Coronavirus - worldwide spread and control

Sweden becomes an example of how not to handle COVID-19
Sweden is one of the richest countries in the world, and as nations started grappling with the coronavirus pandemic earlier this year, the Swedes took a totally different approach to their neighbors. While other nations quickly imposed lockdowns, Sweden allowed people to keep living largely as normal.

Stores and restaurants have remained open throughout the pandemic, as have elementary and middle schools.

The economy has still taken a serious hit, however, and now Sweden is being seen as a cautionary tale on the risks of allowing businesses to reopen too early.

The country's mortality rate from the coronavirus is now 30% higher than that of the United States, when adjusted for population size.[...]

https://www.cbsnews.com/news/sweden...c-hWMJjM6SCkweu0GPI2LNSYlTG8Ak899VouH4Ghw#app

 

More "optimistic" speculations about herd immunity by the Swedish Public Health Agency...

Original source:
Dagens Nyheter: "FHM: Stockholm kan ha 40 procents immunitet"

I can't help wondering, are these (in my opinion, overly optimistic) speculations some kind of attempt at justifying their strategy (lack of action, really) and their repeated choice to not change their strategy?

(Again, the reason I keep posting news from Sweden so frequently here is an attempt to help dispel some of the mis-/disinformation that is currently being spread by international media, by people on social media and elsewhere about "the Swedish situation". Please do let me know if you think it's too much or not interesting enough.)

 

I guess the people at the Swedish Public Health Agency are really bad at arithmetic...

 

There is another possibility, if you remember the Diamond Princess. Because early response was based on symptoms, everyone on that ship was exposed before tests were widely available. Asymptomatic crew members could not be well isolated while dealing with passengers, and crew accommodations did not allow the kind of isolation from other crew that passenger cabins did. About 40% did not become ill. From a few other reports it seems a percentage with prior immunity do not exhibit antibodies. There is talk of T-cell mediated immunity prior to seroconversion as with the earlier SARS outbreak.

My point in this is that those numbers may be correct, but the meaning could be that the Swedish epidemic has had no detectable effect on the percentage of susceptible people in the population. It was 60% susceptible before the epidemic, and remains more or less the same. Any "herd immunity" remains far off. The major effect in reducing the susceptible population came via mortality.

Added: corrected percentage.

A Swedish friend my age took his spring vacation this year on a small island off Göteborg which could only be reached by boat. That's one effective way to isolate.

He now faces a different economic problem with his business. He can't enter any other Nordic country without going into self-isolation. He recently told me his business is "singing the swan song."

 

Here's a scathing article on Arizona's response to the pandemic, from a source with a definite political bias. What it says in objective terms remains reasonable. Arizona is still less lunatic than a state which opened theme parks, etc. when important measures showed substantial epidemic potential.

I'll use this soapbox to vouchsafe a comment on the misunderstanding of contact tracing. Prior to our recent surge, Orange County, with a population of 1.3 million, had 22 people tracing contacts. If testing delays recognition of infected patients by a week, and symptoms take days to a week or two to develop, you end up having to trace all the contacts the patient has had in the last two weeks, after the shelter-at-home order had been lifted. Once our daily cases passed 1,000 per day, I'd say the job became impossible. You can't just throw in a large number of new tracers (wherever these come from) at a late stage in the pandemic who don't know the community, and expect miracles.

Contact tracing is an excellent way to control an epidemic -- if you test widely (including asymptomatic people), restrict contacts, and isolate suspect cases. When the vast bulk of cases are the result of community spread, it becomes virtually impossible. When you don't even have numbers for suspected cases and excess morbidity and mortality, and the results of testing are delayed, this response becomes a farce. What is going on now, I fear, is political leaders laying the groundwork to say, "we tried that, and it didn't work."

Of course, if 1/3 of your population will not comply with instructions, and you have no enforcement power, the effort is doomed anyway. At the moment we have substantial numbers of people saying they won't wear masks and will not accept a vaccine if one becomes available.

 

I've already addressed this nonsense about there being any significant proportion of individuals who magically have COVID without ever having any symptoms... (don't confuse reporting biases, test contamination, lack of test specificity or pre/post symptomatic cases with "asymptomatic" cases.)

The hypothesis of prior immunity is also highly speculative, without any empirical justification so far for this "40%". Specificity is important!
There are also opposing hypotheses too (the first antigenic sin hypothesis), which suggests that antibodies against other coronaviruses may actually worsen outcomes and explain worse outcomes for the older generation.

 

Your last point seems related to the risk of a cytokine storm, which is separate from questions about infection. It is clear people who are not flattened by a cytokine storm are transmitting the disease.

The cases I'm talking about do not seem to have antibodies prior to exposure, and I don't want to get into debate about the meaning of asymptomatic. I've already seen that professionals can't agree on what they mean. We may be talking about asymptomatic, presymptomatic or oligosymptomatic; the operational point is that neither patients nor doctors believe they are sick. Some in this category later show lung damage on CT scans, despite saying they feel fine. My point there is that nobody was able to identify many infected people without a RT-PCR test.

