People who don’t like government-mandated shutdowns often point to Sweden as a model. This is a mistake. Instead of pointing to a nation that has seen rapidly increasing deaths from coronavirus while avoiding lockdowns, we should be looking at a place with very few deaths from coronavirus, which also avoided widespread lockdowns.
It’s too soon to know how Sweden will do with its current policy. But given the fact that Sweden (10.1 million people) recorded 170 deaths today, vs. 11 in Norway (5.4 million) and 10 in Denmark (5.8 million), it’s not at all clear that they are succeeding. Certainly Sweden is doing better than a number of countries in Southern Europe, but overall their strategy doesn’t look all that promising.
In contrast, Taiwan (24 million) has recorded a total of 6 deaths during the entire epidemic. In recent weeks, there has been virtually no community transmission and just a few imported cases, which all go into quarantine. This is an amazing achievement for a place that was impacted early on due to very heavy travel back and forth with Mainland China. Yes, Taiwan is an island, but Sweden’s cases most likely are coming through international flights, not over the land borders with Finland and Norway.
You might wonder why these cases are so different. After all, haven’t they both followed the same policy of “no lockdown”? Haven’t they both put freedom and prosperity ahead of saving a few lives?
Actually, the cases are very different. Taiwan was impacted by the SARS epidemic, and its government took this issue very seriously. There was lots of testing, quarantining of those infected, and tracing of contacts. The Taiwanese people were encouraged to wear masks, and take other precautions.
As far as I can tell, the Swedes did not take the crisis as seriously, seeming to content themselves with the inevitability of mass infections. That’s a defensible strategy, but as each day goes by the evidence tilts more strongly in the Taiwanese direction.
I worry that libertarianism might come to be associated with the Swedish approach, whereas there are other approaches that don’t involve government-mandated shutdowns and that are more effective in reducing deaths.
Inevitably, people always suggest that for “cultural” reasons countries like South Korea and Taiwan have no lessons for the West. (Actually, Sweden’s culture is also quite different from America’s culture; so then why take lessons from Sweden?) Wired magazine has a very good article that pushes back against the “docile” Asian stereotype:
But the truth is that Taiwan, one of Asia’s most vibrant and boisterous democracies, is a terrible example to cite as a cultural other populated by submissive peons. . . .
First, and most important was Taiwan’s experience battling the SARS outbreak in 2003, followed by the swine flu in 2009. In the middle of the worst of the outbreak in 2003, the current vice president, Chen Chien-jen, was appointed minister of health and won widespread praise for taking quick and decisive action. The threat of SARS put Taiwan on high alert for future outbreaks, while the past record of success at meeting such challenges seems to have encouraged the public to accept socially intrusive technological interventions. (Jason Wang, a Stanford clinician who coauthored a report on Taiwan’s containment strategy, also told me via email that the government’s “special powers to integrate data and track people were only allowed during a crisis,” under the provisions of the Communicable Disease Control Act.)
Taiwan’s commitment to transparency has also been critical. In the United States, the Trump administration ordered federal health authorities to treat high-level discussions on the coronavirus as classified material. . . .
But Taiwan’s own success at building a functional democracy is probably the most potent rebuke to the Asian values thesis. The democracy activists who risked their lives and careers during the island nation’s martial law era were not renowned for their willingness to accept government orders or preach Confucian social harmony.
It’s not uncommon to see fistfights break out in Taiwan’s parliament. I’ve spent a lot of time in China, and I can assure you that people there are not especially likely to follow rules. Chinese culture is nothing like Japanese culture.
Our tendency to discount Asian models and look at European alternatives reflects a deep-seated culture bias that many Westerners are not even aware of.
Another common mistake is to conflate “opposition to extreme social distancing” with “libertarianism”. If America today were a 100% free market economy with no regulation, we would still be in a deep depression due to people freely choosing to isolate themselves.
PS. In a recent post, I pointed out that Sri Lanka was called Ceylan when I was young. I can also recall when Taiwan was called “Formosa”. For some reason, when countries change their names I almost always prefer the old one. Who likes Myanmar more than “Burma”? Some say we should respect the choice of the locals. It’s OK to believe that, as long as I don’t hear you calling Deutschland “Germany”.
