From Social Distancing to High-Risk Sequestering

I am losing faith in social distancing. The cost is too great, the effect too minimal. There isn’t a lot of evidence, but what evidence there is doesn’t appear to support blanket social distancing policies.

Thanks to the “Sweden Phenomenon,” I’m currently trying to better understand the relationship between death rate and lack of distancing. Sweden barely locked their country down at all when the rest of the world has gone into “bank vault mode,” and they have a much higher death rate than their Scandinavian peers (though lower than Italy, UK, Spain, US). This high death rate is interpreted as evidence that their approach is largely a failure.

But I’m not so sure. It seems to me that death rate variations between countries is better explained by variances in care provision, not enforcement of distancing measures. I would expect distancing to keep people from getting the disease, but not to influence death rate appreciably. And in this, Sweden is very close to their peers in number of cases. In the chart below they are above their peers, but not dramatically, as modelers are currently predicting with discontinuation of social distancing rules in the U.S. Furthermore, the chart is not corrected for per capita population differences. With that correction, because Sweden is substantially larger, they would be even closer to their smaller peers in total number of cases.

cases

Additionally, compare the number of cases in Sweden vs. Germany. Both enjoy high trust in government and robust public health systems, so it can be assumed that people largely do what they are told. Germany locked down almost to an extreme. And yet they have many more cases than Sweden in raw numbers. Corrected per capita, the two countries would be very close in number of cases. To me, this suggests that distancing really doesn’t work. If nothing else, it calls into question the value of distancing especially given the spectacular devastation distancing is causing.

If all-society distancing doesn’t work very well, then Sweden’s approach makes incredibly good sense. They acknowledge that they need to do better with targeted high-risk populations. But they also wisely do NOT meddle with low-risk populations (emphatically not closing schools, for example). The damage to their society is dramatically minimized.

I was initially a proponent of social distancing, but I’m becoming less so every day. Social distancing protocols are little-changed from those of 100 years ago. To this, we have added our more modern procedures of extensive testing and contact tracing. But these procedures really are only possible for containing low-frequency infection events like sexual infections. If you sneeze in a grocery store, you potentially infect 30 people, but I admire your stamina if you manage to have sex with all of them.

COVID19 is a massively high-frequency event. In the five or so days it takes to show symptoms after being infected, it’s possible to infect HUNDREDS of people, most of them anonymous to you. In short, social distancing coupled with massive testing and contact tracing is antiquated. It’s not really tailored to the realities of this specific pathogen, or today’s modern society. Not only are these techniques not working, they’re destroying society in the process of trying to deploy them.

I’m thus beginning to think that the world needs to move away from social distancing, and toward a system of “high-risk sequestering” where intense protections are placed on problematic areas but minimal interventions placed on low risk populations. Nursing homes, prisons, homeless shelters all should have extensive support and distancing procedures applied to them. Furthermore, there is good research into “Super Spreader Events” (SSE’s), which identify single events that are disproportionately responsible for the majority of infections around the world. Those can be targeted and suppressed as well. 50% of Sweden’s deaths have so far occurred in nursing homes. Imagine if they simply did better with protecting that population.

We need a new approach to COVID19. Social distancing is not safe and may not even be effective. I recently heard social distancing likened to a parachute: it keeps us safe as we drift slowly down to earth. But, as the analogy goes, cutting the straps to release the chute while we’re still in the air is a terrible idea, which is the idea of emerging from social lock-down too early. We can’t get out of the chute until we’re actually on the ground (when the virus is basically eradicated).

The problem with this analogy is that in real life, parachutes are benign to the user and once open they almost always work. Unfortunately, social distancing is neither benign, nor is it clear that it works. A better analogy is that social distancing is chemotherapy. Use the drug only if helps you, and then only use it as long as needed to kill the cancer. Put too much faith into it, or use it when it isn’t even helping, and it will just kill you.

 

2 thoughts on “From Social Distancing to High-Risk Sequestering

  1. Evan

    Geoff,
    If by “death rate” you mean per capita or deaths per million populations, then your numbers are off. As I said in my post, the per capita death rate in Sweden is HIGHER than the US. Also, you seem to say Sweden did as well as Germany which did a major lockdown. Actually, Swedens per capita death rate is nearly FOUR times Germany’s.

    Belgium 730.08
    Spain 553.4
    Italy 491.2
    United Kingdom 452.35
    France 384.92
    Netherlands 302.01
    Sweden 288.81
    Ireland 283.3
    United States 224.11
    Switzerland 211.94
    Canada 117.81
    Portugal 105.92
    Ecuador 94.71

    https://www.statista.com/statistics/1104709/coronavirus-deaths-worldwide-per-million-inhabitants/

    The POLITICAL decision to open up the US before we have adequate testing and downward trends means we will probably move up this list. The decision to be more “like” Sweden is based on falsehoods and really comes down to trying to get Trump reelected. The last falsehood about the Sweden response is that somehow they spared their economy… They didn’t as they have had a first quarter contraction and expect a bigger one the next quarter! People “voluntarily” avoided going out as often, frequenting bars, and traveling almost as much in “true” lockdown nations. Moreover, they are as much integrated into the EU and global economic order, and like viruses, they ignore borders.

    https://www.scb.se/en/finding-statistics/statistics-by-subject-area/national-accounts/national-accounts/national-accounts-quarterly-and-annual-estimates/pong/statistical-news/national-accounts-first-quarter-2020/

    As I said, it is along a spectrum. They have traded a higher death rate for a smaller economic contraction. It comes down to math and morals and a business case analysis…. what is the value of a life? To prevent a 0.1% drop in GDP, is an acceptable trade-off 10,ooo lives? How about 100,000?

    Leaders have to lead in difficult times, and explain (rather than tweet) why they made their decisions. And lastly, accept that the buck does truly stop with them so stop blaming everyone and everything as that just kills any reassurance you could have been giving to your people in a time of need. That is the main reason Sweden’s response is so idealized and deserves praise.

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    1. Love the input! Thank you.

      I’m not sure I made the general thesis of this post clear: I don’t think the death rate is a good measure of the efficacy of lock-downs. I think the best way to measure the utility of lock-downs is CASES, not deaths. So when I said Sweden did about as well as Germany, I’m talking about per capita positive case rate, not death rate. If I’m right, then the corollary is also true, which is that lockdowns aren’t worth the cost because case rates are similar between a locked-down country and a relatively open one.

      The high death rate in Sweden needs to be examined, which they also admit. The working theory is that their retirement homes are in very poor order (apparently they have been for a long time). A more robust lock-down on THEM (targeted high-risk sequestering), would likely have led to dramatically-lowered death rates, because that is a specific population for whom COVID19 is particularly lethal.

      I will appreciate being disabused of the notion that distancing prevents/reduces CASES but not DEATHS. Or at least hearing a strong counter-argument that I can ponder. I readily admit to being currently world-class guilty of reading for confirmation bias. Suddenly everything I read confirms this idea of mine. I know this can’t be true. At least, not to the level of certainty that is calcifying in my psyche.

      Like

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