Critiquing the “Sweden Model” as a Cure for COVERT-20

Just having fun with one of the many armchair COVID-19 aficionados out there...

Source: The Economist

A few days ago I came across "THE REAL COVID-19 STORY" on a DiNK Gesprek (THINK Discussion) Facebook forum post below.

Please be patient with me here. You're first going to have to read through the following bit, before the fun starts afterwards. 

Skim through it if you have to get the gist of it, but please don't get too bogged down in the blah, blah, blah... as that would divert from the intended lighthearted intent of this post.    

When reading, please bear in mind what journalist H.L. Mencken once said: 

"For every complex problem there is an answer that is clear, simple and wrong."

____________

THE REAL COVID-19 STORY

Logical and rational people make decisions based on evidence.

However, the main problem in reviewing “evidence”, particularly in complex issues like virology and medicine is differentiating between cause and effect with respect to evidence. It’s not always easy to do.

Let’s take the issue of flattening the curve as an example. The objective of this exercise is clear – it is solely to retard the rate at which the infection progresses in order that the rate at which patients that require intensive care present, do not overwhelm the medical facilities’ ability to deal with the problem. The degree to which the curve needs to be flattened is therefore directly related to the particular state’s medical care capacity and this will differ from country to country and district to district.

The objective of flattening the curve is never about reducing the amount of people that become infected nor is it about reducing the ultimate death rate from the disease except insofar as it ensures that there are no “excess deaths” due to medical care capacity constraints.

In the absence of a vaccine and/or effective treatment, the ultimate outcome in terms of death rate per person infected will converge regardless of whether you advocated hard lockdown or a soft lockdown ala the Swedish model. The Swedes are taking the inevitable deaths upfront and inflicting minimal (but not zero) economic damage. Other countries have adopted hard lockdown which reduces upfront deaths but inflicts serious economic damage (which in itself causes death) and are now faced with the need to find a way to come out of lockdown and deal with multiple future recurring outbreaks and deaths.

On face value therefore, both Sweden and most hard lockdown countries have evidence to show that their strategies worked in terms of keeping infections below hospital capacity (Lombardy in Italy and New York in the USA are notable exceptions). Uninformed commentators however, look at evidence of current deaths per million and claim that this is evidence that the strategies followed by Norway and Denmark for example, are more successful than that of Sweden. This is incorrect as the real measure of success on the score of overall mortality will only be known 12-24 months from now. The fight against Covid19 is a marathon, not a sprint. Claiming success for Norway is the same as claiming success for the 42km marathon runner who passes the 1km mark first. Clearly nonsense, as the guy that’s in 100th place at the 1km mark may well be the guy who has paced himself perfectly and who will cross the 42km finish line in first place. We cannot predict yet who will win the Covid19 marathon. My money is on Sweden because their strategy is evidence and logic based, rather than being based on mass hysteria and a political need to be perceived as taking hard action. However, I also cannot be sure as the end point is still far in the future. What I do know though, is that Sweden has done the least damage to its economy and will therefore suffer the least economically induced deaths.

The hard reality is that in the absence of a vaccine and/or the ability to sustain a permanent hard lockdown, this particular airborne virus will infect around 60% of the population (the precise % is unknown as it is a factor of the contagiousness of the disease).

The second hard reality is that in the absence of effective treatment or drugs for people getting sick with the disease, the % of the population that will die is dictated by the IFR (Infection Fatality Rate) which is not yet known, but preliminary research puts it at somewhere between 0.1 and 0.3%, with some research suggesting 0.6%. It’s definitely not the 2-3% numbers bandied about by uninformed commentators who confuse CFR (Case Fatality Rate) with IFR.

Nothing we can do, short of an effective treatment drug or vaccine or permanent lockdown, can stop 60% people getting infected and the IFR deaths occurring. The average citizen doesn’t understand this though and politicians don’t seem to either. The reality is that we will have to learn to live with this virus and the good thing is that the human body has evolved to become a remarkable machine in achieving exactly this. We live in symbiosis with a multitude of microorganisms both within and around our bodies and our immune system (at least in the average healthy person) is remarkably efficient at adapting to new threats. That’s also evidenced by the low death rates by Covid19 which is a brand-new virus that our bodies have not encountered before.

