A Tale of Two Countries

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Sweden and Denmark are both Nordic countries speaking similar languages, sharing a lot of culture and a lot of common history. But they followed very different approaches to managing the Covid-19 pandemic. Denmark was among the first in Europe to shut down schools, restaurants and other businesses like beauty salons. Sweden, in contrast, allowed businesses to stay open and street travel to continue unimpeded. These two countries, thus, offer us a natural experiment to investigate the effectiveness of lockdown in controlling Coronavirus. This question is quite important, as lockdown is hugely disruptive both socially and economically.

Currently it looks bad for Sweden. It’s deaths per 100,000 population due to Coronavirus are about three times as high as in Denmark. Here’s a good (although week-old) summary of evidence: Sweden says its coronavirus approach has worked. The numbers suggest a different story.

Of course, Sweden and Denmark, despite their strong similarities, differ in some ways. This is a problem with natural experiments. For example, Denmark’s population density is much higher than in Sweden. But that should make Denmark’s epidemic harder to control, so this consideration only strengthens the conclusion that a lack of lockdown hurt Sweden. In Norway and Finland, which, like Denmark, closed themselves down, but have population densities comparable to Sweden, death rates have been even lower than in Denmark, making the contrast with Sweden even more striking.

Still, a comparison of death rates, while useful, doesn’t really get at the most important question: how differently did Sweden and Denmark manage to depress the rate of spread of the epidemic? After all, one thing we learned recently is that death rates per 100,000 differ dramatically among countries, much more than expected, and we don’t know why. So a direct comparison of disease transmission rates and the resulting exponential growth rate of the epidemic is in order.

A month ago, as part of the CSH-Vienna initiative on Covid-19, I developed a model-based approach to analyzing epidemic trajectories (see How Effective Are Public Health Measures in Stopping Covid-19?). So let’s see what it tells us about Sweden versus Denmark.

Let’s first look at Denmark. Most of the charts below are self-explanatory. In (a) through (f) data are indicated by points, and model trajectory is shown by the curves. The interesting parts are in the bottom tier. Thus, beta(t) in panel (g) shows how the disease transmission rate responded to the lockdown. It started quite high, around 0.3, which means that the number of infected grew by 30% every day. After March 15 it dropped to 0.1, and the gradually declined to half that, although with fluctuations.  In (h) delta(t) is the death rate about which I will talk a little later. The most interesting is (i) r(t). This is the exponential rate of increase. The goal is to bring it below 0 at which point the epidemic starts to subside. Denmark succeeded in this by April 15. This is good news.

Denmark

Now let’s look at Sweden:

Sweden

Swedish dynamics are surprisingly similar to those in Denmark. There was also a rapid decline in the transmission rate, beta(t), by March 15, but not as deep as in Denmark. After that beta continued to decline, but again ,more slowly than In Denmark. As a result, the exponential rate of disease growth approached the zero-level veeery slowly and has just touched it yesterday (we don’t yet know whether this will be sustained).

So the verdict seems clear, although perhaps not as clearcut as might be expected. The approach of Denmark clearly worked, rapidly bringing an end to the epidemic there. But Sweden didn’t do as poorly as I expected. Somehow, despite a lack of lockdown, they are depressing the transmission rate down.

Let’s now look at death rates. Note that these are not death rates per 100,00 which conflate two processes: what proportion of population is infected and what proportion of infected dies. This is a look at just the second part.

Surprisingly, we find that for most of April, Coronavirus patients in Sweden had nearly twice as great probability of dying than in Denmark. I’ll offer a possible explanation below, but it is clear that it made a rather large contribution to the difference between death rates per 100,000 in Sweden and Denmark.

I started this analysis expecting to demonstrate clear support for the wisdom of lockdown. Make no mistake, I continue to be a strong proponent for comprehensive shutdown as the best currently available method of controlling the Coronavirus pandemic. In personal life my preference, definitely, is to endure sharp pain now to solve the problem in the long term. In line with this philosophy, I think we should drive Coronavirus to extinction.

But in science one needs to set one’s personal preferences aside. It turns out that the comparison between Sweden and Denmark has some hidden complexities that we shouldn’t ignore. Let’s rerturn to the difference in delta, the death rate. If it’s real, then it weakens the case for comprehensive lockdown. On the other hand, Sweden has tested a much lower proportion of population for the virus. What if the elevated death rate there is a result of a larger number of unknown infecteds? These are the kinds of complexities that need to be resolved.

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Scott Novak

Let’s return to the difference in delta, the death rate. If it’s real, then it weakens the case for comprehensive lockdown.

So sweden did not lock down and has a higher death rate, and that weakens the case for a comprehensive lock down? I don’t get it.

Zak

From what I understand, an enormous number of Covid deaths in Sweden have been in nursing homes (similar issues elsewhere). Is this the case in Denmark? Has Denmark protected the elderly more proactively?

Jennifer

“what you should do instead is treat the patients more effectively to decrease their chance of dying”

But wasn’t part of the point of the lockdown to decrease transmission so that those who do become ill are more able to access treatment, as opposed to overwhelming health services?

J.H.

