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The Swedish healthcare system has thus far withstood an onslaught of COVID-19 cases under the country's less restrictive approach to fighting the pandemic, but it can't hold out much longer unless cases subside, public health experts there warned.

Over the past month, the cumulative number of cases has climbed sharply with no sign of flattening, , reaching about 22,000 in a nation of roughly 10 million. That's less on a per-capita basis than in the United States, but not by much.

Maria Furberg, MD, PhD, an infectious diseases expert at Umea University Hospital in northeastern Sweden, said the system "has been under heavy pressure for several weeks now but I do not [believe] that it has been overwhelmed as of yet ... though it has been close."

"I believe perseverance will become an increasing problem if the pressure will not decrease soon, however," Furberg told 麻豆传媒, noting that this pertains mainly to Stockholm, which has been the hardest-hit part of the country.

Mozhu Ding, PhD, an epidemiologist at the Karolinska Institute, said that while the system isn't overwhelmed and there's excess capacity due to a field hospital set up in the Stockholm Exhibition Center, "the situation is not improving and there are concerns of not enough personal protective equipment [PPE] and health professionals."

Medical experts in the country have publicly criticized its response to the COVID-19 outbreak. Last week, a group of 22 clinicians, virologists, and researchers penned calling for the closure of schools and restaurants, and requiring PPE for those who work with the elderly. More than a month ago, 2,300 academics to tighten restrictions in order to protect the healthcare system.

"No one has tried this route, so why should we test it first in Sweden, without informed consent?" Cecilia Soderberg-Naucler, PhD, an immunologist at the Karolinska Institute, told Reuters at the time. Soderberg-Naucler did not respond to a 麻豆传媒 request for comment.

Essentially, only high schools and universities have closed; businesses have remained open. Swedes have been asked to keep their distance in public, refrain from non-essential travel, and work from home when possible. Gatherings of more than 50 people are also banned, as are home care visits.

Ding emphasized that it has not been "business as usual in Stockholm and other parts of Sweden," and others have noted that there has been a lockdown feel in the country.

"Apart from a few popular streets in central Stockholm, the pedestrian traffic elsewhere is down anywhere from 50% to 90%," Ding told 麻豆传媒. "Home delivery of groceries has exploded in popularity, making it difficult to make an order."

She noted that there's been "wide public support" for Sweden's approach, "despite the grim numbers coming out from the daily briefings."

Furberg called Sweden's approach "adequate and well balanced," but said, "one might question if the response was initiated a bit late in the process of the pandemic."

"An earlier onset of the recommendations could perhaps have taken some of the pressure off the healthcare system in Stockholm," Furberg said.

Sweden's death rate has been far higher than its Scandinavian neighbors: about 250 per million as of Thursday, compared with roughly 75 per million in Denmark and 42 per million in Norway, both of which instituted lockdowns in mid-March.

Anders Tegnell, the chief epidemiologist at Sweden's Folkhalsomyndigheten, or public health agency, has attributed the higher death rate to extensive infections in the country's elderly care homes. He has said nearly half of the country's deaths have occurred in those facilities. Tegnell declined an interview with 麻豆传媒.

Furberg said the virus was likely imported into the country during "sports holiday" weeks in mid-February to the beginning of March, "which injected the country with a great number of infected individuals at the same time and in particular to the densely populated regions of Stockholm and Gothenburg."

"The persons who contracted the disease were mainly young and healthy and I believe many of them spread the disease quite extensively before being detected as cases," Furberg said. "The virus has later made its way into our care homes for the elderly, which of course is a great failure, and that's where we see a lot of deaths at present."

Ding agreed that "prohibiting visitors to care homes for the elderly and testing the caregivers much earlier during the outbreak would have led to a much lower death toll."

"Norway, for instance, has done a much better job at preventing this through testing the caregivers and providing PPE to those who work in care homes," she said.

Tegnell and the health authorities, rather than political leadership, have led the country's response to coronavirus, with Tegnell heading up the majority of the country's daily press conferences. He has been quoted as saying that the response was designed to be sustainable over a longer period, and has denied claims that their approach was to create herd immunity.

He has also stated that he believes Sweden is past its transmission peak. However, models from the University of Washington's Institute for Health Metrics and Evaluation , at 494 per day.

Furberg suggested other Scandinavian countries "may catch up on the current high deaths rates in Sweden later on when they de-escalate their restrictions. Time will simply tell and no one knows today what the correct strategy is, hence, the Swedish strategy is no more experimental than any other country. We are all groping in the dark."

Filip Knop, MD, PhD, who leads a metabolic research team at the University of Copenhagen, close to the Swedish border, agreed that "the situation is unprecedented and no strong evidence exists to support either of the responses."

"I like the idea of 'freedom with responsibility' as the Swedes have adopted; it'll probably also be easier on the economy," Knop told 麻豆传媒. "However, as a medical doctor it's tough to see the immediate greater impact on health."

"I'm used to favoring solutions with evidence of optimal benefits for my patients," he continued. "This is simply not possible when it comes to 'choosing' between the Danish and the Swedish response to the COVID-19 pandemic. In the future, we'll get some very interesting and extremely valuable comparative data on how the two countries fared economically and health-wise."

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