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tv   Discussion on Swedens Response to COVID-19 Pandemic  CSPAN  August 20, 2022 4:26am-6:02am EDT

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free mobile video abbott also >> many -- countries curtailed socioeconomic to various degrees. other non-pharmaceutical or npi interventions to reduce incidence of death. those npis impose a enormous ecological -- and social costs. elsewhere, most famously in sweden, public health officials
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were criticized for implementing npi and -- and less harsh measures. it is a fascinating experiment in the merits and demerits of a more liberal approach to the covenantee pandemic. if the loss in personal economic freedom was comforted by the increase in illness and death. an independent third-party commission set up from this we can government included the government strategy of not introducing lockdowns as many other countries have done was fundamentally correct for maintaining individuals personal freedoms in countries. the commissions was critical of -- not introducing more measures. also saying the government delegated too much responsibility to the public health agency of sweden and
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responsible bodies for decision-making outweighs clear. figures from the european union statistics agency shows sweden had 7.7% or that's in between 20 than the average in the proceeding or years 2020 then the preceding four years. it compares well with other countries and suggest that strict mpi policies impose more harm than good, sweden's policy still has its critics. as recently as march of 2022 a group of scholars from sweden, norway, belgium, u.s. co-authored a review in nature that they claim that sweden's public health agency was systematically in effect and there risk assessments and ignoring scientific evidence on transmission, face masks, children and covid come along
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covid, and insufficiently intimated and that of the pandemic response plan that was constructed for an influenza pandemic. they went on to state that the cautionary principle that was written into into the -- into the eu's function is to have a more passive approach. it was only not to overwhelm health care contrary to the advice of the debbie ho in the european cdc -- who and the european cdc. they point is data showing sweden had significantly higher rates of covid deaths per million publishing than their neighbors. joining us to discuss just how well their approach did is jeanne lenzer, her articles appeared in new york times, washington post, atlanta, smithsonian, and send -- scientific american.
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she is the author of the danger within us, the book about bad medicine and medical devices. vinay prasad, md, mph who at the beginning of august was promoted. congratulation. jay bhattacharya, md, phd professor of health policy at stanford university medicine. author of the great barrington -- co-author that were dashed that focused on pandemic policy and protection. johan norberg senior fellow at the cato institute who resides in stockholm sweden and has studied and experienced his countries pandemic policy and comes to us live tonight from stockholm, sweden. after each of our experts share their thoughts we will engage in
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conversation and take questions from unit -- viewers. please submit your questions on the cato website, youtube, facebook, twitter using a # catohealth. you co-authored a -- i admit it inspired me to organize this event, let me ask you to help me start this thing off. >> i didn't think i am saying anything controversial today, covid in the united states is an unmitigated disaster. many people have died. children out of school, many did not attend school for the last two years. the very active lockdowns, school closures, restaurant closers, the title of her
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efforts we're still feeling the effects of this pandemic 2.5 years on and the repercussions will be felt for years, the question is, could we have done better, one way to answer that question is a look at how other wild ep or nations, did they do better or did they do worse, if they did what can they do differently? when public health experts in the media started cooking at this question, what was quite fairly widely accepting nine states there was one contest united states there was one country everyone held onto as a real unmitigated disaster and that is sweden. we would not want to emulate the way sweden managed the pandemic. sweden only closed at school for two weeks and children up to the
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age of 16 were back in classrooms. they did not low businesses -- close businesses or restaurants. they were pointing out that because of this light touch approach they were so reckless, more of their elderly population died than other countries. they blasted as a cautionary tale and the medical committee by a large echo this attitude about sweden. experts who try to dissent from that prevailing wisdom were attacked and sometimes silenced, as were journalist. in the middle of all this in april 21, the kaiser family foundation released a study, that was a study that we reported on. that study contrary to prevailing wisdom found that sweden did extreme and well protecting its published during the covid pandemic. the question is how is it the
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kaiser report very so much from everyone else in the other reported studies. how could they have come up with such a different answer? the answer that question rests with the metric that was used. it turns out that counting covid deaths is a lousy method. that is because countries have different populations and a country can do everything right in terms of his health efforts and so have a lot of covid debts because they have a -- deaths because they have a much larger elderly population. conversely they might do better in terms of covid measures and that's if they are so poor -- deaths if they are so poor that everyone dies before of starvation and diseases. we cannot use that to tell us how their wink, only telling us
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how they are doing a baseline. what the kaiser approach was, they looked at a particular metric in order to address the question of how the interventions affect the population. the one look at the downstream effects of side effects. every method of intervention, every public health intervention has a side effect. they looked at what is called excess lethality. they looked at 11 wealthy pure nations -- peer nations the average number of deaths five years prior to the pandemic. in the year 2020. five years prior to 2020 they averaged out the deaths.
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the nations were sweden, u.s., belgium, switzerland, u.k., netherlands, france, germany, australia. when they compare the average number of deaths in the country prior to the pandemic to the year 2020 was what they found was absolutely stunning. i will say how it was measured. if you have one million deaths in a country on average in the year prior to 2020. and then you had 1.3 million deaths in 2020 would say there would be an excess mortality. the reason before 2020 as the year before vaccines and antivirals. the only tools they had were public health interventions. this is where it gets interesting, to understand the net effect, not just covid
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debts, express -- excess totality measures not just -- we think about what the express -- at the same time drug abuse deaths, alcoholism, and homicides just sort -- soared. the cdc found that homicides were already high in the u.s. and ratcheted up 35%. looking at both covid deaths and these knock on effects or downstream effects, we find is in the nine states the excess mark -- united states the excess mortality. when the kaiser researchers, they looked at the database, maintained by the u.s. centers for disease control prevention and an institute in germany.
