I think it is interesting that the discussions are only framed in measuring deaths, and also focus on deaths of the old.
I'm watching friends and family knocked back by this virus for weeks, and now pushing into months (36 days and 42 days since first symptoms for 2 people I know), and research in the US and China points to the increase in long term health risks in the 20 to 50 year olds that recover from this. I know people that just walk away from this with no impact, but if we only focus on death we are likely missing the bigger picture.
The "how many time the flu is this" misses how damaging this is beyond it's potential casualties, how damaging to the health care system this is and so-forth.
The thing is, I also don't think you can get away from the way that those pushing for lower-end estimates aren't arguing from pure, selfless virology. They're arguing from a "this is uncertain, so should we really risk our economy to avoid potential lives lost?" position. I can see that if you could translate the lost money directly to other lives lost. But you can't. The various state could just support people for the period of the lockdown - all the advanced nations besides the Dysfunctional US are essentially doing this. So if you phrase things in terms of just paying lives for money, I would disagree with the article, that is evil. People who actively enable that are evil. Sweden's policy looks to be baring bitter fruit and I wouldn't forgive Dr. Giesecke any blame for that if it matures. I could be wrong and I'm OK risking money on that, it's a better choice imo.
I think this is generally true but with two significant complications:
a) People running out of money is only the surface level problem. Money is an abstraction over value. We can and should mess with the abstraction, but we can't do anything about the underlying value in the economy going up in smoke. "Bullshit jobs" notwithstanding, the things people do at work all day do actually have a role in our collective standard of living. There is a reason we can do modern medicine while the third world can't, and we could lose it.
b) Social life seems frivolous in the small, but in the large it is not. Years without human contact will seriously fuck you up. Not only are individuals in distress, but friendships, relationships, families, communities, and society itself are all in rapid decay. Screen time can only slow that down a little.
Becoming a world of 7 billion hermits for as long as it takes carries real risks and real costs, too.
As someone in NY where at least 17,000 people have died of SARS2 in the last ~6 weeks including two middle aged people one older person I know personally I am absolutely certain that this is nothing, "like the flu" no matter what anyone claims. We don't get 500-1000 people dying (especially middle aged people) of the flu every day - especially when we are in virtual lockdown.
There's no question that a lot of questions remained unanswered, but one question that has a concrete answer is that this is nothing like the flu.
I don't really think it is about economy only. I don't see the same people pushing for help for businesses nor coming up with ideas how to make economy run as much as possible under closed conditions. The push is to make it like before and act like nothing is happening. Beyond that, there is not much.
It seems to me more of "I dont want this to be true whether for both practical or for ideological reasons, therefore it can not be true".
> The various state could just support people for the period of the lockdown
Isn't that just hiding the truth though? After all, what is the state, where does it get the funds? Whether you take my money today or tomorrow, you've still taken my money. I don't see any reason to believe that there will be a magical no-tax funding of government any time soon.
A lot of these discussions also sound like lockdown measures are "free". But in reality it's about balancing two unknowns.
On the one hand we don't know how dangerous the virus actually is. If you look around you can find very serious scientists calculating the risks both as very low and very high. There are a number of various complicating factors (like comorbidity, or lockdown measures) to take into consideration.
On the other hand we have some idea that lockdown is going to be really bad. We are likely to face a huge economic crisis, except a lot of the outlets for negative emotion have been cut off. That is going to have a very real death toll as well. But again, we don't know how bad this is going to be. Will it cause wars? Perhaps. Will it cause suicides? Definitely.
I am personally fairly surprised that the Giesecke view isn't more popular around the world. Having a bit more scepticism about the virus before one decides to also sacrifice a lot of people's livelihoods seems prudent to me.
The tail risk angle is pretty interesting. We have a pretty good idea of the upper bound of mortality of the virus, and we also know that with some basic precautions the worst case scenario can be avoided. It's worse than the flu, but not 10 times worse. On the other hand we have no clue what the end result will be of mass unemployment and food insecurity for millions who used to be middle class, on top of unprecedented central bank policy. It's pretty reckless to shut down the world economy and hope it will turn out OK.
We don't know that it's not 10 times worse. Data is confusing and sketchy, but there are many datapoints that indicate that the IFR is over 1%, and maybe as high as 2%.
The issue is that it is a false dichotomy. You can't just "reopen" the economy and everything goes back to normal.
Sweden has effectively voluntarily shutdown with >80% reductions in hospitality spending, etc.
Until a region effectively eradicates the disease (elimination, vaccination or haphazard herd immunity) there is no option of returning to normality.
