Archive for the ‘Sweden’ Category

Sweden: Flattening the curve (update 1)

March 31, 2020

The time-series of new Covid-19 cases detected every day might suggest that a peak has been passed.

However, it is very difficult on the exponential growth section to be able to tell when the curve begins to flatten off. The growth of Covid-19 cases is better looked at, I think, in terms of new cases against the cumulative number of cases rather than just the traditional time-series. A caveat is that the number of positive cases depends upon the testing strategy. Nevertheless plotting the daily new cases against the cumulative cases on logarithmic scales is a better guide as to whether exponential growth is still occurring.

There are indications that the growth may just be getting off the exponential growth rate but it is not clear yet.

In any event I prefer this plot to the simple time-series.


Sweden’s voluntary lock-down may be able to flatten the curve


 

Coronavirus ethics: When healthy and young has priority over sick and old

March 29, 2020

In the last few days, the prospect of limited intensive care places and too many patients has become more real. Professors of philosophy have been sought after for their views. In Sweden, the National Board of Health and Welfare (Socialstyrelsen) has produced new guidelines so that doctors and nurses forced to make life and death choices have support for their decisions. The guiding principle is stated to be the “expected remaining lifetime” without consideration of “social standing, disabilities or actual age”. Of course this is inherently contradictory since expected remaining lifetime and actual age cannot be divorced. In their new guidelines the Board skates over this contradiction by claiming that it is “biological age” that is being considered and not “actual age”.

The guidelines define priorities for intensive care (my translation):

Priority 1: Patients who have a serious illness but are expected to survive longer than 12 months. If it becomes necessary to prioritize within this group, it must not be done based on the patient’s social situation / position,  any disabilities or the person’s actual age. It may, however, be based on what is called biological age. The latter means that the expected life expectancy is calculated using a number of factors. Those who are younger are then given priority over the older if the health status of both is otherwise equal. But conversely, a patient who is older but otherwise in good health should be given priority over a younger person who, due to illness or otherwise, is expected to live shorter.

Priority 2: Patients with one or more severe systemic disorders with significant functional limitation. These include, for example, insufficiently controlled diabetes, COPD, morbid obesity (BMI ≥40), active hepatitis, alcohol abuse, pacemaker addiction and a heart attack or stroke older than three months. This group also includes those who have an expected survival of 6-12 months.

Priority 3: Patients with an expected low probability of survival. These may be cases where the intensive care unit is normally only used to enable a renewed assessment and consultation with related persons.

Swedish television reports:

SvT:

If the corona crisis worsens, healthcare will be forced to prioritize – and patients who have had good prospects of coping may be rejected. “It can be so in an extreme situation”, says Lars Sandman, Professor of health ethics.

Health care always needs to be prioritized. But in a situation where the number of corona-infected who need intensive care is increasing dramatically, this can result in many difficult decisions. Therefore, new guidelines for priorities in health care have been developed on behalf of the National Board of Health and Welfare. “Suppose we get completely full departments with many very seriously ill people who have marginal conditions to come back to life after intensive care and then other more basically healthy people knock at the door. Then it can be a very difficult decision”, says Andreas Hvarfner, chief physician in anesthesia and intensive care at Karolinska University Hospital in Solna.

Will this mean that infected elderly patients who have severe diabetes, lung disease, pacemakers and are overweight are at risk of not receiving intensive care? “Of course, that may eventually be so” says Andreas Hvarfner.

Lars Sandman, professor of health ethics at Linköping University, has been involved in developing the new guidelines. “When faced with these difficult decisions, it is important that there is clear support and that one can lean back on ethical principles that in this case are legal and instituted by Parliament in 1997. We have tried to clarify how they should be interpreted” , he said.

If there is now a storm that many believe, will people prioritize between people who may have roughly the same conditions? “It can be so in an extreme situation. Then we have stated in the guidelines that you can choose the one that has the longest remaining life expectancy . We want to avoid getting into that situation and therefore we are working hard to get more intensive care places”. This means that young people do come ahead of the elderly if they have similar conditions to survive. According to Lars Sandman, the problem is that there are no alternatives. “You can of course imagine a queuing situation, but then you run the risk that a patient who may have less chance of survival gets the place and that two patients instead of one die in the end”.

