Spanish life is not always likeable but it is compellingly loveable.
- Christopher Howse: A Pilgrim in Spain*
Coronavirus: A Brief-ish ReviewSpain: Despite the horrendous number of daily deaths, it's claimed that both the death and infection rates are declining, The other good news is that Spanish scientists are making good progress with a vaccine against Covid-19. It's even suggested this'll be available by end April, against the standard estimate of 12-18 months. Though the latter might relate to the post-testing approval and implementation dates. Meanwhile, the government is reported to be on the verge of sending 18.5 million masks to the 17 regional governments.
The UK: 1. Richard North: A nation in lockdown, governed by emergency laws, is entitled to be alarmed by what looks like a shambolic response to the coronavirus pandemic, notably by the quango Public Health England. 2. Jeremy Warner: National humiliation of epic proportions is threatened, with decades-long damage to the economy and our international reputation. . . . The problem can be laid squarely at the door of confused political direction, managerial incompetence, and logistical inadequacy. [Incidentally, I was (almost) amused to read that the Health Secretary has said that the UK needs a large player in the medical diagnostics industry. Back in the 1980s I was running an operation charged with doing exactly that, before my company - threatened by a hostile takeover bid - aborted the acquisition of a US diagnostics company and abandoned plans to establish a major UK diagnostics company.]
Sweden, as the articles below show, is an outlier. Supported by epidemiologists and confident the country has the hospital resources to cope, the government there is, in effect, going - as the UK government initially tried to do - with the 'herd immunity' strategy. If this is successful, there won't be the horrendous political price that the British government was told by (discredited?) modellers it would face in due course, as the healthcare system was totally overwhelmed. If it's a failure, there will be a health and political disaster.
As for the USA, a friend has alerted me to a site, which here addresses the issue of mask-wearing I touched on yesterday, and here claims that the US will now experience a gigantic epidemic wave, for reasons of ill discipline, ignorance and incompetence, nutty religiousness and racism. If true, there'll surely be an immense political fallout later this year. Won't there??
Life in the Time of Something Like Cholera
- Day 20 of María's Chronicle of life in a Galician village. The consequences of living on the black. Will these change things for the future?
- I've discovered how the begging gypsy gets to my gate without being seen by the police. My neighbour who met the wild boar has changed his nocturnal bosky walking route and now goes up past the petroglyphs at the end of our cul-de-sac. He tells me that, halfway up, there's a path which goes down through the trees to one of our local gypsy settlements. This allows the mendicant to get into our cul without being copped.
- Phrases of the day:-
- Chivo expiatorio: Scapegoat. (Lit. Expiatory goat)
- Cabeza de turco: Ditto. (Lit. Head of a Turk)
- Here are 2 Private Eye items which I (provocatively?) sent to an old friend who's a Jehovah Witness** and who believes Covid-19 means The End Times, as we've known nothing like it before:-
- My younger daughter has posted yet another vlog, this time on motivation.
THE ARTICLES
1. The Swedes think it’s the rest of the world engaging in a reckless experiment: Fraser Nelson, the Telegraph,
Faced with what many there believe will be a manageable illness, Sweden has decided – for now at least – that lockdown represents a greater risk: The Swedes argue that their country might be the only one in Europe to come out of the corona crisis with the economy semi-intact.
There is, still, no lockdown there. Shopping centres remain open, as are most schools and firms. Many work from home, many don’t – all are at liberty to choose. When I called a friend in Stockholm to ask about the Swedish experiment, he was on his way to a book launch. To him there is no Swedish experiment: it’s the rest of Europe that is experimenting – by locking down economies in response to a virus which may prove to be no more deadly than flu.
It’s not that Sweden is in denial. It has had 5,466 confirmed cases, 282 deaths. Coronavirus has been found in a third of Stockholm’s (many) elderly care homes. But the debate there is still where the British debate was 3 weeks ago when the Prime Minister was resisting lockdown. This changed for Britain when Imperial College London published its study suggesting that avoiding lockdown could mean 250,000 deaths. This logic applies to Sweden – but the country of the Nobel Prize and the Karolinska Institute believes its own experts. They disagree with Imperial. They still see Covid-19 as a manageable risk.
