The crisis in Sweden’s care homes

Sweden’s refusal to embrace lockdown measures used elsewhere to deal with the threat of coronavirus hasn’t led to the steep spike in deaths and intensive care patients that some feared. Our death toll is, at the time of writing, close to 2,020 – and the rate of infections is slowly declining. The number of patients in intensive care has flatlined and the number of new patients in critical care has gone down sharply in the past week. If this development continues, Sweden will end up very far away from frightening estimates suggesting 80-90,000 people could die before the summer. The situation at our hospitals will be stressed, but under control. Sweden will then exit the pandemic with a tolerable death toll. Unlike other countries, it will have managed the pandemic without harming civil liberties and wrecking our economy.

However Sweden and its authorities do deserve some criticism. And the verdict is already clear on one major part of our policy: the failure to protect elderly people living in nursing homes. The death toll among nursing home residents in Stockholm is appallingly high, and the pandemic has finally laid bare how careless Sweden has been for a long time in protecting this most vulnerable group from infections.

Even if most of the nursing homes have been closed for visitors since early March, more than half of the homes in Stockholm have at least one infected resident. The mortality rate speaks for itself: forty per cent of those in Stockholm who have died and tested positive for Covid-19 were residents at nursing homes.

This is an alarmingly high proportion. But the sad reality is even more shocking: Sweden’s nursing homes have for a long time been dangerous places for their residents during the flu season. If previous years are anything to go by, the number of nursing-home deaths will continue to rise.

I know this all too well as relatives, including my grandfather, who was especially dear to me, have passed away in a nursing home over the last few years. And it wasn’t just him. Other residents in the same corridor where he lived died around the same time: all of them suffered badly because the flu had caused pneumonia. Just like the Covid-19 casualties today, they had severe breathing problems in their final days and hours.

Cynically, Sweden has generally accepted a high number of flu-related deaths at our nursing homes and too little has been done to improve the protection of residents during the winter months. Since most of the residents are very old and frail, many don’t get the annual flu shot. Most of these homes have no organisation and little capacity to deal with virus outbreaks. Staff have no access to personal protective equipment (PPE), and even when they do get advanced equipment few have been trained in how to use it.

Ultimately this has a strong impact on Sweden’s Covid-19 death toll. A disproportionally high number of older people live in nursing homes in Sweden. The country’s has about 12,150 nursing home beds per million citizens compared to 7,800 in Norway. Each nursing home also has more residents. A virus that is spread in a Swedish nursing home will kill more people than in a Norwegian home.

Would the situation at our nursing homes have been different if Sweden had locked down its society like the rest of Europe did? It’s impossible to say. But it is a difficult argument to make. 

First, Sweden isn’t alone: many countries have experienced high numbers of nursing home deaths, even if they opted for full lockdowns. Belgium, for example, started their full and country-wide lockdown on 18 March and have so far had about 2,100 reported Covid-19 deaths by residents in nursing homes. Britain has similar problems. The National Care Forum has estimated that the number of residents in nursing homes that have died with Covid-19 is about 4,000. Care England puts the number even higher: 7,500.

Second, it is very likely that nursing home fatalities have to a large degree been infected by staff members that have spread the virus without knowing they were infected. Just as in hospitals, care workers at nursing homes need adequate PPE that protects themselves and the residents, but there has been an acute shortage of masks, gowns and other equipment needed to make the nursing home safer. A lockdown wouldn’t have produced a better supply of PPE.

Lastly, if schools had closed, many more of those working at nursing homes would have had to stay at home to take care of their children. Just as in Britain, there has been severe staffing problems at nursing homes in Sweden because people have stayed at home when they have felt sick. A lockdown would therefore have required more temp staff to fill shortages, and they usually have less training in virus control that full-time staff.

Sweden has experienced significant excess mortality during the difficult influenza seasons in the past years, and it’s among the oldest people that the death rate is particularly above trend. So the Covid-19 mortality rate isn’t just a reflection of the virus being far stronger than the seasonal flu: it’s an endemic problem in Swedish elderly care that nursing homes become a death zone during the winter months.