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

[Exile]

Originally Posted by goboatingnow

Some of The worst performers in the class


But interesting that the US look is like it “ gave up “

But still the US absolute cumulative death number is a spectacular indictment on a wealthy firs5 world country.

BY comparison some counties with very meagre resources did quite well.

So would you also conclude that people in the UK, Italy and France have also "given up?" Your comment is quite disrespectful to millions of people in the US, along with their state govts who have primary responsibility, who have been making sacrifices and otherwise doubling down on their precautionary measures in the midst of this surge/second wave. Meanwhile, the first round of vaccines are reportedly headed first to nursing home patients and staff as early as next week. The US has been instrumental in helping to get the world a vaccine in what is apparently record time.

Many of the deficiencies in the US response at many levels are well known and beyond serious dispute. As has been pointed out, a country's first world status and wealth does not necessarily point to greater success fighting a pandemic due to, among other things, their citizens' greater mobility. Without diminishing obvious shortcomings on the part of the US, the only "spectacular indictment" I'm seeing from your many posts in this and other related threads is a high degree of political bias. How about we try and put that aside when discussing how different nations and regions are struggling to combat this crisis?

[Dockhead]

Originally Posted by goboatingnow

Some of The worst performers in the class

But interesting that the US look is like it “ gave up “

But still the US absolute cumulative death number is a spectacular indictment on a wealthy firs5 world country.

BY comparison some counties with very meagre resources did quite well.

Outcomes are not a direct function of "performance" and can't be equated with performance. This is a very complex phenomenon where many factors are at play. Do you really think that India or Ghana "performed" better than Switzerland? Or that Bulgaria is "performing" better than France?

And how in the world do you see in the data, that the U.S. "just gave up"?

[Dockhead]

Things are bad in Northern Europe today:



No sign of our delayed second wave abating. Lithuania still awful at over 900 daily cases per million. Sweden knocking on 600. And really bad news -- big outbreak in Denmark, rising rapidly from 450. Latvia and Estonia at just under 350 -- that's not such a low rate, but at least not rising quickly so far.

As to deaths:



No longer the good picture of a few weeks ago. Still not all that bad -- only Lithuania has a higher death rate than the European average -- but it's not good. Germany going up inexorably and now over 5. Latvia over 5.

There are new measures in many countries: Germany, Denmark and Sweden are closing some schools. Germany was much praised for getting its schools reopened quickly in the spring: https://www.npr.org/2020/12/08/94433...g-the-pandemic. The Danish health chief has spoken at length about the grievous harm that school closures cause, and indeed Danish schools were reopened already on 17 April, after just a few weeks of closure. But the pandemic situation now is so bad that these countries now that this grievous harm apparently seems worth incurring.

Even Finland, which by the numbers seems to have avoided the second wave altogether so far, seems to be "balanced on a knife's edge", as the Finnish health chief put it. There are alarming outbreaks in Finnish nursing homes, and a surge in hospitalization. https://www.helsinkitimes.fi/finland...-official.html.

It's going to be a grim Christmas season.

[Dockhead]

The situation today:



The Second Wave continues to batter the seawalls of Northern Europe. It hit us with a month or so delay compared to the rest of Europe.

Lithuania is having the worst of it. With over 1000 daily cases per million (7 day rolling average), this looks like the hardest hit European countries of last month -- Czech Republic, Belgium, etc. God help them. Why Lithuania, and not neighboring Latvia? No one knows; probably some random superspreader events.

Sweden continues to be very bad at 619, but thank God the curve isn't all that steep. Perhaps the more rigorous recommendations of a couple of weeks ago are starting to have some effect. The prediction is that the infection rates will peak around Christmas -- I hope so.

What is really terrifying is Denmark. Over 550 now, but look at the shape of that curve! That's even steeper than Lithuania. I really hope they can manage to get that under control. Some of my best friends are living there, and my boat is in Denmark!

Latvia, Estonia, Germany clustered around 300 daily cases per million -- not a very good situation. Latvia has already ordered shops closed during weekends; restaurants have been closed for a weeks already. They are weighing very severe new measures. Germany is likewise ratcheting up the measures as they try to get this under control -- this is the worst by far that has been experienced in Germany; they got through the first wave rather unscathed.

Finland and Norway continue to ride it out, relatively untouched.

What concerns deaths:



Death rates reliably lag infection rates. They are still notably less than during the First Wave, but there is nothing to be happy about here. Germany, Sweden, and Latvia all around 7 daily deaths per million. Note that the overall death rate in Europe has turned back upwards -- no doubt driven by the Northern European second wave.

