Thread by @celinegounder

1/ THREAD on Sweden & "natural herd immunity":
COVID cases RISING in Sweden since August/September, as is the case across Europe. DEATHS are a LAGGING indicator (~6-8+ weeks after infections). It is likely Sweden will experience another SURGE in DEATHS in the coming weeks.

@celinegounder 2/ Like the U.S., Sweden FAILED to suppress virus transmission over the summer, in contrast to Sweden’s neighbors, like Norway and Germany. That was DESPITE many Swedes leaving urban and suburban areas for remote cabins in the summer.

@celinegounder 3/ Italy was hit hard and early. England initially took a herd immunity approach to the pandemic (the tallest peak). The U.S. and Sweden have almost identical curves. Sweden’s neighbors Norway and Germany sustained much smaller losses from COVID.

@celinegounder 4/ Sweden’s death counts are vastly UNDERESTIMATED because many died without getting tested.
sciencemag.org/news/2020/10/i…

@celinegounder 5/ MANY severely ill patients WEREN'T HOSPITALIZED. On March 17th, Stockholm area hospitals were instructed not to admit anyone over the age of 80 or with a body mass index above 40 to intensive care.
sciencemag.org/news/2020/10/i…

@celinegounder 6/ Most Swedish nursing home residents were NOT TAKEN TO HOSPITALS. Many nursing homes were unable to administer supplemental oxygen, so gave their residents MORPHINE INSTEAD.
sciencemag.org/news/2020/10/i…

@celinegounder 7/ Stockholm’s nursing homes lost 7% of their 14,000 residents to the virus. In the U.S., we have ~1.4M nursing home residents. To put this in perspective, this would be equivalent to our having lost 119K nursing home residents. sciencemag.org/news/2020/10/i…

@celinegounder 8/ The Swedish Public Health Agency instructed people over age 70 to avoid socializing with others. In late March, the Swedish government banned gatherings of 50+ people and nursing home visits. jamanetwork.com/journals/jama/…

@celinegounder 9/ The Swedish Public Health Agency never ordered a shutdown or lock down, but strongly recommended social distancing, working from home, and avoiding unnecessary travel. jamanetwork.com/journals/jama/…

@celinegounder 10/ Anders Tegnell, Sweden’s state epidemiologist, has said many times that Sweden did not set out to achieve “natural herd immunity.” edhub.ama-assn.org/jn-learning/au…

@celinegounder 11/ The Swedish Infectious Diseases Act can restrict individuals, but it does not allow for a general lockdown. This is why Sweden’s COVID mitigation measures have been recommendations rather than mandates. ncbi.nlm.nih.gov/pmc/articles/P…

@celinegounder 12/ But in contrast to Americans, Swedes have a high level of social and institutional trust. This means they’re more likely to comply with public health recommendations without mandates and strict sanctions.

@celinegounder 13/ An opinion poll in Sweden in early April found that 98% of respondents had changed their behavior to protect themselves from COVID. msb.se/sv/aktuellt/ny…

@celinegounder 14/ Though stores and restaurants remained open in Sweden, Google mobility tracking data suggests that Americans and Swedes decreased their visits to restaurants, cafes, and other retail / recreation locations at similar rates (-16% versus -12%).

@celinegounder 15/ Sources for prior Tweet:
gstatic.com/covid19/mobili…
gstatic.com/covid19/mobili…

@celinegounder 16/ Standing in lines / sitting at crowded tables at restaurants / bars not allowed. Guests served at their table & urged to stay at least 1 meter away from other parties. Many restaurants & bars were closed for violating this guidance. onlinelibrary.wiley.com/doi/10.1111/ap…

@celinegounder 17/ The Swedish government kept open daycare centers and primary schools (NOT secondary schools, colleges, and universities, which went online).

@celinegounder 18/ Note that children 10 and under seem to be less likely to transmit coronavirus to adults.

https://twitter.com/celinegounder/status/1281310036673867776?s=20

globalhealth.washington.edu/sites/default/…

@celinegounder 19/ Anders Tegnell, chief epidemiologist for the Swedish public health authority, was concerned about recommending face masks in public because such advice “would also imply that the spread is airborne.”

@celinegounder 20/ SARS-CoV-2 is transmitted by BOTH droplets and aerosols (i.e. airborne). cdc.gov/coronavirus/20…
Tegnell was afraid of spreading panic. sciencemag.org/news/2020/10/i…

@celinegounder 21/ This is not unlike the confusing messaging about wearing face masks in the U.S. axios.com/surgeon-genera…

@celinegounder 22/ Swedish health authorities estimate that <12% of residents in Stockholm and 6-8% of residents nationwide had COVID antibodies by mid-June. sciencemag.org/news/2020/10/i…

@celinegounder 23/ This is nowhere near high enough to achieve herd immunity. Furthermore, if natural immunity lasts at best 2-3 years, “natural herd immunity” is simply not a realistic strategy. jamanetwork.com/journals/jama/…

@celinegounder 24/ What’s been the impact of the pandemic on Sweden’s economy? In the 1st half of 2020, Sweden’s GDP fell by 8.5%—less than in neighboring Germany, but MORE than in neighboring countries Norway and Finland. Also less than in the U.S.
washingtonpost.com/outlook/2020/1…

@celinegounder 25/ Sweden’s central bank forecasts the nation's economy will contract by 7-10% in 2020. The EU commission forecasts an economic contraction for the eurozone of 7.75% in 2020. ESSENTIALLY THE SAME. politico.eu/article/sweden…

@celinegounder 26/ Was the Swedish strategy worth the cost? In @WashingtonPost, Stockholm University’s international economics professor Lars Calmfors did a quick back of the envelope calculation looking only at deaths from COVID. washingtonpost.com/outlook/2020/1…

@celinegounder 27/ The Swedish approach is “profitable” if each life lost is worth less than $1.12M. This doesn’t take into account the cost of COVID long-haulers, etc. washingtonpost.com/outlook/2020/1…

@celinegounder 28/ It’s also important to note that Sweden—unlike the U.S.—has social and economic safety nets and a central, publicly funded healthcare system with universal coverage. washingtonpost.com/outlook/2020/1…

@celinegounder 29/ In addition, the Swedish government’s policy of sick leave:
onlinelibrary.wiley.com/doi/10.1111/ap…

@celinegounder 30/ Without Sweden's more generous social and economic safety nets and healthcare system, a “natural herd immunity” strategy will likely be MORE destructive to public health and the economy in the U.S. than it has been in Sweden.

@celinegounder 31/ In summary, the Swedish approach wasn’t really a “natural herd immunity” approach. But the Swedish strategy was highly costly with respect to cases and deaths with little economic benefit.

@celinegounder 32/ Cumulative confirmed COVID deaths per million people (does not include deaths due to COVID where testing was not performed):
U.S. 679.45
Sweden 587.47
Denmark 120.85
Germany 119.74
Finland 63.71
Norway 51.46
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