Investigating Sweden's coronavirus response

by George J. Dance

Lockdown advocates hate Sweden, for good reason. Back in March, Europe (not to mention the rest of the world) seemed to face a choice between mass lockdown or mass death. Only Sweden and Britain resisted the pressure to confine their societies and shut down their economies (and British resistance crumbled in two weeks). Immediately Sweden was condemned for its risky "experiment" with its citizens' lives. (Never mind that nation-wide lockdown was actually the novel, untried experiment.)

Predictions were dire. Neil Ferguson of Imperial College estimated that 80,000 Swedes would die – and that was before the forecast collapse of the country's health care system (which was the real fear driving the lockdowns). Modellers who looked at the latter scenario found even more deaths, as in this study's summary:

Our model for Sweden shows that, under conservative epidemiological parameter estimates, the current Swedish public-health strategy will result in a peak intensive-care load in May that exceeds pre-pandemic capacity by over 40-fold, with a median mortality of 96,000 (95% CI 52,000 to 183,000). 

Now it is July, and there have not been 96,000 deaths in Sweden – or 80,000 – or even the low-ball estimate of 52,000. There have been 5,400, in a population of 10 million. For comparison, Quebec has 5,500 COVID-19 deaths in a slightly smaller population (8.5 million). Nor, as the historical chart makes clear, is the country on track to reach 52,000 deaths anytime soon:

COVID-19 deaths in Sweden, 11/3/20 - 29/7/20 - courtesy statista.com

The mass death never happened. Yet that has not stopped the pro-lockdown media from pretending it has, giving us lurid stories of Sweden's "shocking death toll," "the highest number of COVID-19 deaths per capita in Europe," even "one of the highest per-capita rates of coronavirus death in the world." And the false narrative continues: In its latest iteration, even the Swedes have recognized the danger of letting people work, shop, and visit friends. This week, Business Insider reported:

Sweden's prime minister orders an inquiry into the failure of the country's no-lockdown coronavirus strategy

• Sweden has launched an inquiry into its no-lockdown policy after thousands of coronavirus deaths in the country. 
• Sweden now has the fifth-highest per capita death rate in the world with a larger death toll than all of its neighbours' combined....

Sweden's prime minister has ordered an inquiry into the country's decision not to impose a coronavirus lockdown after the country suffered thousands more deaths than its closest neighbours.
"We have thousands of dead," Swedish prime minister Stefan Lofven said at a press conference on Wednesday, while admitting that the country's handling had exposed Sweden's "shortcomings," The Times of London reported.
"Now the question is how Sweden should change, not if." (stress added)

Notice that, despite the word's prominence in the article, Lofven never uses the word "lockdown". There is a reason why; however you have to read to the end of the article to discover it:

The inquiry announced by Lofven will first consider why approximately half of Sweden's deaths have taken place in its care homes, The Times of London reported.
"We did not manage to protect the most vulnerable, the elderly, despite our best intentions," the prime minister said.

Precisely: Just like in Quebec (and Ontario, and many U.S. states), Sweden's policy failed to protect the vulnerable elderly in nursing and long-term-care homes. That failure was a tragedy and a scandal, but it cannot have been caused by the country's "no-lockdown policy," since the same failure occurred in multiple jurisdictions that did lock down.

That tragedy and scandal should be investigated, in Sweden and in those other jurisdictions; not to assign blame, but to figure out how to prevent such a tthing from ever happening again.  If the lockdown advocates are interested in helping in that goal, their assistance is welcome. But if they are only interested in propagandizing for their new pet social engineering scheme, thanks but no thanks.

80% of Canadian COVID deaths at nursing homes

Canada’s proportion of coronavirus deaths in nursing homes top 16 other nations: study | Global News - Cassandra Szklarski, Canadian Press:
June 25, 2020 - "A new study finds the proportion of Canadian COVID-19 deaths that have occurred in long-term care facilities is about twice the average of rates from other developed nations. The analysis released Thursday by the Canadian Institute for Health Information provides a damning snapshot of senior care as of May 25, when LTC residents made up 81 per cent of all reported COVID-19 deaths in the country compared to an average of 42 per cent among all countries studied....

