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

[Dockhead]

Originally Posted by Paul L

DH
Sweden is still a along way from their peak. There are no signs that their approach is doing better than the formal lockdowns in other similar countries.
https://covid19.healthdata.org/sweden

Yes, I agree completely, and I never said that the Swedish approach is BETTER than others. I don't know this, and no one does or can know it.



I only said that it is not obviously so that the Swedes are idiots and doing it all wrong. There's a big difference.


I also said that the jury is still out and we will only see in a few weeks or months how all this plays out.


Moreover I said that lockdown policies are by far not the only factor which determines how the pandemic plays out in different countries, so you can't assume that there will be a direct correlation between lockdown policies and outcomes.


So the Nordic countries are blessed with excellent health care systems and well housed, highly educated and disciplined populations. They have relatively small and low density populations. These are factors which probably keep the epidemic down compared to Spain and Italy (and New York).


This also means that a lockdown policy which is apprpriate for one country may be totally inappropriate for another country. The Swedish approach, which is very similar to the Danish approach by the way, may or may not be working well -- we'll see. And if it does work well, that doesn't mean that that's the way they should have done it in, say, Spain.

[Dockhead]

Originally Posted by slug

Still to early to judge Swedens experiment

That's right:





As your source said:


"The Swedish strategy can’t be fairly evaluated until at least a year out. In all likelihood, the USA will cycle in and out of lockdown for the next year with large exponential bumps in cases/deaths. Also, see the data that was left out of Shadi’s graph."


https://twitter.com/shadihamid/statu...078483462?s=19

[Paul L]

Originally Posted by Dockhead

Yes, I agree completely, and I never said that the Swedish approach is BETTER than others. I don't know this, and no one does or can know it.



I only said that it is not obviously so that the Swedes are idiots and doing it all wrong. There's a big difference.


I also said that the jury is still out and we will only see in a few weeks or months how all this plays out.


Moreover I said that lockdown policies are by far not the only factor which determines how the pandemic plays out in different countries, so you can't assume that there will be a direct correlation between lockdown policies and outcomes.


So the Nordic countries are blessed with excellent health care systems and well housed, highly educated and disciplined populations. They have relatively small and low density populations. These are factors which probably keep the epidemic down compared to Spain and Italy (and New York).


This also means that a lockdown policy which is apprpriate for one country may be totally inappropriate for another country. The Swedish approach, which is very similar to the Danish approach by the way, may or may not be working well -- we'll see. And if it does work well, that doesn't mean that that's the way they should have done it in, say, Spain.

Which is in the same vain of what I said. There's no evidence that the Swedish approach is working better than other approaches. While Sweden certainly has a top notch health care system, they do have a low number of hospital beds and ICU beds per capita. So we will see if their system gets overwhelmed with cv19 patients or not. Which is what the early lockdowns purpose is - avoid overwhelming the hospital system. If you do that, then you are reasonably successful.

Years from now there will be some fascinating epidemiological studies with lots of public health approach comparisons. For now we can just watch.

[Dockhead]

Originally Posted by Montanan

Denmark is now starting to ease some of its COVID-19 restrictions. It will re-open schools and daycare centers on April 15 as its first step towards lifting its lockdown.

Denmark was the second country in Europe to announce a lockdown to limit the spread of the coronavirus, doing so before the country had even reported its first death.

Prime Minister Mette Frederiksen warned that social distancing measures will remain, and that the country can't reopen too quickly.

The Danish restrictions were never as stringent as many countries in Europe and beyond, but seem to have been adhered to very closely.

The country recorded 5,830 cases and 237 deaths as of Friday morning. New daily figures have yet to consistently decline, but remain lower than in many other countries.

The Danish restrictions that will remain in place for another four weeks include bans on public gatherings of more than 10 people, and border controls.

Denmark's lockdown, which came into effect on March 11, never got as strict as those in many other nations, where people were limited in leaving their homes.

This meant that people in Denmark were not limited in going outside, could still attend events with fewer than 10 people, and get takeaway food and drinks from restaurants and cafes.

The country initially used a "containment" strategy, which Danish police said based on "fast diagnosis, contact tracing and quarantine of those evaluated to be at risk."

But as it spread, the police said their early plan became "irrelevant" and Denmark moved to a "mitigation strategy," which banned large gatherings and protected the most vulnerable people.

These are the measures in Denmark:

People are urged stay one to two meters from each other.

Gatherings of more than 10 people, indoors or outdoors, are banned.

People are urged to minimize trips to busy places like supermarkets and regularly wash their hands.

Businesses where people come into close contact, like restaraunts, salons or nightclubs, are closed.

Schools and daycares are closed.

Public employees with "non-critical functions" were sent home.

People cannot visit nursing homes or hospitals.

Yes, and the Danish policies are almost the same as the Swedish ones. The difference is that the Danes closed borders and closed schools and the Swedes didn't, but the other rules, and particularly the emphasis on voluntary compliance with recommendations, are quite the same.


The border closing is fairly irrelevant as Schengen as a whole is closed, so no one can fly into Sweden from outside of Europe, or indeed even from the UK, anyway. There is very little international travel going on in practice. Sweden is not the only European country with open borders; Germany also has open borders.


