Northern Europe during Pandemic -- Summers 2020 & 2021 & onwards

[Seaworthy Lass]

Capn Jimbo, if measures taken during this pandemic are primarily responsible for the outcome, how do you explain the differences in excess deaths for the four countries in the UK: England, Northern Island, Scotland and Wales?

Although not identical, the restrictions have been very similar in all four countries. The outcomes are very different. Data for the last 4 years is shown below:

[Capn Jimbo]

Originally Posted by Seaworthy Lass

Capn Jimbo, if measures taken during this pandemic are primarily responsible for the outcome, how do you explain the differences in excess deaths for the four countries in the UK: England, Northern Island, Scotland and Wales?

Although not identical, the restrictions have been very similar in all four countries. The outcomes are very different. Data for the last 4 years is shown below:

Like most analyses you'll see, I've followed the UK as a whole, but a great question worth my time. I did locate a stringency response index for these four:




I learned that although the UK did start with a unified response, the four countries then broke off and diverged significantly from one another in both timing, different response profiles and extent. Seeing them all together should make the differences more obvious. Not only do the scores diverge, but the combinations of interventions do also.

I'd also point out that the new and faster spreading variant had a very significant effect on these differences, as it is believed it started in S. England, and spread randomly to various hotspots elsewhere.

I believe those factors together would account for these differences. Thanks for the question and the opportunity to take a good look.


Best,
CJ

[Dockhead]

Originally Posted by Capn Jimbo

Sweden Finally Tightens Covid Measures After Being Slammed by Virus: Sweden, Odd Man Out

Quoting Bloomberg:

From a Public Health Perspective:

I'm not going to debate with the thread's Dr. Googles, but I will keep it professional and simple. One of the greatest errors the failing countries made was to allow the virus to get a foot hold. The countries that started earliest and most agressively did the best, and now have performed quite nicely, and don't need the severe interventions that the losers who allowed the virus to become community based and uncontrollable.

Sweden - like the US - is a perfect example of what not to do.

Why is Sweden some particular example of what not to do? Sweden is in the middle third of outcomes in Europe, and in the top third of outcomes in terms of excess mortality. Much better outcome than the U.S,. U.K., France, Spain, Italy -- all of the large European countries except Germany. What in the world is Sweden supposed to be an example of, if you don't have some axe to grind? Answer -- nothing. This is a pure, biased, axe-grinding exercise.

And what country DIDN'T allow the virus to get a foothold? Nowhere in Europe. In Finland, where I live, we were just lucky -- as everyone in Finland will tell you. We didn't do anything especially different from what was done in Sweden, only Sweden had a dozen planeloads of skiiers coming back from Bergamo just as Bergamo exploded with infections, and we didn't. Everyone in Finland knows that.

And proof of that is that of the three big cities in Sweden, two of them -- Stockholm and Gotheburg -- accounted for like 90% of the infections in the first month. Whereas the third big city -- Malmo -- had nothing. Had actually a lower infection rate than Copenhagen across The Sound. The difference? Spring break in Malmo is the same as in Denmark, and a week later than in Stockholm and Gotheburg. That's all there is to it. I have, furthermore, quoted peer-reviewed science on the proposition that regional differences, even large ones, are driven by random factors, and cannot be attributed to differences in pandemic response.

Yet all you can come up with, to demonize the Swedish pandemic response, is differences to Sweden's immediate neighbors, and never mind that in the broader European context there is nothing especially bad about Sweden's outcome. Peer reviewed science says that this is nonsense -- irrelevant.

Originally Posted by Capn Jimbo

Again - there is no such thing as a "sustainable Nordic response" in my professional world. Sweden is indeed an outlier whose performance should NOT be sustained, and is in deep trouble. Swedish data, like Mexico's, is hard to get and unreliable; yet it is still very, very bad.

CJ
Public Health, 30 years

Again, I'm sorry, but this simply wrong in all respects. I have given detailed factual information about how it's done in the Nordics. You have given nothing but naked assertions -- not a single contrary fact of your own. And the head of public health in Finland, who is a close friend of the head of public health in Sweden, disagrees with your assertions. If I'm wrong, you will need to do better than just assert over and over again.

