Northern Europe during Pandemic -- Summers 2020 & 2021 & onwards

[Dockhead]

Denmark, like Sweden, rolling out massive testing: Coronavirus testing tents popping up across Denmark - The Post


Finland, as it turns out, has not been reporting any COVID deaths except for ones which take place in hospitals, so has not reported nursing home deaths at all (the majority of Swedish deaths): https://www.helsinkitimes.fi/finland...ch-higher.html


So Finland is apparently not as different from the other Nordics as it seemed. We've discussed the incomparability and possible unreliability of statistics before; we should keep that in mind.




U.S. is still on the steep part of the exponential curve, and has leapt ahead of most European countries, including all the Nordic countries, just about catching up with France, in cumulative cases per million: https://www.worldometers.info/coronavirus/#countries. What a difference a week makes. Deaths have reached 123 per million. That is the country as a whole, which blends low infection areas of the central part of the country with hotspots like New York State. New York State has reached 13,869 deaths which is 693 per million, far surpassing any European country (worst are Belgium 490, Spain 437, Italy 391).



Situation in the Nordics continues to look good (although noting the issue with Finnish reporting of deaths). New deaths reported yesterday in Sweden are 29, but there is a lag in reporting over weekends. But daily deaths and daily new cases are stable or falling comparing the previous week with the week before that, so we seem to clearly be on a flat part of the curve in Sweden. Denmark looks even better than that, with definitively falling new cases and new deaths for the previous week compared to the week before that, and a sharp downturn in the number of active cases. See: https://www.worldometers.info/corona...untry/denmark/, something we don't see in Sweden.


Today most of the few trades closed down in Denmark will reopen (hairdressers, tattoo parlors, dentists). Maybe I can get my hair cut at last. Waiting very much for the border to reopen, preliminarily on 10 May. If that happens then I may start sailing towards Finland, cruising Swedish waters while waiting for the Finnish border to reopen.

[Quebramar]

Originally Posted by DeepFrz

The argument that there may be a much higher rate of infection seems to be a flawed argument as several studies have not done well when peer reviewed.

I don’t think you need loads of studies to realise that many many people who got infected never made it to the stats, for various reasons: from a lack of symptoms to mild ones, to ignorance, to impossibility to get checked by doctor, to fear to go to the hospital...
I know of personal colleagues in various countries, including Sweden, who got infected and sick yet did not go to the doctor nor to the hospital.
In parallel, the data points provided by each country vary widely (and wildly) because of a lack of collection procedure and systems and of homogeneity thereof.
My little Belgium country is the champ for transparency, publishing not only hospital deaths but also those in rest homes, something that few authorities do. The candor of local authorities here goes that far that, for a lack of testing capacity, suspected cases in rest homes are also included in the stats, boosting the figures even further. [emoji15]

To me one of the most relevant measure to policy makers is the number of cases in ICUs. Opening up the lockdown measures should be done as to maintain a manageable level of this number. If I may use the analogy of sailing, it is how far can you open the sheet until the sail starts flogging,that is where too much relaxing would be. Balancing focus on the most vulnerable economic parts vs. the most vulnerable population could be an appropriate measure to take in a gradual re-opening, which is what some countries are starting to consider or decide.

As some said above, first-liners don’t have an easy job and others should learn from them. Only time will tell what is the best way to adjust in the mid-term.

[Dockhead]

Originally Posted by Quebramar

I don’t think you need loads of studies to realise that many many people who got infected never made it to the stats, for various reasons: from a lack of symptoms to mild ones, to ignorance, to impossibility to get checked by doctor, to fear to go to the hospital...
I know of personal colleagues in various countries, including Sweden, who got infected and sick yet did not go to the doctor nor to the hospital.
In parallel, the data points provided by each country vary widely (and wildly) because of a lack of collection procedure and systems and of homogeneity thereof.
My little Belgium country is the champ for transparency, publishing not only hospital deaths but also those in rest homes, something that few authorities do. The candor of local authorities here goes that far that, for a lack of testing capacity, suspected cases in rest homes are also included in the stats, boosting the figures even further. [emoji15]

To me one of the most relevant measure to policy makers is the number of cases in ICUs. Opening up the lockdown measures should be done as to maintain a manageable level of this number. If I may use the analogy of sailing, it is how far can you open the sheet until the sail starts flogging,that is where too much relaxing would be. Balancing focus on the most vulnerable economic parts vs. the most vulnerable population could be an appropriate measure to take in a gradual re-opening, which is what some countries are starting to consider or decide.

As some said above, first-liners don’t have an easy job and others should learn from them. Only time will tell what is the best way to adjust in the mid-term.