But has Sweden’s health services been overwhelmed? If they have then this holds. If they haven’t been overwhelmed then wouldn’t it suggest that the difference lies in the kind of treatment received.

Personally I suspect the difference is down to there being a much larger number of unknown infected. With the virus having been confirmed as having been in a Paris suburb from December 27 and very likely from at least December 22 and possibly even having been in France from November 16, its not surprising that Anders Tegnell suggested Sweden might have had cases from November 2019. Of course the same should hold true for Denmark, but what Peter said about Sweden testing a lower proportion of the population may also have something to do with it. On the 3rd of May Sweden had tested 148,423 persons (with 22,455 positives) which worked out to about 14,000 persons tested per million in the population. For Denmark it was 243,136 tests (9,721 positives) working out to 41,000 persons tested per million in the population. Proportionally Denmark has tested 3 times as much of its population as Sweden.

What might be most concerning from my point of view is that if this proportionality in testing translated into cases that weren’t found in the same proportion (so Sweden having actually 3 times as many cases as they have officially identified) then it might suggest that Coronavirus patients in Sweden actually had fourth-fifths the chance of dying than patients in Denmark.

Ruben Nelson

Peter,
Thank you for doing the work you do and for your willingness to share it with us as you learn. Over time, the model you offer us is as important as the results of the work.
Ruben

Arisa

Hi Peter. Thank you for your comprehensive analysis and sharing your data.

I like the way you took two countries that are geographically close to one another and perhaps quite similar in culture to look at how their differing policies may be affecting infection and mortality rates. Taking that into account, it looks like Sweden is approaching a similar beta(t), and delta(t) as Denmark but with a greater number of lives lost. How mutually exclusive would you say the lockdown is to a country’s capacity to treat patients effectively? I am curious if there is perhaps a universal equilibrium value for beta(t) and delta(t) that different countries are more or less approaching currently without an effective treatment and vaccine for Covid-19. With that being said, I am certainly mystified by the staggering differences between countries in terms of the death tolls from Covid-19. In your opinion, what would be the interesting variables to look at to attempt to demystify this situation? Or what could be the biggest hurdle in trying to find the answer?

Graeme

One of the things that is emerging as a possible factor is vitamin D status. Vitamin D is known to reduce risk of infection with respiratory viruses, and there is some evidence that this is also the case with Sars-Cov-2.

This is particularly interesting because it’s so easy to do something about.

Ernst NIlsson

What surprised me was the Swedish data that 80% of the people who died were over 70 years old, other 10% between 60 and 70 years. The Swedish authorities have acknowledged that they blew the protection in old people especially in elder care facilities.
I wonder what the age distribution of deaths looks like in Denmark and other Scandinavian countries.

Dmytro

Thank you very much for interesting comparison.

Would you please update the program code at GitHub, so that we will be able to calculate the essential plot r(t) for Ukraine? This would be helpful for our national forecasting efforts.

Dmytro

The R(t) may decline in Sweden and other countries due to the simple rise of temperature:

https://www.sciencedirect.com/science/article/pii/S0048969720325687

This can invoke a false sense of security, with a stronger and harder to mitigate second wave in November. In Autumn, there’s going to be a more virulent strain, and current resources will be exhausted.

Graeme

Without wanting to harp on (too much), this could also be related to vitamin D status. In colder temperatures, people get out in the sun less. It’s well known that vitamin D levels drop in winter (also due to less sun, not just temperature).

Iuval Clejan

So exciting to see intelligent science about this. When I first played with the computer model from the New York Times link, I was surprised that for some of their parameter values, flattening of the curve (whether total infected or death rate per capita (not per infected)) did not reduce the area under the curve (hence total per capita dead). Can you say something about that? Are you assuming in your model that once people get infected and recover (or after a certain time if they are asymptomatic) that they are no longer contagious?

Sweden’s higher delta can also (besides the number tested being lower in Sweden hypothesis) be explained by having a greater proportion (per total infected) of old people getting infected in Sweden than in Denmark. Is there data to test this hypothesis? What about the initial reason for flattening the curve, which was that it allows hospitals to not be overwhelmed? Are Danish hospitals saving more lives? Is there data to test this hypothesis? I would be surprised it this were the case, as last I heard Swedish hospitals were not overwhelmed. Also I am skeptical that hospitals/respirators actually save lives. There is no data with controls to show this for respirators, as far as I am aware.

Can you also look at South Korea, which supposedly has implemented a “smart” quarantine of old people only?

It looks like the delta curve for Sweden is starting to go under the delta curve for Denmark. If this continues, can you speculate on why?

Richard England

There are two kinds of lock-down, lock-down by fiat and lock-down by fear (or for that matter, self-preservation). The importance of lock-down by fear explains why Sweden has not done as badly as would be expected. Both forms of lock-down are economically destructive. Lock-down by fiat is usually either too slow or too incomplete to be much different from lock-down by fear, and both are more than enough to knock over a weak economy. Fear dissipates, and the economic life resumes more quicky where the disease has been essentially eliminated. Condons sanitaires need to be maintained against the world by clean countries like Australia, New Zealand, South Korea, and China, though they can open up to each other.

