Most U.S. states are now on the Swedish plan?

by philg

My Facebook feed is alive with righteous expressions of outrage at growing coronaplague in reopened Sun Belt states. A typical story posted, underneath some complaints about the unmasked, Donald Trump, etc., would be “Florida shows signs as next coronavirus epicenter as cases spike across the country” (CNN, June 18) or “Coronavirus Cases Spike Across Sun Belt as Economy Lurches into Motion” (NYT, June 14).

I wonder if the majority of U.S. states inadvertently adopted the Swedish approach to managing COVID-19.

Consider that the shutdown happened in a lot of states at a time when there was, in fact, hardly any virus at all. The shutdowns were therefore months too early to have any effect, even if one were to accept that shutdown accomplishes anything, because the virus does not spread in the U.S. suburbs the way that it spread in Wuhan, New York City, or Italy.

So essentially the shutdown never happened from the perspective of the virus. The typical U.S. state now has the general population running around and mingling more or less as in 2019, while retirement homes and nursing homes are “locked down” as best they can be (temperature checks, etc. for the staff; restrictions on visitors). The immunocompromised, otherwise vulnerable, and healthy-but-fearful are hiding in individual bunkers (apartments/homes). Mass gatherings are canceled. How is that different from the Swedish policy?

Stockholm, 2016:

Related:

43 thoughts on “Most U.S. states are now on the Swedish plan?”

  1. I. In the CNN article linked to above there are two references to contact tracking or tracing:

    Epidemiologists argue case numbers should go down with greater testing, because theoretically health officials should be able to trace the cases and slow the spread of the virus…

    While the governor (Arizona) announced Wednesday that he would be calling up 300 National Guard soldiers to help with contact tracing, he said he would leave mask requirement decisions to mayors.

    II. There is one reference to quarantine or isolation of those testing positive:

    Pinal County, Arizona, Sheriff Mark Lamb announced Wednesday that he tested positive for Covid-19 and is self-quarantining for at least 14 days. He likely encountered an infected person at a campaign event he held Saturday, he said. The county Public Health Department is working to track everyone he came into contact with, he said on Facebook.

    III. I didn’t see anything about what’s being asked/required of those who have been in contact with a person who tested positive.

    Just not of general interest I guess.

  2. I know you have your infatuation with Sweden but I think the mor interesting comparison is US to Europe. Both fairly comparable in overall population with diverse areas managing the pandemic in a “federal” (local) approach… I’m coming to the general conclusion that we suck at government.

    BTW – the rest of Europe not eager to embrace the Swedes to travel as countries have opened borders. Wonder how long they will keep Americans out.

    • LinePilot: If they’re smart, they’ll keep us out for decades! Why would they want visitors from a country where residents can’t get along, riot and destroy their own cities, etc.?

      A lot of European countries have had lower plague death rates through June 20, 2020 than the U.S.? That’s great. As the Swedes and Angela Merkel said, the virus will wait patiently and will likely infect them soon enough. https://www.cnbc.com/2020/03/11/angela-merkel-most-people-will-get-the-coronavirus.html

    • One of Michael Levitt’s points is that very low rates of infection are a negative not a positive because they mean that once the country opens it its rates will normalize with everyone else’s.

  3. > Consider that the shutdown happened in a lot of states at a time when there was, in fact, hardly any virus at all. The shutdowns were therefore months too early to have any effect

    This is blatantly false. It’s always easier to get a pandemic under control by taking early action. There’s a reason the virus is now spreading much faster in the Southern states than it was before. To make the numbers simple, let’s say the number of infected people doubles every week if there’s no lockdown, and halves every week if there is a lockdown (realistically, poorly-enforced American-style lockdowns seem to keep the number of cases about constant, but that’s an implementation problem). Here are two alternative scenarios that involve essentially the same amount of lockdown:

    Early lockdowns:

    Week 1: 1 case
    Week 2: 2 cases
    Week 3: 4 cases
    Week 4: 8 cases
    …
    Week 15: 32,768 cases

    “Oh shit, lockdown time!”

    Week 16: 16,384
    Week 17: 8,192 cases
    Week 18: 4,096 cases

    “Man, everyone really needs a haircut. Let’s open back up again.”

