Living the Pandemic - Again, Sweden

 The following article appeared in Dissent Magazine dated August 31, 2020.  I've copied the text below in case it disappears into the ether somewhere.

All Luck and No Virtue: Sweden’s Coronavirus Response

Sweden bet on both national character and herd immunity, hoping they would complement each other. Months later, the country has little testing and one of the highest rates of cases.

Adele Lebano  August 31, 2020

In the spring, my neighbors here in Sweden were having friends over for Easter and going to restaurants, gyms, and swimming pools while my family and friends in Italy could not take a walk around the block without being questioned by a police officer. The differences were striking even for someone who, as often happens to those living in a foreign country, is used to surprise and estrangement.

In Sweden everything was open and functioning as usual. The government had decided not to implement disruptive measures such as closing schools for children younger than sixteen so that parents could continue to do their jobs. It recommended that people work from home, but never prevented them from going to their offices if they chose to do so. In fact, some were actually encouraged to show up at work so as not to communicate a sense of emergency. Healthcare workers were supposed to wear masks and protections only when dealing with suspected COVID-19 cases to avoid spreading panic.

When my friend brought his mother to the hospital with COVID-19 symptoms in April, healthcare workers took off their PPE as soon as she tested negative, despite the test’s high rate of error. Swedish politicians, public health experts, and the people I knew explained this approach as the natural response of a country that runs on trust. The government trusted people to comply with recommendations as if they were laws; people trusted the government to take care of them in the best possible way; politicians trusted experts to come up with the best measures. Everybody was in agreement and everybody was trusting.

I come from Italy, a place where it is hard to find two people who agree with each other (to borrow Alexis de Tocqueville’s description of nineteenth-century France), a place where the government is blamed for the rain. My feeling of displacement was therefore profound in those early days of March and April. I could not rejoice at my luck for having landed in Sweden and being able to enjoy freedom as if there were no pandemic, and not only because my family and friends were on the other side of the wall. Because what I saw around me, in Sweden, was not freedom.

Months later, what I see is still not freedom as I understand it. Instead, Swedes interiorize norms and rituals and act as if they were free. The country is famous for its so-called consensus culture, but people generally begin in agreement rather than ending there. I argued in the Boston Review that this characterizes an organicist society, where individual choice and public choice perfectly overlap and dissent is expelled; where twenty eminent scientists can publish an editorial against the Swedish approach in one of the country’s two flagship newspapers and have almost no impact on public debate or policy.

But there is something else I have seen in these past months: denial. At the beginning this was to be expected; it was the same in Italy, France, the United Kingdom, and the United States. Coronavirus was always someone else’s virus—the Lombardy virus, the Chinese virus, the Italian virus. As infections spread, people got busy drawing distinctions: Europe is not China, they said, the United States is not Europe, China is not Italy. Some countries notably went the other way and learned from similarity: Greece, for example, modeled its policy on its Mediterranean neighbor Italy. In Scandinavia, Norway, Denmark, and Finland decided to lock down early, apparently judging that pandemics trump national character, rituals, and geography, especially as societies become more interconnected.

But Sweden went its own way. It decided to bet on both national character and herd immunity, hoping they would complement each other. The prevailing attitude was that the virus might run faster among those who did not conform to the customary Swedish independence between generations, or those who favored crowded venues to the solitude of the forest and privacy of their docks—but that would help establish some immunity among the larger population. Interviewed by the Financial Times at the beginning of May, Anders Tegnell, the state epidemiologist and architect of the Swedish no-lockdown approach, was serene: “In the autumn there will be a second wave,” he said. By then, “Sweden will have a high level of immunity and the number of cases will probably be quite low.”

