From Deborah, Oct.8, 2021

infections and deaths in people 70 and older

1. There has been a steady increase in infections and deaths in care homes for people 70+, graph attached. From a recent article: “the number of vaccinated people dying with covid-19 in Sweden is increasing. Between 1–24 September, seven out of ten of the covid-related deaths were people vaccinated with two doses, according to figures from the Swedish Public Health Agency. The median age of the fully vaccinated who have died since 1 July is 86 years old.” This is why you are seeing an increase in deaths while hospitalisations are decreasing - this group tends to receive care in place and not be moved. Also, this seems to be a care home issue, infection rates were lower among older people being cared for at home. Much of yesterday’s press conference was taken up discussing these two main areas:

1) boosters – the Public Health Agency is still hesitating, saying the scale of the problem doesn’t warrant them yet, and

2) unvaccinated care workers, who legally can’t be forced to be vaccinated. The Public Health Agency has been clear that they consider this a labour issue and they don’t press too hard here – encouraging vaccination but also saying that employers need to work with their employees to find solutions.

There is no suggestion that deaths are occurring in younger age groups. The relative increase in younger people in hospital during the delta wave was explained several press conferences ago this way: this is the group with the lowest vaccination rates + delta is a more transmissible variant + this group has more social contact. So not more virulent for this group per se, just a numbers game, more people infected and fewer vaccinated in this age cohort.

ICU numbers, patients with and without covid

2. They have really dialled back the rhetoric about vaccinated vs unvaccinated in hospital, so no data, nor discussion about this.

Hospitalisations and ICU continue to drop to low levels so it is a difficult argument to make - “the terrible unvaccinated clogging up the system! Oh wait…” - There are currently only 31 covid patients in ICU out of about 400 occupied ICU beds (less than 10%). There are 207 covid hospitalisations outside of ICU. Graph attached – the pale blue line are covid patients, dark blue other ICU patients. The only time the unvaccinated get mentioned these days is with respect to 1) care workers, and 2) recommendations to unvaccinated to avoid contact with vulnerable people.

3. Vaccination rates are high, graph attached. Orange is “at least one dose” and grey is “unvaccinated”, interesting that they haven’t broken it down into “one dose” and “fully-vaccinated”, like they did before. The Public Health Agency have previously expressed concern that many who had one dose, haven’t returned for their second dose.

vaccinated vs. unvaccinated, by age category

There have been no domestic vaccine mandates in Sweden, there was some political momentum for them, and then the Public Health Agency outmaneuvered the politicians by taking away all covid restrictions and recommendations, making domestic vaccine passports completely out of sync with other government messaging (the virus is endemic, time to get on with life, etc).

Fyi, Tegnell says he is very confident there will not be another significant surge this winter. I think of this as I follow the Canadian vaccine mandate & passport debate: how can they continue to justify these measures as covid cases continue to decrease?

4. No discussion, not a peep, about 5-11 year olds. We are still digesting the idea that 12-15 year olds will be offered the vax later this fall, which has been controversial here, as elsewhere. Kids 5-11 have been in school, gloriously maskless, living fairly normal lives during the pandemic, so there won’t be the same incentive to vaccinate kids to “get back to normal”. There just hasn’t been the same push to vaccinate kids here, I am always shocked to see this elsewhere when I leave my Swedish bubble.

The big news here of course is that the Public Health Agency has halted Moderna vaccines for people aged < 30. Countries across the Nordic region compiled their data and found a significant difference in myocarditis rates between Moderna and Pfizer. The Public Health Authority claims that even with Moderna, the rates of myocarditis are still lower than potential severe outcomes with covid, but the Pfizer data is so much better, so it makes sense to only use that vaccine. I was surprised we were using Moderna at all in Sweden, I had thought we were only using Pfizer. Since this announcement several regions in Sweden, including Gothenburg and Gävle, have said they’ll stop using Moderna for all age groups. Tegnell, showing his media training, turned the halt on Moderna into a positive: “It shows our data collection process is working!” There is no decision yet what those young people who have received one shot of Moderna will get as a second dose – either 1) ½ dose Moderna, 2) second dose with Pfizer, or cryptically 3) another vaccine in the pipeline to be approved.

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