    Week 19: 8,192 cases
    Week 20: 16,384 cases
    Week 21: 32,768 cases

    Then you forever alternate between 8,192 and 32,768 cases per week. On the other hand, if you take action “too early” but enact lockdowns for the same fraction of time (50%), we end up with:

    Week 1: 1 case
    Week 2: 2 cases
    Week 3: 4 cases
    Week 4: 8 cases
    (lockdown starts)
    Week 3: 4 cases
    Week 4: 2 cases
    Week 5: 1 cases
    (lockdown ends)
    Week 6: 2 cases
    Week 7: 4 cases
    Week 8: 8 cases

    Doesn’t that seem strictly better than the alternative? If you’re thinking “well we shouldn’t lock down at all and just let the virus kill everyone,” I don’t think there’s not a place on earth that’s tried that completely, and it’s not going well for any of the places trying it the most.

    There’s also the Mongolia plan (unfortunately too late for us), where if you ignore imported cases and only look at community transmission, the numbers look more like:

    Week 1: 0
    Week 2: 0
    …
    Week 25: 0

    But, then we wouldn’t have gotten to kill off the sick and elderly and become an international laughingstock.

    • I wonder what metric you used for a state to qualify as an international laughing stock. According to the mortality rate, Belgium, UK, Spain, Italy, Sweden and France should be qualified as such ahead of this country, no ?

      As to killing off the elderly, it is the governors of NY, NJ, MI, PA and CA who distinguished themselves in this respect by issuing their deadly nursing home orders, with Cuomo leading the pack.

    • Ryan: “To make the numbers simple, let’s say the number of infected people doubles every week if there’s no lockdown”

      That’s precisely the exponential growth that I am disputing. I don’t think the number of infected actually does reliably double every week among people with a typical U.S. lifestyle (bleak, lonely, suburban, and car-dependent).

      If, given a few basic interventions, the virus in fact bumps along at a slowly rising and/or simply flat burn, does a dramatic shutdown change anything?

    • > I wonder what metric you used for a state to qualify as an international laughing stock. According to the mortality rate, Belgium, UK, Spain, Italy, Sweden and France should be qualified as such ahead of this country, no ?

      What about the other 187 countries? Why are you only comparing against shithole countries? If I said, “violence in the US is rising, but we’re still ahead of Somalia, Iraq, South Sudan, Syria, Yemen, and Afghanistan,” would you be impressed?

  4. Philg, you’ve fallen into the trap that experts warned of early on: if the prevention measures work, people will think they were unnecessary. How is it that a professional expert like yourself, has such little respect for other experts who’ve spent their entire careers studying such things?

    • Senorpablo: I have tremendous respect for MD/PhD epidemiologists… in Sweden!

      I am not sure we can say that “prevention measures work”. Most of the U.S. states had similar shutdown policies. The results were wildly different: https://www.statista.com/statistics/1109011/coronavirus-covid19-death-rates-us-by-state/

      If shutdown “worked”, why the 50:1 ratio in death rate among states that shut down at roughly the same time? (with the highest death rate among the states that stayed shut down the longest)

    • All great questions that no one will know the answers to, until it’s all hindsight. Here’s my speculation: it will all seem simple and obvious looking back. When I look at that list of states, it started in NYC, a city with a very high level of international travelers, and radiated from there to neighboring states on the east coast. It spread faster in more dense urban areas, but there’s a lag time. The long incubation period and high transmission rate make it formidable. By the time NYC knew what hit them, it was out of control. They were the canary in the coal mine, because no one in the US believed what was happening in Wuhan could happen here–with the “best healthcare in the world.” CA was both lucky and proactive. Lucky because we weren’t hit first, and leadership believed what they were seeing in NY. Proactive because state and county governments, plus the residents took things seriously very early on, before the spread was out of control. People weren’t whining about wearing masks, or having to shut down, people just did what needed to be done. At least that was my experience here in the metro LA area.

    • The state government [of California] did “take things seriously” indeed. Your governor has been trying to kill off nursing home patients in the Cuomo manner albeit with less success (patients were “lucky” ?):

      “SNFs shall not refuse to admit or readmit a resident based on their status as a suspected or confirmed COVID-19 case.”
      http://savenewport.com/2020/05/21/gavin-newsom-orders-sick-patients-to-be-forced-into-nursing-homes/

      49% of California corona-deaths came from nursing homes.

    • Ivan – there is no proof that executive order had any effect on the death rate. You have zero knowledge of what rate people are being admitted or readmitted with COVID, or the rate at which facilities are not able to quarantine them successfully. Also, what do you propose in the scenario that a patient in a skilled nursing facility goes to the hospital, because they contracted COVID–while in the nursing facility!–and are then discharged from the hospital after recovery. Where else would you put them, give them a tent and drop them at an overpass? Hospitals can’t refuse patients, why should skilled nursing facilities be any different? Where do these people go?

