18 votes

Sweden has revealed that despite adopting more relaxed measures to control coronavirus, by late April only 7.3% of people in Stockholm had developed the antibodies needed to fight the disease

24 comments

  1. [15]
    patience_limited
    (edited )
    Link
    Herd immunity through infection with live coronavirus is a spectacularly bad idea. Every new infection is a selective event in terms of the virus' evolution. SARS/MERS-family coronaviruses have...

    Herd immunity through infection with live coronavirus is a spectacularly bad idea. Every new infection is a selective event in terms of the virus' evolution. SARS/MERS-family coronaviruses have already been selected for the more infectious variant, SARS-CoV-2, in the span of time since they were first discovered causing human disease in 2003.

    There is no evidence that viral mutations are automatically selected for less virulence. Lab and mathematical models have shown that it's a 50/50 chance either way. The really scary possibility is that COVID-19 will become something like feline infectious peritonitis, another coronavirus-related syndrome which is slowly fatal in cats. There are already case reports of people with very lasting symptoms, re-hospitalizations, and late deaths that may reflect virus successfully hiding in immune cells or organs.

    SARS and Ebola establish that high mortality rates don't guarantee extinction of viruses as long as there are animals or asymptomatic human carriers which can serve as reservoirs for passing the virus back and forth.

    There is also no guarantee that exposure provokes durable immune responses that will protect people long enough for SARS-CoV-2 to stop circulating in human populations. There is reason to suspect that at least some percentage of the population may have severe immune responses, potentially like those in dengue hemorrhagic fever, to reinfection or prior immune priming from exposure to other coronaviruses. This also complicates the search for a safe and lastingly effective vaccine.

    Sweden, and other nations' stated or unstated policies to avoid isolation, were based on a misapprehension of the risks. It's now too late to have kept the virus from becoming an endemic human disease.

    The best we can do now is mask up, sanitize, and maintain distance for the indefinite future. I hate to be so pessimistic, but this is a science-y reality check on all the bullshit that's been spread.

    21 votes
    1. [4]
      NaraVara
      Link Parent
      I think this entire post is unduly pessimistic and fearmomgering. Most of the risks you’ve mentioned could apply just as easily to regular influenza as well as several strains of the common cold....

      I think this entire post is unduly pessimistic and fearmomgering. Most of the risks you’ve mentioned could apply just as easily to regular influenza as well as several strains of the common cold. The count of deaths out of Sweden is basically the same as the US and U.K. with or without lockdowns, so the idea that the herd immunity approach has been any worse than anything else doesn’t hold up.

      Granted, Sweden has better healthcare access and capacity than the U.K. or most of the US. So it’s possible the same transmission rates here will kill a lot more people. But that’s an argument for more hospital capacity rather than saying we should mask up forever.

      It’s seeming like most of the large upsurges in infections is probably happening from large transmission events, so once you ban the large gatherings of over 50 people it’s looking like additional interventions beyond that hit diminishing returns fast.

      11 votes
      1. vektor
        Link Parent
        But you've got to dig into those diminishing returns interventions at least a little bit to get R to below 1. Banning large gatherings tremendously helps contact tracing, but it won't protect you...

        But you've got to dig into those diminishing returns interventions at least a little bit to get R to below 1. Banning large gatherings tremendously helps contact tracing, but it won't protect you nearly enough. We're seeing in a lot of places that a lighter approach doesn't work. This virus is so heavy on the hospital system that once you realize you have it in your country, even a R of 1.2 or 1.3 won't save you from getting overwhelmed long term, it's just a matter of time then.

        I don't think we should compare Sweden to the US or UK. Those are two countries with (some of) the most preventably disastrous outcomes. Both countries bungled it and could be in a much better place were it not for chronic and acute issues preventing that. They are also very different in their political landscape. Scandinavian countries or maybe Germany are a much more reasonable point of comparison, at which point Sweden is the odd one out with it's death rate being 4x that of the others. Sweden's strategy is neither here nor there.

        Sure the OP is a bit heavy on the pessimism, but frankly, I can't blame them. It's going to be a very long or very costly time till we can get anywhere near normal again. It is completely out of the question now to eradicate the virus without a vaccine. In some (even some developed) countries, I'm doubtful of the population's capacity to maintain social distancing long enough to buy enough time. The worse it is in a country, the harder you have to hit and the longer you have to keep that effort up to get it under control again. So depending on where you are, it's going to be a long while until we can get this over with. Unless you go for herd immunity. Which you shouldn't.