READER COMMENTS
Gordon
Apr 15 2020 at 6:04pm
When adjusted for population size, Sweden has 4 times the number of covid-19 fatalities as Norway and over 2 times the fatalities as Denmark even though Denmark has 6 times the population density of Sweden. And when I checked the numbers about a week ago, Sweden had 50% more fatalities than the US when adjusted for relative population sizes. The problem is that people think Sweden’s voluntary social distancing controls were effective because they’re looking at the absolute number of fatalities and not taking into account the fatalities in relation to population. I wonder if the Swedes will ever realize that their government bungled its response.
Thaomas
Apr 15 2020 at 7:57pm
Maybe they were (at least I was) going on numbers of confirmed cases in Sweden. THOSE population-adjusted numbers do look good good compared to the US.
Oleg
Apr 15 2020 at 11:28pm
Except that both Denmark and Norway will have to switch to something else very soon. The idea was, I think, that the lock down and mass testing would reduce the case load sufficiently that one can switch from lock down to aggressive testing and contact tracing, while keeping the resulting deaths from rising significantly during the “reopening.”
Will that work? I’m not prepared to guess. Also to get to that point, the lock down would have to reduce total cases sufficiently by the time it is lifted to make contact tracing and quarantine an effective alternative. The initial lock down may be sustainable for 1 or 2 months, or so it appears for now, but what if they need to wait 4 months, or 6?
Tyler Wells
Apr 16 2020 at 8:42am
I don’t think current deaths per population is the right metric to judget the Swedish response. As Oleg mentioned, perhaps they are keeping in mind the long game. Locking down the country can only be a temporary solution.
Or perhaps they are seeing that the number of people who have died from coronavirus is miniscule in comparison to total deaths from all normal causes. If all of the Spaniards currently in critital care die then 0.056% of Spaniards will have died from the virus. I would imagine, like the US, about 0.9% naturally die every year and we understand that is unavoidable, all of us will die someday. We have no idea how many would have died without mandatory quarantines and really no way of knowing until extensive testing of antibodies is available.
At some point you have to accept your mortality and decide whether you would accept a little additional risk (really, uncertainty, as there is currently no way to permanently avoid coronavirus) if that meant keeping civilazation as we know it continuing along. That is a judgement call that mathematical models can help guide (assuming the assumptions are somewhat realistic), but can’t make.
John Alcorn
Apr 15 2020 at 6:19pm
Might Sweden be playing a long game, whilst also expecting (or hoping) that in phase one of the pandemic the contagion won’t greatly exceed hospital capacity?
Or might policy be endogenous everywhere, heavily shaped by national culture and by background public-health readiness (e.g., recent experience with SARS)? Then it would be unrealistic to expect country X to emulate country Y in phase one of the pandemic.
Market Fiscalist
Apr 15 2020 at 7:09pm
‘If America today were a 100% free market economy with no regulation, we would still be in a deep depression due to people freely choosing to isolate themselves.’
I am pretty sure that in a a 100% free market economy social distancing would have been adopted in a much more pragmatic manner and the recession would have been less deep.
Scott Sumner
Apr 15 2020 at 8:37pm
Yes, less deep, but still extremely deep.
Matthias Goergens
Apr 17 2020 at 2:24am
Apart from the supply side, exactly how deep a recession also depends on how well you think free banking would stabilize nominal GDP vs how many mistakes the real world Fed will make.
Thaomas
Apr 15 2020 at 7:59pm
The Fed allowing a 5 year TIPS spread of less than 1% pa, would get us a deep recession with not one case of Covid-19.
Thaomas
Apr 15 2020 at 8:04pm
The Portuguese called that island Formosa because they though it was a beautiful island “isla formosa.” 🙂
Scott Sumner
Apr 15 2020 at 10:47pm
Interesting. The Chinese word for America is “beautiful country”
Liam
Apr 15 2020 at 9:47pm
Taiwan is not China. Taiwan is much closer to Japanese culture than Chinese culture, as far as following rules is concerned (parliament brawls or not).