      Democratic governors from the two most populous states have shown up our idiot president in handling this crisis, and this is nothing more than a lame attempt to generate some kind of manufactured crisis and outrage among the folks who love to hate democrats for no meaningful reason at all.

    • I love the idea that Governor Cuomo demonstrated wisdom and forethought and that governments around the world will be seeking his advice on how to manage coronaplague. Now that coronavirus is over in NYC (having run out of hosts?), why haven’t we heard of Cuomo jetting off (in a private Gulfstream, of course) to help out a state within Brazil, for example? Why keep his special genius for winning the war against coronavirus to New Yorkers alone?

    • Philg – If you’re not a fan of Cuomo’s response, do tell us where he went wrong.

    • According to abcnews, “more than 4,500 recovering coronavirus patients were sent to New York’s already vulnerable nursing homes under a controversial state directive that was ultimately scrapped amid criticisms it was accelerating the nation’s deadliest outbreaks, according to a count by The Associated Press.”

      Wise California has 2x nursing home deaths than dumb Florida (the God’s waiting room) with about the same total mortality rate ( https://www.usatoday.com/story/news/investigations/2020/06/01/coronavirus-nursing-home-deaths-top-40-600/5273075002/ ).

      So, yes, there is some knowledge about how “wise” Cuomo (and Newsome) really are in handling the most vulnerable segment of the population that accounts for 40% of coronavirus deaths contrywide. To be quite honest, I do not think various states governments had much positive impact on how the coronaplague played out (is playing out). Negative, yes, but positive, no.

      It is rather strange to observe the uncalled for political affiliation strawman you are trying to erect in order to defend the undefensible, though.

    • Senorpablo: Where did Cuomo, in command of an $88 billion/year state Department of Health go wrong? If you don’t like the raw numbers, i.e., the spectacularly high death rate compared to never-shut Sweden, just look at New York State’s failure to attempt load balancing of patients to hospitals. They spent more money every year than Russia spends to keep a fearsome military going and yet could not transport patients from the Fall of Saigon-style hospitals to the empty hospitals. Stuffing Covid-19-positive patients into previously uninfected nursing homes also does not seem smart when there were all kinds of temporary facilities available (and hotels if necessary; I don’t think New York City and State hotel occupancy was at a peak in April).

    • Ivan – you never did answer the other questions. 4,500 sounds scary, but it’s just a number without context. Also, if not nursing homes, where? If it’s such an awful idea, surely there must be an alternative, obvious solution? As for the deaths in FL vs. CA nursing homes, that should be no surprise at all since CA has over twice the population of FL. More numbers without context.

      Philg – your faults seem to lie with the free market. How is Cuomo responsible for hospitals failing to coordinate with a few weeks notice? And, whom are the temporary shelters going to be staffed with? Presumably, those were primarily for infected but otherwise healthy people to be quarantined, not intended to provide the same level of care as skilled nursing facilities. Our free market has eradicated all waste in the form of excess capacity, whether skilled healthcare workers, or toilet paper.

    • Senorpablo: free market in hospital care and other health services? As noted above, the New York Department of Health budget is $88 billion per year (more than the Russians spend on their entire nuclear-equipped military). As in the typical U.S., the state Department of Health has absolute power over hospitals via regulation (e.g., can shut them down or open them up) and the hospitals will typically get roughly half of their revenue from the government (Medicare, Medicaid, etc.). The state Department of Health had decades of time and billions of dollars to prepare for a situation in which patients would need to be shuttled among hospitals. (The French managed to do this, incidentally, so we know that it is not technically impossible to transfer patients during coronaplague.)

      If an $88 billion/year agency can’t accomplish anything, why does it make sense to keep giving them $88 billion/year in hard-earned taxpayer funds?

      But… you might be right that Cuomo is an example of bureaucratic excellence. Since coronaplague will likely be with us for many years, we should expect Cuomo to be in high demand from other states and countries to provide advice on how they can manage the challenge presented by the virus as well as New York did!

    • “that should be no surprise at all since CA has over twice the population of FL. ”

      That’s a good point. If we consider the death rate amongst nursing home populations(73K FL, 100K CA and NY) instead of absolute numbers, we’ll get approximately 1.4%, 2% and 6% respectively.
      https://www.kff.org/other/state-indicator/number-of-nursing-facility-residents/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

      I.e. mortality rate is 43% worse in CA and 4 *times* worth in NY in comparison to FL for nursing facilities patients. Of course, it’s not a real model, we do not know how patients were distributed across multiple facilities, their infectiousness, etc., but judging by those numbers there is a strong indication that sending infected people to the population with weakened immune system is probably not a good idea which is rather obvious and commonsensical to anyone familiar with the notion of quarantine.