The virus did hit some groups more than others. As in other places, it hit the old, the weak, the ones with few options. In Sweden, many migrants and refugees find work in essential jobs such as healthcare and nursing facilities. Without the necessary PPE or the option of staying home to care for sick family members, they became vectors; they were at greater risk of contracting the virus themselves as they continued to interact with colleagues at work without being provided masks. Testing has never been the default option in Sweden, even for healthcare workers. According to Our World in Data in mid-June—at the height of its testing effort—Sweden was administering only twenty-seven tests per 1,000 people, compared to 180 in Iceland, ninety-eight in Denmark, and forty-seven in Norway.

The result? A disease that was still spreading in Sweden at the end of June, even as it had been contained elsewhere. The country’s seven-day new infection average on June 25 was 1,275 cases per day, compared to forty-two in Denmark and eleven in Norway. This number has since declined, but so has testing, which was drastically curtailed in early July. And the dead stay dead. As of August 25, COVID-19 had already killed fifty-seven of every 100,000 Swedes, compared to fifty-four out of 100,000 in the United States, eleven out of every 100,000 in Germany and two out of every 100,000 in Greece.

Confronted with this grim picture, Tegnell continued to defend the Swedish approach, conceding only that things went worse than he had “hoped.” This was the very same expert who claimed all along to be basing his policies on scientific evidence and mathematical models. It turned out he just banked on luck—and lost. “If we were to encounter the same disease again, knowing exactly what we know about it today,” he told Swedish Radio on June 3, “I think we would settle on doing something in between what Sweden did and what the rest of the world has done.” He insisted that the basic strategy was sound, although there was “potential for improvement,” adding that whereas other countries introduced many measures at once, not knowing which of them was going to work, Sweden was right to run its experiment. Otherwise, Tegnell insisted, “you don’t really know which of the measures you took had the best effect.” It was left to Jimmie Åkesson, leader of the far-right nationalist Sweden Democrats, to voice his “astonishment.” “For months critics have been consistently dismissed,” Åkesson tweeted. “Sweden has done everything right, the rest of the world has done it wrong. And now suddenly this.”

The failure of Tegnell’s approach is not really a matter of bad luck. If anything, Sweden was far luckier than Italy, Spain, or Germany. The virus reached the country relatively late. Swedes had ample opportunity to prepare and take steps to contain its spread. They had the three great assets of time, money, and organization—assets they could have used to stock up on PPE, set up treatment and quarantine facilities, and test, track, and treat as the World Health Organization advised. They had knowledge and expertise in spades, and they had a trusting and compliant populace. Perhaps most important, they had the example of other countries to learn from. If Sweden did not see Italy—then the epicenter of the crisis in Europe—as a useful model, it could have used Denmark, which locked down early even while acknowledging the uncertainty of such measures. As Danish Health Minister Magnus Heunicke said in March, “We have no evidence that everything we are doing works. But we would rather take a step too far today than find in three weeks that we have done too little.” Instead the Swedish government decided to do almost nothing and just hope for the best.

Niccolò Machiavelli, the sixteenth-century Florentine philosopher, described the human condition as dominated by luck (fortuna) and virtue (virtù). The second, he argued, lies in not wasting the first. The vagaries of chance should not simply be accepted; they should be recognized and used. “I hold it to be true that Fortune is the arbiter of one-half of our actions,” Machiavelli wrote in The Prince. “But she still leaves us to direct the other half, or perhaps a little less.”

In this sense Sweden has been lucky—but not virtuous. The country had many chances to change its approach by responding to new evidence and correcting earlier mistakes. On April 18, Parliament voted to allow the government the power and discretion to introduce emergency measures without asking for Parliament’s approval. The exceptional and time-limited law was a dead letter. In a stroke of preparedness, at least since the beginning of April, schools and other organizations all had plans ready to move most of their activities online (Sweden is already among the most networked societies on earth). But they never used them. Failing government (in)action, citizens could have listened to the few who have spoken out against official policy. They could have held both the government and so-called experts like Tegnell accountable for the rising death toll. None of this happened. Swedes chose instead to stand behind their leaders, ignore the data, and put Tegnell’s image on coffee cups and T-shirts.

