The “BUT SWEDEN” Model: Already Outdated and Completely Wrong

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Michael Siegel

Michael Siegel is an astronomer living in Pennsylvania. He is on Twitter, blogs at his own site, and has written a novel.

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  1. Avatar Jaybird
    Ignored
    says:

    Kick the can down the road as long as you can until the eggheads come up with something.

    What I don’t like about this is that the government is completely inept. The FDA and CDC has proven that it can’t get out of the way of private individuals doing stuff (shutting down testing, for example) and the financial plans to help people out are considering giving money to corporations instead of to people and instead of to small businesses.

    Pressing “Pause” on the economy *IS* the best play. But that means that the paused people need to have a job to come back to and giving money to the corporations that have the means to treat this interruption like a snow day is the worst possible way to do it.Report

    • Avatar DensityDuck
      Ignored
      says:

      The assumption is that the “pause button” actually is a pause button, and not “let’s look at this as a chance to make a bunch of moves we always wanted to make anyway”.

      This applies to more than just corporations. I’ve seen soooooo many takes to the effect of “we need to change (thing) to reflect the Coronavirus Crisis, and the crisis will show how we never needed (thing) all along!”Report

    • Avatar Urusigh
      Ignored
      says:

      “Pressing “Pause” on the economy *IS* the best play.”

      We don’t know if it is. As the article points out, neither vaccines or herd immunity are guaranteed, so it’s not actually safe to assume an end state of “we beat the virus, NOW the economy can reopen”. As you noted, people need to have jobs to come back to, and even the best way government can address that (I agree that the measures thus far are, shall we say, poorly designed) isn’t all that good.

      We can’t actually print money without limit and resuscitate businesses that have been shuttered too long to maintain worker skills and supporting supply chains. The defining trait of most business is that money is made only when money is moving. “Pause” held too long is functionally indistinguishable from “Stop”. That’s going to have drastic impacts on worker health, wages, and lifetime earning potential all by itself, with corresponding shocks to the political system as the wealth gap between generations grows and the youth face a future where they not only make less than their parents, but never even catch up to them. At the same time, GDP is going to be down and so are revenues, so gov literally won’t be able to afford the explosion in safety net spending. Entitlement programs were already within a generation of going broke, it’s unlikely they’ll be sustainable as is, and that too will force some hard political choices and backlash.

      Whether it’s right now, next month, or a bit further down the line, voluntary compliance isn’t going to hold. We’re going to need a plan to get the country running, even under pandemic conditions, to the greatest extent feasible while otherwise maintaining strong mitigation measures. The sooner we manage that, the less long term pain we may be in for.Report

      • Avatar Stillwater
        Ignored
        says:

        “Pressing “Pause” on the economy *IS* the best play.”

        We don’t know if it is.

        I think the idea that the economy has paused by the active decision of a centralized authority needs to be reconsidered, myself. Suppose that gummint issued the decree today to Open Up The Economy? Would the disposable income-driven sectors suddenly restart? Personally, I don’t think they would, at least at a level sufficient to keep businesses afloat without bailouts/subsidies. The vast majority of people aren’t gonna put their kids back in schools; they aren’t gonna go to restaurants; they aren’t gonna fly to Europe; etc etc. Folks are (justifiably) scared.

        I mean, I’m all for a hybrid model where policy straddles a line between elevated risk of contagion and keeping the economy chugging along, but it seems to me that the added risk of contagion isn’t worth the almost negligible added economic value. Short of a vaccine or symptom ameliorating drug (like what Remdisivir proposes) our best strategy is to focus on the antibody testing side of the equation.Report

        • Avatar Urusigh
          Ignored
          says:

          “I think the idea that the economy has paused by the active decision of a centralized authority needs to be reconsidered, myself.”

          A fair point, I’m rather lumping “Government” at all levels together in this. State Governors and legislatures are likely the more critical pivot in this regard than anything the Federal Government tries to do.

          “Would the disposable income-driven sectors suddenly restart? Personally, I don’t think they would, at least at a level sufficient to keep businesses afloat without bailouts/subsidies.”

          I suspect that many businesses would at least be operating at less of a loss than that imposed by completely closing. As has been noted many times elsewhere, a lot of the more recognizable brands can afford to operate at a loss for some time. Likewise, we’ve almost certainly already lost some percentage of businesses that were marginally profitable to begin with, so anything that reopens is likely to benefit from inheriting a larger market share than they had previously, which in some cases will be sufficient to offset reduced customer demand from those still voluntarily sheltering (e.g. even if half the people who used to shop stay home, that’s enough customer base to sustain half the shops that used to be open). It’s not going to work everywhere and there will still be a lot of pain in any scenario, but the more community anchors running provides that much more solid a base for others businesses to return to a functioning market and that many more employees who still have paychecks in pockets to frequent them. It won’t be like it was, but there’s a lot of businesses out there that could survive even with mandatory 10ft spacing between customers, simply by using apps to schedule a more consistent stream of customers instead of the usual busy/quiet cycles throughout the day (e.g. flatten the usage curve). Even theaters could be running a few showings (with at least 12hr between each use of a given showroom, since that seems to be the limit for how long COVID-19 survives on a surface). I’d much rather that we were finding safe ways to do things occasionally rather than give up on doing them at all.

          “I mean, I’m all for a hybrid model where policy straddles a line between elevated risk of contagion and keeping the economy chugging along,… ”

          You and me both.

          “…but it seems to me that the added risk of contagion isn’t worth the almost negligible added economic value.”

          Here I disagree. We don’t have very good data on what exactly that “added risk of contagion” actually is and the prospective added economic value is far from negligible. There’s no fix out of this situation that isn’t going to be ruinously expensive one way or the other, but a functioning economy provides a lot more revenue and less need for gov aid than a shuttered economy. No one wants to see the need exceed availability for hospital beds, but there’s also the very real risk of another Great Depression leaving us with needs exceeding availability in social spending. I don’t like most social spending (a “social safety net” should be a ladder, not a hammock), but even if every entitlement reform republicans ever dreamed of were passed immediately the necessary programs are still going to severely strain, if not break, the budget if things continue the way they are now. Despite what certain fringe economists say, there IS a limit to deficit spending both in terms of uncontrollable inflation and the simple fact that the rest of the world is in no shape to continue financing our debts.

