Philip Greenspun’s Weblog

Department of Lies, Damned lies, and Statistics: “In Sweden, Will Voluntary Self-Isolation Work Better Than State-Enforced Lockdowns in the Long Run?” (Reason).

As noted previously in this blog, despite having access to schools, restaurants, gyms, and offices, Swedes have been dying at a lower rate than residents of shut-down Massachusetts (latest). But there are some European countries in shutdown that have yet lower official COVID-19 death rates. Almost nobody in Germany or Norway dies from COVID-19. Are they exceptionally lucky, doing something better, or using a different standard to attribute death to the evil coronavirus?

(Summary: Swedes automatically count anyone who has tested positive for COVID-19 as a COVID-19 death; the Norwegians require that a doctor assess that an ancient person has specifically died because of COVID-19, rather than one of 3 pre-existing conditions, and then take time from his/her/zer/their day to report that to the authorities.)

From the article:

There are also reasons to think that Sweden is doing better than these comparisons suggest. Many countries don’t count COVID-19 deaths outside of hospitals. When people die at home, in nursing homes, or in prisons, they don’t show up in the coronavirus death count.

In the Stockholm region of Sweden, 42 percent of deaths took place in nursing homes for the elderly. In many countries, and some U.S. states, those deaths would not show up in the data.

According to Johns Hopkins University, Belgium has twice as many COVID-19 deaths per capita as the Netherlands. But in Belgium, almost half of those deaths are from nursing homes, while testing is more rare in Dutch nursing homes so fewer deaths there are attributed to the disease.

After France started to include nursing homes in the statistics, the total number of French COVID-19 deaths jumped by almost a third.

During the present pandemic, Sweden systematically checks the list of people who have tested positive for the virus against the population register. Every time the government discovers that someone who had the virus has died, that person is registered as a COVID-19 death if it happened within 30 days of the diagnosis—even if the cause of death was cancer or a heart attack.

It means that Sweden reports the number of people who die with COVID-19, not of COVID-19.

Even in a culturally and geographically similar country like Norway—celebrated for its low death rate—they do things differently. The Norwegians only count something as a COVID-19 death if a doctor concludes that someone was killed by the disease and decides to report it to the country’s public health authority.

The article confirms what I posted earlier, i.e., that Swedes are not running out of ICU capacity:

The Swedes who have died from the coronavirus did not die due to lack of hospital beds or ventilators. Thanks to a rapid increase in intensive care unit capacity, 20 percent of Sweden’s ICUs are unoccupied. Stockholm has built a new field hospital, already equipped to receive hundreds of COVID-19 patients, including 30 ICU beds. So far it has not had to open. The average age of the dead has been 81, which is close to our average life expectancy.

Why didn’t Swedes drop dead like the models said they would?

For example, the influential Imperial College model estimates a higher reproduction rate of the disease in Sweden than in other countries, “not because the mortality trends are significantly different from any other country, but as an artefact of our model…because no full lockdown has been ordered.”

In other words, the model could only handle two scenarios: an enforced national lockdown or zero change in behavior. It had no way of computing Swedes who decided to socially distance voluntarily.

[Believers in the Church of Shutdown, of course, will say that Swedes are completely different from Americans (note that 25 percent of people living in Sweden have no genetic, cultural, or linguistic connection to stuff we might consider “Swedish”; one quarter of the population was born somewhere else or has two parents born somewhere other than Sweden; Swedish 15-year-olds actually scored slightly lower than Americans in the science section of the PISA test (though they did a lot better in math)). Had at-risk Americans not been able to tap into strong leadership (from epidemiology professor Donald Trump in the White House!), they would have read media reports of mass deaths and not changed their behavior in any way. No American would have switched to work-from-home. No American would have decided to cook at home rather than spend an hour in a jammed restaurant. No American would have invested in a mask or Clorox wipes. Due to universal stupidity among Americans (or at least the nearly half who voted for Donald Trump), a Swedish approach of shutting down mass gatherings and trying to isolate the vulnerable could never have changed behavior or epidemic velocity in the U.S.]

Of course, we probably won’t be able to evaluate the success or failure of any country’s policy until early 2021 (otherwise we risk celebrating a country for preventing deaths when all that happened was that the country either postponed the death or classified it differently). But I think it is interesting that already we’re getting a glimpse into why apparently similar countries should have such different death rates.

Related:

• “Sweden Says Controversial Covid-19 Strategy Is Proving Effective” (Bloomberg; Swedish church priests say that their religion is true)
• “Sweden grapples with high death toll after controversially refusing to lock down” (New York Post; members of the Church of Shutdown say that the Swedish religion is false)

Full post, including comments

Today’s numbers are out. From my big tracking post:

4/17 comment: Sweden at 613 cases/130 deaths; Denmark at 321/12; Massachusetts at 2,221/159. It is getting tougher to argue that the Danish shutdown was ineffective (but maybe Denmark will suffer its infections starting in a few weeks; kids in Denmark went back to school on Wednesday). And it is getting tougher to argue that the Massachusetts shutdown was effective (but maybe we won’t have a second wave since we were so incompetent at slowing down the first wave?). Sweden has had 1,333 total deaths without shutting down. Massachusetts shut down and has had 1,404 deaths (1.5X the rate).

American journalists and the Facebook righteous are sure that, just as it was in March, disaster is just around the corner for Sweden. The hospitals will be overwhelmed. People who could be trivially saved with a ventilator will drop dead in the street. (Example from fivethirtyeight.com hero Nate Silver.)

How is that going? The Swedes make their hospital situation public: https://www.icuregswe.org/en/data–results/covid-19-in-swedish-intensive-care/. It looks as though they have roughly 500 people in the ICU, up from 450 on April 8:

About 50 COVID-19 patients go into the ICU every day, but, if we interpreted the above chart correctly, nearly 50 are also coming out (unfortunately quite a few will be dead when they emerge, since there is no cure for COVID-19).

How do Americans maintain their faith in the face of these data. And in the refusal of God to smite the Swedes with a full ICU or a higher-than-Massachusetts death rate? One professor (of computer science, not epidemiology) simply asserted his sincerely held belief that Sweden would suffer an explosion of disease and ICU demand in the next week. Therefore, we had obviously saved lives by shutting down. Couldn’t Massachusetts have saved a lot more lives by continuing to operate our economy, maybe with a few more COVID-19 patients that had to be shuffled to a mostly-empty hospital, and sending the extra few $billion of wealth created (by the open economy) to Africa for clean water projects? No! Without a shutdown, the death toll in Massachusetts would have been staggering.

Related:

• An interesting video (thanks, Mattias!). Sweden has at least a second infidel who rejects the Religion of Shutdown, Professor Dr. Johan Giesecke, an infectious disease doc who had the State Epidemiologist job before Anders Tegnell (MD/PhD/infidel); WHO web site: “From 2005 to 2014 he was the first Chief Scientist of the European Centre for Disease Prevention and Control (ECDC).” (i.e., he will be considered “not an expert” by the New York Times). In the video he says that the various policies adopted by the various western governments won’t have a significant effect on the final death toll. (His best guess is that COVID-19 will prove to be comparable to a severe flu season and kill in the neighborhood of 0.1% of the population. But he is not primarily in the prophecy business, so his larger message is that we won’t be able control what the virus does.)
• https://philip.greenspun.com/blog/2020/04/14/swedes-persist-in-refusing-to-die-from-covid-19/
• https://philip.greenspun.com/blog/2020/04/12/everything-the-gleeful-journalists-said-would-happen-to-sweden-has-happened-to-massachusetts/
• https://philip.greenspun.com/blog/2020/03/28/why-arent-a-ton-of-swedes-on-their-way-to-being-dead/

Full post, including comments

I am informed by the New York Times and friends on Facebook that coronaplague was easily foreseeable and every intelligent person (i.e., not Donald Trump) saw it coming. Regrettably, in our own household we thought that coronavirus might be like the H7N9 avian influenza, about which WHO raised the alarm during 2013, 2014, 2015, and 2016 outbreaks (that later fizzled).