Modern pandemic response analysis is of course not weighing pro's and cons of lockdown, but instead anticipating outcomes from different scenarios and mitigation strategies.
Ie. What may be the outcomes of not locking down by any measure, and is this response in any way realistically viable? The deeper reflections are missing from public discourse.
The problem is that scenario analysis cannot really be open to the public, and is also highly complex where "small" variables may turn out to have high impacts.
The UK budget watchdog estimates that 6 months of lockdown will lead to national debt increase of about 25% GDP [1] - an unthinkably huge number in a world where 5% GDP debt increase is a huge amount, in normal times. UK's current debt-to-GDP ratio is something like 80%.
Assuming an optimistic "vaccine" scenario of 1 year of lockdown, universal vaccine, then immediate bounce-back, and extrapolating the debt figures, that's 50% GDP new debt; and in reality, I expect that the longer the lockdown, the more expensive it is. I can well imagine the casualties of such a scenario to be worse than the pessimistic Coronavirus numbers. Public health funding collapsing, God knows what about schools, social spending etc., and yes, perhaps even societal collapse.
I'd love to be proved wrong, but the UK government at least doesn't see it as necessary to even share its thinking of the financial consequences of lockdown, or even acknowledge that there is a trade-off.
Yes, exactly. If the lockdown and the subsequent recession decreases the life expectancy of the average person by 0.5%, then the policy is already a net negative. Add the massive wealth destruction on top of that and the picture becomes even murkier. We, sadly, live in a world where lives can be saved with relatively little effort. Clean water, malaria nets, nutrition. If we wanted to prevent those unnecessary deaths we easily could. And now we're settings trillions on fire without even thinking carefully about the humanitarian consequences.
Being a swede it's hard but I don't know if non-swedish epidemiologists make the same mistakes and claims.
Giesecke has claimed less than two weeks ago that at least 600k people in Stockholm (pop 950k) have had it. We did viral and antibody tests that came up with 11%(and had to be retracted because it was based on blood donors and included all donors who had recovered and were specifically asked to donate plasma with antibodies, so 11% is above max) and 2.5% respectively.
This claim and Gieseckes claim that deaths are <0.1% were was then the basis of a study published to show the Swedish policy was right, which had to be retracted because it put the population of Sweden to be >3*45million.
Gieseckes claims and articles starting to disappear/overwritten on same URLs made me back up 4000 news articles yesterday. I think we are close to one of our famous overnight 180 degree public opinion turns from the media starting to question any claims at all.
A large anti body study was supposed to be released yesterday, and I'm waiting to see what it says. We seem to be very far off the herd immunity Gieseckes strategy is based on.
> Giesecke has claimed less than two weeks ago that at least 600k people in Stockholm (pop 950k) have had it
Stockholm has 2.34 million inhabitants. (Stockholm in this context is always stockholm area, not the city). That makes a 600k estimate much less outlandish although still optimistic (25%). Self-selecting hospital workers showed 20% in yesterdays publication, which seems like it should be an upper bound for the general population.
It's also important to remember that when people make the claim that "X had it" they also simultaneously estimate that perhaps X/2 would show up as positive in serological tests (because the rate of infection and delay of antibodies would create a lag) so a person claiming 20% having been infected isn't contradicted by a serological result of 10% positive.
> Stockholm has 2.34 million inhabitants. (Stockholm in this context is always stockholm area, not the city).
I agree, counting only Stockholm city isn't reasonable. But I've found the 'Metropolitan Stockholm' number is seldom used as well, but looking at the definitions it should be more common.
What is more commonly used is the number for the Stockholm urban area (I'll link the Swedish wiki article since it contains a lot more data, https://sv.wikipedia.org/wiki/Stockholm_(tätort) ).
It's interesting to compare the metropolitan areas. In Stockholm is stretches so far that it includes areas that feed to (and somewhat off) some of the other large cities (mostly Uppsala I guess), but in Skåne the metropolitan area only covers a few municipalities although commuting by car is more commonplace and there seems to be a lot more commuting by train from Helsingborg and Kristianstad to Malmö (it's also extremely handy by train) than from Uppsala to Stockolm (no hard numbers, but I commuted Uppsala -> Stockholm for five years and Helsingborg -> Malmö for a while).
So it does make more sense to use the 'Greater' areas for all the major cities.
Where does Giesecke propose a strategy of heard immunity? Does every set of restrictions that leave out total lockdown count as a "herd immunity" strategy?
