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

[Sos]

It has been said by the SAGE group in the UK that we will not know how effective each country's measures were until the excess deaths are known, once the pandemic has died down/gone away.
But then will they all be counted the same?

[GordMay]

There are standard, generally consistent protocols for determining/reporting “Cause of Death”.

“INTERNATIONAL GUIDELINES FOR CERTIFICATION AND CLASSIFICATION (CODING) OF COVID-19 AS CAUSE OF DEATH” ~ WHO (Based on International Statistical Classification of Diseases, April 16, 2020)
➥ https://www.who.int/classifications/...h_COVID-19.pdf

➥ https://apps.who.int/iris/handle/10665/40557

➥ https://www.cruisersforum.com/forums...ml#post3286993

[Dockhead]

Originally Posted by GordMay

There are standard, generally consistent protocols for determining/reporting “Cause of Death”.

“INTERNATIONAL GUIDELINES FOR CERTIFICATION AND CLASSIFICATION (CODING) OF COVID-19 AS CAUSE OF DEATH” ~ WHO (Based on International Statistical Classification of Diseases, April 16, 2020)
➥ https://www.who.int/classifications/...h_COVID-19.pdf

➥ https://apps.who.int/iris/handle/10665/40557

➥ https://www.cruisersforum.com/forums...ml#post3286993

If countries are following that, then this is very good. My information may be out of date.

[GordMay]

Originally Posted by Dockhead

If countries are following that, then this is very good. My information may be out of date.

At least in North America, we are.


“Instructions for Completing the Cause-of-Death Section of the Death Certificate” ~ USCDC
➥ https://www.cdc.gov/nchs/data/dvs/blue_form.pdf
“
“Physicians' Handbook on Medical Certification of Death” ~ CDC
➥ https://www.cdc.gov/nchs/data/misc/hb_cod.pdf

“Handbook on Medical Certification of Death” ~ Ontario, Canada
➥ https://www.publications.gov.on.ca/s...les/016600.pdf

[Dockhead]

Originally Posted by Sos

It has been said by the SAGE group in the UK that we will not know how effective each country's measures were until the excess deaths are known, once the pandemic has died down/gone away.
But then will they all be counted the same?

Excess deaths over some period are the preferred way to get the "big picture" of the pandemic, for a few reasons:

1. It washes out the categorization problem

2. It washes out deaths of people who would have died anyway this year.

One disadvantage of using excess deaths is that there is no distinction between pandemic deaths and deaths caused by pandemic measures. But as long as your main purpose is [EDIT: NOT] trying to drill into that distinction, then excess mortality is the way to go.

What you generally see is that:

1. Less developed countries are under-reporting pandemic deaths

2. Better developed countries (especially, countries with good health care systems) are over-reporting pandemic deaths, because a bigger share of reported pandemic deaths, or even a majority of them, are people who would have died this year anyway.

[Seaworthy Lass]

Originally Posted by Dockhead

Excess deaths over some period are the preferred way to get the "big picture" of the pandemic, for a few reasons:


1. It washes out the categorization problem


2. It washes out deaths of people who would have died anyway this year.


One disadvantage of using excess deaths is that there is no distinction between pandemic deaths and deaths caused by pandemic measures. But as long as your main purpose is trying to drill into that distinction, then excess mortality is the way to go.


What you generally see is that:


1. Less developed countries are under-reporting pandemic deaths


2. Better developed countries (especially, countries with good health care systems) are over-reporting pandemic deaths, because a bigger share of reported pandemic deaths, or even a majority of them, are people who would have died this year anyway.

The lack of good data both for numbers infected and particularly the death rate has severely hindered management of this pandemic, especially in the early days.

I think that the number for excess deaths is about as good an estimate as we will ultimately get for the death toll, although for many underdeveloped nations accurate figures are apparently not available to allow a good comparison to previous years.

Apart from under reporting, I wonder if another factor that is contributing to the apparently low number of deaths in some poorer countries is the lower median age in these countries? In numerous African countries this is under the age of 20.

SWL

[Dockhead]

Originally Posted by Seaworthy Lass

The lack of good data both for numbers infected and particularly the death rate has severely hindered management of this pandemic, especially in the early days.

Indeed -- SEVERELY. With no idea of the IFR, much less IFR by age, and no idea how many people were being infected, the world was flying totally blind. It was mostly guesswork in the early day.