To fully understand why Swedes went along with the country’s lack of a plan, we need Machiavelli’s thirteenth-century Florentine predecessor, Dante Alighieri. Two of the mortal sins named in the Inferno are ignavia and hybris. The first, which translates roughly as “moral torpor,” is the laziness of those who rest in comfort and never question anything. The ignavi are walking dead, “the miserable lot, who never were alive.” Hybris, which Dante borrowed from Greek tragedy and myth, is nearly the opposite. It is the flaw of Icarus and Oedipus, Ulysses and Prometheus. It is the arrogance and vanity that blind the hero to his true circumstances, and which inevitably lead to his fall.

Sweden’s COVID-19 policy bears the mark of both ignavia and hybris. Countries like Italy and Spain made mistakes and had an unbearable number of deaths, yet they were virtuous in making the best of the hand they were dealt. Others, like Denmark, Norway, and Finland, were also virtuous as they tried to learn everything they could from mistakes and missteps elsewhere. Sweden, by contrast, wasted its luck. Arrogant and vain, it sleepwalked into this crisis and continues to sleepwalk through it. And that is more than a shame. It’s a sin.

Living the Pandemic - Playing With Numbers

 Over the past few weeks, it's been fun to see all the debates over death rates, even though this pandemic isn't over yet and it will be almost impossible to calculate a true death rate until after it's finished.

However, a new assertion that has popped up recently, one I hadn't heard of earlier, how the USA was predicted to have 3 million deaths from this virus, but here we are, only 200,000 deaths and isn't it great how well the Trump administration has done to save us from that devastation.

So I decided to find some of those predictions and arrange them in chronological order to see what I could discern from them.

March 18th, 2020, Healthcare Purchasing News published an article: COVID-19 Predicted to infect 81% of the US Population, Cause 2.2 million deaths in US.  This warning came from Imperial College London and the study can be read here.  It includes a table showing estimated Infection Fatality Rates for different age groups which they claim would result in an overall IFR of 0.9%.

April 21st, 2020 - The Libertarian Cato Institute considered some of the early predictions from those models, mentioning the most sensational one that came from Imperial College London.  That was the report that predicted 2.2 million deaths in the USA.  The Cato Institute's article went on to comment that:

"A month later that 2.2 million estimate was still being used (without revealing the source) by President Trump and Doctors Fauci and Birx to imply that up to two million lives had been saved by state lockdowns and business closings and/​or by federal travel bans."

In retrospect, this seems to be where people on social media are coming up with this notion that since we were supposed to have 2 or 3 million deaths and now we don't, that the Trump administration is doing a great job.

The Cato Institute went on to dismiss this projection.

"The worst‐​case Imperial College estimate of 2.2 million deaths if everyone does “nothing” did not simply mean no government lockdowns, as a March 31 White House graph with two curves implied. It meant nobody avoids crowded elevators, or wears face masks, washes their hands more often, or buys gloves or hand sanitizer. Everyone does literally nothing to avoid danger.The Ferguson team knew that was unrealistic, yet their phantasmal 2.2 million estimate depended on it. As they reticently acknowledged, “it is highly likely that there would be significant spontaneous change in population behavior even in the absence of government‐​mandated interventions.” An earlier February 20 brief said, “Some social distancing is to be expected, even in the absence of formal control measures.”"

So it would seem that, once again, the White House was using a single projection to support the notion that it had been doing a great job of containing the virus.

May 4th, 2020 - CNN Health put out this article: Coronavirus model projects 134,000 deaths in US, nearly double its last estimate.  This model comes from the Institute for Health Metrics and Evaluation (IMHE) at the University of Washington and has been cited by the White House.  It also represents a steep increase from around 72,000 deaths predicted only the previous week.  Relaxed social distancing and increased mobility were given as reasons for the sharp increase.  At the time, only 68,000 deaths had been recorded as being caused by the virus.