        8 votes
      2. BuckeyeSundae
        Link Parent
        It's worth pointing out that a lot more matters than just government policy. If you have, say, a highly individualistic culture where group action is relatively hard to encourage through less...

        It's worth pointing out that a lot more matters than just government policy. If you have, say, a highly individualistic culture where group action is relatively hard to encourage through less restrictive means, and especially where trust in the government is very low, you have fewer soft options available to leverage to encourage people to engage in the sorts of personal behaviors needed to help contain the virus. If, however, you are in relatively low population density country where trust in the government is considerably higher, then you have more public policy options than only harsh lockdowns.

        It's worth remembering that Sweden has the population density roughly equivalent to Arizona, which is the US' 39th most dense territory (including places like DC and Puerto Rico above the state). Given the nature of this virus' spread, especially among highly urban areas, it's not unreasonable to expect Sweden to have less at stake overall than a more densely populated country (like most of the US).

        8 votes
      3. patience_limited
        (edited )
        Link Parent
        Sorry to take so long to respond - getting out in the sunshine while it lasts! First off, let me push back against the accusation that the post was "fearmongering". This was not a deliberate...

        Sorry to take so long to respond - getting out in the sunshine while it lasts!

        First off, let me push back against the accusation that the post was "fearmongering". This was not a deliberate attempt to incite unreasonable alarm. It's based in evidence from virology, epidemiology, immunology, and a considerable amount of review of the available well-validated research on coronaviruses. I'd like to believe I don't have to annotate or publish a bibliography on every post, but I can if there's general interest.

        Second, I'm also going to push back on any analogy between SARS-family and influenza viruses. Humans have been co-evolving with influenza viruses for thousands of years - we've been selected for a broad array of immune defenses against them. It's been well-established that the human immune system mounts a more effective defense against even high-virulence influenza mutations, than against the new-to-us SARS/MERS coronaviruses. We also have known-effective anti-viral drugs for influenza viruses.

        Third, healthcare access and capacity are helpful, but it seems there's irreducible mortality*** among people who catch COVID-19. The U.S. has a higher proportion of the population with established vulnerabilities other than general immune system decline with age, but it's clear that death rates are disturbingly elevated in all age groups, including non-hospital deaths. One rough comparative risk assessment estimates that living in New York City during the COVID-19 outbreak was twice as risky as being a U.S. soldier in Afghanistan during the worst year of the war. Certainly, the risk isn't evenly distributed, but it's ethically abominable to evade relatively undemanding mitigations (masks, distancing, sanitation) and act as though that risk is acceptable.

        Finally, upsurges in infections aren't limited to large transmission events. As shown in my home state (and locally, as recently as yesterday), silent carriers distributed the virus through their in-person connections for multiple days. We saw almost every single city or town along major highways turn into a hotspot. Presumably, unprotected contact with retail service workers, who then have multiple public contacts, is a major source of contagion. That's why everyone should be wearing masks in public for the foreseeable future.

        Edit: ***U.S. CDC excess mortality data is available here.

        Edit 2: Discussion on SARS-CoV-2 evolution that's worth reading.

        6 votes
    2. [5]
      vektor
      Link Parent
      Another valid view of "The Sweden Situation" (dibs on indie band name) is that voluntary measures just don't work. People will people. At least officially, Sweden's position was never to reach...

      Another valid view of "The Sweden Situation" (dibs on indie band name) is that voluntary measures just don't work. People will people.

      At least officially, Sweden's position was never to reach herd immunity, but to let common sense of the people prevail: inform, recommend, but don't enforce. That has failed, it seems. Their stance seemed to me to be informed mostly by a pro-social liberties rather than a pro-business angle.

      On the epidemiology, I completely agree. Even though SARS 2 has that proofreading gene, the more people you infect, the more likely an adverse evolution of the virus becomes. Immunity dodging is at least according to experts not a problem, but I'd like an expert to confidently say that that'll hold even if the disease slowly creeps through the entire world population.

      7 votes
      1. ohyran
        Link Parent
        Well again, this is something that needs to be repeated - we can't do an enforced measure. If the state declared war - then yeah. If not, then collapse as part of our base laws (think the US...

        Well again, this is something that needs to be repeated - we can't do an enforced measure. If the state declared war - then yeah. If not, then collapse as part of our base laws (think the US constitution) are pretty clear on what can and cannot be done. Its a bummer but it is what it is and so far things are going ok.

        Volontary measures DO work, just not as effectively as forced quarantine.

        The fact that our privatized homes for the elderly that where the core reason for our disease numbers is something I hope will be taken up more seriously in the future tho.

