Already happening in Sweden: https://nationalpost.com/news/world/covid-19-as-swedens-deat...

I don't understand the Sweden example. Their daily % increase in deaths is well below California. I don't know if there is a difference in counting deaths but Sweden seems to be doing ok relative to other countries. I have heard that they are effectively shut down voluntarily, so government action was not needed but the effect has been the same. Maybe a Swede can weigh in.

https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_C...

https://en.m.wikipedia.org/wiki/2020_coronavirus_pandemic_in...

Swede here. Like you say our isolation is pretty much volountary, with only larger groups gathering being banned - though I very much doubt that would happen anyway should it be allowed. Our neighboring countries who opted for total lockdown are slowly starting to open up too. I think the death toll in pretty much any country will be primarily depending on how well you’ve protected your elderly. We’ve done OK but could certainly have done better. Though still very far from the “devastatingly wrong” claim above.

It's in the major league of deaths/million pop (along with the UK, US).

I have to say, as someone usually loathes my generally scientifically-blinkered federal government (Aus), it's relaxing and pleasant to be able to think quite well of them for once. Australia at this stage seems almost like a case study in how to handle a pandemic like this intelligently. Time will tell, of course.

Not a Swede but an Aussie living in Sweden here

Sweden is at 118 deaths per million vs 53 per million in Denmark or 94.5 in the US

Australia is at 2.52 per million

Sweden has a population of something like 10 million while the greater Sydney area alone has a population of 5.98 million so population density isn't the reason why Sweden has so many more deaths.

Voluntary lockdown means that some people still stand too close at the supermarkets, still plenty of people socialising around my area as normal & different companies apparently have different ideas when it comes to work from home policies

To be fair many countries are locked down as much as Australia and are also doing worse so I'm not sure what it is that is working so well there.

https://www.statista.com/statistics/1104709/coronavirus-deat...

Sweden isn't performing a lot of tests for one:

https://www.thelocal.se/20200414/understanding-swedens-figur...

Why do they need to perform a lot of tests if their strategy isn't dependent on testing?

If you're not testing a sizeable enough sample of the population, then whatever number of cases you give has to be taken with a rather large helping of salt.

For example, my country's CDC has the official number of confirmed cases in the low hundreds with a dozen deaths, but anyone wise enough knows that between the ridiculously low number of samples tested (less than ten thousand in a population of a couple hundred million), the poor public health infrastructure, the anaemic government response and general public health illiteracy, the real number of cases is easily an order of magnitude or two higher.

Completely agreed. Sweden is worth observing in terms of number of deaths and how overloaded their hospitals get. But their number of cases, like in a lot of countries, is essentially garbage data that can't possibly help our understanding of the situation to consume.

Right, but in planning for a hospital overrun you can't see it coming if you have no idea how many sick you have, if you don't test.

Are you suggesting that as long as your hospitals aren't overrun, inflection rates aren't worth knowing ?

If your hospitals aren't overrun, and you don't expect them to become overrun in the future, improving your estimate of infection rates doesn't seem like a high-leverage activity. The argument for doing a lot of testing is that it enables good contact tracing, which Sweden doesn't seem to be planning to do anymore.

Because if there’s a giant spike of currently asymptomatic carriers, you’d want to know.

If they at least did testing + contact tracing (like NZ) they probably could have saved a tonne of lives even without locking down

Every developed country did testing and contact tracing, even the ones popularly seen as doing nothing. That was why leaders were saying it wouldn't be a problem in February; they didn't expect a magic cure, they expected their testing and contact tracing to handle it.

I definitely want to know. But it seems like Swedish public policy is that the current measures are the strictest sustainable ones, so they're going to maintain them until strict measures are no longer needed. It's not clear that early visibility of a spike would change that.

Given that mortality rate is closely tied to the availability of ventilators, it would be catastrophically short sighted to not react to a spike with strong, short term measures.

