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Post Sweden as Coronavirus Control Group; The Game Theory of Toilet Paper
Created by John Eipper on 04/11/20 9:22 AM

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Sweden as Coronavirus Control Group; The Game Theory of Toilet Paper (Sam Abrams, USA, 04/11/20 9:22 am)

Regarding John E's point about the absence of a control group to test the hypothesis for the effectiveness of social distancing, we, in effect, have such a control group: Sweden.

As explained by Christina Anderson and Henrik Pryser Libell in a March 28th article in The New York Times, the Swedes decided to go down a very different path than their Nordic neighbors in combating the coronavirus.


In contrast to the Danes, Norwegians, and Finns--who have shut down schools, restaurants, bars, and otherwise imposed strict lockdown measures, including, for example, the prohibition of travel into and out of the Helsinki metropolitan area--the Swedes have merely shut down universities and high schools and urged vulnerable populations to shelter in place. According to a March 27th article posted by The Local, an online newspaper in English about events, politics, and culture in Sweden, the government has also banned gatherings of 50 people or more.


The expectation in Sweden, wrote Anderson and Libell, is that the nation's strong tradition of trust in its citizens to do the right thing would prevent behavior causing the virus to spread. In addition, according to an April 9th article by Alex Ward for Vox, the Swedes expect that their strategy will help people build immunity to the virus.


Ward wrote that Anders Tegnell, Sweden's chief state epidemiologist, has repeatedly stated that it would be good for the Swedes to build immunity to the virus though he denied purposely pursuing herd immunity.

Purposely pursuing herd immunity had been the strategy of Mika Salminen, Finland's director of health safety, reported The Helsinki Times in a March 20th article, but Salminen's recommendation was soon reversed by the Finnish government, which imposed restrictions as stringent as any mandated by other European governments.


The results so far of this grim experiment do not validate the Swedish approach. According to the global map of coronavirus data published by Google, Sweden, with a population of 10 million, has so far suffered 887 fatalities related to the coronavirus; Finland, with a population of 5.5 million, 49 fatalities; Denmark, with a population of 5.7 million, 247 fatalities; and Norway, with a population of 5.4 million, 114 fatalities.


Of course, if the Swedes are right that there is no hiding from the coronavirus and that immunity should be developed sooner than later, these proportions could in time change in their favor.

On a lighter note, there has been no run on toilet paper in Sweden. Even in Finland, where consciousness of other people's needs is supposed to define the nation's solid social contract, there has been such a run. The Helsinki Times reported in an April 10th article that a bakery in Helsinki has responded to this run by selling novelty cakes looking just like rolls of toilet paper: if you can't get the real thing, you might as well make believe you did by serving it.


This run on toilet paper constitutes a textbook case of game theory, I concluded after failing to find toilet paper at one store after another on the Upper West Side of Manhattan two Sundays ago: if you don't hoard, others might, and then you'll be in trouble. After all, such hoarding was happening even in a highly civic-minded country like Finland.

In an April 4th Q&A with grocery mogul John Catsimatidis published by The Wall Street Journal, Catsimatidis said, "There is no reason to panic about supplies. I want people to know that. Only panic buying causes shortages." Catsimatidis went on to say that his stores, comprising grocery chains Gristides and D'Agostino in New York City, have plenty of toilet paper.

I ultimately did find toilet paper at a Gristedes on that search two Sundays ago, but the store had only individual single-ply rolls, the kind of toilet paper one finds at summer camps, ice rinks, amusement parks, and stadiums. And they weren't cheap. Catsimatidis was charging $2 a roll.

As game theory would imply, Leo Durocher's maxim, alas, holds for toilet paper during a pandemic as well as too many other situations: "Nice guys finish last."

JE comments:  In the very grim calculus of coronaculture, we are collectively using less toilet paper, not more.  But Sam Abrams (nice to hear from you, Sam!) has put his finger on the game theory of TP:  hoarding begets hoarding, which begets even more hoarding.  The 2020 Great Run on Toilet Paper is a play on the pre-emptive strike in geopolitics:  get your enemy before s/he gets you.