We need to put aside hysteria, deal with the real facts and evidence we have, and move towards regaining some form or normality. The new normal will be different to the old normal and we will be obliged to protect those whose immunity is compromised. However, the rest of society must get on with life. Children must go back to school and people must go back to work. We must all strive to live a healthier life and protect and build up our immune systems, because there is one thing we can know for sure - there will be future pandemics coming our way and we cannot hide from them.  

____________  

This seems like a reasonable argument if you don’t dig any deeper because it’s generally very well written and lots of disparate ideas are intelligently (although not logically) woven together. And if you were not reading it critically, you’d think it was a pretty decent perspective.

This is just as recent misinformation such as Plandemic seems reasonable, if you don't challenge it by digging deeper and employing your critical thinking . 

Here’s my critique as an example of such an exercise. And you're more than welcome to be critical of my criticism if you think it's deserved. Note that it was modified somewhat for dramatic effect.  

____________  

COVERT-20: A Tale of TRUE Fruits

Your argument is devoid of facts, logic and rationality. I don’t have the whole day to waste so let me state the most obvious.

Firstly, you’re attempting to compare apples with pineapples as if they’re the same kind of fruit. And then after by biting in each concluding that you like the apple more because the pineapple tastes leathery and spikes your mouth. In doing so completely disregarding that it is best to truly get to know the nature of the fruit only once it's peeled.

Let’s say Sweden is the apple in this tale. Yes you can compare Sweden and Norway because they are both apples for the purposes of analogy (a Granny Smith and Pink Lady for argument's sake).

And yes the death toll is significantly worse in Sweden and the economy is currently better. And yes, they made an informed logical decision in this regard, and I would argue it could pay off for them in the long run. Economically that is.

But that’s only because the Swedes are the Swedes. As Carl Bildt, a former PM, indicated in a CNN interview, the Swedes are already naturally socially distant. And with small modifications in behaviour, have the discipline to pull it off without any major measures.

What about countries who adopted strong early measures,  and are now are good to go? Prime example being New Zealand where the virus had essentially been eliminated in very short time. And despite a significant drain on the economy, and infrastructure that does not remotely compare, South Africa is not doing badly on the death and infection front (and therefore one can legitimately argue that the lockdown is too severe, though there’s some complexity here and is an argument for a post of it's own).

On the other hand, what about the UK? The pineapple in the argument, let’s say. Because they were late at implementing measures, arguing for the herd immunity argument Johnson made, they now are experiencing a massive death tol.

That is with an eventual very restrictive lockdown.

Now what would’ve happened had they not?

Estimations are that a few hundred thousand would’ve died given the rapid exponential growth of COVID-19, had they not done so. Notwithstanding these eventual measures, because they were late to respond Britain who is now per capita the worst case is exactly where they are because they employed your underlying logical assumptions.

The USA is now relaxing social distancing and the forecast is that the death rate would exceed 3,000 in three weeks, and that 200,000 would be dead by August according to a John Hopkins projection if America opens up now.

Notably the common thread between the three countries with the worst outcomes are that they are run by populists: the USA, Britain, and Italy. In this case I would say the USA, particularly because of Trump, the banana – or should that rather be, paw paw (specifically the orangeier version, otherwise known as a papaya) – in the basket.

Another illogical argument is the way you made irrational inferences from the “flattening the curve” model.

The model’s two graphs shows a mathematical area under the curve that theoretically shows the same number of patients. But it’s employed to do exactly that, compare apples with apples to simplify the theoretical argument, basically the “Epidemiology for Dummies” version. To take this literally, as you indicated that would eventually result in the same amount of deaths, is like saying ceteris paribus as they do economics, i.e. all other things being equal, in order to make sense of complex systems.