Restaurants are open in Sweden but people are supposed to stay a meter away from each other. So restaurants are practically empty.


It is forbidden in Sweden to visit nursing homes.


In both Denmark and Sweden people are out sailing, are cruising from port to port, are taking trips in RV's, and are visiting friends and relatives in a careful and selective way. Shops of all kind are open. Many people work at home but businesses are open and have not been closed by decree as in many other countries.



Denmark and Sweden are much closer to each other, than they are to severely locked down places like the UK, France, etc., where people have been ordered to stay at home and "non-essential" shops and businesses are closed.


I have been in Denmark during this period and I'm extremely glad to be here, and not somewhere else.

[Wotname]

Originally Posted by Dockhead

.............

So the Nordic countries are blessed with excellent health care systems and well housed, highly educated and disciplined populations. They have relatively small and low density populations. These are factors which probably keep the epidemic down compared to Spain and Italy (and New York).

.............

I think this is likely to be one of the most important aspects as to how aggressively the virus spreads though the community.

Maybe there is some genetic factor at play as well (????).

[Dockhead]

Originally Posted by Paul L

Which is in the same vain of what I said. There's no evidence that the Swedish approach is working better than other approaches. While Sweden certainly has a top notch health care system, they do have a low number of hospital beds and ICU beds per capita. So we will see if their system gets overwhelmed with cv19 patients or not. Which is what the early lockdowns purpose is - avoid overwhelming the hospital system. If you do that, then you are reasonably successful.

Years from now there will be some fascinating epidemiological studies with lots of public health approach comparisons. For now we can just watch.

I agree.


We have seen a dramatic reduction of the rate of increase of new cases all over Europe, from doubling every 4 or 5 days, or even 3, to an average now of about every 10 days. This is exactly the "curve flattening" which policy is trying to achieve.



If you get to that rate while you still have a relatively low total number of infections, then you can hope that the health care system will cope. In Sweden and Denmark the doubling time is more than 10 days (compared to 7 days a week ago and 5 days two weeks ago), and the total cases is still very low at around 1000 per million. Hard-hit Spain has also gotten the doubling time over 10 days (it was 3 days for several weeks), but they are already at 3,349 cases per million, so working from a much higher base. Nevertheless, if the rate of increase continues to fall, all these countries should be OK.


Italy was really whacked because it happened so fast and before the health care system could be really mobilized. Now a lot has happened in the month since Italy's most gruesome days, and Spain is coping better, and France even much better still. The time bought with curve-flattening seems to be having a big effect. Intense mobilization is taking place all over Europe to prevent the kind of disaster Italy had. New ICU beds are being created at a huge rate.



Interesting that Switzerland has been so hard hit -- a country otherwise a lot like Sweden -- wealthy, thinly populated. 2,837 cases per million.

[Wotname]

Originally Posted by Dockhead

.....

Interesting that Switzerland has been so hard hit -- a country otherwise a lot like Sweden -- wealthy, thinly populated. 2,837 cases per million.

Do the Swiss travel more or perhaps had been recently travelling though neighbouring Italy?

[Paul L]

Originally Posted by Wotname

Do the Swiss travel more or perhaps had been recently travelling though neighbouring Italy?

Yes, winter ski holidays south where there's a little more light.

[Paul L]

DH,
I'm just not seeing the dramatic reduction of cases in Sweden. This is the current daily new cases.

[Dockhead]

Originally Posted by Paul L

DH,
I'm just not seeing the dramatic reduction of cases in Sweden. This is the current daily new cases.

I didn't say there's a reduction of cases -- naturally cases are increasing everywhere.


I said the rate of increase goes down. I have been following it by watching the daily cumulative cases and counting back the days to when the number was half of today. This tells you the exponentiality of the increase in cases.


How many days does it take to double the cases? That tells you a lot. This has fallen considerably all over Europe in the last two weeks. In Sweden and Denmark it's now 10 days and 10.5 days respectively, whereas it was 7 days just a week ago.

[Dockhead]

Just one more among a bunch of different factors which are probably influencing how the pandemic develops in different countries is something I haven't seen discussed anywhere in the press -- the different approaches to resuscitation in different countries.


In Italy doctors are obligated to use all possible means to keep patients alive, even in hopeless cases. Living wills are legally invalid in Italy. Whereas in the Nordic countries almost everyone has a DNR instructing doctors not to use heroic methods of lifesaving or even to allow people to die in case of any serious illness or unconsciousness. This will profoundly affect how resources in hospitals are used. The average age of the Covid 19 dead in Denmark, Sweden and Finland is 84 or 85 years. How many of those were patients who were pretty much at end of life anyway, and had DNRs, which would have prevented doctors from putting them on ventilators even if they could have been easily saved that way?


How many ventilators in Italy were occupied by people who would have died within the year anyway? This may be one explanation, at least, of why there was triage in Italy but not so far in other countries.

[LittleWing77]

Originally Posted by Dockhead

But I agree that this is going to be true just about everywhere, so why not die with your sea boots on? I'm quite OK with this myself, although since I have already had COVID-19 I doubt if I will get it again.

