Archive for the ‘Sweden’ Category

A failure of Public Health policy, globally and in Sweden

January 25, 2021

A Monday morning rant.


One thing is certain.

The pandemic has shown, globally and in Sweden, an utter failure of public health policy. Epedemiology is not a science. It may use scientific methods but science is a process which leads to knowledge. And the level of knowledge of pandemics and human behaviour is clearly not so very high. The media and governments – and the general public – have been incredibly gullible and have swallowed speculation as being knowledge.
Health organisations (WHO and FHM) were not even certain to begin with whether to encourage the spread of the virus to get to herd immunity or to contain the spread. Even now, one year later, the only real advice is “avoid infection”. Social distancing, lockdowns, closed schools, closed shopping centres, isolation bubbles, face masks are no different to the advice available 500 years ago when infection was experienced.

The Lancet: “From the onset of the COVID-19 pandemic, the Public Health Agency, Folkhälsomyndigheten (FHM), embarked on a de-facto herd immunity approach, allowing community transmission to occur relatively unchecked”.

For every crazy proposal from the scientific community there was another scientist available to present the opposite view. For every crazy idea there was a politician available to promote it. Governments abdicated their own responsibility by relying on bureaucrats pretending to have knowledge. In the case of the Swedish government there was first denial followed by abdication of responsibility. The excuse given was that they were following the advice of “expert institutions” – except that the experts did not actually know very much.

In any case, all those old people who died were going to die anyway.


En misslyckande i folkhälsopolitiken

En sak är säker.

Pandemin har visat en misslyckande i folkhälsopolitiken globalt och i Sverige. Epedemiologi är ingen vetenskap. Det kan använda vetenskapliga metoder men vetenskap är en process som leder till kunskap. Och kunskapsnivån om pandemier och mänskligt beteende är uppenbarligen inte så hög. Media och regeringar – och allmänheten – har varit otroligt lättlästa och har svalt spekulation som kunskap.
Hälsoorganisationer (WHO och FHM) var inte ens säkra på att börja med om de skulle uppmuntra spridningen av viruset för att komma till flockimmunitet eller att begränsa spridningen.

The Lancet: “From the onset of the COVID-19 pandemic, the Public Health Agency, Folkhälsomyndigheten (FHM), embarked on a de-facto herd immunity approach, allowing community transmission to occur relatively unchecked”.

Redan nu, ett år senare, är det enda riktiga rådet att “undvika infektion”. Social distansering, lockdowns, stängda skolor, stängda köpcentra, isoleringsbubblor, ansiktsmasker skiljer sig inte från de råd som fanns för 500 år sedan när infektion upplevdes. För varje galet förslag från det vetenskapliga värld fanns en annan forskare tillgänglig för att presentera motsatt uppfattning. För varje galen idé fanns en politiker tillgänglig för att marknadsföra den. Regeringar avstod från sitt eget ansvar genom att förlita sig på byråkrater som låtsas ha kunskap. För den svenska regeringen var det första förnekandet följt av avstående från ansvaret. Ursäkten var att de följde råd från “expertimyndigheter” – förutom att experterna faktiskt inte visste så mycket.

 I vilket fall som helst skulle alla de gamla människorna som dog ändå dö.


Sweden’s non-strategy has failed dismally to “flatten the curve”

December 12, 2020

I take skepticism to be the most important characteristic of any scientific inquiry. All “experts”, and especially media proclaimed experts, need to be met with a high degree of skepticism. “Experts” have a high level of knowledge, but only of what is known and what is known may not be very much. The inherent paradox is that it is the “experts” who need to be challenged the most, but can only be challenged by other experts. But the very clear lesson that can be learnt is that little “experts” are dangerous.

