The national response to the COVID-19 pandemic in Sweden continues to be an outlier in the second wave of the pandemic, with the number of cases and deaths rising at a far faster rate than in Sweden’s Nordic neighbors.
1, 2 On December 20, 2020, the number of COVID-19 deaths in Sweden had surpassed 80003, which is equivalent to 787 deaths per one million inhabitants and is between four and a half and ten times greater than its neighboring countries. 1, 2, 3 This discrepancy across the Nordic nations cannot be explained simply by differences in national cultures, histories, population numbers and densities, immigration patterns, the pathways through which the virus was initially transmitted, or how cases and deaths are reported. Instead, the solutions to this mystery can be found in the Swedish national COVID-19 plan, the assumptions on which it is founded, and the health system’s governance that has made it possible for the strategy to continue without major course corrections.
The Agency for Public Health
The Swedish Public Health Agency, known as Folkhalsomyndigheten (FHM), adopted a de facto herd immunity strategy from the very beginning of the COVID-19 pandemic. As a result, community transmission was allowed to continue somewhat unregulated.
4 Although no obligatory steps were established to reduce crowds on public transportation, in shopping malls, or any other crowded places, a limit of fifty persons was recommended for gatherings5 as of March 29, 2020. This limit will go into effect. The testing for coronavirus, the tracing of contacts, the identifying of sources, and the reporting of findings, as recommended by WHO6, were restricted and inadequate. 7 In our opinion, the national plan does not provide adequate emphasis on the significance of the presymptomatic and asymptomatic transmission of the disease and the information of the virus through aerosols8, nine and the usage of face masks. 9, 10 Recently, face masks were made mandatory in care homes and other healthcare facilities (on November 11, 2020, in Stockholm)11. Face masks will be suggested beginning January 7, 2021: “on public transportation at specified times.” 12 Other gradual interventions are being introduced, such as modifying a prohibition on the sale of alcohol from 2200 h (introduced on November 11, 2020) to 2000 h (beginning on December 24, 2020), which will be implemented on December 24, 2020. 12, 13, suggesting further limits on the number of gatherings and advising individuals to take personal responsibility and remain at home if they are experiencing signs of the illness.
With this gradual approach, the number of COVID-19 deaths in Sweden reached its peak during the first wave at 102 reported deaths (7-day rolling average) on April 21, 20203. This was at a higher level and with a slower decline than in the neighboring Nordic countries, eventually reaching a low at the beginning of September 2020.
1, 3 Instead of preparing for the second wave and changing direction, the government of Sweden decided to relax restrictions at the beginning of October 2020. The number of people allowed to attend public events increased from 50 to 300, and senior citizens aged 70 and older were given permission to get together with family and friends.
Many voices have been voiced that are critical of Sweden’s national response to COVID-19 and its failure to meet its objectives to flatten and shorten the curves of cases, hospitalizations, and deaths. [Case of Viral Infection in Sweden]
4, 15 The Corona Commission (Coronakommissionen), which the Swedish Government created to assess the country’s response to COVID-19, has originally concentrated on the issue among older people. 16 The Corona Commission reached the following conclusion on December 15, 2020: “the overall spread of the virus in the society is the single most important element behind the major outbreaks and the high number of deaths in [elderly] residential care.” 16 In addition to the failure of the COVID-19 strategy, there are other structural issues connected to the organization of senior care in Sweden that has not been resolved.
The recommendations made by the World Health Organization (WHO) to maintain a physical distance, wear a face mask, keep rooms ventilated, avoid crowds, and practice good hand and respiratory hygiene have been validated by an independent review of the evidence17 conducted by the Royal Swedish Academy of Sciences.
18 However, it wasn’t until December 18, 2020, that the government issued directives to begin putting more of these recommendations, such as the use of face masks, into practice. This is because the trend of rapidly rising cases and deaths continues, and intensive-care facilities and healthcare professionals are already at their maximum capacity in many regions of Sweden.