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Last Week in Sweden: a Covid Report (November 8 – 15, 2020)

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 46.

(This story was originally posted in Swedish)

6,164 people have now died with Covid-19 in Sweden; an increase of 142 reported deaths compared to last week. As always with these statistics, not all deaths actually occurred in the last week, but the prognosis for this week is that we’ll return to levels of deaths last seen in June, at around 20 per day.

The rate of infection continues to increase sharply. 228,023 people were tested during the last reported full week, and 10.9 percent were infected: a total of 25,483 people. This is a record high, but the number is probably even higher, as enormous pressure on testing has meant that not everyone has been able to test themselves.

Figure 1A: Number of individuals per week, split into negative and confirmed positive cases for weeks 6 to 26; the number of tests split into negative and positive tests up to week 39, and negative and confirmed positive individuals from week 40. The graph shows the total number of completed tests and the number of positive (green) and negative (purple) tests.

Sweden now has the fastest growing hospitalization rate of Covid patients in all of Europe, but state epidemiologist Anders Tegnell believes that this is because we find ourselves in a different part of the curve, and started from a lower level than other European countries. With that said, Tegnell remains concerned about the situation and believes that immunity among the general public is lower than was estimated by the Public Health Agency in the spring.

The number of people admitted to intensive care continues to increase sharply, and last week’s trend has continued as we see an unusually high proportion of admissions over the age of 80. Generally speaking, the average age of ICU patients has risen during this second wave, but those over 80 are now more numerous than in the spring. This could indicate that doctors in the spring were more restrictive in allocating intensive care beds to the over 80s, for fear that ICU capacity would be under threat. It could, though, also be that we’ve learned more about the virus by this stage. A Swedish register study shows mortality in hospitals having decreased from 24.7 percent in March to 13.3 percent in June. Mortality in intensive care dropped from 36 percent to 20 percent. This is partly due to improved medicine, but also to increased knowledge. For example, ICU patients are no longer automatically intubated on a respirator, which is physically hugely stressful, especially for the elderly.

Figure 4B: Number of new ICU cases with lab-confirmed Covid-19 by age group and week

One death in the oldest ICU age group received the most attention of the week: actor Sven Wollter, 86, died with Covid-19. Wollter had toured earlier in the autumn, but it was during a visit to his family in Stockholm that he became infected.

Not everything is looking dark. This week, Uppsala – the region first out with more restrictive recommendations – has started to see the beginnings of a flattened curve of the number of infections. Only as of this week has the outcome of the regional strategy change been able to be measured.

Uppsala: confirmed cases: 8,060 (2,100.5 per 100,000 pop.);
+179 new cases at Nov 13; +2,255 (587.7 per 100,000 pop.) last 14 days

Despite these efforts, the curve still isn’t trending downwards in Uppsala.

The government therefore decided this week to stop all alcohol sales in restaurants and bars after 10pm. ”We’re facing a situation that risks becoming very dark indeed,” said the Prime Minister, and announced that the restriction would be in place until 20 February. Restaurants are particularly vulnerable to the spread of infection, especially in combination with alcohol, said Lena Hallengren. But several restaurateurs questioned that line of thought, including noted chef Thomas Sjögren on his Instagram:

Hi @stefanlofven!

I fully understand that you need to put your foot down to ”flatten the curve”.

Working in the restaurant industry and running my own restaurants during the pandemic, I have, according to your restrictions, limited the number of guests and worked to enable guests to take care of themselves during their time with us. This has had financial consequences, of course, which we have to some extent been able to mitigate with short-term furloughs, reduced employer contributions and state support.

This support has meant that many in our industry have survived so far, yet they have also helped many companies in other industries to be able to increase their profits significantly as they also apply to ICA (a supermarket chain), Bauhaus (a home improvement and building supply chain) and IKEA. Congratulations to them!

Now it is clear that ”the party’s over” and that we must regulate the amount of people who come to restaurants during the evening. Great that you are taking action! But should we not also regulate the amount of people and the distance between them in activities during the day?

I and many others have had to travel with work during the autumn and I have asked myself the question: how can the state decide that guests at restaurants must maintain a distance of 1 meter while cramming people in next to each other on your own trains? Even SAS, where the state is the majority owner, sees no problem in filling every single seat?

I myself have avoided infection and have been among people during the pandemic, but when you visit IKEA or similar companies in the trade, I wonder if you even know that they exist? If we now take IKEA as an example, they run their restaurant well with colored plates where they disinfect the tables and make sure that people do not sit too close. But when they then have to pick up a new bookshelf or plan a new kitchen, they’re free to squeeze in among other people completely without distance.

