Introduction

In the spring of 2020, the COVID-19 pandemic shocked Swedish society and put unprecedented pressure on the Swedish health and long-term care (LTC) system for older people. The pandemic functioned as a stress test of how prepared, robust, resilient, and well-organised the Swedish welfare system was to confront a crisis of this magnitude. The handling of the pandemic seriously challenged the Swedish self-image as an efficient and well-organised welfare state.

During the very first phase of the pandemic, Sweden had similar ambitions and strategy as most other countries: slowing down the spread of the virus (flattening the curve) and protecting older people. However, it soon became clear that the Swedish COVID-19 strategy stood out among European countries and most of the world. Unlike most EU countries, Sweden did not respond with a general lockdown or harsh restrictions. Instead, the Swedish strategy was based on voluntary measures, emphasising individual responsibility to follow government recommendations. As a result, Sweden was considered an international outlier at this time, where the efforts to stop or slow the spread of infection were few, weak, and late.

The first months of the pandemic were in fact chaotic. The healthcare system was ill-prepared and had not yet reorganised and adapted to the situation, or developed routines and effective treatments for COVID-19. There was a severe shortage of personal protective equipment (PPE), hospital beds, and care personnel. The situation in the LTC and care homes was even worse: lack of PPE and insufficient knowledge of basic hygiene routines among care personnel.