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that is when they found this. sweden is the only nation that had no excess mortality for people under the age of 75. even for people 75 and older, sweden outperforms seven of the other peer nations that i mentioned. so, the question is, he might wonder how could it be -- you might wonder how could be there no excess mortality if in fact there were covid deaths? i'm sure there were some covid deaths in sweden, and part they're able to do that because, number one there are fewer deaths, and in part because some sweden's -- swedes did self isolate. this was a voluntary program. people are less likely to be infected from covid and or to
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die from other causes like automobile accidents. a large part they're able to avoid the excess totality among younger people they did not shift the burden of otalgia from older people to younger people by shutting down -- older people to younger people by shutting down businesses and schools. that is what happening that states, what happened in sweden is something we can learn from. i also want to mention, there is this false narrative that if you are concerned with keeping businesses open your only worried about money. what is wonderful about this panel, we have people from a range of perspectives from the right to the left. i am on the left. it is a false narrative to say you are concerned about closing businesses because you are concerned about money. i am concerned a closing businesses cost lives.
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>> thank you jean, vinay, lemme go you -- go to you next, looking back with hindsight what he thinks sweden got right and what you think they got wrong? >> thank you for that, they certainly got a few things right. those things had to do with children. they got a few things wrong those had to do with the population. as written about this issue a lot want toss out a few additional considerations that often get overlooked in this question of what do nations do? what do nations do and was the impact of covenant and palsy? desk policy. one is the age structure of a nation. we know covid-19 had a steep almost exponential risk of death with advanced age. the second thing is voluntary behavioral changes.
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anytime you hear about the catastrophic health system hope collapse and york sit -- collapse in new york city, you may make various changes. the next factor we do not talk about is c load, every nation -- seed load. every nation had a different seed load based on travel. australia would have a different seed load thin stockholm, rome, london. seed load has indications for all of what happened in the early parts of 2020. policy is important, what policies did human beings make at the federal, governmental, regional level? what indications of those work. i think randomness is also glossed over. this is a disease has a heavy right tail just to be snow
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spread. a few of -- distribution of spread. if you were to re-create it a thousand times it would be during substantively in the fate of nations. schools i think is very likely to be sweden's greatest success story. schools were famously kept opening sweden for primary school throughout the pandemic. a very tough and controversial decision of the time. other schools did close as she mentioned, but very briefly. sweden is that one and of the spectrum, a number of other nations were quick to reopen. united states liberal left of center cities to their detriment did not open for prolonged period of time up to 18 months in some regions which will have lasting implications i think for decades to come. i think it is important to remember the policy response most nations took part in an 2020 was contrary to nearly all
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established agree pandemic guidance. it did not call for the use of broad sweeping lockdown measures and was historically thought of as unthinkable. one factor we should include in the discussion is why we might have entered into palsy that was hit considered unthinkable that we learn from the -- policy that was thought of as unthinkable was because we learn from china. upper-class workers could participate in the lives resume, they were not laid off in mass, if a rap resume, amazon prime, hoover eats, they would not -- uber eats, there would be a different response. well look the indices of sweden such as covid-19 deaths per 100,000 or excess deaths it is hard to say anything other than they are roughly doing similar to other nations. they're not doing to support those -- disproportionately worse.
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they are not measuring things the same, they may not be counting the same debt as a covid-19 death and divinations. two, excess mortality we act as if it is given by god, is not. it is observed deaths minus expected deaths. what is an expected deaths? you have to measure the deaths in the year receding and making extrapolation acknowledging that a population is older in the future. it is not a perfect value is divided can be debated. human excess -- it is a value that can be abated. even excess mortality is lot -- is flawed. you cannot give me the model that explains the fate of many many nations. that model i think will be when the great intellectual challenges of the 21st century. finally i want to state that the ultimate verdict is not in. at this point in the pandemic we
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have clearly an endemic virus. very likely that covid 19 will ultimately infect 93% 97% of all people on earth and very likely to re-infect few years episodically for as long as human beings exist. the final verdict on sweden is not yet in. we are not at these -- the finish line. we will see how sweden fared in terms of the good things they did, empowering children to continue their education and all the good things that come from that versus some of the early setbacks and have based -- based. critically around their care of elderly people. is a challenging question, sweden was unfairly demonized, and as time has gone on it is clear they were vindicated a number of their choices although i think they also have made some [no audio] . >> sweden's pandemic policy
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aligned with the approach advocated, generally advocated by you and the other authors of the declaration, like to hear your thoughts as well as your thoughts what we have already said3 >> -- set. >> i would do the easy part first, i am in broad agreement with the strengths and weaknesses of the swedish policy. let me emphasize, i completely agree with two particular things that were said there are worth emphasizing. one, these kinds of outcomes or complicate to assess and need to be assessed in the long run. rather than pile on in the midst very early in the pandemic where people assume where they know what the long-run effects would be. the second thing i want to emphasize something jean said, it is quite important, this cuts
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across traditional political lines. the swedish government that government mentored this was a left-wing government. the only protests in the early days of the pandemic against the swedish policy was by the right wing parties within sweden. in fact it is a mirror image of what happened in the united states. left-wing governments were in in favor of harsh lockdowns and other policies. where as right wing governments were less so. this is one of these things where as a social scientist we will be learning lessons from this for a very long time to come. sweden particular provides a fantastic in terms of those lessons because it provides such a contrast to some much of the rest of the world what it did. as i said and i agree with, as far as the infection control outcomes look, they look pretty much like their neighbors looked. not too different. i look at the finish outcomes
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for overall excess debt per capita. -- death per capita. in between 22 they have higher than sweden does. finland has worse, there palsy is relevant more progressive than -- policys were more progressive than sweden. let me turn to jeff's question, how closely did sweden align with the policy recommendations i think were associated with the great barrington equation. it is based on very simple facts. one, there is an enormous adrian for mortality risk from covered risks. all the people had a much higher risk of dying than younger people did. almost one thousandfold, a much deeper gradient than the flu.
