This video showed up in my YouTube feed, and I thought of you when I saw it. It is an interview with a senior epidemiologist in Sweden. It was very interesting. He talks about Sweden's approach:
https://youtu.be/bfN2JWifLCY

The interviewer was very good and asked a lot of good questions.

Since I'm the person who first used the "different approaches for different areas" phrase, I feel compelled to reply -- I wasn't suggesting that we should ignore the relevant science or should decide for ourselves whether or not we feel like obeying the guidelines set down by our health officers. Au contraire!

I guess I am speaking from the standpoint of someone who is living in a country where, by and large, the politicians have been guided by the medical experts and epidemiologists -- to good result. But here, as we begin to discuss relaxing the stricter measures we've been under, we are doing it on a province by province basis, depending on the health care capacity and the number of new infections (along with other factors).

That may prove ill-judged -- especially since we're able to travel between provinces without self-isolation in some cases. (Janet's pee in the pool metaphor comes to mind). I suspect what the experts have seen, though, is that overall, the Canadian public is willing and able to get behind stricter measures when required to do so, and if any relaxation results in trouble, we know we'll go right back to square one.

Suz, I took your remark (and others) about differences the way I think you intended. I didn’t think anyone was questioning the science about community transmission. But I think it’s correct to say that there are different factors at work in different nations that affect how governments formulate virus suppression policies and whether they are successful.

One difference being suggested for Sweden is that there is a high level of trust in government there. So there “may” be enough people who willingly do what is being asked of them (stay home, physically distance, avoid gatherings) to suppress community transmission sufficiently without being actually required to do it. I think they already had a relatively high number of people who work from home (compared to say, Japan) and that may be another difference that helps them to avoid industry shutdowns. Time will tell.

I don’t think that approach would work here in Australia. But in our response we have been able to exploit a high level of border control that many other countries don’t have, and that’s a difference that has worked in our favour. We’ve also placed border controls between states to help prevent the spread, which other federally governed nations don’t seem as willing to do (for which I know they have their reasons). And we are testing, tracing and isolating with the best of them. All of these things could help us to ease lockdown measures eventually.

I have a background in political science and I’ve worked in government for over 25 years, so I would love to have a discussion about how governments are responding to this virus in different parts of the world. This is history in the making. But I completely understand and respect Angie’s cautionary words about the potential for these sort of topics to turn heated and political. And of course this is a fashion forum first and foremost.

I hope, as I’m sure we all do, that all nations get on top of this thing, one way or another.

Thanks, Brooklyn -- you understood me, yes. And what you say about Australia's situation makes so much sense. And YES to everybody finding a path out of this with as little harm to all as possible!!

Brooklyn - thanks for tire viewpoint. I agree with your thoughts. And Suz - I took your words as they were intended which is always with integrity and wisdom.

Suz, I took your thoughts as intended also. I get a bit heated about things these days, as many of us in the States do. Again, wanting to respect Angie’s wishes and not get political, but it’s hard to discuss policy without getting into it.

Brooklyn, if you are at all interested in an excellent analysis of current events in the US from a very bright and articulate historian, check out the writings of Heather Cox Richardson. She posts a daily summary on Facebook and they are essential readings for me. Not to make this a US-centric discussion, but it’s only natural that a country that has been a world leader up until now deserves special scrutiny. I’d love to know the thoughts of anyone who reads Richardson’s work.

I follow Heather Cox Richardson too - not every day - but very regularly. I find she manages to summarise and synthesise events In a historical
Context. She is brilliant.

Janet, I’ve been reading Richardson’s writing ever since a close American friend mentioned her work to me. Richardson has helped me understand WHY something that dumbfounds me actually makes unexpected sense when understood in its historical or political context. While Canada and the States share a common border and many commonalities, we live under quite different political and societal systems. At times, the US seems much more “foreign” to this Canadian than countries like Sweden, Australia, and the U.K.