          “Short of a vaccine or symptom ameliorating drug (like what Remdisivir proposes) our best strategy is to focus on the antibody testing side of the equation.”

          You may well be right. I suspect that in the short term we may need to simply rely on finding and productively employing the people with the highest baseline general health. AFAIK COVID-19 is primarily dangerous not as the cause itself, but via aggravating existing health problems, so there may be potential in recruiting upfront the people most likely to become asymptomatic or only mildly affected (until we can bring online effective treatment and/or sufficient detection to catch and handle more severe cases) and continue building cut-outs into the chain of contact to limit possible transmission vectors. We need to be doing what we can with the things we do control, not freezing in fear indefinitely waiting on cures that may not come.Report

    • Avatar Swami
      Ignored
      says:

      “Pressing “Pause” on the economy *IS* the best play. But that means that the paused people need to have a job to come back to and giving money to the corporations that have the means to treat this interruption like a snow day is the worst possible way to do it.”

      I disagree. We should never have paused the economy. Water under the bridge now, of course.

      What we should be doing now is a two tiered approach of (voluntary) quarantining anybody in an at risk category (those with asthma, diabetes, heart disease, immune deficiencies, severe obesity, old age, etc) into houses, apartments, etc with virtually no exposure to the outside. IOW, true lock down for those most at risk. This should be funded and coordinated by governments and families and charities.

      The younger and healthier among us should be encouraged to work within social distancing protocols (masks, six foot distance, plexi glass shields, no cash transactions, no crowds, no meeting rooms, automatic doors, disinfect at entrance and exit, careful work place monitoring and eventually measuring, etc)

      We should be straddling reasonable and safe working along with even safer lock downs for those at risk.

      The government should then focus on supporting the at-risk, enforcing reasonable social distancing (this doesn’t include Malibu paddle boarders), measurement, and facilitating cures and vaccines.Report

      • Avatar Michael Siegel
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        says:

        This is what Sweden is trying. And it’s not working. And the risk for young people is quite dramatic, not just in terms of serious illness but long-term injury.Report

        • Avatar Stillwater
          Ignored
          says:

          It’s also what Britain tried. Right up until the lockdown.Report

          • Avatar Michael Siegel
            Ignored
            says:

            Yep. And their rate of infection and death is much higher than Ireland, which has a similar timescale but closed down quickly.Report

          • Avatar Urusigh
            Ignored
            says:

            Are you sure about that? I did some quick looking and here’s what I found:

            Swami’s proposed mitigations, which I’ll dub “Plan A”: True lock down for those most at risk. This should be funded and coordinated by governments and families and charities. The younger and healthier among us should be encouraged to work within social distancing protocols (masks, six foot distance, plexi glass shields, no cash transactions, no crowds, no meeting rooms, automatic doors, disinfect at entrance and exit, careful work place monitoring and eventually measuring, etc).

            vs

            Britain’s original guidance, which I’ll dub “Plan B”: Boris Johnson held a press conference and announced new measures to tackle Covid-19. People who developed symptoms, however mild, were advised to stay home for seven days. Those over 70 were told not to take cruises, and schools were advised against international trips. The government was considering banning major public events, but did not do so. Schools, pubs and restaurants stayed open, in a major deviation from other countries around the globe.

            and

            Britain’s lockdown guidance, which I’ll dub “Plan C”: On Monday (March 16) the government dramatically changed course. Anyone with a fever or persistent cough was told to stay home for seven days if they live alone, and 14 days if they live with others. If one person in a household displays symptoms, all family members stay home for 14 days (family quarantine). People were told to stop non-essential contact with others, with a special emphasis on those over 70, those with underlying health conditions and pregnant women. The population was told to work from home if possible, avoid pubs and restaurants and theaters, and stop unnecessary travel. Schools would remain open, for now anyways.

            Swami’s Plan A is drastically more restrictive than Britain’s initial Plan B posture and in some ways still more restrictive on those still working than even Britain’s lockdown Plan C, while more generous to those quarantined (AFAICT on first check, Britain’s lockdown does not explicitly offer government funding to support the vulnerable populations on lockdown).

            It’s also not the same as Sweden’s approach, which set the crowd limit at 500 people and still had bars open and old folks wandering around public squares. That’s not the same at all as Plan A’s enforcement of social distancing and “virtually no exposure to the outside” for those most at risk. Both of those countries were originally permissive on both quarantine AND other mitigation strategies, whereas Swami proposed strict lockdown of the most vulnerable (even moreso than either of those countries are now) while the healthy continue business under much stricter non-lockdown mitigation measure than either country are currently even proposing, much less employing.

            So no, this isn’t “what Britain tried” or “what Sweden is trying”. That’s like comparing weekend paintball teams to special forces rangers: they look a little alike from a distance, but they are very unalike in effectiveness. I think Swami has the right of it.Report

            • Avatar Chip Daniels
              Ignored
              says:

              I don’t necessarily disagree with Swami’s proposal, since on its face sounds reasonable. However, maybe a real epidemiologist might have more profound issues, but lets put that aside for the moment.

              What strikes me is that what makes this proposal so reasonable is its assumption of near-unanimous compliance, and fragility.
              By fragility I mean that all the pieces are needed to work together; if only one or two pieces have significant amounts of noncompliance, the whole edifice collapses.

              Which is why oftentimes brutal hamfisted approaches are more robust; It may be unjust to say a single paddleboarder can’t use the beach, but enforcing a total ban on beaches is easier than parsing out the complex contours of “You can use it, but not you, and for this purpose and not that purpose”.

              If America had a culture of deference and obedience to authority where complex sets of rules could be disseminated and complied with, this would probably be fine.

              But we have a culture of “Screw you, Ima lick every doorknob in the office because you’re not the boss of me!”Report

              • Avatar Swami
                Ignored
                says:

                My guess is that we will be seeing something similar to this going forward.