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the second fact that is built upon, is that the lockdown themselves in the restriction policies have enormous negative consequences directly on the health and psychological well-being of populations wherever they are applied. they create deep anxiety, this placement, direct harm on people. making them skip routine and necessary screenings of cancers for instance. closing schools have long-run negative effects on the health and longevity of children. all of these are pretty well-known and pretty well-established. you put those two facts together, the right policy is to protect the vulnerable from covid as best as you can while minimizing the disruption to the rest of the population. the disruptions themselves because more health harms robin
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for people that the protections from covid would gain -- problems for people dandy protections from covid would gain. how well did sweden do? in one sense they did quite poorly at the beginning. the biggest failure was the spread of covid in the stockholm nursing homes early in the pandemic. this was just a disaster. allow the swedish commentators and review panels that looked at as great. -- at this agreed. the authorities in stockholm that randy's nursing homes did not a priest -- ran these nursing homes and appreciate how important it was to keep covid infections out of nursing homes. this is something many countries shared a problem with. denies states in new york, andrew cuomo sent covid infected patients back to nursing homes killing how many people. canada and québec there are
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stories of nursing home workers abandoning their posts because they are so scared of covid, leaving patients with dementia to die from starvation and thirst. from the early days of the pandemic, around the world negative stories about nursing homes. that is something sweden shares some of the problems. on the other hand, over time i think sweden learned much better about how to manage folks protection. they protected nursing homes better than they had previously done. they left schools open, critically important for young kids, they did not disrupt the lives of children. there are reports coming in unlike nearly every other country that did disrupt education, there has been almost no learning loss of four and children -- sweden learning -- no change in outcome across social class and income.
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unlike the essays where there is a tremendous difference in the two harm -- in the harm with children faced with poor kids in my nordic is -- minority kids facing in worst outcome. because they decided to follow the data. when the vaccines came, sweden did and asked gillooly -- and absolutely exceptional job in prioritizing older people first. when you know that older people have a much higher risk of dying from getting sick and the vaccines protect against you from dying after getting sick the biggest benefit will come from vaccinating old people. they did that. there was a case of a young fortyish swedish government employee who skip the line. he lost his job because he skip a line to get the vaccine to early. this is fantastic. you can see the benefit of it.
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when the third wave hit in the spring of 2021 there was an enormous wave of cases in sweden , but many fewer deaths than expected if you had a lesson vaccinated population. there is a printable -- principal focus and protection, decouples the cases of deaths and negative consequent as of the disease. that is franco the best you can do given the technologies we have -- frankly the best you can do given the technologies we have. the other thing sweden did right is it maintained the public trust people had in public health. sweden is one of the few countries on earth where people, if you ask them if public health today good job during the pandemic they will say yes they did. contrast with the nine states where a very large number of people nights -- united states where a large number of people absolute loss drops -- loss of trust with public health. they did not ask everyone to
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stay home and stay safe when only 20% of the population had the ability to do so. it provided resources for people who were sick to stay home, giving sick leave the people who were sick so they did not have to make a choice between feeding their family or going to work when sick. it followed its constitutional duties. the constitutions did not permit lockdowns. unlike other countries where the law was basically up ended in favor of a state of emergency it actually followed the sweetest constitution to protect the right of citizens with good outcomes. it never told a noble lie to the population. internet users authority to inability population -- it did not use its authority to manipulate the population. is said here what we know, here's is what we do not know, we are asking do this to protect the older people. at this time there is more
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spread, please stay home if you are sick. all that people listened to because they are trusted because they were not lied to. finally, i think they exuded a sense of not panicking. this is why the major principles , those violating nine states and many other countries. -- the united states and many other countries. it causes tremendous harm. for instance a lot of the anti-, scrum and tory policies -- discriminatory policies that unvaccinated individuals based resulted from noble lies talking about how risky unvaccinated people are to the vaccinated and the sense that was ok to denigrate them. we stigmatized unvaccinated people, many of them were low
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income, many of whom were minorities. we adopted policies that prevented them from engaging in civic life. sweden did not do any of that and as a result maintains trust with the entire population. i think the answer is yes, they did quite a good job, not a perfect job, very far from perfect job. i do not think a perfect job was possible. the results are quite clear in terms of not just the numbers, in terms of overall excess deaths. also in terms of the trust that the celt -- the public has an public health and i think that will pay enormous dividends going forward. >> when we ask somebody from sweden? johan norberg is a scholar in swedish ideas, swedish, he lived in sweden and you experienced the pandemic policy firsthand. someone with your background and
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the social sciences can help us put this into proper perspective. let's hear what your experience and perspective is. >> thank you very much. it is been very interesting to hear about these views on sweden from the outside in a comparative perspective. let me tell you would look like from stockholm at that time. one thursday afternoon early march 2020 if humans before 3 p.m. i got a call from a nurse that asked me if i sat on seat 12 a and a flight from the munich on -- i checked my information and answered in the affirmative. she said i probably knew why she was asking and i did. i had been sitting next to the novel coronavirus and was told to self-quarantine for two weeks.
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this was a moment i realized sweden would quickly be submerged by the pandemic. stockholm had just had its sports break. a week long spring break from school when many swedish families go to the alps for skiing. since in stockholm this was in the last week of february it was right when northern italy experienced booming infections. and the austrian alps we saw the same infections appearing at this time. it is what scientists call and amplifying -- an amplifying effect. it is important because we did not have the same kind of spring break at that time in copenhagen, denmark, oslo in norway, or helsinki in finland. happened at stockholm at the time, that we were exposed to infection in italy. the barbarians had broken to the
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gates and i was one of the barbarians. that as where learn from the phone call. the next few months would be frightening and confusing time of isolation, disease, death, loss of loved ones and a terrible strain on the health care system. as you all know compared to what was going on in the rest of the world there was also a sense of normalcy in sweden. if possible talk about normalcy. there were no stay-at-home rules, no shelter-in-place orders, we not confronted by police we tried to get somewhere were asked about our papers or business going there. there were no mask mandates. we did not shut down schools, strengths, offices, -- restaurants, offices, gyms, there were a couple of restrictions on public events, public gatherings were limited to 50 people. apart from that was mostly voluntary recommendations.