1. He's aiming for herd immunity, using the people who are the less likely to have severe cases to protect the most vulnerable
2. He believes the death toll will really not be that high to justify the actions that we are taking to prevent the virus from spreading
3. He does not care about the deaths, and the faster they die, the faster we can go back to normal
Of course I don't think he believes in number 3, which is quite horrible in my opinion.
Regarding 2, the numbers emerging of the population that has actually contracted the virus seem to be much smaller than what Giesecke was assuming. So it would seem correct to assume that the death toll is going to be much higher than he was anticipating based on a wrong hypothesis.
To me it only leaves number 1 as a potentially valid approach that does not rely on quarantine.
> A large anti body study was supposed to be released yesterday, and I'm waiting to see what it says.
Also be aware that there are false positives, especially significant with these antibody tests, so with the low numbers of positives it's extremely important to evaluate if the claimed values are more than noise artifacts of the tests themselves. It is also important to be aware of the scenarios for which the use of the apparent test results is not reasonable.
Moreover, here's what happened in the UK a few weeks ago:
"John Newton, Public Health England’s director of health improvement, said:"
"A number of companies were offering us these quick antibody tests, and we were hoping that they’d be fit for purpose, but when they got to test, they all worked but were just not good enough to rely on.
“The judgment was made [that] it’s worth taking the time to develop a better antibody test before rolling it out, and that is what the current plan is.”"
"Newton told the committee that the tests trialled so far had lacked sufficient sensitivity to identify people who had been infected. “We set a clear target for tests to achieve, and none of them frankly were close.”"
I also share your concern about claims made by Gieseke.
The article quotes Gieseke as saying "The real death toll, he suggested, will be in the region of a severe influenza season — maybe double that at most".
Sweden's official death toll was 2270 yesterday (2020-04-28). The three worst influenza seasons in Sweden since 1969 killed 807, 674 and 652 people[1]. So we've already passed his "at most" claim. The only way I can see that working out is if he feels that none of the influenza seasons in the past 50 years count as "severe".
[1]: numbers taken from the Swedish wikipedia entry on influenza. I didn't bother to check wikipedia's source. An average Swedish influenza season kills about 200.
> Sweden's official death toll was 2270 yesterday (2020-04-28). The three worst influenza seasons in Sweden since 1969 killed 807, 674 and 652 people[1]. So we've already passed his "at most" claim. The only way I can see that working out is if he feels that none of the influenza seasons in the past 50 years count as "severe".
> [1]: numbers taken from the Swedish wikipedia entry on influenza. I didn't bother to check wikipedia's source. An average Swedish influenza season kills about 200.
Sorry, but you can't just throw around numbers without explaining exactly what they mean or where they come from. The numbers you're quoting is most likely deaths that has been diagnozed as influenza. To get the full picture you need to look at excess mortality (which is reported by EuroMOMO[1]) and possibly adjust the numbers to pick out the influenza-related excess (FluMOMO[2] is the model most countries use).
If you look at the 2016/2017 season in Sweden [3, figure 17, page 46] you will see that the excess mortality as reported by FluMOMO goes way beyond ~600 for a season. In the peak season we see that it was ~300 per week. There are of course uncertainties in these numbers (which is why you won't see any official "x number of people died of influenza" figures), but it was probably closer to thousands than hundreds in 2016/2017.
The problem with the Giesecke approach is that it relies on 2 assumptions being true. 1) that infection brings long term immunity to the currently circulating strains. 2) that covid-19 will not mutate into a new strain with equivalent pathogenicity to which those with immunity to the current strain are no longer immune.
If either of these are false then you will not get a meaningful form of immunity in the population. Currently we don't have any evidence that either assumption is true so pursuing this approach carries an increased risk for very little benefit.
To point 1, you’re right we don’t know for sure, but past experience with Coronaviruses (4 are endemic plus SARS and MERS) suggests that 0.5-3 years is not unreasonable. Past that the question becomes how much immunity, I.e. even if not completely immune, do you get a milder illness. Again we don’t know for sure but it’s a good Bayesian prior to assume yes, recovering from a legitimate SARS-COV-2 infection yields useful immunity for a meaningful period.
For 2, it’s unlikely to mutate to the point of not being recognized within a relevant timeframe. We can track how fast it’s mutating reliably, and it’s not dangerously quick. The good news is if we have immunity, it should last for several years if considering only what we can see about the mutations. Follow the NextStrain project and Trevor Bedford on Twitter for a smarter analysis than I can provide here.
Regarding point 2 - it is more likely that mutations would actually cause sars-cov-2 to be less pathogenic. Futher if you judge merits of approach solely by looking at death counts you miss the bigger picture: what is the total cost of the approach when you include economy and other indirect impacts, eg. mental issues caused by more severe isolation.