                Governments do hamfisted real well. On the issue of surfing, a reasonable approach is to allow people to participate in individual, isolated activities. What should be prohibited are crowds and parties. These could be controlled partially by restricting parking, restricting peak hours or just stepping in and closing beaches and parks on high traffic days (as I stated last week, the issue with crowds is that it is an emergent quality, not an individual transgression).Report

              • Avatar Urusigh
                Ignored
                says:

                I’d say that the emergence of speakeasies already argues that lockdown measures are perhaps even more fragile and prone to eventual noncompliance. Swami’s approach may actually be better in this regard: gathering the most vulnerable in government controlled (and financed) quarantine is perhaps more authoritarian than I’m necessarily comfortable with, but it would enable closer monitoring and enforcement while removing the financial incentive for those without savings to break lockdown. Likewise, requiring masks and sanitizing for ALL people out and about would likely exert a strong social norm of compliance in that regard. As we’ve discussed previously, if you can get ~80% of people to socially enforce a norm, you can get near full compliance from the rest simply through peer pressure. I’d say Swami’s plan has a much better chance of long-term compliance than trying to sustain lockdown measures on everyone for even another 3mo, much less the 18mo some people are calling for.Report

              • Avatar Swami
                Ignored
                says:

                More than another month or so, and they might as well ask us to pen the next installment of civil disobedience.Report

            • Avatar Swami
              Ignored
              says:

              Thanks, you said it better than I did.

              I am not suggesting anything like what Sweden did(as best I can tell.) I am suggesting substantially better quarantining and substantial better social-distancing-while-working than exists in the US today.Report

              • Avatar Stillwater
                Ignored
                says:

                Well, if we can use hindsight I think we’d *all* create better plans than the ones which were actually implemented, yes?

                “Latex gloves, N95 masks, full face shields and Tyvek suits for all waitstaff!” 🙂Report

              • Avatar Swami
                Ignored
                says:

                All joking aside, then do you agree going forward that this is a better strategy?Report

              • Avatar Stillwater
                Ignored
                says:

                No, I wrote about that in my initial reply to Urusigh. I don’t think inconsequential economic gains are worth the risk of increased spread of the disease. Going forward, we need positive results on antibody testing and risks of reinfection and so on.Report

              • Avatar Swami
                Ignored
                says:

                We perhaps differ on the issue of “insubstantial” economic gains. I believe the country (or world) is at risk of getting trapped in a period of twenty percent plus unemployment, massive default on debt and mortgages, the collapse of government (and perhaps private) pensions. I don’t think this is insubstantial.

                And I strongly believe my plan would flatten the curve and result in substantially fewer deaths than yours. Yours is less protective of those most at risk and no better at protecting the healthy, at least longer term.

                Are you sure you are grasping how much more I am suggesting for those at risk?Report

            • Avatar Stillwater
              Ignored
              says:

              You left out Boris Johnson’s plan A, only citing his revised plans as the epidemic predictably spread.

              I’m genuinely surprised that people don’t remember this plan, or weren’t aware of it. Here’s a summary of Johnson’s initial plan A on dealing the coronavirus found at an MIT journal published on March 16:

              The background: Last week, Prime Minister Boris Johnson announced that his country would adopt a different coronavirus strategy from the ones its European neighbors have followed. Most governments have sought to suppress the spread of the virus by reducing mass gatherings, imposing quarantine restrictions, and encouraging social distancing. But Johnson said the country would forgo such measures with an unusual plan to prevent the outbreak from overwhelming the health-care system and protect the most vulnerable groups during peak infection seasons. Under the strategy, at least 60% of the population were expected to contract the virus and get better—mostly younger individuals who would face only a mild form of illness. The government believed this would result in a “herd immunity” that would subsequently protect vulnerable groups from infection, while avoiding “behavioral fatigue” that would cause people to stop cooperating with safety measures over time.

              Report

              • Avatar Swami
                Ignored
                says:

                This is the antithesis of what I am suggesting. What can I do to clarify this?Report

              • Avatar Stillwater
                Ignored
                says:

                I see that you were saying something different now, maybe because you’ve gone into more detail about it, possibly because I didn’t read your initial comment correctly. You’re basically advocating for social distancing-PLUS (with protective gear) rather than stay at home orders. My concern is that there are no customers for the goods/services which those employees would be creating/providing. Hence my joke about waitstaff wearing the full HazMat suit when they bring you your food. Maybe I’m wrong but I just don’t think many people will want to eat out during a pandemic.Report

              • Avatar Swami
                Ignored
                says:

                I wouldn’t eat out either. I would certainly order take out where they deliver it curbside or order delivery. Indeed I have done so at least ten times so far.

                Let me clarify that I am objecting to stay at home orders for “non essential businesses” as has been the case in California for some time now. I understand that social distancing effectively shuts down some businesses as they operate today. There will be no nose-hair trimmer jobs for a while.Report

              • Avatar Urusigh
                Ignored
                says:

                “Deliberately let healthy people get sick so herd immunity develops” is pretty much the opposite of Swami’s “enforce every possible mitigation on healthy people besides keeping them home”. Those don’t share either method or intent in common.

                Which is not to say it wasn’t a possibly better approach if the implementation had been better and certain unknowns were known. Some diseases of this kind vary in their severity based on both initial infection vector (i.e. did it get in the lungs via breathing or into the blood via a cut?) and initial concentration of exposure (e.g. live vaccine vs someone coughed in your face). It’s entirely possible that deliberately exposing people to the smallest sample of the virus in the right way would result in only mild or asymptomatic cases followed by immunity (for at least a year or more until it mutates). That would certainly be better overall than the results our methods are getting…if it worked. It’s one hell of a high risk/high reward gamble to take with an entire country though. Not my preferred strategy, but I can understand why someone would try it.Report

          • Avatar Swami
            Ignored
            says:

            If you think what I am suggesting is anything similar to GB, then I have not been clear enough. My approach is more dramatic on protecting those at risk and has more serious social distancing. The only similarity is that it doesn’t require stay at home (not working) for the young and healthy.

            I understand that I did not spell out the severity of my social distancing recommendations very well or give details on how I would support the at risk. But they would be extreme.Report

        • Avatar Swami
          Ignored
          says:

          Let me clarify…

          You are suggesting that Sweden has been doing the following for a month (the amount of time it requires to bend the curve)….