"Sustainability" is indeed a cornerstone of the Nordic approach, explicitly discussed everywhere in this region. Salaminen, in Finland, said explicitly, that lockdown, even if it were legally possible in Finland (which it is not), would never be done, because harming the economy in that way has grave public health implications. And secondly, because since lockdowns are unsustainable, we would be forced to leave off doing them just when we need them most -- as is happening in New York right now. Our PM quoted Salminen with approval; stating explicitly, that whatever we do, has to be something of keeping up for not only months, but possibly years. She said -- "it's a marathon, not a sprint". I give the exact quotes and cites upthread. So sustainability is very much a thing here, and there is great harmony of views on that throughout the Nordic region. The uninformed, biased attacks on Sweden are not to be found here -- it is an almost uniquely American, politicized, biased phenomenon. As I know -- I live here. It is an absolute litmus test of the quality of anyone's thinking on this issue. Americans with their polarized, combative view of the world simply can't think straight on issues like this, and this is a good example of it.

And you refer to "my professional world" -- what world is that? You are a retired nurse, right? I read scientific papers from real epidemiologists, a lot of them. I don't think any of them are nurses, retired, or active. In their "professional world", which is manifestly a different world from yours, there is nothing like what you talk about. They are, on the contrary, grappling with complex sets of data, and are exceedingly modest and curious in their approach, respectful of contrary opinion, acknowledging that we understand little, and grappling towards more understanding in the midst of a complex phenomenon. Totally different from this. I greatly respect your experience as a nurse -- it's a noble profession, especially in times like these. My stepmother is a retired professor of nursing. But that does not make you an epidemiologist. You'll have to do better than just assert this alleged authority over and over again, as if we should just believe you, without even hearing any facts or logic.

[Seaworthy Lass]

Originally Posted by Capn Jimbo

Like most analyses you'll see, I've followed the UK as a whole, but a great question worth my time. I did locate a stringency response index for these four:

...... image .......

I learned that although the UK did start with a unified response, the four countries then broke off and diverged significantly from one another in both timing, different response profiles and extent. Seeing them all together should make the differences more obvious. Not only do the scores diverge, but the combinations of interventions do also.

I'd also point out that the new and faster spreading variant had a very significant effect on these differences, as it is believed it started in S. England, and spread randomly to various hotspots elsewhere.

I believe those factors together would account for these differences. Thanks for the question and the opportunity to take a good look.


Best,
CJ

Hi Capn Jimbo
The very first restrictions in the UK commenced on the 24th March (beginning of week 13) and were uniform. Your stringency index graph confirms that.

They remained the same throughout the UK then diversified slightly mid May, around week 20. Again, your stringency index graph confirms that.

So we are both on the same page so far .

During this time the B117 variant did not come into play so your comment “the new and faster spreading variant had a very significant effect on these differences” does not apply to weeks 13-20.

Yet have a look at the difference between excess deaths in England, Northern Ireland, Scotland and Wales during this time. I have zoomed in and highlighted the relevant weeks in yellow. There is a dramatic difference between the 4 countries, not minor.

This strongly supports my view that measures do not necessarily correlate at all with outcome, not your view that they do.

If you mull over this, do you not think that perhaps your comments regarding Sweden “failing” due to lack of measures imposed may have been made erroneously?

PS Could you please stick to standard font? It gives me the impression that you are shouting.

[Seaworthy Lass]

Capn Jimbo, to take this one step further, lets look at weeks 20-36 for England, Northern Ireland, Scotland and Wales. This takes us to the beginning of September when perhaps the B117 variant first may have started circulating.

I have highlighted these weeks in green.

Here your stringency index graph shows that measures diversified for the first time (and they did).

However, excess deaths suddenly became more uniform for the 4 countries.

Again, this confirms that measures do not necessarily correlate at all with outcome.

[Capn Jimbo]

A Public Health Perspective:

One should never assume that the original virus will be introduced or spread any more uniformly than the variant.

The same process - introduction of the virus in a particular city or area - which then spreads (usually via travel or movement of infected persons) to other areas which then lead to diverse hotspots and local/regional spikes. Without study I can't address the age distribution, density, testing capabilities, public cooperation, how excess data is gathered, modified or classified and the like - all of which differ from country to country, if not region from region.

Your theory if correct, is extreme and a case for what? Sweden again? BTW in your original question you claimed "the outcomes are very different".