It's shaping up to be an awfully grim Christmas.

Not Northern Europe, but it is notable that another European country which had a delayed second wave is Switzerland. This is a country which resembles the Nordic countries in many ways -- very wealthy, superb health care, small homogenous population, broad civil liberties, uncrowded lifestyle. They are having an awful time -- death rate now over 11, even more than Lithuania.

[goboatingnow]

Switzerland is a relatively densely populated country. Up there with the U.K. and Germany , > 200 P /km2 compared day to Finland at 8 P/km2 etc. It’s also urban centric at 86% similar to Finland unlike say Ireland at 38 P/km2 but much better spatial diversity at 63% .

Ie Switzerland is a population largely clustered together which undoubtably aids the spread of the virus, whereas Finland has similar clustering but 3 million people

It’s interesting to note that both Ireland and Finland have being doing well with similar population figures.

( mind you since the Christmas opening up , daily cases are up here to 400 , a day , public health is getting nervous. ) undoubtably a January travel restriction will be advised

[Dockhead]

Originally Posted by goboatingnow

Switzerland is a relatively densely populated country. Up there with the U.K. and Germany , > 200 P /km2 compared day to Finland at 8 P/km2 etc. It’s also urban centric at 86% similar to Finland unlike say Ireland at 38 P/km2 but much better spatial diversity at 63% .

Ie Switzerland is a population largely clustered together which undoubtably aids the spread of the virus, whereas Finland has similar clustering but 3 million people

It’s interesting to note that both Ireland and Finland have being doing well with similar population figures.

( mind you since the Christmas opening up , daily cases are up here to 400 , a day , public health is getting nervous. ) undoubtably a January travel restriction will be advised

I think that population density per se is pretty much irrelevant to how the pandemic spreads. I'm not sure even urbanization is all that relevant -- look at how horribly hard the very rural and thinly populated States of the Upper West in the U.S. have done -- Montana, North Dakota, etc., with infection and death rates worse than anything seen in Europe.

My guess is that much more important is patterns of social life, and how people live. Living in apartment blocks with elevators has got to make a big difference, as does living in crowded dwellings with a lot of people per m2. So wealthy countries with a lot of single person households, more solitary lifestyles, and a lot of m2 of residential space per capita have got to have an advantage over countries like in Southern Europe where you still have a lot of multigenerational and otherwise large households and were people spend more time in the company of others.


The Finns have a wry joke about this: "We've been social distancing for 1000 years".

[Seaworthy Lass]

Hi Dockhead
Have you left Scotland out of your detailed discussions for any reason?

It has a similar or higher latitude compared to Denmark, Lithuania and Latvia, most of the country overlaps with Estonia and Sweden, and northern regions overlap with Norway and even slightly with Finland.

Populations are not dissimilar (figures from 2019):

Sweden 10.2 million
Denmark 5.8 million
Finland 5.5 million
Scotland 5.4 million
Norway 5.3 million
Lithuania 2.8 million
Latvia 1.9 million
Estonia 1.3 million

Restrictions in Scotland have been made almost independently from those in England. Even the tiers of restrictions are different. The country was closed off to the rest of the UK for several months during the first wave in spring.

Just curious .

[Dockhead]

Originally Posted by Seaworthy Lass

Hi Dockhead
Have you left Scotland out of your detailed discussions for any reason?

It has a similar or higher latitude compared to Denmark, Lithuania and Latvia, most of the country overlaps with Estonia and Sweden, and northern regions overlap with Norway and even slightly with Finland.

Populations are not dissimilar (figures from 2019):

Sweden 10.2 million
Denmark 5.8 million
Finland 5.5 million
Scotland 5.4 million
Norway 5.3 million
Lithuania 2.8 million
Latvia 1.9 million
Estonia 1.3 million

Restrictions in Scotland have been made almost independently from those in England. Even the tiers of restrictions are different. The country was closed off to the rest of the UK for several months during the first wave in spring.

Just curious .

Hi! Yes, Scotland is in some ways kind of a Nordic country. I haven't paid that much attention to it since stastics separate from the rest of the UK are not available on the resources I use. According to NHS Scotland, there have been 4 203 deaths to date, which is 778 per million, about the same as Sweden. According to other sources, though, there are over 5 000 deaths.

What has it been like there this autumn?

