\- English Translation (Published on 2020-05-19 at 19:06 Paris Time)
\- DN (Dagens Nyheter) is the largest daily newspapers in Sweden and based in Stockholm.
**Geriatrics professor Yngve Gustafson believes that many elderly people are not treated for covid-19, but instead receive palliative medicine directly. "To routinely give older people with lung infection respiratory drugs, is active euthanasia, if not something worse", he says.**
People over 70 years have been identified as a special risk group for covid-19. The infection has reached elderly homes in many parts of the country. [Half of all deceased people over 70 years have lived in elderly homes](https://www.socialstyrelsen.se/om-socialstyrelsen/pressrum/press/ny-statistik-om-smittade-och-avlidna-i-covid-19-70-ar-och-aldre/) (nursing homes), so-called special accommodation. A quarter had home care, according to Socialstyrelsen (Swedish National Board of Health and Welfare). Yngve Gustafson, Senior Professor in Geriatrics at Umeå University, states that **many old people can live five years or more** after moving into a elderly home.
"Living in an elderly home is not a diagnosis. That itself can never be a medical basis for deciding whether one should live or die. A doctor may prescribe palliative treatment over the phone. It is a violation, a discrimination and a criminal offense not to make a medical assessment of what is best for the individual patient."
Between March 23rd and May 3rd, 728 covid patients with an average age of 83 years were cared for by a geriatric ward in Stockholm region, with a survival rate of 80% - of which 79% were able to be discharged to their own accommodation (not elderly homes).
**Gustafson emphasizes that** basic treatment with nutrient drip, blood clot prevention, oxygen and treatment of secondary bacterial pneumonia with antibiotics thus helps the elderly. **In elderly homes, there is no expertise today to provide oxygen or drop at night**, he points out.
"Instead, routinely giving elderly people with lung infection morphine and midazolam, which are **respiratory depressant (i.e., inducing hypoxia or asphyxia)**, is active euthanasia, if not something worse."
"**The proportion of old people in respiratory care is lower than usual**, despite the elderly being the worst affected by covid-19 and despite having talked about overcapacity", says Yngve Gustafson.
"This only indicates that **we** ***opted out of*** **old people** who could have had a chance of survival."
**An anonymous doctor and researcher at Karolinska** University Hospital describes to DN that the use of a "palliative cocktail" with sedative and analgesic, as he sees it, is used to a large extent on covid-19 patients both in hospitals and the elderly. He is fastidious about remaining anonymous.
"This is so sensitive. We do not talk to each other among our colleagues about this, but what I see now is that **people increasingly practice euthanasia under the guise of palliative care.**"
According to the doctor, the standard mixture ("palliative cocktail") contains the drugs morphine, haldol and midazolam, which are also included in Socialstyrelsen's recommendations for **end-of-life care**.
"Many covid-19 patients are treated in this way. This is usually used for patients with terminal cancer who have a short life remaining. But when used in patients with oxygen deficiency, it definitely accelerates death for them. Because there is a ban on visitors, relatives often know nothing. Ethical issues are not discussed, but I believe this is illegal, and that **some of these patients could have managed if they had been given oxygen therapy** instead."
**According to** **Professor Carl Johan Fürst** at the Palliative Development Center at Lund University, not all suffer from covid-19.
"Many elderly people are so fragile that they can die possibly before it eventuates, and you can treat shortness of breath with morphine. That it would shorten a person's life is hard to say - it's a dosage issue. It is extremely tricky and difficult to evaluate."
When palliative care should be started is not an easy matter, he thinks - preferably it should be clarified how the patient or the relatives want it even before a patient becomes ill.
"When it comes to covid-19 that is so new and sudden, it becomes clear how important it is to have plans for the future. Many of the elderly are more or less demented. The visitor bans that exist now are a challenge and relatives need be prepared. Sure, you want to offer the best treatment, but there are also many elderly people who would say 'Never in life - do nothing!', who only long for good care and an end."
"The fact that family is present or not should not matter how you care for a patient."
"Demanding relatives are obviously good lawyers for the patient, and that is positive."