If you are now going to put your foot down, do so instead of stamping with only your big toe on those who have been hit the hardest.

Remember to disinfect your hands!

So where are we most easily infected? According to a major study from the US, restaurants followed by gyms are the spaces where the spread of infection is most likely (homes and workplaces weren’t included in the survey). There hasn’t yet been a similar study in Sweden, but regional infection trackers produce reports on the public environments in which transmissions take place. In these reports, places of work and ‘sports activities’ are the places where the spread of infection occurs most frequently. These activities include ‘after work drinks’ and ‘partying with the team’, according to the Swedish Public Health Agency. Preschools and ‘means of transport’ are said to have the lowest spread of infection.

What is the Swedish strategy? There’s a degree of confusion around this particular question. After the summer, several regions in Sweden changed their strategy, as the Public Health Agency predicted that Sweden would be affected by clusters of infections, and not a full second wave. Now the same regions feel taken aback, reports national daily newspaper Dagens Nyheter. Many also believe that reassuring messages issued over the summer caused the general public to relax, a theory reflected in cellphone data on how Swedes moved around. This week, a study described how every fifth Swede doesn’t trust information from authorities about the virus. State epidemiologist Anders Tegnell does not agree with the suggestion that authorities were unclear, but regrets having raised the limit on audiences to 300. The government has taken note of the confusion and this week directed relevant authorities to ‘strengthen and develop communication efforts’. In short: clarify the Swedish strategy.

We have a vaccine! Pfizer made it out first with a record-breaking vaccine development. The vaccine is said to offer 90 percent protection and Sweden can receive its first doses in January. Many question marks remain, however. On the one hand, the vaccine is sensitive, requiring storage in -80°C (-112°F), and we still know little about the duration of immunity offered. In Sweden, 150 cases of reinfection with Covid-19 have occurred, so will the vaccine make a difference? It is also not known if there are side effects. The test has been performed on just over 40,000 people and the idea is that Pfizer will follow the vaccination closely to detect deviations.

Is Covid-19 airborne? Yes, according to a published study from Uppsala Academic, which found genetic material from the virus in a ventilation system. The material is not contagious and Anders Tegnell believes that as a result, the study does not change the thinking behind the Public Health Agency’s advice and recommendations.

A Swedish nursing assistant has been excluded from state sick pay. She worked with the coronavirus in the spring, but became infected herself and ended up needing longer-term rehabilitation. As a result, she has fallen victim to an unusual rule that means her circumstances were unable to be appropriately assessed before her sick pay expired. A political decision is required if the rule is to be changed, and such a decision does not yet have sufficient parliamentary support. The news about sick pay exclusions became one of the biggest stories of the week.

Test-then-party is a concept fast becoming a new trend in Sweden. Young people test themselves for coronavirus, to then – if negative – be able to go to a party. The trend is receiving harsh criticism, not least given that 20 of 21 regions have testing infrastructure that has reached or is close to reaching capacity. Meanwhile, the Italian doctor who first discovered the coronavirus in Europe believes that mass testing is the wrong way to go. He believes it to be unsafe and open to misuse, and instead recommends self-isolation. However, the Swedish Public Health Agency wants to expand testing capacity, with regions understanding they’ll have better capacity within weeks.

This week’s news in brief:

The Director General of the Swedish Public Health Agency, Johan Carlson, will have his term extended for another year, the government decided this week. Johan Carlson is 66 years old.

The Stockholm Regional Council had to withdraw 270,000 faulty face masks from use in the spring. Those claiming the masks were faulty were however from a company that instead wanted to sell its own face masks, Expressen newspaper revealed this week.

The Stockholm Regional Council has recommended all healthcare staff wear a visor or face mask, even during simpler tasks such as changing sheets.

Doctors in Kronoberg organized a Halloween party at regional taxpayers’ expense. During the party, several people became infected and as a result, care places had to be reduced. The regional council has now apologized.

The mutated coronavirus found in mink in Denmark has not yet been found in Sweden. The issue of closing Swedish mink farms has been raised, but also for reasons other than the virus.

Astrid Lindgren’s World – a theme park based around the works of the beloved ‘Pippi Longstocking’ author – may go bankrupt next year. If they’re unable to open in May, bankruptcy looks to become an inevitability.

The Moderate Party leader left quarantine after testing negative. The Prime Minister had already done the same, but this week the Center Party’s leader announced that she is now self-isolating pending test results.

And finally:

The German government has made a short film to highlight the severity of the spread of infection, and outline what’s really being asked of us all at the moment. It’s incredible, don’t miss it:

What I’m working on ahead of next week:
Has the Swedish Public Health Agency got it right on infections among teachers?

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