Here's an image of the Finnish TP Cake.  It looks good enough not to eat...

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  • Is Sweden's Reaction to the Pandemic Really That Different from the Rest of Europe? (Cameron Sawyer, Russia 04/12/20 6:13 AM)
    I would respectfully dispute much of what Sam Abrams (April 11th) wrote about the Coronavirus response in Sweden and the development of the pandemic there.

    I am writing this from a Danish harbor within sight of the Swedish coast, where I have been hunkering down during this crisis.

    A number of articles and comments have appeared expressing alarm at the Swedish approach to the crisis--all based on the reflex that many have had that the Swedes can't possibly doing it right, if the rest of us have had to go through so much pain and economic devastation. The numbers are cherry-picked to support that narrative, but the picture is distorted and wrong.

    It is typical in these articles to focus on the difference between the death rate between Sweden and other Nordic countries, but this leaves out the fact that death rates in the Nordics are generally low compared to the rest of Europe. Sweden's death rate is low, so the fact that they are even lower in Denmark and Finland means that death rates are really low in those countries, not that Sweden is high.

    Cumulative cases, and cumulative deaths, per million:

    Sweden: 1005 cases, 88 deaths

    Denmark: 1035 cases, 45 deaths

    Norway: 1173 cases, 21 deaths

    Finland: 524 cases, 9 deaths

    So this looks like horror in Sweden? Come on:

    UK: 1559 cases, 146 deaths

    France: 1913 cases, 202 deaths

    Switzerland: 2877 cases, 117 deaths

    Germany: 1466 cases, 33 deaths

    Netherlands: 1384 cases, 154 deaths

    Belgium: 2418 cases, 289 deaths

    And for comparison:

    New York State: 8525 cases, 392 deaths

    It should be said that the rate of increase of new cases has been falling everywhere in Europe. Days to doubling of new cases has fallen from an average of 7 days to about 10 days now--which is a huge difference in the exponentiality of the curve--doubling 3 times rather than 4 times per month. And the rate is still falling. This is likely the result of social distancing kicking in.

    Sweden is doing fine by this measure--new cases today are 10,151, and were 5568 on April 2, so less than doubling in 10 days, in line with other Nordic countries.

    The death rate is strikingly higher in Sweden than in other Nordic countries, but what is the significance of this? There are wide variations between countries in the rate of deaths compared to the number of cases, with no obvious explanation, and no obvious relationship to lockdown policies. The total deaths per million population in Sweden as has been shown is not high by European standards and not that high compared to the number of cases, either.

    Another fallacy in the narrative that Sweden is experiencing some kind of disaster is that the policies in Sweden are not actually so different from other Nordic countries, particularly Denmark, where I am now. You cannot oversimplify it down to "Sweden--no lockdown. Rest of world--locked down." It's much more complicated than that, involving not one but an array of policies which are implemented to different degrees in different places.

    There is no stay-at-home order anywhere in the Nordics, and "non-essential businesses" have been closed in the Nordics only in Finland. In Finland there has been an order against non-essential travel into and out of the capital region, but there is no stay-at-home order and shops are open. In none of the Nordic countries is it forbidden to visit family and friends, so long as the group does not exceed some stated number, 50 in some countries, 10 in others. In Denmark relaxation will start next week with reopening of all of the schools, at which point Denmark and Sweden will be operating under pretty similar regimes.

    Borders are closed to international travel in most European countries except Sweden and Germany, but this is not very important since travel into and out of the Schengen zone is now generally forbidden, and other international travel has almost stopped anyway.

    So in short: Sweden does not have policies which are radically different from some other European countries, and Sweden is experiencing a fairly low rate of cases and deaths per million of population with a moderate rate of increase of new cases compared to other European countries. The whole narrative to the contrary is made up to satisfy a particular prejudice against a road which superficially looks different from the norm.