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swedes were asked to work from home if they could. they could travel if possible. reduce interactions and meetings as much as possible. life was not normal. the streets were quiet. when i took the subway or had to go shopping or went to a restaurant i was quite alone. we did not have the same kind of crowds we usually did. that means people at cap -- adapted to the situation voluntarily because he to keep themselves -- because they wanted to keep themselves and left one safe. it means if you really had to go to work, if you really had to meet someone you could do it, no one would stop you. most importantly, i think there is a consensus on the panel our kids were not thrown out of school. they did not lose a year, not even a month of education. i think we will see the consequence of that had --
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ahead. the social democratic prime minister summarized the policy in this way. we will never be able to legislate everything. we will never be able to ban all harmful behavior. it is a matter of common sense and individual response billeting. in march 2020 such words were radical. too many they seemed dangerous. the rest of the world looked at us and talked about the swedish experiment. that is not what it looked like to swedes. to swedes and looked like the rest of the world was engaged in an experiment. to lockdown societies to almost a chinese model anyway and scale that had never been attempted before. sweden, just did what the swedish authorities had already planned for and wargame for in advance. actually what most other health
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agencies had planned for in case of a pandemic. the other agencies and governments they throughout the manual the moment they panicked. they moment they became frightened by the virus, or the voters. sweden became an elect -- exception because did not throughout the manual. this is partly because of a very unique division of power in sweden's system of government. sweden's government agencies are independent. unlike most other government agencies. the government appoints a general secretary but is actually not allowed to tell them what to do. agencies are not supposed to act according to the political will of the moment, but according to the law and the facts. there is to trusty science, if you will and come up with -- trust the science if you will and come up with recommendations. by tradition and means they
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often defer to the expert agencies. you might say they sometimes hide behind them. even if voters or journalists demand tough action the government can say that the public health agency has said nothing has really changed. this is still the best course of action. to me it is incredibly interesting that the public health agencies and neighboring countries in denmark and norway they also opposed closing schools and closing borders just like the swedish one did. in those countries, those agencies are not as independent. the decisions are primarily political decisions and politicians had to show strength. plus, obviously modeling and nightmare scenarios scared all of these politicians. we know about the infamous imperial college modeling about how many people will die in britain. a swedish team inspired by the imperial college model set by
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july 1 and 2020 sweden would have 82,000 covid-19 deaths with this model. it was not easy to stand firm with scenarios like that. but, the government still caps on saying the health agent -- kept on saying the health agency said this is the right course of action. let's not throughout the book. i guess it is easier to blame something -- have someone to blame if things go wrong. as a modest political style, having strongmen attending they have answers to all of our questions. interestingly, swedes generally welcomed this policy, there were obviously opposing voices and heated debate, public trust in both the government and the social democratic party and in the public health agency increased rapidly during the pandemic.
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in another sign the sweden was different, as he pointed out, all major political parties in sweden were in general agreement except for the populace right. the populace right in the sweden want to shut down schools and fire the lead state have to be -- lead state epidemiologist. apart from the far right, most political forces were in agreement. how did it turn out? this and the comparisons and the others will have more to say about i'm sure during the questions and answers. we deftly know it worked better than anyone expected. there were mistakes, some to stupid -- some stupid decisions and i agree that many deaths among the oldest could have been avoided because we waited too long stop visits to nursing homes. at the same time i got that call about the trip and let -- in late february.
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the barbarians, that was outcome we were here in stockholm spreading the virus before even thought of coming out with a response to this. we do know that despite this, the models were completely inaccurate, by july 1 sweden had not suffered 82,000 deaths, a bit more than 5000 deaths. sweden did better than almost all other european and north american countries. one reason why the models failed, they, just like most politicians, underestimated how people spontaneously adapt to new circumstances and new information if you have a clear message. they, the modelers, the politicians usually thought of it in terms of lockdowns versus business as usual as the alternatives but failed to consider a third option that people engage in social distancing voluntarily when they realize lives are at stake.
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this also meant that we kept most of our freedoms. something that he cannot count. something you cannot put in a chart. just a year or two, they said that we can get back to normal. what if you do not have a your two? what about the young that lost a year of education and will never get the formative years of self-discovery back? as witnessed by the sharp increase in loneliness, anxiety, drug abuse and other countries there is more to life than surviving at. -- it. mike luminary assessment is that -- my preliminary assessment is that i agree, limiting measures to recommendations that the population is excited to follow voluntarily is fundamentally a correct approach. thank you. >> thank you ,jeanne i believe you have a question you want to ask. >> do i understand correctly
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that when you talking about throwing out the playbook, while sweden stuck threat, joins think rightly that the world had taken a stand prior to the panic that there should not be lockdown stay pandemic? >> this is at least what we heard about the world health organization early on during the pandemic. that is what the swedish public health agencies said. they do have their people in w.h.o. as well saying this is how we wargame it, this is how a pandemic would play out. nobody talked about shutting down entire societies. nobody talked about shutting down schools in this way. i am not an expert, aunt debbie rachel maddow's i do not do what really happened there, that will -- on who matters, i do not know
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what happened there, swedish experts were shocked. we have seen studies, a swedish team of expert -- researchers looking at countries that entered into lockdowns. what was the course and what was the timing? they look to the state of the health care system, the spread of the disease, the number of cases and deaths in that cannot explain the timing of lockdowns. only one thing's claimed it, what did the neighbors do? they basically imitated the policy of other countries. i think there is, if you are a politician and there is this general exception -- expectation that you will deal with the situation, at least you did not want to go it alone, that is scary, you do not want to be the odd man out doing something risky that others do not agree with and then you make a mistake.