        4 votes
      2. [3]
        Gaywallet
        Link Parent
        What are their policies if you decide you want to social distance but your work disagrees and decides you should be in the office? I'm not so sure this is more pro-social liberties than pro-business.

        inform, recommend, but don't enforce. That has failed, it seems. Their stance seemed to me to be informed mostly by a pro-social liberties rather than a pro-business angle.

        What are their policies if you decide you want to social distance but your work disagrees and decides you should be in the office? I'm not so sure this is more pro-social liberties than pro-business.

        3 votes
        1. ohyran
          Link Parent
          We removed the one day "karens" so that anyone who is sick, fear being sick, care for someone sick or is close to someone sick can stay at home from day one with full sick leave. But it IS a class...

          We removed the one day "karens" so that anyone who is sick, fear being sick, care for someone sick or is close to someone sick can stay at home from day one with full sick leave.

          But it IS a class illness - and class exists here too of course - and a lot of jobs simply can't be done from home and due to past bad choices politically (the shitty 90's of Blairism) some jobs are hour-paid meaning it doesn't make sense staying at home because sick leave pay is only relevant if you get booked for hours of work, if some boss thinks you're not worth it you're boned.

          As for politicians - and this needs to be reiterated - Swedens way of handling its version of CDC is different from the US due to a tradition of not letting political inclinations change their work and often here they have a lot of say. THAT means in turn that it can quickly become kind of... distanced communication wise. Think "dry little person with calculator" instead of "politician". It also means cruel calculations - which is impossible for politicians to communicate like "How many people die of poverty? Lets compare with this number too!" - so very darkly utilitarian I suppose.

          Upshot is that most of Swedens politicians, left to right, are all fairly on board. Its been insanely quiet on the politician front in terms of Covid, compared to all other issues.

          7 votes
        2. vektor
          Link Parent
          That's what it could end up being if you're not careful - absolutely. I deliberately say "seems" to be informed by ~. That's what they communicated. And we all know politicians would never lie.

          That's what it could end up being if you're not careful - absolutely. I deliberately say "seems" to be informed by ~. That's what they communicated. And we all know politicians would never lie.

          2 votes
    3. [5]
      babypuncher
      Link Parent
      What do we do if it turns out a vaccine is not possible? Do we just live in this socially distanced hellscape indefinitely? At what point do we decide that the "cure" is worse than the disease?

      The best we can do now is mask up, sanitize, and maintain distance for the indefinite future. I hate to be so pessimistic, but this is a science-y reality check on all the bullshit that's been spread.

      What do we do if it turns out a vaccine is not possible? Do we just live in this socially distanced hellscape indefinitely? At what point do we decide that the "cure" is worse than the disease?

      1 vote
      1. patience_limited
        Link Parent
        (pessimism = off) It's pretty clear by now that we can modify many public activities without too much trouble, and don't have to maintain maximum isolation for everyone. As tests become more...

        (pessimism = off) It's pretty clear by now that we can modify many public activities without too much trouble, and don't have to maintain maximum isolation for everyone.

        As tests become more available, we can create our "bubbles" of known uninfected friends and family (as long as they're reliably maintaining precautions), and gather outdoors.

        Otherwise, keep going out with masks, hand-washing, and observing distance guidelines. Outdoors should remain preferable to indoors, at least for the months where that's tolerable. Public transit and retail stores should require masks and reduced capacity to allow distance.

        That's enough to keep everyone reasonably safe, excepting those who are in regular immediate contact with symptomatic patients, or members of highly vulnerable populations who can't wear masks.

        SARS-CoV-2 isn't magic. There's no evidence that it becomes airborne again once it lands on a surface, or that people are getting infected through consuming contaminated food or beverages. It's not as contagious as measles (e.g. a virus with durable airborne transmission, and a single-digit number of virus particles will cause infection).

        Despite the lack of targeted anti-viral drugs, treatment is getting more effective as the data comes in. We now know that many deaths can be prevented with anti-thrombosis prophylaxis, non-invasive high-oxygen ventilation, and simple prone positioning. Reducing the hospital mortality rate from COVID-19 isn't a justification for eliminating precautions, but it does lower the overall risk of disability and death.

        We're going to have to make modest sacrifices, and probably enforce some regulations to ensure minimal outbreaks. Even in an environment that's not polluted with disinformation, that has high social/governmental trust, that has ample social services, people will be people. [Footnote: two symptomatic out-of-state visitors likely started an outbreak in my neck of the woods this weekend - twenty people are quarantined now.] Granting that I have relatively small social needs, it's still not what I would call an indefinite hellscape.