Suz- I completely understood your comments. I certainly took it to mean that everyone should follow public health recommendations, and that, in addition to that, there might be specific directives for more specific populations. I live and work along the heavily populated Washington, DC to Boston corridor, so I know I'm in this for the long haul. I am heartened to see that as we have more data, our local public health officials are putting that to use, and quickly. For example, in my county, over 30% of the cases, and 75% of the deaths have been associated with long-term care facilities. Getting that under control is clearly key to any re-opening, and our county commissioners are making it a priority. The chair of our county commissioners is a woman, and a physician- like so many of the women leaders people have mentioned (Dr. Henry!) she's done a great job in explaining what we need to do. Truly a bright spot.

I just think things are more complicated/ nuanced regarding the shutdown and “ health vs economy “. The shutdown is mostly to slow down spread over time and let healthcare systems get patients in “manageable “ numbers. The old “ flatten the curve”. That may only work in countries that can actually take steps to prepare, as many US hospital staffs have worked maniacally and selflessly to do ( other countries also of course). And hopefully taking steps to increase the pipeline of many related meds and supplies. I have no idea how a country like India, for example, can manage the disparity between population and healthcare resources.
We will not be able to stay home until there is a vaccine. So, many many people will get the virus but over longer time. And of course there’s always the hope that it might be less active in summer, or there’ll be some antigen shift to less virulent.
There are huge numbers of people for whom the economic downturn will make their healthcare futures very bad, educational options lost, savings gone— not immediately fatal but may have the unintended consequence of later lost years. States need the money from some level of functioning economy to fund the very care they are giving. Where do people think the $$ for all the relief is/ will come from?
Ok, no solution here! Hoping some of the cautious re- openings will work out and also give feedback on how/ what works. But will of course continue to have more cases of infection.

I've been so busy I haven't been able to get back to this - SO much to read now, I'm going to get to it. Thanks for so many good insights!

It's true that Pneumococcal or streptococcus bacteria is the cause most often seen in nursing homes, and it is responsible for approximately 50,000 deaths each year in the U.S. This is different than viral pneumonia (though it is all debatable to various immunologists apparently).

texstyle, I am not sure I am correctly reading between the lines of your post. Are you suggesting that Covid-19 deaths may be overestimated because authorities are lumping together deaths from multiple types of viral respiratory infections and calling it all Covid-19? And similarly are you suggesting that people may be infected with the virus that causes Covid-19 but are actually developing pneumonia because they are also infected with some strain of influenza?

I must say that both of these scenarios seem unlikely to me. It is my understanding that particularly for hospitalized patients, they are being tested for multiple types of infections. If they have a pneumonia-causing virus, in general, we know which virus it is. In fact, particularly early on, when Covid testing was even more limited, people were only tested for Covid AFTER testing negative for influenza.

For a variety of reasons the current tally of Covid-19 deaths is much, much more likely to be an undercount than an overcount.

For those who like data the Worldometer site is interesting. From my research it is a reliable factual site.

https://www.worldometers.info/coronavirus/

@Sal - I check that site everyday. The numbers are sobering.

I follow that site too. And I agree with SarahD8. The official numbers are most likely an underestimate, given that (sadly) many people die untested.

Sal, that's what I check, too. It is interesting that Sweden's approach has 2,854 deaths, while Norway's has 215. Norway essentially shut down while Sweden suggested but mandated very little. We are looking at over TEN TIMES fewer deaths in Norway. IMO, if anyone thinks Sweden is on to something, they need to look at the numbers again.

Likewise, I will be interested to see where the numbers end up in other high-population countries like India, Indonesia, and Pakistan. I'm not sure we can rely on the numbers coming out of China or Russia, but the US saw this coming and did nothing to prepare. Health officials have told us what it will take to reopen safely, but most states are just setting arbitrary dates. My fear is that by mid-summer we will see what this virus does to children and young adults, and by the time school starts, it will be back with a vengeance. Whatever the US is doing, it isn't working, and re-opening will not help things. The economic pain is real, but as Cuomo said, "How much is a human life worth?" Evidently, not much.It is frustrating to see that others value their right to get a Big Mac over my elderly mother's life.

