Philip Greenspun’s Weblog

Journalists around the world love to condemn the Swedes for their refusal to attend the Orthodox Church of Shutdown while instead following the false prophet (former chief scientist of the European CDC). Example: “Graph shows Sweden’s coronavirus death toll rapidly increasing compared to other countries” (Independent). (When writing this kind of story, it is best to avoid comparing Sweden with shut-down Massachusetts!)

Today’s New York Times, however, gives us the data that are least likely to be subject to variation from recording: total deaths by country. From “28,000 Missing Deaths: Tracking the True Toll of the Coronavirus Crisis”:

Sweden actually seems to over-reported their COVID-19 deaths (see “Sweden may be recording COVID-19 deaths differently than other countries”), the only country in the survey to have done so.

The reporters and editors who worked on this story somehow neglect to mention that the country with the smallest increase in deaths is still running its schools, restaurants, offices, nightclubs, gyms, etc.! (Maybe this didn’t seem significant to them, despite the 12% versus 298% discrepancy. For True Believers in the Church of Shutdown, what Sweden is doing is merely a variant form of their own religion, just as Hinduism was for the Portuguese who spent an entire summer on the west coast of India in the late 15th century. So strong was their belief in Christianity that they believed Hindu temples to be churches (and Ganesha was Jesus with a big Jewish nose?). They attended Hindu religious rituals and believed that they were observing Christian practices.)

[How did New York City get to be such an outlier? A friend’s wife’s theory is that it was the three shopping days between when the governor announced a lockdown and when the lockdown actually began (Friday morning to Sunday at 8 pm). “I have never seen stores so crowded in Manhattan,” she explained. “People were panic-buying everything that they thought they might need over the next three months. Bed, Bath, and Beyond was so jammed you could barely move. Nobody was wearing a mask. I think most of the infections in New York City happened during those three days.”]

Related:

• 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/2020/04/14/swedes-persist-in-refusing-to-die-from-covid-19/

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One of my Facebook friends, a guy closing in on Medicare eligibility:

I was almost 13, standing before my temple congregation, and I still remember reading these words from my Torah (bible) portion, “Choose life — if you and your offspring would live” It was somewhat random that of all the dates for me to be born and selected for my Bar Mitzvah, this would be my portion to read. If you know me, you know I don’t preach, I do think people should make their own choices. So these days, I can’t stop thinking about these words, and the choice we all make every day. Choose life over the alternative.

In other words, we can choose to stay home and save lives or go out and party (where, exactly?) and kill people via covidiocy.

In a previous post, I pointed out that, even if the Swedes are wrong and our quasi-lockdown has some effect on transmission rate, we can’t “save lives” by shutting down the U.S. economy because the resulting poverty will kill Americans (2011 NYT article) and kill poor people in trading partner countries, e.g., some of the hungry among the 200 million in Nigeria now that we’ve driven the price of oil below their production cost. The Earth can sustain a population of 8 billion only with a functioning modern economy of trade. If that weren’t necessary, the human population would have hit 8 billion before the birth of Jesus. The best that we can do is “save older richer American lives” by trading them for deaths among the poor. (But probably we won’t succeed in saving any rich old Americans.)

So we don’t have a choice to save lives, only, if the Swedes are wrong, whom to kill.

A physician friend said, “I agree with you on the poverty. That’s the biggest single determinant of clinical outcomes. However, you’re missing two big factors.” He pointed out that all clinical trials are currently shut down. If you were hoping to survive heart disease, diabetes, or cancer with the assistance of a new drug, you’d better come up with a way to survive an extra 6-24 months with the old pharmacopoeia. Any innovations will now be delayed by however long the coronapanic lasts.

He also directed me to “The Untold Toll — The Pandemic’s Effects on Patients without Covid-19” (Lisa Rosenbaum, M.D., New England Journal of Medicine, Apri 17). The author points out that a postponed “elective” treatment may result in death:

Although canceling procedures such as elective hernia repairs and knee replacements is relatively straightforward, for many interventions the line between urgent and nonurgent can be drawn only in retrospect. As Brian Kolski, director of the structural heart disease program at St. Joseph Hospital in Orange County, California, told me, “A lot of procedures deemed ‘elective’ are not necessarily elective.” Two patients in his practice whose transthoracic aortic valvular replacements were postponed, for example, died while waiting. “These patients can’t wait 2 months,” Kolski said. “Some of them can’t wait 2 weeks.” Rather than a broad moratorium on elective procedures, Kolski believes we need a more granular approach. “What has been the actual toll on some of these patients?” he asked.

[Note that NEJM makes this article available for free because it is COVID-19-related. Consistent with “Why do we care about COVID-19 deaths more than driving-related deaths?”, they want to make sure that all doctors worldwide have access to information that could save a COVID-19 patient, but they don’t care if a patient dies from some other preventable cause because the doc couldn’t afford a subscription!]

This death toll is in addition to deaths from patients who try to avoid going to the hospital in the first place because they’ve read that it will be a Fall of Saigon situation and they will get coronavirus during their 14 hours in the ED waiting room.

Finally, if you were hoping to be cured by a well-trained physician a few years from now, you might be disappointed to learn that all medical student clinical training has been suspended (and classroom training for years 1 and 2 has become a less effective virtual experience). It doesn’t matter to that our future doctors will miss 3-6 months of training? If so, why not cut medical school to 3.5 years?

Separately, but also on Facebook, there seems to be a rich vein of social distancing scolding. Here’s one from a nowhere-near-old-enough-to-be-at-risk guy who married the daughter of a rich guy and thus lives in a big beautiful custom-built home on a large suburban lot:

As of yesterday, 4.2% of Massachusetts residents who contracted Covid 19 died.

Today on my solo bike ride, I observed PACKED parks, with zero social distancing measures.

We can do better than this. I’m beyond ready to get back to work.

(He doesn’t have a W-2, 9-5 job, thanks to the father-in-law’s success, so “work” is creative, rather than oppressive.)

From a nurse in the Bay Area, regarding an outbreak in Truckee:

Wtf?!! What don’t people get? Stay the F* home!! Do not go to your 2nd or 3rd homes/ski leases!!! They don’t have the medical facilities/ICU capabilities for Bay Area people going back and forth and potentially spreading the virus!! All of us Bay Area/ SC/ Monterey 2nd homeowners are SIP at our PRIMARY homes… not escaping to our 2nd/3rd homes (Kirkwood) to “get away into the high altitude wilderness”. It’s ABSOLUTELY F**** selfish!!!!

Here’s one posted by a friend, in which the Seattle Parks & Rec folks tell the rabble “Enjoy Your Backyard”:

Nobody on either coast seems to be thinking about Americans who aren’t rich enough to have a backyard!

Related:

• “COVID-19 Is Likely to Lead to an Increase in Suicides” (Scientific American)
• Fun, even if the Swedes say it won’t make much difference: Sound of Music “Do Re Mi” remixed for Covid-19
• “‘Instead of Coronavirus, the Hunger Will Kill Us.’ A Global Food Crisis Looms.” (nytimes, April 22)

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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)

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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/

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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?

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