Sweden’s response to COVID-19: “Life is not carrying on as normal”

Sweden’s response to COVID-19: “Life is not carrying on as normal”
© iStock-Alexander Farnsworth

Swedish Minister for Health and Social Affairs Lena Hallengren tells HEQ about Sweden’s response to COVID-19.

The Swedish response to the COVID-19 pandemic has attracted international attention by diverging from the common European approach, eschewing the strict lockdown measures favoured by other nations. HEQ speaks with Lena Hallengren, Sweden’s Minister for Health and Social Affairs, about the constitutional factors informing the country’s public health response and the role of the Swedish healthcare sector in ‘flattening the curve’.

What factors informed Sweden’s decision not to institute a full lockdown in response to the COVID-19 outbreak? In retrospect, what additional measures could have been taken?

The Swedish constitution does not allow the government to declare a state of emergency. Under the Swedish constitution, freedom of movement is a fundamental right and limiting such rights requires a decision by the Swedish Parliament. But that does not mean that it has been business as usual in Sweden.

Sweden’s public health response is firmly based on expertise and lessons learned. The decisions taken by the government are based on advice from our expert agencies and international expert organisations. Measures are regularly being fine-tuned and adjusted in response to developments on the ground. The government has made legal preparations to be able to quickly implement stricter measures if necessary.

Sweden is tackling the COVID-19 pandemic through both legally binding measures and recommendations. The government and the Swedish Public Health Agency have taken a number of decisions involving a wide range of new regulations and recommendations that affect the whole of society, including people’s private lives. There is no full lockdown in force, but many parts of Swedish society have shut down.

Life is not carrying on as normal in Sweden. Many people are staying at home and many have stopped travelling. This has had severe effects on Swedes as well as on the Swedish economy. Many businesses are folding. Unemployment is expected to rise dramatically. The Government has taken several measures to mitigate the economic effects and to stabilise the economy.

Sweden shares the same aim as all other countries: to protect the life and health of its population. Fundamentally, Sweden’s measures only differ from other countries in two regards: we are not shutting down schools for younger children or childcare facilities and we have no regulation that forces citizens to remain in their homes.

What measures implemented in Sweden have been successful to date in preventing the spread of infection?

It is far too early to draw any firm conclusions as to the effectiveness of the measures taken in Sweden, or any other country for that matter. It is obvious that older people are most vulnerable to the virus. One of the main concerns now in Sweden is to strengthen the protection for those living in care homes for older people.

So far, it is difficult to assess exactly how the government’s measures and recommendations have impacted the spread of COVID-19. What we do know, from statistics from the Public Health Agency of Sweden, is that the ongoing outbreak of the annual seasonal flu ceased almost entirely when recommendations on social distancing were made. There is also clear evidence that the level of domestic travel has decreased drastically, which it is assumed will also slow down the spread of the virus.

The effectiveness of measures is continuously reassessed, and measures are added, or stronger enforcement of measures is applied, if and when deemed necessary by experts. The government’s aim is to ensure that the right measures are taken at the right time.

What has been the impact of the pandemic on the wellbeing of doctors, nurses and other hospital staff? Have any measures been put into place to offer additional support to hospital employees?

In Sweden, the responsibility for healthcare lies with the regions. Different regions have put different measures in place to support healthcare workers in the pandemic. On a national level, the National Board of Health and Welfare have published a multitude of knowledge-based reports and web-based guidance for the health and social care workforce and to support decisionmakers on different levels of the health system. These include:

·       Basic healthcare hygiene;

·       Triage in pre-hospital care and triage in emergency care;

·       National principles for prioritisation;

·       Introduction to new healthcare workers;

·       Revised guidelines for palliative care;

·       Information on sick leave due to COVID-19;

·       Information to clinics working with addiction issues;

·       Caring for migrants and asylum seekers;

·       Classification of COVID-19 in the World Health Organization’s International Classification of Diseases (ICD-10) and the Swedish National Board of Health’s official Classification of Care Measures (KVÅ);

·       Donation and transplantation;

·       Information for dental care workers; and

·       Information for social care workers.

Additionally, on behalf of the National Board of Health and Welfare, Karolinska Institutet has prepared two e-learning courses on COVID-19, which are available in several languages. The objective is to strengthen preparedness and provide information on the most important principles and challenges involved in the work to prevent the spread of COVID-19; and the focus is on principles of hygiene and the use of personal protective equipment (PPE).

How has the Public Health Agency been monitoring the spread of COVID-19?

The Public Health Agency uses several different surveillance systems to monitor the spread of COVID-19 in Sweden. Since COVID-19 is subject to mandatory reporting under the Communicable Diseases Act, physicians and laboratories continuously supply data to be analysed by the Public Health Agency on a daily basis. Other sources of data include random samples from patients with symptoms of influenza, or from other groups of people. Statistics from the medical advice service 1177 (web searches and telephone calls) is also used to monitor the situation.

Collected data provides a background for decisions about interventions made with the aim of minimising mortality, the number of people affected by the disease, and the negative effects for society. Data from surveillance also makes it possible to monitor and evaluate the effects of interventions so far, and to follow and somewhat predict the further development of the pandemic.

The Public Health Agency issues a weekly report showing the number of COVID-19 cases, beginning 20 March 2020: weekly reports and other information about surveillance can be found here (in Swedish).

What lessons can Sweden take from the COVID-19 pandemic in preparing for future outbreaks of disease?

Even though the situation is gradually looking better in Sweden and in many other countries, it is too early to draw any definitive conclusions on the effectiveness on what we have done so far. What we can say is that past investments and development we have done within the healthcare system including infrastructure for digital care has proven to be valuable.

We are now in month four of this pandemic in Sweden. Flattening the curve of infections has been an important goal in order to make the healthcare system cope. So far it has been successful. The capacity of the Swedish healthcare system has been dramatically scaled up to match the increasing number of patients.

Lena Hallengren
Minister for Health and
Social Affairs
Government of Sweden

This article is from issue 14 of Health Europa. Click here to get your free subscription today.


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