This turns out not to be the case. Ventilators don't actually help much with COVID-19. If you end up severe enough to not be able to breathe on your own you're likely to die, and the ventilator only prolongs it. So running out of ventilators won't actually cause many more deaths.

The way to prevent a lot of deaths is simply to prevent people from catching it at all.

Most recent numbers I've seen are that if you go on a vent, you've got a 70% (San Fransisco) to 90% (New Orleans) chance of dying. Not great.

Anecdotal word from family members working in ERs is that none of them have been on a shift with a successful code run on a covid patient. CPR is low single digits 30-day survival based on Chinese numbers released this week. It was something like (1) patient survived out of 37 attempts.

The question of if the 10-30% of vent survivors would have survived without a vent is fair, but that's a maximum efficacy at this point.

Vents are definitely not the answer everyone thought they would be.

Given the misery and problems associated with long-term ventilator usage, I'm not sure vents for covid is a good idea at all

Yeah, I started to go there earlier, but stopped myself.

Doctors seem to be doing a better job of informing patients (or families) of those issues before intubating, especially if they have multiple risk factors, and a surprising number of cases have opted not to vent.

But also:

1) There are quite a few really sad stories of patients getting dropped at the ED curb by a spouse as if they'll get checked out and be right back out to go home, only to be immediately intubated and sedated, and ultimately dying without family by their side and no chance to say goodbyes.

They now make a lot of effort to make phone calls or video chats to family before intubating anyone, but it's still rough without anyone being able to be there, and then not being able to speak either. And it just adds to the weight of what the nurses have to deal with, emotionally.

2)There's also the murky topic of straining hospital resources. You obviously don't know ahead of time who the 10-30% of survivors will be and you want to save whoever you can, and hopefully we never get to the point of true rationing. But...

It's hard to be blind to the fact that it's a huge amount of risk, resources, and physical & emotional effort that are seeing relatively little success. I don't have an answer. Hopefully we get better at it.

10-30% survival odds are much better than 0, and the negative consequences of being ventilated depends on the ventilator settings; more time is worse, but it also varies by the ventilator pressure.

Germany is seeing better results by ventilating earlier, FYI.

Some of the folks on vents would have survived anyway. Probably fewer than survive with.

But I don't know, severe permanent lung damage guaranteed, delirium and dementia likely, and the misery of the treatment itself, all for a 1-in-5 chance of surviving (where survival is measured only at 30 days)?

I'm not saying nobody should be allowed to make that choice -- they should -- but I don't know that I would.

I guess I'm not sure what to say in response to that. Swedish officials simply don't agree that strong short term measures are required to ensure a sufficient number of ventilators.

Every strategy is dependent on testing, because every strategy requires an accurate assessment of sickness rates. If you don't know the extent of the problem, how can you even formulate a plan to fight it?

If by "strategy" you mean herd immunity, Sweden isn't doing that. No one is publicly claiming to be trying that anymore.

You can call it herd immunity or not, and Sweden has indeed picked "not". But their plan is to keep doing what they're currently doing. The Swedish government has no phase 2 where they expect to contain the coronavirus more strongly.

They aren't testing. I have 3 friends bedridden right now with COVID19 symptoms in Stockholm, all of which were denied a test after they asked for one. They were told to stay home and get over it.

Their numbers aren't reflective of reality.

To be fair, that's a lot of places right now. I have a neighbour (Kitchener, Canada) who had all the symptoms and wasn't tested— all they wanted to hear is that her house had an area with a separate bathroom where she'd be able to isolate from the rest of her family. She recovered on her own without medical intervention.

True but I didn't say otherwise. Sweden is failing at the only thing that can begin to mount a successful response to COVID19 which is widespread testing.

Same as the US and Canada I suppose.

Sweden has 1/4th the population of California. It looks like the total deaths is around 50% higher than California although of course California might have deaths that should have been attributed to COVID-19 that weren’t.

It looks like it was estimated to have arrived in Sweden two days earlier.

