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HEALTH

Sweden disputes accusations of lack of coronavirus action

Sweden has got broad media attention for its soft approach to the new coronavirus outbreak, but it strongly rejects the idea that life is carrying on uninterrupted as the country passes 6,000 confirmed cases.

Sweden disputes accusations of lack of coronavirus action
A man wearing a protective face mask looks on his cell phone in Stockholm, Sweden, on April 2, 2020. Jonathan NACKSTRAND / AFP

A cradle-to-grave welfare state with strong social protection, Sweden has in recent weeks been accused by some, both internationally and domestically, of risking the lives of its citizens by not taking more stringent measures to curb the spread of COVID-19.

“No, it's not business as usual in Sweden,” Health Minister Lena Hallengren told international media outlets this week.

Sweden has not ordered a lockdown, instead issuing recommendations and calling on citizens to “each take responsibility” and follow the guidelines.

Hallengren, who together with Deputy Prime Minister Isabella Lovin and Foreign Minister Ann Linde held a special briefing for international media, stressed that the Nordic country had introduced a string of measures and was ready to do more if needed.

People over the age of 70 and in risk groups have been strongly encouraged to avoid contact with other people, and higher education institutions have been advised to conduct classes remotely.

Economic measures have been adopted to make sick leave less costly, and people have been repeatedly asked to work from home and self-isolate at the slightest symptom of the new coronavirus.

Among the stricter measures are bans on gatherings of more than 50 people and on visits to nursing homes.

The ministers stressed the recommendations were having a noticeable effect. They estimated that about 70 percent fewer people were moving about the city centre, and one-third of Stockholmers were now working from home.

But in stark contrast to much of Europe and its Nordic neighbours, restaurants and primary schools remain open. And even though the streets of Stockholm – the epicentre of Sweden's outbreak – are less bustling than usual, it's far from a ghost town.

People visit the cherry blossom trees at Kungstradgarden in Stockholm on April 1, 2020, during the coronavirus pandemic. Jonathan Nackstrand/AFP

'Russian roulette'

“Everyone is responsible for their own well-being, for their neighbours and their own local community. This applies in a normal situation, and it applies in a crisis situation,” Linde said, stressing that public trust was a key element of Sweden's strategy.

So far the approach seems to resonate with voters. A poll published earlier this week by analyst firm Novus showed that faith in the government was significantly up in March, with 44 percent of respondents saying they had a lot or a great amount of trust in Prime Minister Stefan Lofven, up from 26 percent in February.

However, not all are fans of the Swedish approach. Marcus Carlsson, a mathematician at Lund University, went so far as to accuse Sweden of playing “Russian roulette with the Swedish population,” in a video posted to YouTube and cited by The Guardian among others.

And a study published last week in the medical journal The Lancet, titled “COVID-19: Learning from Experience,” said that the “initial slow response in countries such as the UK, the USA, and Sweden now looks increasingly poorly judged.”

As of Friday, Sweden had reported 6,078 confirmed cases of the new coronavirus, with 333 deaths.

On Wednesday, state epidemiologist Anders Tegnell at the country's Public Health Agency said that while Sweden had observed a relatively flat curve for several weeks, it was now seeing “a fairly steep curve”.

Healthcare services have reported shortages in equipment, but they have so far not been overrun like in Italy and Spain.

However, Stockholm plans to open its first field hospital this weekend amid a sharp rise in cases in the capital.

Public broadcaster Swedish Radio also reported on Thursday that a third of the country's municipalities had confirmed or suspected cases of the new coronavirus in elderly care facilities.

Trust being questioned

Speaking to AFP, Foreign Minister Ann Linde conceded that she did receive a lot of questions from foreign counterparts about Sweden's response, but said this was in part because of disinformation.

Linde said her government had “the same goal as every other government,” the main difference being that most of Sweden's measures were not legally binding.