          1) Has been requiring masks for those in public?
          2) Has prohibited all mass transportation?
          3) Has required sanitizing hands as they enter and leave all places of business as employee or customer?
          4) Has prohibited all gatherings, parties, Concerts, churches, crowds, in store dining, and bars?
          5) Has required protocols to protect cashiers from customers (credit/shields/gloves, etc?)
          6). Has required taxis and ride sharing to sanitize after every use and build protective barriers between the driver and passenger?
          7) Has closed schools?
          8). Has required businesses to test employees (as best possible at the time) and maintain records of illness?

          Second, I do not believe Sweden has created a coordinated process for the at risk to get true quarantining. Not even close. I believe they have simply suggested they stay home. Not the same thing.

          Please correct me if I am wrong.

          But I totally disagree that the mortality risks of CV are worth shutting down the economy for those outside of the at risk groups. 95 to 99% of all deaths are occurring to those with one or more high risk factors. Masks, gloves, and extreme social distancing As I am recommending for the rest of us will decrease the death rate for the non high risk to a rate LOWER than a regular Business as usual flu year.Report

          • Avatar Michael Siegel
            Ignored
            says:

            “But I totally disagree that the mortality risks of CV are worth shutting down the economy for those outside of the at risk groups. 95 to 99% of all deaths are occurring to those with one or more high risk factors.”

            40% of the population has “high risk factors”, including several of the 50-and-under authors of this blog. And even those who don’t die get very seriously ill. Weeks of convalescence. This is a really bad talking point.Report

            • Avatar Swami
              Ignored
              says:

              Then those 40 percent should stay home and get better isolation and support than they get today. And this includes a significant portion of my family (asthma, diabetes, over age 88, etc). Indeed I am supporting a total lock down of some of these family members and offering to do so for some of the others.

              Your argument is that everyone should do a half axed lock down. Mine is that 40%? Should do it right and the others should work with substantially smarter social distancing.

              How is your better?Report

              • Avatar Swami
                Ignored
                says:

                I can’t access this article. Can you summarize it for me?

                I will add though that anyone reading my suggestions on extreme social distancing as “just isolating the elderly and vulnerable” is not comprehending what I am suggesting.Report

              • Avatar North
                Ignored
                says:

                Mcardle’s got a few points in this article:
                -The first, that you’ve already addressed, is that there’re a lot more risk factors so the number of people who’d have to severely isolate is a lot higher than most people who suggest just isolating the vulnerable accept.
                -The second is that self-isolating will be almost impossible for people if the virus is able to rage through the population who isn’t vulnerable since the infection vectors will quickly encompass the delivery people and other non-vulnerable people who’d enabling the affluent vulnerable people to self-isolate.
                -Her third point is that a vast number, quite possibly the majority, of vulnerable people don’t have the economic wherewithal to self-isolate like you’re suggesting- they live in multigenerational homes, or group homes or otherwise simply don’t have the money to keep themselves apart for the population in effective self-isolation, especially given her second point.
                -And her last point is any attempt to assist the vulnerable alone to self-isolate, like setting aside housing for them or any similar effort, would simply group them together where the virus would take the whole group by storm when it inevitably snuck in.

                And, macabrely, her Dad who was isolated in a cardiac rehab home, is now infected with the virus which snuck in via some vector.Report

              • Avatar Swami
                Ignored
                says:

                Thanks, North! This really helps improve the discussion…

                “-The first, that you’ve already addressed, is that there’re a lot more risk factors.”

                Check.

                “-The second is that self-isolating will be almost impossible”

                I am specifically and emphatically NOT suggesting self isolating. My suggestion is for the government, families and charities to provide and facilitate near total quarantining for the vulnerable. This would be a huge investment in infrastructure (albeit temporary). Think more “Manhattan Project to protect the vulnerable”, than “encourage grandma to stay home.”

                “…the majority, of vulnerable people don’t have the economic wherewithal to self-isolate like you’re suggesting.”

                Which is why I am supporting a coordinated government plan to fund and support their isolation. This would be expensive and require millions of people to support it logistically.

                “…any attempt to assist the vulnerable alone to self-isolate, like setting aside housing for them or any similar effort, would simply group them together where the virus would take the whole group by storm when it inevitably snuck in.”

                OK. This is a valid point. However I am not sure I buy her logic. I certainly agree we should not be grouping people together. We should even try to separate out some of those who are currently grouped together. However, if there are vectors — and there are — we can control them better through a real quarantine process than by half measures and the current stay at home requirements for non essential workers.

                The current process is just a ticking time bomb for the elderly and the economy.Report

              • Avatar North
                Ignored
                says:

                Well I, myself, don’t exactly think on McMegans wavelength. She’s enormously more libertarian than I am. But if we’re talking about housing and grouping vulnerable populations en masse in government operated quarantine/housing facilities. I.. uh… gotta admit that I think her point seems pretty solid to me. The virus has a very stealthy no-symptom contagious mode and this would both heighten the odds of if it breaching a state run quarantine community and then absolutely rampaging within it.

                And on top of that it’d be absolutely crazy, insane, wildly expensive to build such a thing.Report

              • Avatar Swami
                Ignored
                says:

                I bet we could build it for one tenth of three trillion dollars!

                On a more serious note, isn’t it kind of an odd argumentation tactic for her to shoot down a recommendation for improved quarantining of the at risk based on the fact that the current system — which I am arguing against — failed her grandpa? That said, she makes a great point that we need to be careful about putting the vulnerable together.

                Thanks again for the great feedback, it was helpful. Really.

                I still think the path forward will be much smarter social distancing (The fact that experts were CONDEMNING masks was borderline criminal), combined with even better quarantining of those most at risk. I will trust the experts on when we should move from lock down to the next phase.Report

              • Avatar North
                Ignored
                says:

                Yeah, happy to help, but government organizations haven’t exactly covered themselves in glory in this disaster either. I suspect saying “let’s trust the government to build and house all our vulnerable populations in government run quarantine facilities” would be a tough sell. Definitely before this mess blew up and probably even more definitely now. I wouldn’t trust the Trump administration with the feeding and care of a hamster, let along care of my elderly mother.Report

              • Avatar Dark Matter
                Ignored
                says:

                I bet we could build it for one tenth of three trillion dollars!

