Sweden coronavirus press conference, April 14, 2020

Today it was very tense in the press conference. I never saw it like this before.

On this day, there were 1.9 million cases worldwide. They gave the numbers for Sweden, as well, but they said: there’s still probably cases stuck in the system somewhere that haven’t reached the national database. (Spoiler: I think they believed this because the reported cases in the last few days was quite low. But actually, the revised numbers from the next day’s press conference were not that different.)

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On April 14, 2020, there were 11,445 cases in total, with almost 500 reported in the last day. In total, 915 people had needed intensive care.

They also showed the number of new deaths by day, but they said that graph was afflicted by an even greater lag in reporting (the green bars show the update in deaths reported from the last day).

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Anders Tegnell, the national epidemiologist, said again that the infection curve was flattening out.

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Anders Tegnell

And Johanna Sandvall said that the medical supply situation was getting better — more availability, more stored up.

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Johanna Sandvall

And then came the questions:

Reporter: Twenty-two researchers have today released an article with strong criticisms of Sweden’s mortality rate from coronavirus, which now is about the same level as Italy’s. And the numbers from today are only making the mortality rate worse. Also, what do you think of the criticism that we don’t have a well-working, well-thought-out strategy?

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Anders Tegnell’s unamused look

Anders Tegnell: First, I want to absolutely reject the idea that we don’t have a well-working, well-thought-out strategy. That we absolutely have. Also, the mortality rate they cited was incorrect. Um. They don’t match the Swedish mortality rate that we are seeing on the figures here. Besides, in Italy are they now only reporting deaths that happen in the hospital (?). So unfortunately there are a number of inaccuracies in this article. I don’t have more comments about that.

Reporter again: And when it comes to the reporting lag in deaths … there were 114 new deaths reported late today … how many more such late-reported deaths can we expect?

Anders Tegnell: I don’t want to … if you look at the curve, you’ll see that we’ve had about 60 deaths a day recently. It’s gone up a bit from week to week. So we might go up to 65 deaths a day this week.

Reporter again: That this daily number of deaths continues to rise, what does that signify …

[Cut off by Anders Tegnell] No, no, but, no, if you look at the death data, you’ll see we don’t have an increasing curve, it’s linear (?). What I’ve said is that we’ve had a very unfortunate development in Sweden, especially compared to our neighbors, where we’ve had coronavirus infect our retirement homes. That is reflected in these figures. And we and many other agencies are working hard on this. To see what happened, and make sure it is not repeated in the rest of the country.

A new reporter [and it’s a reporter who works at the publication at which the 22 researchers published their critique!] She says: I want to continue on the same topic (you bet she does!) These 22 researchers say that if Sweden had taken stricter measures, then that would have given us some breathing room to do the preparations that now have to be done in parallel with tackling the infection. So why didn’t we decide to do that?

Anders Tegnell: Yes, well, I don’t really understand exactly what they mean. Our medical system has the whole time been able to stay one step ahead. It’s been hard, but we haven’t had a crisis. We’ve the whole time had empty rooms in the intensive care. The problem with the care for the elderly is <something something> that <something> a few weeks back. And then we can look at some countries that took very strict measures, for example, Belgium, where things are much worse than in Sweden. so there’s a lot of things to be looked at. And you should be very careful to make judgments about how well things have worked in different countries at this point, when we’re in the middle of the infection, and we’re all at different points in the developments.

A new reporter: Back to this article, the 22 researchers say that you all at the Public Health Agency are career employees (?) without talent. What do you say to that?

Anders Tegnell: Mumble mumble. OMG, I didn’t understand what he said at all. But it was short.

A new reporter: you said that you’ve done a survey to ask municipalities (?) about (?) what else concrete are you doing to support the municipalities with elderly care and home care?

Johanna Sandvall answers this: Yes, we’ve done a whole lot … I didn’t really pay attention. I’m sure it was great.

Reporter again: but have you identified where the failings in the retirement homes are happening?

Anders Tegnell: That’s what we’re looking at now. This is where we must be careful and not come to quick solutions, and think if we only give everyone a face-mask (direct translation: mouth-mask) things will get better. It’s certainly more complex than that. We’re working on this analysis with Stockholm, which has seen the worst of retirement home infections. There’s surely many different things we need to do, and we need to do better. And the most important thing is to spread the knowledge and experience to the rest of the country. We are working on getting all the information together, and then it will be the job of the retirement homes to implement (?)

A new question from a school group: We represent teachers, and we hear from teachers saying that we can’t both follow the restrictions of the Public Health Agency and do our job. They don’t feel like they’ve gotten clear answers for how they should act. They cannot separate the kids and get them to wash their hands (????)

