1189:  Minutes of Virtual Meeting of CMAAO NMAs on “An interaction with WMA President-elect on Sweden model for COVID-19”

5^th December, 2020, Saturday, 9.30am-10.30am

Participants: Member NMAs: Dr KK Aggarwal, President CMAAO; Dr Yeh Woei Chong, Singapore Chair CMAAO; Dr Alvin Yee-Shing Chan, Hong Kong, Treasurer, CMAAO; Dr Marthanda Pillai, India, Member World Medical Council; Dr Ravi Naidu, Malaysia Medical Association; Dr Marie Uzawa Urabe, Japan Medical Association; Dr Md Jamaluddin Chowdhury, Bangladesh Medical Association; Dr SM Qaisar Sajjad, Secretary General, Pakistan Medical Association

Invitees: Dr Russell D’Souza, Australia UNESCO Chair in Bioethics, Dr Suresh Mittal, Dr S Sharma, Editor IJCP Group, Dr Meenakshi B Soni

Key points from the discussion

Video of an interaction between Dr KK Aggarwal, President CMAAO with Dr Heidi Stensmyren, President-elect World Medical Association, was shared today at the meeting.

• Sweden is a fairly big country with a small population of 10.2 million. The number of COVID-19 deaths is 6972 (2.12.20); the incidence of cases is 613 per 100,000 population, which is 6-7 times of that in the neighboring countries.
• Some of the lessons learned in the process of management of COVID-19 in Sweden are that testing and contact tracing is important – Sweden did not scale up testing fast enough; regional restrictions are important; prevent spread to the elderly and high-risk groups; physicians and healthcare workers are essential and increased national governance for healthcare is needed. There are 21 different healthcare systems, who are not working in coordination.
• Sweden managed to bring down the R number after 58 days, while this was 30-34 days (average) in Europe.
• Improved care (early use of anticoagulant and steroids) has reduced hospital mortality by around 50%.
• Sweden faced initial challenges: Reduction in civil emergency stocks (lack of PPE, ventilators, medicines), low number of ICU beds (5.8 per 100,000 population), lack of testing capacity, regional self governance (21 different healthcare systems with their own guidelines and their own decision on scaling up testing), shortage of doctors in elderly care in municipalities. Sweden has low rate of family doctors.
• The government cannot declare a state of emergency in peacetime; restrictions are implemented as official recommendations and include those that could be endured for a long period of time. Also, Sweden tried to balance the needs of public health and social economy. Primary schools were not closed, while universities were closed.
• Herd immunity is not part of the official strategy.
• During the first wave, tracking, tracing and diagnosis were late. People were already in the ICU and deaths came before the country had testing capacity. The waiting time for testing is 4 days.
• The pandemic spread to elderly care homes, which accounted for 50% of all the deaths in Sweden. The number of ICU beds was very few, although this has been successfully rapidly increased. There were lot of cancelled surgeries along with a major backlog of treatments. There has been increase in digital healthcare. There is reduced inflow of patients to primary care and emergency care. Increasing number of cases of fatigue, heart problems, and respiratory problems, which is a cause for worry.
• In Sweden, no testing is required in children below 6 years of age; in children aged 6-12 years, testing is optional, while children older than 12 years are tested.
• Masking is not mandated in Sweden.
• The cases are increasing in winter season with flu coming in. There were fewer cases in the summer.
• Sweden is still far behind in terms of testing and testing turnaround time.
• Some lessons derived from COVID-19 experience in Sweden: It is important to protect the elderly. Elderly and the high-risk persons should not be segregated in one area as mortality is very high and the symptomatic cases should be isolated.
• Sweden relied on individual responsibility, which fell short.

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA