Call to Action to Control COVID in the Winter

This text offers a revised version of the authors’ article published in Swedish in Göteborgs-Posten 23 October 2020.

This autumn, a second covid-19 wave sweeps across Europe, and many countries have introduced drastic restrictions. In Sweden, we also already appear at the beginning of a major wave of infections. The rapid increase in detected cases, and the increase in the number of intensive care patients indicate this. Therefore, we must act now. The government should first urgently address the immediate threats and not reduce restrictions. We must then begin a constructive discussion to devise a long-term and sustainable strategy. This should apply the principles of the WHO Code of Ethics: transparency, inclusiveness, consistency and accountability.

The government / FHM never clearly communicated their strategy to the population this spring. The intention was said to be to “flatten the infection curve” so that healthcare and health care would not be overburdened, while at the same time protecting the elderly and other risk groups. Herd immunity was not said to have been the target. At the same time, it is impossible to ignore the fact that the way in which infection control was applied in Sweden was de facto characterized by a striving for herd immunity through natural infection. This has also been confirmed by several internal e-mails issued between representatives of FHM and comments by hired experts. Thus, we had no early closure like the other Nordic countries, they allowed entry from countries with a high spread of infection, introduced liberal rules for restaurants and nightclubs, did not take into account asymptomatic spread, never applied WHO quarantine rules, delayed testing and made it more difficult for infection control doctors to contact trace. In practice, a herd immunity strategy has been applied in combination with recommendations for physical distancing and meeting restrictions.

In any case, the strategy has not succeeded. People have died to a far greater extent here than in our neighboring countries. Only by failing to treat many patients over the age of 80 has intensive care been managed. Other consequences are that many nurses are now resigning, surgical queues of around 185,000 operations have arisen and postponed checks of serious illnesses will have to be overcome in the future. Mental illness is increasing. According to SVT’s calculations, at least about 25,000 currently suffer from long-term covid. A recent study suggests one in seven people is ill for at least four week, one in 20 people is ill for at least eight weeks, and one in 45 people is ill for at least 12 weeks.

And what about immunity? In Stockholm, it was found that about 12% were antibody positive at the end of June. In the rest of the country, the figure was 6 to 7 percent.

The number of cases is now increasing again, and we are at a crossroads. This spring, the decision-makers acted without involving the population. This is not only ethically unacceptable and detrimental to democracy, it also had catastrophic consequences in the number of deaths and patients with long-term covid. Now that the infection is spreading like wildfire across Europe again and as winter with increasing transmission risk approaches, we need the political courage to take early action. We know that reactive waiting and reacting late can be devastating.

The government has partly taken measures in the right direction. Restrictions have been introduced for nightclubs. Testing capacity has been drastically increased and a limited lukewarm family quarantine has been introduced, but everything is happening slowly. At the same time, and in the opposite direction, the ceiling for how many people can be raised has recently been raised, and the recommendations for the elderly over the age of 70 have been removed, now making them exposed to the same risk of infection as the rest of the population. Infection increases, yet measures are reduced!

Instead, the government should have implemented a number of scientifically and internationally accepted recommendations a long time ago:

• We must use face masks in shops and on public transport.
• Face masks must become mandatory routine in all medical and elderly care.
• The government must improve reporting so that people get to know the infection rates in detail in all municipalities and districts in the country in order to be able to take precautionary measures themselves.
• We should introduce regionally adapted rules for follow-up and testing, and throughout the country switch back from the patient-centered contact tracing to the active infection and contact tracing the Infection Control Act requires. We need to form larger infection tracing teams, so that small infection hotspots and clusters can be rapidly checked.
• We must keep the old recommendations for the elderly over 70 years until we get the infection down.
• We should introduce similar quarantine rules for household contacts, including children, to infected, and for immigrants, as the other Nordic countries.
• We should consider further limiting the number of persons that can gather from the current 50.

In this way, we can coordinate Sweden’s strategy with the rest of the Nordic region and the EU countries, and finally also follow the emerging European control plan.

We must also start a constructive discussion in our society where we all discuss together which strategy serves everyone best in the new situation.

Stefan Hanson, infektionsläkare, fil dr i internationell hälsa
Sigurd Bergmann, professor emeritus, Norwegian University of Science and Technology
Nele Brusselaers, docent i klinisk epidemiologi, Karolinska institutet
Andrew Ewing, professor i molekylär­biologi och kemi, Göteborgs universitet
Manuel Felices, MD, PhD, sektionschef endokrin kirurgi, Norra Älvsborgs Länssjukhus
Åke Gustafsson, med dr i virologi, tidigare chef för mikrobiologi och vårdhygien, Region Gävleborg och Region Uppsala
Anders Wahlin, professor emeritus i hematologi, Umeå universitet

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