Half of the nearly 6,000 COVID deaths in Sweden have been in care home residents.
A few months ago, Sweden’s chief COVID policy architect, Anders Tegnell, was interviewed about the number of Swedes in care homes who died from COVID. His official title is Chief Epidemiologist of Sweden’s Public Health Agency. When asked about the deaths in the Swedish care homes, he responded, “You have to remember these people are very old and extremely ill and normally you don’t move these kinds of people from their homes to hospital care.” I wondered about that statement, so I looked around more.
In a separate report, a nurse who works in a care home was quoted, “They told us that we shouldn’t send anyone to the hospital, even if they may be 65 and have many years to live. We were told not to send them in,” says Latifa Löfvenberg, a nurse who worked in several care homes around Gävle, north of Stockholm, at the beginning of the pandemic. “Some can have a lot of years left to live with loved ones, but they don’t have the chance… because they never make it to the hospital,” she says. “They suffocate to death. And it’s a lot of panic and it’s very hard to just stand by and watch.”
Other Swedish officials have been asked about this. Officials from the National Board of Health and Welfare said that, “Decisions about healthcare staffing and resources are taken at a regional level in Sweden, although national guidelines suggest that elderly patients, whether in state or privately run care homes, should not automatically be taken to hospital for treatment.” The report goes on to state that even oxygen therapy may not be provided in care homes and that care home “workers should ‘professionally weigh the potential benefits’ against risk factors such as catching the virus in hospital and the ‘costs’ of transporting patients, including the likelihood of disorientation and discomfort.”
Another analysis found that “[Swedish} hospitals did not become as overwhelmed as those in northern Italy or New York City, but that was in part because many severely ill patients weren’t hospitalized. A March 17 directive to Stockholm area hospitals stated patients older than 80 or with a body mass index above 40 should not be admitted to intensive care, because they were less likely to recover. Most nursing homes were not equipped to administer oxygen, so many residents instead received morphine to alleviate their suffering.”
Anecdotes can be powerful in shaping public opinion, such as the stories of angry and frustrated care home workers and families of the residents who were not allowed to see their loved ones as they were given morphine for comfort and died alone. But how many elderly Swedes actually died in their care homes without ever stepping foot in a hospital? A report from the National Board of Health and Welfare calculated that only 13% of care home residents with COVID were sent to the hospital.
As our national election/slash debate includes another round of promises about the healthcare system by the politicians, the tired old dichotomy of a free market vs. “socialist” system has re-emerged, with a heaping side serving of pre-existing conditions. No candidate for either party that I’m aware of has demonstrated any understanding that countries with much more affordable and successful healthcare systems have learned how to make difficult choices about spreading their systems equitably, but also understanding that they must set limits. The healthcare systems can’t have everything they want either.
The current Swedish reality in the midst of the European COVID resurgence is that there is an increase in reported cases in Sweden that is much less severe than surrounding countries, with very few reported deaths. Agree with the Swedish COVID approach or not (or something in the middle), they must be recognized and respected for being willing to make difficult rationing decisions. The final scorecard about the success or failure of any country’s COVID response is several years away.
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