If you have ever seen the crew quarters on a cruise ship you will realize it is very difficult to isolate crew members merely suspected of being infected. It is like being in the Navy or jail. There is a problem explaining why the entire crew did not test positive. That is where the hypothesis comes from, and respectable epidemiologists take it seriously. They may be wrong, in which case we need another explanation.

For that matter, why didn't all the passengers become infected? Those "staterooms" are nothing like isolation rooms in hospitals, and they regularly interacted with crew, before everyone was properly equipped or tested.

I'm not dogmatic on the subject, and admit we don't know a great deal about this infection. We won't know until the crisis is long past, but decisions have to be made now. What I'm suggesting actually agrees with the thrust of your argument. I could pull out 40% as having prior immunity we don't understand, and it wouldn't make any difference in the question of "herd immunity".

What has happened in Sweden is not enough to "move the needle." This, plus the poor economic results, now that other countries around them are returning to something like normal, shows that strategy has failed.

 

One more brief update from Florida, which has been doing a great deal wrong. "A ship on the shore is a lighthouse to the sea."

The current estimate of the mortality rate is 1.44%, significantly worse than I used above. The state has reported 709 deaths in the last week, though these may have happened some time earlier. This is not sustainable or politically acceptable.

We are also learning that there are again serious problems in long-term care facilities, which suggests to me that nobody was sufficiently careful about either discharging patients to these facilities while they were still infectious, or testing staff who did not exhibit symptoms.

A friend from California assures me that we do not have a monopoly on crazy people. I recognize the type.

 

I live in Texas, where cases are skyrocketing. For months now, I've worn a mask every time I go out. In addition to my mask, I'm going to start wearing face shields in public. I'm sure I'll feel self conscious at first, but if it helps even a tiny bit, it will be worth it.

 

Levels of herd immunity within the UK may already be high enough to prevent a second wave of coronavirus, a new study by Oxford University scientists suggests.

From the independent

 

erm...I thought we were only at 5-7% penetration (someone on BBC news earlier today) and herd immunity couldn't possibly kick in until 60% at the lowest....

Add to that the possibility that acquired immunity may not last longer than a few months.

And of course the 'possibilities' opened up by long covid cases suggesting longer term effects on QoL.

Herd immunity looks like a bad idea, and if the various 'clues' we have so far are anything to go by should not be counted on to prevent a second wave - especially when it's really quite easy to avoid.

 

I remember watching an interview from Professor Gupta (author of this new pre-print) about an earlier paper that seemed really unconvincing. She seems to keep producing papers that can be used to generate headlines that make it sound as if people are over-reacting to C-19, but are just based on models that lack much empirical support.

Saying that, there's a lot of uncertainty, and I wouldn't be amazed if things turned out much better, or much worse, than most people seem to expect. Maybe models showing how very different explanations could explain much of what we see is useful for reminding people of this?

Deaths in Sweden have really gone down in a way that surprised me. I wouldn't be happy if their policies were followed here, but it seems really difficult to know exactly what is happening and why.

 

Why are they even at the hospital getting scans if they aren't sick. There have been several "asymptomatic" cases discussed recently. The first is an individual had shortness of breath but no fever, but was considered "asymptomatic" as the doctors claimed the shortness of breath and mild cough was due to an underlying illness (but why did the patient go to the hospital?). The second was an Australian woman who dismissed her symptoms as "allergies". In both cases they did have symptoms, but they were ignored for one reason or another. I consider this a reporting bias.

More scientists who are bad at arithmetic...

Cytokine storms are rare and not the cause of mortality in most COVID cases, inflammation in tissues directly related to a strong infection is not a "storm".

 

Not at all, @mango. I'm eager to hear Swedish members' reports and perspectives about what's going on there.

 

I took a respiratory infection last October. I wasn't as sick with it as I have been with other bugs but it affected my hearing and I was left with a disabling dry cough for the next 6 weeks. Every time I tried to talk or move I would cough for 5 minutes making it hard to breath. I'd never had anything like it before.

A doctor talking about when covid-19 appeared said that there had been a bad coronavirus going about last year so I assume that is what it was.

Now I don't know whether it has left me with an immunity to SARS-cov-2 or if I am at greater risk of a cytokine storm! There is never an answer to what you really need to know

 

Video on BBC website (4mins 45)

Coronavirus: US v other countries... did it mess up its reopening?

"While European countries have managed to keep new infections at bay, by the time most Americans had emerged from lockdown restrictions, a second surge in cases was already under way.

Were the requirements met to safely reopen and how much testing was actually being done?"

https://www.bbc.co.uk/news/av/world...-other-countries-did-it-mess-up-its-reopening

 

"not overrun" Yea tell that to family members whose elderly parent didn't get a slot on a ventilator because of their age; or the Doctor who had to decide who went on a ventilator and who didn't.

 

The unintended surgery cancellations has caused hundreds of Canadian cardiac and cancer patients deaths after waiting for treatments/surgeries at hospitals because of COVID. The huge backlog for years to come is unimaginable.

 

Excess death rate in the US has gone quite negative, after it had been quite high (obviously due to corona):

https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm#dashboard

I guess it will stay negative for some time, regardless of any corona tests.