Richard England

It should have been “Cordons Sanitaires”

Michael Mehlhorn

Interestingly around May 1 the lines cross. Could it be that the “scientist” got one thing right (i.e. flattening the curve didn’t save lives it just spread the deaths over a longer period). Perhaps this analysis is premature and needs to be done much later. Perhaps the costs up front will be more than worth the final results. And perhaps the costs of containment (loss of liberties) will not be worth flattening the curve.

Benign Brodwicz

Not all people are at the same risk from SARS-Cov-2. This analysis is very brute force, and ignores such differences. It also ignores the long-term health costs of lockdown, as the poor are subjected to even more stress, hunger, neglect, and abuse. I have not seen any credible analysis of this.

If Sweden had taken better care of their elderly, the numbers might tell a very different story.

The longer-term damage to the younger generation in lost education, in trauma and mental and spiritual impairment, in loss of hope, in loss of future births, in the destruction of businesses that might provide employment–none of this is taken into account in this or most analyses. This is very surprising coming from a social scientist.

The analysis also ignores the apparent fact that, so long as there is no vaccine, infections will spread; lockdowns only postpone infections and do not ultimately eliminate them, as I understand it; they postpone the hoped-for herd immunity. If the requirement for herd immunity is ~60%, flattening the curve only postpones infections. Lockdown may “extinguish” the epidemic, but only so long as lockdown continues! Come on, this is basic, I should think.

A tendentious analysis from someone whose work I follow with interest.

Richard

“The longer-term damage to the younger generation in lost education, in trauma and mental and spiritual impairment, in loss of hope, in loss of future births, in the destruction of businesses that might provide employment–none of this is taken into account in this or most analyses. This is very surprising coming from a social scientist.”

You’re making a lot of conjectures on the damage, though. We don’t actually even know if any of those have worsened (especially since governments around the world have spent a ton of money money to counteract the economic effects of lockdown). A lot of pollution just got removed in urban areas, for one.

I suppose we’ve just had a ton of natural experiments to analyze later.

Ross Hartshorn

Dr. Turchin,
Interesting post! I’m going to have to reread it in more detail. For the moment, I’d just like to share a bit of analysis that I did, which puts shows Sweden and Denmark as part of a larger trend, that may indicate that the virus is evolving in the direction of lower lethality:comment image
The full explanation of where this graph came from is here:
https://www.rosshartshorn.net/stuffrossthinksabout/did_closing_schools_help/

DFT

Dr. Turchin,
One problem appears to be that the Swedish government had no prior authority to control the elderly care; it is run by municipalities who have preferred to cut labour cost using workers on hourly contracts. This has lead to an excessive spread of the virus across elderly care facilities by workers who cannot afford to stay home.

The current estimate is that half of the Swedish Covid-19 deaths are in the elderly care!
See https://sverigesradio.se/sida/artikel.aspx?programid=83&artikel=7467473

Karl Kling

There are no legislative nor material measures Sweden have in place for order a full lockdown. The emergency laws regulate wars or fires/floods, not pandemics. The material resources with spare for extra ICU, N95masks etc. were scrapped in the twenty years following the end of the Cold War (this was a bipartisan issue btw). Add to this the current government is a minority government soc-dem with Greens running with support from two former/in-waiting center-right parties and tacit support from former communists, which does not make a strong political leadership. Hence they prefer to shut up and let the bureaucrats run the show to not stir the pot.

As for the elderly care, many workers have hourly contracts and do not speak Swedish that well. Most statistics are on a total regional level though as the regions provide health care. Would be great if there were more granular statistics as there are now rumors spreading about which ethnic groups are harder hit than ethnic Swedes.

Iuval Clejan

When I said there is no data to show that hospitals save lives, I meant as far as covid-19, not in general…. And I could be wrong…

J. Daniel

If someone goes onto a respirator and then survives, wouldn’t that be someone who most likely would not have survived without the respirator? This is so obvious that there is no great urgency to collect the data you are asking for. Furthermore you can’t keep people off a respirator that they need just to collect the data you need. So, lack of data that hospitals save lives is not evidence that they don’t save lives.

Iuval Clejan

“If someone goes onto a respirator and then survives, wouldn’t that be someone who most likely would not have survived without the respirator? ” No, because there is no control. They may have survived without the respirator. The rate of survival on respirators is about 20%. If we could get data on survival from similar conditions pre-respirator that would help make a rational decision whether respirators, which cost much money, actually are helping save lives during this epidemic.

Richard

I prefer to look at total death rates (excess total deaths, in fact) because so few cases are being caught (actual number of cases, based on analysis of sewage water; our sh*t), is estimated to be 10 times the reported number in the US) and the percentage actually being caught as COVID19-positive may vary wildly by locale.

We really need to look at all sorts of factors, including vitamin D/sunlight/warmth; maybe that common TB vaccine.
I’ve been hearing of the fear of a massive explosion of COVID19 cases in developing (hot tropical) countries overwhelming the healthcare system and so far, I haven’t heard of that happening.

It’s been the richer (colder) generally Western regions that have been most hard-hit. It gets cold in winter in northern Italy, Iran, NYC, and Belgium. Also Wuhan.

VLADIMIR DINETS

There are reports from Sweden that people actually self-isolate rather well, much better than in some countries where it’s mandatory but not obeyed.