In Sweden, the media made an epidemiologist from the Public Health Agency (Anders Tegnell of Folkhälsomyndigheten – FHM) into some kind of a superhero in March. The government abdicated its responsibilities and left the stage free for “experts”. The media hype converted FHM’s limited position that face-masks were of most use within health care into a belief that face-masks were counter-productive in general use. “Flattening the curve” was the slogan being touted by everyone (including me). But epidemiology is more art than science. We know a lot about viruses but we knew very little about how humans behave and how the coronavirus spreads. The WHO was an unmitigated disaster as they tried to hide any information that was critical of China. (Someday China will need to be held accountable and take some responsibility for having failed to contain, and allowing the spread of, the virus). The government (and the Public Health Agency) proved to be utterly incompetent in predicting the behaviour of the young (who were not at great risk) and the effects on the old (>80% of fatalities).

Of course, almost every country has failed to flatten the curve. The Swedish non-strategy has also failed.

The diagram below needs little comment. The top curves were what we were shown everyday in March and April by FHM about what the strategy (or non-strategy) would achieve. The bottom curve is the actual burden on the health services in terms of the number of admitted Covid-19 patients in hospital (excluding intensive care places which are 70% full).

“Flattening the curve” has become a nonsense slogan.

Flattening the curve didn’t work

Sweden: Covid 19 deaths no longer stick out.

October 12, 2020

 As schools and colleges have opened and partying has resumed, the number of infections have been rising.

However the deaths attributed to Covid-19 no longer stick out of the average of deaths/day (all causes).


Wuhan virus perspective

September 26, 2020

It takes time to gain perspective.

Wuhan virus versus the Spanish Flu.


 

Parts of Sweden burn while the Social Democrats fiddle

August 29, 2020

I was recruited to Sweden in the 1980s and stayed on. That makes me an immigrant, now a Swedish national of Indian origin, but where my “Indian culture”, in everyday life, is subordinated to the dominant, mainstream, “Swedish culture”. However my presence here probably does contribute – even if in very small measure – to bringing some little parts of my culture into the evolving mainstream.

In recent times, it has become very clear that parallel cultures have splintered society. Criminal (mainly immigrant) gangs have been running rampant in some parts of large cities in Sweden. There have created no-go areas with their own rules and social hierarchies. Cars are torched every weekend and kids are knifed as initiation events. Rival gangs bomb each others hangouts. They set up their own checkpoints, indulge in shoot-outs with rival gangs and even torture victims with methods that ISIS would be proud of. It may not be due to their religion, but I perceive Muslim immigrants as being hugely over-represented among the criminal gangs.

It is my contention that over the last 50 years the liberal left in Sweden (and in Europe) has not had the common sense (or the courage) to distinguish between multi-ethnic and multicultural. A multi-ethnic population needs a unifying culture to form a coherent society. Having multiple cultures without an over-riding culture only gives a fractured society. Having many cultures present as sub-cultures enriches society but multiculturalism tries to deny that one must dominate. Promoting multiculturalism prevents integration, and together with a multi-ethnic community can only give multiple, parallel, abrasive, communities which makes a fractured society inevitable.

The future of Europe is multi-ethnic but not multicultural

I have for long held the position that a society needs a single overriding culture to be a society. All cultures are dynamic and change as times change and as new groups may be assimilated into it. The new culture inevitably contains elements of what new communities bring to the table and the original culture of that community – in some adjusted form – can continue as a sub-culture, but subordinate to the overriding culture. What is not tenable is the idea that a single society can remain a single society when it is splintered into a collection of many parallel cultures (and which are not subordinate to an overriding culture). It has been the misguided, do-gooding, politically correct approach of the “liberal left” in Europe which has actively encouraged new communities to maintain the cultures of where they came from and remain separate to the existing, prevailing culture. There has been little emphasis on getting new communities to assimilate and a far greater emphasis on separateness. This approach has also given rise to the fear of demanding assimilation from new communities. That has in turn led – and not very surprisingly – to the immigrant ghettos, the no-go areas and large parts of the new population who cannot even speak the local language (into the 3rd generation in some cases).

I have a theory that part of the problem in Sweden is that governments have been so ashamed, and so afraid, of Sweden’s past role in promoting Race Biology and eugenics, that they have overcompensated and been blind to the folly of multiculturalism in a multi-ethnic community. Many of the leading politicians (including Social Democrats) of that time were part of the Eugenics Network which provided the Nazis with the academic legitimacy and support they needed for their own Race Biology theories. Gunnar and Alva Myrdal were among the leading Social Democrats who supported eugenics but so also did George Bernard Shaw and H.G. Wells and Leon Trotsky. The Sami and the Roma (rather than the Jews) were the main targets for Swedish eugenics.

