Despite a sharper tone from authorities and new restrictions, Sweden, which has famously relied on non-coercive measures, is struggling to contain a strong second wave of COVID-19 it thought it could avoid.

The capital Stockholm is once again at the epicentre of the epidemic and this week called on members of the public with medical training to help offset some of the burden on healthcare.

Lars Falk, a doctor at an intensive care unit at the Karolinska Hospital in Stockholm, told AFP the second wave had hit much harder than they expected.

“We got three different scenarios from the Public Health Agency this summer. We prepared for the worst, and it turned out twice as bad,” Falk told AFP.

Others regions are also seeing resources stretched thin.

On Monday, the number of people receiving hospital care reached 2,406, near the peak of 2,412 on April 20.

For now, the number of people in intensive care is still less than half the level seen in April, according to Sweden’s National Board of Health and Welfare.

The total number of deaths associated with COVID-19 in the country of some 10.3 million reached 7,802 on Wednesday, with more than 500 in the last week and over 1,800 since the beginning of November.

Non-coercive measures

With very few coercive measures and no face mask rule, Sweden has stood apart by relying on citizens’ “responsibility” and issuing only recommendations—with no sanctions if they are ignored.

Authorities have tried to call for greater personal sacrifices as new cases have risen—notably urging people to limit social interactions to those in their household or a very small circle of friends.

However, some measures are binding, and on November 24 a ban on public gatherings of over eight people went into force, lowering the number from 50.

“We become tougher, but I think we need to be even tougher than this,” intensive care doctor Falk said.

Contrary to media reports, the Scandinavian nation never targeted so-called herd immunity as part of its official strategy.

But health officials did argue that the high level of spread in the spring should weaken any second wave.

“I think we will have a relatively low even spread during the autumn, with clusters in different places,” state epidemiologist Anders Tegnell told broadcaster TV4 in August.

That seemed to be borne out for a while, as the second wave hit later and deaths remained low in October.

Tegnell stuck to his assessment that the country could do better than many others in Europe.

“With the expertise and tools we have in place in Sweden, there are good reasons to believe we can avoid that type of development,” Tegnell said at the end of the month.

Despite criticism, Prime Minister Stefan Lofven has refused to call the strategy a failure, arguing it is too early to make a final assessment.

But in an interview with daily Aftonbladet on Tuesday, Lofven also said he felt many experts had underestimated the second wave.

“I think most in the profession did not see such a wave incoming, there was instead talk of different clusters,” he said.

‘I believe we have failed’

An independent commission appointed by the government did however conclude that the strategy failed in its effort to protect the elderly in care homes, a lapse already conceded by authorities.

Over 90 percent of coronavirus deaths in Sweden have been among those aged 70 and up, and nearly half of all deaths have been in retirement homes.

“I believe we have failed,” Sweden’s King Carl XVI Gustaf told broadcaster SVT in a programme summing up the year and released Thursday.

Analysts noted the unusually sharp tone of the message from the king, whose power is ceremonial and who typically refrains from commenting on political matters.

The response has also been constrained in part by legislation, including a guarantee on freedom of movement enshrined in the constitution.

The government is preparing a temporary, one-year “pandemic law” it aims to have in place by March 2021, which will empower ministers to limit the number of people in public places and regulate businesses and services by restricting opening hours or even shutting them down.

Among Swedes, support for the strategy and confidence in authorities has generally remained strong throughout the pandemic.

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