      As to what could have been done… In NYC, there was this large hospital ship that was largely unused (treated only 170 patients) and departed on May 1, ten days before Cuomo cancelled his order on May 10th. There were three ? temporary tent hospitals that did not serve a single patient.

      https://www.npr.org/2020/05/07/851712311/u-s-field-hospitals-stand-down-most-without-treating-any-covid-19-patients

      Instead of using those facilities for treating and quarantining nursing home patients, they were discarded back to where they came from.

      I am less familiar with the CA situation, but judging by the relatively low infection/mortality rates, there was apparently enough capacity in the existing healthcare system to avoid mimicking Cuomo’s management approach without need for navy and temporary hospitals.

    • Philg – France has a socialized health care system, as you well know. What’s an example of free-market hospital co-ordination? Also, do we know for sure that significant deaths resulted from a disparity in hospital capacity? Did a lack of coordination have any practical consequences? Perhaps it was just that hospitals that serve well to do clientele are more savvy at turning away commoners without insurance.

      Philg and Ivan – I’ll ask again, who was going to staff these temporary “hospitals” you’re both enamored with?

      NYC was clearly caught off guard and bore the brunt of the surprise. It will be interesting to see if any other states reach crisis levels, which at this point will be out of sheer ignorance, now that we know what’s possible and likely if measures aren’t taken.

    • But I’m not sure that New York would have had to build anything. They could have just designated a couple of hospitals a couple of hours out of the city as Covid recovery facilities and sent everyone there instead of to nursing homes. The state overall had empty hospitals that were laying off doctors and nurses.

    • Philg – Have you even been to a skilled nursing facility? I have, when my great aunt was recovering from a broken hip. She was bed ridden, but not sick enough to be in a hospital. Where are the restrooms in that photo? Looks like it’s for people who can walk 50-75 yards to a restroom. Perhaps not the typical nursing home resident.

      From your article:

      “All the beds at the DCU Center are intended for patients who are sick with the virus but do not require intensive care.”

      “Mayor Marty Walsh also put out a plea for qualified health professionals to apply to work in the Boston convention center site during a public address on Tuesday.”

  5. “ because the virus does not spread in the U.S. suburbs the way that it spread in Wuhan, New York City, or Italy.”

    The virus spreads just fine in the suburbs or even rural areas, because humans being humans, they spend most of their time around other humans in offices, factories, stores, gyms, restaurants, churches, schools and homes. The 90m suburbanites spend in their cars, rather than a subway, makes some difference, but there is still the other 1,350 minutes a day.

    Meanwhile high-density living doesn’t necessarily lead to massive spread.

  6. I figured out what the new normal is going to be. Everyone has to wear a mask, around their neck. Except for me I still haven’t donned the mask o’shame. Drove by some seaside restaurants with outside dining today they were all full of seemingly happy people. Whatever the Chinese death breath was the spell seems to be wearing off on the masses. Except for the Karen Hiroo Onodas they will never fall for the Swedish instrument of surrender pysop.

  7. It appears to me that what the lockdown did accomplish is to allow hospitals and medical systems to prepare for treating large numbers of elderly patients with ARDS, and to know how to manage outbreaks. Beyond that it seems they’ve had little effect on spread of the virus. Also, the public is now much better educated about their own individual risks, which I believe is why so many are deciding to participate in the reopening and taking only minimal measures to avoid contact with others. Essentially, those behaviors translate into the “Swedish Model” but not by specific intent. They do make life livable, and restore most social relationships which are important to societal health….at a calculation that a second shutdown of the economy is not worth the collateral damage. Nevertheless, ‘normal’ is a long way off.

    • Jim: It seems that Heba Habib, the “freelance journalist” who wrote the non-peer-reviewed opinion piece in a magazine published in the UK, now entering Month 4 of shutdown, thinks that the Swedish approach is a failure. But where is your respect for “science” and “scientists”? You want to take Heba Habib’s opinion over that of the MD/PhDs who designed and implemented Sweden’s strategy?

      (Separately, let’s have a look at the UK versus Sweden. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200622-covid-19-sitrep-154.pdf?sfvrsn=d0249d8d_2 shows 42,632 plague deaths in Shutdown Karen UK versus 5,503 in Mostly-Open Sweden. If we adjust for the 6.6X difference in population, we find that the Church of Shutdowners in the UK have 1.27X the death rate so far compared to Sweden (and, if the UK shutdown actually worked, they will have more as soon as they emerge from their bunkers (if they ever do emerge)).)