Please recall that the entry points in the US were in New York and LA who suffered greatly, although you'd have never known it in most of the country, and the overall stats weren't yet threatening. It took many months for less traveled areas to catch up. With the variant, we all are in trouble. Again, read the OP - the same score does not mean the same interventions.

We will agree to disagree, but thanks again for the question. Final answer, lol...


CJ
Public Health, 30 years

[Seaworthy Lass]

Originally Posted by Capn Jimbo

One should never assume that the original virus will be introduced or spread any more uniformly than the variant.

The same process - introduction of the virus in a particular city or area - which then spreads (usually via travel or movement of infected persons) to other areas which then lead to diverse hotspots and local/regional spikes. Without study I can't address the differences in age, density, testing capabilities, public cooperation and the like - all of which differ from area to area.

Precisely.
I would guess far more differences exist between the various Nordic countries than within the UK, including how the virus spread. If the UK countries’ deaths cannot be compared, how can you do so for the Nordic countries and conclude measures are responsible for any differences in outcome?

Originally Posted by Capn Jimbo

Again, read the OP - the same score does not mean the same interventions.

Well, in this case the restrictions (interventions) were identical throughout the UK during weeks 13-20 of 2020. The outcome was dramatically different for the four countries within the UK (the excess deaths could be compared to the very worst and best rates that occurred in Europe). It is a good example to study.

[goboatingnow]

Originally Posted by Seaworthy Lass

I agree completely.



PS I have just found that Irish Colcannon cakes made with red cabbage are a wonderful treat. Comfort food at its best. They do end up a slightly peculiar colour though .

Enjoy. All that “ ethnic “ food does little for me.

[Dockhead]

Originally Posted by Capn Jimbo

. . .Please recall that the entry points in the US were in New York and LA who suffered greatly, . .

As usual, factually incorrect information.

I thought everyone who follows the pandemic even superficially would recall that the first case and also the first outbreak in the U.S. were in Washington State, not New York, not LA. It happened in Seattle, Washington: https://www.biorxiv.org/content/10.1...322v1.full.pdf. Interestingly, the first case and the first outbreak turned out to be unconnected, so Seattle was altogether the first entry point in the U.S.

In California itself, the entry point was not LA but rather San Francisco.

Nor did LA, or California, "suffer greatly", at least not at first:



California did an early and extremely hard lockdown, and had very low infection and death rates during the first wave, compared to many other states. Confusing outcomes with "performance", as Jimbo constantly does, Governor Newsom crowed, prematurely, about the brilliant pandemic response in California, looking down his nose at states harder hit by the virus at the time.

Which measures did not work at all during the second wave, which rages on unabated, making California one of the hardest hit regions in the world for weeks, despite the "hardest lockdown in the country", according to Newsom. The daily infection rate (7 day rolling average) in California has been over 1000 for almost a month, something hardly seen in Europe setting aside Belgium and Lithuania. Despite the "hardest lockdown in the country", and notwithstanding claims by the governor about the brilliance of the California measures.

There but for the grace of God go all of us. Ireland went from the lowest to the highest infection rate in Europe within a few weeks, just last month. This breezy, arrogant certainty about what constitutes "performance", is completely unjustified by reality, is completely anti-scientific.

[Dockhead]

Originally Posted by goboatingnow

if you don't believe lockdowns are effective , well Irelands experience says different ( 5km unnecessary travel limit , schools closed , work from home, non essential retail closed , hospitality closed )

we might not like them but they work , The Sep spike was also a result of a partial relaxation plus return of schools and a post summer effect . . .

I think lockdown works. It's almost obvious that it must work. The question is whether it works better than other, less destructive measures. That is a very different question.


It's not obvious, that it works better than other measures. Nearly all of the least affected countries in Europe, did not use any lockdown. And nearly all of the worst affected countries, did use lockdown. Correlation does not prove causation, so we have to be careful what we do with that, but at the very least we have to say that it's not obvious that lockdown is particularly effective compared to other measures.

[goboatingnow]

Originally Posted by Dockhead

I think lockdown works. It's almost obvious that it must work. The question is whether it works better than other, less destructive measures. That is a very different question.

The point is the the U.K. strain which seems much more transmissible simply forced social distancing that’s the key. You simply cannot let people congregate. If you can do that by social agreement, brilliant. However if not then You have to institute solutions that mandate anti congregation measures.

