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Friday, August 07, 2020

Covid Update: Sweden's Eden

I've been meaning to write this for a while but haven't had the time. Today's the day because someone just did most of the work for me -- more on that below.

Here's my good/bad overview of COVID-19 at present, with the bad first:

I know a few people who have had it now, and have had a few friends of friends die of it (no direct acquaintances yet). If you have any doubts that it's something you really want to avoid getting, peruse the Survivor Corps group on Facebook, or reddit's COVID-19 Positive group. It sounds very much worth avoiding if you possibly can.

The politicization/monetization of treatments is unfortunately over the top, with the mainstream narrative eschewing hydroxychloroquine (HCQ) in favor of wildly more profitable drugs with worse track records like remdesivir. The only clear evidence I've seen so far re. HCQ is that the process of evaluating it has been so hopelessly tainted that it's really hard to find any clear evidence about HCQ. There are some things coming up that may change this, and I'll try to remember to post them if so. (My current soft bet is in favor of HCQ being helpful, possibly very, if applied early and probably with Zinc. But this is old news that shouldn't still be old news. And no, don't send me studies--unless they're from yesterday, I've probably already read them more carefully than you have.)

Steroids were suggested early, then deemed unsuitable, and then recently re-discovered as if a new idea, but at least they've managed to stumble into something that helps. I think this is more for late stage as opposed to early. Mostly I'm unimpressed with the process so far.

Locally to us here, Portland is a new hotspot for cases. But it's not because of the protests, because as everybody knows coronavirus only spreads at conservative protests. Unfortunately we have to do some business downtown soon, so the timing isn't great.

Now for the good:

I asked a while ago what people thought would happen if we did not have any mandated lock-downs, just let people choose their own precautions for themselves. Shortly after that, Sweden volunteered to run this experiment for me. Many predictions were pretty dire, like exponential growth until 99% of the population had it and 0.5% to 3% were dead depending on the particular cynic (or more, accounting for overrunning the hospitals!). And hence the need for lockdowns.

Well, here we are today:

I'll resist sarcasm and just point out that Sweden is pretty much lost in the middle of the pack there, that the exponential growth slowed roughly in the same region as many other countries with wildly different policies. The fact that those histories are all so similar says it's much more about the natural dynamic of the disease than about particular policy -- to say that Sweden's cultural differences happened to exactly mimic the lock-down policies in all those other countries would be pure rationalization. These are the countries I chose to plot at the outset of this experiment--I did not change my metric to suit the outcome. Many want to compare Sweden now to Finland and Norway instead because it makes Sweden look a lot worse by comparison, but this misses the point entirely. The lock-down decision wasn't made based on how Sweden vs. Norway look today, it was made based on that very wrong, dire hyopthesis above. If we had known this future then, would we have made the same choice? Further, we are still very much playing the long game here. It's not over for Germany or Norway or Finland or much of the US. But it might just be over in Sweden. (And, as I suggested in April, in New York as well--even the IHME forecasts shows minimal activity there in the most lenient of scenarios).

Here is the daily rate of deaths (linear) for a more dynamic view of where we are (Spain has a data glitch that's keeping it from showing, sorry):

A big, open question is whether the countries that have done well so far (like Germany here, and even the US relative to the rest for a while) have just delayed the inevitable and will have their time eventually. It is of course possible they could retain that lead until there is a vaccine or better treatment or both. And then we'll need to look at the health costs of the economic impact to decide whether it was a net win for those countries.

Note that at this time, Sweden's death rate has fallen below that of a typical flu season. To fully appreciate the relevance of that, read this, which is better than me giving a second hand account of what's going on in Sweden (and covers some other things I had planned to talk about):

How bad is covid really? (A Swedish doctor's perspective)

The main thing I would differ with him on there is that he is using the usual bad model of Herd Immunity, so the IFR is likely higher than he thinks (did I mention you don't want to get it?). But that's net inconsequential in terms of deaths.

I wish this kind of information would change any perspectives, but I've learned the power of rationalization is infinite.

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Simon Funk / simonfunk@gmail.com