Karl Kling

In the case of Sweden, a great website if you wish to check the distribution of reported cases:

https://www.coronakartan.se/

The national health care system is run by 21 regions which is responsible for providing healthcare to its inhabitants. Which is why there sometimes have been misunderstandings between the National Healthcare Agency (Folkhälsomyndigheten, FHM) and the actual numbers of the day as they do not necessarily coordinate their reportings in time.

As is clear from the map, most cases are in Stockholm with a 200 km vicinity or what one might say the regional commuting vicinity from Stockholm. The Danish lockdown probably helped to keep the numbers low in Scania/Skåne (1.4 million inh.) which else as Denmark is the gateway to northern Scandinavia and should have expected to have many more cases. Scania has multiple connections to the European mainland with ferries to/from Poland, Germany and Denmark with the bridge in the Sound. Västra Götaland (1.7 million inh. including Gothenburg with around 1 million inh. in metro area) has also done quite well so far.

For information of population stats on a regional level, this is as it stood on New Years’ Eve 2019/2020 (“Län” = Region, the two-digit codes with municipalities in four-digits):
https://www.scb.se/hitta-statistik/statistik-efter-amne/befolkning/befolkningens-sammansattning/befolkningsstatistik/pong/tabell-och-diagram/helarsstatistik–kommun-lan-och-riket/folkmangd-i-riket-lan-och-kommuner-31-december-2019-och-befolkningsforandringar-2019/

Almost all regions except the four largest ones have a population less than 300k inhabitants. Which is needed to factor in. Geography with the thin population density and distance to and from Stockholm seems so far to be decisive for the number of cases.

Johnny Caustic

You’ve made no mention of the elephant in the room: Sweden has a huge immigrant population, unlike Denmark and Sweden’s other neighbors, and that population is behaving entirely differently than the ethnic Swedes. The ethnic Swedes are largely self-isolating, even despite the lack of legal requirements to do so, because of heavy peer pressure to do so. The immigrants are enjoying business as usual, with large gatherings and plentiful personal contact in their enclaves.

Word on the street is that a disproportionate number of cases are among the immigrants. Lack of social distancing is one factor, but there are probably other factors too, such as Vitamin D deficiency among darker-skinned people in Sweden. But Sweden won’t gather race data–I guess they think that’s discriminatory–so they’re deeply handicapping their and our ability to analyze what’s really happening in Sweden.

What I’m saying is that you’re comparing apples and oranges, so I don’t think you can draw any strong conclusions from your data at all.

J. Daniel

Just to clarify the situation in light of some of the comments above:
Lockdowns and other measures to reduce the rate of new cases can lead to

– near elimination of the disease (cases in point being China, Korea, Taiwan, Australia, New Zealand);

– better treatment for those cases that occur by flattening the curve enough to not overwhelm hospital facilities

– better treatment for cases that occur later instead of earlier because of increased knowledge about how to treat the disease.

– fewer cases/deaths before a vaccine is developed.

Many commenters above cited the economic costs and seemingly are hinting at a “just let them die” approach. Since lives have value (yes, effectively they have dollar value, and in addition, ignoring the dollar value, they also have intrinsic value), then COVID-19 deaths constitute a transfer of value (i.e. wealth) from the old to the young, and from the poor (who are more likely to catch it and die from it) to the rich. Lockdowns transfer wealth too, but I’m not sure from who to who – perhaps from the general population to the types of people who see their interests as best served by ending lockdowns.

One more point. R(t) in Peter’s graphs/discussion is normally considered, I thought, to have a threshold value of 1, not 0. Exponents over 1 lead to exponential increase in cases over time, while exponents under 1 lead to decrease over time.

Iuval Clejan

@J. Daniel: “Just to clarify the situation in light of some of the comments above:
Lockdowns and other measures to reduce the rate of new cases can lead to”

Some of these (S. Korea, Taiwan) had a “smart” quarantine (based on quarantining people who test positive), instead of a universal lockdown.

“– near elimination of the disease (cases in point being China, Korea, Taiwan, Australia, New Zealand);”

That’s very hopeful. I don’t see evidence for that, but we’ll get more evidence in the next few weeks. Low numbers of new cases is not “near elimination”. And even if it is, unless you want a permanent lockdown (unsustainable), all it takes is one infected person (or animal?) post lockdown to start the epidemic again. It’s a pesky thing about exponential processes.

“– better treatment for those cases that occur by flattening the curve enough to not overwhelm hospital facilities”

Do you have evidence that hospital treatment lowers death rates for this virus? I want to believe this is true.

“– better treatment for cases that occur later instead of earlier because of increased knowledge about how to treat the disease.”

What new knowledge has been used for treatment? I think we’ve known about plasma transfers from recovered patients to sick ones since 1917.

“– fewer cases/deaths before a vaccine is developed.”
That is a good hope. But “While there is much evidence that various vaccine strategies against SARS are safe and immunogenic, vaccinated animals still display significant disease upon challenge.”–from https://www.medscape.com/viewarticle/706717_1
What if a good vaccine is never developed?

“Many commenters above cited the economic costs and seemingly are hinting at a “just let them die” approach.”