    None of this is to say that Sweden, or any other country, has got the policy mix right. No one knows that at this stage--there are a great deal of things we don't understand about this virus and how it spreads, and we are not doing enough testing to know for sure even how widespread it is. It is far too early to tell. We can however say that it is not yet obvious that Sweden has got it wrong, or that what they are doing is some kind of "grim experiment."

    Furthermore, one mix of policies is not necessarily the right prescription for every country. The pandemic is developing differently in different countries for different reasons, including many we don't even begin to understand. Social distancing definitely slows down the pandemic, but how much of it is necessary may be different in different countries. The Nordic countries have some natural advantages being relatively thinly populated, with well-housed populations who do not live in crowded conditions (a majority of Swedish people live alone in fact), with well-educated and disciplined populations who respond better than most to voluntary measures. The fact that the Swedes and Danes are not compelled to do much social distancing, does not mean that social distancing is not taking place. On the contrary, the streets of Stockholm are notably empty, as is public transportation.

    So what is essential in Spain or in New York may not even be necessary in some other place. And in general we won't really understand it completely for another year or so.

    JE comments: Sam Abrams did point out that Sweden has closed its schools and prohibited large gatherings. The Swedish policies do not sound much different from the de facto situation in corona-plagued Michigan.  Two days ago we went shopping in the bustling metropolis of Adrian (!), and my subjective impression was that traffic was at normal levels.  Much activity is banned, but nothing is really enforced.

    Stay safe, Cameron!  What do you hear about the situation back in Moscow?

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    • Sweden's Coronavirus Policies *Are* Different from Rest of Europe (Sam Abrams, USA 04/13/20 3:54 AM)
      Cameron Sawyer's response to my post about Sweden conflicts with what Christina Anderson and Henrik Pyser Libell reported in their March 28th New York Times article I cited.


      That article, entitled "In the Coronavirus Fight in Scandinavia, Sweden Stands Apart," opened with this assessment:

      "When the coronavirus swept into the Scandinavian countries, Norway and Denmark scrambled to place extensive restrictions on their borders to stem the outbreak. Sweden, their neighbor, took a decidedly different path.

      "While Denmark and Norway closed their borders, restaurants and ski slopes and told all students to stay home this month, Sweden shut only its high schools and colleges, kept its preschools, grade schools, pubs, restaurants and borders open--and put no limits on the slopes."

      Anderson and Libell continued:

      "Finland closed the borders of its most populous region--which has 1.7 million people and includes the capital, Helsinki--for three weeks to fight the outbreak there.

      "Norway limited groups outdoors to no more than five people, and those indoors must keep a distance of more than six feet (except relatives). Denmark closed its borders, sent public workers home with pay and encouraged all other employees to work from home. It shut nightclubs, bars, restaurants, cafes and shopping centers, and banned gatherings of more than 10 people outdoors....

      "Some Swedes have suggested that their country is deviating from most other nations' response to hasten herd immunity, risking lives unnecessarily.

      "The public health agency denies this.

      "In the meantime, the infection curve in Sweden has started to rise sharply, and on Friday the government tightened the limit on crowds to no more than 50 people [after initially limiting crowds to no more than 500]."

      Regarding schools, in particular, the difference is stark: Denmark, Finland, and Norway closed all schools. As Anderson and Libell reported, Sweden closed only high schools and universities and kept preschools and primary schools open.

      Alex Ward provided more detail in his April 9th Vox article that I cited. That article is entitled "Sweden's Government Has Tried a Risky Coronavirus Strategy. It Could Backfire." I encourage WAIS members to read this article, as well.


      As for fatality rates, the difference between 88 deaths per million inhabitants in Sweden, on the one hand, and, on the other, 9 per million in Finland, 21 per million in Norway, and 45 per million in Denmark speaks for itself.