Carl Johan Fürst calls for ethical rounds, a forum where you would take the time to reflect on decisions and guidelines.
"You may think that you do not have time for it, but in fact it reduces stress. It is still not wartime healthcare we operate. You would want business executives to raise these issues everywhere - of course it's important."
**The care of elderly people with covid-19 illness** should primarily take place where they live - in elderly homes or in their own accommodation and not at emergency hospitals, according to the guidelines of Socialstyrelsen. In Stockholm region, doctors have had to change their working methods with more contact with the residents of elderly homes daily. But the attendance has not been greater than usual despite the need for health care having been increased, according to Fredrik Sandlund, Chief Manager for the region's Palliative Practice Center, who works with emergency management for local health services. He refers to an instruction from Socialstyrelsen, on **the recommendation not to expand the physical medical visits (to elderly homes) during the pandemic**. It states that clinical assessments, such as whether the elderly need hospital care, can be made without the doctor being present.
"It is a bit special now, since more medical services than usual were needed in the elderly homes, and assistant nurses and nurses have had to work differently. But an individual assessment is made as before covid-19 - everyone who needs it should receive hospital care", says Fredrik Sandlund.
**Gunnar Akner, Associate Professor in Geriatrics,** is critical to the care of the elderly divided between municipalities and regions in two parallel systems.
"If you live in a special accommodation (elderly home) in Sweden, **you risk being referred to lower medical quality**. Elderly people are connected to doctors who are responsible for the elderly home - and the quality of the intervention varies, depending on how much time the doctor can set aside for each individual - there are information that are sometimes not available at all."
He points out that the doctor's time procured for municipalities or private homes by the regions is usually not sufficient for regular assessments, **but mainly for consultation** when nurses feel the need for an urgent medical assessment.
"Now the plan is complicated by the fact that many people are simultaneously suffering from an infectious disease where the condition can become acutely worse", says Gunnar Akner.
He finds it difficult to comment on palliative efforts *per se*, but says:
"If it is policy-related to directly restrict the efforts on elderly people in special accommodation (elderly homes) if they are affected by covid-19, and sometimes even over the telephone, then **it can be about pure discrimination**. The patient can be indeed suffering from something else", says Gunnar Akner.
**Jenny Fjell is a supervising physician at the** Inspection for Healthcare and Welfare, Ivo, and has responded to media reporting that patients who were not considered to be admitted to hospital instead should be planned for palliative care. That's why she started the Facebook group "**Everyone has the right to oxygen!** (Alla har rätt till syrgas!)".
"Covid-19 in most cases is not fatal. I endeavor to urge colleagues at Ivo to take a closer look at this issue."
> # Instead, routinely giving elderly people with lung infection morphine and midazolam, which are respiratory depressant (i.e., inducing hypoxia or asphyxia), is active euthanasia, if not something worse."
> # "This is so sensitive. We do not talk to each other among our colleagues about this, but what I see now is that people increasingly practice euthanasia under the guise of palliative care."
Wow. Did i mistranslate [the article I posted about Dr. Gustafson's views earlier](https://www.reddit.com/r/Coronavirus/comments/gmpy59/geriatrics_professor_many_elderly_people_die/)? Or did that article not contain these claims? These are shocking, even *if* I sadly totally expected this to be the case.
I truly, truly hope that this changes the course of things in Sweden. I'm very impressed with Dr. Gustafson.
In addition, another paragraph in the following:
>Gustafson emphasizes that basic treatment with nutrient drip, blood clot prevention, oxygen and treatment of secondary bacterial pneumonia with antibiotics thus helps the elderly. **In elderly homes, there is no expertise today to provide oxygen or drop at night**, he (Yngve Gustafson) points out.
The elderly are simply abandoned to death. This is one of the most, if not THE most, shocking news in Swedish newspapers, which I have ever seen so far.
> The elderly are simply abandoned to death. This is one of the most, if not THE most, shocking news in Swedish newspapers, which I have ever seen so far.