Consider the case of two sick patients and only one intensive care place. Younger and healthier will always have a higher expected remaining life and have a higher priority. If both have the same chance of survival, the younger will always get priority. For an older person to get priority by the remaining lifetime criterion, the chance of survival will have to be much higher than for the younger person. The stipulation that social standing have no impact means that a younger, healthier, anti-social, scrounger will get a higher priority than a worthy, productive, sicker, older person.

Of course, this is oversimplified. In reality the chances of survival with intensive care have to be first judged against chances of survival without. It is unlikely that chances of survival without intensive care could both be zero in two cases which had widely different chances with intensive care.

Take:  expected remaining life = (life expectancy – actual age) x chance of survival

Let us assume a life expectancy of 90 years and a base case of a very sick 20 year old with only a 10% chance of survival. Expected remaining life would then be 10% of life remaining giving 7 years. An older person would have priority if their chance of survival was sufficient to give an expected life remaining of greater than 7 years. To get priority a 50 year old would need a chance of survival of 17.5%, a 70 year old would need 35% and and an 80 year old would need a 70% chance of survival. Anybody over 83 would never get priority – even if they had a 99% chance of survival.

Of course, it is age discrimination disguised with words (biological age) to ostensibly comply with the laws on discrimination. But the Board really has no choice.

The issue I have is not really with the Board but with the delusion that the value of humans is not connected to their social behaviour and the myth that humans are equal.


 

In Sweden there is some encouraging data, but ……..

March 28, 2020

I would expect that the really heavy load on the Swedish health care system is dominated by the number of coronavirus patients needing intensive care places. Of course any patient who needs hospitalization and isolation also raises the load. The number of tests to be carried out places a load on the labs and the health care system in general but probably not specifically on hospitals.

Maybe I am just an optimist and it is probably too early to be sure, but the daily number of cases needing intensive care has dropped over the last few days. At the time of writing there are a total of 310 Covid-19 patients in intensive care. The daily new cases for intensive care reached 43 and 42 respectively on 23rd and 24th March. However, there has been a drop in new cases since then.

Source: Swedish Intensive Care Register

The age and gender distribution of the 310 intensive care cases (as of 28th March) show a predominance of men and over 50% between the ages of 50 and 70. Those over 70 account for 28% of intensive care cases. It seems a relative under-representation which, in turn, suggests some success with the voluntary social distancing.

78% of those in intensive care are people with some “risk” condition (chronic heart-lung conditions, chronic liver-kidney conditions, hypertension, diabetes, ……)

It is far too early to draw any clear conclusions but possibly Sweden has yet to see any wave of Phase 3 “community transmission” of the virus.

My guess is that after 3 weeks of a voluntary lock-down, it will be time to start allowing manufacturing to restart, but that service businesses with high levels of customer contact will need another 3 weeks after that. The risk groups will probably need to practice social distancing for 2 – 3 months.


 

Sweden’s voluntary lock-down may be able to flatten the curve

March 26, 2020

Sweden has been following a voluntary lock-down for some time now. Those who feel ill (with a cold or influenza-like symptoms) have been asked to stay at home. Those over 70 have been asked to self-isolate, stay home and only go out if absolutely necessary. Formally, only public gatherings of over 500 are not permitted. People have been asked to be socially distant but there are no compulsive measures. The strategy is absolutely reliant upon people being responsible. Of course, there are cases of irresponsible young people. However, bearing in mind that the areas of critical judgement in the human brain are not fully developed till the age of 25, this is not too surprising. Mass testing for the virus is not being carried out. Only those who clearly show symptoms and require hospital treatment are tested. Large scale testing of hospital staff and health care workers is being done. So there is no clear number of how many are actually infected. The only reliable statistics are the number of those hospitalized, those in intensive care and those who have died. Of course, the markets have crashed and small businesses are dying. Travel services, restaurants and all the service industries are in deep trouble. Big companies are sending workers home and declaring redundancies at an alarming rate.  Economic support packages are being announced every few days.