This is wrong. The concept Giesecke has not considered this is a little bizarre.
We have studied corona viruses before so we have information about mutations and immunity. We have also been watching covid-19 for these for 4 months.
So this is 100% untrue - "Currently we don't have any evidence that either assumption is true"
"for very little benefit." - We are talking millions of millions of lives, so I'm not sure why you'd say this. The lockdowns are killing millions, a lot of them are the very poor.
We need to plan for the fact it might mutate or we are not seeing immunity stick. But that's different to throwing out Giesecke approach because we don't know something with certainty.
On the other hand, if we don't get long term immunity from the virus we wont get it from a vaccine either. In my opinion there is three paths through this. Two of them depends on immunity.
1. Slow down the spread with soft lockdown, let it pass and get immunity. Will take a long time.
2. Try to severly limit spread with hard lockdown. Either to open up and do lockdown again as necessary or stay in lockdown. Untill vaccine. This is a long road. Optimistic figures is a vaccine somewhere second half of next year.
3. Contact tracing and severe quarantine for infected and contacts until the virus is eradicated. Quick, only possible if the spread is limited. You can't open your country to others until they have done the same or a vaccine is here. The unicorn exit is of course every county doing this and a total eradication of the virus.
A country could possibly change track from strategy 2 to 3 if the spread is down really low and contact tracing is in place. Testing without tracing wont do it.
So soft lockdown in maybe a year or more, deaths will be in the 0,5% vicinity, more in some countries, less in some.
Hard lockdown in the same timespan as above. Less deaths but will you have any society to return to? If you do hard lockdown for a while and then lighten up you're in situation 1 basically or forced to lock down soon again.
Number three is very attractive. Had we all been prepared and had plans for this like South Korea and being island nations with easily shut borders like NZ it would have been simpler. But most countries were not and are not any of that.
South Korea is effectively a island nation in this context: ain't nothing much passing over their land border unless something goes severely wrong in North Korea.
To clarify, the Giesecke approach is merely to use the clearer goal of keeping the case load manageable to the health services.
I don't know who came up with the idea that the goal would be heard immunity. Arguably, a "lockdown until vaccine" strategy is more clearly focused on (artificially) reaching herd immunity.
The lockdowns were sold on “flatten the curve” — which they have done, dramatically so, if we take ex ante predictions as accurate. They were not supposed to be the new normal.
There's a third assumption that I find particularly pernicious: that the long-term health effects of getting and surviving COVID-19 don't need to be part of the equation. We're learning more every day about how the disease not only affects the lungs but also the heart, the brain, the kidneys, and so on. Treatments, unlike vaccines, are likely to be mere months away, and don't just include drugs. We're already learning about better ways to deal with the oxygen starvation that is COVID-19's hallmark.
Every person who merely delays getting COVID-19 until better treatment is available is a win. Even if it succeeds by other metrics, the Swedish approach will fail (has already failed) by this one.
Every approach to Covid-19 relies on certain assumptions, so this is hardly unique to Giesecke. For example, most lockdown approaches assume we will have a vaccine in 12-18 months, and/or that we will be able to suppress secondary outbreaks after lockdown ends (via test and trace or other methods). Neither of these assumptions are guaranteed either.
How is Giesecke's approach of "so we should do what we can to slow it so the health service can cope, but let it pass" different than what is currently happening?
As I understand it, that is what most countries do and achieve with various success. And as soon as there is any respite in the load of the hospitals, people are already pushing for a easing of restrictions in place.
A few countries have eliminated the virus entirely. Most other countries are in lockdown as more or less a desperation move and effectively have no articulated plan. Maybe they'll get infection rate down and can get testing and contact tracing working enough to do elimination in heavily effected areas but in the US, certainly, all plans are vague and the authorities seem to be reacting to events rather than planning. I think WHO articulated the elimination path but again, who knows.
But with all that, Giesecke's approach is more like getting the whole thing over with quickly, which would have brutal effect on the health care system, to say the least. IE, once this is done, all the doctors and nurses in the emergency care system are going to quit.
> But with all that, Giesecke's approach is more like getting the whole thing over with quickly, which would have brutal effect on the health care system, to say the least. IE, once this is done, all the doctors and nurses in the emergency care system are going to quit.
The point of lockdowns wasn't to stay locked until total control. That simply will not happen in the US, at this point. (And I'm not sure it's feasible anywhere other than South Korea, now.)