According to Linde, this can partly be explained by Sweden's tradition of ministries taking their cue from expert authorities, and that citizens typically have high a level of trust in politicians and authorities. “But politicians and authorities also trust people to take responsibility,” she said.

However, as cases have increased, that trust in authorities is being questioned.

Last week, a group of 14 scientists wrote an op-ed in newspaper Dagens Nyheter asking the Public Health Agency for more  transparency, questioning why Sweden had stayed its course when others, like the UK, followed the rest of Europe with tougher measures.

“Different countries have different conditions, but we struggle to see why the Swedish context is so different from the British,” they wrote.

Member comments

  1. How can you protect the elderly in care homes when, logically, they are being cared for by staff that have children in school being contaminated and thus, infecting their parents, who go on to infect the elderly. The new reporting on the large amounts of people that don’t even show symptoms. It’s frightening. In addition Sweden keeps moving towards the other countries apropos safely measures sure, but it only confirms that their initial stance was wrong…..They need to shut the schools.

  2. But key workers like elder care workers will still need to work and hence will still have their children in preschool/school. So how does closing schools actually help?

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HEALTH

EXPLAINED: What to do if you face a long wait for healthcare in Sweden

Sweden theoretically has a "healthcare guarantee" limiting your wait to see a GP to three days, and to see a consultant to three months. The reality is somewhat different. Here's what you can do if you face a long wait.

EXPLAINED: What to do if you face a long wait for healthcare in Sweden

What is Sweden’s ‘healthcare guarantee’? 

Sweden’s “National Guaranteed Access to Healthcare” or vårdgaranti, is a right to care, protected by law, that has applied in Sweden since 2005. You can see the latest version of the relevant laws here and here. Here is a summary of the guarantee on the website of the Swedish Association of Local Authorities and Regions (SKR).

Under the system, all patients are guaranteed:

  • contact with a primary care centre by phone, in-person, or by video-link on the day they seek care 
  • an appointment with a doctor, nurse, physio, or psychotherapist within three days of seeking help 
  • an appointment with a specialist doctor or consultant within 90 days of seeking help 
  • treatment or operation within 90 days, if the specialist considers this necessary 

Does the guarantee mean I have a right to treatment? 

No. If the doctor at the primary care centre, after examining you and questioning you, decides that there is no reason to refer you to a specialist doctor, they do not need to do so. 

Similarly, if the specialist doctor, after examining you, decides that no treatment is necessary, then your case is considered completed.  

Can the waiting times to see a specialist or to get treatment be longer than 90 days? 

Absolutely. In fact, they very often are. 

According to the Swedish Association of Local Authorities and Regions (SKR), in February, 32 percent of patients had been waiting 90 days or more to see a specialist, and 43 percent of those who had seen a specialist had been waiting for treatment for more than 90 days.  

The situation in primary care was a little better, with 80 percent of those seeking care in contact with their primary care centre on the same day, and 83 percent having their case assessed by a doctor or nurse within three days. 

In addition, if you agree with your specialist doctor that you are willing to wait longer for an operation, then that wait doesn’t get counted in the statistics. 

So what can I do if I’ve been waiting longer than the guaranteed time? 

In reality, it’s actually less a guarantee than a target.

In primary care, there is no way for individual patients to complain that they have had to wait too long to see a doctor or nurse, or to cut their waiting times by citing the guarantee. 

“There’s no system for enforcing that guarantee,” says Emma Spak, the primary care doctor who doubles as section chief for SKR’s healthcare division. 

It would make no sense to set up a complaints line for those who have had to wait too long for phone contact with their primary care centre, she points out, when they could instead talk to patients seeking a primary care appointment in the first place. 

“It’s more of an incentive system for the regions,” she explains.

Every primary care unit and every region reports their waiting times to the national waiting time register, and then as part of the access agreement between SKR and the government, the regional health authorities receive a bonus if they meet their waiting times goal, or if they improve their waiting times. “That’s one way of sort of enforcing this guarantee,” she says. 