        4 votes
      2. [3]
        Gaywallet
        Link Parent
        No evidence currently points to this being a possibility, so how about we cross that bridge when we get to it?

        No evidence currently points to this being a possibility, so how about we cross that bridge when we get to it?

        3 votes
        1. [2]
          babypuncher
          Link Parent
          At what point do we decide it's a definite possibility? There are many viral diseases out there that we have never been able to produce a vaccine for despite decades of research, so we should have...

          At what point do we decide it's a definite possibility? There are many viral diseases out there that we have never been able to produce a vaccine for despite decades of research, so we should have a contingency plan.

          It's a legitimate question worth asking.

          2 votes
          1. Gaywallet
            Link Parent
            I would say we need to at least give it enough time for a vaccine to be feasibly possible, or at least let a few of the candidates play out. At this point there's no cause for a concern, and...

            I would say we need to at least give it enough time for a vaccine to be feasibly possible, or at least let a few of the candidates play out. At this point there's no cause for a concern, and comparing this viral disease to others which we have not been able to produce a vaccine for is far too quick a judgement. We only just started studying this.

            4 votes
  2. [5]
    Comment deleted by author
    Link
    1. ohyran
      Link Parent
      Well we knew that didn't we? Remember when Fox news talked about how Sharia law courts ruled? Or when they talked about how there where no-go zones across the country? The problem with any...

      Well we knew that didn't we? Remember when Fox news talked about how Sharia law courts ruled? Or when they talked about how there where no-go zones across the country?

      The problem with any political stand-point is that you often want to use bad alternative examples to show what would happen if you don't do "X". The further away the better but in a pinch you just repeat what others say and we often get a good dollop of this (I mean we are far from alone, or those getting the worst sting of it).
      Tbh I think the internet have made things WORSE disinformation-wise.

      Either way. Just like other times, we just have to ignore it and roll with the punches

      5 votes
    2. [3]
      stu2b50
      Link Parent
      I don't think this title is that bad, considering it's for an American audience. The main difference is the connotation in the title: in the original, there is the connotation of disappointment,...

      I don't think this title is that bad, considering it's for an American audience. The main difference is the connotation in the title: in the original, there is the connotation of disappointment, in the alternative, there is the connotation of expectation.

      However, I'd say that while it's inline with expectations for the Swedish government, it is not in expectation with the American public. There is a vocal minority in America arguing for herd immunity, that it will take months rather than the years for a vaccine.

      However, this is to the contrary; to achieve the 70-80% infected necessary, it will take years.

      So it's not to the expectation of its audience, hence the title.

      3 votes
      1. [2]
        ohyran
        Link Parent
        Just a note, we are not going for herd immunity. That is something our FHM (Health Ministry) have said over and over. Plus its not up to the government since the FHM is isolated like a lot of...

        Just a note, we are not going for herd immunity. That is something our FHM (Health Ministry) have said over and over.

        Plus its not up to the government since the FHM is isolated like a lot of ministries from political input and only uses medical expertize. Technically politicians CAN demand things from them but its a massive faux pas politically.

        4 votes
        1. Algernon_Asimov
          Link Parent
          The alternative title that was suggested here (I saw it before it was deleted) implied this. That title said something about this level of infection being in line with forecasts expected for May....

          Just a note, we are not going for herd immunity.

          The alternative title that was suggested here (I saw it before it was deleted) implied this. That title said something about this level of infection being in line with forecasts expected for May. That implied that Sweden had planned for this outcome.

          1 vote
  3. [4]
    Overzeetop
    (edited )
    Link
    So, by Sweden recommending voluntary distancing, they have found that the virus has successfully spread to over 7% of the population. To put that in perspective, the US would have roughly 25...

    So, by Sweden recommending voluntary distancing, they have found that the virus has successfully spread to over 7% of the population. To put that in perspective, the US would have roughly 25 million people infected at that rate.

    If I did the math right - 10 million Swedes x 0.07 = 700,000 infected. 3800 fatalities / 700,000 infected = 0.0054 or 0.54% IFR. This also appears to be in line with most of the world. It also means that, for Sweden they can expect about 30,000 more people to die before they reach herd immunity, presuming that everyone's antibodies continue to protect them over the time it takes to reach that level. The equivalent in the US, per capita, would be 1.2 million. That doesn't sound so hot.