Deaths in nursing homes are not counted in most countries? That's weird. In Sweden a MAJORITY of deaths are in care homes, and they are counted. This means the statistics are even less comparable than I thought.

[Exile]

Originally Posted by AKA-None

Why would you let people go didn’t they do stuff before?

Originally Posted by Wotname

I can't speak for Exile's area but here in Oz, all elective surgery had been put on hold (public and private) as they (gubbermit) wanted to keep enough supplies of consumables (PPE etc) available for a possible overload of CV19 cases.

So many hospital staff had nothing to do in the meanwhile.

The supply lines of consumables have been firmed up and a larger stockpile now exists. Combined with a lower than expected serious CV19 cases (in Oz) has meant they are planning to allow certain elective procedures to re-commence.

Not only purely elective surgeries, but many cardiac and other more pressing surgeries were put on hold to free up ICU beds and other resources in anticipation of an onslaught of CV-19 cases. Even in hard hit areas (albeit outside NYC), hospitals are now having to make difficult decisions on whether to resume more normal operations (how long can cardiac patients for e.g. wait??) only to potentially become overwhelmed with a second wave of virus patients.

On top of this, with people staying at home there are fewer accidents, injuries, DWI's, and the other sorts of issues that arise with more normal human behavior. The incidence of violent crime is also way down, so far fewer shootings, knifings, beatings and other sorts of 'pleasantries' of everyday life. Finally, I think many people who might otherwise opt to go to the hospital are likely deferring out of fear of catching the bug. Much of this also applies to doctor offices, urgent care centers, etc.

[Quebramar]

Originally Posted by Exile

Hospitals are now having to make difficult decisions on whether to resume more normal operations (how long can cardiac patients for e.g. wait??) only to potentially become overwhelmed with a second wave of virus patients.

Just spoke with a friend who is on the board of one of the major hospitals here in Brussels. The lack of «*normal*» activity will badly hit the hospitals financially... so the trade-off between health and economy is not only a policy issue, it is getting inside these institutions also.

[Dsanduril]

Originally Posted by Quebramar

Just spoke with a friend who is on the board of one of the major hospitals here in Brussels. The lack of «*normal*» activity will badly hit the hospitals financially... so the trade-off between health and economy is not only a policy issue, it is getting inside these institutions also.

Yes, we are closely connected with Children's Hospital Oakland. Their financial picture has gotten much worse as a result of the lockdown. They are dealing with few COVID cases, and all the "normal" cases with which they would deal are put on hold. They are still treating a near-normal volume of emergency work, but the bread-and-butter "business" is gone, which affects their ability to provide any care. Will be interesting to see how it all shakes out.

[GordMay]

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[DeepFrz]

Originally Posted by Quebramar

I don’t think you need loads of studies to realise that many many people who got infected never made it to the stats, for various reasons: from a lack of symptoms to mild ones, to ignorance, to impossibility to get checked by doctor, to fear to go to the hospital...

Yes, I agree and my post was poorly worded by me. I was referring to some reports saying that there were extremely high rates of infection in the community. This may actually be so, I really don't know. However, many of the reports were based on "studies" that were not at the time peer reviewed and in fact later received poor grades on review, for the reasons outlined in my post and that was discussed in the Med Cram video.

[Dockhead]

Originally Posted by DeepFrz

Yes, I agree and my post was poorly worded by me. I was referring to some reports saying that there were extremely high rates of infection in the community. This may actually be so, I really don't know. However, many of the reports were based on "studies" that were not at the time peer reviewed and in fact later received poor grades on review, for the reasons outlined in my post and that was discussed in the Med Cram video.

Yes, the quality of all of the studies and all of the data is pretty questionable -- understandable since this happened rather suddenly and time for normal processes hasn't gone by yet.


The Royal College study from a month ago which was so enormously influential seems to have been totally wrong about almost everything.


It turns out death statistics by country are so different that some don't even count care home/nursing home deaths, counting only deaths in hospitals -- so obviously undercounting by a factor of 2 or more.


Most countries are testing a fraction of a percentage of their populations, and don't waste tests on the dead. Some count "probable" cases, others count only lab confirmed cases.


It's crazy.


One of the absolutely crucial things to know however is what is the extent of infections in society. We need massive testing to know this; something being rolled out in Denmark (tents for drive in/walk in testing have popped up all over the country today) and Sweden (who will soon have capacity to test 1% of the population per week). Without having some clue about this, you cannot possibly hope to form effective policy. How stupid would a lockdown be, for example, if 50% of the people have already been infected? What chance of eradication does a country have if 10% of the population already have it? What about our building out of temporary hospital beds and ICU wards? Based on statistical prediction of peak cases based on testing which undercounts case by 10x, 20x, even 50x (which implies morbidity is overestimated by 10x, 20x or 50x)? Those empty hospital beds cost money; getting this wrong is destructive. We need testing, better data, better analylsis of this data -- we need to understand the pandemic way better than we do.