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it is much safer if you do the same thing everyone else did. that explains it more than anything we wargame and looked at in advance. >> could i add something there? >> yeah, sure, sorry. >> just on that point, you may remember that in early 2000's, george w. bush had done some commission work on the applications of a pandemic would be in the reaction -- what the reaction would be. it talked about pandemic strategies. this was hypothesizing an influenza epidemic that took a disproportionate effect on the young. they cautioned against lockdowns and school closures. i do think that the preponderance of pre-pandemic guidance would have suggested against those measures. i think that to the excellent
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point, the things that allow politician to entertain those measures is observing that other people are doing it. other people are doing it, it would be risky not to do it, they are learning from china and we were coupled with a imperial model that put the fear of god into a lot of politicians. >> unless everyone else has anything they want to say, i want to ask a question. then i start taking questions that are coming in. i will direct this to vinay, anyone else on the panel though like to chime in please feel free. what is your reaction to the article that came out in march those basically calling sweden's -- an abject failure. >> i guess i would say i would be extremely reluctant, i disagree with that characterization. i think i agree with most of the points made on this panel. jay is right if they could turn
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back time and do it all over again they would put a special emphasis on nursing homes. that is the error they made early on. the point that was made is that the barbarians were already storming the gates, it refers to without talking about seed load. how may cases on the ground per 100,000 citizens was on loan -- unknown. if you are an island nation in the middle of the pacific and you do not have a high seed load, and instituted -- you take a very contagious respiratory virus and for a short time asked in which it. if you are connected to numerous upper -- other global cities, in the setting of a soccer match, if you are coming off of holiday as they were doing in stockholm. it made it much more vulnerable to a higher caseload on the ground. the other point jay made that
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was a superb point, the impact of school closure, he will not see that this year or next year. you've already seen some of it, you will not see the full impact for 20, 30, or years. -- 40 years. that impact to be so devastating it could overwhelm every other policy decision made. the impact of one-year loss of education on american youth is likely to be as tropic -- catastrophic. when you have a generation knows cheated out of education it could have implications applicable processes. it is far too early to be crowning anyone the victor or the sinner. >> j did you want to comment on that? i know you are very interested in that came out in nature. >> to be fair to the authors i do think they make good points about how, about the failure of
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the swedish public health to protect all the people. especially at the begin of the pandemic is a fair point the authors make. there is some element, when i was reading the paper the sense of absurdity to it. the paper complains that the critics of the swedish public health authority did not have a voice reflected in the public health authority. to me it is funny. that is exactly my criticism of american public health policy. public health essentially systematically excluded any voices that did not agree with the lockdown policies we followed. it was interesting to read swedish scholars complaining in the same direction. in that sense i am sympathetic to them. it is better for public health to include all voices when there is a disagreement and that discussion of a rather than
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systematically excluding or ridiculing people that disagree. in those two senses, i was sympathetic to the offers -- authors of the paper. broadly i do not agree with them, they are shortsighted and think about the effects -- the effectiveness of these policies. i do not think these policies actually had an effect on the long run infection control. i also very strongly disagree with the harms of these policies. the harms of these lockdowns, biz closures, school closures, as entire panel has said are tremendous in the paper under plays those. >> say something in follow-up? >> since he mentioned -- i worked with him before he died, what you said about not walking down is not just some radical idea because he is --
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theoretical idea because he was a smart guy. his extremes wasn't smallpox, i remember asking him about -- his experience was in smallpox, ira asking him, he is the person that convinced me from his experience in eradicating smallpox he came to the conclusion that it would have terrible effects. people would lie and move around and it does not respect peoples ability to protect themselves and others. he said that by doing this in an involuntary way, so i think he was an important voice. >> i would like to start taking
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some questions from viewers, i have one question this is directed at jay, but anyone else who wants to take it can take it afterwards. this is from dr. ross, who is a physician in phoenix. because i am from phoenix and i happen to know him. he says jay bhattacharya, md, phd, as an epidemiologist you are familiar with large-scale modeling, what do the model say about possible american lives saved had the -- they followed the swedish approach? there were no excess deaths from noncovered causes and problem -- in sweden, how many of those non-excess deaths would have been avoided from a different pandemic palsy? -- policy? >> i don't not think we have a good answer and scholarly literature.
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what i've seen during the pandemic has been incredibly naïve about the structure of societies. especially the poor and viable how they interact with the restrictions. the imperial college model is a good example. they make strong assumptions about the ability of people to comply with draconian lockdown orders and assume essentially that they will be effective. we see they are not. i am most convinced to date, by comparisons across countries. you can try to be careful about this, the most careful comparisons across countries tend to find that lockdowns did not save very many lives from covid. at least over the short run, and probably over the two-year period since they were first instituted they did not save very many lives. you compare countries that were more strict versus countries
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that were less strict in a systematic way trying their best to look at some national regions that are similar to each other and so on. you tend to find -- is much more difficult to find an empirical effect of lockdowns. there was a meta-analysis by john hopkins that so almost no -- that showed almost no benefit of lockdowns. on the other side, we do not know yet, in part the full longtail harm of lockdowns has not come to pass. what consequences it will have ultimately on the health and well-being on nations. we do know it is negative and is likely to be large and negative, the full extent -- extent is yet to come into play. i think the right policy now is to work very hard to find out how to mitigate those consequent is. we do not want the --
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consequences, we do not want those to come about. how do we get to the backlog of all the folks that did not have cancer screenings during lockdown? how do you deal with in nine states the tsunami of people who are now, on fentanyl and other drug overdoses. the enormous backlog of people who are basically depressed and anxious through the pandemic and that is showing up especially in children. how do you deal with the catastrophic learning loss import populations that could not afford to go to private school in the united states? you have to move the conversation from counting those deaths, although that is to happen towards hadley mitigate them so the long -- towards how to mitigate them so the longtail effects do not come to be. >> vinay d1 say something about that? >> the thing i would add is one
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of the consequences of lockdown in the march of 2020 is not all places were able to sustain it as long, some places with different ideas of liberty and freedom the moment it was over they had the opposite involuntary reaction. we heard about voluntary behavioral changes, had a huge outbreak in the dakotas prior to the vaccine, one wonders how the united states would have fared with a response that was lester kony and and more measured -- less draconian and more measured. in sweden, you do not know when there would be vaccine and is not a two week -- were lucky to get it in november, it could have been another year, had a been another year what would've happened? >> i have a question, came in from anonymous.