No solution that allows congregations can survive contact with this strain. The infection rate simply rockets and two weeks later your hospitals are over whelmed.

So congregating must be prevented , however it’s achieved is rather immaterial. The nett effect is that people simply can’t meet up.

[Dockhead]

Originally Posted by Seaworthy Lass

Precisely.
I would guess far more differences exist between the various Nordic countries than within the UK, including how the virus spread. If the UK countries’ deaths cannot be compared, how can you do so for the Nordic countries and conclude measures are responsible for any differences in outcome?. . .

Indeed. And not only between countries, but between regions in the same country, which is an excellent demonstration of this point.

In Sweden, as I've said before, Stockholm and Gotheburg were hard hit during the first wave, while Malmo was almost unaffected, with an even lower death rate than Copenhagen across The Sound. The exact same measures, exact same timing, radically different (like 10x different) outcome.

I don't think there is any scientific doubt that outcomes and measures are not related in any scientifically discernable way. Read this:
https://onlinelibrary.wiley.com/doi/...1111/eci.13484

It simply means that there are many factors at play, than just the measures -- this is not a complicated concept. Human nature longs for simple explanations of complex phenomena, and leads to overestimating our power over nature. These impulses lead to terrible errors.

[Dockhead]

Originally Posted by goboatingnow

The point is the the U.K. strain which seems much more transmissible simply forced social distancing that’s the key. You simply cannot let people congregate. If you can do that by social agreement, brilliant. However if not then You have to institute solutions that mandate anti congregation measures.

No solution that allows congregations can survive contact with this strain. The infection rate simply rockets and two weeks later your hospitals are over whelmed.

So congregating must be prevented , however it’s achieved is rather immaterial. The nett effect is that people simply can’t meet up.

That all seems quite sensible to me.


I am not dogmatically against lockdown. I actually agree completely with the WHO -- that it might be necessary in some countries as a last resort.

[Seaworthy Lass]

Originally Posted by Dockhead

That all seems quite sensible to me.

I am not dogmatically against lockdown. I actually agree completely with the WHO -- that it might be necessary in some countries as a last resort.

I think particularly so if rates are out of control, the death rate is soaring and a vaccine is being distributed. The measures need not be sustainable then. They are a “one off” measure.

[UFO]

Originally Posted by Seaworthy Lass

Batches are recorded in case there are problems. Not necessarily “killing a few hundred” though . If you do not have a record of this, then at least your GP does.

I respect that you are entitled to your opinion. No arguments from me there, but have you considered that the side effects from therapeutic drugs are far worse than those from vaccines?

Have you ever given one of your children an aspirin? Do you know that it is not approved for use in children in the US due to the risk of Reye syndrome?

Drugs initially approved as being “safe” are sometimes removed off the market when serious side effects occur. All this is part and parcel of anything therapeutic, whether it be drugs or surgery or vaccines.

Here is a list of a few of these. Have a look at the reason some of these “safe” drugs were removed from use, some long after they were first prescribed. This is not even universal:
https://en.wikipedia.org/wiki/List_of_withdrawn_drugs

Vaccines can literally be lifesaving. One way or another, previously common diseases such as smallpox and polio and scarlet fever and diphtheria and rubella etc have destroyed countless lives. Even measles: “Measles in older children can lead to inflammation of the brain, called encephalitis, which can cause seizures and brain damage.”

Are you never going to pop a pill in your entire life for fear of side effects? If so, your life span (or quality of life) is likely to be significantly reduced.

I believe it is not sensible to be dogmatic in your views (although I have been known to jump up and down about some issues ). YMMV.

Last time I took a paracetamol was about 6 years ago when I had the worst sinus infection and have not had any other pharma drugs since then. The kids are very healthy and have fortunately not needed anything themselves, so no issues there


I understand that Viruses can have side effects - I know of several people who have had horrendous side effects from the Flu: 1) Got septicemia and lost both legs and 1 hand 2) Got Pneumonia and died 3) Got Diabetes 4) Had a stroke and my cousin lost both her kidneys from a sore throat and unfortunately is now no longer with us. It happens and is unfortunately part of life and I am certainly not against vaccinations or pharma drugs as long as they are not mandatory.