[wannabag]

I live in Stockholm, Sweden, so while I acknowledge my bias I'd bet my money on the fact that other countries will change their approach rather than Sweden starting to follow others.

While there are some undeniable social (think multiple generations in a household), geographical and cultural (swedes are notorious in keeping their distance from other swedes) differences at play here, other European countries have gone for a "people can't be trusted so we must restrict individual freedom". While there is certainly some good reasons to think that this will work the means used to implement this have some really sad consequences. Look at France, people are getting fined and in some cases brutalized; protests are sparking in places where strict measures have been implemented, not because they are unfair but because they affect people unfairly! Easy for well-off people to "leave early, far and for a long time" but far from everyone has that luxury (oh if you understand French, check out Twitter on the "lockdown diaries" parodies and compare that to how people in the suburbs of Paris are being treated!). This is without even starting to talk about how the economic impacts will be spread amongst social classes. To me Sweden has chosen the most socially (in this case as opposed to morally) fair route to handle this crisis.

That being said, it's morally very difficult to defend this strategy in the face of a higher death toll amongst seniors in care homes. I cannot come up with a single argument that I don't know will get shot down immediately and that is a good sign that it's probably not morally optimal. We live in a time of humanism and human life comes first, rightly so but even with that said, it shouldn't hide the picture and justify every consequence out there. The approaches in many countries are incredibly reactive and short sighted in that regard.

[nollbit]

To be honest, I'd like somebody to explain to me how a lockdown would have prevented more deaths in elder care facilities in Sweden.

[marvin]

Speaking of today's situation, that's straightforward. Fewer infections in the population in general, lower probability that an elder care worker in a given facility gets infected and goes to work contagious without their knowledge. Once that happens, game over.

This effect is evident just from different death rates per capita in countries that have similar demographic and housing situations, e.g. between the Scandinavian countries.

[kzrdude]

I'd expect that better working conditions would have been a much bigger help.

These workers would like to follow the general guidelines and stay home if they have any symptoms, but they generally work hours, not salary jobs, and can't miss too much work.

If they had the flexibility and leisure a lot of the swedish middle class experience at their office jobs, being able to call in sick, then more of the care workers could have obeyed the recommendation by the health authority.

But for now it's a low-wage, high pressure sector with less than ideal working conditions.

To add to that, the same patients meet very many different caregivers during a week due to the same working conditions, and this is also not good for preventing transmission.

[CuriousSkeptic]

I suspect that in the aftermath of this. There’s are the things that will have had the biggest impact on outcomes. The pre-conditions at the start. Not differences in response strategies.

[gvjddbnvdrbv]

Preventing general spread in the population prevents the care home workers catching it.

[bigfudge]

But his point is that they are just experiencing these deaths now rather than in 2 or 6 months time, and that does seem likely given a vaccine is at least a year away.

[gvjddbnvdrbv]

Unless he has an accurate crystal ball I can't see how he can see the future.

[logicchains]

>That being said, it's morally very difficult to defend this strategy in the face of a higher death toll amongst seniors in care homes. I cannot come up with a single argument that I don't know will get shot down immediately and that is a good sign that it's probably not morally optimal.

It's easier if rather than "lives saved", you look at "life years saved". In this sense, somebody in their 80s who only has a couple of years left dying early is equivalent to the situation of a young adult being pushed into poverty by the lockdowns and never managing to recover a middle-class lifestyle, so they die a couple years earlier (I'm not sure about Sweden, but in English speaking countries poor people on average die a few years earlier). A 20-year-old commiting suicide due to sudden poverty, or depression from being locked inside, is equivalent to twelve 80-year-olds who have five years to live dying early.

[jacquesm]

If only life were so simple. Essentially you are saying:

if 12*(lifeexpectancy@80) > lifeexpectancy@20 and if (20 year old will commit suicide due to poverty or depression) then 12 oldies get to die.

That sort of reasoning is faulty in so many ways that it would be bothersome to work out all the various ways but let's start off with the assumption that those 12 people are not just as eager to live a few more years and that those last few years may be more precious to them and those around them than a 20 year old that may or may not commit suicide.

This sort of cold-hearted calculus is not going to solve anything at all, merely create rifts by polarizing what it means to be 'young', 'old', 'suicide prone', 'depressed' and 'suddenly poor'.

Being 'suddenly poor' is really hard in Sweden by the way.

[s1artibartfast]

I think the comments about suicide are a bit of a red herring.

There are many reasons why death rates increase with economic hardship and I do not think this is a significant one. More significant are changes to factors which are already leading causes of death (cancer and heart disease). In the short term, examples are how many treatable cancers are not being found or how many people are skipping other medical procedures. In the long term, how many life-years would have been saved with tax money which is lost. Even with socialized medicine, countries have budgets which need to balanced, and not every procedure is available to everyone who could benefit.

This study [1] estimated 260,000 extra deaths from treatable cancers from 2008 to 2010 in the OECD. One should ask how will this scale when additional diseases are considered and how the current economic impact will compare.

I'm not saying that I know what the correct choice is here, and perhaps we will never know, but it isn't as simple as saving lives vs suicide.

[1] https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

[jacquesm]

And then there are the factors on the other side of the ledger: fewer traffic deaths, ironically - fewer COPD related deaths because of significantly improved air quality. And many more. This is not a simple problem by any stretch of the imagination and trying to make it seems as though only one or two factors are suddenly dominant and should be given precedence without taking into account other effects of larger or equal magnitude and possibly with inverted sign makes it all about as useful as badly informed guesswork.

[s1artibartfast]

I wholeheartedly agree. My hope is that people can at least recognize that there is a complex risk benefit problem and encourage or at least permit our health experts to asses the problem.

Unfortunately, the pubic ( at least in the US) is dividing into camps which largely ignore this fundamental question. Either any action which which increases covid deaths is amoral, or the economy should be the primary concern. In reality, the real question of how to optimize quality adjusted life years has been squeezed out of the conversation.

[jacquesm]

Part of the reason is that the US tends to treat any major political issue as though it is a spectator sport rather than as something society will have to find a good solution for.

[logicchains]

>This sort of cold-hearted calculus is not going to solve anything at all, merely create rifts by polarizing what it means to be 'young', 'old', 'suicide prone', 'depressed' and 'suddenly poor'.

However "cold" the reasoning is, it doesn't change the fact that there are people who'll die decades earlier now than they otherwise would have without the lockdown. I don't see how sixty years of a young person's life is worth any less than 60 years of multiple old people's lives; the only difference is that it's easier to see the direct consequences (old people dying now) than the consequences that take years to materialise. Ignoring and not measuring second-order consequences isn't warm, it's stupid.

[jacquesm]

Yes, but you are not capable of pointing out which people, and that is part of the problem here. If you could then you could take care of them on an individual basis. Which is one of the reasons most countries have some kind of social net to catch people in trouble. In an each-for-themselves-and-god-for-us-all setup those people will likely not make it. But that's no reason to address the superficial symptom, you'd do better to examine the root cause and fix that instead.