As for centralized approaches, all these people are in the same online groups, go to the same conferences, and read each other's papers, so it's not surprising that there's a strong notion of "we will do things This Way and No Other" that develops quickly...
As for funding, one huge problem with federal funding is it comes with so much mandated things-to-do around it that often half or more of the grant money disappears in "administration" as opposed to actual research.
I saw this at Postgres at Berkeley "way back when", and apparently the "overhead problem" of such grants is even worse nowadays...
Preparing a grant proposal and walking it through the bureaucracy is a major undertaking - often quite a bit more complex than writing a nontrivial scientific paper...
In Sweden we _did_ isolate the vulnerable. The end-of-life nursing homes _were_ locked down. And this meant that people who had been promised that their last months spent there could be spent surrounded with family ended up dying alone or with health care workers. This is what the king was critical of in his widely-reported "we failed those people" quote. By taking the quote out of context from his speech, people were left to fill in the blanks and assume that the king was in favour of stronger lockdowns, when the failure he was speaking about was not finding a way to let the dying see their loved ones. The people in the care homes were all expected to die within the year (except for some with dementia, who also are cared for in such places) because this is the major criteria for being accepted into such places in the first place. And while isolating them could protect them from dying of covid, they were still going to die of whatever had been killing them that had brought them to the care homes.
In addition, on On March 16th, the Public Health Authority urged people aged 70 and over toavoid unnecessary social contacts as far as possible. We basically told the old people to stay at home, until either the disease went away or we got vaccines that worked. We were all set to do this for 3 or 4 years, the time we thought it would take to test and develop a vaccine, based on how long it was done in the past. So we organised into groups that delivered groceries, meals, craft supplies, books, lumber and what ever else to the old people. This happened everywhere, and was organised by the church, and the grocery stores, and golf and other athletic clubs, and homeowners associations and so on and so forth. It was pretty much all private acts of generosity and kindness, and not something the government did, which pleased those of a more libertarian bent who had long listened to statists claiming that this sort of communal undertaking was not possible in the modern world.
The very oldest were already making use of 'hemtjänst' -- people, and this part is funded by the government and is available for everybody, who come by a few days a week to clean the house, help them with tasks around the house, and with showers, haircuts and the like if needed. And since Swedish elders tend to live alone, and not with family members, we thought we were well set up to isolate the elders as compared to other places.
Most of the early deaths in Sweden came from people who were isolating, either collectively locked down in the care homes, or by their own choice though personally being visited by hemtjänst. Locking down the country as a whole wasn't going to get these people any more locked down than they already were doing voluntarily. And the greatest pandemic failures were had were related to *not enough isolating equipment for the staff here* and *improper training in how to use the equipment we did have*. It is notable that the variant of covid circulating in Sweden in 2020 was not the same variant as was circulating in Denmark, Norway or Finland (or Italy, and most of Europe). The variety we got was called 20B/S:1122L
and it was unique to Sweden and part of Latvia. Something called EU1 was the majority over most of Europe.
This has naturally fuelled speculation at the time that 1122L may have been more deadly than the EU1 sort. We'll never know now. But what was evident in the first measurements we took was that the people who were dying in the earliest stage of the pandemic were catching covid from their doctors, care providers (in homes and as hemtjänst), ambulance workers, cleaners who worked in the care home, etc. And these people were catching the disease from other people in their professions. We know this because for a while the variants remained separate, and they all circulated, yet the old people pretty much all got sick and died from 1122L, which meant that it wasn't 'general spread' that was the culprit here, but the focused spread of the variant which was prevailent in health-care settings. And if we had _had_ a lockdown in Sweden, there is no way that these particular workers would have been locked up -- they were the epitome of people doing vital work that could not be halted.
The other notion 'that Sweden should be expected to have the same rates as Denmark and Norway, and if they didn't they must be doing something wrong' is one of the more egregious cases of 'how to lie with statistics' I have ever come across. There are two major factors which were conveniently overlooked by those who wanted to use Sweden as a model to support their be. The first is that the Swedish elderly population was unusually large in 2020, because in the previous winter many fewer people died than expected. Indeed, the magnitude of the 'excess continued-to-live' in that cold season was larger than the magnitude of the 'excess deaths' in 2019/2020. If covid had not come along, and the old people had simply succumbed to the run-of-the-mill respiratory infections, it would have passed with little or no comment, except among those who were responsible for building new care facilities when needed. They would then nod and say that their decision not to start a large number of new projects was the correct one. It wasn't that old people had discovered a way to live longer than the models predicted, as you could imagine happened due to some novel new medicine or treatment and we would permanently need more care homes -- it was just an exceptionally mild respiratory disease season and had just corrected itself.
See Tommy Lennham's analysis of the SCB (government statistics bureau) data here.
The second significant factor which was overlooked, which to my mind is even more significant, is the Scandinavian vacation schedule.
First, some facts to know:
Copenhagen is the capital of Denmark and the greater Copenhagen area has a population of ~2 million -- Denmark as a whole has a population of ~5.8 million.
Oslo is the capital of Norway and the greater Oslo area has a population of ~1 million -- Norway as a whole has ~5.5 million.
Malmö (in Skåne) is the third largest city in Sweden and the greater area has a population of ~700,000. Göteborg (in Västra Götaland) is the second largest city in Sweden, and the greater area has a population of ~1 million.
Stockholm is Sweden's capital and the greater Stockholm region has a population of ~2.4 million. Sweden as a whole has a population of ~10.3 million.
In Denmark and Norway, spring break is held at the same time all across the country (possibly with some exceptions, though I didn't find any.) In Sweden, they are staggered for the benefit of the ski resorts and other tourism and travel related things.
So, in 2020 when were the winter breaks?
Winter break Copenhagen and Göteborg: 10.2.2020 - 14.2.2020
Winter break Oslo and Malmö : 17.2.2202 - 21.2.2020
When the people of Copenhagen, Göteborg, Oslo and Malmö came back from their winter vacation, they did not arrive home sick, or at any rate they did not immediately head for the hospitals in large numbers . It was travellers in the last week of February and the first week of March who did so, in all three countries. But the last week of February is one of the weeks when the fewest people travel in Norway and Denmark. Not only have they already had their vacations, but if you are the sort of person who wants to have their vacation at an unusual time so as to beat the crowds in the alps, the last thing you want is to schedule it when the slopes are full of Stockholmers. So under 1% of the population of Denmark and Norway
is estimated to have travelled in the last week of February. It's one of the lightest weeks of the year for airplane travel.