Europe’s shame

The collective Swedish amnesia about sterilisation is difficult to explain. From the outset it was viewed as an integral and widely-proclaimed part of the Swedish welfare programme. … The Swedish commitment to eugenic sterilisation was especially emphasised in the widely-known writings of Alva and Gunnar Myrdal; their book on the Crisis of the Population Question of 1934 achieved best-seller status, and was translated into English in 1940. The sequel, Alva Myrdal’s Nation and Family, appeared in English in 1941. Both books forcefully argued the case for sterilisation on eugenic grounds, and the second described the work of the Swedish Royal Commission on Population, which produced a report on sterilisation in 1936. This led to strengthening of the sterilisation law, as a consequence of which the number of sterilisations increased and peaked shortly after World War II.

Though the Swedish eugenics movement started in 1909 and was most active before WW2, Sweden’s sterilisation policies continued all the way till 1976 under a series of Social Democrat governments.

Between 1934 and 1976, when the Sterilisation Act was finally repealed, 62,000 people, 90 percent of them women, were sterilised. 15-year-old teenagers were sterilised for “crimes” such as going to dance halls. One woman was sterilised in 1960 for being in a motorcycle gang. Orphans were sterilised as a condition of their release from children’s homes. Others were pinpointed on the basis of local neighbourhood gossip and personal grudges. Some were targeted because of their “low intelligence”, being of mixed race, being gypsies, or for physical defects.

Sweden’s Race Biology Institute included leading academics and politicians and played a crucial role in selling Eugenics not only to Germany but throughout Europe and the USA. (The origins of Planned Parenthood, for example, in the US lie with Margaret Sanger and eugenics and a desire to control black fertility).

Eugenics Sweden (pdf)

The eugenics network consisted mainly of academics from a variety of disciplines, but with medicine and biology dominating; connections with German scientists who would later shape Nazi biopolitics were strong. The paper ……. also outlines the eugenic vision of the institute’s first director, Herman Lundborg. In effect the network, and in particular Lundborg, promoted the view that politics should be guided by eugenics and by a genetically superior elite. The selling of eugenics in Sweden is an example of the co-production of science and social order.

Whether the overcompensation for the past eugenics connections is the main reason for promoting multiculturalism or not, the fact remains that Swedish cities are now paying the price for the stupidity of promoting multiculturalism in a multi-ethnic community.


 

Covid puts ethics under pressure in Sweden

July 18, 2020

The Wuhan virus pandemic is bringing many ethical questions about the treatment of the aged into stark relief.

90% of all deaths in Sweden due to the Wuhan virus have been of those over 70 years. I have been less than impressed by the Government and the National Board of Health and Welfare (Socialstyrelsen) in Sweden. Their “remaining useful life” criterion is rational but hypocritical in trying to maintain the pretense of it not being age discrimination. They have effectively removed those over 70 from their definition of the herd to be protected. Even the trade unions were extremely concerned about protective equipment for their members working in the care sector. They threatened to strike at some care homes. I suppose that very few inmates of the care homes are active trade union members.

Suspected cases in care homes were usually kept away from the health care system and its facilities. The health system was under stress but never overwhelmed. Isolating those over 70 certainly helped reduce the pressure on the health services, but did not protect the over 70s from themselves being infected in their care “prisons”. In most cases the inmates were infected by their carers. However, unlike the inmates, the carers had recourse to the hospitals. The isolation also eliminated – probably as intended –  any chance of the +70s participating in any herd immunity that may develop. In the fight against the Wuhan virus, “Official Sweden” (from government to bureaucrats), has taken the position that the over 70s are not part of the herd and are expendable.