The rationale for ending universal quarantines (aka lockdowns), or at least making them smarter (based on people infected) is not “let them die”, but only imprison those who are infected, let the rest live with the basic need of human freedom (or as much of that as can be had in the industrialized world). Also that many will die anyway, just more slowly, and might as well have them be free until they get infected.

Joey Harrison

Still working my way through, but I have to tell you that the colors you chose for the “Death Rates, delta(t)” chart look identical to my colorblind eyes. I’d greatly appreciate a version with blue instead of green.

Kaleberg

For one Swedish blogger’s take on the lockdown:
https://aardvarchaeology.wordpress.com/2020/04/28/a-swedish-perspective-on-covid19/

Basically, Sweden has banned large (>50) gatherings, closed schools and day care and encouraged people to work from home. Swedes have been generally social distancing and avoiding mass transit. He admits that the Swedish custom is to put older people in care facilities which are staffed by people who are poorly paid and unable to socially distance and that this is not a good thing in light of the epidemic. He believes that the major difference between what is actually happening in Sweden and elsewhere is that there is no real ban on meeting others in small groups.

How different is it in Denmark?

William A. "Skip" Williams

Do you have any insight from this exercise that informs some of your other work relating to population from a thousand or more years ago?

Joseph Landau

Oysya, ty oysya, ty menya ne boysya.
I would like to know more about how these crises are affecting the Slavic hinterland. I wonder if Russia will strengthen from this

Loren Petrich

https://twitter.com/AlecMacGillis/status/1258458201688887303 – “Hard to overstate how much Germany has surpassed just about everyone. It has a quarter of the deaths of other major European countries despite having the largest population by far; its schools are now reopening; and 80 percent of its factories stayed open.” – that WSJ article: https://www.wsj.com/articles/how-germany-kept-its-factories-open-during-the-pandemic-11588774844

From a scan of part of the article, “Social distancing, ubiquitous face masks, in-house Covid-19 tests, and contact-tracing when an employee fell in helped the company keep its plants open.”

Loren Petrich

To add to that, I note this article by Max Boot: Trump isn’t the only populist leader losing the battle against the coronavirus – The Washington Post https://www.washingtonpost.com/opinions/2020/05/06/trump-isnt-only-populist-leader-losing-battle-against-coronavirus/

“Some of the most successful countries in fighting COVID-19 are democracies with well-educated populaces, high levels of trust and transparency, and governments that are run by technocrats. They have tested early and often, and they have used contact tracing to isolate carriers. Examples include New Zealand, Australia, the Czech Republic, Germany, South Korea and Taiwan. Some autocracies with scientifically literate leaders, such as Vietnam, Hong Kong and Singapore, have also performed well.”

But those he calls populists have performed much worse. Donald Trump of the US, Alexander Lukashenko of Belarus, Boris Johnson of the UK, and Jair Bolsonaro of Brazil.

I think that we may also find similar differences between US states. Andrew Cuomo of New York, Gavin Newsom of California, and Jay Inslee of Washington State have done well, and they are on the technocratic side. They have been very careful in laying out reopening plans, for instance.

Peter van den Engel

The reduction to zero was the result of immunity build up, as foretold/ while the isolation in the behavioral pattern represented an artificial immunity only (when applied overall unnecessary, because it concerned only those who where vulnerable, hitting the economy) vulnerable to a second wave, which might be mittigated by either changed humidity in the air because of changed waether conditions, or the virus having mutated into a less agressive type, which I believe always depends on immunity anyway, because that’s the channel for it in theory.

Elderly homes were especially hit because of their closed airsystem and people staying in their room. So isolation turned into a boomerang effect.
Death rates are also influenced by wether autorities provided a bonus for curing corona, while the underlying disease was the real cause, but not mentioned in statistics anymore.

The overall death rate still is much lower than an ordenary more serious flue epidemic.

Coronaisabeer

Say what??

Benoit Mandelbrot

“On the other hand, Sweden has tested a much lower proportion of population for the virus. What if the elevated death rate there is a result of a larger number of unknown infecteds?”

Yes! And this means your whole analysis might be flawed.

” In personal life my preference, definitely, is to endure sharp pain now to solve the problem in the long term. In line with this philosophy, I think we should drive Coronavirus to extinction.”

Drive the virus to extinction in the long term? Are you mad? Not even Singapore or South Korea can do that. What are you expecting from liberal democracies or Russia or Third World countries? How?

Seriously, what measures at what cost would be necessary to drive the virus to extinction?

This virus will become endemic and will never go away.

Mark Pontin

Peter van de Engel: “The reduction to zero was the result of immunity build up, as foretold.”

Benign Brodwicz: “they postpone the hoped-for herd immunity. If the requirement for herd immunity is ~60%, flattening the curve only postpones infections. Lockdown may “extinguish” the epidemic, but only so long as lockdown continues!”

No human population has ever developed herd immunity to a coronavirus to date, and to some extent such viruses’ very nature mitigates against it. Anybody who knows anything about this class of pathogens knows that. So both you gentlemen know nothing and are talking out of your behinds when you blither on about ‘herd immunity.”