Mark Brady
Apr 15 2020 at 10:19pm
And, as I’m sure you know, Taiwan was occupied by Japan for fifty years (1895-1945).
Scott Sumner
Apr 15 2020 at 10:51pm
Interesting. I’ve never been to Taiwan, but I’ve watched a few dozen Taiwanese films. The culture as portrayed in the films certainly looks Chinese. But I do understand that films don’t always portray reality. And I have heard that the Taiwanese are more polite than the Chinese, which supports your point.
J. C.
Apr 27 2020 at 1:32pm
Since I grew up in Taiwan, I can tell you Taiwan is Chinese culture with Western (for younger Taiwanese) and Japanese (for older Taiwanese) influences. Unfortunately, Chinese in mainland China have changed after 70+ years of communist rule (culture-cleasing during culture revolution, skewed family structure due to one-child policy, relative-morality, maxi nationalism). Please don’t use mainland Chinese as the barometer of Chinese culture. Confucius must have turned in the grave to hear CCP used his philosophy to justify totalitarianism.
John Alcorn
Apr 15 2020 at 9:53pm
Compare Jaron Lanier & E. Glen Weyl, “How Civic Technology Can Help Stop a Pandemic: Taiwan’s Initial Success Is a Model for the Rest of the World”.
It’s plain that Taiwan’s response to contagion risk was agile, swift, resourceful, impressive. It’s also plain that a like response was infeasible in Sweden. Here is an excerpt:
It is an open question whether Taiwan’s ‘civic technology’ model can be adopted promptly and broadly in the USA when lockdowns will be lifted.
The better part of wisdom for libertarians anywhere would be to try and make the most of any (slim?) local or national possibilities. As we anxiously watch events unfold in Taiwan and Sweden, let’s hope that there are several ways to skin a cat.
Kevin Dick
Apr 15 2020 at 10:04pm
To evaluate the Swedish strategy, you have to look at death tolerance. How many deaths per unit time from various sources does each culture routinely tolerate?
Tolerating fewer covid deaths per unit time is arguably irrational, at least when comparing similar modes of death across a similar demographic. Unless the cost per life year saved for covid lives is incredibly cheap (it isn’t), this behavior results in more deaths than necessary–an outcome I’m sure most members of most cultures would agree is a flawed one.
In the six months of the 2017-18 flu season, the US tolerated somewhere between 7500 and 16,000 flu deaths per month (95% confidence interval) according to the CDC. The mode of death for flu is very similar to that of covid and the demographics are somewhat worse–more young people die of the flu.
So I disagree. The Swedes have it right here.
Mark Z
Apr 15 2020 at 10:27pm
I think this is a straw man of the argument from cultural differences. First of all, the characterization of rule-following, adherence to social norms, and a degree of conformity as docile subservience is idiotic, perhaps the legacy of Theodor Adorno’s (imo rather nonsensical) attempt to associate some normal, useful psychological traits with authoritarianism. But two particular issues come to mind here with the notion that Taiwan’s success is purely a political feat: 1) the people who make up governments are, after all, people, products of their cultures, and 2) people – bureaucrats and citizens alike – have to comply with policies. A social distancing directive in Taipei would probably reap better compliance than a social distancing order in New York (where compliance seems to have been pretty bad). A policy’s effectiveness depends on how people react to it.
It isn’t just the Taiwanese government that experience and learned from SARS; the people did too, hence why they don’t need much urging from the state to wear masks in public. It’s part of their collective cultural memory, so to speak. New York has had to require New Yorkers to wear masks in public (when near people), and even then I doubt it will be well followed or thoroughly enforced.
BC
Apr 15 2020 at 10:34pm
It is puzzling why no one seems to be looking at the Taiwan model more closely, given it’s success. Has any country been more successful than Taiwan in suppressing the virus, looking at the two dimensions: infections/deaths vs. fewest restrictions on businesses/schools?
I don’t think it’s just because people ignore Asia. There has been plenty of commentary about Japan, South Korea, and to some extent Singapore. It’s particularly frustrating when people look to Japan and Sweden as the leading experiments as to whether one can successfully deal with the virus without closing businesses while completely ignoring Taiwan. It’s almost like they don’t want to find a successful case.