[Montanan]

"Sweden is seeing an unsettling rise in coronavirus deaths, as comparatively lax restrictions across the country are coming under scrutiny."

https://www.foxnews.com/world/sweden...ise-guidelines

"The Nordic country had reported 1,540 deaths tied to the coronavirus pandemic, an increase of 29 from Saturday. Last week, the Public Health Agency of Sweden said 1,333 people had died of COVID-19.

Sweden’s figures are considerably more than in the rest of Scandinavia. While its population of over 10 million nearly doubles those of Denmark, Norway and Finland individually, its COVID-19 death toll was up to 17 times higher than those countries, according to reports.

Many people around the world have been getting upset over government-overreach lockdowns brought about by the coronavirus pandemic.

However, so far, Sweden has banned gatherings larger than 50 people, closed high schools and universities, and urged those over 70 or otherwise at greater risk from the virus to self-isolate -- a softer approach than many other countries have taken. Schools for younger children, restaurants and most businesses have remained open, creating the impression that Swedes were living their lives as usual.

Sweden called for its people to take personal responsibility for social-distancing rules instead of ordering lockdowns, AFP reported.

“The authorities and the government stupidly did not believe that the epidemic would reach Sweden at all,” Bo Lundback, a professor of epidemiology at the University of Gothenburg, told the outlet.

Sweden stood out for what Anders Tegnell, the country’s chief epidemiologist and top strategist in the COVID-19 fight, has called a “low-scale” approach that “is much more sustainable” over a longer period.

He insisted that Sweden’s approach still seemed to make sense, though he also acknowledged that the world has been in uncharted territory with the virus."

Whereas I compare the Covid-19 infection rates in my State of Montana, USA whereby the Governor enacted a complete lockdown minutes before the first death in the State on March 26. Our State has about 1/10th the population of Sweden [Montana 1.069,000] but to date has only 433 cases of Covid-19 with 243 recovered and only 10 deaths. Sweden's death rate seems rather extreme in comparison, wondering why the mortality is so drastically high. During the last day, there were NO ADDITIONAL NEW Covid-19 cases confirmed in Montana. The Governor will address a plan of phased easing the restrictions later this week.

A snipet of the Governor of Montana's executive emergency orders is copied below. In addition to this requirements, any and all persons entering the State are required to undergo 14 days self-isolation upon arrival.

All schools kindergarten through University are closed with Distance Learning curriculum deployed so as to keep education continuing. All places of lodging and short-term rentals have been closed with the exception of providing services to essential travelers. And Montana's lengthy northern border is with Canada and the USA / Canadian border has been closed to all but essential travel [e.g., medical and commercial cargo transit].

I. Stay at Home; Social Distancing Requirements; and Essential Businesses and Operations

• 1. Stay at home or place of residence. With exceptions as outlined below, all individuals currently living within the State of Montana are directed to stay at home or at their place of residence to the greatest extent possible, except as allowed in this Directive. As used in this Directive, homes or residences include hotels, motels, shared rental units, shelters, and similar facilities.
Non-essential social and recreational gatherings of individuals outside of a home or place of residence are prohibited, regardless of size, if a distance of at least six feet between individuals cannot be maintained.
All persons may leave their homes or place of residence only for Essential Activities or to operate Essential Businesses and Operations, all as defined below.
Individuals whose residences are unsafe or become unsafe, such as victims of domestic violence, are permitted and urged to leave their home and stay at a safe alternative location.

• 2. Non-essential business and operations to cease. All businesses and operations in the State, except Essential Businesses and Operations as defined below, are required to cease all activities within the State except Minimum Basic Operations, as defined below. Businesses may also
continue operations consisting exclusively of employees or contractors performing activities at their own residences (i.e., working from home).

To the greatest extent feasible, Essential Businesses and Operations shall comply with Social Distancing Requirements as defined in this Directive, including by maintaining six-foot social distancing for both employees and members of the public at all times, including, but not limited to, when any customers are standing in line. Essential Businesses and Operation should also employ, where feasible, telework or other remote working opportunities to limit disease spread.

3. Prohibited activities. All public and private gatherings of any number of people occurring outside a household or living unit are prohibited, except for the limited purposes permitted by this Directive.
The March 24, 2020 Directive that closes certain businesses to ingress, egress, and occupancy by the public, while expanding delivery and to-go options, remains in effect. However, the portions of that order requiring social distancing (Section 1) and social distancing guidelines for retail businesses (Section 3) are superseded by the requirements in this Directive.

