Comment by cjblomqvist | Hacker News Reader

Comment by cjblomqvist | Hacker News Reader

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I don't know what you've read or what sources you have. I'm a swede and have been following the Corona situation relatively closely (looking at facts and not media hysteria too much). My parents are retired health care professionals. My sister-in-law works at FHM. I've been in contact with hospitals and health services quite a bit the last year (my wife's grandma died due to cancer, I had a child that was born at one of the largest hospitals in Sweden). At times, the situation has been hard for health workers, having to work more than normal (sadly, the personnel situation was a big problem even before COVID, it just tipped it across the border). But to say that the Swedish health system collapsed is a lie (or at least back it up with data/some facts/sources).

I do agree though it'll be interesting to see what the cause for the relatively high amount of excessive deaths was (not bigger than many other western countries, such as Belgium or the US), but still. I'm not saying the Swedish approach was the best one (or even a good one), but let's not spread misinformation. Sweden is so much misused in this debate (on both sides) and that scares the me the most.

On that note, several really bad/horrible incidents in the spring where health care workers did strict prioritizations was due to media and mass hysteria - NOT because of health system collapse... Misinformation is really dangerous - life and death dangerous...

I guess it all depends on your definition of "collapse". I would describe a situation where hospitals are overloaded to the point where they have to choose who gets to live and who has to die a collapse.

Sources in English are harder to come by about this, but for example in spring when Stockholm's ICU beds were at full capacity it is implicit that people with better prognosis had to be prioritized. Seniors with severe cases of corona were instead given morphine and sent to die in care homes:

https://www.svt.se/nyheter/lokalt/stockholm/skarp-kritik-eft...

Nothing like this happened in Sweden's neighboring countries with more cautious COVID approach because ICU beds so far never reached full capacity. In a modern Nordic welfare state denying a dying person of care that could save their life is not only a complete failure of the health care system but also a crisis of moral values. I am not sure the Swedish public is yet ready to even admit the latter crisis.

Your source doesn't say the same thing you do (unless I'm missing something). The article talks about the problems at care homes. Aside from a few hospitals, we never maxed our ICU beds (AFAIK anyway). The "implicit" makes it really hard to argue without any source. Most likely you're referring to what I specifically brought up in my original comment. Some were not treated properly and sent home because of hysteria - not because of a national health care "collapse".

Did care homes in Sweden (which are separately organized from the rest of the health care system) manage COVID well? Probably not. Did some people panic and made they stupid decisions? Probably.

Did we dismantle some temporary ICUs without using them? Yes. Did we reach max ICU bed capacity in any region (the Swedish health care system is organized by regions)? Not that I know. Did we have a national health care collapse? Not as far as I can see. If we did, please provide sources.

Sure, you can say that ICU bed limit was never actually reached, because you prioritized.

From the very beginning of the epidemic it has been clear a person with serious case of corona would go to an ICU and put on a ventilator for the best treatment. Hospitals instead told care homes in Stockholm not to send seniors with severe corona in at all:

> Now, increasing numbers of workers are also coming forward to criticise regional healthcare authorities for protocols which they say discourage care home workers from sending residents into hospital [...]

> "They told us that we shouldn't send anyone to the hospital, even if they may be 65 and have many years to live. We were told not to send them in," says nurse who worked in several care homes around Gävle, north of Stockholm, at the beginning of the pandemic.

https://www.bbc.com/news/world-europe-52704836

You need to look up what the word "collapse" means.

What you actually meant was "got a bit busier".

Like the GP says, "overloaded to the point where treatable patients are given morphine and sent back to die" means "collapse" in my book.

There is an ongoing investigation of the COVID response.

https://coronakommissionen.com/

https://coronakommissionen.com/wp-content/uploads/2020/12/su...

> The Health and Social Care Inspectorate has shown that there was a marked reduction in the number of referrals to hospitals from residential care facilities for the older people during February–June 2020. However, it is hard to establish whether this type of guidelines led to physicians failing to make individual assessments of care need

So I gather that even if the health care system was never overloaded, there might have been some confusion in the elderly care that led to mistakes.

But to the extent the elderly care system was “overloaded” this has been the case for decades. Not due due to the COVID response.