    • I don’t know how you can call this an “opinion” piece. He attributes all of the figures he states to other sources…meaning it’s not his opinion.

      As a Journalism major myself, attribution is the first rule of reporting. Granted, you can question his sources, and you’re free to disagree with them, but this is most definitely NOT an “opinion” piece.

      I’m simply posting links to sources that offer a differing view from your sources.

    • Jim: The opinion starts before the article even opens… “Sweden’s public was supportive of the strategy, but is now paying a heavy price”.

      If the “heavy price” is the Covid-19 death rate through mid-June 2020, Massachusetts is paying more than twice the price… while in Month 4 of shutdown. Would Heba Habib say that the Massachusetts public is “paying a heavy price” for the decision to shut down that seems to be correlated with a death rate more than 2X that of Sweden’s?

      The idea of not shutting down society and the economy is “controversial”. This is an opinion, like that it is “conservative” to shut down in the face of a virus with an unknown death rate. I.e., do something that has never been previously done in the history of the human race and call it “conservative”.

      Let’s see… the opinion continues in the choice of comparing Sweden to “neighbours”. Like we could make Massachusetts look off the charts bad by comparing to neighboring Vermont and New Hampshire (and near-neighbor Maine). If Heba Habib, the freelance journalist, had instead chosen to compare Sweden to Belgium, the UK, or Massachusetts, the reader would have gotten a different story. That’s the key to opinion!

    • Too funny, Phil. You conveniently leave out all of the attributed quotes. You’re better than that.

    • Jim: Attributed quotes are also “opinion”, by and large. Sweden is a country of 10 million people. Unlike in the U.S., I don’t think that they have a full system for deplatforming heretics. So you just find 10 Shutdown Karens in a country of 10 million, interview them, and say “this is what Swedes think”.

    • Well, OK then. I guess we’ll regard the information in all of your links as someone’s opinion as well. Even stat sheets, graphs and charts are visual summations based on a distillation of information from sources who presented facts from attributed sources.

      I guess that’s why nobody can agree on anything anymore.

    • Jim: Of course my blog entries, even when supported by peer-reviewed journal papers as references, are opinion. I pick which papers to cite! The difference between me and the NYT, though, is that I admit that I am offering opinion rather than unbiased news. Also, I do sometimes like to check and see whether I was wrong!

    • @philg: I know it tortures you and I do feel badly for you (and me), but look at it this way: In the past year, the New York Times made an editorial, philosophical and ideological decision to throw itself in with Marxist activists and undertake the recasting of American history since 1619 as the story of a nation that founded for the purpose of enslaving and oppressing people of color, women, and 100 genders that didn’t even exist in 1619. People warned about the dangers. Do you honestly expect them to ever check, admit, or care that they are wrong, ever again?

  9. Jim,

    Hard numbers are facts, e.g. number of deaths in the nursing facilities . The graphs relying on the numbers represent the same facts, they may make the numeric facts easier understandable or not, intentionally or not. If you cannot measure a phenomenon, hardly any productive discussion can happen.

    Now, various kinds of models can be built based on numeric facts. A model usefulness is determined how well future developments can be predicted using such a model. E.g. what will happen if people wear masks based on the current physical properties of the mask, percentage of compliance, ambient temperature, the spreader virion production level when talking/singing/laughing, etc. So far, covid modeling predictive power has not been very good as Phil mentioned many times. You can discuss/criticise models, data collection methods, suggest alternatives, etc, making the discussion productive.

    Everything else is just more or slightly less worthless opinion and speculation regardless of whether “attributed” or not. Especially when colored with political meaningless labels such as “conservative” or “controversial”.

    This should be elementary, but for many reasons is not.

    • With all due respect, Ivan, “Hard Numbers” concerning anything to do with Covid 19 are based on the source you are getting them from. And from what I’ve read, you can find 2 or more sources about the same “facts” that present different numbers. And that is a fact.

    • Well, if you do not have hard numbers, you cannot say anything reasonable at all. Or you can say whatever you want but that would be meaningless noise.

      If your claim is that the numbers are fraudulent, on a massive scale provide some evidence, e.g. such and such hospital misclassified 40% of corona deaths.

      With so many competing interests in the matter, the likelihood that mortality numbers are faked is rather low in this country.

    • Ivan, I’m not saying the numbers are fraudulent, I’m saying you can go to two or three sources and find different numbers for the same subject.

      Take care.

  10. Sounds like travelers from the US will not be welcome to travel to EU countries… yep – the Swedish plan!

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