• 4. Prohibited and permitted travel. All travel should be limited to Essential Travel and travel for Essential Activities. People riding on public transit must comply with social distancing to the greatest extent feasible. When individuals need to leave their homes or residences, they should at all times maintain social distancing of at least six feet from any person who is not a member of their immediate household, to the greatest extent possible.

• 5. Leaving your home for essential activities is permitted. For purposes of this Directive, individuals may leave their home or residence only to perform any of the following Essential Activities and must ensure a distance of six feet from others not in their household:

For health and safety. To engage in activities or perform tasks essential to their health and safety, or to the health and safety of their family or household members (including, but not limited to, pets), such as, by way of example only and without limitation, seeking emergency services, obtaining medical supplies or medication, or visiting a health care professional.

For necessary supplies and services. To obtain necessary services or supplies for themselves and their family or household members, or to deliver those services or supplies to others, such as, by way of example only and without limitation, groceries and food, household consumer products, supplies they need to work from home, and products necessary to maintain the safety, sanitation, and essential operation of residences.

For outdoor activity. To engage in outdoor activity, provided that individuals comply with social distancing, as defined below, such as, by way of example and without limitation, walking, hiking, running, or biking. Individuals may go to public parks and open outdoor recreation areas, including public lands in Montana provided they remain open to recreation. Montanans are discouraged from outdoor recreation activities that pose enhanced risks of injury or could otherwise stress the ability of local first responders to address the COVID-19 emergency (e.g., backcountry skiing in a manner inconsistent with avalanche recommendations or in closed terrain).

For certain types of work. To perform work providing essential products and services at Essential Businesses or Operations or to otherwise carry out activities specifically permitted in this Directive, including Minimum Basic Operations.

To take care of others. To care for a family member, friend, or pet in another household, and to transport family members, friends, or pets as allowed by this Directive.

[DeepFrz]

Originally Posted by Dockhead

Neither, so I don't assume 100% that I'm immune. I was perhaps the first case in Finland. I had no personal contact with anyone from the day I returned from Asia, several days before I became symptomatic, except with my doctor, so I don't think I was a spreader. Doctor says he is sure that it was COVID, and tested himself (negative). Symptoms were a perfect match, and it was not like the flu in several respects, and it was bad -- worst cough I ever had in my my life, slightly relieved only with narcotic cough syrup.



I will take the antibody test when it's available.

Dockhead, I hope that you have developed immunity and I'm glad it wasn't deadly serious. I also hope you are well recovered.

[Dockhead]

Originally Posted by DeepFrz

Dockhead, I hope that you have developed immunity and I'm glad it wasn't deadly serious. I also hope you are well recovered.

I am definitely well recovered, never felt better! And thank you for your good wishes.

[Dockhead]

Originally Posted by Montanan

. . .

Whereas I compare the Covid-19 infection rates in my State of Montana, USA whereby the Governor enacted a complete lockdown minutes before the first death in the State on March 26. Our State has about 1/10th the population of Sweden [Montana 1.069,000] but to date has only 433 cases of Covid-19 with 243 recovered and only 10 deaths. Sweden's death rate seems rather extreme in comparison, wondering why the mortality is so drastically high. . . .

Drastically high morbidity in Sweden? Maybe from the perspective of Planet Montana, but by world standards, morbidity in Sweden is quite moderate:





And the curve has turned down. 2/3 of ICU beds in Sweden are unoccupied and further loosening is in the works. Sweden is doing great.



Low population density is a definite advantage in this pandemic. So Montana is much blessed, and Sweden, though not so blessed as Montana in this respect, still has a big advantage over most other European countries. And in Montana's case, over New York State. These advantages should not make us smug, either in Sweden, or in Montana.



Also, don't forget the rather plausible theory that this disease is so infectious that sooner or later we will all get it in any case. So these good numbers might just reflect -- both in Montana, and in Sweden -- an early stage in the process of the pandemic, so that eventually we will all have more or less the same results, the same death rates. As the doctor in the linked video suggested.

[letsgetsailing3]

“On a long enough time line, the survival rate for everyone drops to zero."


- Fight Club

[DeepFrz]

Originally Posted by Dockhead

...
Also, don't forget the rather plausible theory that this disease is so infectious that sooner or later we will all get it in any case. So these good numbers might just reflect -- both in Montana, and in Sweden -- an early stage in the process of the pandemic, so that eventually we will all have more or less the same results, the same death rates. As the doctor in the linked video suggested.

Hence the reason to flatten the curve. Left to run its natural course we see by example that it soon overwhelms the health care system. We get far more deaths than if we can slow its progression, flatten the curve and not overwhelm the health system's ability to care for those infected patients that have a chance to survive.

However, by locking down the system the governments must support those who need the help. I think that the protests in the US, for example, are caused by the government not lending financial support to those who are locked down.