More interestingly, there’s some evidence that COVID19 — again like other coronaviruses, most notably SARS — exploits antibody-derived enhancement. See forex —

‘Impact of immune enhancement on Covid-19 polyclonal hyperimmune globulin therapy and vaccine development’
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7161485/

‘Is COVID-19 receiving ADE from other coronaviruses?’
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7102551/

This doesn’t mean a vaccine for COVID19 is impossible, especially as in 2020 the advance of biogenetic engineering means that what modern medicine means by a vaccine can be a very different thing from what was classically meant. But it may put a COVID19 vaccine in the same realm of difficulty as a vaccine for HIV, for example.

Mark Pontin

Having raised the issues above, I got this response from a top virologist who spent more than twenty years at USAMRIID, Lawrence Livermore, and NIAD.

The key to understanding ADE is that it is not universally observed, even in cases in Dengue. It can happen but not always. DEN vaccines are looking promising but have taken 40 years. When we think about vaccine safety this is a key consideration and an easy to measure aspect of the immune response.

Different vaccines will elicit different immune responses so it is really a matter of trying different antigens and methods to deliver in phase 1.

It is possible that we see ADE from the other corona viruses. SARS1 and 2 are about 70% similar. So it is a reasonable hypothesis. If we do have a significant problem with ADE then it will be possible to prescreen people for the antibodies that are causing the ADE and exclude them from trials or treatment. Not great but herd immunity is much more powerful then we give credit to.

So while we haven’t seen human herd immunity emerge with any previous coronavirus, he thinks I’d be wrong to assume that it cannot eventually with COVID19. He also believes, however, that the virus’s R0 might actually be as high 9.2 and in the end the human global population is going to show a fatality rate of about 1 percent from the virus.

Iuval Clejan

Here is some (weak) evidence that plasma transfer is effective, in response to my concern about evidence for hospital treatment being effective:
https://www.hematology.org/covid-19/covid-19-and-convalescent-plasma.

Another way to deal with this (if it’s truly effective) is to make these treatments be available over-the-counter, so people could inject themselves or their friends/family, instead of overwhelming hospitals.

Peter van den Engel

Since the virus only kills certain conditions, like obese, old age and lung problems (the underlying entry qoefficient) speaking about herd immuty alone represents the definition of a non existing reality (Fact no. 1).
Medical science should never apply this frasing again.
Because then you have a defnition of the target group being vulnarable you actually only have to isolate them/ in stead of everyone which is a ridiculous solution.in mathematical terms (Fact no. 2)
When the sum 10 – 1 = 9 this does not mean it has a 90% probabillity being answered wrong, because the question knows only one frasing. It means it has a 100% probillity being answered correctly, when the problem is red correctly. (Fact no. 3)
Providing a medicine, or immunity improvement to this small group would even be a better solution then isolation. (Fact no. 4)
As a result a whole group of 1000 would always contain only 1% of the perfect combination for the virus to strike. This is the inverted definition of herd immunity, which is the irrelevant onther side in geometrics.
This could be scaled up to a million or more, but will always remain 1%. (Fact no 5)
The incubation period for the virus is stated at two weeks/ but the transfer rate it uses is much faster than that. It does not use the suggested parallel. (Fact no 6)
So by isolating only the effected cases (note: not everyone), it does not mean the virus has stopped spreading, because it already did (the false scientific.conclusion)/ but it helps the contaged to develop immunity itself, before spreading it further. It has an inverted effect to wat is supposed (theory 1)
In the past when fighting a virus like tuberculoses humanity has never deceided to isolate the whole community, for prevention, because that would have been equal to mass hysteria.
(Fact no 7)
It is not uncommon humans lose their memory during evoiuton, as the Romans did when they forgot how to make concrete a hundred years after they build their arenas. (Fact no 8)
Neither is it uncommon professionals applying tunnel vision on reality, because they are (focussed) professionals. (Fact no 9)
Since statistics prove already existing medicine like TB vaccination and an anti malaria drug have proven to be succesfull in preventing or curing the disease, this indicates a vaccin is not the only and even an inefficient method for curing because it is never available at the beginning (Fact no 10)
We should find a universal medicine against virusses based on these types (theory 2)
A vaccin is nothing but a copy of the disease and therefore not a cure. With a lot if side effects (Fact no 11)
Statistics has proven people using anti flue vaccination had a higher probabillity getting the disease than those who did not. (Fact no 12)
It has been scientiffically proven the virus does not rest on surfaces, but travels through the air. So any instructions not to touch surfaces are based on misinformation. (Fact no 13)

Mark Pontin

@ Peter van den Engel –

It’s not what you don’t know, it’s what you think you know that’s wrong, as Mark Twain said, IIRC.

Start with the fact that you do NOT even understand what a vaccine is.

Yes, classically a vaccine *was* a dead or deactivated sample of the pathogen being inoculated against — in that sense (sic) a “vaccin is nothing but a copy of the disease and therefore not a cure. With a lot if side effects”

But it’s 2020 — you may have noticed this yourself? — and none of this is any longer necessarily true.