Originally Posted by Seaworthy Lass

I think that the number for excess deaths is about as good an estimate as we will ultimately get for the death toll, although for many underdeveloped nations accurate figures are apparently not available to allow a good comparison to previous years.

Apart from under reporting, I wonder if another factor that is contributing to the apparently low number of deaths in some poorer countries is the lower median age in these countries? In numerous African countries this is under the age of 20.

SWL

I think you're right; plus those countries have far less mobility and far less internal travel, so inherently less spreading.

[Seaworthy Lass]

Originally Posted by Dockhead

Indeed -- SEVERELY. With no idea of the IFR, much less IFR by age, and no idea how many people were being infected, the world was flying totally blind. It was mostly guesswork in the early day.


I think you're right; plus those countries have far less mobility and far less internal travel, so inherently less spreading.

I remember data from China in January indicated the CFR was around 4%. It has since been estimated that the IFR is likely to be only less than 10% of this. Largely because of the high number of cases who are asymptomatic or little affected, and the erratic testing, almost a year from the time first cases were reported in China we still don’t have a decent grip on the IFR.

Although judging figures seems to have largely been a guessing game, it has been clear since the very beginning of the year that the most vulnerable are the elderly. The early reports from China were spot on regarding this. The lack of decent direct measures to protect or offer help to this group, meanwhile closing businesses and issuing stay at home orders (policed) to those whose risk of severe illness is negligible, and the willingness of so many people to readily accept this has for me been unexpected (and scary).

I have found the whole issue of freedom to make personal choices vs having severe restrictions imposed to help protect a small percentage of the population in the short term, meanwhile without doubt causing more extensive problems in the long term, a difficult one to grapple with.

SWL

PS It is snowing here! The deck and surrounds look like a Christmas card. Aussies get very excited seeing snow .

[goboatingnow]

Originally Posted by Seaworthy Lass

I have found the whole issue of freedom to make personal choices vs having severe restrictions imposed to help protect a small percentage of the population in the short term, meanwhile without doubt causing more extensive problems in the long term, a difficult one to grapple with.



SWL



... Aussies get very excited seeing snow .

I think I’m fairness everyone has grappled with that. But most people have accepted the community good that protecting the vulnerable was a good thing

Ireland lost 2000 eldery patients in care homes , to Covid , in the first wave , largely to not appreciating the effect of displacing such people from trauma hospitals to care homes to free up beds. This inflected care homes.

It represents nearly 80% of our deaths under Covid

My view is Italy scared everyone sh#tless, certainly in Europe.

As a result the focus has been overly on hospital resources. Yet nobody repeated the Italy experience ( you could say NY came close )

I’m of the view the lockdowns are over done and like you rail against movement controls , even though here it was easy enough to get around as the police have no enforcement rights for most of the Covid restrictions ( the police asked not to given them !!)

What’s surprising is lockdowns have enjoyed 70% support amongst the population. !!! The major criticism being we didn’t restrict travel in or out of the country ( constitutionally difficult to do here ) we even had US tourists here in the summer.

Anyway it’s look like it will be coming to and end by Q1 2021 and we’ll be “ reminiscing “ about the weird year 2020 was

I hope humanity will learn things , like minding the planet better etc. But I fear it will fall on deaf ears.

[Dockhead]

Originally Posted by Seaworthy Lass

I remember data from China in January indicated the CFR was around 4%. It has since been estimated that the IFR is likely to be only less than 10% of this. Largely because of the high number of cases who are asymptomatic or little affected, and the erratic testing, almost a year from the time first cases were reported in China we still don’t have a decent grip on the IFR.

Although judging figures seems to have largely been a guessing game, it has been clear since the very beginning of the year that the most vulnerable are the elderly. The early reports from China were spot on regarding this. The lack of decent direct measures to protect or offer help to this group, meanwhile closing businesses and issuing stay at home orders (policed) to those whose risk of severe illness is negligible, and the willingness of so many people to readily accept this has for me been unexpected (and scary).

I have found the whole issue of freedom to make personal choices vs having severe restrictions imposed to help protect a small percentage of the population in the short term, meanwhile without doubt causing more extensive problems in the long term, a difficult one to grapple with.
.

There is some new science on IFR by age, from the American Council on Science and Health:



https://www.acsh.org/news/2020/11/18...-and-age-15163

Previously the CDC had published similar numbers.