"The CIHI data compares Canada’s record to that of 16 other countries in the Organisation for Economic Co-operation and Development. The proportion of LTC deaths ranged from less than 10 per cent in Slovenia and Hungary to 31 per cent in the United States to 66 per cent in Spain. At 5,324, the reported number of LTC deaths in Canada was near the average but data varied widely among countries: from 28 in Australia to 30,000 in the U.S., with more than 10,000 in France, Italy, Spain and the United Kingdom.... [I]n the case of Italy, data was available from only 52 per cent of the nursing homes operating in the country....

"The contrast in LTC deaths is even more stark between provinces and territories, says the report, which notes LTC deaths represented more than 70 per cent of all COVID-19 deaths in Quebec, Ontario and Alberta and 97 per cent of all [63 - gd] deaths in Nova Scotia. There were none in Newfoundland and Labrador, Prince Edward Island, New Brunswick and the territories at the time of the study. Two LTC residents have since died in New Brunswick."
Read more: https://globalnews.ca/news/7106098/canada-coronavirus-seniors-homes-report/

Nobody died in these nursing homes - what did they do right? | CTV News - Solarina Ho:
June 24, 2020 - "In Quebec, centre d'hébergement Sainte-Dorothée, a 285-bed facility in Laval, reported 95 deaths, according to data collected by freelance journalist, Nora Loreto. The Notre-Dame-de-la Merci in Montreal reported 93 deaths in its 398-bed residence. The Quebec government operates both facilities and many other hard hit locations. The province’s coroner ordered a public inquiry into the deaths last week. More than 3,640 out of the more than 5,400 deaths in the province so far have happened at public long-term care homes (CHSLDs). Another 930-plus have been at private care facilities.

"According to Loreto's database of deaths in residential care facilities – collected through public health data, media reports, reports from homes, obituaries and families – nine of the 10 worst-hit homes were in Quebec....  More than 560 homes in Quebec and more than 430 in Ontario have experienced some level of outbreak, according to data compiled by the National Institute on Ageing. But other regions in Canada were not immune: 53 died at Northwood Manor, a 485-bed home in Nova Scotia, while 24 died at Langley Lodge, a 121-bed facility in British Columbia. And overall, Loreto's data shows that more than 7,100 -- roughly 84 per cent -- out of the more than 8,400 deaths related to the coronavirus in Canada have been attributed to nursing homes."
Read more: https://www.ctvnews.ca/health/coronavirus/nobody-died-in-these-nursing-homes-what-did-they-do-right-1.4998204

Studies question official Chinese COVID narrative

How many people have REALLY been infected with Covid-19 in China? Data shows 1.2 MILLION people had the 'flu' in December - 10 times higher than normal | Daily Mail - Stephen Matthews:

June 19. 2020 - "China suffered ten times more flu cases than average at the end of 2019, according to suspicious figures that cast more doubt over the true scale of the country's Covid-19 crisis. Data published by Chinese officials show 1.2 million cases of influenza were recorded in December - up from 130,000 in the same month the year before. Analysts who spotted the figures fear the 'explosion' of flu - which can cause a fever and cough, the two tell-tale signs of coronavirus - may be down to the 'undetected spread' of coronavirus. Beijing health chiefs first warned of a mysterious disease, now known as Covid-19, on December 31....

"Questions have repeatedly been raised about the accuracy of China's Covid-19 data, with cases of the disease tracked back to November and studies suggesting the real death toll is much higher than official data shows. One study published this week claimed China's real Covid-19 death toll could be 14 times higher than figures given by Beijing, with US researchers estimating 36,000 people had died in Wuhan alone by March 23....

"Early reports said the first case was diagnosed on December 31 but studies have since suggested that the first cases of the virus were circulating as early as October 2019. At the start, officials insisted the condition was 'mild', 'under control' and was not being transmitted between humans.... And other cities in mainland China didn't reveal they had cases until Hong Kong news media reported that cases of the virus had been confirmed in its region.