The point was to give everybody time to react and get ready. It's been almost 45 days since the lockdowns started--healthcare workers should have all the gowns, wipes, masks, etc. that they need, by now.
The fact that they don't is an indictment of most of the governments of most of the countries.
In my opinion, we stay locked down until healthcare workers have what they need even if a gigantic wave hits. If enough healthcare workers die, we're all in deep shit even after Covid-19 reaches herd immunity.
Want to unlock things? Start smacking some idiot leaders around about giving equipment to healthcare workers.
When I see healthcare workers saying "Please, stop, we have all the equipment we need and then some," then I'll believe we can come out of a lockdown.
> A few countries have eliminated the virus entirely.
Cool. Any resources to read up on that? To my knowledge only a few countries have very few cases. But eliminated completely? Wow. I'd like to dive into this topic.
> But with all that, Giesecke's approach is more like getting the whole thing over with quickly,
Wait are we saying that Giesecke is arguing for an (even) more relaxed approach than is currently happening?
I assumed he was arguing for the status quo in Sweden, because hospitals are effectively at capacity now, and have been stable there for a while. A significant increase in new infections would be pretty bad so I don't think he's arguing for "business as usual".
If I understand him correctly then what he's saying is that it's not good to minimize the number of infected, but rather one should only ensure hospitals aren't overwhelmed. A good outcome is if hospitals are never overwhelmed and a significant portion (enough to make a difference) have immunity. A poor outcome would be one where either people die from lack of available care or one where the outbreak is contained through means that aren't sustainable until a vaccine is available.
Obviously if there are long term effects on the health care system from the situation where hospitals are not overwhelmed but just overworked so they quit or are burned out (e.g. many countries won't be able to give healthcare workers summer holiday this year) then that needs to be taken into account as well of course.
An interesting aspect is that the authority where the Swedish State Epidemologist works is the "public health agency". That is: the agency responsible for the health of the whole population. That's not irrelevant here.
Their mission is always the long term health of the population. They are not in a position to recommend actions that they belive will reduce deaths from Covid if they simultaneously believe that e.g the economic effects on the healthcare system will mean it is a net negative for the public health long term.
Meanwhile in other countries perhaps some authorities are working from shorter term ethical guidelines.
Using different views and optimizing for different goals isn't necessarily wrong. There is no "right" here. Everyone realizes that thousands will die in the coming years from things we can afford to treat today, but that we won't be able to afford if we have 15% unemployment. Whether that's part of the equation or not varies between countries and experts. In many places these decisions aren't even left to relevant expert authorities but rather to politicians who have an additional set of concerns (such as popularity) to deal with.
Note: Johan Giesecke is no longer working as State Epidemologist but his views are rather consistent with those of the current authority and the current State Epidemologist Dr Tegnell, so his views are probably shaped in this framework.
I doubt there’s a single best way of dealing with this crisis across the entirety of our planet, given the incredible diversity in demographics, cultures, population density, wealth, health care systems and dna.
EDIT: should have added politics as another differentiator
I found an interesting article that argues exactly this. It points out that Africa is the youngest continent, and also loses the most from not being able to work to get food, etc. And that Africa should follow a different plan than other continents.
I absolutly agree, and it's something pretty much no reporter or goverment spokesperson mention. Also, even though it's talked about, there is absolutely risk of death and misery greater than the disease if economics are not considered.
and diversity in politics... don't forget politics
Korea "should" be comparable to western countries if it wasn't for politics. But they have 100x fewer deaths. They're not trying to reach herd immunity, it's a political choice.
Readit News
I'm watching friends and family knocked back by this virus for weeks, and now pushing into months (36 days and 42 days since first symptoms for 2 people I know), and research in the US and China points to the increase in long term health risks in the 20 to 50 year olds that recover from this. I know people that just walk away from this with no impact, but if we only focus on death we are likely missing the bigger picture.
The thing is, I also don't think you can get away from the way that those pushing for lower-end estimates aren't arguing from pure, selfless virology. They're arguing from a "this is uncertain, so should we really risk our economy to avoid potential lives lost?" position. I can see that if you could translate the lost money directly to other lives lost. But you can't. The various state could just support people for the period of the lockdown - all the advanced nations besides the Dysfunctional US are essentially doing this. So if you phrase things in terms of just paying lives for money, I would disagree with the article, that is evil. People who actively enable that are evil. Sweden's policy looks to be baring bitter fruit and I wouldn't forgive Dr. Giesecke any blame for that if it matures. I could be wrong and I'm OK risking money on that, it's a better choice imo.
a) People running out of money is only the surface level problem. Money is an abstraction over value. We can and should mess with the abstraction, but we can't do anything about the underlying value in the economy going up in smoke. "Bullshit jobs" notwithstanding, the things people do at work all day do actually have a role in our collective standard of living. There is a reason we can do modern medicine while the third world can't, and we could lose it.
b) Social life seems frivolous in the small, but in the large it is not. Years without human contact will seriously fuck you up. Not only are individuals in distress, but friendships, relationships, families, communities, and society itself are all in rapid decay. Screen time can only slow that down a little.