Take this ethical question:

When an 80+ year old in a care home contracts a treatable condition (bacterial pneumonia for example), but is misdiagnosed (assumed) to have the Wuhan virus and, without any further testing, is put on “palliative” care (morphine) leading inevitably to death, is it 

    1. unfortunate accident? or
    2. humane care?, or
    3. negligence?, or
    4. incompetence?, or
    5. euthanasia?, or
    6. justifiable manslaughter?, or
    7. murder?

“Official Sweden” has generally taken the comfortable position that such cases  – and there are more than a few – are all “unfortunate accidents”. I would put it less complacently at 3 on the list above or even higher.

The nice thing about “unfortunate accidents” is that nobody is accountable and nobody needs to take any responsibility.


 

The great success and the great betrayal of the Swedish coronavirus strategy

July 3, 2020

The Swedish lockdown has been more voluntary than enforced. The over 70’s were told to quarantine themselves to protect the health system. Since the compliance with the voluntary social distancing requirements has been quite high, the spread of infection has not been much worse than in many countries enforcing very strict lockdowns. In total number of deaths due to the Chinese virus, Sweden sticks out among its Scandinavian neighbors who enforced much stricter lockdowns. But Sweden is not an outlier among other European countries. Economically, Sweden will probably be among the countries which recover fastest.

The Swedish strategy has been both a great success and a great failure. The numbers tell the tale.

source: worldometers

There is no right or wrong to the various strategies applied by different countries. Decisions have probably been made in good faith though these have been dominated by the culture of fear and risk aversion that permeates the world today. The fear of alarmist, imaginary crises has meant the world was totally unprepared for a real crisis. The impotence of a politicized WHO and the duplicity of a terrified Chinese bureaucracy has not helped. The stupidity of relying on imperfect and alarmist mathematical models was very evident.

But diving into the Swedish statistics also shows great successes among some very great betrayals.

Only 10% of the deaths have been of those under 70. Based on the National Board of Health and Welfare (Socialstyrelsen) criterion of “expected remaining life”, the loss of expected remaining life has been kept to a minimum. The 90% of deaths of those above 70 do not contribute much to “expected remaining life”. Among the “productive” population the loss of life has been kept down to about 50/million of population. That is the great success. 

Also among the successes have been:

  • intensive care places were more than doubled in a very short time
  • intensive care places were never overwhelmed
  • restarting the economy is well under way, and
  • herd immunity may not yet have been achieved but the risk of infection to the general population under 70 is greatly reduced. (Effectively, Swedish policy excludes the +70s from the herd).

But the cost has been the betrayal of the elderly. The unvoiced, undercurrent of opinion is that “but they were going to die soon anyway”. Care homes became virtual prisons for their inmates. Following the Socialstyrelsen’s publishing of their criteria for prioritizing lives based on “expected remaining life”, there were cases of those infected in care homes being denied oxygen and respirators. There have been cases where they have been put directly onto palliative care (sometimes a euphemism for a self-fulfilling, end-of-life care). The Swedish government through up its hands and abdicated its responsibilities to the bureaucracy of the Public Health Agency (Folkhälsomyndigheten) and of the National Board of Health and Welfare (Socialstyrelsen). The Public Health Agency were, I think the heroes, at least for honesty and fidelity and for stepping-up, if not always for compassion. The Health Services were also among the heroes. The bureaucrats of the Socialstyrelsen were hypocritical, mealy-mouthed and less than impressive. The reality, which is the opposite of what they often voiced, is that the elderly are second, or even third, class citizens in Sweden. The Swedish herd has protected itself by excluding the elderly from the herd.

I am over 70 and may be a trifle biased. But the villains of this pandemic internationally are the Chinese bureaucracy, the Alarmist Brigade and the WHO. Within Sweden, the villains are the government and the National Board of Health and Welfare (Socialstyrelsen).

And even if herd immunity is achieved, the over 70’s will remain at great risk until such time as a vaccine is developed. Every herd protects itself by sacrificing the weak and the sick. And the old.


 

Fatality League: Without the 70+ deaths, Sweden would be doing very well

April 14, 2020

The pandemic is far from over, but as some countries contemplate or begin to relax their lockdowns, it is not too early to begin to look at some of the emerging data.