      The fatality rate in Sweden indeed pales by comparison to rates in Belgium and France, as Cameron noted, but the point of my post was to compare countries as similar as possible yet distinct in strategy. After all, the fatality rate in New York City, where my family lives, is now nearly 800 per million inhabitants, or 9 times the rate of Sweden. But the population density of New York City makes comparison to Sweden or any other country irrelevant.

      Again, given the difference in strategy employed by Sweden in combating the coronavirus, the country indeed represents a compelling epidemiological test case. In time, scientists should be able to discern important lessons.

      JE comments:  We've seen several references to "herd immunity."  I'd like to learn more about the harsh logic of the concept.

      On a related topic, population density does not seem to predict infection or death rates.  Our own Detroit is one of the least dense major cities in the US, yet its population-adjusted infection rate is higher than NYC:


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      • More on Coronavirus Policies in the Nordic Countries (Cameron Sawyer, Russia 04/14/20 1:26 PM)
        In response to Sam Abrams (April 13th), there are plenty of articles critical of Sweden's pandemic response. It is an understandable if ugly human impulse to want to disbelieve, when everyone is suffering such cost and damage from lockdowns, that some other country may get away with less cost and damage.

        But the articles which Sam cites are demonstrably wrong about different things. First of all, Sweden does not indeed stand so much apart from other Nordic countries. Which Swedish policy, exactly, is being objected to? There is no unitary concept called "lockdown" which is the same everywhere--there are rather an array of different policies which can be combined in different ways, to wit:

        1. Close borders to non-essential international travel.

        2. Stay at home orders: people not allowed to leave their homes except for narrowly specified reasons.

        3. Closing public spaces

        4. Curfews and/or blanket bans on "non-essential travel"

        5. Closing schools

        6. Banning large gatherings

        7. Banning social contacts outside of one's own household.

        8. Closing restaurants and bars

        9. Closing factories and companies in "non-essential" industries

        10. Closing shopping centers and/or "non-essential" shops

        Most of Europe has taken all or nearly all of these measures. But not the Nordic countries. In Denmark, where I am now, only 1, 5, 6 and 8 were done, and starting on Wednesday, schools will be reopened so 5 will be off. So three out of 9 categories of measures, and without ever having had any of the most intrusive ones, which are stay-at-home orders, restrictions on internal travel, closing businesses, and closing public spaces. As to 8, restaurants in Denmark are actually open, but you are not allowed to dine inside.  Two people at a time are allowed inside to pick up orders.

        Just about the same thing is true in Finland and Norway, where there are likewise no stay-at-home orders, no closing of public spaces, no curfews, no bans on small gatherings or visiting. Finland has a short-term ban on non-essential travel into and out of the capital region--intended to slow down the spread of the virus from Helsinki into the countryside. This will be lifted at the end of this week. Norway has a short-term ban on people going to their country houses, which will also be lifted soon.

        Sweden has banned large gatherings like the other Nordic countries, has banned visiting nursing homes, and has closed high schools and universities. Sweden is alone among the Nordics in leaving borders open, but this is not a very important fact since international travel has just about stopped anyway, and Schengen as a whole, including Sweden, is closed to travel into and out of the Schengen zone, including from the UK. From Wednesday, the only difference between Denmark's policies and Sweden's will be that you can sit inside restaurants in Sweden, rather than going inside two at a time, and that Sweden's borders are theoretically, of not practically, open. That's it. Both Denmark and Sweden rely principally on people following non-mandatory recommendations about social distancing, which has profoundly changed behavior in both countries, and which has resulted in a significant flattening of infection rate curves.

        So all the Nordic countries differ radically from the tight lockdowns imposed in other European countries, and are more like each other, than to anywhere else, and that includes Sweden. Life in the Nordic countries goes on in a way much closer to normal life than elsewhere--people are out sailing and travelling by RV, the parks are full of people having picnics and going for walks, people visit their friends, children, and grandchildren (albeit selectively and carefully), people go to shops of all kinds, everyone who has not been laid off is working. People are not cowering in their homes and hoarding toilet paper like elsewhere.

