Virus experts: Sweden’s strategy broke here

Mikael Köhler, director of health and medical care in the Uppsala region, believes that Sweden’s strategy against the virus sometimes entails late decisions. Stock Photography.Image: Pontus Lundahl / TT

Alcohol ban after 22, new restraining order in nursing homes and stricter municipalities. The pandemic fall was significantly bleaker than predicted by the Public Health Agency (FHM) forecasts. What went wrong? Four virus experts discuss how we ended up here.

– This spring, we expected and believed that it was a new disease. We didn’t want to see that it was the virus of winter spread as it is, which spreads when it’s cold and we started spending more time indoors, says Mikael Köhler.

For several weeks your region has topped the brochures with black headlines. Behind the scenes, feverish work is being done to reverse the Uppsala trend and flatten the curve pointing up from mid-October.

– What we do differently now is we do our best to test and track infections. FHM made the decision not to trace the infection and we followed the advice and recommendations that came, which turned out to be completely wrong. We would have tried to keep track of the infection, not have abandoned it so soon, says Köhler.

Occasionally During the pandemic, he has been concerned about the national calendar and the ability to make quick decisions, such as advice on protective gear. As a doctor, it’s a matter of course: If you want to save lives, sometimes you have to “just drop everything and run away,” says Köhler.

– In Sweden, we traditionally base our decisions on facts and anchors, but sometimes it is better to make a quick decision than nothing at all. We don’t need all the facts on the table to make a decision, as long as you are prepared to be open and humble before reassessing.

That one more time Infection in nursing homes is a “national disaster,” says Johan Styrud, chief physician of the Danderyd Hospital surgical clinic and president of the Stockholm Medical Association. He does not want to criticize Sweden’s strategy in the spring – “it took over the knowledge we had then” – but, on the other hand, the reopening of the company in early autumn.

– It did not accompany the opening of society at the same time that the number of infections increased. And we see what happened: we are in the middle of a second wave, it did not go well.

But the reopening shouldn’t be attributed solely to the Public Health Agency, according to Styrud.

– It’s a political discussion. We are dead tired of not being able to go to the theater or football. It became politically impossible not to open society.

Is the general advice we have today enough?

– Well, they are, but I have doubts about the regional councils. I think we should have national councils, so that everyone understands the gravity of the situation and is more at the forefront. The disease is rampant and spreads from region to region, so why not have national rules tightening everything properly?

From a Norwegian perspective The increased spread of the infection in Sweden during the fall was not a big surprise. Frode Forland, often called the Norwegian equivalent of Anders Tegnell, claims that Sweden had a more difficult starting position than Norway as autumn approached.

– I think what we see now is a reflection of what we saw last spring. The countries that were hit the hardest at the time have had a spread that was hidden during the summer, and which now glows again when we hang out together indoors. I think it’s important to attack quickly when you see an increase in infection, he says.

During the fall the spread of the infection has also gained new momentum in Norway. Like this spring, the Norwegian strategy has been to quickly introduce tough measures, combat outbreaks, break the curve and work “rock hard” on tracking infections, Forland says.

– For us, tracking infections has been very important. There is a team in each municipality, in each district, in each hospital that mobilizes when necessary and that can support each other beyond the municipal limits. Anyone who has been within two meters of an infected person for more than 15 minutes is contacted by authorities.

Is infection tracking something we haven’t been able to do in Sweden?

– That’s your interpretation. I’m just saying what worked here.

Before Anders Tegnell took the presidency as the Swedish state epidemiologist belonged to the job title Annika Linde. Unlike its successor, it thinks that Sweden’s recommendations should include a higher proportion of distance education and mouth guards in places with a lot of congestion.

– It does not provide absolute protection, but everything suggests that mouth protection reduces the spread of infection. If many are infected, a small positive effect that reduces the spread will reduce the entire disease. There’s nothing to support the hypothesis that something would get worse with mouth guards, but there are plenty of things to support that it would reduce the spread, he says.

Give signals it doesn’t make much of a difference in the current situation, says Linde. However, the problems and difficulties that arose during the pandemic should not be forgotten in future contingency plans.

– There is much to learn from this, but it will probably be very difficult to make major changes, for example, in the division of responsibilities in the midst of a prevailing crisis. But I think the management would have been facilitated by a clearer national responsibility. Today, a lot of responsibility is distributed in many different places, regions do it differently, and it can be difficult. But now it is as it is.