[Dockhead]

Not about the pandemic, but relevant to cruising in the Baltic Sea, some really interesting historical/cultural background to the Eastern Baltic:

https://qr.ae/pNZqYd

The Eastern Baltic Sea region, a wonderful cruising ground, was formed in the interface between different peoples and empires -- Swedes, Finno-Ugric peoples (Finns, Estonians and Ingrians), Slavs (Russians), Germans, and Balts (Latvians and Lithuanians), and the mighty empires of the Swedes, Russians, and Germans. The main political dynamic was the dominance of the Swedish Empire gradually giving way to the rising Russian Empire through the time of Catherine the Great, finally culminating in a big defeat of Sweden at the beginning of the 19th century which fixed Russia's dominance of the region until the Russian Empire fell apart in 1917.



Whereupon Finland managed to gain her independence under the leadership of an exceptionally gifted Russian army officer of German descent, and favorite of Nikolai II, Mannerheim, the father of the Finnish nation, who led the country again in the 30's and 40's and successfully fought off another attempt to reincorporate Finland into the USSR by force. Whereas the Baltic States were not so lucky, and after a few decades of independence between the wars, were then reincorporated into the USSR by force, where they stayed until 1991.


We think of Finland as a "Nordic" country, but Finland is indeed not a Scandinavian country, and in fact is arguably closer historically to the Baltic States of Estonia, Latvia and Lithuania, sharing a very similar history. One of the points of this very interesting Quora article.

[Seaworthy Lass]

Originally Posted by Dockhead

Hi! Yes, Scotland is in some ways kind of a Nordic country. I haven't paid that much attention to it since stastics separate from the rest of the UK are not available on the resources I use. According to NHS Scotland, there have been 4 203 deaths to date, which is 778 per million, about the same as Sweden. According to other sources, though, there are over 5 000 deaths.

What has it been like there this autumn?

The second wave in autumn has been dramatically less than the first in spring if the deaths and excess deaths are anything to go by. Number of detected cases compared to the first wave is impossible to judge, as so very little testing was done initially.

Up until recently when a “tier” system of regulations applying to each distinct Scottish region was introduced, restrictions were significantly more severe in Scotland compared to England. The UK government website is careful to point out that information listed applies only to England.

The tension between Nicola Sturgeon and Boris Johnston regarding the discrepancy in regulations has been palpable (this pandemic followed hot on the heels of Boris’s refusal of a new Scottish referendum for independence).
Nicola’s handling of the pandemic, has been calm, steady and “open” without false optimism (very much like Jacinda Ardern’s in NZ) and she has been largely respected by the nation for this.

We were anchored off a small town (population around 10,000) during the spring lockdown. Detected cases then were very low and deaths zero from COVID-19. Unless classed as “essential” workers (and this was a very limited number of people) no one could travel further than 5 km from home until the 3rd of July. A date that won’t soon be forgotten .

I have only experienced remote communities in Scotland since July, with case numbers zero, however, these have tended to be communities/islands with a high percentage of older residents so everyone has been super careful to protect those around them. People tend keep well apart, even when passing outdoors. Numbers in shops are strictly limited. Some shops even have different hours for residents so they can avoid contact with newcomers entirely if they wish. Hand wash and masks are used very routinely now. Some small local hotels are even refusing rooms to essential workers visiting from higher “tiers”. Amongst this older population I have sensed resignation, rather than frustration with the restrictions.

We are in a Tier 1 zone, but even this has been further restricted to prohibit any socialising indoors in private residences. Restrictions will be relaxed for 5 days over Christmas (together with the rest of the UK). I think they figured people would meet with families anyway after an especially tough year, but this move has been criticised.

These measures have clearly been working so far in many small communities, despite the influx of tourists this past summer.

Numbers are difficult to compare between countries in the UK, as each country is doing its own thing with how numbers are recorded, but on the 13th December in Scotland there were 4173 deaths with a positive test (765 per million population) and 6092 cases were COVID-19 is mentioned on the death certificate even if the person has not been tested (1117 per million population). What criteria is Sweden using for deaths counted from COVID-19?

Between 12th March and early December there have been 6389 excess deaths above the 5 year average. These have been dramatically lower in the second wave.

Graph below showing deaths this year is from this Scottish government website. The pale blue shaded area shows excess deaths.

https://data.gov.scot/coronavirus-covid-19/detail.html

I do not know how figures for each country are being combined as one for the UK. It underscores how hard it is to comparing stats to other countries worldwide. Regarding detected cases, rough trends up or down is I think all we can compare. Even within each country this depends on numbers being tested and how many of these are repeat measurements. These figures are not static and they affect the significance of trends seen.

I haven’t provided a mass of links, as these are easy to Google.

Large chunks of the coast of Scotland and outlying islands were in Viking hands for centuries, so apart from the high latitude and being part of Europe, it is another good reason to include Scotland in discussions of “Northern Europe” .