        As to the "infection curve rising sharply" in Sweden, this is objectively false. The curve in Sweden has on the contrary steadily flattened, like elsewhere in Europe. As of April 13th, there are 10,483 cumulative cases. On 2 April, there were 5,568 cases, so in 11 days, the number of cases has not doubled. See: https://www.worldometers.info/coronavirus/country/sweden/ . This compares favorably to Denmark, with 6,174 cases, which has just about doubled since 3,107 cases on 1 April, so roughly the same rate of doubling as Sweden. Although not as good as Norway, with 6,525 cases which has taken more than two weeks to double. But better than France and UK, and similar to countries with the outbreak well under control like Germany. Note that the rates of doubling in Europe have very recently been 6, 5 even 4 days. The dynamic of spreading of the disease has dramatically slowed all over Europe, not excluding Sweden. The rate of doubling is indeed the critical metric--because the whole purpose of the economically devastating lockdowns is not to reduce the ultimate extent of the infections, but to "flatten the curve" of new infections sufficiently that critical cases are spread out over enough time that health care systems are not overwhelmed as happened in Italy.

        All of the Scandinavian countries, including Sweden, have managed to flatten their infection rate curves early in the game, with infection rates lower than the rest of Europe, namely: Norway 1,204, Denmark 1,066, Sweden 1,038. Finland is even much better than this, but all the Nordic countries have the lowest infection rates in Western and Northern Europe. Finland is the only country in Northern or Western Europe with a lower infection rate than Sweden. See: https://www.worldometers.info/coronavirus/#countries . So the number of daily new cases in Sweden has stayed in the range of a few hundred cases a day, 332 yesterday, or 33 per million of population. This is rather sustainable compared to thousands of cases a day in other countries, for example, more than 5,000 cases yesterday in the UK, and recently near 10,000 in a single day. This is 83 - 160 cases per million per day.

        As to death rates, Sweden's is notably higher than other Nordic countries, but at 89 per million of population, is still low by European standards, below the average of Western and Northern Europe. On two days only have there been more than 100 deaths per day. The worst day was 114 deaths. Yesterday there were 12. This is 11 and 1.2 per million respectively. In France, there have been five days with more than 1,000 deaths, 1417 on one day last week. That is 23 per million, and cumulatively 221. We won't talk about Italy or Spain, or certainly not New York State, where more than 9,000 people have died just in the last 3 weeks, for a population only twice that of Sweden, for cumulative deaths of 469 per million, in less than a month since the first death. To paint the situation in Sweden as alarming in any way, compared to the rest of the world, you have to severely torture the data.

        As to the underlying demographic, economic and climatic differences between the Nordic countries and the rest of Europe--why should that be taken into account in the way that Sam suggests? So Sweden shouldn't accept a cumulative death rate of 89 per million, which is 2 ½ times less than France, although Sweden is at a later stage in the epidemic? Why? On the contrary, logically, the Nordic countries should be exploiting their natural advantages to disrupt life and disrupt their economies less, and to implement measures which are sustainable over a longer term than the kind of measures implemented elsewhere. And that is exactly what all the Nordic countries are doing, and not just Sweden, with much milder measures than the rest of Europe. The kind of lockdown being done in France and the UK cannot be sustained for long without total collapse of society and economy (and it is not clear that total collapse is avoidable even now), and could probably not be repeated. But the Nordic countries have taken measures which can be sustained for a longer periods of time, or which can be relaxed and reimposed as necessary as successive waves of the virus come through.

