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Last Week in Sweden: Hospitalizations with Covid at a record high

Throughout the Coronavirus crisis, I’ve been summarizing on a weekly basis the most important and talked about happenings from a Swedish perspective. This is week 50 (December 6 – 13, 2020).

(This article was originally posted in Swedish)

7,514 people have now died with Covid-19 in Sweden; an increase of 447 reported deaths compared to last week. We have to look as far back as the beginning of May to find a week in which more deaths have been reported. Even then, and as usual, deaths occurring during the most recent week are yet to be reported. As Adam Altmejd’s graph shows, Sweden has experienced a longer delay in reporting deaths during the autumn, than in the spring. Altmejd’s forecast of the death toll at the moment (100 per day, in line with the ECDC’s forecast for mid-December) is tricky to assess, as it is not particularly effective at taking into account when the death toll might start trending downwards.

Unfortunately, there isn’t too much good news to be found in other available data. Mortality in the country has now returned to a level above normal and the kinds of numbers we’re seeing admitted to intensive care would indicate that units seem to be reaching capacity. This isn’t because there are more Covid cases in intensive care than in the spring, but because there are now also more ICU patients admitted for non-Covid illnesses. This week, the alarm was raised in Stockholm that intensive care is in principle full. In the spring, a field hospital was made available, but it has since been closed down and converted into a mail processing and distribution center. Had the field hospital still been available, it still would not have helped, as the problem now is centered not on beds but healthcare staff. It’s been announced, therefore, that the National Board of Health and Welfare will redistribute the nation’s resources in order to relieve Stockholm. During the week, figures were released that showed in total, there is still 22 percent availability nationally.

At the same time, the total number of hospitalizations with Covid is at a record high. We saw a slight decline a week ago, but it turned out to be temporary. Even though Stockholm seems to have reached a plateau, the rest of Sweden has now passed the spring peak and now has a record high hospitalization rate.

This week’s total for the number of people tested has decreased slightly for the first time during the autumn from 275,000 to 261,000 during the last measured full week (week 49). The decrease is probably due to the fact that several regions were facing issues with testing capacity, as well as having been more restrictive with those who were allowed to take tests.

Light purple: number of people tested; dark purple: analysed tests
X-axis: week / Y-axis: number
Note: data does not include cases diagnosed from ’Sentinel monitoring’; a Swedish system in which a selection of doctors, surgeries and clinics sample patients with influenza-like illness or acute respiratory infection.

If you look instead at what percentage of people returned positive tests, there has been an increase of just over one percentage point, from 13.3 to 14.4. Even in absolute numbers, there was an increase to a record number of 37,544 people in a single week.

Figure 1C: Number of confirmed cases of Covid-19 per week, split between testing among priority groups (shown in gray), and mass testing (purple).

The heavy burden on the healthcare system is unparalleled in Swedish history, according to the Swedish Medical Association. Many have resigned after the tough spring and more are expected to do so because healthcare professionals have to work incredibly hard for a salary that is far too low. The risk now is that already exhausted staff will be pressured even harder, which increases the risk of incorrect decisions. To cope with the emergency situation, several measures are now being taken. All non-emergency operations have been canceled, including children’s operations, and regions are offering bonuses of SEK 6,000 per day for healthcare staff who work over Christmas.

Sweden is ready to vaccinate as soon as there is an approved vaccine, the government announced this week. The latest announcement is that a vaccine can be approved on December 29 and that vaccination can begin immediately after New Year. This is Pfizer’s vaccine, which has already started to be used by the United Kingdom, and which was approved for use by the United States this week. This week, allergy sufferers with experience of severe reactions were advised against taking the vaccine in the UK. Such advice is not uncommon regarding vaccines.

During the last week, several nursing homes have had to send home staff who have been infected, even though they have not displayed any symptoms. The homes have been part of a trial for new rapid testing whereby staff receive a test result within 15 minutes. Several regions are now expected to use them to avoid the situation seen in the spring where many nursing home residents died.

Sweden is set to implement new pandemic legislation, giving the government more power to be able to shut down not only cultural and religious gatherings (included today in the definition of ”public gatherings”), but also public transport and shopping centers. If everything goes according to the government’s plan, the law will enter into force on March 15, 2021.

The Swedish county of Norrland has many times more deaths than in neighboring countries. This is despite the fact that the population density and proportion of foreign-born residents is low. National daily tabloid Expressen released the survey this week, and believes that this refutes the Public Health Agency’s theory of why Sweden is hit harder than our neighboring countries.

This week’s news in brief:

Finally:

To spread a little festive cheer, but perhaps also to remind us all of the severity of the situation we face, healthcare teams in Uppsala presented their own traditional St. Lucia’s Day parade – wearing full PPE.

That’s all for this week, let me know in the comments if you think there’s something missing!

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