"China's huge spike in influenza cases at the end of 2019 was flagged by Taiwanese consultancy group SindoInsider, The Times reports. It pointed to data released by the nation's Centre for Disease Control and Prevention (CDC). SindoInsider claimed Chinese health officials ... stopped providing flu updates on December 27, four days before Covid-19 cases were first reported. The report said: 'We have reasons to believe that the uncharacteristic explosion of flu cases in December may be due to the undetected spread of the coronavirus. We estimate that tens of thousands of people could have been infected with Covid-19 by the end of December.'

"A separate study released this week suggested China covered up the true size of its epidemic, after calculating deaths based on the activity of crematoriums in Wuhan. Wuhan crematori[a] were operating 24 hours a day at full capacity during the peak of the crisis, according to reports analysed by the researchers. They estimated Wuhan was burning up to 2,000 bodies a day by the second week of February, when the official death toll for the whole of China was only 700. And they suggested by March 23 - when the UK went into lockdown - around 36,000 people had died in Wuhan alone. China's official toll at the time was 2,524....

"A surge in road traffic outside Wuhan hospitals at the end of last summer – coupled with an increase in internet searches for coronavirus-like symptoms - suggests Covid-19 could have hit China before autumn. A study from Harvard Medical School led by Dr John Brownstein analysed commercial satellite imagery. His team 'observed a dramatic increase in hospital traffic outside five major Wuhan hospitals beginning late summer and early fall 2019'. He said the traffic surge 'coincided' with a rise in internet searches for symptoms that are 'closely associated' with coronavirus, ABC News reported....

"A graph of the data shows the number of cars began to increase in August and peaked in December before falling when lockdown was introduced.... Brownstein said ... his results were 'pointing to something taking place in Wuhan at the time'. He said that on 10 October 2019 there were 285 cars parked at Wuhan's Tianyou Hospital - 67 per cent more than the 171 recorded that same day a year earlier."

 Read more: https://www.dailymail.co.uk/news/article-8439183/How-people-REALLY-infected-Covid-19-China.html

Trump, progressives move on from COVID-19

We are living in a bipartisan state of denial about the coronavirus | Washington Post - Max Boot:

June 10, 2020 - "I have some good news and bad news. The good news: At last, there is some bipartisan agreement in America. The bad news: It’s a tacit agreement to pretend that the threat from the novel coronavirus has somehow gone away. Covid-19 has become the forgotten plague — and it’s nowhere near ending.

"The mass demonstrations following George Floyd’s death were well warranted, but they also posed a significant public health risk on both sides of the barricades. It’s true that many demonstrators wore masks and they were outdoors, but they were also shouting in close proximity to large numbers of other people. Fewer police and National Guard troops seemed to wear masks, so it’s hardly surprising that some members of the D.C. National Guard have tested positive for covid-19 in recent days. Anthony Fauci — remember him? — said on Wednesday: 'When you get congregations like we saw with the demonstrations, like we have said — myself and other health officials — that’s taking a risk.'

"Unfortunately, public health experts have impaired their own credibility and raised suspicions that they are politicizing science because more than 1,200 of them signed a letter 'advocating for … demonstrations against systemic injustice occurring during the COVID-19 pandemic.' Their reasoning is that white supremacy is a public health issue. That’s true, but if the demonstrations spread COVID-19, that’s likely to hurt communities of color worst of all. Demonstrators have a right to risk their own lives, but not the lives of the most vulnerable members of their communities.

"Conservatives quickly jumped on what seems to be a double standard: Public health experts had opposed much smaller protests against lockdown orders, and they had discounted concerns about the toll that the lockdown was taking not only on the economy but on public health, too.... Politico put it pithily: 'Suddenly, Public Health Officials Say Social Justice Matters More Than Social Distance'....

"President Trump is bent out of shape about the protests, but it’s telling that he didn’t utilize the most powerful argument against them. He claims they are all engineered by antifa, for which there is no evidence. Instead, he could have argued that they threaten public health — for which there is copious evidence. But Trump didn’t make that case, because he, too, is pretending that the coronavirus has magically gone away — just a little later than he had originally predicted. (In February, he had claimed it would disappear by April)....