Becoming a world of 7 billion hermits for as long as it takes carries real risks and real costs, too.
There's no question that a lot of questions remained unanswered, but one question that has a concrete answer is that this is nothing like the flu.
It seems to me more of "I dont want this to be true whether for both practical or for ideological reasons, therefore it can not be true".
Isn't that just hiding the truth though? After all, what is the state, where does it get the funds? Whether you take my money today or tomorrow, you've still taken my money. I don't see any reason to believe that there will be a magical no-tax funding of government any time soon.
On the one hand we don't know how dangerous the virus actually is. If you look around you can find very serious scientists calculating the risks both as very low and very high. There are a number of various complicating factors (like comorbidity, or lockdown measures) to take into consideration.
On the other hand we have some idea that lockdown is going to be really bad. We are likely to face a huge economic crisis, except a lot of the outlets for negative emotion have been cut off. That is going to have a very real death toll as well. But again, we don't know how bad this is going to be. Will it cause wars? Perhaps. Will it cause suicides? Definitely.
I am personally fairly surprised that the Giesecke view isn't more popular around the world. Having a bit more scepticism about the virus before one decides to also sacrifice a lot of people's livelihoods seems prudent to me.
Until a region effectively eradicates the disease (elimination, vaccination or haphazard herd immunity) there is no option of returning to normality.
Ie. What may be the outcomes of not locking down by any measure, and is this response in any way realistically viable? The deeper reflections are missing from public discourse.
The problem is that scenario analysis cannot really be open to the public, and is also highly complex where "small" variables may turn out to have high impacts.
Deleted Comment
Assuming an optimistic "vaccine" scenario of 1 year of lockdown, universal vaccine, then immediate bounce-back, and extrapolating the debt figures, that's 50% GDP new debt; and in reality, I expect that the longer the lockdown, the more expensive it is. I can well imagine the casualties of such a scenario to be worse than the pessimistic Coronavirus numbers. Public health funding collapsing, God knows what about schools, social spending etc., and yes, perhaps even societal collapse.
I'd love to be proved wrong, but the UK government at least doesn't see it as necessary to even share its thinking of the financial consequences of lockdown, or even acknowledge that there is a trade-off.
[1] https://www.bbc.co.uk/news/business-52393472
Giesecke has claimed less than two weeks ago that at least 600k people in Stockholm (pop 950k) have had it. We did viral and antibody tests that came up with 11%(and had to be retracted because it was based on blood donors and included all donors who had recovered and were specifically asked to donate plasma with antibodies, so 11% is above max) and 2.5% respectively.
This claim and Gieseckes claim that deaths are <0.1% were was then the basis of a study published to show the Swedish policy was right, which had to be retracted because it put the population of Sweden to be >3*45million.
Gieseckes claims and articles starting to disappear/overwritten on same URLs made me back up 4000 news articles yesterday. I think we are close to one of our famous overnight 180 degree public opinion turns from the media starting to question any claims at all.
A large anti body study was supposed to be released yesterday, and I'm waiting to see what it says. We seem to be very far off the herd immunity Gieseckes strategy is based on.
Stockholm has 2.34 million inhabitants. (Stockholm in this context is always stockholm area, not the city). That makes a 600k estimate much less outlandish although still optimistic (25%). Self-selecting hospital workers showed 20% in yesterdays publication, which seems like it should be an upper bound for the general population.
It's also important to remember that when people make the claim that "X had it" they also simultaneously estimate that perhaps X/2 would show up as positive in serological tests (because the rate of infection and delay of antibodies would create a lag) so a person claiming 20% having been infected isn't contradicted by a serological result of 10% positive.
I agree, counting only Stockholm city isn't reasonable. But I've found the 'Metropolitan Stockholm' number is seldom used as well, but looking at the definitions it should be more common.
What is more commonly used is the number for the Stockholm urban area (I'll link the Swedish wiki article since it contains a lot more data, https://sv.wikipedia.org/wiki/Stockholm_(tätort) ).
