The Public Health Agency’s assessment led to poorer preparation

– I was going to start by denying our colleague from Stockholm, Anders Tegnell, who perhaps suggested that the situation is beginning to improve.

It is October 22 and Uppsala Health Director Mikael Köhler begins his press conference speaking out against Sweden’s state epidemiologist. Instead, Köhler emphasizes that the situation in the region is deteriorating, comparing the spread of the infection to a car accelerating from 20 to 100 kilometers per hour.

Joining the director of health care is Fredrik Settergren, head of infection tracking and sampling in Uppsala. He will later tell DN that the Public Health Agency has contributed to an image that Sweden, unlike other countries, would not be affected by a second wave of viruses.

Uppsala was one of the first to sound the alarm. We saw that this was something that was about to happen, he says.

After the decline of summer the spread of the infection resumed in early October. In the latest state report from government offices, the Swedish Public Health Agency describes a “wide social spread of covid-19”. More than half of the regions have entered personal mode. Although the situation is not yet as dire as last spring, the number of reported deaths has risen since the end of October, with 42 new deaths reported on Friday.

Several infection control doctors DN spoke with emphasized that it has been very difficult to predict the development of the virus. Despite this, the Swedish Public Health Agency and other Swedish experts have repeatedly assessed that Sweden is not facing a classic type of second wave this fall.

The Public Health Agency line led to the Swedish strategy being changed before the fall. On September 1, the government and the Swedish Public Health Agency presented the new address for a joint press conference. The focus shifted from national recommendations to local restrictions that would be based on effective infection screening. On September 15, the government decided to lift the national ban on visiting the country’s nursing homes.

Since summer has Anders Tegnell said he doesn’t believe in a typical second wave this fall, but rather in the spread in small local groups. Just three weeks ago, on October 15, the state epidemiologist said during a press conference that the situation in Sweden could not be classified as a second wave.

– It requires a very extensive spread of the infection over much of the country, which we do not see at all in Sweden.

At the same time that the spread began to increase again, the government made new decisions to ease the restrictions. On October 22, the audience cap at certain events was raised to 300 people. Johan Carlson, CEO of the Swedish Public Health Agency, admitted that it could be confusing, but also said the basic idea is to have balanced measures.

“Europe has shown that austerity over austerity does not have a major effect,” Johan Carlson told DN.

The Swedish Public Health Agency also decided to remove specific recommendations for people over 70 years of age. Many perceived it as a relief, “Now the 70+ are released,” Aftonbladet wrote.

After the virus again Anders Tegnell has admitted that the authority was wrong. Uppsala’s head of infection tracking Fredrik Settergren says statements from the Public Health Agency over the summer had the region braced for a different kind of infection spread, with local outbreaks, than it has been.

– Now we just fill and fill with staff to try and catch up. It is clear that if in August it had been said that there was a high probability of a very difficult second wave here in October, “make sure you are loaded to the teeth with personnel and sampling stations,” then surely we would have acted differently.

It was in early October that Fredrik Settergren and his infection trackers noticed how the number of people infected with viruses began to rise.

– So we didn’t think at all that it looked like a group or something like that, he says.

– I asked if no one else experienced what we saw in Uppsala. We had curves that pointed upwards. But no, it wasn’t something I’d seen, maybe just a slightly higher number of positive samples. It was as if they thought “that’s just for Uppsala”. But now, in principle, the whole country is catching up with us.

Fredrik Settergren thinks that the public signs were confusing in early fall.

– The signs that came were that now you can still meet your grandchildren, you, as over 70 years old, should not have to worry anymore. It became a very strange psychology when the restrictions dropped at the same time most people saw that infection rates were increasing, says Fredrik Settergren.

The infection also developed in Norrbotten to a greater extent than feared, says regional director Anna-Stina Nordmark Nilsson. To try to predict the development, the region took the help of the three different scenarios from the Public Health Agency, but also tried to follow the spread locally. It was difficult.

– We are used to the fact that when an authority speaks, we listen. We are a small region and we rely heavily on the knowledge that exists that we think we do not possess.

During the fall, the infection has intensified and lack sufficient laboratory capacity for testing. But responsibility for the situation also rests with the region, says Anna-Stina Nordmark Nilsson.

– We could have been much more powerful and withstood even more tests. But when we saw the infection subside, the focus was mainly on resuming care that had been displaced due to the pandemic, he says.

Even regional DN politicians spoke to believe that second wave authority assessments have had negative consequences. Mikael Johansson, (M), president of the regional board in Kronoberg, says that the sampling material has been prepared mainly for a cluster infection.

– If we had known that there would be a second wave, we would be prepared for larger amounts of sampling. I think last week we reached 4,500 samples, we never would have guessed it. We think we had loaded it with additional material and testability so that would be enough and that’s it, but it’s not.

DN has been in touch with about ten infection control physicians across the country. Several also emphasize that the region has prepared to the best of its ability and that it has not been adversely affected by the Public Health Agency’s incorrect assessment of a second wave.

In the capital region, they did not dare to trust any scenario before autumn.

– We are prepared for the fact that we could have the same situation as last spring. We know that forecasts and scenarios rarely materialize, says Björn Eriksson, director of health and medical care in Stockholm.

Instead, the region has closely monitored the spread of the infection on a day-to-day basis, both regionally and nationally, but also in Europe, in order to rapidly increase health care capacity.

One of the largest emergency rooms in Stockholm, the Sös ER, feared a second wave and, in early August / September, put out a 5-step plan.

– We are already on plan C. We have the biggest problem in the emergency department, where the number of patients with suspected covid is increasing like an avalanche at the same time that the staff gets sick, says Clara Strömberg, chief physician of the department of emergencies and president of the medical association in the hospital.

She believes that the public was affected by the fact that the expert authority did not believe in a second wave.

– When the Swedish Public Health Agency says that, many people think it is calm. People are crowded into stores and ignore distance marks.

Thursday, November 12. The Swedish Public Health Agency is holding a press conference and says that 17 of the 21 regions are now subject to stricter restrictions. Anders Tegnell tells DN that he does not believe that the communication from the Swedish Public Health Agency had consequences for the regions’ preparations.

– The forecasts that we have made so far as to how many health cases and how many VAT cases will be relevant, until last week those forecasts have been above what is seen in reality.

Would it have been better if the regions had prepared for a second wave rather than local cluster buds?

– I am completely convinced that the regions have been very interested that there may also be many cases this autumn. The National Board of Health and Welfare and others have ensured that there is good storage on site and are well prepared to increase their VAT capacity again, says Anders Tegnell.

According to Anders Tegnell, it has been very difficult to see what the development would look like during the fall.

– We have a situation that is more serious than we thought, says Anders Tegnell.