Covid-19 Pandemic In Sweden
The COVID-19 pandemic in Sweden is part of the pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The virus was confirmed to have reached Sweden on 31 January 2020, when a woman returning from Wuhan tested positive. On 26 February, following outbreaks in Italy and in Iran, multiple travel-related clusters appeared in Sweden. Community transmission was confirmed on 9 March in the Stockholm region. Since then, individuals in every län (county) have tested positive for COVID-19. The first death was reported on 11 March in Stockholm, a case of community transmission. However, it is believed that the virus could have reached Sweden as early as December 2019, when several individuals sought care for respiratory illness in Falun after contact with an individual with recent travel history to Wuhan.
Sweden has not imposed a lockdown, unlike many other countries, and kept large parts of its society open. The Swedish Constitution legally protects the freedom of movement for the people, thus preventing a lockdown in peace time. The Swedish public is expected to follow a series of non-voluntary recommendations from the government agency responsible for this area, in this case the Public Health Agency of Sweden (Folkhälsomyndigheten). The Swedish Constitution prohibits ministerial rule – politicians overruling the advice from its agencies is extremely unusual in Sweden – and mandates that the relevant government body, in this case an expert agency – the Public Health Agency – must initiate all actions to prevent the virus in accordance with Swedish law, rendering state epidemiologist Anders Tegnell a central figure in the crisis.
The Swedish government's approach has received considerable criticism. Some Swedish scientists had called for stricter preventative measures throughout the pandemic, and an independent commission (Coronakommissionen) found that Sweden failed to protect care home residents due to the overall spread of the virus in society. In December 2020 both King Carl XVI Gustaf and Prime Minister Stefan Löfven admitted they felt that Sweden's COVID-19 strategy had been a failure due to the large number of deaths.
Following agency advice, the government has passed legislation limiting freedom of assembly by temporarily banning gatherings of over 50 individuals, banning people from visiting nursing homes, and physically closing secondary schools and universities. Primary schools have remained open, in part to avoid healthcare workers staying home with their children.
The Public Health Agency issued recommendations to: if possible, work from home; avoid unnecessary travel within the country; engage in social distancing; and for people above 70 to stay at home, as much as possible. Those with even minimal symptoms that could be caused by COVID-19 are recommended to stay home. The karensdag, or initial day without paid sick-leave, has been removed by the government and the length of time one can stay home with pay without a doctor's note has been raised from 7 to 21 days.
The pandemic has put the Swedish healthcare system under severe strain, with tens of thousands of operations being postponed throughout the year, and only emergency and COVID-related care being available during a surge in the winter. Initially, Swedish hospitals and other facilities reported a shortage of personal protective equipment. Swedish hospitals were able to increase their intensive care capacity during the earlier stages of the pandemic, but Stockholm's health system still became seriously overwhelmed during the winter surge, with intensive care bed occupancy reaching 99% by December 18 and the city experiences healthcare staff shortages.
As of 23 December 2020[update], there have been 396,048 confirmed cases and 8,279 confirmed deaths related to COVID-19 in Sweden, with Stockholm County being the most affected. Sweden has several times the number of confirmed cases and deaths of all neighboring Scandinavian countries. Close to half of those who died had been living at nursing homes, which is similar to other European countries.
Background
On 12 January, the World Health Organization (WHO) confirmed that a novel coronavirus (nCoV) was the cause of a respiratory illness in a cluster of people in Wuhan, in Hubei, China, who had initially come to the WHO's attention on 31 December 2019. This cluster was initially linked to the Huanan Seafood Wholesale Market in Wuhan City. A few days later, on 16 January, the Public Health Agency of Sweden issued a press release highlighting the discovery of the novel coronavirus, and the agency monitoring the situation. The risk of spread to Sweden was described as "very low" as there was yet no evidence that the virus could spread between humans, but they recommended that individuals developing cough or fever after visiting Wuhan should seek medical care, and asked for healthcare professionals to be observant.
After the World Health Organization classified the novel Coronavirus as a Public Health Emergency of International Concern on 30 January and demanded that all member states should cooperate to prevent further spread of the virus, the Agency requested for the Swedish government to classify the novel disease as a notifiable infectious disease in the Swedish Communicable Diseases Act as both dangerous to public health (allmänfarlig) and dangerous to society (samhällsfarlig), where contact tracing is required, giving the disease the same legislative status as Ebola, SARS and smallpox. The agency also announced that they have analysing methods that can diagnose a case of the novel disease ‘within hours’ after testing, and that such tests had already been carried out, but that all had turned out negative.
Planning
Following the 2005 outbreak of the H5N1 avian flu, Sweden drafted their first national pandemic plan which since then had undergone several revisions. Since a 2008 revision to prepare for the 2009 swine flu pandemic, the plan includes the formation of a National Pandemic Group (NPG) in the event of a possible pandemic. The group involves several Swedish government agencies and defines each agency's role.