When it comes to specialist treatment, though, patients do have the right to demand to be examined or treated by an alternative specialist or hospital if they’ve had to wait longer than 90 days.

If your primary care centre issues you a referral to a specialist, and the specialist cannot then offer you an appointment within 90 days, the specialist, at the same time as offering you a later appointment, will often put you in contact with a unit at the regional health authority who will offer to find you an alternative specialist, either within the region or elsewhere in Sweden. 

The regional health authority will then have to reimburse any extra travel or hotel costs incurred by the patient.  

Similarly, if after examining you, a specialist cannot offer you treatment within 90 days, they will normally put you in contact with the same unit. 

Some regions have a phone line for people who have been waiting too long, or else you can contact your specialist or primary care centre and ask for information on seeking an alternative specialist. 

What happens if I don’t want to travel to see a specialist or get treatment? 

If your regional health authority offers you an alternative specialist, either within your region or in another region, so that you can get treated within the 90 day period, and you are unwilling to travel, then you lose your rights under the guarantee. . 

“If you’re in Gothenburg, and they say you have to go to Stockholm to get your treatment, and you say, ‘no, I want to go here, then then you’ve sort of forfeited your right, and you have to take what’s on offer,” Spak says. 

What happens if I agree with my specialist to wait longer? 

If your specialist says that they can treat you in four months, but also offers you treatment elsewhere within the guaranteed 90 days, and you choose to be treated by your specialist, then that counts as a patient choice, which will not then be counted in the statistics. 

“The specialist might say, ‘I don’t think you will get any worse for waiting two months extra, and if you wait five months, then I can make sure that you get your surgery done here, and we can make sure that you get all the aftercare and everything here as well,” Spak says. 

But these patient decisions are also counted in the statistics, and if a region sees a sharp rise in patients choosing to wait, SKR will tend to investigate. 

“If some region all of a sudden has a lot of patients choosing a longer waiting time, then we will call them and ask what’s going on here, because patients don’t tend to want to wait extra,” Spak says.  

Can I get financial compensation if I’ve been waiting too long? 

No. 

What other ways are there of speeding up the wait for treatment? 

Don’t underplay your symptoms

When drawing up their timetable for treatment and assessment, specialists will tend to give different patients different wait times depending on the urgency of their case.

For this reason, it’s important not to underplay your symptoms when visiting a primary care doctor, as they will tend to include a few lines on the urgency of your case when they write their referral. 

Stress your flexibility 

If you are unemployed, a student, retired, or have a very flexible job, it is worth telling your primary care doctor about this, because they may write in your referral that you are able to make appointments at very short notice. The specialist may then put you on their list of people to ring if one of their patients cancels. 

“Sometimes I write in my referrals that this patient could easily come at short notice, so please put the patient on the list for people you can call if there’s a time slot available,” Spak says. 

If you haven’t told your primary care doctor this, it’s not too late. You can ring the specialist yourself and tell their receptionist that you are very flexible, and ask to be put on the back-up list. This is particularly useful if you’re waiting for a scan, but you could also potentially work even if you’re waiting for heart surgery or a hip replacement. 

“If they’ve accepted you as a patient, and they’ve made sure that you fulfil the criteria for having that scan or whatever, then you can call them and say, ‘I have a really flexible job, I can come anytime if you have a gap,'” Spak says.

“A lot of people do that, because they can have [back-up] waiting lists. If you tell them ‘I work around the corner and I only need 15 minutes to be there’, then they might call you if someone doesn’t show up.” 

Ring up your specialist 

The queue system tends to be quite ad hoc, with no strict rules over who should be treated first, so it is often possible to reduce your wait by ringing up your specialist a few times a month, just to bring your case to their attention. Sometimes the receptionist will remember a slot that has just come free and bring forward your treatment while you are still on the telephone. 

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