Anders Tegnell: well, at its core, the Swedish approach relies on many different actors doing the best possible job they can. We have chosen not to have absolute, keep-your-distance rules. Instead, we try to minimize the risks as much as possible. I am convinced that there’s a lot to do in the schools, and that the schools have already done a whole lot. But these rules you mention are not absolute, and it’s kind of up to each teacher (?) to find a way that works best for them, to minimize the risks; not to take the risks completely away.

Follow-up question: What the teachers have a hard time with is, sure, the rules aren’t so strict, but … we talk about how children don’t really get infected so much, but the teachers aren’t children. They can be infected as much as anyone. So there’s some worry about that, and the teachers don’t feel like they are getting good answers.

Anders Tegnell: we’ll have to look at that, but so far we have not gotten any signals that teachers are sicker than any other group. We have coronavirus spreading throughout the country, and if we look at other places, we see that the place you most are likely to get infected in is your home, with people you stay  in very close contact with all day long, and not in other places. That’s probably also true for Sweden. And we have very little evidence of spread in schools. The few cases that popped up were when adults who were sick came in and made other adults sick. Kids weren’t involved in the transmission chain. So I don’t think — there’s no evidence that this environment is more infectious than any other.

A new reporter: The infectious disease doctor here at the island of Gotland says that he, until now, has not seen any spread of coronavirus in the retirement homes on Gotland, where they have 600 spots. They prohibited visits to retirement homes on March 12. The infectious disease doctor doesn’t say anything further, but … ? (The reporter is getting at: if all of Sweden had prohibited visits to retirement homes that early on, would less people at retirement homes have died?)

Anders Tegnell: Our signals are that for the most part, there was a more or less total stop on retirement home visits throughout Sweden from that date. It happened in some places and not others, though. We’re still looking at it, but our preliminary analysis doesn’t show that whether or not visits were prohibited was the big problem, but that other aspects needed to be strengthened instead.

New reporter: the annoying American who showed up a few weeks back: asks in English: For deaths in Sweden, if someone has not been tested for Covid-19, and they die and they were showing symptoms, what happens and who decides if there’s a post-mortem test done to find out if they had the virus or not? Or is there always a post-mortem test done?

Anders Tegnell: No. It’s always the attending physician who decides if there should be a post-mortem test. That is is always the case, not just for coronavirus. I would say that’s the same case in all countries, as far as I know. I would say we catch more deaths here than probably most other countries. We also have a system for looking back at death rates to see if there were excess deaths during a particular period. We are currently doing that, we are seeing an increase*,  but we need to calculate further to see how much it was related to coronavirus.

*a few days ago, they said the death rates seemed unchanged.

Follow-up from the American: are there guidelines for the physicians for how to determine if a test should be carried out or not? And to end up on the death toll list, do you have to test positive, or are assumptions sometimes made based on your symptoms?

Anders Tegnell: No, there are no specific guidelines. I would say the opposite. The main point is not to find the cause of death, but to stop the spread (?) so that’s mainly why … And yes you have to test positive for the virus, it’s never assumed. I would say that’s the same for all countries. In the very beginning, assumed cases were sometimes counted, but no countries are doing that now. We need all to remember that the number of people we test and catch is a small portion of all the cases we have in society. So we have to be very careful if we discuss if it should be one or two or three more (tests?) a day because that’s never going to catch anything.

A question from the old German reporter: We talked before Easter about the Swedish strategy. If you only look at the mortality rates from Germany, Norway, and Denmark, and compare to Sweden, would you still say that the Swedish strategy works? And do you have an explanation for why the mortality in Sweden is so high compared to other countries? Is it maybe because of the restrictions the other countries have?

Anders Tegnell: Ehhh, yes, at the same time if we compare to New York, which is about as big as Sweden in population* but has 10 times the death rate; or to Belgium (poor little Belgium is getting sledge-hammered here!) which also has many more deaths. And again, we have to be very careful in comparing this early in the pandemic. It can change a lot before it’s all done. For us, it’s very clear that what happened in Sweden is that the coronavirus infiltrated the retirement homes. That’s a very sensitive environment to have the infection. And you do get a lot of deaths there. I’ve looked at least at Norway and the median (or mean) age of those who are sick there is much lower than in Sweden. So I state here that it’s not the general strategy in Sweden where we’ve failed, but we have failed in our way of protecting the elderly in retirement homes.

*BUT NOT IN SIZE BY AREA AND DENSITY!!!!

German reporter again: So you think the infections in retirement homes is why the death rate is so different between Sweden and Germany?