With its 10.1 million population Sweden has suffered over 1,000 deaths due to Covid-19. In the fatality league (deaths/million of population), Sweden has by far the worst numbers in Scandinavia and lies among the worst 10 globally (and in Europe) as of 14th April 2020. (Countries with fewer than 100 deaths are not included). Almost 90% of the fatalities in Sweden are of those over 70. Without these included, Sweden would have a fatality rate just one tenth of that observed.

I merely observe that in a mathematical model which gives little value to the lives of those over 70, Sweden would be doing very well indeed.

The questions are accumulating but any attempt at answers will have to wait at least a year.

Death League (as of 14th April 2020)

Some of the questions that will have to be addressed in Sweden at some time are:

  • Most countries have used “worst case” models (which are always ridiculously alarmist) but Sweden has used, it seems, “best case” models. Why?
  • Do the mathematical models give a lower “value” to the lives of the 70+?
  • Policy has been to restrict the movement of those over 70 to reduce load on the health service in case they are infected. However the infection carriers are the young and the mobile. Has the policy led to more of the 70+ being infected or less?
  • How much of the spread of infection was initiated/due to returning, asymptomatic tourists from the Alps who were neither tested nor quarantined?
  • Almost 90% of the dead in Sweden are 70+. Was this modeled at all?
  • How many of the 70+ were “prisoners” to infection in their care homes?
  • Was the main source of infection in the care homes through infected but asymptomatic staff?
  • Sweden has more than doubled Intensive Care Places in the last month. By establishing “priorities” for intensive care, Sweden has succeeded in ensuring that they have not been full to the limit. How many of the 70+ were denied Intensive Care due to the “priorities” established by the Social Welfare Board? (Priority is based on “expected life remaining”).
  • Was it optimal that unlike in other countries, leadership was abdicated by politicians in favour of the officials of the National Health Board.
  • …….
  • ….

 

 

In Sweden, coronavirus deaths are almost invisible among average daily deaths

April 12, 2020

In response to great demand Sweden’s Statistics Central Bureau (SCB) has published daily deaths (all causes) data for 2015 – 2020.

For the month of March 2020, the daily total deaths do not appear much different than the average for 2015-2019. The average daily death toll is about 250 (+/- 30). The coronavirus has been responsible (so far) for about 30 fatalities per day but there is some probable offset due to reduction of deaths from some other causes. During March there is no visible spike in total daily deaths that can be attributed to the coronavirus.

Daily Deaths March 2020 compared to average 2015-2019

We can never know what it would have been without a lockdown. What is visible during March is that with the voluntary lockdown in place, fatalities by all causes have not increased significantly.

In a few months, when the outbreak has been brought under control, I will not be surprised if we will be asking if the level of economic disruption was worth it.


 

Swedish coronavirus policy least successful of the Nordic countries

April 8, 2020

Much as I admire Anders Tegnell (Sweden’s Chief epidemiologist) he appeared, at today’s press conference, to be brushing aside the differences between the Nordic countries a little too lightly. I am sure the health services have done a fantastic job. But, for whatever the reason, Sweden’s policy has so far resulted in many more fatalities (actual and per capita) than in the surrounding Nordic countries. The fatality rate is almost twice that of the next nearest Nordic country (Denmark). There is most likely a lapse of policy, rather than lack of equipment or failure of care, which lies behind this reality.

The reason is probably not unconnected with the overwhelming representation of the over-70’s (88% of all deaths in Sweden) among the fatalities.  (They are not particularly over-represented in the number of cases registered). It seems as if many of these older people were a “captive and doomed” population, stuck helplessly within their care homes – not protected in time from infection by the developing policy.

 


Note for reference:

In the Nordic countries the crude mortality rate (all causes) is between 7,000  and 8,000 per million of population every year. Sweden would normally see about 70,000 -80,000 deaths every year (all causes) compared to the 687 attributed so far to covid-19.

In Italy with a population of 60 million, there would be about 450,000 deaths due to all causes every year. The deaths attributed to covid-19 are currently about 17,500.


 


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