The face of Sweden’s response has been Anders Tegnell, the state epidemiologist, who has held daily press conferences. Politicians have taken a back seat. His team have published their own assessment of the virus and its likely trajectory, showing it peaking with about 250 needing intensive care in Stockholm. The nation’s hospitals, he says, can cope. A 600-bed temporary ward is opening tomorrow, south of the city – and when it does, a quarter of all intensive care beds will be used. So for now, no reason to impose any more restrictions.
He urges caution, and Swedes are responding. Sixth formers and university students are learning from home. Sports fixtures continue, but with spectators more spaced out. Online meet-ups are replacing real ones, elbow-bumping (remember that?) replaced handshakes long ago. A naturally cautious country is taking Tegnell’s advice.
But crucially, he isn’t asking Swedes to trust him. Hospital data is published all the time, so Sweden’s “experiment” is being conducted in the open. Every time a patient is admitted, the data is updated on a Covid live website in striking detail. Average age: 60. Those with diabetes: 26 per cent. With cardiovascular or lung disease: 24 per cent. With at least one other underlying health condition: 77 per cent. Sweden is also updating its statistics to say if someone died from Covid, or of something else – but with Covid. This might reduce the “death” figure by two thirds.
If Tegnell’s analysis proves wrong, the public will be able to see it unravel on his dashboard. In which case, he says, he stands ready to tighten things up. Sweden’s famous love of transparency – you can look up your neighbour’s salary online if you feel the urge – is being used as a tool to foster trust. So far, it’s working: polls show that three quarters of Swedes support the strategy. The debate, overall, is very different from Britain’s. There is no shortage of epidemiologists in the Swedish press, backing Tegnell and denouncing the “desk-based theory” of the Imperial College study.
The Swedish prime minister is asked if he has ceded power to Tegnell: he doesn’t seem offended. Time will tell if we made the right choice, he says. Over here, this would be seen as dangerous, even heartless. Doesn’t he want to save lives? But Swedes are also looking at Britain’s surging unemployment, one in five small firms on the verge of going bust, children deprived of education, working mothers edged out of their job. That also hits lives.
And this case is being made, in Sweden, in a way it might not be over here. Kerstin Hessius, who runs a government pension fund, has been arguing that money vs lives is a false choice. Rising unemployment hits pensions directly,” she says. “What’s more, the tax base disappears – then we have to start cutting welfare.” And Swedes should be proud that “we have not extinguished the entire society, as many other countries have done”.
The risk is pretty obvious. Tegnell might soon find out that the virus spreads far faster than he thought – and by then it would be too late. Sweden’s hospitals would be overrun. A letter signed by 2,000 luminaries appeared in the papers this week saying it was time for Sweden to fall in line with the rest of the world. Åre, where I had hoped to be skiing next week, will shut its lifts the week leading up to Easter. Posters had started appearing in train stations, put up by locals, telling visitors they were endangering lives by refusing to stay home.
Sweden is not immune from what is, now, a fierce global recession. Unemployment has spiked and bailouts have started – albeit ones that will be easier to pay off than Britain’s. Swedes tend to have more of a sense of the economy as the engine of the welfare state: damage one, and you damage the other. You also damage public health, society, education and democracy. As one former politician told me, Sweden is not resisting lockdown in spite of being a strong social democratic state. It’s doing it because it’s a strong social democratic state.
For now, Stockholm is perhaps the last capital in Europe where there are signs of normal life – with shoppers, skateboarders, pensioners and commuters (albeit in far fewer numbers). They know who to thank for their liberty. On Vasagatan, there’s a poster taped to a wall saying “All power to Tegnell, state epidemiologist”. Whether they’ll be saying this at the end of the month is, of course, another question entirely.
2. Coronavirus: Why the Swedish experiment could prove Britain wrong: Sarah Knapton, Science Editor, the Telegraph.
Sweden's decision to remain open for business is in direct contrast to Britain's strategy of locking down the country
In Sweden, an interesting experiment is playing out, which may soon reveal that Britain is way off when it comes to modelling the number of coronavirus patients who will end up in intensive care.
The country has bucked the near-global lockdown trend, choosing to allow schools, businesses and sports venues to remain open and relying on the good sense of its citizens to control the virus through social distancing and maintaining good hygiene. But the country has chosen this path largely because its prediction of how its health service will cope is vastly different from the trajectory that British modellers have forecast.
The vast ramping up of intensive care beds in the UK in recent weeks was driven by modelling from Imperial College, which suggested up to 30 per cent of people who are hospitalised for coronavirus will need intensive care.Amid fears that the NHS would not be able to cope, Britain was placed in lockdown to give the health service time to reach capacity.