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it is something we should discuss. while the tone it is meant as a criticism it is a important question. how many immuno copper mice patients landing in the hospital -- immunocompromised patients landing in the hospital covid is an important price to pay for the economy? i assume it means for economic well-being. i also presume the answer the anonymous questioner asks, they are looking for the answer of zero. i would like to hear what your thoughts are on this. let me start with the economist of the group, jay and then we will move on to whoever wells -- else wants to chime in. >> that is an x in question but the problem is a false premise underlying it. the idea is that money is less important than lives, that i do
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not disagree with. i do not think any reasonable person disagrees with. the issue is, what does the money represent? what are the trade-offs? if you make a generation of kids pork, there will be --poorer will be literally shorter less healthy lives. if you stop the cancer screenings it will cost lives. what we are talking about is a trade-off between lives and lives, not merely lives and money. the premise is wrong. the other part of the premise of the question that is wrong is how you protect immunocompromised people from staying out of the hospital? how do you do it with a vaccine vaccine becomes available? you prioritize them with vaccination. that is what we have done. how do you protect them before
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the vaccine comes? that is difficult even before covid. immunocompromised people face all sorts of challenges in their lives. during covid, it might actually be easier because other people are being more protective of other people, even voluntarily when there is a disease afoot. this may make the lives of immuno compromised people safer simply because there are less random interactions with other people. so, i do not think -- there are two premises of the question. a value premise and a fact question. i think they are incorrect at the heart of the question. my goal has always been to protect life. that is why i went to medical school to begin with. why else would i do that? i think the economics of it are not an irrelevant thing that you can throw away and say, ok, that has no effect. the main reason i care about economics is because it is fundamentally important to
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people living long, healthy lives. >> do you have anything you would like to say about that? >> i think the question has already been answered in an excellent way. two things. first, if you are immunocompromised, you always face risks. one of the problems, and i agree, this is an excellent question, very important to think about. the problem with some of the policies implemented during covid could be used in the same way to legitimize lockdown for ever. if we have cases and a death in
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a certain area this means we may have to lockdown society forever to avoid that. the problem with doing that is we -- whenever we focus on one instance, one problem, one goal, one vision anywhere, we lose all of the other objectives, the other goals we have. that results in defeat, death, problems in other areas. we have talked about learning loss. we should talk about the general state of the health care system. we should talk about normal childhood vaccinations that have been shut down or seriously compromised in a lot of places. by lockdown. that's not the case in sweden. we had almost exactly the same rate of childhood vaccination during the pandemic.
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i think .5 percent higher during the pandemic. so, it is not life over the economy, it is life versus life. >> ok. i have a question here. trust in authority in sweden. the usa is known to have low public trust in leading vertical institutions. science remains among the most trusted u.s. institutions. it is a trust the key variable here? trust is unlikely to change quickly. i think i should probably start with johan and anybody else wants to jump in, please do.
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>> excellent question. it has often been suggested that one of the reasons why recommendations worked in sweden is that we already have that trust in the government and in our fellow human beings. our neighbors. when we hear that we should work from home when we can or avoid public transport as possible, ok. we follow these recommendations. it may not work in the same way where you have less trust in government. where you have less trust in medical experts and public health agencies. that might be the case. i think that is something. it is definitely the case that in sweden and scandinavian countries we have a high degree of social trust. whether it would work in other places, i think that is of two others then scandinavians to think about, perhaps others in this panel. but i would add that this very
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problem, the fact you have less public trust in the u.s., in governments and health agencies and so on also means that you cause problems with rules, legislations, lockdowns. you instantly create the problem that people might try to avoid following these rules. if they are treated in a way they find unacceptable, they might begin to revolt completely rather than trying to protect themselves and their fellow men and women. that is something we have seen in other areas as well. how even if it is not legislation it could be about vaccines. it could be about general recommendations from the united nations. suddenly everything is politicized. it's like you don't care about what anyone in the profession
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says because it's suddenly a political statement about which side you put onto. that is something that happens and affects every policy whether a recommendation, legislation, or vaccination programs. we always have to take it into consideration. it is not just affect how much we follow recommendations or not. >> jake? >> i wanted to comment about american trust in public health. some observations that i have looked at during the pandemic us to why. i think americans generally have less trust in public health at authority but i think the pandemic made that problem so much worse. i think in my career i have never seen public trust and public health at such a low
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point before. i think that spans blue and red states, though, i think it is worth in red states. -- worse in red states. a couple observations as to why i think this happens. this is a politicalization of public health that i think is deeply unfortunate. public health is not like politics. it is about work. you need 90%, 95% of the populations trust you -- to trust you. people will not be able to check everything you say. because these are complicated questions of data, medicine, or science. you will need them to trust you about that. when they do not, they won't listen to you. the advice will get followed. that is what happened with american public health. there were incidents during the george floyd riots where 1000 people in public health signed a letter saying, it is fine to
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protest for the george floyd riots. the same people argued it was irresponsible to protest lockdowns. there is this sense of like, a left-leaning public health authority who wanted to put their thumb on the scale in politics. that should've never happened. it undermines their ability to speak to half of the american public automatically. the second thing i think is the telling of noble lies by public health. from very early in the pandemic, that really undermined the confidence people have. for instance come around masks. the very first messaging was masks don't do anything. they don't work. you don't need them. we should save them for people in hospitals. then, the messaging became, ha ha, we do you -- fooled
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you, they do work we just needed to save them for people in the hospital. when you do that you undermine the ability of people to believe you wanted other things. it is mind-boggling that professionals in public health decided that those games being played with messaging to the american public would have any good effect whatsoever. you can if you went in the short run you end up losing in the long run and that is what happened. >> related to this subject, in light of the cdc recent mea culpa, which u.s. health authorities would you fault, federal or state? what would you recommend for reform? that is kind of a big question. >> which part of the pandemic
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you want to start with? the last question was about trust. we do not have the same trust as sweden, so we cannot do what they do. that strikes me as an honored argument in favor of greater mortar chromium -- more draconian restriction policies. i think if we go back to the beginning of the pandemic, the people most responsible for the architects of the current response were probably dr. briggs and dr. fauci who were advising the president at the time and moved in the direction of a strong 15 days to stop the spread kind of response. i think that history will be the ultimate arbiter of that. it was likely and appropriate. many places had no spread to stop. other places had let the horses out of the barn. it was a one-size-fits-all solution across a very broad and different nation. i think some of the challenges were -- the great success of 2020 was the development of the
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vaccine at an unprecedented timescale. in 2021, i think some of the errors were the prioritization issues j was talking about. vaccine prioritization. the logical way would have been to prioritize the elderly, only then going down the age gradient. the u.s. prioritized essential workers including young healthy people, young healthy teachers who took the vaccine and it did not immediately go back to teaching in person. a train the social contract there for the vaccine. -- betraying the social contract there for the vaccine. in 2021 there was an insistence on one sized fits all booster policies. use of a vaccine mandate. use of a vaccine mandate when it was clear the vaccine cannot halt transmission.