        Note also that it is not necessarily desirable to reduce the rate of infections too low. The idea that the epidemic should be allowed to spread uncontrolled so that "herd immunity" can come into play to stop further spread, has been generally discredited. But that doesn't mean that we don't care about herd immunity--on the contrary, it is desirable that people develop immunity, and countries whose citizens have been infected and have recovered, but not so fast that health care systems were overwhelmed, will be able to return to normal life sooner. Finland, for example, with one of the lowest infection rates in Europe, may be more vulnerable to the second wave, than other countries. There will be at least three waves of this before we have any decent chance of having a vaccine. So it may well be that Finland, even with its very light lockdown, has overdone it, at the cost of the biggest recession in a century--we won't really know for at least another year.

        As I wrote--whether Sweden or indeed any other country in the world has gotten the policy mix right, no one can say at this stage. It is still early days. If "flattening the curve" is indeed the right goal to be pursuing--and I'm not sure that we know even this for sure--then objectively, according to the data, Sweden has succeeded better than most, and indeed has succeeded in doing so at an early stage of the epidemic, while the total number of infections is still relatively small. Maybe Sweden's policies are not optimal, but you can't say that at all today, based on the data.

        JE comments:  Cameron Sawyer raises a new question on our extensive coronavirus discussion:  Will the nations that took extreme (even draconian?) measures against the virus be more vulnerable to the (inevitable?) second wave?  Finland vs. Sweden, perhaps, will provide the competing test cases.

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    • Can Coronavirus "Fit" on the Left-Right Spectrum? (from Gary Moore) (John Eipper, USA 04/13/20 4:31 AM)

      Gary Moore writes:

      This somber Easter seems to be "prejudice" day on WAIS.
      Serendipitously and subtly, but importantly, two posts
      and a comment, on different themes, have brought up
      questions about warping of discourse, or bias impeding
      the usefulness of communication by hiding relevant facts.

      Cameron Sawyer's impressive reply (April 12) to Sam Abrams's
      thoughtful post, on whether Sweden is getting a bad rap
      for its coronavirus moderation, is followed by José Ignacio
      Soler, in quite another vein, with his admirably considerate
      but frank concerns that, on the subject of independence for
      Catalonia, our moderator John E might be prejudiced.

      Cameron stated about a theme in the news (on Sweden):
      “The whole narrative... is made up to satisfy a particular prejudice."
      If he's right, the question is: Why would the naysayers want to do this?
      What would, hypothetically, prejudice an influential segment of
      opinion on a question that isn't even politically right or left, but
      would have to have some other buried prejudicial trigger, causing
      a kind of avoidance reaction?

      Cameron suggested that in Sweden's case, it might be, so to speak,
      lockdown-compensation, as more confined cultures spawn proselytizing
      to rationalize their own distress. Quickly, we begin to see just how deep
      the everyday question of "prejudice" can go.

      In answering José Ignacio Soler's concerns about Catalonia prejudice,
      JE said he feels "agnostic" on the Catalonia issue--not a true believer
      on either side--but he then broadened the field to prejudice's more
      familiar mazes, saying: "I acknowledge my anti-Trump bias"--though
      acknowledgement would seem to mean it's not felt to be a bias at all,
      but an opinion owned as reasoned.

      The pandemic, with its bewildering streams of oft-distorted information,
      rising and then disappearing within days at times, affords tantalizing glimpses
      of the emotional wellsprings of over-selective belief, hidden in better
      times behind orthodox labels of left or right. It reminds how far we have to go
      in understanding what might seem heretically taboo: the implication that
      "left" and "right" lead deeply into matters of psychology.

      JE comments:  Gary Moore is onto something, in that we've found two controversies that don't fit the left-right template:  Catalonia and coronavirus.  Even Trump embodies "right" in a sense that would have been incomprehensible to US conservatives prior to 2016.

      Can coronavirus policies be placed on the political spectrum?  An orthodox libertarian response would be to let the people do what they want and fend for themselves.  But there are nations both left and right with the strictest of quarantines in place.  Do criticisms of Sweden's policy, as Gary suggests, reflect the need of "locked down" societies to rationalize their sacrifice?  Meaning, to put it bluntly, that the free-range Swedes deserve their higher levels of infection--even if they're not all that higher?

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