Is this related to WHO’s unpersoning of Taiwan to placate China? I could see that if people look to WHO for guidance and WHO ignores/omits data and information about what Taiwan has done, then that could lead to less awareness about Taiwan’s efforts. (I believe Taiwan also tried warning WHO about the outbreak in China in December, but WHO did not heed those warnings.)
I agree that people focus too much on lockdowns when the biggest problem with not acting quickly enough is that one loses the chance to contain the virus through testing, isolation, and contact tracing. People say that this or that country should have locked down sooner. No, if that country had started sooner, then they would have had a chance to contain the virus making a general lockdown unnecessary. These lockdown blinders might also be related to ignorance of Taiwan’s success.
Ray
Apr 15 2020 at 10:51pm
The whole purpose of the lock downs is to “flatten the curve” e.g. reduce the chance that our health care systems would be overwhelmed.
In the end, probably the same # of people will die because the only way to beat COVID-19 is to achieve herd immunity (staying holed up for years while vaccines are created for numerous SARS-CoV2 mutations is unrealistic). Sweden is trying to get their faster without destroying their economy. I’d say it’s working and their hospitals haven’t been overwhelmed. Ours probably wouldn’t have been either but the models were pretty terrible at predicting that, unfortunately.
Didn’t know much about the Taiwanese approach though. Certainly should be considered.
Scott Sumner
Apr 15 2020 at 10:55pm
You said:
“In the end, probably the same # of people will die because the only way to beat COVID-19 is to achieve herd immunity”
This is false, although I do see the idea pop up frequently. In my view, the virus will eventually be defeated by a vaccine.
robc
Apr 15 2020 at 11:03pm
I think you missed the parenthetical at the end of the sentence you quoted.
A vaccine wont be developed in time.
Scott Sumner
Apr 16 2020 at 1:25am
I’d expect a vaccine within about 2 years. That won’t be enough time to build up herd immunity in places like Taiwan and South Korea. Not even close.
AMT
Apr 17 2020 at 4:02pm
So are you saying we must either tolerate lockdowns until there is a vaccine, or tolerate numerous excess deaths? I am guessing you are not optimistic we can actually emulate the taiwan model effectively.
Todd Kreider
Apr 15 2020 at 11:48pm
Scott,
Please stop being a drama queen. How is your prediction of under 17,000 deaths in the U.S. going? We are up to 25,000 and will end this round at 50,000.
Scott Sumner
Apr 16 2020 at 1:28am
I didn’t predict 500 deaths. Or a million deaths. Or 200,000 deaths.
Mark Bahner
Apr 21 2020 at 12:21am
I’m curious, Todd. What was your prediction, and when did you make it?
Weir
Apr 16 2020 at 12:20am
I suspect China’s the model for those cops in Colorado who arrested the dad playing t-ball with his kid in the park.
Wasn’t China the model for the cops who arrested the paddle-boarder on his own on the ocean? For the cops who issued fines to people driving unnecessarily far? For the cops writing down plate numbers at an open-air Easter Sunday mass?
When governors ban the purchase of car-seats or paint, their model is China. They see a police state, they think that’s what it takes, and they emulate that example.
Drones taking photos of hikers on a mountainside. Drones with loudspeakers telling people to stop enjoying the sun. CNN says China has conquered the bug. So that’s CNN’s model.
Scott Sumner
Apr 16 2020 at 1:29am
Governments around the world don’t need a “model” to engage in their worst instincts. There’s plenty of home grown authoritarianism.
Weir
Apr 16 2020 at 5:52am
This was a Bloomberg headline in March: “Lockdown’s Success in China Offers Hope for World’s Virus Fight.”
This was NBC: “U.S. reports 1,264 coronavirus deaths in over 24 hours. Meanwhile in China, where the pandemic broke out, not a single new coronavirus death was reported.”
And Chuck Todd on MSNBC: “How uncomfortable is it that perhaps China’s authoritarian ways did prevent this? Meaning, had China been a free and open society, this might have spread faster?”