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if you cannot benefit a third-party to ethical prerequisite for mandate is gone. the idea of mandating the vaccine would only undermine trust in a nation like the u.s. that has always been fiercely individualistic. i am not sure that helped many people want all. we were already on the trajectory of vaccination and i think it would have continued in the absence of the mandate. there were a number of lies jay spoke about. lies and confusion round masking. that was paired with another error, the lack of randomized cluster trials. globally we will finish the pandemic with at most two clusters randomized controlled trials both done prior to vaccination for community cloth masking. we will have no trials of distancing policies, of cohort and, of testing strategies, pointing policies. none of these word debt -- were tested with the best science and that to me is a huge error.
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i did not view the cdc director's latest memo as a mea culpa. i did not view it as the cdc director assuming responsibility for her many errors. i viewed it as a document that tried to push the blame to people below her in the agency. that is how i read her memo. i disagree with the curved edition of an apology -- the characterization of an apology. i think that public health should issue an apology and that would help them regain some credibility. >> would you like to make a point? i am not an expert on american pandemic policy but from a swedish perspective, we were testing people i think six weeks before you did in the u.s. because we were using a test from a university in berlin
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recommended by the world health organization as well. it was not allowed by the cdc in the u.s.. they wanted their own test. they talked about how, well, it might be that the first test they had to find out who had it and who did not might not have worked. we don't need anybody else's test. i think that was the exact quote from the primary deputy director the cdc. they said they wanted to fix that test again. it took weeks and weeks while hospitals and universities and companies had tests they wanted to start using, but were not allowed to because off the permission -- because the permission process was far too difficult. eventually, they got the hang of it. the cdc did. but it took six weeks. that's important.
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it is shocking to me that they thought they could not use the tests that the whole of europe used and the who recommended. i am glad -- >> i am glad you brought that point up because i was going to ask about it if no one else brought it up. i know in the eu there is reciprocity when it comes to drugs. i assume it is the same with testing. if a test was developed in, let's say, germany, then, it was ok to use in any other eu member countries? is that the same in sweden as well? >> yes, if it is good enough for the germans, it could have for us. they do have their processes. we can trust them. it is shocking for me especially
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when the who then looks at it and says, they might not have made the right decision in every single instance. but when they said this is the test to use, saying that we don't need anybody else's test, we will do it ourselves, that is just a waste of time, money, and human life. >> jean wanted a comment about masking. >> yeah, there were actually two. one, there was a believe a danish study --[inaudible] i spoke with an editor and it took some courage for them to publish results. it was unexpected.
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[inaudible] then a bangladesh study came out announcing big headlines in september 2021. headlines in the washington post. masks work just like we knew they did. i read the 92 pages of that study. it turned out it showed absolutely no such thing. those headlines argued children must be masked in school. it turns out they did not allow any children under the study. everyone under 18 was excluded. cloth masks showed no benefit whatsoever. the only benefit was an 11% reduction when there was an 89% failure rate. dealing with surgical masks. that was only for people over 65.
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i called the lead researcher on the study. i said exactly what i said here. i said, do i understand these 92 pages correctly? she said yes. i have the email back from her. you hear people say things like, well, i wear a mask in surgery. that is were a different reason. that is to prevent bacteria from people's mouths and elsewhere from going into open wounds. bacteria are bigger than viruses. the ability of a mask to protect us from viruses is really in question. if people want to wear them i have no problem with that. i think it is fine. but i don't thing you should exaggerate what the benefits are and force little children to be wearing these masks. >> jay you wanted to comment
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also. >> i wanted to bring back the testing question, although i agree with jeanne's characterization of the bangladesh study and the danish study. we don't have a randomized study on masks and children at all and on adult the studies we have, the randomized studies indicate an effectiveness of most -- ineffectiveness of most masks. that is from before the pandemic too. good randomized studies on the flu found nothing. it is astounding to me that public health rep itself around this idea of masks as the way to get to the pandemic when there was such a weak evidentiary base supporting it. on testing it is interesting. i ran a study in the early days of the pandemic in april looking for antibodies in the population in santa clara county where i
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live and in l.a. county just a few hundred miles south of me. the idea was to look and see how any people had been infected through early april 2020. 3% or 4% of the population. that meant a few things. one, the disease was too far gone to ever get to zero. it was 50 times more cases or infections that public health new about. the infection fatality rate in the community was something like .2%. 99.8% for best survival. of course that was much higher in nursing homes. we had a long way to go, only 2%, 3% of the population. we still had quite a way to go in the pandemic. those three lessons we knew, april 2020. the u.s. the cdc did not run a study like this until midsummer. i have no idea why.
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it makes no sense they relied on some anonymous professor at stanford university to run this study when they should have been the ones running this. these swedish authorities ran one very quickly in stockholm. 7% prevalence in april. the performance of the u.s. the cdc is an absolute scandal performed to the performance of many many other public health authorities around the world. i think the swedish story is among the very best. they were trying to ask the right questions, generate the right evidence, to see whether their response was good or bad. i think the fact that the u.s. cdc was so slow in getting basic information together address bonding appropriately to it is really something that americans should ask. it's not enough for the cdc to apologize and didn't essentially ask for more power and money to do more of the same. the american people should ask for much better.
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policies should include a plan to say what exactly went wrong, done independently. then, a plan to make sure this never happens again. >> a doctor asks, and i have seen him talk about this a lot, how do we educate the population about assessing their personal risk going forward to prevent one size fits all measures? >> well, you know a great question. my point of view on this has been that this is a place in which the current administration has done a poor job of communicating to the public what is to be expected. i think this moment it is clear that there are three buckets of things you can do about covid-19. there are things you can do that can lower your risk of bad outcomes if and when you meet the virus.