Because I like to be awesome at fighting the last war, what should be in our garage to prepare for a flu-like epidemic?

Here’s the beginning of a kit:

• masks (50 per household member?)
• gloves (100 pair)
• pulse oximeter
• ear thermometer
• infrared forehead thermometer (how are these different from grill thermometers, if at all?)
• hand sanitizer
• Clorox Multi-Surface Cleaner
• Clorox wipes (will these dry out between plagues?)
• toilet paper (still can’t figure out why!)
• paper towels (ditto)
• high quality webcam for any desktop computer
• high quality USB headset
• Facebook Portal or Google Nest Max for keeping in touch with friends and family from the living room? (which one is better?) Also have a similar device already set up inside the homes of any older relatives.
• ordinary cold/flu remedies

Readers: What else?

Full post, including comments

Our Boston suburb, which imposes a two-acre zoning minimum to keep out the riffraff, has hung a “We’re all in this together” banner across the main road. (We can restore the Black Lives Matter banner eventually?)

What about on a national scale? Are we actually all in this together? I talked to four friends from the aviation world in the last few days. One is isolated on 40 acres of oceanfront with 12,000 square feet of interior space, a dock with a sailboat and a power boat (not in the water yet this season), jogging trails, a tennis court, a hotel-size home gym, etc. One is isolated on 90 acres of ocean inlet with more than 8,000 square feet of interior space, a pool, a tennis court, a dock with multiple boats. One is on 20 acres of oceanfront over in Europe (in a country that is smart enough to do load balancing of patients to hospitals). One is in a city in a southern state with ample health system capacity. He’s on more than 2 acres with more than 13,000 square feet of interior space.

None of the Americans are in states where the University of Washington doom prophets forecast any shortage of hospital or ICU beds.

We use the same “lockdown”, “stay-at-home”, and “quarantine” terms for all Americans, but the experience of this life can be vastly different for those at different income levels. In non-plague times, when rich and poor Americans go for a walk they might have fairly similar experiences. Right now, however, even if the rich started out in a medium-sized city apartment they’ve often managed to escape to an uncrowded vacation destination, e.g., the Hamptons, Nantucket, or Maine. No matter how tight the lockdown gets, the rich can usually get ample fresh air simply walking around on their own private property.

I’m thinking that this variation in experience of lockdown is driving some of the ruling class’s high comfort level with lockdown. It is one thing to hear about a single mother, her boyfriend, and three kids from previous sex partners all crammed into a 3BR in public housing nearly 24/7. But can people with massive suburban estates actually understand what a Victimhood Studies professor would call “the lived experience” of this quasi-family?

Thomas Friedman, writing in the New York Times, on March 26, 2020, demanded that the Great Father in Washington issue a “shelter in place” order. Leaving aside the issue of whether any state governor would be required to comply with such an order, let’s consider what Mr. Friedman’s life would be like under “shelter in place.” He lives on 7.5 acres in Bethesda, Maryland (a 1/4 acre lot there is now considered lavish). He and his wife (the daughter of a billionaire) demolished the house that was on it and built an 11,400 square foot mansion. What relationship does Mr. Friedman’s “lived experience” of sheltering in place on 7.5 acres and 11,400 square feet have to that of a middle class family stuck in New York City in a 2BR?

Related:

• “Shutdown decisions are made by people with no skin in the game; when would they ever decide to reopen?”
• “Entrepreneur vs. government worker perspectives on Coronaplague”
• “Time for caravans of Americans to flee to Honduras?” (still looking safe, according to latest WHO numbers!)

Full post, including comments

On April 12, I noted “Everything the gleeful journalists said would happen to Sweden has happened… to Massachusetts”. Massachusetts has been shut down since mid-March. Swedes, on the other hand, are still going to school, eating at restaurants, and working at offices and factories as necessary. They may not even be using #StayHome and #SaveLives on their Facebook posts.