This indicates that IFR is something less than 1% for age group 60-64, and falls sharply from there below 60. And rises sharply from there. So COVID is really extremely dangerous for old people and not really dangerous at all for younger people. Mikka Salminen, the head of the health authority in Finland, has said that COVID is approximately equally dangerous as the flu for people under 60, a proposition which was ridiculed in another thread, but based on these numbers looks approximately correct.

That is the idea behind the Great Barrington Recommendation to protect old people and other risk groups and let everyone else live like normal.

The eminent epidemiologists who wrote the Great Barrington Declaration might be right, and certainly this view at least deserves respect, but based on my own reading and thinking it seems to me that it's not really possible to protect risk groups if the virus is raging unchecked in the rest of the population.

I think I agree with Anders Tegnell, who said:

"[S]triving for herd immunity is neither ethical nor otherwise justifiable. . . there has been no infectious disease in history in which herd immunity has completely stopped the transmission without a vaccination beforehand. And that won't happen with COVID-19 either . . . Even if younger people have less severe disease and die less often, it can still happen. Accepting that is not good from a public health perspective . . . " https://www.msn.com/en-us/health/med...nt/ar-BB1ay6wZ

At the other extreme, however, the "just freak out and shut down the entire country with restrictions carrying the force of criminal law" also seems questionable to me, something better calculated to exploit panic and win points for politicians than actually protect public health. So I'm with you on that one.

Therefore the moderate Nordic approach, as devised by Tegnell and Salminen and other Nordic health chiefs and their teams, which takes into consideration all aspects of public health, and not just pandemic deaths, and which relies almost entirely on voluntary behavior and the good sense of the population, has always seemed better to me, and now more and more as it seems like it works well enough, certainly not less effective than lockdowns, with much less infringement of civil rights and less collateral damage.

But I think it's still early to draw final conclusions. As I've written, we are waiting for an explosion of cases in Finland right now, and it could go either way in the rest of the Nordic & Baltic region, as of today. Sweden has broken 500 daily cases per million and the death rate has increased to almost 6, still below the European average but 6x higher than it was a month ago. Lithuania is off the charts in infections. Latvia has broken 300. We don't know what the next month will bring.

[Wotname]

Originally Posted by Seaworthy Lass

..........
PS It is snowing here! The deck and surrounds look like a Christmas card. Aussies get very excited seeing snow .

It has been snowing here too (in the highlands) but we are not so excited being as it is only day 2 of summer!

At least there is no Covid19 (ATM) and handshakes, hugs and cheek kissing are common place.

Economy is doing OK as well if you believe the guvmit people.

[Dockhead]

Here is some more really interesting new science:

https://europepmc.org/article/MED/33171481

A massive study of mobility patterns with infections overlaid, to attempt to understand WHERE people get infected. The gist:

"Our model predicts that a small minority of "superspreader" POIs account for a large majority of infections and that restricting maximum occupancy at each POI is more effective than uniformly reducing mobility."

Which is a powerful confirmation for the Nordic tactic of limiting occupancy rather than closing most kinds of establishments. "Uniformly reducing mobility" is, of course, lockdown.


As I write this, restaurants, for example, are open everywhere in the Nordic countries, but with limitations on occupancy (some % of max) or distance between tables, and in some countries, table service only restrictions. Unfortunately I am in Latvia today, where restaurants have been closed for almost two weeks

[Seaworthy Lass]

Originally Posted by Wotname

It has been snowing here too (in the highlands) but we are not so excited being as it is only day 2 of summer!

At least there is no Covid19 (ATM) and handshakes, hugs and cheek kissing are common place.

Economy is doing OK as well if you believe the guvmit people.

We woke up to a snow covered tent one Boxing day camping by a stream at the southern end of Lake St Clair (Tasmania, not Ontario ). It was 30+°C a week later.

Everyone has kept well apart in the isolated spots we have anchored in Scotland since we were free to move this summer, even in our current location, despite zero cases so far for the entire peninsula. Walking on forest trails people I have encountered have moved so that we keep several metres apart. Comfort levels for “personal space” have extended dramatically. I have forgotten what it is like to shake hands with or hug acquaintances. None of that for me since February .

SWL

[Dockhead]

Originally Posted by goboatingnow

. . . What’s surprising is lockdowns have enjoyed 70% support amongst the population. !!! The major criticism being we didn’t restrict travel in or out of the country ( constitutionally difficult to do here ) we even had US tourists here in the summer. . .