Anders Tegnell: Yes, I don’t know if Germany has such figures, but we know that here in Sweden, about half of all the deaths among people over 70 are from those living in retirement homes, and that means that living in a retirement home is a large risk. But I don’t believe you have the same types of statistics in Germany. I don’t know, I haven’t seen them at least.

German reporter: we do have retirement homes in Germany with many cases, but another question. In Germany and Denmark they’re discussing school-openings, and they’re taking measures to keep distance between students, and having small groups in kindergartens. In Sweden, I haven’t seen as many measures, I visited a school where the kids were together as usual in the class without keeping distance, and out on the playground, they were all playing together. Do you in Sweden have some sort of experience that Denmark and Germany can use as far as infections in schools go?

Anders Tegnell: We’ll have to look at it, but we can say this much: we have very little cases among this age group. We don’t have more cases among school-children than in other countries. You might say, well, they don’t show a lot of symptoms. Sure. But so it doesn’t cause a rise in infections by having the schools open.

Question from a new reporter: how many times have you met the Prime Minister and kept him up-to-date?

Anders Tegnell: yes, my boss meets and has contact with the government many times a week.

Reporter again: how many times has he talked to the Prime Minister, do you know that?

Anders Tegnell: not exactly.

Reporter a third time: A question to Johanna Sandvall. Now that there’s many more intensive care places, does this mean that each nurse is now responsible for many more patients?

Johanna Sandvall: how the care is organized is up to every hospital. (Nice swerve)

A new reporter: you just said a while ago that no country just assumes someone died from coronavirus, a test is always carried out. But the CDC came out with a guideline in early April saying that they could count someone as a coronavirus death even without a test, if the other aspects checked out.

Anders Tegnell: says a whole long thing, but the thing I think he most enjoyed saying was this: the USA has a whole different situation, and they had problems with testing, and back in March, we did more testing in Sweden than the entire US. So that’s probably why they decided it would be okay to assume someone died of coronavirus without doing an official test. Their testing capacity was so bad.

Reporter again: does this mean that the deaths in the US will be higher than in actuality.

Anders Tegnell (enjoying himself again, I’ll wager): I don’t believe you can over-estimate the deaths in the US, they are just too high.

Whew! So that was the end of the press conference.

Then it was time for the individual interview:

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Anders Tegnell, stoic in the face of his grilling

Question: last week, we talked about how the spread was slowing down in Stockholm, but maybe picking up in other parts of the country. What can we say now?

Anders Tegnell: it’s still very low in other parts. We’ll look at it again tomorrow.

Question: you got very sharp criticism from the 22 researchers who wrote that article. What do you say?

Anders Tegnell: we also have many researchers and colleagues all over the world who are very positive about what we’re doing. I think debate is good, but it needs to be done with the correct statistics and data to take us constructively forward. I listen always to criticism, and see if they’re relevant, and if they cite sources we hadn’t seen before, or if they have figures we hadn’t seen before.

Question: and about the higher mortality rate in Sweden compared to our Nordic neighbors?

Anders Tegnell: I think there’s different reasons that explain that. First, we are on different places of the curve. Second, unfortunately in Sweden, we had a very unhappy development with the infection spreading to retirement homes, which we haven’t seen in the neighboring countries. That we must analyze further, why did the Swedish retirement homes end up like that? Third, we can compare to Nordic countries, but we can also compare to Belgium, the US, and other countries, and our death rate is lower.

Question: how certain are you that Sweden’s way is the right one?

Anders Tegnell: I am certain that we are doing the best we can the whole time, based on the assumptions we have, and that we’re working really hard on it.

Question: many countries in the EU are now lightening their lock-down restrictions. What can be the consequences?

Anders Tegnell: They are worried about precisely what we in Sweden have tried to avoid, that you suddenly would get a sudden spike in cases as soon as you lighten very strict lockdowns that quite simply cannot be maintained any longer. It’s not that the infection has been reduced, it’s that you simply of economic reasons cannot keep the lockdown going. Here in Sweden, we have a very sustainable strategy compared to other countries.

Question: The EU chief said over the weekend that the elderly might need to continue to be isolated for the rest of the year, at least until we get a vaccine. Do you share that prediction?

Anders Tegnell: it’s hard to say. I think it will be different in different countries, based on the developments. There’s absolutely signals that we have to be much better at protecting our elderly.

Question: when will we know what’s gone wrong at our retirement homes?

Anders Tegnell: we’re still finding out, it’s complicated on many levels. But I think there’s many things in retirement homes that can be changed, tweaked, etc, to reduce the risks.

 

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