Anders Tegnell is the chief epidemiologist at the Public Health Agency and is on the news every day. To me he has been the face of common sense, even if many “influencers”, some in the media and prominent celebrities have been crying out for draconian measures to be applied (always it seems, to others). Saint Greta has been starved of attention and has just dramatically announced that she has probably been infected with Covid-19 but is recovering. (!!!??). It is not yet clear if the relatively low-key Swedish approach has worked and it will be some time before this real crisis is over. It is quite interesting that Sweden takes the common sense approach when dealing with a real crisis but becomes hysterical when dealing with imaginary crises. Virus smart but climate dumb. However, every day that goes by without the number infected increasing sharply (“day zero” when exponential growth takes off) means that the time baseline has been extended and the potential peak has been reduced. It is thought that it needs 80 days after “day zero” for the virus to have run its course.

Anders Tegnell: “Contrary to many other countries, like Great-Britain or Germany, the number of infections in Sweden has not yet started to incline dramatically, despite the fact that 36 Swedes have already died of covid-19. No region, not even Stockholm where the virus has spread considerably, has already experienced their ‘day zero’. Everything lies still ahead of us. Moreover, day zero will most likely not arrive simultaneously in the different Swedish regions.”

As of writing there have been 44 deaths in Sweden attributed to the virus and nearly all had some other underlying conditions.

The voluntary approach can only work if the sense of civic responsibility is strong. Civic responsibility runs high here. I note that it had to be enforced in China where they seem to be coming out of the crisis. It also runs voluntarily very high in S Korea and Japan where the curve does seem to have been flattened.

At the personal level, we have been “social distancing” for more than a week. Our lives are somewhat discommoded. It isn’t quite warm enough to be out on the deck. Much needed and necessary surgery is inevitably being delayed since intensive care places are limited. We don’t have the usual network of relatives or friends to run our errands or do our shopping for us but I remain quite hopeful that common sense will prevail.


 

“Dangerous lack of academic qualifications in top Swedish politicians”

January 25, 2019

The “knowledge society” is the catchphrase. But in Sweden it is administered by career politicians without academic qualifications of any significance.

As an opinion piece in the SvD points out:

Even the new Löfven government  thinks that politically groomed ministers without any special academic background or insight into the conditions of research should lead Sweden into the “knowledge society”. One can no longer imagine a Swedish prime minister with a doctoral degree or an education minister with a professorship ……

Science is and remains the largest and most important knowledge generator in society. One might therefore think that the ministers and other politicians who will lead us into the “knowledge society” – a mantra repeated by the new Löfven government – would themselves possess especially high academic competence and particular insight into the conditions of the search for scientific knowledge.

However, nothing could be more wrong.

Nor is the new government Löfven more familiar with knowledge acquisition than other groupings. One may be glad that the newly appointed Minister for Higher Education and Research has read more than a few extra courses and that the Minister of Justice, who is also responsible for migration issues, has at least a Bachelor’s degree. In law? No, in political science.

We can compare this with the German government, where Merkel himself is a PhD physicist and the former Minister of Education was a professor of mathematics. Almost all ministers in the new German government have an academic degree, of which six are PhDs.

………..Unfortunately, there are no clear signs that the new  Löfven government will be able to even identify the underlying system errors, let alone take measures and steps to actually fix them.

The talk about Sweden as a knowledge nation will therefore also in the future be in ironic contrast to the political reality.


 

Swedish voting procedure – An illusion of secrecy

September 11, 2018

Sweden has a population of just under 10 million and 7.49 million were registered to vote in the general election last Sunday. There were 6005 polling stations so each polling station would deal, on average, with less than 1300 voters. As a comparison, an Indian General Election has 814 million voters and 930,000 polling stations giving an average of less than 900 voters per polling station.

On average a Swedish polling station has 50% more voters than an average Indian polling station. Yet the Swedish voting procedure is almost entirely manual with very little use of electronic devices. Surprisingly, it is also prone to human error in the recording of who has voted.

