Sweden | 1,153,655 cases, 14,827 deaths (as at 5 October 2021)
A European country that took a more relaxed approach to suppression
Sweden has, arguably, taken the most idiosyncratic response to the pandemic, for the most part relying on individual responsibility with minimal government intervention. Despite taking a lighter approach in encouraging suppression of the virus, a range of steps were taken to support and prepare the health sector.
Sweden has a largely decentralised approach to healthcare, with three levels of care, so preparation was mostly undertaken by its 21 regions and councils. In one such example, a region was able to triple its ICU capacity, with pandemic‐specific leadership establishing a centralised process for procuring and distributing medical equipment. Other steps to reduce the burden included opening intermediate care units, stopping some elective surgeries and visitation, and the rapid deployment of a large workforce of anaesthetists and nurse anaesthetists to ICUs. Despite these resources, the increase in ICU capacity meant significant staffing challenges, with additional difficulties because of staff illnesses and quarantines, which could not be resolved. However, this approach meant that there was not an overwhelming demand for beds, in this specific region, despite Sweden having the second-lowest number of ICU beds per capita in Europe.
There was a national support for this regional approach. The Swedish Government also took the decision to assign the National Board of Health and Welfare to set up a coordination function for ICUs to support the regions in the coordination and expansion of intensive care centres in the country. On aggregate, the capacity for intensive care doubled, with an expanded national capacity of 1,046 ICU beds.
‘All in’ approach
Sweden has also seen the use of a variety of different resources, including and beyond the ‘normal’ health sector, to support system readiness for case demand. In general, there is no designation of specific hospitals or departments that are meant to deal exclusively with COVID-19 patients, so the entire health system is involved in pandemic care. People with a background in care or healthcare offered their services to hospitals who were often hiring ‘on-demand’ to support the demand for workforce. A selection of primary care providers were utilised to work with sentinel surveillance, reporting the incidence of infection, and sending samples to labs. This approach has extended to include the Swedish Armed Forces, which contributed with equipment, including ambulances, masks and respirators, establishing field hospitals to increase capacity, and contributing personnel to support the health response.
A key part in broader support of health readiness has been the use of data to understand, and potentially remedy, COVID-19 demand. Hospitals were utilising daily projected numbers of patients based on a national model and local data to understand, and prepare for, expected demand throughout the pandemic. This use of data has since been taken a step further to understand how to keep people out of hospital. Since the start of 2021, Region Jönköping adopted a new way of working with risk prediction to identify 2,500 individuals who have a higher risk of suffering from severe COVID-19 and related hospitalisation. The region has established close contact with these individuals and monitors their wellbeing with home visits and phone calls.
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