Tuesday, April 28, 2020

If Sweden is so wrong to keep pubs open why is its health chief's face the tattoo everyone wants?

Children are still in school, bars and restaurants are open, as are garden centres and shops; crowds of up to 50 are allowed, and no one is chastised for sunbathing, sitting on park benches or daring to flee to countryside boltholes.

It is a strategy aimed at allowing some exposure to the disease to build immunity among the general population, while protecting the vulnerable and ensuring hospitals are not overwhelmed.

But the country’s light touch has incurred criticism. Sweden has a reputation as a ‘moral superpower’ and commentators seize upon any death-toll spike as evidence of a foolhardy gamble that risks lives for the sake of the economy.

Sweden considers the big picture, though, and argues that part of its policy is aimed at preventing an economic crash, as mass unemployment will have dire health consequences. For example, after the 2009 debt crisis, suicides in Greece increased by up to 40 per cent.

But many Swedes feel as if outsiders enduring lockdown are willing them to fail. ‘It makes you defensive,’ says Anglo-Swede Alex McBeath, who works at the Tudor Arms. ‘I’m cautiously optimistic about the future. I support the way we have approached the crisis.’

So does the majority of the country. Anders Tegnell, 63, state epidemiologist with the Public Health Agency of Sweden and the architect of its Covid-19 response, fronts daily press conferences. Inevitably, he receives online vitriol.

Yet he is so popular that some in Stockholm have had his face inked on to their arms and legs. Tattooist Zashay Tastas, who designed the image, says: ‘Tegnell has become the face of Sweden’s approach. This is the first time a real nerd is being idolised.’

Or as Dr Tegnell himself puts it: ‘It is the first time in history that an epidemiologist has been considered famous.’ He modestly notes, however, that he is just one of 15 experts meeting daily to analyse data and make recommendations.

But have Dr Tegnell and his colleagues got it wrong? Is managing coronavirus impossible without a lockdown?

Sweden has recorded 2,192 deaths, more than twice as many as neighbouring Denmark, but it has almost twice the population, at ten million. In Britain, the toll has topped 20,000. So far Sweden has defied forecasts saying that, unless it changed course, it would suffer 50,000 to 180,000 deaths.

Arne Elofsson, a biologist at Stockholm University, initially estimated that the nation’s health system would be quickly swamped, but now concedes: ‘It appears the epidemic is plateauing and that the catastrophic scenarios predicted by some will never appear in Sweden.’

Dr Tegnell is cautious by nature but declares himself ‘satisfied’ the strategy appears to be working, even if there are some things he would have done differently, especially in care homes.

Nationally, the number of new cases rose sharply last week – due mainly to increased testing – and stands at 18,177. Most are in Stockholm and its suburbs, with very small numbers in the thinly populated areas elsewhere.

Every country, one way or another, has to reach herd immunity so the chains of transmission break, says Dr Tegnell. He believes Stockholm could do so in weeks – but acknowledges he doesn’t have all the answers as so much about the virus is still unknown.

In a way, the story of Sweden’s response to the crisis begins in Britain. Dr Tegnell studied in London and his team’s approach is based on models developed here.

In mid-March, both Dr Tegnell and Bjorn Eriksson, Stockholm’s director of health, believed Britain and Sweden ‘were on the same page’. On March 12, ITV political editor Robert Peston wrote about Government thinking, saying ‘herd immunity’ was the key phrase and warning against shutting schools.

But a fortnight later the UK abruptly changed tactics and imposed a draconian lockdown, having been unnerved by a study suggesting that without it, up to 250,000 people might die.

Today the Cabinet is divided between ‘doves’ such as Health Secretary Matt Hancock, cautious about easing restrictions, and ‘hawks’ led by Chancellor Rishi Sunak who want a quick end to lockdown.

Sweden stayed the course, based on the understanding that the disease can only be managed not eradicated. Social distancing and working from home were suggested, not ordered, as the elderly were encouraged to stay at home.

Stockholm’s mayor, Anna Konig Jerlmyr, told us: ‘We trust our citizens and treat them with respect. In return we expect them to take responsibility and I’m proud that the majority have done so. In other European cities I was saddened to hear how the police watch people and enforce rules. That is not our way. Also we are as transparent as possible. It is important to share information and all the figures.’