And it is the heaviest week for airline travel, and travel out of the country in general for Sweden. It's much larger than Christmas. In 2020 the number of people out of the country that week was about 1 million people, i.e. more than 10% of the population. see:
So the next thing we would dearly love to know is what percentage of the travellers got sick, but we cannot learn that one either. But, in a hand-waving way you can see that if you start with 20 or 30 times as many travellers, adjusted for population, you could easily end up with 10 times as many sick people to seed your population with early 2020 cases of covid, which would then yield 10 times as many people dying. There is nothing that goes *THUD* -- this data doesn't make sense.
So, my personal belief is that if the week to get sick with covid contracted abroad had been one week earlier, we would be now be talking about why it was that the Norwegians had such a larger early death toll, and if it had been two weeks earlier we'd be talking about why the Danes did.
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There are lots of things to criticise in the Swedish pandemic response but the international press seems to have outdone itself in not getting the facts of the story correct. For instance, we closed the universities and had the 16-19 year olds work remotely. They really should have been opened as soon as we figured out that covid was a deadly disease for the sick and the old, but not teenagers and young adults. But people still think that these schools, like the elementary schools were left open.
I think the relevant fact on excess mortality is that it was not unusually high. Whether it was unusually low may depend on the details of how you calculate, whether you adjust for the age distribution of the population, and the like. But not unusually high is enough to show that the orthodox views at the time were wrong and the costs they imposed unnecessary.
On the other hand, it could be argued that Swedes were unusually responsible people, and that the policy Sweden adopted would have worked in some countries but not in others.
The question I am interested in is how close it was to the Great Barrington plan. It sounds as though the elderly were not really isolated. The end of life nursing homes were in some sense locked down — were their caretakers in any way isolated? But the rest of the elderly, if I understand you correctly, were advised to stay home but still vulnerable to infection from hemtjänst and perhaps others. I assume the full scale version of the plan would have any necessary support people for the elderly themselves isolated.
The caretakers in the end of life nursing homes I know about were not isolated. But these things are, for the most part, privately run and so there may have been places in other parts of Sweden that isolated their caretakers as well, and I simply don't know of them. I think that I would have heard of it if it had happened, which is why I don't think it did.
Most of the rest of the elderly were not receiving visits from hemtjänst. And the ones I knew well -- the people I delivered groceries to and the like -- weren't meeting with anybody at all. They did 'shelter in place until the authorities say you can leave' -- with the addition of special times when they could visit parks and the like and just walk around outdoors without coming close to others. It was incredibly lonely and hard on them.
The people who were receiving visits from hemtjänst couldn't be isolated from hemtjänst -- the whole point of having these visits is that that you need them, and cannot function without them. Rather more people ended up needing them as the pandemic dragged on. Part of it was genuine decay in mental health caused by the isolation. This is an area where we could have done a lot better.
The support plan for the elderly had two main parts that I knew of. The first was that hemtjänst and the like were to be outfitted with serious protective gear -- biohazard suits and the like. We were supposed to have enough of them, but it seems that successive governments had decided that a large stockpile was not necessary. The Finns did not make such an error -- they had plenty as part of their war preparedness. We _used_ to have a similar stockpile in the past, and do again, but we were seriously unprepared at the time. And the notion that 'well you can always order more and get it delivered in 3 days' absolutely did not work in April 2020. Everybody was sold out of the things and you couldn't get any more from China, because they were sold out as well.
The other part of the plan was to make use of the understanding that people who caught covid early ended up with lasting immunity. (Lasting for months at any rate.) It was only after omnicron came out that some of those who caught covid early caught it a second time, and that did not happen very often. Thus these recovered people could safely visit the elders and do the sort of chores and repairs that you normally hire somebody to do.
A great advantage the Sweden has compared to other nations, when it comes to isolating people, is that we don't live in large family groups. The average age of moving out of the parental home is 21.4 years. And adults continue to live in their own houses and don't move in with their children at the end of their lives. So isolating them is a much simpler job than, say in Italy where it is common to live 3 generations in a house.
A striking example of what you describe was the public inquiry in the United Kingdom into the response of the government to the pandemic. I remember looking at the terms of reference. The question of whether compulsory lockdown was a good or bad idea was not there. Essentially, the only issue up for debate was whether there should’ve been more lockdown than there was.
I live in the boonies and only get to the nearest substantial town 30 miles away once or twice a month. I was convinced the danger was exaggerated and carried a cloth mask in my pocket which I only dragged out when store clerks told me to.
Two things convinced me of the exaggeration, but 5 years later, I may have the details wrong. One was the early reports from Italy had the average age of COVID death 1t 80 years, same as without COVID, or at least near as makes no difference. Second was that cruise ship, with 800 passengers locked up for a week or two, and only three deaths, all attributed to COVID, but I had my doubts about even that by then. Were they with or from COVID? Never has been clear.
Never got the jabs either. Didn't like how they'd been rushed, and with so much hand waving about not needing the details, not needing all the testing.
I will never know if I was lucky or right. I only know the propaganda was wrong.
I did some sanity-check Googling, and apparently about 200 people die on cruise ships per year, out of over six million passengers. Three dying on the same ship would be unusually high, but the absolute numbers are low enough that it's hard to say for sure (variance with low single digit numbers matters more than percents). That cruise ships tend to have much older populations and that covid affects the elderly far more than most populations lines up pretty well. Likely those deaths would not have occurred otherwise, because it was a vulnerable population. But it's not so far outside of normal to think that those three definitely died of covid but for sure would not have otherwise.
I hadn't even considered what the normal death rate would be absent COVID. It just seemed that if COVID had been as deadly as claimed, locking up 800 senior citizens with a COVID outbreak should have killed more then 3 of them. Pure guessing.