So for example Moderna — the company that produced the first vaccine candidate out the gate to human trials a month back — got the genomic sequence of COVID19 from a lab in China, analyzed it, and then designed a vaccine in silico — all completely on a computer, which is common practice these days. They then built real samples of both COVID19 and their vaccine model with DNA synthesis in a couple more days. That vaccine model is what’s now in human trials —
https://investors.modernatx.com/news-releases/news-release-details/moderna-receives-fda-fast-track-designation-mrna-vaccine-mrna

And Moderna’s vaccine is NOT a dead or deactivated sample of COVID19. What they’ve done is created an mRNA module as a vector that encodes for a prefusion stabilized form of the Spike (S) protein of SARS-CoV-2, which is the means by which the real pathogen would penetrate a human cell.

So this is a copy of one small component of the pathogen, but NOT the rest of it. The vaccinated individual’s antibodies and immune system, having been shown this protein, then recognizes it and learns to fight it.

Now whether this will be effective and, more relevantly, whether the process can be scaled up to manufacture enough vaccine for a world of almost 8 billion people is another question. But of the COVID19 vaccine model candidates I’ve seen — and there are somewhere between 80 to 120 last I looked — the majority do not meet your description of a vaccine.

Your very first statement is false: “Since the virus only kills certain conditions, like obese, old age and lung problems ….” No. While there’s a high correlation with those conditions, we’re also seeing fatalities in people without them, and problems even in children. Forex —
https://wwmt.com/news/local/michigan-doctors-warn-of-condition-in-children-linked-to-covid-19-virus

I’m not going to work my way through the rest of your garble after that. It’s mostly wrong.

Mark Pontin

Iuval Clejan wrote: “The costs of the lockdowns in lives lost due to suicide, depression and stress might exceed the benefits (in lives saved).”

So this is an argument from utilitarian or consequentialist philosophy —
https://en.wikipedia.org/wiki/Utilitarianism

In other words, you’re saying the debate should be framed as basically one of long-term serious harm for a minority (death and wrecked pulmonary systems) versus short-term serious harm for the majority (lost employment, financial and social collapse,etc.). Which is worse?

That’s what you’re suggesting here, right?

What must also be brought into the debate, however, is the *reality* that successful lockdowns *have* been achieved by South Korea, China and other East Asian countries. So these countries experienced very short-term harms. Consequently, they will *not* be experiencing the long term harm of COVID becoming endemic for years to come, with the resulting deaths and labor market damage.

Conversely, the ineffectuality and pathological failures of Western societies — particularly those suffering from the dyfunctions created by neoliberal capitalism — to achieve effective lockdowns as the Asian nations have done will mean that Western societies *will*suffer both short-term and long-term in terms of both continuing deaths and labor market damage, as COV19 will now be endemic — and maybe will remain that for years to come since we don’t even know that innate human immunity to COV19 is possible. It’s never happened with any coronavirus before.

On that basis alone, the consequentialist answer is pretty clear. Given the far smaller harms both long-term and short-term the Asian nations have achieved, the lockdown was the right way to proceed.

Now in the real world, given the dysfunctions of Western societies, maybe Sweden’s strategy is bad but the best realistic policy it could achieve. But I repeat: there’s no evidence that effective herd immunity from COV19 is possible and the pathogen may remain endemic in Sweden till there’s a vaccine(s) or therapeutics (i.e. a synthesized peptide administered as an aerosol into the lungs which blocks the Spike (S) protein is something one company is working on).

To be clear: IMO, the Swedish ‘expert’ who formulated this whole policy based on herd immunity — and who’s now surprised at the fatality levels — is an arrogant, ignorant idiot. Though I’m sure it’s what the Swedish pols wished to hear, I hope he pays a price for promoting this strategy.

Iuval Clejan

Mark Pontin wrote:
“So this is an argument from utilitarian or consequentialist philosophy —
https://en.wikipedia.org/wiki/Utilitarianism
Yes, how else should policy makers make decisions? Based on their liking or disliking of capitalism and the way it deals with collective action problems? Or their liking or disliking of totalitarian state control? Or their wanting to give an advantage to their own class which does not depend on a weekly paycheck, and is happy in the virtual world? Is that what you’re suggesting?

“In other words, you’re saying the debate should be framed as basically one of long-term serious harm for a minority (death and wrecked pulmonary systems) versus short-term serious harm for the majority (lost employment, financial and social collapse,etc.). Which is worse?”

That’s what you’re suggesting here, right?”
Almost, but not exactly, because qualifying death as “short term serious harm” is not accurate. The harm of death can be considered to be long-term. But yes, in the sense of the harm of continuing death due to these secondary causes will be short term, IF the lockdown is lifted soon.

“What must also be brought into the debate, however, is the *reality* that successful lockdowns *have* been achieved by South Korea, China and other East Asian countries. So these countries experienced very short-term harms. Consequently, they will *not* be experiencing the long term harm of COVID becoming endemic for years to come, with the resulting deaths and labor market damage.”

You are implying that all these countries used universal lockdown. My understanding is that S. Korea and Taiwan did not do that, they only quarantined people who tested positive and tested almost everyone, doing just as well (not sure about this–needs to be analyzed carefully because of other factors, as we saw with Peter’s analysis of Sweden and Denmark) as the countries that had universal lockdown. So we have another choice (but maybe not practical due to higher populations of some other countries?) besides universal lockdown and no lockdown at all. Also, it is not clear yet that even the universal lockdown for only 2 months “worked”. Let’s hope so, but we shall see.