It's interesting to compare the metropolitan areas. In Stockholm is stretches so far that it includes areas that feed to (and somewhat off) some of the other large cities (mostly Uppsala I guess), but in Skåne the metropolitan area only covers a few municipalities although commuting by car is more commonplace and there seems to be a lot more commuting by train from Helsingborg and Kristianstad to Malmö (it's also extremely handy by train) than from Uppsala to Stockolm (no hard numbers, but I commuted Uppsala -> Stockholm for five years and Helsingborg -> Malmö for a while).
So it does make more sense to use the 'Greater' areas for all the major cities.
1. He's aiming for herd immunity, using the people who are the less likely to have severe cases to protect the most vulnerable
2. He believes the death toll will really not be that high to justify the actions that we are taking to prevent the virus from spreading
3. He does not care about the deaths, and the faster they die, the faster we can go back to normal
Of course I don't think he believes in number 3, which is quite horrible in my opinion.
Regarding 2, the numbers emerging of the population that has actually contracted the virus seem to be much smaller than what Giesecke was assuming. So it would seem correct to assume that the death toll is going to be much higher than he was anticipating based on a wrong hypothesis.
To me it only leaves number 1 as a potentially valid approach that does not rely on quarantine.
Also be aware that there are false positives, especially significant with these antibody tests, so with the low numbers of positives it's extremely important to evaluate if the claimed values are more than noise artifacts of the tests themselves. It is also important to be aware of the scenarios for which the use of the apparent test results is not reasonable.
Moreover, here's what happened in the UK a few weeks ago:
https://www.theguardian.com/world/2020/apr/09/uk-government-...
"None of 3.5m home tests ordered have so far been accurate enough to detect coronavirus immunity"
UK got 3.5 million(!) unusable antibody tests.
https://www.bmj.com/content/369/bmj.m1449
"John Newton, Public Health England’s director of health improvement, said:"
"A number of companies were offering us these quick antibody tests, and we were hoping that they’d be fit for purpose, but when they got to test, they all worked but were just not good enough to rely on.
“The judgment was made [that] it’s worth taking the time to develop a better antibody test before rolling it out, and that is what the current plan is.”"
"Newton told the committee that the tests trialled so far had lacked sufficient sensitivity to identify people who had been infected. “We set a clear target for tests to achieve, and none of them frankly were close.”"
The article quotes Gieseke as saying "The real death toll, he suggested, will be in the region of a severe influenza season — maybe double that at most".
Sweden's official death toll was 2270 yesterday (2020-04-28). The three worst influenza seasons in Sweden since 1969 killed 807, 674 and 652 people[1]. So we've already passed his "at most" claim. The only way I can see that working out is if he feels that none of the influenza seasons in the past 50 years count as "severe".
[1]: numbers taken from the Swedish wikipedia entry on influenza. I didn't bother to check wikipedia's source. An average Swedish influenza season kills about 200.
> [1]: numbers taken from the Swedish wikipedia entry on influenza. I didn't bother to check wikipedia's source. An average Swedish influenza season kills about 200.
Sorry, but you can't just throw around numbers without explaining exactly what they mean or where they come from. The numbers you're quoting is most likely deaths that has been diagnozed as influenza. To get the full picture you need to look at excess mortality (which is reported by EuroMOMO[1]) and possibly adjust the numbers to pick out the influenza-related excess (FluMOMO[2] is the model most countries use).
If you look at the 2016/2017 season in Sweden [3, figure 17, page 46] you will see that the excess mortality as reported by FluMOMO goes way beyond ~600 for a season. In the peak season we see that it was ~300 per week. There are of course uncertainties in these numbers (which is why you won't see any official "x number of people died of influenza" figures), but it was probably closer to thousands than hundreds in 2016/2017.
[1]: https://www.euromomo.eu/ [2]: https://www.euromomo.eu/how-it-works/flumomo [3]: https://www.folkhalsomyndigheten.se/publicerat-material/publ...
Or that he doesn't think deaths in past influenza seasons were all attributed to influenza but rather just "normal" deaths.
The excess all-cause deaths will be the figure to look at, but it will take quite a while before those numbers are reliable.
Source: https://www.socialstyrelsen.se/globalassets/sharepoint-dokum...
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For 2, it’s unlikely to mutate to the point of not being recognized within a relevant timeframe. We can track how fast it’s mutating reliably, and it’s not dangerously quick. The good news is if we have immunity, it should last for several years if considering only what we can see about the mutations. Follow the NextStrain project and Trevor Bedford on Twitter for a smarter analysis than I can provide here.
We have studied corona viruses before so we have information about mutations and immunity. We have also been watching covid-19 for these for 4 months.