I was in Tanzania for most of the Covid pandemic. They stopped counting 'Covid deaths' at about 500 and controls such as masks were largely ignored. I have no idea if there has been any study on the effects of this.
In the hospital I work in we are still following the silly covid rules set up at the beginning of the pandemic. We give Remdesivir to covid patients, in spite of no evidence of efficacy. Why? Because it was mandated by the federal government.
We use droplet precautions even though covid is primarily an airborne disease with only limited spread via droplets. We follow what was mandated by the feds way back then. There is no updating of policy with improved information.
I don't know what the evidence is on Remdesivir, but judging by the Wiki it is at least widely believed to reduce mortality from Covid and approved for that purpose in most countries.
Yes, Wiki is surprisingly gung-ho on Remdesivir. WHO recommended not using it as useless. Not sure why Wiki does not report the controversy which was big news at the time. Certainly on a practical level we gave Remdesivir to covid patients with no obvious benefit. Possibly there is some slight benefit not noticeable without statistics.
Albeit my question is more about how to make science in that region more developed in research and output, as simply throwing more money might not be the best option
Why would a developing country want to spend money on scientific research? Are you imagining a case where there is particular research important only for them, such as a cure for a very local disease? One possibility in that case is to offer a prize for the first solution.
Outside of that sort of case I would think it would be sensible for poor countries to free ride on research done by rich countries.
I don't understand your answer. The science for industrialization is already known. It makes very little sense for a developing country to spend its scarce resources trying to do cutting edge research.
At least, it makes very little economic sense. It may make political sense if the government wants to pretend its economy is much more advanced than it is and finds press releases about scientific breakthroughs a way of doing so.
I remember reading reports during Covid, that the "cause of death" was being listed as Covid even when it was not, because that had some kind of financial benefit for the hospital or institution.
Has someone actually compared death rates between Covid and non-Covid years and normalized for reduced traffic deaths to see how many folks Covid really did kill?
I also remember that during Covid, when the media kept claiming that there were Soooooo many deaths, I never heard a single one of them do a by the numbers comparison to previous years' death rates. I kept listening for it...
The excess mortality figures try to do that, although they include people killed by precautions against Covid.
There was a running mortality total for my county (Santa Clara County) which at one point shifted from deaths with Covid to deaths from Covid. A news story at the time reported a 22% drop as a result.
I think there is good information on excess mortality but not on deaths due to Covid. The former gives you some information on the latter, but there are multiple problems. One is that there might be unrelated reasons why mortality is higher or lower than usual — for an extreme example consider Ukraine and Russia at present. Another is that precautions against Covid might either increase or decrease mortality from other causes.
A further problem in evaluating strategies by their outcome is that a high or low death rate from Covid might have other causes such as age distribution of the population or population density. I think the Swedish experience is strong evidence that the strategy they followed was not nearly as bad as commenters claimed at the time, evidence but not strong evidence that it was a better policy than other countries followed.
"the most vulnerable part of the population, principally the old, they should be isolated and the disease allowed to spread through the rest of the population" -- it was never explained to me how one would go about doing that. My elderly, obese, formerly heavily smoking grandmother lived with my aunt, a school teacher. How do you isolate the former but not the latter?
"Judged by excess mortality, increased mortality during the pandemic relative to its normal level, Sweden suffered less from Covid than most comparable countries." -- that's... exactly the opposite of what Figure 3 from the link in your footnote 2 shows.
You either move your grandmother to a different facility, move out your aunt, or isolate both of you. Our family consisted of me in my seventies, my wife in her sixties, and two adult children, neither of whom worked out of the home — our daughter works online, our son trying to establish himself as an author. I am retired, my wife left work long ago to be a full time housewife. We isolated all four of us until the vaccine was available. That would not be as easy for everyone, but could be done at a cost much less than the US government actually paid for the Covid programs it followed.
Figure 3 shows mortality in Sweden higher in the first year, lower in the second and third. That's the same pattern you see in Figure 2. It fits the Great Barrington model — mortality higher as Covid spreads through the population, lower when enough people have resistance due to having had the disease. I have now added that figure to the post.
I think Table 1 paints a clearer picture, as Figure 3 lacks a sum over the three years, and I think the only reasonable conclusion is that all four countries were probably hit about as hard over the three years in terms of excess deaths. But the error bars are huge – the only thing we can clearly say with statistical significance is that Sweden had fewer excess deaths per capita than Finland in 2022.
The only solution to establish objective truth is the realization of an intersubjective consensus (Karl Popper). If there is a consensus on the solution that is true, there is no problem. If consensus is established on the solution that is wrong, there is temporarily a problem, but there is no methodological alternative to consensus. Indeed, this consensus includes an institutional and sociological element (not purely methodological), for example that related to research funding. Indeed, funding reinforces (in practice) monoculture. But we must not throw the baby out with the bathwater: reject the methodological virtue of consensus in order to praise the practical virtue of diversity.
Consensus that occurs because everyone is convinced by the evidence and arguments is fine. Consensus that exists because the funder wants it and most people in the field want funding is not.
One way to better apportion public research funding would be to use it as a risk reduction tool for research by private sector companies, depending upon the type of research being conducted. For example, a company researching a new drug or treatment aimed at reviving the dead tissue in a heart from heart attacks might qualify for a 70% refund of capital spent if their research fails, whilst a companies researching a drug or treatment which only treats a chronic condition, making life more liveable, or only forestalling death, through continuous treatment, might only qualify for a 30% refund if their research fails.
Drug research has always had an unusually high risk profile- it's why a disproportionate share of private sector research goes towards maintaining patent- it's a safer bet. Risk reduction, based upon utilitarian cost-benefit analyses aimed at maximising human outcomes would go a long way towards correcting an inherent tilt in private sector research. Make the big bets, with huge human returns, safe for investors. The exception would be blue sky research aimed at improving our understanding of the world and the human body, but of no immediate clear commercial value. This type of research generally pays future dividends in further scientific and medical discoveries, so it's well worth the investment and should remain public. Apart from anything else, one doesn't want a single company achieving a monopoly on component parts of future research and technology.