“Conversely, the ineffectuality and pathological failures of Western societies — particularly those suffering from the dysfunctions created by neoliberal capitalism — to achieve effective lockdowns as the Asian nations have done will mean that Western societies *will*suffer both short-term and long-term in terms of both continuing deaths and labor market damage, as COV19 will now be endemic — and maybe will remain that for years to come since we don’t even know that innate human immunity to COV19 is possible. It’s never happened with any coronavirus before.”

Maybe true. Totalitarianism works better for collective action problems….But it has other disadvantages…. Still, has the effective strategy in these capitalist countries been that different from China? Ultimately people are still under lockdown in the west (except Sweden, the land of the free), maybe it took a bit longer, and maybe they grumble about it more.

“On that basis alone, the consequentialist answer is pretty clear. Given the far smaller harms both long-term and short-term the Asian nations have achieved, the lockdown was the right way to proceed.”

I disagree based on above arguments. Smart as opposed to universal lockdown as in Taiwan and S. Korea (and Iceland?) would have been better. I think if the lockdown continues beyond a CERTAIN point (China had 2 months and they are much more culturally open to totalitarianism than the west), “secondary” deaths will exceed primary ones. And we don’t yet know whether the lockdowns will stop the epidemic in the long run once they are ended, so it could all have been for nothing except to increase secondary deaths.

“Now in the real world, given the dysfunctions of Western societies, maybe Sweden’s strategy is bad but the best realistic policy it could achieve. But I repeat: there’s no evidence that effective herd immunity from COV19 is possible and the pathogen may remain endemic in Sweden till there’s a vaccine(s) or therapeutics (i.e. a synthesized peptide administered as an aerosol into the lungs which blocks the Spike (S) protein is something one company is working on).”

I thought there was some evidence from monkeys (macaques?) that re-infection is impossible. Is the problem new mutations that evade previous antibody-mediated immunity? Or too long a time for immunity to develop (greater than the average time it takes an infected person to randomly meet an uninfected one in a herd of mostly (fraction dependent on a few variables including the time to acquire immunity, but I suppose it could be close to 1) immune people)? In either case, are you saying therefore that lockdown should be forever (ignoring all the secondary deaths)? Or are you saying that even though no herd immunity is acquired, that the virus can be eradicated if the lockdown is long enough?

“To be clear: IMO, the Swedish ‘expert’ who formulated this whole policy based on herd immunity — and who’s now surprised at the fatality levels — is an arrogant, ignorant idiot. Though I’m sure it’s what the Swedish pols wished to hear, I hope he pays a price for promoting this strategy.”

I will google him when I have time. Usually people don’t admit mistakes…And (perhaps) it’s too early to tell if it WAS a mistake.

Mark Pontin

Iuval Clejan wrote:”Smart as opposed to universal lockdown as in Taiwan and S. Korea (and Iceland?) would have been better.”

Yeah, I agree. Considerations of length — my already-lengthy comment made me abbreviate discussion there. Though it’s worth looking at just what S. Korea did do, If you haven’t seen it, here’s a twitter thread from an American, Michael Kim, detailing some of that —
https://twitter.com/michaelvkim/status/1258987354934538248

$10,000 dollar fine and jail time if you break quarantine? The U.S. can’t even stop people shooting a security guard outside a Dollar General who asks them to wear a mask or spitting on store clerks.

I.C.: wrote: I thought there was some evidence from monkeys (macaques?) that re-infection is impossible. Is the problem new mutations that evade previous antibody-mediated immunity?”

Yeah, mutation, as with other coronaviruses. To the extent of whatever rate it mutates at. We think.

It’s kind of the Swiss Army knife of viruses.

IC wrote: “Are you saying therefore that lockdown should be forever (ignoring all the secondary deaths)? Or are you saying that even though no herd immunity is acquired, that the virus can be eradicated if the lockdown is long enough?”

Obviously, no lockdown can be forever. I’m saying: –
(a) that natural herd immunity as a feasible, near-term inevitability should never have been assumed by responsible actors who applied critical intelligence and looked at the actually-existing data we had on COVID19 alongside the dat from other coronaviruses, and the people who chose not to look at that data were ignorant, arrogant fools and in some cases — I will not mince words — scum serving their political masters;
(b) and, yes, the virus can be *effectively* eradicated if the measures taken are strenuous enough and it’s worth doing that because otherwise the virus will become endemic just like other coronaviruses — but with far higher rates of fatality and permanent physiological (and even CNS!) damage in survivors.

And we’re getting off light with COVID19. Our societies need more strenuous biodefense programs to survive. This is a message that’s going to be as unpopular among the Left as the Right in Western societies.

It’s not generally known but the surveillance measures that became the NSA programs that Edward Snowden revealed to the world in 2020 first began as biodefense programs in 1998 at MIT and Carnegie Mellon in shocked response to US discovery of what had been done by Biopreparat, the former USSR’s bioweapons program. These technologies then became the basis of the Total Information Awareness program under John Poindexter, and then were moved into the black as, IIRC, the Topsail and Genoa programs at NSA.

Cheers..

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