"Fauci is one of the government’s top experts on infectious diseases, yet he said on June 1 that he hadn’t spoken to Trump since May 18. There are no more daily coronavirus briefings from the White House, and the administration’s coronavirus task force is no longer meeting every day. Trump has moved on....

"If only the coronavirus could die of benign neglect. But it is utterly, pitilessly indifferent to our collective attention-deficit disorder. We have already lost more than 114,000 Americans to covid-19 in the past four months — more than have died in all of our wars since 1945 — and we are still seeing an average of more than 20,000 new coronavirus cases a day... yet lockdowns are now ending and social distancing rules are being widely flouted....

"To paraphrase Leon Trotsky, you may not be interested in the coronavirus, but it is interested in you."

Read more: https://www.washingtonpost.com/opinions/2020/06/10/both-trump-his-critics-act-if-pandemic-has-gone-away/

Biden and Pelosi call for federal mask law

Biden says he would make wearing face masks mandatory for Americans amid coronavirus pandemic | CNN - Veronica Stracqualursi & Sarah Mucha:
June 26, 2020 - "Presumptive Democratic nominee Joe Biden said if elected president, he would make wearing a face covering in public compulsory.... 'The one thing we do know is these masks make a gigantic difference. I would insist that everybody out in public be wearing that mask. Anyone to reopen would have to make sure that they walked into a business that had masks,' Biden told CNN's affiliate in Pittsburgh, KDKA, while wearing a black mask.

"Pressed if he'd use federal power to mandate wearing a mask in public, Biden responded, 'Yes, I would. From an executive standpoint, yes I would.' Asked again if that meant he would 'in effect' mandate mask wearing, Biden said, 'I would do everything possible to make it required that people had to wear masks in public'....

"At least 16 states and the District of Columbia have mandates on wearing cloth face masks in public, but masks have become a political flash point as some argue the requirement infringes upon their civil liberties."
Read more: https://www.cnn.com/2020/06/26/politics/joe-biden-masks-mandatory-coronavirus/index.html

Nancy Pelosi Calls Trump 'Cowardly' For Not Wearing Mask, Supports Federal Mandate | NPR - Alana Wise:
June 26, 2020 - "House Speaker Nancy Pelosi on Friday told NPR she agreed with presumptive Democratic nominee Joe Biden's assessment that mask usage should be mandated on the federal level amid a surge of coronavirus cases across the United States....

"'I totally agree with Joe Biden. As long as we're faced with this crisis, masks should be mandatory,' Pelosi told NPR's Ari Shapiro and Susan Davis on All Things Considered. 'In fact, the reason the CDC hasn't made it mandatory is because they don't want to embarrass the president, or insult the president, whatever it is,' Pelosi said, calling Trump 'cowardly' for not wearing a face mask....

"Rep. Liz Cheney, R-Wyo., the House GOP Conference chair, who rarely agrees with Pelosi, tweeted a picture of her father, former Vice President Dick Cheney, on Friday with the message: 'Dick Cheney says WEAR A MASK.'"
Read more: https://www.npr.org/2020/06/26/884039346/house-speaker-nancy-pelosi-talks-about-the-coronavirus-police-reform-and-health-

Lockdowns and libertarianism (2)

by George J. Dance

As regular blog readers have no doubt noticed, since April I have given increasing space to the COVID-19 pandemic and the unprecedented government interventions (the lockdowns and business shutdowns) that accompanied it. I hope readers have enjoyed that because, whether you have or not, I expect it to continue. As I see it, we are living through another one of those pivotal crises - like the two World Wars, the Depression, and the War on Terrorism - that have defined modern history.

As a libertarian, I bring my ideological bias to the table. In this case, I have been informed by the work of economist Robert Higgs, whose masterwork Crisis and Leviathan documented well how governments (1) have a systemic bias towards increasing power; (2) use crises to vastly expand their power; and (3) retain much of their new power after a crisis has past. (Dr. Higgs explains his thesis at greater length in the accompanying video.) My bias obviously affects what material I forward, and I cannot pretend that it is non-existent. What I can and will do is admit that my bias can be wrong, and let it be challenged by empirical evidence.

