COVID19 update, June 1, 2020: Sweden’s “road alone” and elderly care; avoiding lockdowns in a new flare-up; not even Stanford immune from cuts and layoffs

 

(1) Sweden’s Sonderweg (“special road”, idiomatically, “going its own way”) is the subject of heated debate pro and con.

At first sight, per capita mortality is an order of magnitude higher than in adjacent countries with similar ethnic profile, climate, and sociology. (Sweden does, however, have a higher percentage of 1st-generation immigrants than Norway, Denmark, and Finland — see below.)

At second sight, however, it turned out that Swedish morbidity and especially mortality is disproportionately concentrated in two populations: elderly in care homes (over 70%) and 1st-generation immigrants. Mortality among native Swedes from young to independent elderly, is actually not that elevated compared to the neighbors. 

On the gripping hand, while the Swedes may have avoided the economic ruination of a full lockdown and may be closer to herd immunity now should a second wave arrive, there are costs to this epidemic for everyone (the travel and airline industries, for instance, are on life support everywhere, lockdown or no lockdown). Some aspects of the world economy will be changed forever — and some already existing ‘creative destruction’ trends will be accelerated worldwide. Sweden will see a recession, just not as deep, and possibly with a quicker recovery. 

But let’s come back to those care homes. Die Welt has an exposé on what is going on there: “The true problem of the Swedish sonderweg“. If it were in English, I’d say “read and weep”. But as it’s in German, let me summarize a few points (reader beware):

  • As explained earlier, the Swedish elderly care model is based on encouraging people to live independently for as long as possible, with paid ‘home helpers’ if needed. Assisted living facilities seem to be primarily a private-sector option, while true homes for the elderly are seen as the last resort. Median survival time in them is less than a year
  • Caregivers in these homes were alleged not issued PPEs, and testing was only carried out people who showed symptoms, despite adequate testing capacity being available.
  • The Swedish newspaper Aftonblådet quoted gerontologist Prof. Yngve Gustafsson of Umea University as saying that 70-80% of care home residents admitted to geriatric hospitals with COVID-19 are sent back to the care home. Residents checked into the hospital with COVID19 were often sent back to the home, where of course the infection then spread.
  • He adds that in many cases they don’t die from COVID19 but from secondary infection with bacterial pneumonia, and could be saved with intravenous antibiotics. However, the prescribed care protocol for such patients is purely palliative — Morphin, Midazolam and Haldol – which according to him is a nearly 100% certain death sentence
  • A man named Thomas Andersson, who discovered that his father Jan, aged 81 had been put on this protocol (following diagnosis over the phone!) managed to get the decision reversed after first contacting the care home management, then going to the media. His father was put on an antibiotic IV and, once the bacterial pneumonia receded, managed to fight off the relatively mild COVID19 infection on his own. Below is Jan celebrating his recovery with children and grandchildren. Thomas still cannot believe such a thing was possible in Sweden.

Infuriating and appalling as such stories may be, they have a flip side: that if Sweden hadn’t gone “full Cuomo” on its elderly, its mortality might well have been a fraction of what they have now, and Sweden’s sonderweg might look a good deal better.

(2) Israel is, sadly, seeing a spike in new infections, almost all of them at a few schools in the Jerusalem area. Prof. Eli Waxman of the Weizmann Institute, who led the team that laid out Israel’s COVID19 planning,  discusses here how to handle a possible 2nd wave without lockdowns.

It sounds a lot like what  Norway envisages as its strategy for a second wave: individual test, track and trace as the first line of defense, where speed is of the essence; localized isolation measures as a second line of defense; expanding the ring of those if necessary; but national lockdown only as a very last resort. (It sounds like nobody in Israel, Norway, nor for that matter Belgium has any stomach for a second lockdown. This is especially true as Norway is wondering, with hindsight in numbers, if voluntary social distancing might night have been adequate. Your mileage may vary, of course — Norwegians and Italians, for example, would react very differently to strong social distancing recommendations.)

[…] In Israel, the HaMagen [“The Shield”] app, which was developed and endorsed by the Health Ministry and can tell people if they have been in the presence of anyone who has been diagnosed with coronavirus, could play a key role, he said. “The more people who download it, the better.” 
[In addition, the] Shin Bet [Israel’s domestic security service] was reported to have traced a third of Israel’s coronavirus cases, some 4,089 people, [through their cell phones.  Israel’s Supreme Court has however ruled that this cannot continue past the emergency order, unless anchored in law.]

[…] Waxman said South Korea has two advantages over Israel: It learned the importance of moving fast from its experience with Middle East Respiratory Syndrome (MERS) in 2015, when the virus killed 36 people, infected 186 and put thousands of citizens into isolation. The outbreak was ultimately traced to a single visitor from overseas. 
In addition, South Korea has leveraged some technological tools that “Israel cannot and should not be able to use” because they might infringe on privacy rights, he said.

 

(3) One “industry” which will be hit hard is higher education. Especially in the US, much of it is built upon an unsustainable base, with people paying extortionate tuition for amenities and administrative overhead that has nothing to do with education — be it the country-club level gym and dormitories, the football stadium (which only in a few places is net profitable), or the ever-expanding army of administrators. Now that these places were forced to move to distance learning, they found themselves competing with much cheaper online colleges. Instapundit has endlessly blogged (and written a book) about the “Higher Education Bubble” and the coming wave of creative destruction in that industry: COVID19 only accelerated a process waiting to happen. I had always assumed, however, that blue-chip brandnames like Harvard would be largely insulated. 

Now it turns out that not even Stanford (!) is fully immune, as revealed in a statement by the president

Many of our income streams will continue to be diminished: Housing revenue will be reduced due to fewer students living on campus; income-producing events and programs will continue to be limited; and clinical, research and philanthropic income streams will be challenged. At the same time, expenses in some areas, such as student financial aid, will increase. The market volatility affecting our endowment also can be expected to continue, given the seismic disruptions occurring in the national and global economies.

[…]

We previously asked university units to prepare FY21 budget plans based on a scenario with a 15 percent reduction in funding from endowment payout and a 10 percent reduction in support from general funds. We sincerely hope that the reductions needed will be smaller than this, but for now we need to plan to these targets as a contingency. We expect to provide final allocations of general funds and endowment payout to units by the end of June, enabling them to finalize their budgets in July.

As units plan for budget reductions, we expect there will be reductions in some of the programs each of them is able to offer. We will work to ensure that any program reductions still allow us to sustain Stanford’s core academic strengths and our long-standing commitments to student access.

Given the magnitude of the budget challenge, we also expect that program reductions will make some workforce reductions unavoidable as we enter the new fiscal year. We don’t yet know the scale of job reductions. We hope they will be limited, but they will be driven by the program needs and budget capacity of individual units. Our expectation is that some of these reductions will be temporary layoffs (furloughs) until we are able to resume services and bring employees back, and that other reductions will be permanent layoffs. At this time, we expect to be able to communicate more detailed decisions about layoffs in late July.

It would be too much to hope that the “programs” affected would primarily be silliness such as courses on “the poetics of the lowrider” (as Victor Davis Hanson has described elsewhere), rather than the STEM programs that made Stanford such a powerhouse. But never underestimate the reverse Midas touch of professional college administrators…. 

 

(4) And just because: “June came upon us much too soon…”

 

 

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