I have followed this thread and thought about whether to join it or not. However, as I see frequent misunderstandings and politically biased reports about the Swedish approach in the media, I can’t stop myself from writing a long post. I am Swedish, extremely fact oriented and keep a close eye on the statistics. This is how I view it:

• The greatest misunderstanding is that nothing is being done. That is completely wrong. There are official recommendations, which by most people are viewed upon as rules. I feel that we’re being treated as adults and are trusted to act responsibly, and we respond to that by acting as adults.

For myself, I haven’t been to a restaurant, met friends, or been to the hair salon for 8 weeks. We all work from home. My teenagers have online classes. They have no parties, sleepovers or seeing friends indoors. I buy groceries for my old mother, wave to her through the window and leave the bags outside. I long for giving her a hug, meet my friends, visit the theatre and travel to family members in other parts of the country. But now is not the time for it, even though no one would punish me for it. And I’m not an exception, this is how most people I know live.

• It’s not business as usual in Sweden. Stockholm is a quiet city nowadays. The trains and buses are almost empty during rush hour. The traffic is light. Many shops and restaurants are closed. Those who stay open, operate under specific rules and will be forced to close if they become crowded and unsafe. The risk is not so high, as not so many eat out of home now. Yesterday, I passed a square with popular restaurants at lunch time. Only two tables out of maybe 50 were taken. The Easter and Walpurgis celebrations were cancelled. People I meet on my daily walks take care to keep the distance. Of course, there are always (rare) exceptions, and I’m sad to see that photos of those are more likely to being spread around the world than more representative ones.

• There is a great level of trust in the Swedish society, which results in that the guidelines are followed by a majority without the need of law enforcement. 80% support the government’s handling of the situation. 97% have made changes in their daily behavior. The voluntary approach to the situation will, I trust, make us more inclined to keep following the advice for a longer period of time than if it was forced upon us.

• So far, even though the Swedish hospitals undeniably are under very high pressure, they have been able to handle the situation well. At least 20% of the ICU beds are empty. All people who need hospital care get it.

• We are all so extremely sad that the we haven’t been able to keep the disease out of our care homes. I have friends who have lost their parents. This has NOT been done on purpose or as a result from coldhearted calculations. From the very beginning, the communication has stressed the need to protect the old and vulnerable. Visits to care homes were stopped early on. However, we haven’t succeeded in this. One reason can be that the care homes, unlike those in our neighboring countries, are usually large facilities, with a high percentage of temporary staff, many without enough education, skills or understanding of the language. Care for old people has also been subject to savings and budget cuts. I can’t see how a lockdown would have protected our oldest better, as the failure in my view was built into the system.

• Also, the Covid 19 death count can’t really be compared between countries. The numbers don’t tell the same things. Do they register deaths with the virus or of the virus? Do they register only deaths in hospitals and not in care homes or ordinary homes? Do they register those with tested virus or possible virus? Do the official statistics get hold of and report all deaths in a country within a short period of time? The answer to these questions will be different for every country (even between the Nordic countries), which makes the comparison at this stage extremely difficult to make, and even more difficult to draw any conclusions from.

We might have come longer into the pandemic curve with this approach, and other countries might have a larger proportion of the effects coming as they gradually open up. Hopefully, the lockdowns will prove to be an effective solution for them.

It will take a long time until we can understand the full effect the disease has had, both in terms of direct deaths and also on the society in total; health, education, jobs and economy. Probably, we won’t have a good understanding of this until we can compare the total mortality over the pandemic period and compare it to the average yearly mortality of each country. I wouldn’t trust anyone who said they were certain about these things today!

So, now I got this out of my system, thanks for reading. I hope I’ve been able to clarify the Swedish situation a little. We’re all in this together, and I hope for everybody to come safely out of this as soon as possible.