Combining what we’ve learned from U.S. media and 4th grade arithmetic lessons regarding exponential growth, we would expect most Swedes to be dead at this point. Yet as of April 12, a smaller percentage of Swedes had died compared to Massachusetts residents, and there was a dramatic difference in the rate of new cases (8X) and deaths (6X).

Maybe the sharp difference was a holiday (Easter) weekend data entry effect?

Here’s an update for today, based on WHO and mass.gov numbers:

The latest report for Sweden: 465 new cases and 20 deaths (Denmark was at 144 and 12). Massachusetts had 1,296 new cases and 113 deaths (8X the death rate).

I.e., Sweden (10 million population) is doing dramatically better than Massachusetts (7 million) and the stats per person are roughly comparable to shut-down Denmark (5 million). (see this post for numbers on previous days)

How does the U.S. media cover a country with a lower death rate than Massachusetts’s? “Sweden: 22 Scientists Say Coronavirus Strategy Has Failed As Deaths Top 1,000” (Forbes):

Sweden’s relatively relaxed approach to controlling the spread of the coronavirus has come under fire in international media and from many locals in the capital Stockholm, where more than half the country’s deaths have been recorded. Now, 22 researchers have publicly criticized the strategy and called on politicians to make changes.

Major public events such as the start of the Swedish soccer season are postponed and the physical buildings of universities are closed, but otherwise everyday life continues. Schools remain open.

(I will hazard a guess that the “22 researchers” referenced still get paid regardless of how long the shutdown lasts!)

The MD/PhD infidel (not a “scientist”) who doubts the shutdown religion does get one paragraph:

State epidemiologist Anders Tegnell quickly hit back at the researchers’ claims. SVT reported that Tegnell said there is “a fundamental inaccuracy in that article” regarding the numbers used.

How about the local newspaper in what became Wuhan-on-the-Hudson? “Sweden taking lax approach to coronavirus, top doc says it’ll ‘probably end in a historical massacre’” (New York Daily News):

Following the terrible examples of China, the United States, Britain and others, Sweden has decided that coronavirus is overrated.

The European nation known for being cold and socialist has not ordered any sort of lockdown, is still allowing up to 50 people to gather in groups and has been weeks behind the rest of Europe on social distancing advice, Time Magazine reported.

A top doctor as a large Swedish hospital told Time that this lackadaisical approach will “probably end in a historical massacre.”

What about Massachusetts? Is our forecast of suffering 12% of U.S. COVID-19 fatalities (with just 2% of U.S. population) a potential “historical massacre”? A search into the New York Times reveals only a concern about a Massachusetts roommate dispute regarding social distancing religious orthodoxy.

Update from my cumulative tracking post:

4/15 comment: Sweden at 1033/114; Denmark at 299/14; Massachusetts at 1,755/151. It seems that there was a substantial lag in reporting deaths in Sweden due partly to a three-day Easter holiday weekend. Even if all of the 114 deaths had occurred in the preceding 24 hours, the rate of new deaths in Massachusetts is substantially higher when adjusted for population. Total deaths in Massachusetts are at 1,108 versus 1,033 in Sweden, a 1.5X higher rate in the shut-down region of Massachusetts versus the up-and-running get-it-over-with region of Sweden.

It does look as though neighboring Denmark has at least deferred some infections and deaths with its temporary lockdown. As the top epidemiologist in Sweden says, “time will tell.” As noted in the comments below, we were told that, without an economic shutdown, coronavirus would kill 2.2 million Americans. Sweden did not shut down. They should be suffering close to 70,000 deaths from the exponentially growing virus, not 1,000 or 2,000. Even with the upsetting catch-up number of deaths following the holiday weekend, Sweden’s outcome so far seems inconsistent with most epidemiologists and government think that they know about coronavirus.

Full post, including comments