and now they're doing worse than most places in Europe. I haven't heard much about Spain's response.
Western Europe as a whole has been hardest hit. So in some ways it make sense geographically and culturally, but it's also a low bar for comparison.
April 17th, 2020 at 11:23 AM ^
They likely have a much higher percentage of population with the virus. They will also fizzle out faster as well
April 17th, 2020 at 11:34 AM ^
That's not true. Korea and Taiwan fizzled out way before Italy. Italy's deaths peaked 3 weeks ago and they still have about 500 a day dying. Taiwan has had 6 total deaths. SIX! Korea has new cases in the tens. Italy wishes they were down to the daily deaths Korea has for its cumulative number (229). The best way to not have your country ravaged is to stop the spread, not let it run wild.
The idea that countries that let things run their course was always just an idea, not based in fact. Italy is still in lockdown and it's still awful and it's been going on for a long time. I couldn't imagine what it'd be like if people were actually going out as normal.