The voting process has five key steps.

  1. Select a ballot paper from the party of your choice (NOT IN SECRET)
  2. Mark your preference for a particular person on the party list. (IN SECRET).
  3. Put your ballot paper in an envelope. (IN SECRET).
  4. Identify yourself to polling official who crosses you off the electoral list and
  5. places your envelope in the ballot box (NOT IN SECRET).

The voters choice of party is made in Step 1 but there is no pretense of secrecy around this step. The secrecy surrounding Step 3 adds no value. In Step 4 there is no cross check that the name being crossed of the electoral roll is actually the person who has voted.

Considering the voting process as a whole, it is remarkably old-fashioned but steps 1 and 4 are not fit for purpose for even an old-fashioned process.

 

This year the Swedish election has had international observers. I would be surprised if they did not comment on Steps 1 and 4.


 

Sweden election 2018: Too many parties spoil the governance

September 9, 2018

We are about to go and vote.

Red/green or Blue or Blue/Brown.

But the simple reality is that Sweden is actually a politically fractured country with 8 significant parties (9 including the Feminist Initiative) who could cross the 4% barrier and get into parliament. There is zero possibility of getting a majority government. Back room deals and the undue influence of minority parties is a foregone conclusion. We have had the undue influence of the Green party in the last Red/Green government. Instead of 2 major parties we will now have 3. The Sweden Democrats is the Joker in the pack.

Whatever transpires we have a politically messy period ahead of us.

There are just too many parties.


 

Election time in Sweden and stupidity is in the air

August 26, 2018

The Swedish general election takes place in about 2 weeks and it is almost impossible to avoid stupid pronouncements by politicians of all colours and all parties.

There is not a single media outlet which does not have its own agenda. Some openly support a particular party. Others are more sophisticated and oppose particular parties. The most intelligent keep their preferences hidden but support or attack particular policies which, on balance and by a strange coincidence, just happen to be those of a particular party. But there is not a single one which does not have its own agenda. But the worst thing is the oozing, sickly sweet stench of political correctness.

Stupidity is in the air.

 


 

As a second class immigrant, who should I vote for in the Swedish election?

August 18, 2018

I have observed that in a Red/Green Sweden I am now a second class immigrant. I did not ask for or get “political asylum”. I came to Sweden – horror of horrors – to work. I did not seek, and I did not get, social welfare payments.

I am of Indian origin and I was working in England in R & D when I was “recruited” to Sweden 34 years ago. At that time it was still the old Stal Laval which became ASEA Stal and then ABB Stal and then later Alstom and then Siemens. In due course we became Swedish citizens.

Now as we approach the 2018 general election I must decide who to vote for this time. There are actually many parties not worthy of consideration. The Environmental Party is made up of children trying to be adults. They are so sanctimonious they make me ill. The Left party is just another Communist party masquerading as socialists. The Liberals and the Centre and the Christian Democrat parties have no idea what they really stand for and are “dead men walking”.  The Greens, the Left, the Liberals, the Christian Democrats and the Centre are excluded from any further consideration. That leaves three.

  1. For the Social Democrats, I am a second class immigrant because I came to Sweden to work and not for “political asylum”. Moreover they have not understood the difference between multi-ethnic and multicultural. Parallel cultures always give a fractured society. They want to tax me even more for very questionable projects. They have confused sameness with equality. They have made a false God of “equality” without understanding that fairness and justice demands unequal treatment. I find Stefan Löfven uninspiring. They may well win the election but they are probably not for me.
  2. The Sweden Democrats would prefer that I am not here. Jimmy Åkesson has actually developed more over the last 10 years than any of the other political “leaders”. He has more charisma than any of the others. On many issues, except the treatment of immigrants, I am actually closer to the Sweden Democrats than to many of the other parties. But they don’t like any immigrants of any kind and therefore I am not for them.
  3. The Moderate Party should be where I can naturally find a home. Generally, but mainly in theory, they are closer to my views on labour and the economy and free enterprise. But they lack courage and they lack leadership. They are so enslaved by political correctness that they are prepared to go against their own principles whenever the wind blows against them. Ulf Kristersson is solid enough but quite bland. He could grow up but he hasn’t done so yet.