One can say it’s the apple pie (sprint) versus apple cider (marathon) analogy, albeit the exact same number of apples were used.  

Unlike your assertion that they will reach the same conclusion (i.e. a marathon vs a sprint), flattening the curve is ultimately about lowering the overall death rate. 

Indeed, the argument should be reversed. The sprint being about rushing to open up at all costs, resulting in a deadly peak because hospital capacity is overwhelmed. This though can play out over many months, with an eventual very high death rate. 

The marathon is in fact about mitigation measures to flatten the curve. This requires a longer term view, but which can be considerably shortened if earlier mitigation measures are enacted. Again, New Zealand being the prime example. 

The assertion that we generally get the same amount of deaths in the long run whether we flatten the curve or not – "the ultimate outcome in terms of death rate per person infected will converge regardless of a hard or soft lock-down (as per Sweden)" – is blatantly incorrect for a multitude of obvious reasons. Clearly you are confusing overall death tole with death rate, the former being a factor of death rate times infectivity. 

It is not virulance which you were alluding to. In fact it's virulance, that you actually become very sick when the virus inhabits your body, is clearly not the case with COVID-19. But this very low virulance is actually what makes it deadly to the overall population as it increases the R-0 – it's overall infectivity – because of asymptomatic spread. 

If it is not obvious to you, please read my tedious footnote below. [i]

And you were implying that it’s a generally mild virus and that it’s not so deadly? 

Are you referring to the one Boris had? If you're wondering who I'm referring to, he's the head of the pineapple factory. 

Now, to your reference to the impact on the economy?

Do I really have to go down there other than to say this. The fear of omnipresent death and knowing that there’s a mostly undetectable deadly disease on the prowl – like a covert (as opposed to COVID, get it?) KGB assassin – generally does not promote healthy economic activity.

That’s unless you’re a cool Swede (just kidding if there happen to be any Swedes reading this response).

Oh, and a last one before I go.

Yes, there will be lots of deadly viruses and diseases out there in the future that you need to prepare for, the flue for instance. But when do you suppose the next once-in-a-hundred-year plague would befall us in your estimation?

Just curious. 

____________  

His personal post went abuzz with how much of a genius he is. Clearly his followers were greatly impressed with his writing acumen. 

However, besides the general logical floors of the argument, be generally weary of anyone who claims they are giving “THE REAL...” from their narrow perspective, let alone “THE REAL COVID STORY”.  

And I also wonder who the “uninformed commentators” are?

As irony wild would have it, this particular informed expert happen to be a very well educated gooseberry farmer. 

Met ander woorde, ‘n APPELliefie boer. 

Note that I’m generally not such a prickly pear as I was in my retort, but the arrogance of this guy really got under my skin. 

Unlike in this case, I’m usually thicker skinned.

More like a pineapple, but without the pines, I suppose.  

And no, a pineapple minus pines, doth not an pineapple maketh.

En net ingeval jy gewonder het, nee, 'n appeliefie boer is nie net maar 'n gewone appel boer met 'n groot liefde vir appels nie😊 

[If you are interested in a transcript of the subsequent FaceBook discussion go to  this link for pdf download]

---

[i]

The reality is that the death rate varies from around 2% as in South Africa, to as high as 15%. This though is dependent on the number being tested, but in Europe this is generally accurate. That's notwithstanding asymptomatic spreaders which are generally not tested. This adds to the overall infectivity of COVID-19, and therefore also to it's deadliness and scariness as it unknowingly lurks in society. 

This death rate for most countries that are not Sweden, is causally linked to the ability of the hospital system to cope with patients, and therefore to give quality treatment. Even Italy and UK with the best hospital systems in the world, largely crumbled. And this is with very strong lockdown measures in place. 

If they had started with social distancing a week or two earlier, they could've stretched the effects over a longer period, with significantly less consequent deaths. That’s let alone that treatment methodologies improve with time, which will significantly lower the overall death rate as well. Let alone a vaccine or other definitive cure which could stop the disease potentially dead in its tracks.