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one of those things is if you have not been sick from the virus before, get vaccinated to lower the risk. the second thing is maybe lose weight. obesity is a modifiable risk factor. there are things you can do that can delay the time until you meet the virus. if you spend all the time at home and where and in 95 in public spaces that will delay the time you meet the virus. for me that is not make that much sense anymore knowing that the virus is not going anywhere. you are not going to be able to sustain that year after year after year after year. it's not a question of if you will meet the virus, but when you will meet the virus. i think cdc messaging has been confused about this. i had always suggested they take the strategy of once you can do -- you do what you can do to lower your risk of bad outcomes, try to get back to life as much as you would like to. you have to find a sustainable balance. i think people should always do
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what they feel comfortable with. there should always be exceptional cases for people suffering from acute immunocompromised status. like you just received a medication and it will not be in her body eight months from now. you might want to do something different. people have medical conditions and might want to talk to their doctor. but the average healthy person, i walk around san francisco and see 20-year-olds that appear very healthy outside wearing n 95 masks and i think it is part of the cdc messaging failure that they think that will help them in some way. i think it's a matter of time before they will get infected. >> gym in las vegas has a question. what was the impact on sweden? was it a major benefit to hospitals?
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>> first, the overall picture was far superior to what the u.s. did. the models by imperial college said at its peak we had basically 40 covid patients fighting over every intensive care unit hospital bed. we would be so much under capacity. that never happened. we always add extra capacity of around 20%. not geographically equally distributed, but do some heroic work, we have always had extra capacity. a big field hospital was built here in stockholm to take care of patients and at that never had to open because they never faced that lack of capacity over
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there. so, it works out. but obviously, it was a terrible strain on staff and hospitals. they had to put in extra hours and all that energy under very difficult circumstances. but it worked out well. then, we did see less patients in other areas in sweden as well. because, we did have the recommended social distancing happening. so, we had less of the regular flu and other instances that might have taken up space in hospitals as well. so, i don't think that experience in itself was that different in sweden than in other places. i know that in the nature paper there was talk about newspaper reports in sweden about how old
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people who had special preconditions that made it unlikely that they would be safe easily or cheaply that they were denied treatment in sweden and that had been discussed quite a lot in sweden. but when you look at the number and proportion of people with covid that got hospital treatment, oxygen, intensive care in sweden, it is about the same proportion as who got it in neighboring countries like norway, denmark, and finland. so, that has not been a major issue when, for example, the corona commission reviewed what happened in sweden's policy. >> i have a question from jeff justice. according to world and leaders info, india did substantially
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better than sweden, europe, and the usa. is this real? if so, can we learn from india? i'm not aware of that. >> that is correct based on the numbers on that website. but, that makes one wonder about the numbers on that website. i think there are new teeth -- nations that routinely in these rankings do exceptionally better than other nations and you worry they are not counting all the covid deaths. i spent -- suspect that is the case with india. >> anybody else? i guess nobody else knows about that. ok. we are down to our last two minutes. somebody asked a question. why are we comparing the u.s. to
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sweden and not other countries like new zealand or australia that had stricter policies? i think i will ask jeanne to answer that because that's a good way of bringing things full-circle to add symmetry to our presentation. we started off comparing sweden to the world. why didn't we compare the u.s. to countries that had more austere policies than sweden? >> new zealand and what was the other country? >> singapore, australia. >> yes, very different situations. thailand they really controlled. [inaudible] now australia is seeing that. more than that, it is not just
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covid death. what does it do? what are the effects of lockdown? the last question about india. what was the metric they were using? if you don't live that long in certain areas of india, you are not likely to see as many covid death. s. but there is also the counting issue and intervention. >> i could not resist. after you mentioned new zealand being an island nation. jay wrote an interesting piece a few weeks ago about new zealand. why don't you summarize your points so i don't say it for you? >> new zealand is really interesting. i already went through some of the special circumstances of new
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zealand. i will add one other. it is a south pacific nation. in the summer, our winter, a seasonal disease was being spread and they were very successful getting rid of the disease for short time. over the next two years the disease kept coming back. they would lock down big cities again and again and again. they kept the disease out for most of 2020 and 2021. they were very delayed in deploying the vaccine. they did not get going in the vaccine until september 2021. what kept the island under lockdown long after they needed to do that. they had been vaccinating their population early on and they could have avoided almost all of
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2021 under the threat of lockdown. finally, and this is the irony of ironies, the number of cases the last few months in new zealand has absolutely exploded. there are now more cases per capita in new zealand through the entire pandemic in just three or four months then there were in the u.s. through the whole 2.5 year pandemic. more cases in new zealand per capita. that's absolutely striking. the way they got out of this, the thing that allowed them to avoid the death other countries have faced was vaccine. but, they were delayed in deploying it. finally, they could have never developed the vaccine on the items themselves. they needed other people to suffer cases. they needed other people to die so they could get the vaccine to get out of this. to characterize new zealand as a model for anybody misunderstands
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the role nations played together in managing a pandemic. they isolated themselves successfully and got out of it when they could and despite that they put their population through a year of additional suffering along -- around lockdowns that never needed to happen. >> well, that is a great note to end this conference on. this has been such an interesting conversation. i am sure we could go on for much more time. but i know that johan needs to get his sleep. it is very late in stockholm. we were scheduled for 1.5 hours. i appreciate our wonderful panelists. this has been very interesting. thank you all participants. there are two questions coming in -- too many questions coming in for me to ask even a small fraction of them. for those of you who missed some or all of this it is being recorded and will be uploaded to
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the cato institute website. you can review it on-demand.
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>> today, the colorado secretary of state and other panelists talk about voter suppression tactics, such as closing pull locations, shortening the window for early voting and eliminating dropbox locations "washington journal are live coverage begins at 10:00 a.m. eastern and on our free mobile video app, or online at >> over the past few months, the january 6 committee has conducted a series of hearings revealing findings from its investigation. all week, watching c-span as we look back at the committee's eight hearings with depositions, witness testimony into the attack on the u.s. capitol. on monday at 8:00 p.m., officials address allegations of
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election fraud made by then president donald trump. watch monday on c-span or anytime on demand at >> more now from this year's conference in pittsburgh. this discussion features congresswoman katie porter and focuses on nuclear weapons. it is about an hour. [indiscernible conversations]


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