Although even Chat GPT 4.0 is playing a hissy fit on me, and failing to provide the research, there was one aspect of lockdowns which did work- although almost everyone missed it. The complete shutting down of public transport, particularly buses, did work. One of the European countries (perhaps Denmark or the Netherlands?) had two distinct regional authorities which tried different approaches. One shutdown their buses and other public transport, the other did not. Differences were seen in both virus spread and lethality (although the latter is informed guesswork). The reason I claim that latter is because of the extremely high viral loads often present in buses.
The London Transport Authority had a cluster of healthy men in their thirties who died of Covid. The only other place where this was seen was in hospitals amongst young nursing staff- not in the ICUs/isolation areas- but in areas which were directly fed from ventilation systems connected to these areas. This is also the reason why the experiences of Italy led us to believe that Covid was a threat to a far broader spectrum of the public than the elderly who were by far the most likely during the pandemic. The reason why Italian healthcare reported chubby men in their later forties and fifties filling up wards and dropping like flies was because most public transport in Italy is air conditioned and very good. Sure, two-thirds of Italian workers drive to work, but this is generally more true of rural and suburban areas. In cities, use of public transport is far more common.
Insofar as structural racism may be claimed to be purely socioeconomic, this one of several factors which bore upon different outcomes by race. We saw wildly different outcomes by race in relation to Covid. The standard claim was that structural racism was responsible for all of the differences. In the UK we had the perfect tool for measuring the validity of this claim. Pakistani (Muslim) British and Indian (HIndu) British are very similar genetically, but enjoy wildly different socioeconomic outcomes in the UK, with an astounding number of Indians becoming doctors. Both had higher rates of Covid lethality than White British people. When one compared the two groups only 20% of worse Covid outcomes can be attributed to worse socioeconomic conditions and, by extension. structural racism. The prevalence of public transport use by people with lower incomes was a huge factor in terms of virus spread and viral load, and even Covid lethality- bearing in mind that in cities, many more affluent people will use public transport, at least in Europe.
Buses and trains were death traps for high viral loads. Besides, look at the physics. Even without air conditioning or heating, if you can feel the gravity on your body from acceleration or deceleration, imagine how it was helping to circulate high viral loads.
Public transport made what was effectively a bad flu seem like something far more serious. In the UK, at roughly the same time that our official Covid death toll hit 150K, a much less publicised FOI request was disclosed. Of those 150K, only 17K died from Covid alone. Of course, there was a second group for which Covid was a contributing factor to death also due to comorbities, but we will never know how many people who died with Covid, died without Covid being a contributing factor.
It's also worth noting that kids were perfect vectors for spreading the virus in low viral loads. Their anatomy simple wasn't developed enough to deliver Covid in lethally high levels of viral load, unless they had family members with very high levels of medical vulnerability. A smarter approach would have been to put teaching and support staff in schools on sabbatical if they were over forty and obese, or over fifty, and then simply let the kids go to school. This would have delivered herd immunity with low doses of viral load. Although this may seem callous to the extremely rare medical outliers, it would have saved a huge number of human lives, particularly in the developed West.
Unfortunately, the West quickly developed a monoculture of insane confirmation bias, although in some countries there were two distinct monocultures- neither one at all rational or scientific.
"While some of the research subsidized is doubtless worth doing, the costs of having government subsidy of research are greater than the benefits even ignoring the budgetary cost — because the existence of government subsidies makes science work less well, be less likely to produce true conclusions, more likely to produce false ones."
One way I tend to look at this is in terms of science in the counterfactual: if the subsidy weren't there, would that worthwhile result still have been obtained by other means? People today extoll the virtues of DARPA in developing the science that led to the creation of the Internet, without noticing the private corporations which also played a role, possibly because they saw the business case.
This angle is somewhat similar to one employed by Milton Friedman in an anecdote I once encountered, in which someone remarked on how wealthy Swedes were while implementing socialist policies, and he responded that the Swedes in America were wealthier still.
It's not a slam dunk case, even so. It's possible that the private vision of the value of the Internet was so hard to realize that there wouldn't have been enough funding to set it up, especially in light of all the other possible ventures that could be funded. I don't know.
My go-to thought about private research is Bell Labs. Which spent very high sums of money and produced a ton of good results (and a lot of expensive failures I'm sure).
But the federal government shut down Bell, incidentally killing the lab too. I don't know that we can both not subsidize research and also shut down private research (even if incidentally).
The thing that surprised me was the lack of interest / activity with air filtration / sanitization, which has benefits beyond Covid risk reduction itself. My experience is not with bilogical hazards but with chemical / occupational exposure to irritant / toxic agents. I am elderly and my wife's health is definitely frail, so I took stronger isolation measures than most. In general we used N99+ irritant dusk masks when we had to go among people, but when I had jury duty during the Omicron wave I showed up wearing a powered air supplied respirator and associated face mask - think biohazard minus the bunny suit. We also have a MERV 16 filter in the HVAC system and additional HEPA filters in the rooms we spend our time in. Our kids wear N99 masks when they are inside when they visit and so far neither of us has gotten Covid, the flu, or colds since we locked down. Our kids are less locked down and work in office and do other socializing and have gotten all three.
As for centralized approaches, all these people are in the same online groups, go to the same conferences, and read each other's papers, so it's not surprising that there's a strong notion of "we will do things This Way and No Other" that develops quickly...
As for funding, one huge problem with federal funding is it comes with so much mandated things-to-do around it that often half or more of the grant money disappears in "administration" as opposed to actual research.
I saw this at Postgres at Berkeley "way back when", and apparently the "overhead problem" of such grants is even worse nowadays...
Preparing a grant proposal and walking it through the bureaucracy is a major undertaking - often quite a bit more complex than writing a nontrivial scientific paper...
In Sweden we _did_ isolate the vulnerable. The end-of-life nursing homes _were_ locked down. And this meant that people who had been promised that their last months spent there could be spent surrounded with family ended up dying alone or with health care workers. This is what the king was critical of in his widely-reported "we failed those people" quote. By taking the quote out of context from his speech, people were left to fill in the blanks and assume that the king was in favour of stronger lockdowns, when the failure he was speaking about was not finding a way to let the dying see their loved ones. The people in the care homes were all expected to die within the year (except for some with dementia, who also are cared for in such places) because this is the major criteria for being accepted into such places in the first place. And while isolating them could protect them from dying of covid, they were still going to die of whatever had been killing them that had brought them to the care homes.