So this is 100% untrue - "Currently we don't have any evidence that either assumption is true"
"for very little benefit." - We are talking millions of millions of lives, so I'm not sure why you'd say this. The lockdowns are killing millions, a lot of them are the very poor.
We need to plan for the fact it might mutate or we are not seeing immunity stick. But that's different to throwing out Giesecke approach because we don't know something with certainty.
So soft lockdown in maybe a year or more, deaths will be in the 0,5% vicinity, more in some countries, less in some. Hard lockdown in the same timespan as above. Less deaths but will you have any society to return to? If you do hard lockdown for a while and then lighten up you're in situation 1 basically or forced to lock down soon again. Number three is very attractive. Had we all been prepared and had plans for this like South Korea and being island nations with easily shut borders like NZ it would have been simpler. But most countries were not and are not any of that.
I don't know who came up with the idea that the goal would be heard immunity. Arguably, a "lockdown until vaccine" strategy is more clearly focused on (artificially) reaching herd immunity.
Every person who merely delays getting COVID-19 until better treatment is available is a win. Even if it succeeds by other metrics, the Swedish approach will fail (has already failed) by this one.
As I understand it, that is what most countries do and achieve with various success. And as soon as there is any respite in the load of the hospitals, people are already pushing for a easing of restrictions in place.
But with all that, Giesecke's approach is more like getting the whole thing over with quickly, which would have brutal effect on the health care system, to say the least. IE, once this is done, all the doctors and nurses in the emergency care system are going to quit.
The point of lockdowns wasn't to stay locked until total control. That simply will not happen in the US, at this point. (And I'm not sure it's feasible anywhere other than South Korea, now.)
The point was to give everybody time to react and get ready. It's been almost 45 days since the lockdowns started--healthcare workers should have all the gowns, wipes, masks, etc. that they need, by now.
The fact that they don't is an indictment of most of the governments of most of the countries.
In my opinion, we stay locked down until healthcare workers have what they need even if a gigantic wave hits. If enough healthcare workers die, we're all in deep shit even after Covid-19 reaches herd immunity.
Want to unlock things? Start smacking some idiot leaders around about giving equipment to healthcare workers.
When I see healthcare workers saying "Please, stop, we have all the equipment we need and then some," then I'll believe we can come out of a lockdown.
Cool. Any resources to read up on that? To my knowledge only a few countries have very few cases. But eliminated completely? Wow. I'd like to dive into this topic.
Wait are we saying that Giesecke is arguing for an (even) more relaxed approach than is currently happening?
I assumed he was arguing for the status quo in Sweden, because hospitals are effectively at capacity now, and have been stable there for a while. A significant increase in new infections would be pretty bad so I don't think he's arguing for "business as usual".
If I understand him correctly then what he's saying is that it's not good to minimize the number of infected, but rather one should only ensure hospitals aren't overwhelmed. A good outcome is if hospitals are never overwhelmed and a significant portion (enough to make a difference) have immunity. A poor outcome would be one where either people die from lack of available care or one where the outbreak is contained through means that aren't sustainable until a vaccine is available.
Obviously if there are long term effects on the health care system from the situation where hospitals are not overwhelmed but just overworked so they quit or are burned out (e.g. many countries won't be able to give healthcare workers summer holiday this year) then that needs to be taken into account as well of course.
Meanwhile in other countries perhaps some authorities are working from shorter term ethical guidelines.
Using different views and optimizing for different goals isn't necessarily wrong. There is no "right" here. Everyone realizes that thousands will die in the coming years from things we can afford to treat today, but that we won't be able to afford if we have 15% unemployment. Whether that's part of the equation or not varies between countries and experts. In many places these decisions aren't even left to relevant expert authorities but rather to politicians who have an additional set of concerns (such as popularity) to deal with.
Note: Johan Giesecke is no longer working as State Epidemologist but his views are rather consistent with those of the current authority and the current State Epidemologist Dr Tegnell, so his views are probably shaped in this framework.
EDIT: should have added politics as another differentiator
https://mg.co.za/article/2020-04-08-is-lockdown-wrong-for-af...
Korea "should" be comparable to western countries if it wasn't for politics. But they have 100x fewer deaths. They're not trying to reach herd immunity, it's a political choice.
Agreed and I amended my comment accordingly - and thanks for pointing out my oversight!
> it’s like a tsunami sweeping across Europe.” The real death toll, he suggested, will be in the region of a severe influenza season
>UK fatality rate of Covid-19 is likely to be 0.8-0.9%,