                17% of the population is age 70+, or something like 56 million people.

                For perspective, we have something like 560,000 homeless.

                California is planning on dropping a billion dollars on the homeless problem and will probably house about 2k of them.

                If we assume 10% of those age 70+ people need gov assistance in hiding out in the “safe” zone, then we’re thinking that the gov can house 10x as many homeless, basically overnight.

                Not only do I not believe the gov has the resources to do this, but I don’t think the economy has the resources to do this.Report

            • Avatar InMD
              Ignored
              says:

              Concur. The ripple effects need to be accounted for. Even folks like my wife and I who are healthy Xennials could be knocked out of economic activity if our boomer parents got sick. Hell each of us still have a grandparent alive. I doubt we’re particularly unique in having numerous high-er risk loved ones we could be called on to assist.Report

            • Avatar Stillwater
              Ignored
              says:

              And even those who don’t die get very seriously ill. Weeks of convalescence.

              With potentially long term consequences to the lungs and other organs that negatively effect overall health.Report

      • Avatar Windypundit
        Ignored
        says:

        I think this is better as a post-lockdown step. We didn’t have enough testing capacity, PPE, etc to do this right now. Let’s keep hammering the case rate down to where we have enough PPE for healthcare workers, then make sure we have enough procedure masks, hand sanitizer, and bleach wipes for everyone. Then maybe we can operate most of our economy without causing another explosion of infections.Report

  2. Avatar DensityDuck
    Ignored
    says:

    The thing that the “HURD IMOONIDY” crowd doesn’t seem to understand is that without a vaccine, the only way to achieve herd immunity is for everybody to get the disease, and these diseases fucking kill you, or leave you permanently crippled. You don’t just walk away from COVID-19, you have permanent lung damage and sensitization to subsequent exposure with a reaction similar to allergy. You don’t just get past polio or smallpox with nothing more than bad memories and good stories. “Well, they ought to be working on a vaccine then!” They are, Doctor House, but that’s not something you produce just by wanting it real bad, and in the meantime the only options are “get the disease” and “don’t get the disease”.

    As for the But Sweden thing, I had an amusing exchange with some jabroni on Twitter where someone claimed that Sweden’s death rate was actually much lower than the report shows because Sweden had far less testing capability and most of their cases were unreported. He considered this a favorable statement about Sweden’s plan.Report

  3. Avatar Oscar Gordon
    Ignored
    says:

    If the current efforts in the US fall short, it won’t be because of rhetoric about Sweden, it’ll be closer to Em’s post.

    And even if we do come out of this without serious mass death/critical cases, the next pandemic response (should it happen in living memory, and it probably will) will be seriously hampered because of the ineptitude of state and local governments today.Report

    • Avatar Stillwater
      Ignored
      says:

      the next pandemic response (should it happen in living memory, and it probably will) will be seriously hampered because of the ineptitude of state and local governments today.

      Hmm. I have literally the exact opposite view of this. The lesson I’ve learned from this pandemic is that despite a federal government that’s worse than incompetent and obstructs state-level efforts to deal with this pandemic, some (not all) states have demonstrated highly effective, competent governance. The lesson will (or should) be that federalism works.Report

      • Avatar Oscar Gordon
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        says:

        I’m thinking law enforcement response to citizens, rather than public health responses to the disease itself. Although in a lot of cases, public trust of health experts is going to take a hit on this regardless of the outcome.Report

    • Avatar Dark Matter
      Ignored
      says:

      Restock the protective equipment reserves and keep them stocked, change the FDA regs that make it impossible to make tests quickly, increase the reagents that those tests use and stock them too.

      Basically we’re done right there.Report

  4. Avatar Saul Degraw
    Ignored
    says:

    Another important thing to note is that some countries switched from contact tracing and mass testing to lockdown/shelter in place. Singapore is the prime example here.

    The United States is generally too distrustful for contact tracing. The CAP and Harvard plans to “reopen the economy” involved contact tracing efforts that would get the majority of Americans to say no. Paul Romer’s plan involved performing 22 million tests for COVID a day. We are far from being able to do that.

    And then there is mass politicization where California and New York’s tactics are rejected essentially to own the libs.Report

  5. Avatar Aaron David
    Ignored
    says:

    Sweden was neutral during WWII, yet its economy took a drastic hit during that period. Why? All of Europes economy was massively damaged during this period, and Sweden is a part of Europe. Thus it stands to reason that it’s economy would take a massive hit right now, regardless of what it did in relation to the Corona virus.

    But, we should look at some more data here, no? As far as Deaths/1milion goes, Sweden currently sits at 90.2 and while this is greater than the US, comparing it to other European countries, especially those who have gone full lockdown is illuminating. Spain- 374.3. Belgium- 341.7. Italy- 329.3. France- 214.9. UK- 170.4. Netherlands- 163.8. Switzerland- 132.6. Luxemburg- 108.6. And to be sure, there are countries that have fared much better; Ireland 68.8, US- 67.7, Potgugal- 52.0, Denmark-49.2, Austria- 49.6, Germany- 36.8. And other countries are much less.* So, did something else effect the spread of Corona?

    Untill a massively available, cheap test is out there to test whether or not someone has or has had the virus, we still do not know the rates of spread for this disease. We don’t know how deadly it is until we have a much better idea of how many people have had it and gotten over it, undetected and unscathed. There are already reports that the virus had been floating around on the west coast since at least December.

    “This wasn’t recognized because we were having a severe flu season,” Smith said in an interview. “Symptoms are very much like the flu. If you got a mild case of COVID, you didn’t really notice. You didn’t even go to the doctor. The doctor maybe didn’t even do it because they presumed it was the flu.”