Anna Erdunbelau, a 46-year-old shopping in Stockholm last week, agrees. ‘We are generally a sensible people who usually do the right thing. We are treated like adults. And you have to understand this is all built on trust.’

Key to this is the independence of public bodies such as Dr Tegnell’s Public Health Agency. It ensures decisions are based on expertise, prevents ministers meddling and explains why it is Dr Tegnell leading press conferences while politicians take a back seat.

Politicians didn’t try to block his suggestion that schools remain open, a decision partly taken because younger children are not a major cause of the transmission, and partly so health workers don’t need to stay home to look after their children. ‘We need every healthcare worker we can get,’ says Mr Eriksson.

At the moment, hospitals are coping. Sweden had an enviable health care system in place before the outbreak, which has helped. And it hasn’t been beset by quite the same PPE shortages seen in the UK.

‘We think we are at a peak of infections in Stockholm and *we are not at full capacity in hospitals*, so I’m pleased,’ adds Mr Eriksson. ‘But we must not be complacent. The weather is getting warmer, more people will be outside and they will need to be disciplined about social distancing.’

Ministers have warned that bars and restaurants that failed to follow guidelines would be closed. But all around the city, people go about their business, shopping, cycling, watching the world go by while drinking outside bars and cafes.

‘It sometimes seems as if coronavirus doesn’t exist,’ says Andreas Hatzigeorgiou from Stockholm’s chamber of commerce. ‘Things are moving normally. People do observe social distancing – though we did it before Covid-19, it is in our DNA!’

He knows Sweden’s economy will suffer – it is doing so already – but believes it stands a chance of avoiding the kind of crash predicted elsewhere. Consumer spending is down 27 per cent, but’s that compared to 66 per cent in Denmark.



California Docs Say Lockdown vs. Non-Lockdown 'Did Not Produce a Statistically Different Number of Deaths'

On Wednesday Dr. Dan Erickson and Dr. Artin Massihi, who own seven Accelerated Urgent Care facilities in Kern County, Calif., gave a press conference to local media. They extrapolated from their own COVID-19 data, along with data sets nationwide and globally. Using this data, their own medical knowledge and information gathered from conversations with their colleagues around the country, they presented a compelling case, which included unreported health risks related to sheltering in place, for ending the severe shutdowns.

Both doctors understand and support the initial reactions to the COVID-19 outbreak by the federal, state and local governments. It was a novel virus and there was very limited information. However, now they assert that the data is telling them that the disease pattern of COVID-19 is more like the flu. Dr. Erickson phrased it this way, “Millions of cases, a small number of deaths.” He specifically noted that the difference in the number of deaths between Sweden, with limited restrictions, and Norway, which locked down, is not statistically significant.

"Lockdown versus non-lockdown did not produce a statistically different number of deaths. That is the bottom line," said Erickson.

Throughout the briefing he emphasized that decision making going forward needs to be based on data, not predictive models. This echoes comments made by Dr. Anthony Fauci during press briefings. And we have all watched the predictive models be radically adjusted as actual data has been loaded into them.

Their data extrapolations, using a method similar to the one the CDC uses for influenza, suggest that death rates for COVID-19 are similar to those for the flu. According to their analysis, both Kern County and the state of California have likely experienced a widespread viral infection. They both agreed this is almost certain in New York as well. Based on their analysis, the death rate varies from 0.03% in California to 0.1% in New York state. This will be confirmed by additional testing finding new cases for the same number of deaths.

In addition to asserting that this is much more comparable to the flu than originally thought, the doctors present additional information to support their point of view. First, they discussed the rise in mental illness and abuse their clinics and local providers are seeing. This includes an increase in child molestation, domestic abuse, alcohol and drug-related emergencies, and mental health diagnoses.

Next, they were very clear on how self-isolation can actually compromise the immune system in otherwise healthy people. Dr. Erickson explained that the immune system is actually built by exposure to pathogens. Coming in contact with viruses and bacteria in the environment fires the body’s system for fighting infection. Additionally, the normal flora, or good germs we have on and in us all the time, also drop when we isolate.