In addition, on On March 16th, the Public Health Authority urged people aged 70 and over toavoid unnecessary social contacts as far as possible. We basically told the old people to stay at home, until either the disease went away or we got vaccines that worked. We were all set to do this for 3 or 4 years, the time we thought it would take to test and develop a vaccine, based on how long it was done in the past. So we organised into groups that delivered groceries, meals, craft supplies, books, lumber and what ever else to the old people. This happened everywhere, and was organised by the church, and the grocery stores, and golf and other athletic clubs, and homeowners associations and so on and so forth. It was pretty much all private acts of generosity and kindness, and not something the government did, which pleased those of a more libertarian bent who had long listened to statists claiming that this sort of communal undertaking was not possible in the modern world.
The very oldest were already making use of 'hemtjänst' -- people, and this part is funded by the government and is available for everybody, who come by a few days a week to clean the house, help them with tasks around the house, and with showers, haircuts and the like if needed. And since Swedish elders tend to live alone, and not with family members, we thought we were well set up to isolate the elders as compared to other places.
Most of the early deaths in Sweden came from people who were isolating, either collectively locked down in the care homes, or by their own choice though personally being visited by hemtjänst. Locking down the country as a whole wasn't going to get these people any more locked down than they already were doing voluntarily. And the greatest pandemic failures were had were related to *not enough isolating equipment for the staff here* and *improper training in how to use the equipment we did have*. It is notable that the variant of covid circulating in Sweden in 2020 was not the same variant as was circulating in Denmark, Norway or Finland (or Italy, and most of Europe). The variety we got was called 20B/S:1122L
and it was unique to Sweden and part of Latvia. Something called EU1 was the majority over most of Europe.
see the wonderful graphs at https://covariants.org for this information.
This has naturally fuelled speculation at the time that 1122L may have been more deadly than the EU1 sort. We'll never know now. But what was evident in the first measurements we took was that the people who were dying in the earliest stage of the pandemic were catching covid from their doctors, care providers (in homes and as hemtjänst), ambulance workers, cleaners who worked in the care home, etc. And these people were catching the disease from other people in their professions. We know this because for a while the variants remained separate, and they all circulated, yet the old people pretty much all got sick and died from 1122L, which meant that it wasn't 'general spread' that was the culprit here, but the focused spread of the variant which was prevailent in health-care settings. And if we had _had_ a lockdown in Sweden, there is no way that these particular workers would have been locked up -- they were the epitome of people doing vital work that could not be halted.
continued --- there is a length limit on notes.
The other notion 'that Sweden should be expected to have the same rates as Denmark and Norway, and if they didn't they must be doing something wrong' is one of the more egregious cases of 'how to lie with statistics' I have ever come across. There are two major factors which were conveniently overlooked by those who wanted to use Sweden as a model to support their be. The first is that the Swedish elderly population was unusually large in 2020, because in the previous winter many fewer people died than expected. Indeed, the magnitude of the 'excess continued-to-live' in that cold season was larger than the magnitude of the 'excess deaths' in 2019/2020. If covid had not come along, and the old people had simply succumbed to the run-of-the-mill respiratory infections, it would have passed with little or no comment, except among those who were responsible for building new care facilities when needed. They would then nod and say that their decision not to start a large number of new projects was the correct one. It wasn't that old people had discovered a way to live longer than the models predicted, as you could imagine happened due to some novel new medicine or treatment and we would permanently need more care homes -- it was just an exceptionally mild respiratory disease season and had just corrected itself.
See Tommy Lennham's analysis of the SCB (government statistics bureau) data here.
https://softwaredevelopmentperestroika.wordpress.com/2022/11/12/sweden-covid-all-cause-deaths-incl-oct-prel-2022/ Note the Tommy Lennhamn decided that, since 2019 was such and outlier for a death deficit, he would calclulate the baseline as 2015-2018. This gives him a slightly different number than, say the Centre for Evidence Based Medicine. see:
https://softwaredevelopmentperestroika.wordpress.com/2021/04/10/2020-excess-deaths-by-country/ but they are all very much in the same ballpark, so good!
The second significant factor which was overlooked, which to my mind is even more significant, is the Scandinavian vacation schedule.
First, some facts to know:
Copenhagen is the capital of Denmark and the greater Copenhagen area has a population of ~2 million -- Denmark as a whole has a population of ~5.8 million.
Oslo is the capital of Norway and the greater Oslo area has a population of ~1 million -- Norway as a whole has ~5.5 million.
Malmö (in Skåne) is the third largest city in Sweden and the greater area has a population of ~700,000. Göteborg (in Västra Götaland) is the second largest city in Sweden, and the greater area has a population of ~1 million.
Stockholm is Sweden's capital and the greater Stockholm region has a population of ~2.4 million. Sweden as a whole has a population of ~10.3 million.
In Denmark and Norway, spring break is held at the same time all across the country (possibly with some exceptions, though I didn't find any.) In Sweden, they are staggered for the benefit of the ski resorts and other tourism and travel related things.
So, in 2020 when were the winter breaks?
Winter break Copenhagen and Göteborg: 10.2.2020 - 14.2.2020
Winter break Oslo and Malmö : 17.2.2202 - 21.2.2020
Winter break Stockholm: 24.2.2020 - 28.2.2020
(source:https://publicholidays.dk https://publicholidays.no and https://publicholidays.se)
When the people of Copenhagen, Göteborg, Oslo and Malmö came back from their winter vacation, they did not arrive home sick, or at any rate they did not immediately head for the hospitals in large numbers . It was travellers in the last week of February and the first week of March who did so, in all three countries. But the last week of February is one of the weeks when the fewest people travel in Norway and Denmark. Not only have they already had their vacations, but if you are the sort of person who wants to have their vacation at an unusual time so as to beat the crowds in the alps, the last thing you want is to schedule it when the slopes are full of Stockholmers. So under 1% of the population of Denmark and Norway
is estimated to have travelled in the last week of February. It's one of the lightest weeks of the year for airplane travel.