    Just as New York has strong ties to travelers from Europe, who are believed to have brought the coronavirus there from Italy, the Bay Area is a natural hub for those traveling to and from China. Santa Clara County had its first two cases of COVID-19 almost a week before federal approval of emergency testing for the disease Feb. 4. Both were in travelers returning from Wuhan, China, where the virus was rampant.

    https://www.latimes.com/california/story/2020-04-11/bay-area-coronavirus-deaths-signs-of-earlier-spread-california

    All of this is to show that it is, at this point, simply unknowable as far as what effects of Social Distancing, Shelter-In-Place and other restrictions have had on two of the three most importand issues surounding COVID, physical health and economic growth. And as we have seen in EM’s post yesterday, civil liberties are taking a vicsious beating. All three of these points of conflict must be taken into account, and what works in one country will not necessarily work in another.

    *https://www.realclearpolitics.com/coronavirus/
    Yes, these numbers could change dramatically by tomorrow. Either way.Report

  6. Avatar JS
    Ignored
    says:

    “Herd immunity has not protected us from past coronaviruses at all. We just didn’t notice because no one worries about a cold killing them”

    Okay, you’re conflating a lot of crap there. First off, the “common cold” is actually the result of some 200 or so viruses.Half of them are rhinoviruses, with at least four species and — as noted — lots of strains. You do get immunity to them, sometimes for many, many years. That doesn’t make you immune to the other 199.

    Second, there are 4 different common human coronaviruses. (And now three less common). And they’ve been studied a lot — especially after SARS — including immune response. And the general gist is the antibodies hang around for one to three years, at a minimum.

    There’s no reason to think this one is different. As for comparisons to flu and worries about mutation — flu has a nifty little trick, fairly unique to it, where it plays fun games with it’s own surface, basically having a little swap meet with other flu strains, that lets it evade immune response. Coronvavirus doesn’t have this.

    Please don’t conflate the 200 freaking different viruses that constitute the “common cold” with the flu. It leads you into drawing incredibly incorrect conclusions.

    We don’t have a vaccine for the common cold because it’d be 200 different vaccines. We don’t have a vaccine for any of the common human coronaviruses because they weren’t worth the time or effort, although some work has been done on a ‘universal’ vaccine (trying to find some points of commonality among the various strains, to prevent exactly what’s happening now, but that’s a VERY different prospect than a simple vaccine against a single strain).Report

    • Avatar Brent F
      Ignored
      says:

      Coronaviruses aren’t the super mutators that influenza is, but they have a very unstable genome for a virus, basically at the biological limit for genome size for an RNA virus and evolve fairly rapidly. There’s very good reason to think there will be new strains, potentially different enough that previous exposure does not confer immunity a year or two down the line, particularly with how widespread the virus has gotten.Report

    • Avatar Michael Siegel
      Ignored
      says:

      Yes, this is a subtlety I didn’t want to get into. There was a good twitter thread by a virologist on why, while we have coronavirus vaccines for dogs and horses, we don’t have one for humans. Basically, it would protect us from about 10% of colds and only for a few years. So no one would get it. COVID-19 has change the math quite a bit. What I was pushing back on is the idea that once we’ve all had it, we’ll be immune to it. Like the cold coronaviruses, it could come back in a few years and we’d have no protection.Report

  7. Avatar JS
    Ignored
    says:

    “Coronaviruses aren’t the super mutators that influenza is”

    Flu isn’t really a super mutator. It’s just got a nifty trick for swapping it’s coat with any flu strain it meets. It’s the equivalent of repainting a car, or swapping out your mirrors or taillights for another cars. Nothing significant changes, just the bits the human immune system uses to “see” it.

    It’s more “one neat trick” and not “super-adaptive mutating nightmare”.

    ” but they have a very unstable genome for a virus, basically at the biological limit for genome size for an RNA virus and evolve fairly rapidly””

    And this is ALSO wrong. (https://www.businessinsider.com/new-coronavirus-mutates-slowly-vaccine-could-be-long-lasting-2020-3)Report

    • Avatar Brent F
      Ignored
      says:

      Dude, I said it doesn’t mutate like the flu does, as you correctly pointed out, nothing mutates like influenza to avoid immune response because as you correctly noted, influenza has a unique trick for swapping code to present different antigens. The problem here is you’re citing a web magazine piece when you should be consulting the journal literature.

      What your source isn’t telling you which is relevant is that corona is still a fairly mutatagenetically prone virus. Coronaviruses are amoungst the largest single stranded RNA viruses known

      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3185738/

      They have some RNA transcritption editing capacity, which allows them to be of a large size than other single stranded RNA viruses, but that capacity is used up by their greater genome size, such that coronaviruses are pretty much at the limit of viability due how close their are to their catastrophic limits.

      https://journals.plos.org/plosbiology/article?id=10.1371/journal.pbio.3000003

      Now we haven’t seen much by the way of mutation into distinct strains yet, although some has occurred. But the biology of coronaviruses is such that we should suspect a reasonable likelihood of mutation into new strains that potentially can undermine resistance. This is a case where evolving 2 to 4 times less than influenza isn’t all that great a comfort, because you’re comparing to pretty much the fastest evolving type of virus that infects humans, as it is coronaviruses still evolves plenty fast.Report

      • Avatar JS
        Ignored
        says:

        Did you not bother to read the link I posted? They’re not fast mutators, and neither is COVID-19. It’s spread far enough and fast enough to get a grip on it’s mutation rate.

        Why make up trouble when there’s plenty of actual problem here?Report

        • Avatar Brent F
          Ignored
          says:

          I read the article you posted.

          I also went to school for related subjects for quite a bit and don’t rely on the business press as a source on virology.Report

  8. Avatar Kristin Devine
    Ignored
    says:

    I still remain baffled by the number of people who purport to think there wouldn’t have been any negative effect on the economy if not for the quarantine.Report

    • Avatar Urusigh
      Ignored
      says:

      As I remain baffled by the number of people who seem to think there wouldn’t have been any mitigation effect on the spread if not for the quarantine.

      The economy can mostly function with everyone wearing masks, compulsively sanitizing everything, and maintaining a 6ft bubble of personal space at all times, even with unusually large numbers of people simultaneously on sick leave (quarantining those suspected or confirmed to be infected). It’s the shelter-in-place orders (and executive action closing businesses/restricting “non-essential” products) that make a difference of type (stopping transactions) rather than degree by merely increasing transaction costs in time, money, and inconvenience (slowing transactions). The economy was going to take a beating either way, but metaphorically speaking, bruises and even broken bones are ultimately less dangerous than being choked out of oxygen. We can only hold our breath for so long before the treatment literally becomes worse than the disease.Report

      • Avatar Swami
        Ignored
        says:

        I agree completely. There is a middle ground of extremely prudent social distancing which would be more effective — all things considered — than shelter in place.

