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The fixation on the number of deaths WITH covid-19 is misleading

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Το παρακάτω άρθρο δημοσίευσε στο Lakartidningen (το εβδομαδιαίο Περιοδικό του Πανσουηδικού Ιατρικού Συλλόγου) στις 28/08/2020 ο Johnny Ludvigsson, Καθηγητής Παιδιατρικής στο Πανεπιστήμιο του Linkoping της Σουηδίας.
In February – March 2018, died, 17,774 people in Sweden. During the same period in 2020, died 1,687 fewer people, but with daily reporting of the number of deaths in covid-19. Reporting has continued, despite the fact that Sweden has had no excess mortality since mid-June compared with 2015–2019! Some have stopped saying “as a result of covid-19” and switched to “with covid-19”. With a median age for those who died at the age of 84, most with other diseases, it can be assumed that covid-19 has in many cases only been a contributing cause of death. An analysis in the Swedish county of Östergötland showed that only 15 percent of deaths with covid-19 outside hospitals could be considered to be directly caused by covid-19 [1]. The fact that the number of deaths in July 2020 in Sweden according to Statistics Sweden is lower than the average for July 2015–2019 indicates that some of those who died in the spring with covid-19 otherwise without covid-19 would have died in July. In the Swedish guidelines given in March 2020 on prioritization in the event of a shortage of intensive care units we speak about expected survival [2]. Priority 1: »A patient with a serious illness or injury with an expected survival of more than 12 months is given the highest priority for intensive care. If one must also prioritize between patients in that group, one starts from the expected remaining life expectancy, ie from biological age «This approach is accepted in healthcare but has been lacking in the debate of covid-19. For example, deaths due to covid-19 have been compared with deaths in the MS Estonia maritime disaster in 1994. Then all children under the age of 15 died. Of 21 young people from a school in Jönköping, 6 survived, and all 8 from a school in Vilhelmina drowned. If these individuals each lost 60 life years, this corresponds to a large part of the lost life years of the multi-sick people older than 84 years who died with covid-19 somewhat earlier than expected. Every year >55 million people die in the world. To date, about 800,000 have died from covid-19, the same number who are usually registered to die from suicide, but not a fraction of the number who die from cancer or diabetes. Survival is affected by resources. The economic turbulence of 2008-2009 is estimated to have resulted in 260,000 extra deaths due to cancer alone [3], and it is known that unemployment and economic crisis lead to a sharp increase in all kinds of physical and mental problems, with increased mortality, not to mention the dramatic effects of economic decline on mortality in developing countries, not least among children [4]. Total closure of society in several countries has had dramatic effects on the economy in the class of the 1930s. This can kill many more than the virus itself, and then also young people. Not even in Sweden, however, have the effects of the corona strategy on public health been given significant space in the debate. From prominent researchers to editors-in-chief have talked about the “death virus” and demanded the closure of society, and so far succeeded. People have been paralyzed by fear, consumption has stalled, companies have collapsed and unemployment has risen. Politicians accused of inaction, in comparison with neighboring countries that have introduced total closure / state of emergency, have felt compelled to impose a restraining order on nursing homes, stricter than in prisons, and the elderly have been allowed to die without even being able to meet their life partner or own children. And with the help of the law of order, they have managed to stifle cultural, entertainment and sports events, cheered on by death-counting colleagues. When one of my own closest relatives is buried, family members are excluded from the funeral because the number present is maximized to 45 in a church with >400 seats! The corona pandemic has had unforeseen consequences with many deaths, a heavy burden on healthcare, severe healthcare debt and a weak economy. When taking measures and choosing a strategy, there are good reasons not to count the number of deaths with a covid-19 diagnosis in the short term, regardless of the cause of death. Public health, even for the elderly before death, including the risk of lost quality of life, must be given greater weight. Ideally, those who decide should also see the long-term consequences not only for their own country but also for resource-poor countries, and not least for the children.
References: 1) Region Östergötland. Dödsfall med Covid-19 på särskilda boenden eller i eget hem i Östergötland. Rapport efter journalgranskning. 6 aug 2020. Dnr KMC-2020-50. 2) Socialstyrelsen. Nationella principer för prioritering inom intensivvård under extraordinära förhållanden. Version 2.0. 29 apr 2020. 3) Maruthappu M, Watkins J, Noor AM, et al. Economic downturns, universal health coverage, and cancer mortality in high-income and middle-income countries, 1990-2010: a longitudinal analysis. Lancet. 2016;388(10045):684-95. 4) Friedman J, Schady N. How many infants likely died in Africa as a result of the 2008-2009 global financial crisis? Health Econ. 2013;22(5): 611-22.
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