At the same time, I can evaluate others' ideological biases the same way. In the mainstream media, I continually encounter a statist or pro-government bias: that "When public safety is threatened, whether by war or disease, our dependence on government becomes immediately and viscerally obvious"; that ""government has the power and resources to internalize the externalities of contagion and coordinate a rational response;" and that in March "a large and activist government was all that stood between us and mass privation and suffering on a mind-boggling scale" (as a Niskanen Center article recently summed up).

In early March, when no one knew much about the novel coronavirus, it was easy to believe that millions of us were going to die, and that only unprecedented, massive government intervention could save us from untold death and suffering. It was a mass panic reaction, but panic in a crisis is understandable and excusable. However, governance should not be informed by panic alone. Not only libertarian ideological biases, but the prevailing statist ones as well, should be challengeable by the evidence.

How dangerous the virus is, is an empirical question, one that depends on objective facts about the attack rate (how many people in a population are at risk) and the infection fatality rate (how many people who get it will die). We had no way of knowing either in March, but there has been a surfeit of data in the succeeding three months. There is good reason to think that the "millions of deaths" claim was hyperbole. Nor can we rely on models that simply assume that lethality: we need at least a reasonable, fact-based estimate of the worst possible case, of how many people could possibly have been in danger.

Whether government interventions averted this mass death, or any death (on net), is also an empirical claim. It requires accurate death counts, and comparing them to the policies in place. It also requires causally linking specific deaths to specific interventions. (For instance, did stay-at-home orders increase deaths within households more or less than they lowered them in the workplace?)

Finally, we need to measure the effects of voluntary social distancing. Hitherto, government's scientific advisers have often assumed the effect of voluntary social distancing to be zero. However, some of those advisers have begun noticing the phenomenon, if only to blame it for the recession that followed the lockdown.

I would like to discover that voluntary social distancing (combined with a use of government's police power consistent with libertarian principles) would have been enough to reduce most of the disease's harm, while avoiding the long-term harms that the government interventions have caused. That's my null hypothesis, which I think is supportable iff it cannot be overthrown. Hence my preoccupation with the subject in future months. While conclusions reached may be too late for this pandemic, I cling to the hope that what we learn this time will inform our response to the next one.

3 problems with Imperial's 3 million deaths model

Comment on Flaxman et al. (2020, Nature, https://doi.org/10.1038/s41586-020-2405-7):
The illusory effects of non-pharmaceutical interventions on COVID-19 in Europe

Authors: Stefan Homburg, Leibniz University Hannover, Department of Public Finance, Germany

Christof Kuhbandner, University of Regensburg, Department of Human Sciences, Germany

Correspondence to: christof.kuhbandner@ur.de

June 17, 2020 - In a recent article, Flaxman et al.[1] allege that non-pharmaceutical interventions imposed by 11 European countries saved millions of lives. We show that their methods involve circular reasoning. The purported effects are pure artefacts, which contradict the data. Moreover, we demonstrate that the United Kingdom’s lockdown was both superfluous and ineffective.

A key concept in epidemiology is the effective reproduction number, R(t), where t denotes time. This function represents the expected number of infections generated by one infected individual. Ceteris paribus, the effective reproduction number starts at R(0), referred to as the basic reproduction number, and decreases monotonically. The monotonic decrease is due to the fact that the number of individuals susceptible to the infection but not yet infected declines as the virus spreads. Of course, the function R(t) can be influenced by non-pharmaceutical interventions (NPIs) as well as by voluntary behavioral changes. However, in case of a finite population, the effective reproduction number falls automatically and necessarily over time since the number of infections would otherwise diverge.

The model of Flaxman et al.1 contradicts this elementary insight. They estimate R(t) from daily deaths associated with SARS-CoV-2 using as an a priori restriction that R(t) may only change at those dates where interventions become effective. Such an approach does not prove that NPIs were effective but rather begs the result, i.e., involves circular logic. The true effective reproduction number declines continuously, and when its estimates are allowed to change only at intervention points, it is clear that profound discontinuities, which attribute strong effects to the interventions, will emerge. Flaxman et al. (p. 2) conclude that while most NPIs had unidentifiable effects, lockdowns reduced the reproduction numbers instantaneously by 82%.