And at least until a rewrite, this was CNN: “A Chinese naval flotilla headed into the Pacific over the weekend, evidence that the People’s Liberation Army Navy has done a much better job controlling coronavirus than the US Navy, according to a story posted on the PLA’s English-language website.”
It’s true that governments, as you said, “don’t need a ‘model’ to engage in their worst instincts.” They didn’t need it. But they got it anyway. From CNN and Bloomberg and plenty of western pundits.
They didn’t discount the Chinese model. They held it up as their shining city on a hill.
Tom DeMeo
Apr 16 2020 at 9:00am
I would point out that the bottom line is every nation needs to contain the spread any way they can, and that there appear to be certain thresholds. Things that work at one threshold don’t always work at another.
We appear to have hit or even exceeded the Italy/Spain threshold. At that point, the Taiwan style strategies don’t work any more. Severe society wide separation rules are the only thing that prevents reaching the next threshold, which would be highly destructive and dramatically worse for personal freedom than skipping Easter service or a trip to the park to play t-ball.
There is no way around the need to contain the spread. I don’t care what your ideology is, you won’t want to have more than 2% of the population getting this at one time. What worries me is how widespread this kind of whiny disconnect is. There is no way to get our freedom back without offending our sensibilities until over half the population has had it or we have a successful treatment.
I just don’t see America submitting to the tracing and quarantining regime that allows for greater freedom. We cannot have our old notions of freedom right now.
Whether we can have more freedom or less will depend on whether we are able to trade one form of unnatural constraint for more freedom of movement, and whether we can be disciplined enough about it to make it work. I don’t see us able to pull it off.
Scott Sumner
Apr 16 2020 at 1:30pm
I’m doing my part to point out that Taiwan is a much better model than China, as it’s been far more successful. But you are right that our media is not helping things.
Even so, I stand by my claim about authoritarian impulses. Look a what we did to Japanese-Americans in WWII.
Yaakov
Apr 16 2020 at 8:21pm
I suggest you use the official website of the Swedish health service rather than a second hand account:
https://experience.arcgis.com/experience/09f821667ce64bf7be6f9f87457ed9aa?fbclid=IwAR3js7MAFmYfWyQBkETyaC9m-ADcNA13Oyn6DTkZsrh6hyVlDDjGN_-Nb_A
I note that the Swedish case is so interesting, because they are over the peak. The asian countries are doing very well, but they are at the begining. Singapore was a lovely example to learn from until a week ago. South Korea and Taiwan may be on the same path, we do not know.
Mark Bahner
Apr 16 2020 at 11:50pm
But they are not “over the peak”…at least per the World in Data website. According to that website, there were 170 deaths in Sweden on April 16th…the most deaths from COVID-19 ever in one day in Sweden. And the value for April 15th was 114 deaths, which is tied for April 9th for the second-most deaths in one day from COVID-19.
World in Data, “New Deaths”…Sweden hasn’t peaked
Yaakov
Apr 17 2020 at 4:59am
But a brought a link to their official details. I tend to trust information coming from the Swedish health services. They back date the deaths and I trust they do it properly.
robc
Apr 17 2020 at 10:58am
Also, what is lag between death and infection? Peak death would probably occur 2-4 weeks after peak infection, so if you can see peak deaths in the future, you are well past peak infection.
Mark Bahner
Apr 17 2020 at 12:42pm
OK, let’s look at the site you referenced.
I’m having trouble with translating it, but presumably “Sjukdomsfall” is “cases”. There have been 13,216 cases, peaking at 738 cases on 4/6/20. And presumably “Avlinda” is “deaths”. There have been 1,400 deaths, peaking at 99 deaths on 4/7/99.
I don’t see how either of those is particularly wonderful. (I do note, however, that the deaths are tremendously concentrated in the 80-90 year-olds and 90+ year-olds.)
Sweden’s population is only 10 million, versus the U.S. with 330 million. So multiply all Sweden’s values by 33, and we get:
Swedish cases, for equivalent U.S. population = 436,128 cases, with a peak on 4/6/20 of 24,354.
Swedish deaths, for equivalent U.S. population = 46,200 deaths, with a peak on 4/7/20 of 3267 deaths.