        We should support substantially better shelter in place for everyone at extreme risk, and have substantially smarter social distancing protocols (while still working) for those younger and not at high risk.Report

        • Avatar Stillwater
          Ignored
          says:

          There is a middle ground of extremely prudent social distancing which would be more effective — all things considered — than shelter in place.

          Here in colorado all hardware and building supply stores are open, grocery stores and lots of other retailers are open, the construction trades are still going, city workers are still working (natch), lawyers/accountants/programmers/architects/etc are still working (from home); etc etc. Maybe this is the *best* balance possible. ???

          I’m personally bummed that chiropractors are shutdown. I need some bones cracked….

          Check this out. The biggest job losses during March 2020 *by miles* were in leisure and hospitality, which are precisely the kind of easily avoidable activities people will continue to avoid even if we ramp up protective gear.Report

          • Avatar Oscar Gordon
            Ignored
            says:

            I’d love for the construction trades to get restarted here in WA. We are past the point where we need large teams on site. One tradesman at a time is sufficient since it’s all finish work, and we are already setup to segregate us from the workers.Report

      • Avatar DensityDuck
        Ignored
        says:

        “The economy can mostly function with everyone wearing masks, compulsively sanitizing everything, and maintaining a 6ft bubble of personal space at all times”

        But, as I said in the other post, without extreme measure people wouldn’t take any of that seriously. They’ll maintain a 6 foot bubble except, like, when you’re at the store, and the aisles are too tight to be doing that, and as long as nobody’s actually coughing it’s okay right? And they just don’t touch anything, at least not so much that they remember doing it, and just door handles and stuff anyway and they’re sure that’s okay right? After all it probably doesn’t really stick to those surfaces anyway. And they don’t think a mask really helps and it’s hard to wear those and they’re uncomfortable and they keep fogging their glasses and they’re sure it’s okay anyway right? Right? And hand sanitizer always has scent in it that aggravates their migraines and the store was out of the wipes they like and you can’t expect them to stay in the house all day for something that’s not even that big of a deal, right?Report

        • Avatar Swami
          Ignored
          says:

          Great example of assuming what we are doing today works perfectly and exactly as intended and that what we are suggesting will have holes, and human error and unintended consequences.Report

        • Avatar Urusigh
          Ignored
          says:

          Non-compliance is going to be an issue with any proposed measure, lockdowns included. That’s not a reason to not make the base policy the smartest it can be. These ARE extreme policies. Frankly, if your main objection is something that can be addressed by a public awareness campaign, then go ahead and add that to the plan. There’s plenty of ways to convey “this is serious” while still pushing only policies that are actually justified on their own merits.Report

          • Avatar DensityDuck
            Ignored
            says:

            “Non-compliance is going to be an issue with any proposed measure, lockdowns included.”

            i’m glad you agree with me that noncompliance is gonna be a problem but i’m not sure why you seem to be thinking it’s an argument in favor of a higher-risk policy

            like, if I don’t comply with “stay at home”, then everyone who does comply (by staying home) is not at risk. if I don’t comply with “stay six feet away, wear a mask, wear gloves, sanitize things you touch” then every person around me is at risk of catching whatever viruses I’m shedding.

            I’m absolutely in favor of “noncompliance happens so we need to identify the outcomes of the undesirable behavior and the costs of mitigating those before we spend money on enforcement” reasoning, but I think we don’t have to analyze too hard to figure out what the outcomes of the undesirable behavior and the costs of mitigating those are in this instance. Every hospital is full of examples.Report

    • Avatar DensityDuck
      Ignored
      says:

      “I still remain baffled by the number of people who purport to think there wouldn’t have been any negative effect on the economy if not for the quarantine.”

      They honestly think that everyone over the age of 60 dying in a hospital quarantine ward is preferable to burger-flippers losing their jobs.Report

      • Avatar Swami
        Ignored
        says:

        Rude and malicious comment, Duck. Try reading what we are suggesting rather than assuming bad intentions, and it might facilitate a bit better discussion.

        Better yet, how about an apology?Report

        • Avatar DensityDuck
          Ignored
          says:

          Eat my ass. You think that minimum-wage jobs are so terrifyingly vital to the economy that you’d kill millions to keep them in existence. You are so desperately focused on forcing poor people to dance for your amusement that you would ignore the stink of a mountain of corpses. I have no respect for you, or for your position.Report

        • Avatar Chip Daniels
          Ignored
          says:

          Well, to be fair-
          The idea that Republicans prefer to let some old folks die to preserve the jobs of burger flippers is exactly what Republican Lt. Gov. Dan Patrick said last month, and what Republican Trey Hollingsworth said today.

          https://americanindependent.com/trey-hollingsworth-coronavirus-big-boy-girl-pants-social-distancing-gop-house-indiana-covid-19/

          Maybe its not what you said, or what the other Republicans here have said, but its not a completely unfair thing to say about Republicans in general.Report

          • Avatar Urusigh
            Ignored
            says:

            “but its not a completely unfair thing to say about Republicans in general.”

            It’s not entirely inaccurate, but neither is it the complete thought. That’s a bit on par with hearing that a Dem wants to raise property taxes and reinterpreting that as “Dems want to take grandma’s house and throw her out on the street!”. That is a thing that might happen, might even be an unavoidable side effect of the policy, but it certainly isn’t the intent.

