Herd Immunity versus Herd Mentality

 kw: book reviews, nonfiction, pandemics, covid-19, sars-cov-2, politics, epidemiology, sociology

During what we now know was an early stage of the Covid-19 pandemic, Johan Anderberg wrote his analysis of the unique approach taken by Sweden, as compared to all the other First World nations: The Herd: How Sweden Chose Its Own Path Through the Worst Pandemic in 100 years, translated from Swedish by Alice E. Olsson and published in English in 2022.

The book covers from early March 2020 until the end of the year. Writing in 2021 a book to be published the following year, the author could not have foreseen how absolutely middle-of-the road the results would be in Sweden, or how the pandemic would play out for another two full years, followed by a sputtering endemic infection that has become a slightly-worse-than-usual type of flu. Four other coronaviruses are known to cause fall-to-winter colds, and now there is a fifth, that is a little more deadly than the other four, but on a par with Type A influenza.

The action centers on two significant men, Anders Tegnell, Sweden's state epidemiologist, and Johan Giesecke, advisor of WHO to the Public Health Agency of Sweden. Other important men and women played their parts, including the Prime Minister of Sweden, but these two, with Tegnell in the lead, helmed the Swedish strategy for coping with the pandemic, for at least the year 2020.

Just as the two men began to collaborate, on March 12, Giesecke quoted a 17th Century noble who had written to his son, "An nescis, mi fili, quantilla prudentia mundus regulatur" and thoughtfully provided a translation, "Don't you know, my son, with how little wisdom the world is governed?" (p.73) This attitude was the underlying basis for dealing with the hundred-odd world governments and hundreds of news agencies that questioned, then decried, then condemned the light touch taken by the Swedes.

Early on Tegnell and Giesecke sought not to limit transmission but, in the absence of a viable vaccine, to allow the infection to spread while taking measures to protect the frail elderly and other vulnerable persons, with the goal of establishing herd immunity. There is much discussion of this concept in the book, with an equation or two related to R₀, the expected number of persons one infected person infects. Later, discussion moved to such buzz phrases as "limit the spread" and "flatten the curve", which caused confusion and had no discernible effect.

I remember well that President Trump authorized the military to make available great numbers of hospital beds and ventilator equipment, many on Navy ships. These went largely unused. To my discernment, being put on a ventilator was a death sentence for 50% of patients who were thus treated, and a great way to lose a quarter to half of one's body weight and muscle mass for those who survived, leading to months of recuperation. 

This is as good a time as any to note that a good friend of mine, a physician, and I worked out a plan: 

1. Since the main killer of Covid patients is pneumonia, and the lung-filling fluids of pneumonia are primarily composed of sugars, at the first symptom it is best to stop eating, ingesting only water, for at least 2-3 days.
2. Rather than fighting a fever, seek to enhance it into the 102°F range (39°C), to support the T-cells that are fighting the virus. He intended to use hot water baths or to get in the car on a sunny day and turn up the heat all the way. I preferred to not use anti-fever medications such as Tylenol.

As it happens, the doctor and I, in spite of being "fully vaccinated", both contracted Covid-19 twice, and survived quite well. In my case, effective antivirals were available by that time, which no doubt helped a lot.

The Swedish epidemiologists didn't stay "in the silo" of epidemiology, but took a more sociological approach. They disdained the notion of locking down a society, and while the rest of the world (or at least Europe and North America and developed Asia) was mandating masks, forbidding church and other gatherings, closing schools, and issuing "6-foot spacing" guidelines, they kept Swedish society almost completely open.

It seems the rest of the world took their cue from an amateur scientist with no epidemiological training, Tomas Puevo, who published an essay, "The Hammer and the Dance", predicting that the attempt to attain herd immunity would result in 10 million deaths in the USA (pp. 124-5). The actual total by end-April 2024 was 1.2 million, and at the end of 2020, about 380,000. But politicians and some scientists worldwide bought into this totally, and we were all locked down.

I'll jump forward to the denouement, which begins on p. 288 with a bit of genuine epidemiology: comparing year-on-year death statistics to discern "excess deaths" that might more properly be attributed to Covid-19 (or any other epidemic agent). 

• In 2020, the total number who died of all causes in Sweden was 98,124. 
• The annual average for 2015-2019 was 90,962. 
• In 1993, the year of a bad flu outbreak ("the Beijing flu"), the figure was 97,008. 
• Swedish population in 2020 and in 1993 (rounded): 10,369,000 and 8,574,000. 
• Divide deaths by population. 
• In 2020: 9,463 per million
• In 1993: 11,310 per million 
• Population average 2015-2019: 10,109,000. Divide it out: 8,998
• Delta per million in 2020 = 465 excess deaths per million
• Delta per million in 1993 = 2,312 (almost 5x!).

Conclusion: The Covid-19 pandemic was far from being "the worst pandemic in 100 years". It was probably second-worse.

Note: CDC data (https://www.cdc.gov/mmwr/preview/mmwrhtml/00016654.htm) indicates that in an "ordinary" flu season, flu leads to about 10,000 deaths in the USA. In the 1992-1993 seasons, 45,000 such deaths occurred each of the two years. Dividing these figures by a population of about 330 million, we find that flu deaths are "usually" about 30 per million, while the sum of 1992 and 1993 deaths by flu comes to 273. The Beijing flu hit Sweden 8.5 times as hard as it did the USA.

Backing up to p. 223, where the scientific community "turned from evidence-based reasoning to the precautionary principle": One scientist wrote of the reasoning of Anders Tegnell, "If he's wrong, it costs life. If I'm wrong, what harm does it do?" This is a markedly false dichotomy, for the lockdowns and other draconian measures not only did much harm, they cost many lives in themselves, including a great increase in suicide among younger people. The scientist who wrote that statement doesn't deserve to be called scientific.

