The next day: Do we apply the Swedish model or the golden section of the best approaches?

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New article by the well-known professor and government advisor on the corona, Elias Mosialou. The article refers to the model to be followed the next day.

Specifically, it states:

In dealing with the corona crisis, the reactions of most countries can be categorized under 5 broad forms of approach:

  1. The approach of most countries, which closed large sectors of the economy and educational activities in time (such as Greece, Austria, Denmark, Portugal).
  2. The approach of these countries that have lagged behind in time (such as Spain, USA, and to some extent France).
  3. The approach of those who tried to apply the theory of herd immunity (such as England).
  4. The approach of Sweden, which is also trying to achieve the immunity of the herd, but does not officially state it. But when we talk about Sweden, we are talking about citizens with great confidence in the institutions and the government. We are also talking about a different family structure, where the elderly very often stay alone or decide to live in nursing homes. The government in Sweden has asked the elderly and vulnerable to limit their activities and has done so to a large extent. At the same time, he asked the others to be careful and keep their hygiene and physical distance.
  5. The approach of South Korea and Taiwan, which, while not imposing significant restrictions on economic activity, combined surveillance with continuous testing, intensive tracking and implementation of physical distance measures. But we are also talking here about countries where citizens listen to governments and experts and comply accordingly.

Let’s take a closer look now and judge from the results so far what has happened and which countries have been most affected by the pandemic.

  • Countries that underestimated the problem, such as the United States and Spain, and countries that tried to implement the herd immunity theory without making recommendations, had the greatest impact.
  • This is followed by Sweden, followed by the other 2 categories that applied the physical distance measures in combination with measures to limit economic activity, or in combination with milder measures, but with careful tracking and many tests.

Who was more right?

Certainly not the first two who did not protect the vulnerable and the elderly.

But what would be the best approach?

This, for example, of South Korea, which, while not imposing significant restrictions on citizens and on production and education, combined the crisis with continuous and multiple tests, tracking and implementing physical distance measures. And the people reacted responsibly.

But this cannot be taken for granted in other countries. Many countries did not have the opportunity for mass testing or huge tracking capabilities. It is also known that there has been international competition and many countries have banned the export of medical supplies, protection equipment and other important items to deal with the crisis. Nor would the population of many European countries necessarily behave in a disciplined way from the beginning in those countries, without having seen much impact within the country. The truth is that in our country we looked at Italy and then we understood what had happened in the USA and Spain.

So if there was just one recommendation to the general population to keep their distance, and another to the vulnerable just to be careful, would we have the same results now in Greece?

Controversy

Even now, or to be more precise, especially now, we see that some are questioning the reason why the measures were implemented in Greece. Even now that the result of the pandemic was so controlled for the health system. So I think that the tactics of South Korea and Taiwan would be difficult to implement in our country in March.

But did we have to do what the Swedes did and are we going to do that now?

In Sweden until yesterday, with a population of 10.2 million, they had 18.58 times more deaths than Greece (2,679 in Sweden and 144 in Greece). Sweden has a better health system than our country in terms of structures and ICUs. I would like to emphasize that Sweden has at the same time a population that for the most part listens to the instructions and applies them. Nevertheless, Sweden’s strategy in the short term had a much higher cost in terms of loss of life.

But it’s not just deaths. The many deaths correspond to many other cases that have suffered and experienced the disease very severely. We now know that those who become severely ill with COVID-19 and are admitted to the intensive care unit may have many other problems before recovery. https://www.bloomberg.com/news/articles/2020-04-24/life-after-ventilators-can-be-hell-for-coronavirus-survivors

If we look at the cost of the pandemic, in addition to human losses, the cost of the disease for the health system should not be calculated solely on the basis of people who have lost the battle with the virus. We do not yet have all the data to analyze the serious cases, but their cost to the health system in each country, unfortunately, exceeds the cost corresponding to deaths.

But how can this famous herd immunity be achieved and how is it achieved?

In order to achieve this, based on the current data, we need 2/3 of the population to be immune, in order to slow down the transmission of the disease. This does not mean that it will be eliminated, but that R0 will be reduced. Even with 2/3 immunity if there are 1000 cases in a country, with R0 = 0.5 they will transmit it to another 500. So the problem is not completely eliminated, but it is definitely reduced.

For there to be a real reduction, immunity must apply to all those who get stuck but also last for a relatively long time, at least for a year. But there are several uncertainties here as well. I will mention only two words that, however, encompass huge percentages of uncertainty regarding the quantification of risk: asymptomatic and immune. I have referred extensively to both and have emphasized that scientific (mainly clinical and epidemiological) data are still incomplete, and will, unfortunately, be incomplete in the coming months.

So those who seek the immunity of the herd directly or indirectly take risks. But let’s assume that there is immunity for a year and that this risk does not exist.

Is there another risk we need to focus on? In order for 2/3 of the population to develop immunity, more than 6 million people in Greece must be exposed to the disease. Many scientists claim that mortality ranges between 0.5 – 1%, but let’s evaluate for the sake of discussion the scenario that mortality is only 0.2 – 0.25%, and that those who will be exposed will be the youngest. Let’s also consider that the majority of them will be young people without significant health problems (although many may have a health problem and not be aware of it). In that case, the death toll would be between 12 and 15,000. In other words, 12-15,000 of our fellow citizens would die.

Can Greek society withstand this? Probably not. So what should we do in the near future?

The next day: Do we apply the Swedish model or the golden section of the best approaches?

We need to consider the best and most efficient points of the two approaches (Sweden, South Korea and Taiwan) and adopt them. We know from Sweden that although the death toll is 18.58 times higher than the death toll in Greece, it is still lower than in some countries that were slow to take action in the beginning.

So even the most relaxed form of physical distance measurement and isolation for the vulnerable and elderly applied there was still better than the delay shown by other countries.

It was definitely not better than lockdown. But because the lockdown can’t go on forever because the other problems it creates (such as financial, social, psychological) will have a bigger impact than the corona itself, then the gradual de-escalation strategies begin.

What to look for

So what should we pursue? We know what the ‘ceiling’ is probably, both for deaths and for serious cases, but it is a ceiling that has such effects that make it unacceptable in Greece.

That is why we are taking stricter measures than the Swedes and more carefully. We also know that the many tests and systematic tracking in the other two countries have paid off.

So the best combination is the golden ratio between the two approaches. Degradation, however, with physical distance, with masks, with great attention to the elderly and the vulnerable, but more severe than in Sweden and at the same time with an increase in tests and population tracking, as in the other two countries.

In any case, unless the disease becomes seasonal or a drug is found in the coming weeks or if we have a vaccine in the coming months, the risk will continue to exist.

If we don’t want to take any risks, there is a solution as well. Surely if the whole planet stays in lockdown for a year the problem will end.

But this cannot be done because the problems will get bigger.

These problems will include non-COVID-19 disease-related illnesses, a huge increase in mental illness and unemployment, and a possible economic collapse that will lead to serious underfunding of public services.

Therefore, the strategy of Greece until the drug or vaccine is found, should be the golden section of the best approaches, adapted to our data. In any case, we can’t get out of the lockdown without taking the slightest risk.

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