In contrast, the Swedes believe patients needing intensive care will be somewhere closer to five per cent of those hospitalised and so have been cautious about extending their ICU capacity.
Unlike Britain, Sweden is far more transparent about releasing data, so information on whether it has made the right calculation will soon be available.
So far in Britain around 9 per cent of patients testing positive for coronavirus in hospital have died, suggesting that at least that proportion of patients needed intensive care treatment. Many more will have recovered after being in ITU, so the figure could well turn out to be higher than Sweden is predicting, placing it in an unprepared position.
The country has recently started building a military field hospital near Stockholm with 600 extra beds, but it will have just 10 intensive care beds to start with, an indicator that the government is not expecting a surge of very sick patients. The country believes it will see the biggest need for intensive care beds at the end of May, estimating that 500 to 1,000 patients will require intensive care.
Yet despite having the lowest number of hospital beds per thousand in Europe, it is confident it will cope.
The state epidemiologist who is staking his reputation on the strategy is Anders Tegnell (below), who has been scathing of the initial Imperial modelling that set Britain on the path to lockdown. "It might be right, but it might also be terribly wrong," he said. "In Sweden, we are a bit surprised that it's had such an impact."
The former state epidemiologist, Prof Emeritus Johan Giesecke, is in agreement with Mr Tegnell, stating recently in an article for the daily newspaper Svenska Dagbladet: "The lack of reliable knowledge explains why countries choose to do things differently: nobody knows what really works, and they choose measures either on the basis of shaky data or for political reasons. All models require that you enter numeric values for different parameters - values that we often miss and must estimate or guess."
Crucially, Mr Tegnell is releasing all the data on a daily basis so that it will soon become apparent how well Sweden is doing compared to elsewhere and give a stark indication of whether Imperial modelling is mirrored in real-world data.
Sweden is believed to be a couple of weeks behind Britain, having recorded around 6,000 cases and 333 deaths - 10 times fewer that the UK - but experts there are not expecting a big peak, or much more demand than usual.
Although the country has not explicitly said it is attempting to build herd immunity, it wants to slow the virus to a manageable pace. Mr Tegnell has said it is inevitable the disease will sweep through a large proportion of the population, and allowing it to do so could prevent a surge in demand, which could cripple their health services.
The strategy is not without its critics, and some 2,000 scientists and researchers have signed an open letter criticising Sweden's Public Health Agency. Sten Linnarsson, Professor in Molecular Systemic Biology at the world-renowned Karolinska Institute, has branded the plan "embarrassing", while others have called it a cynical ploy to reach herd immunity at the cost of thousands of lives.
But public health officials have one more trick up their sleeves to dampen down the fears over the virus. The country is also about to start releasing figures that show how many people died "from" coronavirus rather than died "with" coronavirus, as the British statistics show. Professor Neil Ferguson of Imperial College, has told the UK Government's Science Technology and Health Committee that up to two thirds of deaths of people with coronavirus would probably have happened this year anyway. So it will be interesting to find out just how many can actually be attributed to the virus, a figure that Britain is unlikely to find out before annual mortality figures are released early next year.
The Swedes believe that changing how the figures are reported will cut the number of people dying from coronavirus by as much as four fifths, and slash the death rate to well below 1 per cent, perhaps even lower than seasonal flu.
The transparency of the data coming out of Sweden is also giving a better indication of how the virus is playing out in a European population, rather than relying on modelling and estimates coming out of China. So far it appears that men account for the vast majority of intensive care cases, with women making up just 24% of those infected. Likewise, of those needing intensive care, some 76% had underlying health conditions, with high blood pressure being the biggest risk factor. In Britain, it could end up being even higher. Just 6%of people who died on Friday, 3 April had no reported health problems.
Whatever happens, within weeks it will become apparent whether Sweden's gamble has been a triumph of common sense or a catastrophic and deadly mistake. And the results of the experiment will be felt throughout the world. If public health officials do manage to flatten the curve it will make it far more difficult for the UK to continue imposing a lockdown that is devastating the economy.
Likewise, if deaths surge, it will give governments the ammunition they need to keep restrictions in place for longer, perhaps even until a vaccine or treatment is available.
*A terrible book, by the way. Don't be tempted to buy it, unless you're a very religious Protestant.
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