May 18th, 2020 - CNN Health has another article that reports that the IHME has revised its death toll down a bit, now to 143.360, in this article: US Coronavirus death toll passes 90,000 but influential model lowers its prediction.  They attributed the difference to people being more careful and wearing masks.

August 7th, 2020 - People carried an article called: US Coronavirus deaths predicted to hit 300,000 by December as current cases near 5 million.    At the time, there were around 160,000 deaths.  The IMHE model is now predicting as many as 400,000 deaths by year end IF states keep relaxing mandates to control the spread of the virus.  The article also notes that every individual who wears a mask is reducing transmission by 40%.  Relaxing these practices too soon results in a further increase.  At least 39 states had some form of mandate to wear masks, with Kentucky governor quoted as commenting that masks were effective.  The CDC came out recommending against masks with vents.

September 3rd, 2020 - A report from IMHE itself suggested that 770,000 lives could be saved if people and governments took precautions:

"In the first global projections of the COVID-19 pandemic by nation, the Institute for Health Metrics and Evaluation (IHME) at the University of Washington’s School of Medicine is predicting nearly 770,000 lives worldwide could be saved between now and January 1 through proven measures such as mask-wearing and social distancing." 

The same article also mentioned "herd immunity" with the following statement:

"... cautioned against pursuing the so-called “herd immunity” strategy, which occurs when a large proportion of a community becomes immune to the virus through infection and recovery. The “worse-case” scenario in these projections reflects a situation where leaders allow transmission to run through their population, resulting in significant loss of life. 

“This first global forecast represents an opportunity to underscore the problem with herd immunity, which, essentially, ignores science and ethics, and allows millions of avoidable deaths,” Murray said. “It is, quite simply, reprehensible.” "

September 4th, 2020 - NBC News carried a report that looked both backwards and forwards.  It noted that early predictions were for as many as 3 million deaths - worldwide - if governments don't tighten up social distancing requirements and "...people aren't vigilant about wearing masks...."  The article said that deaths could be as many as 620,000 deaths in the USA with 4 million worldwide.  At the time of this report, there were 188,000 deaths in the USA.

So, what to make of all this....

There was indeed ONE projection that mentioned over 2 million deaths in the USA from this pandemic.  Interestingly, it was from a single model that had previously also made rather fantastic projections about earlier disease outbreaks (this is mentioned in the Cato Institute's article, above).  The worst-case assumption of this model seemed to be that absolutely nothing would be done to counter the virus - not just no government actions, but no actions on the part of individuals either.  For obvious political reasons, this is the one that the White House latched on to rather early, followed, more recently, by some of the President's supporters

Most of the others were much more cautious and probably underestimated the number of deaths.  Recent projections are for around 400,000 deaths in the USA by the end of the 2020.  Of course, the virus won't have finished with us by then, so we should draw little solace from that number.  Any possible vaccine is still months away.

[Final Edit] - It's September 25th, and Trump is still making the claim that the USA managed to prevent up to 3 million deaths, according to a story from the BBC dated September 23rd.  I guess once you find a good story, it's best to stick with it, even if it's complete nonsense.

Watching a Goat Rodeo

 Thanks to a FB friend of mine, a new term: "Goat Rodeo"

It seems a pretty appropriate way to describe what's going on in the USA these days and perhaps elsewhere, as public health officials try to encourage people to be sensible and take simple precautions, while some politicians deliberately try to confound the whole process.

A recent article in The Atlantic - America is Caught in a Pandemic Spiral accurately describes the situation.

That article was followed by another: How We Survive the Winter, discussing a selection of quite simple things that all of us could do to minimize the problems that will surely visit us in the coming months.

An inordinate amount of air time has been wasted arguing (fighting, really) over this matter of masks.  It is simply too big a task to summarize it all here, but this article from Science Based Medicine, entitled Misinformation and Disinformation About Masks and COVID-19 covers the topic quite well.

So, we will see.  Schools are opening up and already cases are appearing in students all across the country.  Some, in the USA, opened and then promptly shut down again.  Cases are spiking upwards and deaths are slowly increasing.  Protests against lockdowns, masks, vaccines and probably other annoyances, are running rampant in many countries.