The plan states that the Public Health Agency of Sweden will be the expert agency responsible for monitoring diseases with a pandemic potential, and with the mandate to assemble the National Pandemic Group to coordinate pandemic preparations and strategies on a national level between the relevant agencies. The pandemic group includes four additional Swedish government agencies: the Swedish Civil Contingencies Agency, the Swedish Medical Products Agency, the Swedish National Board of Health and Welfare and the Swedish Work Environment Authority, as well as the county administrative boards of Sweden and the employer's organisation Swedish Association of Local Authorities and Regions.
Swedish crisis management is built on a principle of responsibility which means that the organisation who is responsible for an area of activity under normal circumstances is also responsible for that area of activity during a crisis. As the Public Health Agency of Sweden, headed by director general Johan Carlson, is the agency responsible of monitoring and preventing the spread of infectious diseases, the agency had a central role in the Swedish response to the pandemic. The Public Health Agency also tasked with having a coordinating role for the national response to a pandemic according to the National Pandemic Plan, together with the Swedish Civil Contingencies Agency headed by Dan Eliasson and the Swedish National Board of Health and Welfare headed by Olivia Wigzell.
Preparedness
In risk and impact assessments by the Swedish Civil Contingencies Agency, the Swedish expert agency on crisis management, the risk of Sweden in the future being affected by a severe pandemic was assessed as "high" with a "catastrophic" impact on human health and economics. They believed that a future pandemic would be inevitable within 5–50 years.
In the 2019 Global Health Security Index of the ‘most prepared’ countries in the world for an epidemic or a pandemic published by the Johns Hopkins Center for Health Security, Sweden was ranked 7th overall. Sweden received high rankings regarding prevention of the emergence of a new pathogen, early detection and reporting of an epidemic of international concern and having a low risk environment. However, the Swedish healthcare system received a lower score, questioning if it was sufficient and robust enough to treat the sick and protect health workers. In 2013, the Swedish Civil Contingencies Agency investigated Sweden's ability to cope with a pandemic through a simulation where a severe avian influenza infects a third of the population, out of which 190,000 gets severely ill, and up to 10,000 die from the disease. They concluded that Sweden was generally well prepared, with pandemic plans on both national and regional level, but that the health-care system would be the weak link. They noted that Swedish hospitals were already under heavy burden, and would not have the capacity to treat everyone who become sick, even when alternative facilities (like schools and sports centres) were used as hospitals. They also pointed out that issues concerning prioritising, including triage, would become central during the crisis, and that they believed this subject needed to be addressed. Before the outbreak of the new coronavirus, Sweden had a relatively low number of hospital beds per capita, with 2.2 beds per 1000 people (2017), and intensive care unit (ICU) beds per capita of 5.8 per 100.000 people (2012). Both numbers were lower than most countries' in the EU. The total number of ICU beds in Swedish hospitals was 526.
By the time of the Fall of the Berlin Wall, the Swedish Defence Forces was equipped with a total of 35 field hospitals, with what some considered to be the most modern battlefield medicine in the world, with the Swedish Navy having an additional 15 hospitals. The field hospitals had a combined capacity of treating 10.000 patients and performing 1000 surgeries every 24 hours, as well as stockpiles with drugs, medical supplies and personal protective equipment to treat 150.000 war casualties. Additionally, the Swedish state had several preparedness hospitals and Swedish schools were constructed to be converted into hospital units in case of a military conflict and with a total capacity of treating 125.000 patients, supported by a network of preparedness storages containing medicine and medical equipment. From 1990 and onwards, the system was gradually dismantled to eventually disappear altogether, with the equipment, including more than 600 new ventilators, being either given away or disposed of. At the start of the 2020 COVID-19 pandemic, the Swedish Defence Forces owned 2 medical units with a total of 96 beds, out of which 16 were ICU beds, and there were no civil preparedness storages for medical equipment left in Sweden. Until 2009, the Swedish state-run pharmacy chain Apoteket had the responsibility to ensure drug supply in case of emergency. Following a controversial privatisation, the responsibility was handed over to the private sector. However, a lack of regulations meant that the companies had no incentive to keep a bigger stock than necessary, effectively leaving Sweden without an entity responsible for medicine preparedness. At the start of the pandemic, the Swedish healthcare system were instead relying on a "just-in-time" deliveries of medication and medical equipment, and Sweden had no medicine manufacturing of its own, which was considered to make the country's drug supply vulnerable as it relied on global trade and long supply lines. The Swedish healthcare system was already experiencing a growing number of backordered drugs in the years leading up to the pandemic. The lack of medicine preparedness had been strongly criticised in several inquiries and reports since 2013 by a number of Swedish governmental agencies, including the Swedish National Audit Office, the Swedish Defence Research Agency and the Swedish Civil Contingencies Agency. The latter had regarded disturbances in the drug supply as one of their biggest concerns in their annual risk assessments.