![]() 16 In addition to the failure of the COVID-19 strategy, there are other unresolved structural factors related to the organisation of the care of older people in Sweden. 16 On Dec 15, 2020, the Corona Commission concluded that “the single most important factor behind the major outbreaks and the high number of deaths in residential care is the overall spread of the virus in the society”. 4, 15 The Corona Commission (Coronakommissionen), appointed by the Swedish Government to review the national COVID-19 response, has focused initially on the situation among older people. Many critical voices have been raised about Sweden's national response to COVID-19 and its failure to achieve its objectives to flatten and shorten the curves of cases, hospitalisations, and deaths. 1, 3 Rather than anticipating the second wave and change course, the Swedish Government loosened restrictions in early October, 2020, increasing the numbers that could attend public events from 50 to 300 and allowing people older than 70 years to meet with family and friends. With this gradual approach, the number of COVID-19 deaths in Sweden peaked during the first wave at 102 reported deaths (7-day rolling average) on April 21, 2020, 3 at a higher level and with slower decline than in the neighbouring Nordic countries, reaching a low in early September, 2020. 12 Other incremental interventions are being introduced, such as changing a ban on the sale of alcohol from 2200 h (introduced on Nov 11, 2020) to 2000 h from Dec 24, 2020, 12, 13 recommending further limit on the size of gathering, and urging people to take individual responsibility and stay at home when they have symptoms. 9, 10 Recently, face masks were introduced in care homes and health-care facilities (Nov 11, 2020, in Stockholm) 11 and will be recommended “on public transport at certain times” from Jan 7, 2021. 7 In our view, there is still not sufficient recognition in the national strategy of the importance of presymptomatic and asymptomatic transmission, aerosol transmission, 8, 9 and use of face masks. ![]() Coronavirus testing, contact tracing, source identification, and reporting, as recommended by WHO, 6 were limited and remain inadequate. 4 No mandatory measures were taken to limit crowds on public transport, in shopping malls, or in other crowded places, while recommending a limit of 50 people for gatherings 5 as of March 29, 2020. ![]() ![]() Instead, the answers to this enigma are to be found in the Swedish national COVID-19 strategy, the assumptions on which it is based, and in the governance of the health system that has enabled the strategy to continue without major course corrections.įrom the onset of the COVID-19 pandemic, the Public Health Agency, Folkhälsomyndigheten (FHM), embarked on a de-facto herd immunity approach, allowing community transmission to occur relatively unchecked. ![]() 1, 2, 3 This difference between Nordic countries cannot be explained merely by variations in national cultures, histories, population sizes and densities, immigration patterns, the routes by which the virus was first introduced, or how cases and deaths are reported. 1, 2 On Dec 20, 2020, COVID-19 deaths in Sweden had reached more than 8000 3 or 787 deaths per 1 million population, which is 4♵ to ten times higher than its neighbours. In the second wave of the COVID-19 pandemic, the Swedish national response continues to be an outlier with cases and deaths increasing more rapidly than in its Nordic neighbours. ![]()
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