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Why is Sweden cutting testing as Europe enters a new Covid-19 wave?

Sweden's Public Health Agency has been sharply criticised this week for its decision to stop advising vaccinated people with Covid-19 symptoms to get tested. What's behind the decision and why are epidemiologists so worried?

Why is Sweden cutting testing as Europe enters a new Covid-19 wave?
A woman takes an antigen test for Covid-19. Photo: Johan Nilsson/TT

What is the Public Health Agency decision on testing? 

On November 1st, the agency updated its recommendations on testing so that vaccinated people with Covid-19 symptoms only need to get tested for the disease if they fulfil certain criteria. 

These include: people living in a care home, people who work or live in supported housing for the disabled, people who need care or treatment, people who need to get tested as part of contact tracing, and people asked to get tested by a regional infectious diseases doctor. 

Unless they meet these exceptions, vaccinated people will no longer be able to get free PCR tests from pharmacists, even if they are convinced that they have the virus. 

What is the justification for the change? 

Karin Tegmark Wisell, the agency’s new general director, said in an interview last Saturday that it was no longer “fit-for-purpose to test so broadly”. 

“The law clearly states that the interventions made must be balanced against the consequences we see on human health,” she said. 

As those who are fully vaccinated are at a lower risk of getting seriously ill and are also less likely to spread infection, she said, the resources used for testing would be better used elsewhere. 

What are outside experts saying? 

Even Jan Albert, the professor at Stockholm’s Karolinska Institutet medical university has been critical. Albert was one of the Public Health Agency’s most important outside advisors in the early stages of the pandemic. 

“I don’t think that that change should have been made on November 1st, we should have kept the same recommendations in place that we’ve had for the whole pandemic,” he said. “Now it’s hard to know if we are still at a stable level or if we are missing more cases than we did earlier.” 

Tove Fall, professor of molecular epidemiology at Uppsala University, told SVT that the change could have “quite large consequences”. 

“We have less chance of finding outbreaks in time and we actually have a worsened infection surveillance,” she warned.

Anders Vahlne, professor emeritus of clinical virology, and a longstanding critic of Sweden’s strategy, said that the decision was “very unfortunate”. 

“We think it is absolutely obvious that we will get a fourth wave in Sweden, so this is the moment when we should be proactive,  and not reactive when we are faced with a situation full of patients in hospitals.” 

What has happened to testing since the decision? 

According to the latest statistics from the Public Health Agency, the number of people tested dropped a full 29 percent between the week ending October 31st and the week ending November 7th, in a delayed response to the decision. As a result, over the past week, Sweden has had one of the lowest testing rates in Europe. 

What has happened to infections? 

While the average number of new cases a day in Europe has doubled from just over 100,000 at the start of September to over 200,000 last week, Sweden has so far seen only a slight rise in cases over the past few weeks, and currently has one of the lowest rates of infection in Europe. 

Member comments

  1. I fully understand the strategy. But I am afraid the people do not, less testing will lead to lower case numbers. Peolple will act like the pandemic is over, it is not. The way testing is done now it will only show casea within risk and non vaccinated groups. A recipe for a hidden 1000 per 100.000 incidence by christmas. Strong recommendation for going back to measures individually. I will for sure.

    1. Hi, I actually do not understand the strategy at all. Since Sweden is posing no restrictions at all (no masks, all open, no green passes etc) the only way to pass through winter without clogging the hospitals is relying on people getting tested at the first symptoms, albeit tiny. The virus is on, let it free and will grow exponentially as we all know. Once more, we are in the hands of Tegnell, he just want to variolize the population, which is quite a dodgy move: he will infect AGAIN the weak ones, and will run the risk of creating a variant. To make it clearer, few days ago I fall sick, a bad cold. I check the page of the FHM and I do as requested, avoid meeting people, test myself. So what is the newindication of the FHM? just go to work and potentially infect your colleagues? For some people Tegnell is a genius, I can’t agree with that.

      1. I totally agree with you that this new policy of not allowing testing except in special circumstances is ill advised. While Sweden may have less infections AT THE MOMENT these are surely going to rise. Everyone should continue to be able to be tested as soon as possible in order to avoid a massive 4th wave! I have a young child who is showing symptoms and because they have made 1177 regional it is even harder to get information about testing for kids. Every region seems to be doing something different. I fear these policy decisions will have extremely negative consequences in the very near future.

  2. It’s quite ridiculous how the local repeats the fairy tale of “lowest rates of infection in Europe” in this article, which basically describes how the official numbers are kept low by simply testing as few people as possible.