Even in Sweden, by the end of 2020 the situation was no longer driven by science (protestations by fraudulent scientist Andrew Fauci notwithstanding), but by politics, specifically the totalitarian politics of control and the amassing of power. So-called "cancel culture" took control, such that the final sentence in the chapter titled "Science!" is, "What was regarded as a scientific discussion in Sweden was deemed to be misinformation in other countries." (p. 247). This is still true!

Considering the polarizing politics that arose from this, or rather that took advantage of it, I need to point out that on p. 243 the author quotes Glenn Kessler's article in The Washington Post that claimed Donald Trump issued 16,241 false and misleading claims in his first three years in office. He is apparently unaware that the article was debunked within a week by real journalists at the New York Post and The Atlantic. They found that at most, Mr. Trump lied outright no more than a handful of times; rather, Kessler printed thousands of lies in his article. True to form, Kessler just doubled down and issued further claims. The debunking has been so covered up it is hard to track down the truth. In actuality, since 2015 The WaPo, NYT and other "leading" publishers committed tens of thousands of lies against Donald Trump weekly, and continue to do so.

Let's look at some charts from Worldometer, which is cited a few times in the book. Note that the last update to their figures was April 13, 2024. Reporting has become too sporadic and unreliable for them to continue. I must add that early reporting is also somewhat questionable, and in particular, nothing that was "reported" by China or North Korea (DPRK in Worldometer) should be relied upon.

First, to discuss the summary for the whole world:

The fluctuating death rate shows the progress of the different "waves", ten of them, counting the late, rather tiny, bump from November 2023 to February 2024. The biggest wave of cases, in early 2022, with a wave of deaths that is lower than two of the others, shows how infectious the Omicron variant of the virus was, and how much less deadly it was.

When The Herd was written, the third wave, counted worldwide, was just ending. These figures help us establish some criteria. New daily cases in 2022 peaked at 500 per million persons, and exceeded 100 for much of the year; at all other times there were fewer than 100. The current case rate is 2/million or less.

The worldwide Covid-19 death rate exceeded 1/million persons for all of 2021 and the first third of 2022, and then, as the Delta variant petered out, it dropped very low and apparently remains well below 100 total deaths daily, or some 0.012 deaths daily per million population. As mentioned, this is in line with seasonal influenza. This is why, although some nutty politicians continue calling for restrictions to be imposed again, nobody is paying attention.

Next, let's look at how Sweden fared in all this:

It is worth noting that, while the daily case rate prior to August 2020, worldwide and in Sweden, is almost not visible on these charts, the daily death rates in this period were quite high. The very early death rate exceeded 10% of (known) cases. Two factors combine: figuring out how many actual cases there were was very difficult early on, and the large number of deaths represent "low-hanging fruit", or people who were at death's door already. In the USA, this was exacerbated in five states whose governors required nursing homes to take in people dying of Covid-19, which spread through those nursing homes like wildfire, killing many. I contend that those five governors are the five greatest mass murderers of the early 21st Century.

During the second wave at the end of 2020, Swedish politicians were spooked that Covid-19 deaths had again exceeded 100 per day (10/million in a population of just over 10 million), and as is noted in The Herd, began to swerve from the open stance of the prior year.

The figures in brown at top right of these charts show that the total case rate in Sweden was three times the world average, and the total death rate was just under three times as much.

Arguably, the country worst hit by the pandemic was the USA:

I am not sure whether the lockdowns in the USA were the worst in the Free World, but in my experience they were pretty bad. They varied from state to state. The first wave of deaths was not quite as bad, on a per-capita basis, as for Sweden, but the second wave was clearly worse. After the end of 2021, the USA case rate was much higher than that for Sweden, and this apparently continues, but after the middle of 2022 the Covid-19 death rate in the USA is quite a bit lower than Sweden's.

Compared to the world, the total case rate for the USA is 3.7 times higher and the total death rate is just over 4.0 times as high.

I originally prepared two more similar graphs, for the UK and for Norway, but instead I'll present the following:

The vertical axis is deaths from Covid-19 per million population of a country. Sweden, shown as "Swe", is right in the middle. The USA is to its upper right, with the UK in between. Among more authoritarian European countries, I've marked Bulgaria, Hungary, and Bosnia/Herzegovina, which had three of the four highest death rates in the world. The highest was Peru, for reasons I won't plumb here. By contrast, look at Canada and Norway ("Nor"; in each case except "World" the title is to the right of the dot). Nearly all the dots below them are countries in Africa and poorer parts of Asia, places which had few infections and very low death rates. 

I would think an ambitious epidemiologist could make a career of finding out whether there was something more than dumb luck that "blessed" the Third World. But I also must note that I have, from the beginning, strongly suspected that the USA was targeted by China, which released this bug with malice aforethought. I am flabbergasted by the number of American pundits who defend China at every turn. I know enough Chinese people to have an inkling of their way of thinking. Not every war goes fast. The Chinese way is patient, slow, and—insofar as they can ensure it—irresistible. To their way of thinking, WW3 has begun, and if they can manage it, our enemy will remove our head before we notice we have died.

The core message of this chart is that lockdowns had no discernible effect. Every European nation and most others locked down a great deal more than Norway, which stayed open during that very crucial first year, and has remained more open than most other countries thereafter. As a preacher once said about faith healing, "God may heal you today, but eventually you are going to die of something."

We learned from this pandemic that we have more to fear from totalitarian politicians than we do from a global disease outbreak. Sweden showed that society could remain open, taking only certain rather cautious measures, without harming the citizens either medically or politically. It is hard to tell whether any country achieved herd immunity, but it is certain that with the exception of Sweden, most countries fell victim to herd mentality, from which they are still in a very slow recovery.