Maybe, Swedish towns are denser than California ones.

The SF Bay Area has a population that is 75% of Sweden’s entire population.

SF itself is more densely populated than Sweden’s most densely populated city which appears to be Stockholm (7700/km^2 vs 5000/km^2). Stockholm has a population around 20% larger than SF.

According to Wikipedia, California is smaller than Sweden.

So there may be some dense pockets in Sweden but it certainly isn’t more densely populated than California and it doesn’t appear that there are large cities that approach the density of NYC/SF.

Normalizing daily deaths to population, Sweden is doing worse than California. Both are doing much better that Lombardy or NY. Somewhat encouraging, the # of daily deaths is decreasing across the board. Possibly a mix between [voluntary] lockdown effects and better palliative treatments.

https://covid19.quersive.com/chart?c=M&e=SE&e=US-CA&e=US-NY&...

Far too early to say this is "devastatingly wrong." The number under the curve matters more than random spikes (that don't oversaturate the health system, BTW).

Does it make any difference one way or the other? If the response is vital, then some country will get it "devastatingly wrong", and then won't that produce a new wave after a bit everywhere else?

Won't that just be a sequel to the first cycle, where things seemed under control, it was downplayed, and then it got going outside of China. Why should anyone expect other than a fractal replay?

I wish the effects were limited to the politicians making the decisions.

Perhaps Boris Johnson's attitude will change a little bit now, for example.

It will be quite the opposite,I think. The Brazilian president had it as well and here's the article about his actions.

he did not have it. he claimed he had it, not his doctor.

One of the running twitter jokes, started by a famous comedian over there, is asking for the health minister, now that he was fired, to release the real result for the president's covid19 test.

It is already happening in the US.

I think Russia is already setting that example, really no need for two.

https://www.cbc.ca/news/world/covid-19-russia-spike-cases-1....

Moscow and most of the other places in Russia are on a complete lockdown for more than a week now - much stricter that eg. NY or California. I’m not sure what do you mean by your comment.

I think if you read the article I linked to you can see what I mean. They were forbidding medical staff from doing tests and treatments!

... In an interview with CBC News on Monday, Dr. Rimma Kamalova, who heads the hospital's rheumatology department and is quarantined in the facility, said when the outbreak started, regional health authorities refused to test patients for coronavirus.

"According to our policies ... we could not do testing on coronavirus," she said.

"We had orders, at that time, not to give this diagnosis and take the relevant [mitigation] measures." ...

Russia is honestly handling the crisis better than most of the western world. They've done >1.6M tests with a positivity rate of 1.7%.

The number of cases China is reporting in travelers arriving from Russia strongly suggests that Russia is significantly underreporting the scope of its outbreak.

Moscow's metro has been a mess the last few days as big crowd waiting for permission checking:

https://varlamov.ru/3860702.html

This is exactly why I don't understand where people are getting the idea Russia is doing a good job of managing this!

That looks like a lot of things, but it sure as heck doesn't look like a lockdown, certainly doesn't look like one that is going to be anywhere near as effective as the lockdowns in other jurisdictions. Crowding like that is absurd.

Add to that the fact that they share a large border with China and were pretending to have no cases for at least a solid month or so. As the article I linked to stated, they have even given up on the propaganda effort at this point. Even the authorities in Russia whose specialty is self-deception know which way this is headed now!

That positive rate is far too low. If you get < 15% anywhere with a proven widespread outbreak you aren't doing enough testing.

That doesn't make sense to me. If you have a proven widespread outbreak and test everyone in your country, the number's still going to be below 15%.

15% seems to be an average number for an area with known community spread. It was in Korea, it was in Germany.

If you are getting less than that, you aren't testing enough people. ALso if your number is far higher you might be only testing dire cases.

You have it backwards. If your positivity rate continues to plummet as testing ramps up it points to the inverse. See other nations with wide spread testing and low positivity rates, namely Australia, NZ, Taiwan, UAE.