Policy responses for Sweden - HSRM

Sweden


Policy responses for Sweden

3.2 Managing cases

The most imminent challenge within hospitals is not insufficient beds nor materials but the lack of staff with adequate competence. The situation has worsened due to reductions in workforce numbers resulting from both staff resigning due to the high care burden and those becoming ill from COVID-19. On January 7th 2021, the agreement regarding crises was activated in seven regions to handle the shortfall of staff, particularly in intermediate care and intensive care.

In Stockholm, a number of private caregivers have relieved the burden on the public hospitals by contributing with their capacity and competence. During certain periods, one of the big private hospitals in Stockholm (Capio S:t Görans Sjukhus) treated up to 20% of Stockholm’s COVID-19 patients.

To prevent COVID-19 patients from overwhelming hospitals, the number of beds (vårdplatser) has been increased partly by rearranging facilities. In some regions, nursing wards (vårdavdelningar) and facilities previously used for other purposes have been converted to COVID wards. In Region Skåne, certain cohort wards for COVID-19 patients have been arranged.

Sources:
https://skr.se/tjanster/merfranskr/bloggarfranskr/arbetsgivarbloggen/artiklar/krislagesavtaletaktiveratisjuregioner.36272.html
https://sverigesradio.se/artikel/7625272
https://skr.se/tjanster/merfranskr/bloggarfranskr/arbetsgivarbloggen/artiklar/krislagesavtaletaktiveratisjuregioner.36272.html
https://www.vardforetagarna.se/2021/01/privata-vardgivare-staller-om-och-avlastar-akutsjukhusen/
https://www.krisinformation.se/en/hazards-and-risks/disasters-and-incidents/2020/official-information-on-the-new-coronavirus/regional-information-about-coronavirus/old-news-from-the-regions
https://www.mynewsdesk.com/se/region_skane/pressreleases/systematisk-utoekning-av-vaardplatser-i-hela-region-skaane-3063634

Understanding and treating Long-COVID

On July 17th 2020, the Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) is tasked to compile and assess scientific evidence of Long-COVID through a systematic review. This includes research on care, treatment and rehabilitation of patients with long-term symptoms of COVID-19. International data and experiences shall be taken into account and the work be performed in close dialog with National Board of Health and Welfare and other relevant agencies.

On September 8th, the National Board of Health and Welfare is tasked to develop a process model for rehabilitation of patients with complications after COVID-19. 
On January 11th 2021, the government allocated SEK 50 million to the Swedish Research Council to research the long-term effects of coronavirus (Long-COVID). Many patients, among them children, have been experiencing lingering symptoms after COVID-19. Much is still unknown about what causes long hauler symptoms.

On February 5th, the National Board of Health and Welfare is tasked to develop a support tool to assist health care providers in managing patients with Long-COVID. This support will provide overall guidance for how the health care system can identify the condition and plan the health care process, e.g. involve the appropriate professions and allocate enough resources. This support will be updated gradually as more research is available.

On March 4th, the Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) is tasked to continuously evaluate and spread knowledge of treatment and rehabilitation of patients with Long-Covid.

LongCovid Sources:
https://www.regeringen.se/regeringsuppdrag/2020/07/uppdrag-att-utvardera-det-vetenskapliga-stodet-avseende-vard-av-patienter-med-langvariga-symptom-av-sjukdomen-covid-19/
https://www.regeringen.se/regeringsuppdrag/2020/09/uppdrag-att-ta-fram-en-processmodell-for-rehabiliteringsinsatser-for-patienter-med-langvariga-komplikationer-efter-covid-19/
https://www.regeringen.se/pressmeddelanden/2021/01/regeringen-satsar-50-miljoner-kronor-pa-forskning-om-langtidscovid/
https://www.regeringen.se/pressmeddelanden/2021/02/stod-till-varden-for-hantering-av-personer-med-langvariga-symptom-efter-covid-19-infektion/
https://www.regeringen.se/pressmeddelanden/2021/03/oversyn-av-langvariga-effekter-av-covid-19/

Patients with mild symptoms do not need to seek medical advice and should stay at home. If the patient’s condition has significantly worsened or they are experiencing breathing difficulties even when at rest, the advice is to contact a health centre or to call the health care advice line 1177 where a nurse will guide them to the appropriate care at the appropriate place. Patients are asked not to go to a health centre or hospital without calling in advance.

For general questions about COVID-19, there is a national telephone number for information on 113 13.

On March 20th, the National Board of Health and Welfare provided instructions for on-site triage of patients arriving to a hospital’s emergency room on their own. Triage should be conducted outside of a tent built outside the emergency room. Patients with no symptoms of COVID-19 are then sent to the emergency room, while patients with symptoms are further examined in the tent. The National Board of Health and Welfare also issued a document about triage and working procedures for health centres on April 7th.

The Swedish participation in two phase III clinical trials with remdesivir (as an experimental drug for patients seriously ill with the COVID-19) started at the beginning of April after permission from the Swedish Medical Products Agency in March. Remdesivir was then approved for treatment of COVID-19 patients by the EMA on June 25.

Two more clinical trials have started since the beginning of the pandemic: one to explore the safety and efficacy of hyperbaric oxygen for preventing ICU admission, morbidity and mortality in adult patients with COVID-19, and one studying inhaled nitric oxide gas therapy in mechanically ventilated patients with severe acute respiratory syndrome in COVID-19. A drug used for cystic fibrosis is now being tested on COVID-19 patients at an infection clinic in Lund. Fifty patients will receive the drug and another 50 a placebo. Treatment with chloroquine is only permitted within clinical trials.
There are no reports on rationing care for COVID-19 patients. On March 26th, the National Board of Health and Welfare issued a document on principles for prioritization in intensive care under extraordinary circumstances.

Sources:
https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/dokument-webb/ovrigt/nationella-prioriteringar-intensivarden.pdf 
https://www.1177.se/Stockholm/sa-fungerar-varden/varden-i-stockholms-lan/om-corona/covid-19--coronavirus-nat 


https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/dokument-webb/kunskapsstod/covid19-yttre-triage-for-gaende-patienter-akutmottagning-instruktion.pdf 

https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/dokument-webb/ovrigt/triage-arbetssatt-vardcentral-covid19.pdf 

https://www.lakemedelsverket.se/sv/nyheter/beredskapslicens-beviljad-med-anledning-av-covid-19 

https://www.clinicaltrialsregister.eu/ctr-search/search?query=covid-19&country=se&age=adolescent&age=adult&age=children&age=elderly&
status=ongoing&phase=phase-one&phase=phase-two&phase=phase-three&phase=phase-four

https://news.ki.se/green-light-for-trial-study-on-using-blood-plasma-from-recovered-covid-19-patients?_ga=2.58076714.1836920323.1586963398-591222843.1586963398 

https://www.svt.se/nyheter/lokalt/skane/cystisk-fibros-medicin-testas-pa-covid-19-patienter

https://www.lakemedelsverket.se/sv/nyheter/klorokin-och-hydroxiklorokin-bor-endast-anvandas-for-behandling-av-patienter-med-covid-19-inom-kliniska-studier