I don’t have any good choices – only less bad ones.  I think the Social Democrats are unlikely to get my vote for just being too unintelligent. The Moderate party is possible as being the best of a poor lot but it could be a wasted vote. Or I could vote for the Sweden Democrats in the hope that an earthquake will result and that out of chaos can come order.

 


 

High irony in Swedish politics

August 2, 2018

The Swedish Social Democrats (the ruling party) have been in power for almost 80 of the last 100 years. They are not, however, very keen on talking about their past when it comes to the politics of racism. It was at the initiative of leading Social Democrats that the first ever state-run Institute for Race Biology was established in 1922. Within the workers’ movements, it was ingrained that Swedish workers were superior to other races. Even within the intellectual elite of the “Socialist” movement too it was “common wisdom” that Swedish culture and values were superior. It was this institute and their “scientific” work which was to prove the inspiration for the German version of eugenics. Whereas the German Institute was shut down after the war the Swedish Institute continued and later became part of Uppsala University and its genetics centre.

Eugenics Archive:

In 1918, it was suggested that an institute of racial biology be partially funded by the Nobel Committee (Lundborg, 1922). This was unanimously supported by the Nobel Committee itself, but the idea was seen as a misuse of Nobel funds and a race-biology institute was not created at that time. Lundborg argued that a race-biology institute was important to prevent racial degeneration in Sweden, and ultimately, the Swedish state-institute for race biology was created (Lundborg, 1922). ….

…… The purpose of the institute was to research genetics, heredity, and racial characteristics. (Lundborg, 1922; Broberg & Roll-Hansen, 2005). The data from this research was meant to be used to create practices that would supposedly improve the quality of the Swedish population (Lundborg, 1922). As eugenics became less popular in the public, the institute became controversial and was eventually renamed in 1958 (Broberg & Roll-Hansen, 2005).

Through their own eugenics program, where the Sami people were subjected, until as late as the 1970s, to forced sterilisations and abortions, the Swedish program was not so very far removed in its objectives from the Nazi program. The Nazi methods and the scale of their program were of a quite different magnitude. The Social Democrats would rather that this part of their history went away quietly. They have never really confronted the past or come to terms with it. Many leading Social Democrats (among them the Myrdals) were strongly involved in the vision of eugenically ensuring a population with the “right social attitudes”.

A Brave New World

In the mid-1970s Sweden’s parliament abolished the eugenics-inspired sterilization legislation enacted in 1935 by a social democratic government. During the four decades that passed between implementation and abolition, almost 63,000 Swedes were rendered infertile, in many cases in response to pressure from the state and sometimes as a result of outright compulsion. Furthermore, it was chiefly those regarded as ‘‘unproductive’’ who were the targets of that social policy.

The Sweden Democrats is the anti-immigration party which has seen increasing popular support over the last decade. Inevitably it is attacked for having its origins with, and having connections to, neo-Nazi (rather than Nazi) groups in their past. Other political parties have shunned them and have refused to contemplate working with them in any way. In this September’s general elections it is very likely that the Sweden Democrats will end up as the second largest party in parliament. The game is changing.

Yesterday I found it a case of very high irony indeed when the Sweden Democrats released a 1h 45 minute documentary about the place of race in the Social Democrats’ past. They use racism – which they are usually accused of – to attack the Social Democrats. Pure propaganda of course but not factually incorrect. The Social Democrats are trying to shrug this off as propaganda but they have some very dark skeletons in their closet.

One People, One Party

(Ett folk ett parti)

(You Tube keeps removing this video but it can be found quiet easily)

https://www.youtube.com/watch?v=1CekDXP7a6s

The video is still available here: https://vimeo.com/282930261

The Social Democrats with their eugenics program were probably as close, if not closer, to the Nazi eugenics of the 1930s and 40s, than the Sweden Democrats when they began, were to the neo-Nazis of their time.


 


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