SWL

[flightlead404]

Originally Posted by skipmac

For the richest country in the world with an excellent health care system (I cannot call it the best) to have a death rate like this is almost incomprehensible.

I can't really comment on "the richest" but the US does not have "an excellent health care system".

Americans tend to use superlatives when describing themselves or their country. The most free, the most powerful, the biggest this, or the best that.

When you actually look at objective measurements of e.g. "freedom" or in this case measurements of health care quality you find the US isn't what its proponents claim.

Objective measurements of the quality of health care in the US put it at the bottom of the list of 1st world developed countries.

For example, the only 1st world developed country with a higher infant mortality rate is Romania.

[Seaworthy Lass]

I know that looking at excess deaths does not tell the whole tale, but I think it is the best indication we have at the moment of the impact of COVID-19.

For the 26 countries listed, this website:
https://www.euromomo.eu/graphs-and-maps
displays either graphically or by video:

- Pooled number of grand total of deaths by age group. The autumn spike this year has subsided overall and for every age group (unless this is just due to a lag in reporting despite attempting to correct for this).
- Excess mortality (can pick weekly or cumulative data)
- Map of z-scores (video)
- Z-scores by country

An explanation of the Z-score can be found here:
https://www.euromomo.eu/how-it-works/what-is-a-z-score/

I have bolded the countries where the weekly z-score was worse this autumn than this spring (some very minor, some marked). Unfortunately, Latvia and Lithuania were not included in the data, but none of the northern European countries that were examined (including Sweden) were worse in autumn.
Italy and Belgium are about the only countries with high z-scores in both spring and autumn:

COUNTRIES COVERED:
Austria
Belgium
Cyprus
Denmark
Estonia
Finland
France
Germany (Berlin)
Germany (Hesse)
Greece
Hungary
Ireland
Italy
Luxembourg
Malta
Netherlands
Norway
Portugal
Slovenia
Spain
Sweden
Switzerland
UK (England)
UK (Northern Ireland)
UK (Scotland)
UK (Wales)

[Seaworthy Lass]

No discussion on this data?

I find it fascinating and I have been mulling over the figures. There is a mass of interesting information there that I have been trying to make sense of. Split by age, I found the excess mortality for ages 45-64 worse than I thought it was.

In the 26 European countries included, if the unusual data this year is mainly due to COVID-19, then in total it is apparent the second wave in autumn is much milder than the first wave in spring, and unless the lag in numbers reported is skewing the curve dramatically (and unless less people are dying of other causes), then the second wave has already subsided significantly.

The following graph shows weekly excess deaths (deviation in mortality from the expected level) in the data-providing EuroMOMO partner countries for the past 3 years, all ages:

[Dockhead]

Well, this tracks exactly the excess mortality graphs in the Financial Times. I don't know if people have been watching that; I have. It's behind a paywall so I haven't been linking those graphs.

We HAVE discussed excess mortality. One huge advantage of looking at excess mortality over some period of time, rather than simple death numbers, is that you wash out the deaths which are just moved around by a few months or weeks or days, which is a very large part of pandemic deaths in many countries because of the very skewed age-specific IFR of this disease, which is so different from, say the Spanish Flu.

One really interesting thing these data show are that countries with outbreaks bad enough to compromise hospitals functioning, have much more excess mortality relative to the official death rates, than those which did not. At least that's a pattern I think I see. So for example Sweden, although is moderately bad in terms of accumulated deaths per million (about 19% above the European average so far), is well below average in terms of excess mortality, year to date (actually looking like a not much worse than a bad flu year already), whereas Italy, France and Spain are far above average in terms of excess mortality. Sweden, following its longstanding pandemic plan, was able to double available ICU beds in about six weeks in the spring, and was never overwhelmed, whereas the other mentioned countries had overwhelmed hospital capacity and severe triage.

That makes sense to me -- if you let hospitals get overwhelmed, you start killing proportionately more people who would otherwise have recovered, with hospitals functioning well, not that many people die who wouldn't have died this year anyway.

One implication of this (if it's true) is that the initial pandemic planning was correct -- focus on protecting hospitals.

[Seaworthy Lass]

Given recent discussions on numbers rising worryingly in Denmark in particular, but also in Sweden and Estonia, I thought those graphs of Z-scores would spark some interest. I included Switzerland and England as a comparison, simply because they followed Sweden alphabetically.

I know increase in deaths lags an increase in cases by a few weeks, but Denmark, Estonia, Finland and Norway have barely been out of the “normal” range for excess deaths all year (and Sweden has barely, barely bumped out of it since early summer).