Taking the United Kingdom as an example, Fig. 1 illustrates the ineffectiveness of social distancing etc. in the analysis of Flaxman et al. as well as the enormous effect of the lockdown from 23 March.

Figure 1: Estimate of the effective reproduction number by Flaxman et al. (Fig. 1). The authors assumed R(t) constant before 14 March and after 23 March. Changes were allowed only on the four dates [when] NPIs became effective.

Flaxman et al. (p. 2) infer their estimate of the basic reproduction number from the initial growth of reported daily deaths. Our Fig. 2 shows the actual growth of reported daily deaths. 3

Following the presumption of Flaxman et al. that deaths are more reliable than cases, we see growth of reported daily deaths as a good empirical proxy that mirrors the development of the effective reproduction rate. Of course, deaths follow infections after a long delay – a fact which is taken into account below.

Figure 2: Growth factor of daily deaths (Fig. 2). Source: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/891710/2020-06-11_COVID-19_UK_deaths_time_series.csv. Moving averages, 7 days. Retrieved 14 June 2020. Given daily deaths dt, growth factors were computed as dt/dt–1. Note that if daily deaths show exponential growth, any 52 moving average will also show exponential growth.

Disregarding noise in the data, the growth in daily deaths associated with the coronavirus declined steadily during March and April. Moreover, reported daily deaths follow infections with a median delay of 23 days, consisting of a 5 days incubation period[2] and a median delay of about 18 days from symptom onset to death[3]. Note that this delay also underlies the estimations by Flaxman et al. (p. 22 of their supplementary information).

 Considering a total delay of 23 days between infection and death, possible effects of the 23 March lockdown should only become visible in the data around April 15. However, the series does not show the slightest break in mid-April. Hitherto, the growth factor had already declined from 1.54 to 0.97, and thereafter it continued its slowdown. Contrary to the findings of Flaxman et al., Fig. 2 strongly suggests that the UK lockdown was both superfluous (it did not prevent an otherwise explosive behavior of the spread of the coronavirus) and ineffective (it did not slow down the death growth rate visibly).

The argument of a delay of 23 days between infection and death can also be used in the opposite direction. With the growth rate of daily corona deaths falling since mid March, the underlying growth rate of daily infections must have started receding in the second half of February, long before the problem was recognized and any measures were taken. The continuous decrease in the growth factor shown in Fig. 2, even at dates before any NPI could have become effective, corroborates the theoretical insight that R(t) falls automatically over time. We have checked that the growth factors in the remaining 10 countries considered by Flaxman et al. show a similar pattern.

Our final remark regards Sweden, the only country in the dataset that refrained from strong measures, but has lower corona deaths per capita than Belgium, Italy, Spain, or the United Kingdom. In the absence of a lockdown, but with an effective reproduction number that declined in the usual fashion, Flaxman et al. (Extended Data Fig. 1) attribute the sudden decline in Sweden’s R(t) on March 27 almost entirely to banning of public events, i.e., to a NPI that they found ineffective in all other countries. This inconsistency underlines our contention that the results of Flaxman et al. are artefacts of an inappropriate model.

References
1. Flaxmann et al. Estimating the effects of non-pharmaceutical interventions on COVID-19 in Europe. Nature in press, 2020. https://doi.org/10.1038/s41586-020-2405-7.
2. Lauer, S. A. et al. The Incubation Period of Coronavirus Disease 2019 (COVID-19) from Publicly Reported Confirmed Cases: Estimation and Application. Ann Intern Med in press, (2020). https://doi.org/10.7326/M20-0504.
3. Verity, R. et al. Estimates of the severity of COVID-19 disease. Lancet Infect Dis in press, (2020). https://doi.org/10.1016/S1473-3099(20)30243-7.

Author Information
The authors declare that they have no conflicts of interest. Correspondence should be addressed to C.K. (christof.kuhbandner@ur.de).

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) License.