Hi Lena, thanks for contributing your thoughts. What you describe seeing around you sounds very similar to Canada, actually. And despite stricter measures in place, we have also not been able to keep the virus out of the long term care homes, with very similar underlying issues re: budgets, part time underpaid staff, etc. It's a societal/cultural failure that people have been looking away from for a long time, and sadly I am not even sure there is enough outrage that it will be fixed in the future either

Thank you for taking the time to bring us a local perspective, Lena, it is much appreciated and I agree that it will take time to truly get a picture of the effects.
I live in a northern Alberta, Canada community and we have had a portion of our population who didn’t change any of their ways, some did a little and some did a lot. As time went on more and more began to live life as normally as possible. We have had minimal impact from the virus and no deaths. We have, however, had deaths for other reasons because that is how life goes. I don’t like the insinuation that death from COVID19 is somehow more tragic when we have deaths from far more causes than that. It almost seems like any other death is not worth mentioning, it doesn’t serve the purpose of numbers and statistics. It has undermined and cheapened the lives/deaths of many, especially seniors. We have never paid so much attention to their plights as we are now. Hopefully, as Jules and Lena state, it results in some positive change.

Good to see your post Lena! I knew Sweden was doing voluntary measures pretty successfully. I wonder if the testing is more limited (just because I see such a higher % of deaths there I mean). Testing has been pretty limited in Texas - esp. in rural areas but the death rate is not super high.

Unfortunately no one seems very successful at keeping the virus from nursing homes and care centers. Very sad.

Thanks Lena - really good to hear your thoughts.

Care homes here have been affected too by Covid19 with most of the NZ deaths associated with them (a high needs dementia one in particular). Our care homes have some of the same issues - underpaid staff, a varying level of procedures etc... It is a very complex and sad situation.

I agree, Jules, that what Lena describes sounds very much like what is happening in my part of Canada. Mostly, people seem to understand the "rules" are a sensible way to keep our hospitalization numbers down and have been willing to voluntarily adjust their behaviour. The term "lockdown" isn't commonly used by health officials or politicians because of its repressive connotations.

In their public presentations, our chief medical officers have tried to emphasize the power we have as individuals to choose actions which can make the pandemic less deadly for the most vulnerable. As Lena put it so well, as responsible adults we've been urged to take the necessary steps to keep from overwhelming our hospital system and, I think, 90%, of the population see the sense in that. Since Canadians largely trust that our health officials and politicians, while not perfect, are trying their best to cope with a very unique situation, most of us go along with their requests to stay home, wash our hands frequently, and self-quarantine if we show symptoms. Of course, as Tina points out, what makes sense in a large metropolitan area where active cases are being reported daily can seem like overkill in a smaller setting where people are feeling healthy. Canada is a large, sprawling country so it also makes sense that each province has a slightly different take on what kind of action is needed in different areas.

As far as numbers, though, I'm in total agreement with Lena in thinking it's far too early to compare--much less draw conclusions--about how different countries and geographical areas have handled this epidemic. For example, in BC, Dr. Henry clearly stated right from the start that she will NOT be using her limited testing resources to count the number of infections in the community. As chief medical officer for BC, her responsibility was to ensure the hospital resources would be there for the truly ill so the important count, to her, was the number of individuals testing positive for the virus who required hospital care. To date, no one knows what our community infection numbers are, but, by convincing large numbers of people in the metropolitan areas to take immediate action to "flatten the curve", so far BC has not found itself struggling to provide timely medical care for the severely ill.

Like Sweden, the appalling number of deaths in Canada's long-term care situation has saddened and dismayed many of us. As a nation, we know that we can do better--and I hope that perhaps a silver lining from this pandemic will be a long overdue reassessment of what we need to do as a nation to ensure that our national health care system gets the funding and attention it deserves.

Thanks Lena. Here in Australia they tried a voluntary approach at first too but my impression was a lot of people weren’t taking it very seriously.

On the subject of voluntary measures and doing what we can as individuals, our government has introduced a phone app that hopefully will assist with tracing and suppressing outbreaks as we ease ourselves out of lockdown. It’s voluntary. So far over 5 million people have subscribed (population 25 million). It logs the contact details of other users who are in close proximity to you for an extended period and can be accessed by health authorities if one of you is infected. It is not a policing device - just a tracing device. Information is encrypted and only available to health authorities. You log in your phone number and suburb (they actually invite you to use a pseudonym if you want). It’s not intended to replace physical distancing measures.

Despite my near obsessive concerns about privacy, I’ve signed up and I hope lots more Australians will too. And I hope non-Australians will consider lobbying their governments to do something similar. Governments need our help with this. (And apologies if this is straying into political debate.)