Here Comes the Sun: The Good News about COVID-19 the Media Apparently Doesn't Want You to Know
The combination of reducing regular exposure to pathogens in the environment and lowering the good bacteria that helps us fight off infection, concerns both physicians. By reserving nearly all healthcare system assets to treat COVID-19, the available capacity of the system in their area has actually contracted. Two hospital floors are closed. Healthcare workers have been furloughed. In this environment, they worry about an increase in opportunistic infections that will strain the remaining resources as people get back to more normal activities if the isolation of healthy individuals continues.

Next, they say the current guidelines are not backed by science. Dr. Erickson repeated the finding that COVID-19 can live on plastic for three days. So, when you go to Costco or Home Depot, you pick up needed items that may carry COVID-19. He added that it is because of these fomites, inanimate objects that can carry and transfer disease, it is highly likely COVID-19 would be found if your home or car were sampled.

Additionally, there is no science that says it is safer to go to Costco than it is to go to the small local restaurant for lunch. In the opinion of both doctors, the current guidelines are not based on rational thinking. They also think people should absolutely be spending time outside. Dr. Massihi said keeping people indoors can cause Vitamin D deficiencies which further impact immune function and can cause a depressed mood.

Dr. Erickson then explained that the vast majority of people were dying with COVID-19, not from COVID-19. He said after viewing hundreds of autopsies in his career, people rarely die for one reason. A body that has been weakened by chronic disease is not as able to fight off infection. He compared this to deaths with the flu. Most often it is just one of a number of illnesses a patient is suffering with.

With the predictable negatives of self-isolation and the economic pain they are causing, the doctors are calling on political leaders to begin letting the healthy adults return to normal activities. They even say that this should happen without masks and other types of PPE. For those with preexisting conditions or who are immunocompromised, the use of PPE and self-isolation may still be the correct advice. However, for the 95% of individuals who will recover without significant intervention, they say it’s time to end the restrictions and continue testing.

Dr. Massihi said the fear of the unknown is understandable. But giving people accurate information is a way that fear can be reduced. According to the data on deaths for otherwise healthy individuals, the number of deaths is “infinitesimal.” He is equally worried about the person who has abdominal pain and fever and is too scared to seek care. So their appendix ruptures at home and they end up hospitalized with a severe infection. Or any individual with a minor medical problem that will have a bigger impact because care is delayed.

While most of the press conference remained focused on the science and medicine, they did share that their colleagues in emergency medicine around the country report they are being pressured to add a diagnosis of COVID-19. They did not speculate as to why this was happening, but indicated they found it odd.

And Dr. Erickson did hit back at journalists who were challenging his assumptions. At the end of the briefing, he was challenged on why he thought he was smarter than the Dr. Faucis of the world and state health officials. He was clear this was not about being smarter or right. He is using data and his own clinical experience to make these recommendations for his own community and others like them. Essentially pretending everyone is going to be New York is not the correct approach.

He also shot back at reporters who are being paid while their fellow citizens are not. His closing was also a caution worth taking note of:

Who says what’s safe? Are you smart enough to know what is safe for you? Or is it the government gonna tell you what’s safe for you? As soon as they use the word safe, that means control. 'We know what’s safe for you. You’re too dumb to understand disease. We know what’s safe.' And so, they are going to use this model for different things. 'We got a bomb threat from China. Everybody stay in their home for three months.' They [the government] are using this to see how much of your freedom can they take from you. Will you roll over and stay in your house? And it’s working.
Amen, sir. Let’s get America back to work.



For more blog postings from me, see  TONGUE-TIED, EDUCATION WATCH INTERNATIONAL, GREENIE WATCHPOLITICAL CORRECTNESS WATCH, AUSTRALIAN POLITICS, and Paralipomena (Occasionally updated), A Coral reef compendium and an IQ compendium. (Both updated as news items come in).  GUN WATCH is now mainly put together by Dean Weingarten. I also put up occasional updates on my Personal blog and each day I gather together my most substantial current writings on THE PSYCHOLOGIST.

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