And it is the heaviest week for airline travel, and travel out of the country in general for Sweden. It's much larger than Christmas. In 2020 the number of people out of the country that week was about 1 million people, i.e. more than 10% of the population. see:
https://www.thelocal.se/20200611/public-health-agency-head-coronavirus-came-to-sweden-\
from-countries-that-were-under-our-radar
So the next thing we would dearly love to know is what percentage of the travellers got sick, but we cannot learn that one either. But, in a hand-waving way you can see that if you start with 20 or 30 times as many travellers, adjusted for population, you could easily end up with 10 times as many sick people to seed your population with early 2020 cases of covid, which would then yield 10 times as many people dying. There is nothing that goes *THUD* -- this data doesn't make sense.
So, my personal belief is that if the week to get sick with covid contracted abroad had been one week earlier, we would be now be talking about why it was that the Norwegians had such a larger early death toll, and if it had been two weeks earlier we'd be talking about why the Danes did.
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There are lots of things to criticise in the Swedish pandemic response but the international press seems to have outdone itself in not getting the facts of the story correct. For instance, we closed the universities and had the 16-19 year olds work remotely. They really should have been opened as soon as we figured out that covid was a deadly disease for the sick and the old, but not teenagers and young adults. But people still think that these schools, like the elementary schools were left open.
I think the relevant fact on excess mortality is that it was not unusually high. Whether it was unusually low may depend on the details of how you calculate, whether you adjust for the age distribution of the population, and the like. But not unusually high is enough to show that the orthodox views at the time were wrong and the costs they imposed unnecessary.
On the other hand, it could be argued that Swedes were unusually responsible people, and that the policy Sweden adopted would have worked in some countries but not in others.
The question I am interested in is how close it was to the Great Barrington plan. It sounds as though the elderly were not really isolated. The end of life nursing homes were in some sense locked down — were their caretakers in any way isolated? But the rest of the elderly, if I understand you correctly, were advised to stay home but still vulnerable to infection from hemtjänst and perhaps others. I assume the full scale version of the plan would have any necessary support people for the elderly themselves isolated.
The caretakers in the end of life nursing homes I know about were not isolated. But these things are, for the most part, privately run and so there may have been places in other parts of Sweden that isolated their caretakers as well, and I simply don't know of them. I think that I would have heard of it if it had happened, which is why I don't think it did.
Most of the rest of the elderly were not receiving visits from hemtjänst. And the ones I knew well -- the people I delivered groceries to and the like -- weren't meeting with anybody at all. They did 'shelter in place until the authorities say you can leave' -- with the addition of special times when they could visit parks and the like and just walk around outdoors without coming close to others. It was incredibly lonely and hard on them.
The people who were receiving visits from hemtjänst couldn't be isolated from hemtjänst -- the whole point of having these visits is that that you need them, and cannot function without them. Rather more people ended up needing them as the pandemic dragged on. Part of it was genuine decay in mental health caused by the isolation. This is an area where we could have done a lot better.
The support plan for the elderly had two main parts that I knew of. The first was that hemtjänst and the like were to be outfitted with serious protective gear -- biohazard suits and the like. We were supposed to have enough of them, but it seems that successive governments had decided that a large stockpile was not necessary. The Finns did not make such an error -- they had plenty as part of their war preparedness. We _used_ to have a similar stockpile in the past, and do again, but we were seriously unprepared at the time. And the notion that 'well you can always order more and get it delivered in 3 days' absolutely did not work in April 2020. Everybody was sold out of the things and you couldn't get any more from China, because they were sold out as well.
The other part of the plan was to make use of the understanding that people who caught covid early ended up with lasting immunity. (Lasting for months at any rate.) It was only after omnicron came out that some of those who caught covid early caught it a second time, and that did not happen very often. Thus these recovered people could safely visit the elders and do the sort of chores and repairs that you normally hire somebody to do.
A great advantage the Sweden has compared to other nations, when it comes to isolating people, is that we don't live in large family groups. The average age of moving out of the parental home is 21.4 years. And adults continue to live in their own houses and don't move in with their children at the end of their lives. So isolating them is a much simpler job than, say in Italy where it is common to live 3 generations in a house.
Thanks for a very detailed account.
A striking example of what you describe was the public inquiry in the United Kingdom into the response of the government to the pandemic. I remember looking at the terms of reference. The question of whether compulsory lockdown was a good or bad idea was not there. Essentially, the only issue up for debate was whether there should’ve been more lockdown than there was.
I live in the boonies and only get to the nearest substantial town 30 miles away once or twice a month. I was convinced the danger was exaggerated and carried a cloth mask in my pocket which I only dragged out when store clerks told me to.
Two things convinced me of the exaggeration, but 5 years later, I may have the details wrong. One was the early reports from Italy had the average age of COVID death 1t 80 years, same as without COVID, or at least near as makes no difference. Second was that cruise ship, with 800 passengers locked up for a week or two, and only three deaths, all attributed to COVID, but I had my doubts about even that by then. Were they with or from COVID? Never has been clear.
Never got the jabs either. Didn't like how they'd been rushed, and with so much hand waving about not needing the details, not needing all the testing.
I will never know if I was lucky or right. I only know the propaganda was wrong.
I did some sanity-check Googling, and apparently about 200 people die on cruise ships per year, out of over six million passengers. Three dying on the same ship would be unusually high, but the absolute numbers are low enough that it's hard to say for sure (variance with low single digit numbers matters more than percents). That cruise ships tend to have much older populations and that covid affects the elderly far more than most populations lines up pretty well. Likely those deaths would not have occurred otherwise, because it was a vulnerable population. But it's not so far outside of normal to think that those three definitely died of covid but for sure would not have otherwise.
I hadn't even considered what the normal death rate would be absent COVID. It just seemed that if COVID had been as deadly as claimed, locking up 800 senior citizens with a COVID outbreak should have killed more then 3 of them. Pure guessing.
"some of the research subsidized is doubtless worth doing"
What would be examples of such subsidized research that is worth doing?
