COVID-19 and the Swedish enigma.
COVID-19 and the Swedish enigma.
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DOI：
10.1016/s0140-6736(20)32750-1
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发表时间：
2021-01-23
期刊：
影响因子：
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通讯作者：
Hanson S
中科院分区：
文献类型：
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作者：
Claeson M;Hanson S
在COVID-19大流行的第二波中，瑞典的国家反应仍然是一个异常值，病例和死亡人数的增长速度比其北欧邻国更快。1，2于2020年12月20日，瑞典的COVID-19死亡人数已超过8000人，即每100万人口中有787人死亡，是邻国的4. 5至10倍。1-3北欧国家之间的这种差异不能仅仅用民族文化、历史、人口规模和密度、移民模式、病毒首次传入的途径或病例和死亡报告方式的差异来解释。相反，这个谜团的答案可以在瑞典的国家COVID-19战略中找到，它所基于的假设，以及卫生系统的治理，使战略能够在没有重大路线修正的情况下继续下去。从COVID-19大流行开始，公共卫生署Folkhälsomyndigheten（FHM）就开始了事实上的群体免疫方法，使得社区传播相对不受控制。4没有采取强制性措施限制公共交通工具，购物中心或其他拥挤场所的人群，但建议自2020年3月29日起将集会人数限制为50人。世卫组织建议的冠状病毒检测、接触者追踪、来源识别和报告6有限，仍然不足。7我们认为，在国家战略中仍然没有充分认识到症状前和无症状传播、气溶胶传播8、9和使用口罩的重要性。9、10最近，护理院和医疗机构引入了口罩（2020年11月11日，斯德哥尔摩）11，并将从2021年1月7日起建议“在特定时间乘坐公共交通工具”。12其他增量干预措施正在引入，例如将禁止销售酒精的禁令从2200 h（2020年11月11日引入）改为2000 h从2020年12月24日，12，13建议进一步限制聚会的规模，并敦促人们承担个人责任，并在出现症状时留在家中。12
In the second wave of the COVID-19 pandemic, the Swedish national response continues to be an outlier with cases and deaths increasing more rapidly than in its Nordic neighbours. 1, 2 On Dec 20, 2020, COVID-19 deaths in Sweden had reached more than 8000 3 or 787 deaths per 1 million population, which is 4· 5 to ten times higher than its neighbours. 1–3 This difference between Nordic countries cannot be explained merely by variations in national cultures, histories, population sizes and densities, immigration patterns, the routes by which the virus was first introduced, or how cases and deaths are reported. Instead, the answers to this enigma are to be found in the Swedish national COVID-19 strategy, the assumptions on which it is based, and in the governance of the health system that has enabled the strategy to continue without major course corrections.From the onset of the COVID-19 pandemic, the Public Health Agency, Folkhälsomyndigheten (FHM), embarked on a de-facto herd immunity approach, allowing community transmission to occur relatively unchecked. 4 No mandatory measures were taken to limit crowds on public transport, in shopping malls, or in other crowded places, while recommending a limit of 50 people for gatherings 5 as of March 29, 2020. Coronavirus testing, contact tracing, source identification, and reporting, as recommended by WHO, 6 were limited and remain inadequate. 7 In our view, there is still not sufficient recognition in the national strategy of the importance of presymptomatic and asymptomatic transmission, aerosol transmission, 8, 9 and use of face masks. 9, 10 Recently, face masks were introduced in care homes and health-care facilities (Nov 11, 2020, in Stockholm) 11 and will be recommended “on public transport at certain times” from Jan 7, 2021. 12 Other incremental interventions are being introduced, such as changing a ban on the sale of alcohol from 2200 h (introduced on Nov 11, 2020) to 2000 h from Dec 24, 2020, 12, 13 recommending further limit on the size of gathering, and urging people to take individual responsibility and stay at home when they have symptoms. 12