Rushworth’s Blog and the Swedish Covid Doctrine

When looking at the Wuhan pictures of January and February 2020 again, it should be obvious that China never did any real action against the novel coronavirus in that city. Instead, it lured the rest of the world, in particular Western states, into a selfmade trap by staging an grand but cheap open-air specatcle. [Corona Circus Wuhan] In order establish that hypothesis I rely heavily on the blog of Sebastian Rushworth in my medical and epidemiological reasoning. The present text explains why.

1 A Happy Discovery and the Quality of the Blog

On August 9, I received a message from a friend in Prague who made me aware of the blog of Sebastian Rushworth. Rushworth is an emergency doctor in a hospital in Stockholm who, since August 2020, runs a blog with medical information. [Health and medical information grounded in science] His first article, “How bad is covid really? (A Swedish doctor’s perspective)” is a front line report about his experience with the new coronavirus in the emergency room. [Aug 4] By now (mid November 2020) Rushworth has many more articles on covid and also many other topics.

In his blog posts Rushworth deals with medical and health data and studies which are published elsewhere. He explains them in a way the layman can understand. Rushworth has a high standard to assess the quality of a scientific work, evidence-basded medicine. Often though, the data does not have that quality. Rushworth explains his way of assessing studies in “How to understand scientific studies (in health and medicine)” which is highly recommended reading. [Sep 25]

Rushworth’s assessment of the epidemic situation is uptodate with respect to the better research that has been going on during the pandemic. Which is why I often do not bother to give additional references. Either they are discussed by Rushworth anyway or they do not contribute anything different.

2 The Emergency Doctor and the Swedish Public Health Agency in Line with each other

Two things in the first article were obvious: That the report was fresh and by someone with first hand experience of the covid pandemic, but also that the doctor’s evaluation of the pandemic seemed, at the time, perfectly in line with what I call the doctrine of the Swedish Public Health Service (Folkhälsomyndigheten, FHM) in dealing with the novel coronavirus.

The freshness of the first article is not only a general attitude of the writer, which makes all his articles worth reading, but back then he apparently did not know much about the madness that was going on elsewhere in the lockdown world, so the article makes no compromise as to what people in those countries think.

The writing was clearly from a perspective that “covid-19” is not a particularly strange disease. Coronaviruses can cause symptoms of the usual cold, flu etc. and there can be severe conditions as with all the other respiratory viruses. A position that the author has maintained ever since. [Nov 17] The new virus is not particularly deadly. [Oct 24] In the lockdown world people have adapted their imagination of the new coronavirus to the monstrosity of the measures rather than correcting it in the light of available information. Lockdown people have entered “irrational territory” in March and many remain there for the time being. [Yoram Lass]

The peak of deaths from March to May in Sweden was due to the novelty of the virus, not because in itself it is in any way special. Rushworth estimated the infection fatality rate for Sweden to 0.12%, “roughly the same as regular old influenza, which no-one is the least bit frightened of, and which we don’t shut down our societies for.” [Aug 4]

3 The Interest in Sweden in the Pandemic

At that time in July and August, in the pandemic Sweden was of great interest for several reasons.

  1. Sweden went a different way than many other countries as it did not impose lockdowns onto society. Instead, the country went with only few enforcible restrictions and relied mostly on public recommendations thus leaving it to the individual responsibility to judge the danger. All civil rights were maintained. [Oct 31]

  2. Swedish recommendations were based on scientific knowledge. For example face masks were never widely recommended because there was and still is no evidence that it has a slowdown effect on the spread. [Sep 5] In the meantime the same can be said for most lockdown measures. [Nov 9] For contrast, in Germany the scientific research during the pandemic has no influence on the policy in dealing with it. The lockdown fantasy of March still informs the measures in November.

  3. FHM seems to be organized in a way that allows competent operational action in an epidemic. In Germany, measures as well as responsibilities seem chaotic. FHM has the Department for Public Health Analysis and Data Progression (Avdelningen för folkhälsoanalys och datautveckling) whose leader, Anders Tegnell, is by virtue of his office the official state epidemiologist of Sweden. [FHM: FD] The department has units for analysis, data and acquisition, IT, and so on. Units which to the layman appear to be what one would need to clarify an epidemic situation.