The link for "examples" here is not working for me,
" two examples of indefensibly bad work"
I was in Tanzania for most of the Covid pandemic. They stopped counting 'Covid deaths' at about 500 and controls such as masks were largely ignored. I have no idea if there has been any study on the effects of this.
In the hospital I work in we are still following the silly covid rules set up at the beginning of the pandemic. We give Remdesivir to covid patients, in spite of no evidence of efficacy. Why? Because it was mandated by the federal government.
We use droplet precautions even though covid is primarily an airborne disease with only limited spread via droplets. We follow what was mandated by the feds way back then. There is no updating of policy with improved information.
I don't know what the evidence is on Remdesivir, but judging by the Wiki it is at least widely believed to reduce mortality from Covid and approved for that purpose in most countries.
Yes, Wiki is surprisingly gung-ho on Remdesivir. WHO recommended not using it as useless. Not sure why Wiki does not report the controversy which was big news at the time. Certainly on a practical level we gave Remdesivir to covid patients with no obvious benefit. Possibly there is some slight benefit not noticeable without statistics.
https://iris.who.int/bitstream/handle/10665/336729/WHO-2019-nCov-remdesivir-2020.1-eng.pdf
and
https://www.nejm.org/doi/full/10.1056/nejmoa2023184
Now how about solutions for developing countries if I may ask ?
If you are asking about economic development, I think a free market and free trade, the Hong Kong model, is the best option.
Hong Kong before ccp meddling, I suppose.
Albeit my question is more about how to make science in that region more developed in research and output, as simply throwing more money might not be the best option
Why would a developing country want to spend money on scientific research? Are you imagining a case where there is particular research important only for them, such as a cure for a very local disease? One possibility in that case is to offer a prize for the first solution.
Outside of that sort of case I would think it would be sensible for poor countries to free ride on research done by rich countries.
Everything - including industrialization. Albeit I got your points about prioritization of locally sensible stuff
I don't understand your answer. The science for industrialization is already known. It makes very little sense for a developing country to spend its scarce resources trying to do cutting edge research.
At least, it makes very little economic sense. It may make political sense if the government wants to pretend its economy is much more advanced than it is and finds press releases about scientific breakthroughs a way of doing so.
Ever heard "import substitution" ?
Are the numbers on deaths due to Covid reliable?
I remember reading reports during Covid, that the "cause of death" was being listed as Covid even when it was not, because that had some kind of financial benefit for the hospital or institution.
Has someone actually compared death rates between Covid and non-Covid years and normalized for reduced traffic deaths to see how many folks Covid really did kill?
I also remember that during Covid, when the media kept claiming that there were Soooooo many deaths, I never heard a single one of them do a by the numbers comparison to previous years' death rates. I kept listening for it...
The excess mortality figures try to do that, although they include people killed by precautions against Covid.
There was a running mortality total for my county (Santa Clara County) which at one point shifted from deaths with Covid to deaths from Covid. A news story at the time reported a 22% drop as a result.
Thank you. It sounds like there's little conclusive or reliable information.
I think there is good information on excess mortality but not on deaths due to Covid. The former gives you some information on the latter, but there are multiple problems. One is that there might be unrelated reasons why mortality is higher or lower than usual — for an extreme example consider Ukraine and Russia at present. Another is that precautions against Covid might either increase or decrease mortality from other causes.
A further problem in evaluating strategies by their outcome is that a high or low death rate from Covid might have other causes such as age distribution of the population or population density. I think the Swedish experience is strong evidence that the strategy they followed was not nearly as bad as commenters claimed at the time, evidence but not strong evidence that it was a better policy than other countries followed.
Thank you for the extra explanation. I appreciate the additional insight. The real world is complicated. :-)
Covid was DESIGNED for a 100% infection rate but a 99.9% survival rate because it was an airborne animal vaccine!
https://jimhaslam.substack.com/p/is-this-the-man-who-created-covid
"the most vulnerable part of the population, principally the old, they should be isolated and the disease allowed to spread through the rest of the population" -- it was never explained to me how one would go about doing that. My elderly, obese, formerly heavily smoking grandmother lived with my aunt, a school teacher. How do you isolate the former but not the latter?
"Judged by excess mortality, increased mortality during the pandemic relative to its normal level, Sweden suffered less from Covid than most comparable countries." -- that's... exactly the opposite of what Figure 3 from the link in your footnote 2 shows.
You either move your grandmother to a different facility, move out your aunt, or isolate both of you. Our family consisted of me in my seventies, my wife in her sixties, and two adult children, neither of whom worked out of the home — our daughter works online, our son trying to establish himself as an author. I am retired, my wife left work long ago to be a full time housewife. We isolated all four of us until the vaccine was available. That would not be as easy for everyone, but could be done at a cost much less than the US government actually paid for the Covid programs it followed.
Figure 3 shows mortality in Sweden higher in the first year, lower in the second and third. That's the same pattern you see in Figure 2. It fits the Great Barrington model — mortality higher as Covid spreads through the population, lower when enough people have resistance due to having had the disease. I have now added that figure to the post.
I think Table 1 paints a clearer picture, as Figure 3 lacks a sum over the three years, and I think the only reasonable conclusion is that all four countries were probably hit about as hard over the three years in terms of excess deaths. But the error bars are huge – the only thing we can clearly say with statistical significance is that Sweden had fewer excess deaths per capita than Finland in 2022.
The only solution to establish objective truth is the realization of an intersubjective consensus (Karl Popper). If there is a consensus on the solution that is true, there is no problem. If consensus is established on the solution that is wrong, there is temporarily a problem, but there is no methodological alternative to consensus. Indeed, this consensus includes an institutional and sociological element (not purely methodological), for example that related to research funding. Indeed, funding reinforces (in practice) monoculture. But we must not throw the baby out with the bathwater: reject the methodological virtue of consensus in order to praise the practical virtue of diversity.
Consensus that occurs because everyone is convinced by the evidence and arguments is fine. Consensus that exists because the funder wants it and most people in the field want funding is not.