    For the record, I flew out of Sweden 9 days ago, developed symptoms a few days later. Luckily where I am now i got a free test (positive, fully vaccinated), so I am aware of my condition and deal with it responsibly. In Sweden I would not have known without paying, which hardly anyone will do.

  3. I think a very decision. Looking at the figures all over Europe we had and have a test Pandemic. Look at Germany best for that.
    Further consider we have in Europe meanwhile over 2,8 million serious vaccination side effects, 30000 deaths, 35000 side effects non recovering, still over 600.000 hospitalisations anfd 700.000 with unknown status. Side effects are rising dramatically since start of the vaccination campaign for under 65 years. In Europe we have meanwhile 23000 serious sideeffects in the agegroup under 17 and in austria alone 52 kids died by the vaccine. I can only support every measure like that bringing back reasoning in the discussion

    1. Hi, could you please say where did you find your numbers? They are quite interesting, but I would like to cross check your statements. Note: Europe (without the UK) is 450M people, so your quote is 67 deaths per million people, more or less. Very unpleasant if true, but where would we be without vaccines. In Italy 130K casualties over 60M, makes 2100 deaths per million, in Sweden roughly 1400 per million. And the virus also has terrible side effects. Second, yes there are a lot of hospitalizations yet, 70% to 80% related to unvaccinated people, this is what hospitals say. Third: vaccinated people do get infected, but the risk of ICU treatment or death is dramatically reduced. Tegnell’s penny-wise pound-foolish alternative, is letting people getting sick hoping in a natural “herd” immunity. I cannot celebrate the “genius” of this man, nor the total ineptitude of a government that keeps failing in getting hold of the situation. I praise the Swedish miracle, possibly due to a combination of natural distancing, respect of rules (well … bit disappointing sometimes, like in planes where even cabin attendants removed their masks despite clear signs), good job protection system so maybe, people can stay home at early signs, whereas in other country some categories need to work to provide for their family, and doing so exposed the community to contagion. I praise this miracle, but it costed many lives compared to our neighbours, the Danes, who chose a more determined protection of the population. Oh yes, they were old, or had some conditions … so OK, only the fittest have right to survive. This was a shock to me, to be fair. But anyway, miracles don’t last for long. The virus exists, it propagates exponentially, if people congregates with no masks there is no chance: it goes under track for a while and then it surfaces, like mushrooms in the woods. If you don’t test you simply do the Trump job, do not inform, do not scare. Deeply unfair, and disappointing. The only defense we had was informing and testing, and this guy wants to save few kronor from tests and vaccinations. By the way, the vaccination program is not particularly good here, despite what people believe. Check on and you can have a fair comparison between countries in the EU for example: it emerges that Portugal and Spain have immunized more than 80% of the population, Denmark 76%, Italy 73%, Sweden 69% and Germany 67%. My Cassandra prophecy, and I hope to be WRONG, is that this could be a very bad winter.

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Covid deaths in Sweden ‘set to rise in coming weeks’

The Public Health Agency of Sweden has warned that the number of weekly Covid deaths is set to rise, after the number of people testing positive for the virus rose for the sixth week running.

Covid deaths in Sweden 'set to rise in coming weeks'

According to the agency, an average of 27 people have died with or from the virus a week over the past three weeks. 

“According to our analyses, the number who died in week 27 (July 4th-July 11th), is more than died in week 26 and we expect this to continue to grow,” the agency wrote in a report issued on Thursday. 

In the week ending July 17th (week 28), 4,700 new cases of Covid-19 were registered, a 22 percent rise on the previous week. 

“We are seeing rising infection levels of Covid-19 which means that there will be more people admitted to hospital, and even more who die with Covid-19,”  said Anneli Carlander, a unit chief at the agency. “The levels we are seeing now are higher than they were last summer, but we haven’t reached the same level we saw last winter when omicron was spreading for the first time.” 

While 27 deaths a week with for from Covid-19 is a rise on the low levels seen this spring, it is well below the peak death rate Sweden saw in April 2020, when more than 100 people were dying a day. 

The number of Covid deaths recorded each week this summer. Source. Public Health Agency of Sweden
A graph of Covid deaths per day since the start of the pandemic shows that the current death rate, while alarming, remains low. Photo: Public Health Agency of Sweden

Carlander said that cases were rising among those in sheltered accommodation for the elderly, and also elderly people given support in their own homes, groups which are recommended to get tested for the virus if they display symptoms. The infection rate among those given support in their homes has risen 40 percent on last week. 

This week there were also 12 new patients admitted to intensive care units with Covid-19 in Sweden’s hospitals.  

The increase has come due to the new BA.5 variant of omicron, which is better able to infect people who have been vaccinated or already fallen ill with Covid-19. Vaccination or a past infection does, however, give protection against serious illness and death.