  4. Until August Sweden seemed to assess the public danger by the actual situation in the health care system instead of just using arbitrary numbers such as R values or the absolute case count of the PCR test.

  5. It seemed that Sweden would clarify the immunity situation by using scientific studies.

It seemed obvious that the front line report by Rushworth and the Swedish doctrine, which could be infered from FHM’s news page, in dealing with the pandemic were perfectly in line with each other. [FHM: Nyhetsarkiv] I therefore translated some articles of Sebstian Rushworth’s blog for a German online magazine and wrote an additional article to explain this. [Telepolis, Martin]

4 PCR Models and T-Cell Immunity

What cought my particular attention in August were the news from FHM about immunity and PCR models.

Everybody seemed to be talking about the “second wave” almost since the first wave was still going. Sweden too did models of that second wave. It was the responsibility of Tegnell’s Analysis Unit (enheten för analys) to do the computations.

In the beginning of July the Analysis Unit published “Estimates of the number of infected individuals during the covid-19 outbreak in the Dalarna region, Skåne region, Stockholm region, and Västra Götaland region, Sweden” [FHM: Jul 1] The graphs show impressive second waves. However, in the discussion section we read:

Recently, information has been presented that mild cases never seem to develop antibodies against SARS-CoV-2, but only T-cell-mediated immunity. If it is also the case that infected individuals with very mild symptoms have short PCR test windows, perhaps being missed entirely, the assumed test window of 10 days could be an overestimate and we would thereby underestimate the number of infected.

“Recently” most certainly refers to a study by Karolinska Institute which was presented one day later: “Immunity to COVID-19 is probably higher than tests have shown.” [KI: Jul 2] I knew these two articles so it was very exciting that Rushworth explained that very Karolinska study in his second blog post. [Aug 8] He summarizes the study thus:

Firstly, the fact that significantly more participants had T-cells than had antibodies, suggests that if we want to know the true rate of immunity in a given population, then we should be looking at the proportion who have covid specific T-cells, not the proportion who have antibodies.

Secondly, if it’s true that Sweden now has herd immunity, then it seems likely that many other countries will follow over the coming months. By the time a vaccine appears at some point next year (with luck), there might not be many people left that actually need it.

So it appeared that Tegnell’s department knew that T-cell immunity needs to be taken account in order to properly assess the public danger of covid.

Mid July the Analysis Unit published a first version of report on “Three Spreading Scenarios for the Government’s Commission ‘Plan for an Eventual New Outbreak of Covid-19’.” [FHM Jul 21, update: Aug 28] In that we read: “We do not include so-called T-cell immunity.” (Vi inkluderar inte så kallad T-cellsimmunitet.) That was obviously disappointing. Why did the Ananlysis Unit not include it? The explanation is given by Rushworth: “But T-cells are harder to measure than antibodies, so we don’t really do it clinically.” [Aug 4] Ah, there is no data about T-cells!

It is obviously correct not to put parameters into a model if no data exists. Nevertheless, the Analsyis Unit did make an assumption to dampen the second wave. In the discussion the Analysis Unit considered that the 10 day time window may be too long. They left that and instead simply assumed immunity after infection.

The immunity assumption of the Analysis Unit is in line with the FHM “Guideline to estimate immunity after infection.” [FHM Jul 21, update: Sep 4] And also with Rushworth’s observation that reinfections are rare and illness after second infection practically non-existent. [Sep 19]

5 The Break

In August Rushworth estimated that Sweden had reached herd immunity by July. I therefore expected Sweden to declare the pandemic over sometime in September if no new hospitalizations would come. And indeed until October the hospitalizations were very low, September 2020 was the second least deadly month in the history of Sweden. [Oct 24]

But in September things broke apart. Sweden started to do mass testing of otherwise healthy people. Rushworth had recommended against testing in the community:

However, I don’t put much stock in what the PCR tests show on a societal level, for two reasons. Firstly, people stay PCR positive for up to two months after being infected even though they are no longer infectious, so a positive PCR test is often a sign of an old infection that is over and done with. Secondly, how much covid you find depends on how much testing you do, and the rates of testing over the course of the pandemic have varied a lot both within and between countries. This is why it makes much more sense to look at the number of deaths than the number of infections, since that statistic doesn’t vary based on how much testing you’re doing and is much harder to manipulate. [Aug 4]

In the weekly report about covid until September, the fraction of positive PCR cases with respect to the number of test conducted went up and down with hospitalisation numbers, intensive care, and deaths. [FHM: AVR] This indicated that one was following Rushworth’s advice to test only sick people. But since end of September FHM reported higher and higher case counts, and case to test ratios. ICU admissions did not increase in the same rate.

I don’t think that what we are seeing is a “second wave.” I think we are seeing a seasonal effect. It’s important to keep some perspective. As I explained earlier in this article, cases are a very poor way to determine how active the virus is in the population. In Sweden, the number of tests being carried out is now eight times higher than in the spring. That is why we should instead be looking at hospitalizations, ICU admissions, and deaths. [Oct 31]

The PCR test has many problems: the false negative rate is high, it misses many active infections; the false positive rate is high if the incidence is low, e.g. when testing in the normal population; and a positive test result can be due to non-infectious genome fractions months after infection. [Nov 6] “Without the PCR test I think the pandemic would firmly have been declared over by now.” (Rushworth, private mail beginning of October) Sweden seems to be now in what Ivor Cummins calls a “Casedemic.” [Fat Emperor] This is like all other countries which do mass testing, the main difference is that Sweden joined the club so late in the year.

6 The T-Cell Discovery of FHM

To me as a layman the information about the importance of T-cells in July was new and it was great to see the Karolinska study discussed by Rushworth. But also here there is now a break between Rushworth and FHM.

Rushworth explains the fundamentals of the human immune system in an post from end of September. [Sep 28] T-cells are the most important part of the immune system because these cells produce antibodies.

The actual point is that Rushworth explains what should be common knowledge to anybody who works in the health service. It is therefore surprising that the Analysis Unit did express its surprise about T-cell immunity in July being a “recent” information. One would expect that everybody who works for the state epidemiologist to have elementary medical knowledge.

From both the FHM reports in July as well as Rushworth’s explanation of the Karolinska study and his explanation of the immune system in general one would have expected that FHM would conduct T-cell studies so the Analysis Unit can integrate that parameter in its models. But FHM continues to do only PCR and antibody studies.

7 It’s the Doctors’s Judgement

The Western world complicates its life immensely by using a test, both for assessing the public health situation and for modelling the spread, which was never designed for that purpose. [20810.13] Virologists love their PCR test so much that they loose sight of the actual medical situation. They seem to be “lost in PCR” in a similar way the elementary particle physicists are “lost in math” since almost half a century. [Hossenfelder]

In Sweden, since October hospitalizations and deaths with or by the new coronavirus are on the rise but it is as yet not clear if there is an unusual situation for the season. In Germany, a corporation which runs private hospitals publishes its hospitalisation and intensive care data. The overall total is lower in 2020 than in the year before at the same time even though there is a rising fraction who test positive for covid. [Helios]

During the pandemic I have come to the conclusion that its the medical doctors’s judgement which is most reliable. In the order of discovery: Köhnlein, Püschel, Jäger, Rushworth. All the virologists, epidemiologists, analysts, etc. are experts with a narrow view on the medical situation, not to mention the overall societal perspective. Sweden fares much better than most countries but it also complicates its matters much more than necessary. The doctors’s judgement is not just based on abstract data, but on actual experience with sick people, knowledge about the complexity of life, and common sense. Indeed, common sense is what seems to be missing most in the pandemic. This is why I stick with Rushworth’s blog.

Acknowledgements

Not only do I stick with his blog, I also thank Sebastian Rushworth for the continuous exchange we have about the many questions during this pandemic.

Neil Brookes of Prague made me aware of Rushworth’s blog. He runs the highly recommended club London Underground in Prague downtown. [LU]


weltexperiment.com・document 20820 (2020-11-20)・revision 20850 (2020-11-20)・Ulf Martin Mail Telegram