Is the second wave overloading Sweden's intensive care units?

In the summer, Sweden's state epidemiologist frequently pointed out that Sweden had succeeded in one of its main strategic goals: keeping infections low enough to prevent the healthcare system being overwhelmed. Even at the peak of the first wave in mid-April, the country always had at least around 30 percent spare capacity in intensive care. 

But with temporary field hospitals dismantled over the summer and some other emergency measures no longer in place, the country has less intensive care beds available while there is a resurgence in cases. 

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During the spring peak, Sweden more than doubled its available intensive care places after mounting an impressive operation to increase the number to 1,100. 

According to the latest figures from the National Board of Health and Welfare, Sweden on Wednesday December 9th had 673 intensive care beds equipped with a ventilators. 

How much spare intensive care capacity is there in Sweden as a whole? 

According to the latest figures from the Swedish Board of Health and Welfare, 550 of the intensive care beds equipped with a ventilator were occupied on Wednesday December 9th, of which 261 were filled with patients with Covid-19. 

This amounts to 18 percent spare capacity. 

An intensive care worker in a Stockholm hospital. File photo: Staffan Löwstedt / SvD / TT

What's happening in Stockholm? 

Stockholm on Wednesday reported that its 160 care beds were 99 percent full. The region has issued a 'hemmaställan', a formal call for help to the health board, which will in turn be sent to the Swedish Armed Forces, who may be able to provide doctors and medical equipment.

Stockholm's hospitals director Björn Eriksson told Dagens Nyheter that it was primarily a lack of trained staff that was limiting the number of intensive care places.  

What about other regions? 

The health board reports that four other regions have less than ten percent spare intensive care capacity, but has not stated which regions these are.

According to Göran Karlström, a senior doctor in Värmland who is in charge of coordinating intensive care capacity between Sweden's regions, capacity has never been tighter. 

"Both last Friday and on Wednesday this week, we had an all-time low when 13 regions had less than 25 percent capacity at the same time," Karlström, who is involved with coordinating capacity between regions for the Swedish Association of Local Authorities and Regions, told The Local. 

How are Sweden's regions sharing patients? 

According to Karlström, the policy in Sweden is for regions to take one another's patients, rather than for staff to travel to regions with low capacity. 

"The strategy is not to move personnel but patients, and that is because personnel perform better if they are in their own comfort zones and know the routines. We think that patient safety will be better." 

• Coronavirus in Sweden: How many cases are there in your neighbourhood?

Might patients be sent to Finland, Denmark or Norway? 

Sweden's medical newspaper Dagens Medicin on Thursday quoted Sten Rubertsson, a doctor at the health board, saying that a new plan to increase the number of available intensive care beds was likely to be announced within days, and might even involve patients being sent to be treated in Norway, Denmark and Finland. 

Rubertsson told The Local that he was not responsible for planning intensive care capacity, but said that it was possible that patients could be sent abroad. 

"If we reach a situation where we cannot handle this ourselves, we will definitely ask our brother and sister countries for assistance," he said. "It's really hard to know when that's going to occur, or if it's going to occur at all."

He pointed out that Uppsala Region, where he works, already sometimes sends serious burn patients to be treated in Bergen and neonatal patients to Turku in Finland, and noted that Sweden's neighbours had all offered to treat coronavirus patients earlier in the year. 

"During the peak of our problems in the spring, we got offers from our neighbours, saying that they were willing to help us if we ended up in a situation where we couldn't make sure all the patients are safe."

Johanna Sandwall, the board's operations chief, told The Local that there were currently no plans to seek help from neighbouring countries. 

"There are no such plans right now," she said. "Right now we have sufficient capacity nationally to meet our care needs." 

She pointed out that the Nordic Public Health Preparedness agreement provided a framework for Nordic countries to easily seek medical help in a crisis, but that such help had not yet been requested. 

"The National Board of Health and Welfare has not requested any help yet," she said. 

However, Karlström said that the board had this week been in contact with health authorities in Denmark, Norway and Finland to remind them of their commitments under the agreement. 

"A couple of days ago they initiated the first contacts with the other Nordic countries so that they are aware that this is still a valid agreement if the need arises," he said. 

Might Sweden call in the military? 

After Stockholm's call for help, Johanna Sandvall, crisis chief at the Swedish Board of Health and Welfare, said it might be hard to free up armed forces medical personnel, as most were reserve officers who are already working as nurses and doctors in Sweden's hospitals. 

"These are personnel who already work as nurses or doctors in a region, but if we were used the reserve officer system so that the Armed Forces just call in reserves and place them somewhere, we would just be creating a hole that the regions can't control," she said.