Those are not particularly good results! And that doesn’t even include what would happen if I removed from U.S. cases and deaths those around NYC, which is far more densely populated than Sweden. In fact, for simplicity, I’ll remove NY state numbers and NJ numbers from U.S. numbers.
Population of U.S. (minus NY and NJ) = 302 million. Cases in U.S. (minus NY and NJ) = 379,978. Deaths in U.S. (minus NY and NJ) = 17,100.
Now, Swedish cases and deaths adjusted to the U.S. population (minus NY and NJ), we multiply by a factor of 30.2, rather than 33, to get –> Swedish cases = 399,123, Swedish deaths = 42,280.
So Sweden is doing worse than the U.S. so far (and far worse on deaths), when adjusted for the removal of NY and NJ cases, deaths, and population.
Scott is absolutely right. Taiwan’s numbers are far better than Sweden’s. Sweden’s numbers are not particularly good. (Although the vast majority of deaths in Sweden are of very old people.)
robc
Apr 17 2020 at 4:16pm
I don’t think the Taiwan comparison is valid, because neither Sweden nor the US had the infrastructure in place to do what Taiwan did. Maybe we should have? But, we dont so a different approach had to be tried.
I am seeing about 30% more deaths per million from Sweden (source: https://www.worldometers.info/coronavirus/ ). But that is expected if you don’t flatten the curve. You will have more deaths earlier, but will burn out quicker and have less later. Flattening is good to prevent hospital availability issues, but otherwise I like the Swedish approach (as compared to the US approach). But the US is a mixed bag, as some areas are doing bad and some good, but the good ones have a wide range of approaches (although none as open as Sweden).
Larry Campbell
Apr 17 2020 at 1:12pm
They look to be over the peak according to much more detailed stats here. The seven day rolling average for both deaths and ICU care peaked on roughly April 7 to 11, and has been declining since. Discrepancy with other sites’ statistics is concerning, but the Wikipedia link at least provides a source for theirs.
John Alcorn
Apr 16 2020 at 8:42pm
I listened to an hour-long interview of Sweden’s Chief Epidemiologist, Anders Tegnell. The interview begins at cue time 00:07:30. Here are select, telegraphic summaries of what I understood Anders Tegnell to have said:
• Policy failure was localized to elder-care facilities (failure to protect the most vulnerable). Many reforms are needed in elder-care facilities, which are mainly hospices; majority of residents enroll with six-months life expectancy. Almost half of Covid-19 deaths have been elderly residents of these facilities. General reforms are needed to establish best practices and training at elder-care facilities. Testing lagged badly at elder-care facilities.
• Insufficient testing capacity was 2nd major problem. Testing is still scarce. Strategic priorities for testing are 1) hospital and medical personnel, 2) residents and personnel at elder-care facilities, and 3) personnel in essential services.
• In order to ascertain distance to herd immunity, serological testing to establish prevalence of antibodies (prior infection) in populace will be necessary. Such testing isn’t there yet.
• School closures would de facto pull 20% of medical personnel away from hospitals because parents (including medical personnel) would have to stay home with children.
• Stringent measures might become necessary in remote towns.
• Sweden is halfway thru major wave of pandemic. Now seeing slowdown of contagion in Stockholm. Summer probably will diminish contagion. But this virus, unlike SARS and MERS, won’t go away. Key will be to achieve original goal of shielding or isolating the vulnerable (esp. those in elder-care facilities) much more effectively.
• Compared to the flu, this virus is deadly because it spreads widely and quickly, and because many persons get sick at the same time; conditional on infection, death risk isn’t much greater than the flu if individual receives timely care.
• Poll indicates 75% of Swedes support Swedish approach, 20% want more attention to economy, and 5% want more stringent public-health measures.
• Skeptical of face masks (except, of course, in hospitals and elder-care facilities) because masks tempt people who are symptomatic to go out with a mask instead of properly staying at home. This anti-protection effect on others outweighs modest protection masks give from infection.
• Looking ahead to better public-health preparation, Sweden will need stockpiles of PPE and other public-health readiness supplies, but the Regions and the State each want to saddle the other with responsibility for stockpiling. (Health care system is Regional in some important ways.)