This could be an interesting winter.

Conflagration in a Time of COVID

 If the year 2020 wasn't already bad enough, some parts of the country (the US, specifically) are burning up.  There are massive infernos from southern California right up to the Canadian border.

So, yes, it's a climate emergency.  The pictures are certainly dramatic enough.  Scenes from cities bathed in an orange glow and very limited visibility.  Flames everywhere.

Some of the impact has been lost because so many people are preoccupied by the COVID thing, but there are fires, lots of them, and it's just another example of something that has been predicted that we, as a society, have managed to ignore.  Until now.

There are many accounts of what's going on.  

This one looks at the link between the fires and climate change.  What's behind the 'unprecedented' wildfires ravaging California

CNN has this story:  California's wildfires show how climate change is making forced evacuations and power shut-offs the norm

Thick Wildfire Smoke Blocks Sun, Turns Bay Area Sky Orange.

West Coast fires: Hundreds of homes burned to ground, Oregon governor says

And some state politicians have been fighting back, particularly against Trump who, they say, has failed to fight climate change.

So basically, it's pretty desperate down there.  Today, we here in southern BC have very smoky fires as the smoke drifts north.  It's not as bad (yet) as it was during the summers of 2017 and 2018, but it's pretty bad.  I hate to think of the hell that exists in California, Oregon and Washington.

So even though COVID seems to have taken up all our energies, remember that there is an even larger crisis that has not gone away.

Living the Pandemic - Thinking of You

 I received an interesting little card in the mail the other day (actually addressed to me and my partner).  Apparently I have managed to upset someone with my position that SARS-CoV-2 is a real virus and that the virulence of the virus is something that needs to be taken seriously.  Oh, and also masks.  And probably a vaccine, when one is ready.  This is what the card said:

So I composed a reply to Mr/Ms Anonymous.

Dear Mr or Ms Anonymous:

Thank you for your card.  I am flattered that you have considered my comments (wherever they might have been made) to be so poignant and cogent and consequently threatening to your fantasy world that you felt it necessary to write.  I am sorry, however, that you feel so insecure in your position that you needed to remain anonymous.  I at least have the courage of my convictions and the scientific evidence backing them up that I am quite prepared to associate my real name with anything I say.  I'm also prepared to change my position when new evidence requires such change.  I doubt you would be convinced by anything that could be recognized as real evidence.

To make the statements you made, clearly showing where your "thinking" is on this whole issue, really highlights the temerity of accusing ME of arrogance.  I'm not basing my understanding on fairy tales and conspiracy theories that have not a scintilla of truth to back them up.

You insist that the true fight is against tyranny.  I see the true fight to be against the kind of ignorance and fear that must exist for people like you to make the assertions contained in your note.  Really - "... a flu like virus with a 0.024% chance of dying....  SARS-CoV-2 has never been isolated so tests are meaningless".

I hate to state the obvious, but this is NOT the Middle Ages.  If you were better educated, you might know that viruses can be studied quite easily with modern lab techniques.  Far more is known about them (and this virus as well) than it seems you understand.  And if you had any sense of social responsibility, you would recognize that a very small number of simple practices could make a big difference in the kind of damage this virus could do to our society.

Quite frankly, I would consider uninformed people like you to be a serious threat to the rest of us if not for one thing: everyone with any education, critical thinking skills at all and the ability to understand reliable information, will recognize your babblings for what they are and will ignore them.  Consign them to the trash bin of nonsense where they belong.

If you expect anyone to take you seriously, you need to present your evidence and be prepared to show how it supports what you believe to be true.  Don't hide behind pseudonyms and anonymity like a coward.  And, for the love of god, deal with facts, not fictional twaddle.  (As an aside, you won't find facts on Vaccine Choice Canada's website).

I do hope that perhaps someone who recognizes your writing and your views will reach out and offer the help you so badly need.