> We have found that elderly care was unprepared and ill-equipped when the pandemic struck and that this was founded in structural shortcomings that were known long before the outbreak of the virus. The ultimate responsibility for these shortcomings rests with the Government in power – and with the previous governments that also possessed this information

Thanks for providing sources! (which nobody else, me included, couldn't)

> From the very beginning of the epidemic it has been clear a person with serious case of corona would go to an ICU and put on a ventilator for the best treatment.

At the beginning of the pandemic, people thought this. As I understand it, it is actually preferable to keep patients off of ventilators as much as possible.

It is certainly not the case that, if you show up at a hospital and the hospital has unlimited resources, then you should be put on a ventilator because it’s somehow good for you.

I'm not sure I should wade into this, because I think swedish authorities need a lot of scrutiny and they have mismanaged the response, and refuse to accept accountability for this. I would direct this scrutiny towards the health authority and the political administration.

Anyway:

> I guess it all depends on your definition of "collapse". I would describe a situation where hospitals are overloaded to the point where they have to choose who gets to live and who has to die a collapse.

Triaging patients and prioritizing them is every day in a hospital, corona or not. If you talk with a Swedish doctor (I do, because that's the health service I use), they often think in terms of which medicines are cost-effective and for which group of patients they should be used (basically - what is the human basis for using this expensive medication on this particular patient). To make it concrete, maybe they will even tell you that you are a "priority" because you have a long working life ahead of you.

Medicine and care can be infinitely expensive and public health care is a finite resource. They always calibrate towards giving patients adequate care, not infinite care.

You're right, but there's a difference between "it's not worth spending millions on an operation to slightly improve an unimportant part of someone's little finger" and "I have two people who will die if I can't treat them, and due to limited staff/hospital space one of them isn't being sent for treatment".

So yes, it's not binary between normally being infinate and now not, but it's also a bit too reductive to make that point without also being clear that Covid has caused more and worse triaging than usual. (But someone needed to make your portion of that point and you did it much better than I could have, so thanks!)

I don't think semantic debates are very worthwhile, but in my mind a system that collapses is completely non-functional, not partially non-functional.

A system that is choosing which patients to treat is therefor not collapsed.

Similarly, a bridge that has collapsed transports zero traffic - not 50% of the traffic.

But again, venturing into these semantic debates isn't useful. People choose hyperbolic words in order to justify their preconceived conclusions. The hyperbolic adjectives themselves aren't the point of OP above.

You would expect Sweden to do roughly as well as its Scandinavian neighbors, not to perform roughly an order of magnitude worse. I’d say ‘collapse’ describes it well.

I am curious about a thing I read about Sweden, and would be interesting to hear your thoughts on this as a Swede: is it true that nursing home inhabitants per default (and regardless of a pandemic) do not get ICU level care anyway?

In Germany, you typically get 100% care unless you have specified that you do not want it (or your relatives make this difficult call). So the triage threat has been described by doctors as something along the lines of "we would effectively no longer try to treat a 90 year old nursing home patient with severe dementia in our ICU"

> is it true that nursing home inhabitants per default (and regardless of a pandemic) do not get ICU level care anyway?

No

All Swedes have the right to the best possible care based on the individuals needs

In coordination with the patient and/or next of kind it’s possible to take decisions to exclude life preserving care if it is determined to be in the best interest for the individual

It is never up to the care giver to take such decisions

> is it true that nursing home inhabitants per default (and regardless of a pandemic) do not get ICU level care anyway?

That's the case here in Spain for at least some of the oldest patients. Anaesthetizing someone frail and putting a ventilator down their throat stresses the system a lot, so isn't worth the risk - according to a doctor I know who was on the front lines. It sounded like standard medical practice (and she has worked in other countries).

There's a bit of a difference though between "all nursing home patients" and "the exceedingly frail ones". This might vary between countries to, as people in some countries might get put in nursing homes sooner than others.

Belgium overcounts deaths due to covid-19.

( = They don't test suspected cases, but attribute it to covid)

As a fellow Belgian: while that statement is true, even if you would substract the overcounting, Belgium would not really budge in the rankings.

I'm not saying Belgium is doing pretty well, but it's a big factor to take into consideration.

If you want to compare with the US both that and population density have to be taken into account.

Not sure why I'm getting downvotes though. A lot of people don't know about this and saying this 5 months ago actually received upvotes because it informs people about it. I'm 100% sure the op didn't knew.

Something really changed in the last months.

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