Mark Bahner
Apr 18 2020 at 8:45pm
Yes, as I noted in my previous comments, the 1400 deaths Sweden reported as of yesterday would translate to 42,280 deaths if we were adjusting to the U.S. population (minus NY and NJ). In contrast, the U.S. deaths as of yesterday (minus NY and NJ) were “only” 17,100.
But as I also noted, from the Swedish website that Yaakov referenced, the Swedish deaths are overwhelmingly very old people:
90+ years old = 343
80-89 = 617
70-79 = 361
60-69 = 116
50-59 = 51
<50 = 19
<30 = approximately zero (may be one or two or three)
Note: These are today’s data, so they add up to approximately 1507 people, rather than the total of 1400 people from yesterday.
So considering that Sweden has not shut down its economy the way the U.S. has, the Swedish COVID-19 deaths are much better than for the U.S. In fact, if Sweden had done a bit better job protecting elder-care facilities, Sweden’s performance would be extremely good.
Steve
Apr 16 2020 at 9:41pm
No discussion here of climate differences. Taiwan, like Singapore, is a hot weather climate, which would naturally reduce the spread of viruses (assuming Covid-19 is affected similarly).
Sweden may have a higher death toll now, but the evaluation of Sweden’s method will come in the future. If a 2nd wave hits next winter and everybody else is locked down again and throwing a few more trillion dollars at the problem then we may have an answer.
What’s always puzzled me is that other causes of death completely dwarf even the worst case projection of Covid-19, and they happen every year. Yet the dollars spent on those causes wouldn’t even be a rounding error on the amount spent dealing with this, not to mention the restricted personal freedom that we would never tolerate in trying to battle heart disease, diabetes, car crashes etc.
Hans Gruber
Apr 17 2020 at 5:09am
1) you are drawing broad conclusions based on a sample size of 1 day?
2) and, what was the age composition of those 170 and what were there underlying health conditions?
3) were adequate beds and ventilators and medical care available to them?
John Alcorn
Apr 18 2020 at 8:08pm
https://www.youtube.com/watch?v=bfN2JWifLCY
Video interview (30 minutes) – Johan Giesecke, Former State Epidemiologist (and now consultant), Sweden
Here are select excerpts (my trascription):
“The Swedish Government decided early, in January, that the measures we should take, against the pandemic, should be evidence-based. When you start looking around at the measures being taken now by other countries, you find that very few of them have the shred of evidence-based.”
“The [Swedish] strategy is to protect the old and the frail, to try to minimize their risk of getting infected, and to take care of them if they get infected.
[Q: What flattens the curve, if not lockdown?]: “One thing is immunity. The other is that the people who are frail and old will die first; and when that group of people is sort of thinned out, you will get less deaths as well. The other thing is that when you [the UK] start your ‘exit strategy,’ […] you’ll have some other deaths that we had already. […] [Cognizance of an] increasing number of deaths will be part of which strategy should be kept and not. […] When I first heard […] about the different draconic measures that were taken, I asked myself, How are they going to climb down from that one? When they will open the schools again, what should be the criterion to open the schools? Did anyone of the strong and very decisive politicians in Europe think about, How do we get out of this?, when they introduced it?”
“We should have this discussion a year from now. […] the difference between countries will be quite small in the end. […] what we’re seeing is a tsunami of a usually quite mild disease which is sweeping over Europe, and some countries do this, and some countries do that, and some countries don’t do that, and in the end there will be very little difference”
“Most people who get it will never even notice that they were infected. […] I think it will be like a severe influenza season […] which would be an order of 0.1 percent [IFR].”
[Q: Once we get mass antibody testing in place, how many people will we find have had the infection?]: “At least half.”
“What I’m saying is that people who will die a few months later are dying now, and that’s taking months from their lives. […] Comparing that to the effects of the lockdown, what am I most afraid of? It’s dictatorial trends in Eastern Europe. […] It may pop up in more established democracies as well. I think the ramifications can be huge from this.”
[Q: What about fatality rate in nursing homes?]: “The nursing homes in Norway are quite small, whereas in Sweden the nursing homes are quite big, with hundreds of people. Which means that if you get the virus into one nursing home in Norway, it will affect far fewer people. […] Sweden failed, we were not on our toes enough to really shield the old people. We should have banned visitors earlier. Many of the people working in nursing homes are from other countries, they’re refugees or asylum seekers in Sweden, their Swedish may not be perfect, they may not always understand the information that has been shared to the population. There are many things that we could have done better a couple of months ago.”
“I don’t think you can stop it, it’s spreading. You can stop it for some time. […] Taiwan, I don’t know about Taiwan, they were quite successful. […] We’re saying: Protect the old, try to slow the spread of the epidemic a bit, so that the health care system will manage when we have […] many severely ill people. Tsunami is not a bad [analogy], it will roll over Europe, no matter what you do.”
“But how long in a democracy do you think people keep a lockdown? […] You can do it in China. […] Do you think you could keep the lockdown, to protect the old people until we have good drugs and good vaccines, six months, a year, 18 months?”
[Q: Why has this pandemic led countries to adopt lockdowns?]: “New disease, a lot of people dying, we don’t know really what will happen, and this fear of contagion, I think, is almost genetic in people—and showing political strength, decisiveness, force, very important for politicians.”
“I think it will be like a severe influenza. […] lf the influenza came around as a new disease, you never had it before, but suddenly this new disease called ‘influenza’ popped up, we would have exactly the same reaction as we have now.”
“A lot of influenza deaths are not recorded in that way in a normal influenza season. […] This may be double as much, but not ten times as much.”
[Q: Should the UK cancel lockdown?] “No, you can’t do that, then you would have a wave of cases. Then you really have a peak—one week, two weeks later. […] No, you really have to climb down, one rung of the ladder at a time, and probably start [by lifting] school closures, maybe.”
“In Sweden we have one million children between [ages] zero and ten. They need to be looked after. If they’re not in school, then someone has to stay at home with them. One of my friends is a nurse and head of an emergency ward here in Stockholm. She prays every morning when she wakes up that the government will not close junior school, because then she loses her staff.”
[Q: Can we suppress the disease and wait for a vaccine?] “No, it will take too long, it won’t work in a democracy.”
[Q: Will the Sweden persist in its strategy?]: “I don’t think it will be tougher.”
J. C.
Apr 27 2020 at 2:36pm
I know I’m late to the party…several points:
You need to look at Taiwan’s model closer. Taiwan Model has been reported much more widely in recent weeks. You can access many good sources for the details.
One big misunderstanding is that Taiwan mass-tests general public like S. Korea did. It hasn’t. If you compared its testing % with other countries, it’s on the low end. Its success is due to its early screening/testing at the airports, contact tracing, strict quarantine, and travel restrictions. It started screening of inbound passengers on December 31, the day its CDC official learned of 7 atypical pneumonia cases in Wuhan. They test high risk inbound passengers, not general public because there’s minimal community spreads.
For suspected cases, the government provides special transport, lodging (for non-residents), 3 meals and $33 per day during the 14-day quarantine. They also check on them daily to see whether they develop symptoms. The government uses cell phone to monitor their location to make sure they don’t break the quarantine (Americans will rebel against this big time) and heavy fines ($30,000+ USD) for anyone who does.
They also banned flights from Wuhan in late January and later on to all China in February. Now any passengers (residents only) have to go through 14-day quarantine.
Taiwan has been successful because they had a plan to deal with pandemic since the SARS outbreak. They acted earlier than anyone else by not listening to China/WHO. They keep the virus mostly at the borders. They also accounted all PPE supplies in January and started ramping up mask production in cooperation with private companies. The government rationalizes masks for all citizens and figures out a way to effectively distribute them. Mask is required for all.
There have been several misteps. For example, 31 sailors from 3 navy ships were tested positive. They weren’t checked before they were allowed to disembarked. Those sailors went everywhere before they were put in quarantine. However, there have not been community spreads because of those cases in over a week. I guess masks and disinfectant do work.
Another important part is the government’s transparent way of communication with the public. The expertise in the government (Politicians don’t lead the daily briefing. Medical experts do.), the transparent communication and the collective memory of SARS all play a part for the public’s compliance. Let’s not put it down as culture.
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