Hiya Dockhead - do you believe that there would ever come a time when one person would be envious of another just because they've already had a disease...?

I confess I wish I was in your shoes - that I had already had it and was done with it. I have basically exhausted my capacity to attend to this pandemic and I just want it to be over already (and we're only at the middle-or-maybe-not-even-approaching-the-middle)!

I feel like a five-year-old, stamping her feet.

Best wishes to you and yours and hope you get that archepelago sailing in this Summer.

Warmly,
LittleWing77

[Dockhead]

Originally Posted by Wotname

I think this is likely to be one of the most important aspects as to how aggressively the virus spreads though the community.

Maybe there is some genetic factor at play as well (????).

Yes -- I think you are right, and I think that there are many factors -- it's a very complex phenomenon.

[Paul L]

Originally Posted by Dockhead

I didn't say there's a reduction of cases -- naturally cases are increasing everywhere.


I said the rate of increase goes down. I have been following it by watching the daily cumulative cases and counting back the days to when the number was half of today. This tells you the exponentiality of the increase in cases.


How many days does it take to double the cases? That tells you a lot. This has fallen considerably all over Europe in the last two weeks. In Sweden and Denmark it's now 10 days and 10.5 days respectively, whereas it was 7 days just a week ago.

Sweden's new cases are doubling at about once every 10 days which is an improvement. Deaths are doubling every 4 days - a trailing indicator. The UW projection I posted above still has the peak death in Sweden not for 23 days. If this is near correct, then it is still very early.

[GordMay]

Originally Posted by Dockhead

And here is why the Danes are moving towards the Swedish model, and not vice versa:
Attachment 212521
It's a hell of a policy conundrum. I would hate to be in charge of that, anywhere.

Perhaps, not so much.
"Stop covid or save the economy? We can do both”

Contrary to what you’ve heard, shutting down the country is also the quickest way to get it started back up again.

by David Rotman, in MIT Technology Revirew ➥ https://www.technologyreview.com/202...=pocket-newtab.

“... In late March, President Donald Trump warned against letting “the cure be worse than the problem itself” and talked of getting the country back to business by Easter, then just two weeks away. Casey Mulligan, a University of Chicago economist and former member of the president’s Council of Economic Advisers, warned that “an optimistic projection” for the cost of closing nonessential businesses until July was almost $10,000 per American household. He told the New York Times that shutting down economic activity to slow the virus would be more damaging than doing nothing at all.
Eventually the White House released models suggesting that letting the virus spread unchecked could kill as many as 2.2 million Americans, in line with the projections of other epidemiologists. Trump backed off his calls for an early reopening, extending guidelines on social distancing through the end of April. But his essential argument remained: that in the coronavirus pandemic, there is an agonizing trade-off between saving the economy and saving lives.
Evidence from research, however, shows that this is a false dichotomy. The best way to limit the economic damage will be to save as many lives as possible ...
... any measures to slow deaths from the virus will have huge downstream economic benefits. Michael Greenstone, an economist at the University of Chicago, finds that even moderate social distancing will save 1.7 million lives between March 1 and October 1, according to disease-spread models done at Imperial College London. Avoiding those deaths translates into a benefit of around $8 trillion to the economy, or about one-third of the US GDP, he estimates, on the basis of a widely accepted economic measure, the “value of a statistical life.” And if the outbreak is less severe than predicted by the Imperial College work, Greenstone predicts, social distancing could still save some $3.6 trillion ...
... “Our choice is not whether we intervene or whether we go back to the normal economy,” says Emil Verner, an economist at MIT’s Sloan School who has recently looked at the flu pandemic of 1918 for insights into today’s outbreak. “Our choice is whether we intervene—and the economy will be really bad now and will be better in the future—versus doing nothing and the pandemic goes out of control and really destroys the economy.” ...
... In a piece called “National Coronavirus Response: A roadmap to reopening,” former FDA director Scott Gottlieb also argued for ramping up testing and then isolating those infected rather shutting in the entire population. Likewise, Ezekiel Emanuel, chair of the University of Pennsylvania’s department of medical ethics and health policy, called for increasing testing in a New York Times piece called “We Can Safely Restart the Economy in June. Here’s How.” Harvard medical experts, meanwhile, have outlined similar ideas in “A Detailed Plan for Getting Americans Back to Work.”
The proposals differ in details, but all revolve around widespread testing of various sorts to know who is vulnerable and who isn’t before we risk going back to business ...”
More ➥ https://www.technologyreview.com/202...=pocket-newtab




“National Coronavirus Response: A roadmap to reopening,”
➥ https://www.aei.org/wp-content/uploa...covering-2.pdf

“We Can Safely Restart the Economy in June. Here’s How”
➥ https://www.nytimes.com/2020/03/28/o...s-economy.html

“A Detailed Plan for Getting Americans Back to Work”
➥ https://hbr.org/2020/04/a-detailed-p...s-back-to-work

“Testing for Coronavirus Infections and Antibodies”
➥ http://www.igmchicago.org/igm-economic-experts-panel/