One last thing.  Don't EVER make the mistake of dragging my partner into any dispute or discussion that only has to do with my views.  She was quite annoyed that your card was addressed to the both of us because she sees being included the way you did as being just one more example of the kind of patriarchal crap that intelligent, independent women have been fighting for decades.  And I happen to agree with her.  She and I often share similar views on issues like this, but it was MY comments that you had an issue with.  

Sincerely, etc, etc...

I understand that my response was not the kind of kind, calm, understanding missive that our Provincial Health Officer would endorse.  I have to leave that for her.  Frankly, I am increasingly angry, particularly with ignorant, foolish nitwits who insist on confounding every simple, practical effort to control this virus while we wait for better treatments.  And it's not like this hasn't been done before.  HIV/AIDS appeared nearly 40 years ago.  We STILL don't have a vaccine, but we have effective treatments and we have, importantly, excellent and simple ways of avoiding the virus.  By now, surely everyone has heard of "safe sex".  So it CAN be done.  We CAN control this virus using just the knowledge and understanding that we have available right now.  Pretending that this virus doesn't exist, claiming that it hasn't been sequenced, repeating that it's "just the flu", insisting that masks won't help or that taking simple precautions only show how fearful everyone is..... none of those help.  None of them.

What my grandchildren need is the opportunity to go back to school and to play with their friends.  The opportunity to learn science, writing, reading, play sports. For parents to get back to work.  Limiting community spread of this virus can make all of those things possible.  Silly comments from virus-denying clowns will not help.  They either need to get on board or they need to be ignored.

Living the Pandemic - New Insights into Coronavirus - Circa July 6, 2020

 One podcast that I've been starting to listen to lately has been The Daily from the New York Times.

One particular podcast was called "Four New Insights About Coronavirus".  Unfortunately, these are new insights from early July (or even earlier), but they are interesting when placed into more recent context.  I'd suggest readers listen to the podcast, but what follows is my take on what was said.  The link above comes with a transcript which is easier to scan through.

(1) This virus is now being seen as a vascular disease.  It gets into the body via the respiratory system but it attaches to blood vessels, fine blood vessels in particular.  So effects will be seen in the lungs, the kidneys, the digestive system, the brain - particularly the small blood vessels in those organs.  Strokes, dementia....

(2) The virus mutates, apparently about every 2 weeks.  Most of these mutations aren't that important, but one mutation has been.  There are two strains - the Wuhan strain and the Italian strain.  It appears to have made it easier for the Italian strain to transmit between people.  This is still being debated, but it's one more item.  Possibly 5x to 10x better able to infect human cells.  It was noted that this is generally the way viruses go - more transmissible and less virulent.  So far, we aren't seeing less lethal but possibly more transmissible.  There is a reference to what happened in the 1918 flu pandemic.

(3) More and more evidence is showing that you are much safer outdoors than inside.  One study from Japan indicated that you are 20x more likely to pick up the virus indoors compared to outside.  This seems to have much to do with air currents and whether you are sitting inside each others droplet cloud as it floats around.  Outdoors, the breeze blows it away.

We have not seen any big spike in infections in the cities where most of the protests took place. So it looks like they didn’t lead to a lot of transmission. That doesn’t imply that everything is safe just because it’s outdoors. The important thing is how far apart people are when they’re outdoors. So sitting right next to somebody else in front of a stage at Mount Rushmore, for example, where the chairs are zip tied together, is not safe. Masks or no masks, you still really want to try to keep six feet distance.

(4) Finally, there is growing evidence that it could be more safe to open schools.  There is evidence that kids are not big transmitters of this virus.  There have been examples - Denmark opened their schools in April, Finland in May, and neither saw a spike in cases.  Of course, there are other people in schools besides kids - teachers, other adults.  But schools are important, not to mention the value to the economy when parents can go back to work. So it needs to happen, but it needs to happen carefully.

Having said that, schools are more important than restaurants, bars, etc.