    Edit: aside from the region difference I missed (assuming the testing numbers were representative of the country) I also mis-represented IFR. IFR is the fatality rate for symptomatic cases, not symptomatic and asymptomatic combined, which is what an accurate antibody test determines. Note I say accurate because it's unclear which tests are accurately showing antibodies to SARS-CoV-2, and which ones are just showing antibodies to any of the 3-4 most common coronavirus variants which are endemic and about 20% of the over-reaching rhinoviruses which are classes by the average human as "the common cold."

    6 votes
    1. [3]
      Spel
      Link Parent
      No. Your numbers are all wrong. The 7.3% is in Stockholm, the worst hit location, not all of Sweden. The death count you have is from four weeks later than the the antibody tests, in late April...

      No. Your numbers are all wrong. The 7.3% is in Stockholm, the worst hit location, not all of Sweden. The death count you have is from four weeks later than the the antibody tests, in late April there were about 2250 deaths. 90% of the people who have died are over 70, 50% are over 85, and most of them have other health conditions, which means that the death rate would decrease over time. The elderly population in Sweden is larger than in the USA, so the death rate would be lower. I could go on.

      7 votes
      1. [2]
        Overzeetop
        Link Parent
        Numbers being wrong seem to follow this disease everywhere. What did the IFR end up being for Stockholm? 1M residents; 7% (in April?) means 70,000 total infections (all told,...

        Numbers being wrong seem to follow this disease everywhere. What did the IFR end up being for Stockholm?

        1M residents; 7% (in April?) means 70,000 total infections (all told, estimated/extrapolated); 2250 dead (in April) gives a 3% IFR - which is really, really large compared to say 2.7M (Again estimated based on 21% sampled having antibodies...who knows how representative the sample is, though) vs 22,500 around the end of April is more like 0.8%. Bad, but they also had a pretty dense outbreak. [This is a serious response, btw - I would love to get more accurate data, just so I'm not working off of inaccurate numbers. We're all techies; numbers matter.]

        Also, it's true that the elderly will die off of natural causes before the 'rona gets them, but we're also creating "new" elderly each year. My pick-up basketball group likes to remind me of this whenever we play.

        2 votes
        1. Spel
          (edited )
          Link Parent
          It's Stockholm the region, not the the city so the population is about 2.4 million, and at the end of April there were 1287 deaths in Stockholm. So out of at least 175 000 cases (but this number...

          It's Stockholm the region, not the the city so the population is about 2.4 million, and at the end of April there were 1287 deaths in Stockholm. So out of at least 175 000 cases (but this number is likely to be lower than the actual number) 0.74% died, but as I said that's likely an overestimate.

          You can compare it with the second largest region with the next largest Swedish city, Västra Götaland, where 3.7% were found to have antibodies. At that point they had 176 people who had died. That region has a population of 1.71 million, so with avout 63 270 definite cases they had a death rate of 0.26%, but again this is likely to be an overestimate.

          The third largest region is Skåne, with 4.2% having antibodies. At the end of April there were 65 deaths. With a population of 1.36 million that's at least 57 120 cases. That gives you a death rate of 0.11%, again probably an overesimate.

          Since we know that about 90% of the people who died were above 70 years old, despite people between 20-64 being vastly overrepresented among the people who've gotten sick (overall in all of the regions 6.7% of people 20-64 had been infected compared to 2.7% of the people 65-95) the death rate for people under 70 years old should likely be well below 0.1% which seems to jive well not only with reports from other countries such as Italy, where there's been findings of a death rate of 0.04% for people between 40 and 49, but also the comparatively low death rates in regions in Sweden where they were more succesful of keeping out of the care homes for the elderly.

          Really what I think is interesting is something like the fact that Malmö has fewer deaths per capita than Copenhagen despite their lockdown, with the two cities being seperated only by a 40 minute train ride which is a daily commute for many people. This may change in the long term, but it really shows how many factors go into all of this.

          3 votes
  4. Overzeetop
    Link
    I find it (mathematically) interesting that this correlates pretty closely with the NY Metro area numbers - 0.83%. Without question this is affecting the elderly, and they are skewing the overall...

    So out of at least 175 000 cases (but this number is likely to be lower than the actual number) 0.74% died, but as I said that's likely an overestimate.

    I find it (mathematically) interesting that this correlates pretty closely with the NY Metro area numbers - 0.83%.

    Without question this is affecting the elderly, and they are skewing the overall percentages, but that's true of normal influenza as well. I do wonder how the reaction would be different if the age criteria were reversed, with the likelihood of those under 5 years of age having a 1 in 6 change of dying if they contracted it, and those under 15 having a 1 in 20 chance.

    1 vote