            Economic impacts have fairly well established causation with a number of health impacts, including increase in suicides and overall decreased lifespan. So it’s not “completely unfair”, but it isn’t completely fair either to misrepresent the full argument which runs more along the lines “some people are going to die either way, but generally speaking the old would probably prefer to die themselves rather than have to bury their children instead”. You may or may not agree with that sentiment, but it’s not obviously the same moral proposition that you’re accusing us of making.Report

    • Avatar Zac Black
      Ignored
      says:

      Exactly to the precise degree it benefits them and no further, as with every other principle they purport to hold.Report

      • Avatar Mike Schilling
        Ignored
        says:

        Fiscal responsibility, which doesn’t apply to Trump’s trillion-dollar deficits (or any GOP president Reagan or later.) Religious freedom, which doesn’t apply to mosques. Originalism, which doesn’t apply to the 15th Amendment.Report

    • Avatar Urusigh
      Ignored
      says:

      Sure. I’m a Republican. Hell, I’m a Trump supporter. I’ve also been entirely clear that I want the economy reopened ASAP.

      I nonetheless agree that he’s talking out his backside on this one; only the governors can reverse what the governors have done and I think the last 3yr have proved that when the states don’t agree with the President, the States usually get their way (which, with few exceptions, is exactly as it should be). Frankly, even if the President and the governors do work something out, there’s also a lot of private companies that shut their doors voluntarily and it’ll still be up to them whether and when they open up again.

      Yes, I care about federalism. Just because I agree with the intended outcome, doesn’t mean I agree with executive overreach or federal infringement on the powers reserved to the States. This is a wrong claim and it would be a worse precedent if it somehow goes through.Report

      • Avatar Mike Schilling
        Ignored
        says:

        The reasons we can’t start reopening things now are two:

        Lack of tests means we don’t know where we are on the curve. It would also make it impossible to address hot spots that appear as people re-emerge.

        Lack of medical-grade PPE makes it impossible to treat the increased number of infected that would result safely.

        Responsible, competent leadership would be addressing both of these as the highest priority and making plans based on their progress. A shame we don’t have anything even remotely close to that.Report

        • Avatar Urusigh
          Ignored
          says:

          “Lack of tests means we don’t know where we are on the curve. It would also make it impossible to address hot spots that appear as people re-emerge.”

          Debatable. There’s an annoying switcheroo going on here where the people on the other side of this keep simultaneously insisting “infected people couldn’t work because this is horribly crippling for weeks with permanent effects” AND “without more testing we can’t possibly know where we are on the curve or where the hot spots are. Those can’t both be true. Our data isn’t perfect, but at this point we should be able to reasonably estimate what ratio of cases require medical intervention vs the healthy/asymptomatic part of the population. If your number of hospitalizations are going down, that tells you which side of the curve you’re on. We could also get a decently rough picture just by pushing apps and self-reporting of symptoms to chatbots with diagnostic criteria. This is the kind of thing Google has been playing with just via tracking search terms, so it might not reach the same level of precision as mass testing, but we can still get meaningful numbers from other means.

          “Lack of medical-grade PPE makes it impossible to treat the increased number of infected that would result safely.”

          Again, debatable. Last I checked, We don’t have certainty on either the exact means of transmission or relative effectiveness of PPE. We’re going as extreme as we can because we just don’t know better, but it’s entirely possible that more easily improvised or mass produced PPE would still be sufficiently effective.

          “Responsible, competent leadership would be addressing both of these as the highest priority and making plans based on their progress.”

          AFAICT they already have been, but most of that progress is necessarily in private hands (labs and manufacturing). That doesn’t mean the government or the market can afford to sit still and suffocate while we wait.Report

  9. Avatar LeeEsq
    Ignored
    says:

    The Covid-19 speakeasies are beginning to appear. If the crackdown goes on long, incidents like this will increase in frequency.

    https://sanfrancisco.cbslocal.com/2020/04/13/coronavirus-update-san-francisco-police-shutdown-underground-nightclub-blatantly-violating-shelter-in-place-order/Report

  10. Avatar Urusigh
    Ignored
    says:

    This seems relevant. Sweden says their model is working and may have the numbers to back it up

    https://www.msn.com/en-ca/news/world/sweden-says-controversial-virus-strategy-proving-effective/ar-BB12TP18?li=AAggFp4Report

    • Avatar greginak
      Ignored
      says:

      Interesting though they note there is plenty of social distancing going on and that they a well endowed fully functioning medical system. They also don’t note their death rate is much higher then neighboring countries. That seems like a thing to at least note.Report

      • Avatar Urusigh
        Ignored
        says:

        Maybe you missed it, but they DID note their death rate in comparison, right under the heading DEATH RATES: “That’s considerably more than in the rest of Scandinavia, but much less than in Italy, Spain and the U.K., both in absolute and relative terms.”Report

  11. Avatar Urusigh
    Ignored
    says:

    This also seems relevant: Lockdowns aren’t having a statistically significant effect, not when comparing US States or when comparing at the country level: https://www.spiked-online.com/2020/04/22/there-is-no-empirical-evidence-for-these-lockdowns/

    As of 6 April, seven US states had not adopted shelter-in-place orders, instead imposing social-distancing restrictions such as banning large gatherings and mandating six-foot spacing gaps and maximum customer limits inside all retail stores. Those seven states are Arkansas, Iowa, Nebraska, North Dakota, South Dakota, Utah and Wyoming. The social-distancing states experienced substantially fewer cases and deaths than the lockdown states, even with New York out of the mix. Comparing the social-distancing states plus South Carolina to US states minus New York, the social-distancing states experienced 663 fewer cases per million and 42 fewer deaths per million on average than the lockdown states.

    The only variable to be statistically significant in terms of cases and deaths was population (p=0.006 and 0.021 respectively). Across the US states, each increase in the population of 100,000 correlated with 1,779 additional Covid-19 cases, even with multiple other factors adjusted for. Large, densely populated areas are more likely to struggle with Covid-19, no matter what response strategy they adopt – although erring on the side of caution might make sense for global megacities such as New York and Chicago.

    It’s entirely possible, perhaps even probable, that the causation runs the other way (e.g. States who are less hard hit feel less pressure to impose lockdowns), but even if so that decision doesn’t seem to be hurting them. That’s a good indicator as we look at reopening the economy. If lockdowns are largely ineffective, then lifting them should not cause any serious spikes in cases.Report

  1. May 19, 2020

    […] the way back in April, Mike Siegel took to Ordinary Times to write about the issues that came with touting the “Swedish Model” that seemed to be […]Report

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