My guess is that this is down to human psychology. Fear makes a certain number of people crave the strong hand of a strong state, and to see other people getting punished for not falling into line. And so "bold" measures, whether or not they are actually beneficial, are seductive to politicians; whereas nuanced measures which may be more beneficial can be harder to sell.

[Seaworthy Lass]

Originally Posted by goboatingnow

I think I’m fairness everyone has grappled with that. But most people have accepted the community good that protecting the vulnerable was a good thing

Ireland lost 2000 eldery patients in care homes , to Covid , in the first wave , largely to not appreciating the effect of displacing such people from trauma hospitals to care homes to free up beds. This inflected care homes.

It represents nearly 80% of our deaths under Covid

My view is Italy scared everyone sh#tless, certainly in Europe.

As a result the focus has been overly on hospital resources. Yet nobody repeated the Italy experience ( you could say NY came close )

I’m of the view the lockdowns are over done and like you rail against movement controls , even though here it was easy enough to get around as the police have no enforcement rights for most of the Covid restrictions ( the police asked not to given them !!)

What’s surprising is lockdowns have enjoyed 70% support amongst the population. !!! The major criticism being we didn’t restrict travel in or out of the country ( constitutionally difficult to do here ) we even had US tourists here in the summer.

Anyway it’s look like it will be coming to and end by Q1 2021 and we’ll be “ reminiscing “ about the weird year 2020 was

I hope humanity will learn things , like minding the planet better etc. But I fear it will fall on deaf ears.

Hi Goboatingnow
Good to see you on CF again. You have been missed.

Given we had accurate data from China that mainly the elderly were severely affected by COVID-19, we did a pathetic job worldwide with protecting those in care.

The situation in Australia is similar to Ireland in that the vast majority of deaths have been in nursing homes. Australia even had the advantage of seeing what had occurred in Europe several months prior to the spike in Victorian cases that occurred in July/August, yet they were totally unprepared and mismanaged it badly. With very low overall numbers of cases, hospital beds (including intensive care beds) were never even close to being filled to capacity, yet initially ambulances with severely ill patients from nursing homes were turned away, to be returned to their care home.

We have first hand experience with a family member in a private, high end nursing home and infected cases were kept in the home, simply to infect others. In some homes in Victoria with staff being infected and kept away, residents were found absolutely appalling conditions due to lack of any care before being removed and the homes shut done. It was a heartbreaking situation.

This comment was made by head of the Health Law and Ageing Research Unit at Monash University (Melbourne, Victoria, Australia) and an expert witness at Australia's Royal Commission into Aged Care Quality and Safety:

“Homer Simpson could have seen the catastrophe in aged care coming with COVID-19 because it was there in your face”.

https://www.thelancet.com/journals/l...206-6/fulltext

From country to country statistics are all over the place regarding the number of deaths amongst aged care residents as a % of all COVID-19 deaths, but at a quick glance it appears that at least 50% may be the overall figure in developed countries. It is certainly the case in Sweden (I looked up the exact figure in an attempt to keep this thread on topic ).

I keep hearing comments that it is not possible to protect the vulnerable, but a hell of a lot more could have been done in nursing homes. They could be an enclosed environment and the easiest of all to protect if money is just thrown at handling the situation. I think it would have been far less costly than most of the measures enforced.

SWL

Originally Posted by Dockhead

.....based on my own reading and thinking it seems to me that it's not really possible to protect risk groups if the virus is raging unchecked in the rest of the population.

It has been repeatedly said that is not all or nothing. Some very sensible CF members have kept repeating this . You do not have to leave the virus raging unchecked to protect those in care homes (and these people make up a huge chunk of the vulnerable). The rest of them could have been given far better support had they chosen to take measures to protect themselves. This would have avoided far less severe measures such as shutting down businesses and confining healthy populations to their homes (in the case of South Australia recently, not even being permitted out to exercise).

With second waves occurring throughout Europe, we have a far better understanding of this pandemic than we did in March, yet recent measures are are not dissimilar to those used in the first wave. I wonder how much of this is politically driven? As you have suggested, I think bold measures, “whether or not they are actually beneficial, are seductive to politicians”. Engendering fear in the population makes these measures easier to apply.

SWL