One way to better apportion public research funding would be to use it as a risk reduction tool for research by private sector companies, depending upon the type of research being conducted. For example, a company researching a new drug or treatment aimed at reviving the dead tissue in a heart from heart attacks might qualify for a 70% refund of capital spent if their research fails, whilst a companies researching a drug or treatment which only treats a chronic condition, making life more liveable, or only forestalling death, through continuous treatment, might only qualify for a 30% refund if their research fails.
Drug research has always had an unusually high risk profile- it's why a disproportionate share of private sector research goes towards maintaining patent- it's a safer bet. Risk reduction, based upon utilitarian cost-benefit analyses aimed at maximising human outcomes would go a long way towards correcting an inherent tilt in private sector research. Make the big bets, with huge human returns, safe for investors. The exception would be blue sky research aimed at improving our understanding of the world and the human body, but of no immediate clear commercial value. This type of research generally pays future dividends in further scientific and medical discoveries, so it's well worth the investment and should remain public. Apart from anything else, one doesn't want a single company achieving a monopoly on component parts of future research and technology.
Although even Chat GPT 4.0 is playing a hissy fit on me, and failing to provide the research, there was one aspect of lockdowns which did work- although almost everyone missed it. The complete shutting down of public transport, particularly buses, did work. One of the European countries (perhaps Denmark or the Netherlands?) had two distinct regional authorities which tried different approaches. One shutdown their buses and other public transport, the other did not. Differences were seen in both virus spread and lethality (although the latter is informed guesswork). The reason I claim that latter is because of the extremely high viral loads often present in buses.
The London Transport Authority had a cluster of healthy men in their thirties who died of Covid. The only other place where this was seen was in hospitals amongst young nursing staff- not in the ICUs/isolation areas- but in areas which were directly fed from ventilation systems connected to these areas. This is also the reason why the experiences of Italy led us to believe that Covid was a threat to a far broader spectrum of the public than the elderly who were by far the most likely during the pandemic. The reason why Italian healthcare reported chubby men in their later forties and fifties filling up wards and dropping like flies was because most public transport in Italy is air conditioned and very good. Sure, two-thirds of Italian workers drive to work, but this is generally more true of rural and suburban areas. In cities, use of public transport is far more common.
Insofar as structural racism may be claimed to be purely socioeconomic, this one of several factors which bore upon different outcomes by race. We saw wildly different outcomes by race in relation to Covid. The standard claim was that structural racism was responsible for all of the differences. In the UK we had the perfect tool for measuring the validity of this claim. Pakistani (Muslim) British and Indian (HIndu) British are very similar genetically, but enjoy wildly different socioeconomic outcomes in the UK, with an astounding number of Indians becoming doctors. Both had higher rates of Covid lethality than White British people. When one compared the two groups only 20% of worse Covid outcomes can be attributed to worse socioeconomic conditions and, by extension. structural racism. The prevalence of public transport use by people with lower incomes was a huge factor in terms of virus spread and viral load, and even Covid lethality- bearing in mind that in cities, many more affluent people will use public transport, at least in Europe.
Buses and trains were death traps for high viral loads. Besides, look at the physics. Even without air conditioning or heating, if you can feel the gravity on your body from acceleration or deceleration, imagine how it was helping to circulate high viral loads.
Public transport made what was effectively a bad flu seem like something far more serious. In the UK, at roughly the same time that our official Covid death toll hit 150K, a much less publicised FOI request was disclosed. Of those 150K, only 17K died from Covid alone. Of course, there was a second group for which Covid was a contributing factor to death also due to comorbities, but we will never know how many people who died with Covid, died without Covid being a contributing factor.
It's also worth noting that kids were perfect vectors for spreading the virus in low viral loads. Their anatomy simple wasn't developed enough to deliver Covid in lethally high levels of viral load, unless they had family members with very high levels of medical vulnerability. A smarter approach would have been to put teaching and support staff in schools on sabbatical if they were over forty and obese, or over fifty, and then simply let the kids go to school. This would have delivered herd immunity with low doses of viral load. Although this may seem callous to the extremely rare medical outliers, it would have saved a huge number of human lives, particularly in the developed West.
Unfortunately, the West quickly developed a monoculture of insane confirmation bias, although in some countries there were two distinct monocultures- neither one at all rational or scientific.
"While some of the research subsidized is doubtless worth doing, the costs of having government subsidy of research are greater than the benefits even ignoring the budgetary cost — because the existence of government subsidies makes science work less well, be less likely to produce true conclusions, more likely to produce false ones."
One way I tend to look at this is in terms of science in the counterfactual: if the subsidy weren't there, would that worthwhile result still have been obtained by other means? People today extoll the virtues of DARPA in developing the science that led to the creation of the Internet, without noticing the private corporations which also played a role, possibly because they saw the business case.
This angle is somewhat similar to one employed by Milton Friedman in an anecdote I once encountered, in which someone remarked on how wealthy Swedes were while implementing socialist policies, and he responded that the Swedes in America were wealthier still.
It's not a slam dunk case, even so. It's possible that the private vision of the value of the Internet was so hard to realize that there wouldn't have been enough funding to set it up, especially in light of all the other possible ventures that could be funded. I don't know.
My go-to thought about private research is Bell Labs. Which spent very high sums of money and produced a ton of good results (and a lot of expensive failures I'm sure).
But the federal government shut down Bell, incidentally killing the lab too. I don't know that we can both not subsidize research and also shut down private research (even if incidentally).
The thing that surprised me was the lack of interest / activity with air filtration / sanitization, which has benefits beyond Covid risk reduction itself. My experience is not with bilogical hazards but with chemical / occupational exposure to irritant / toxic agents. I am elderly and my wife's health is definitely frail, so I took stronger isolation measures than most. In general we used N99+ irritant dusk masks when we had to go among people, but when I had jury duty during the Omicron wave I showed up wearing a powered air supplied respirator and associated face mask - think biohazard minus the bunny suit. We also have a MERV 16 filter in the HVAC system and additional HEPA filters in the rooms we spend our time in. Our kids wear N99 masks when they are inside when they visit and so far neither of us has gotten Covid, the flu, or colds since we locked down. Our kids are less locked down and work in office and do other socializing and have gotten all three.