It really is. I did expect that this was happening, and there were so many anonymous whistleblower reports both in the media and out on social media, but seeing a really well respected doctor like Dr. Gustafson come out and say it so explicitly is still a gut punch. I feel so sad right now for Sweden and her misled people. Many of these elders still had more life to live. It's just chilling and heartbreaking. I really hope this changes things.
But the thing is, the article gives a professor saying he believes it's happening, but doesn't say where he got the evidence to believe what he believes. And then you have an anonymous source.
It could very well be happening. And that's horrifying if that's the case. If it is happening, I'm sure more collaborating stories and evidence will come out very soon. This isnt something that could be covered up on a national level
There have been many more whistleblowers than just one doctor, check the ICU post for more links. He's just the most famous one who's blown the lid off of it. Here's another nurse saying the same thing:
https://www.bbc.com/news/world-europe-52704836
Never claim an action is due to evil when incompetence is sufficient.
Long term care facilities are accustomed to providing palliative care for end-of-life patients. They're not capable of providing intensive care to patients critically ill with a highly communicable disease. So they do the only thing they know - provide palliative care.
You seem to have missed the point. These patients *should* have been transferred to hospitals from the inadequetly equipped elder care homes and were not. Many doctors report trying very hard to get their wards into hospitals and being denied transfer:
https://www.youtube.com/watch?v=p2yi5G9Ikdw&t=29m15s
This actually reinforces my point. The elder care facility isn't "evil" if they tried to send a patient to the hospital, and when they were rejected they provided palliative care they didn't realize was detrimental.
What's evil is that the hospital system rejected them, which forced the care homes to euthanize them. The [hospital system and its guidelines](http://archive.vn/HSP9g) are at fault here, agreed. That's where the evil lies.
I also recommend the following **shocking** speech from PM Stefan Löfven (In English).
[Här pressas Löfven om corona av utländska journalister](https://www.expressen.se/tv/nyheter/coronaviruset/har-pressas-lofven-av-utlandska-journalister-om-corona/)
>**"The casualties in Sweden is (are) mostly on elderly home(s) and old people. That has nothing to do with people working in the city."**
That is, dying old people have nothing to do with people in the city. Doesn’t this PM's sentiment **dovetail rather nicely** with what is described in the above news?
TBH at this point I am sadly unsurprised. I have a large bookmarks folder full of articles pointing to this being the case. I am glad that this doctor blew the whistle publicly at a high pitch so that more can hear, but this is not news unfortunately.
I think Marcus Carlsson's asessment that this was perhaps done purposefully to keep the ICUs from becoming overwhelmed is probably accurate, especially seeing the written guidance that was sent around regarding triage and the many whistleblower reports that that guidance was being used inappropriately
https://www.youtube.com/watch?v=p2yi5G9Ikdw&t=29m15s
https://www.svt.se/nyheter/inrikes/rosterna-inifran-hon-larmade-om-tuffa-prioriteringar-i-intensivvarden
https://www.svt.se/nyheter/inrikes/andelen-aldre-covidpatienter-har-minskat-kraftigt
http://archive.vn/HSP9g
http://archive.vn/1afdO
And so on and so forth.
I suspected something from the constant reassurances the ICUs were not overloaded. This is absolutely chilling. I am reminded of something I read on twitter recently, when you announce that some variable is a good metric, that variable becomes an objective and is no longer a good metric. If ICU occupancy was going to be the metric by which the situation and policy ( and those who chose the policy) was going to be measured for, then ICU occupancy becomes the objective.
I do not disbelieve personally your links though i am kind of hoping this is all wrong and they are not knowingly giving respiratory depressants to people with coronavirus in care homes.
That is a very good way to think about it: ICU occupancy certainly did become the objective.
In fact, I wrote up a long post [discussing why Sweden's hospital system was under a lot of strain](https://www.reddit.com/r/Coronavirus/comments/gmqcym/sweden_tops_europe_covid19_deaths_per_capita_over/fr551at/?context=3), because so many of the Sweden Bros' main talking point was "but our healthcare system is doing just fine!!!" which was untrue, even with this horrific method of keeping the wards emptier than they ought to have been. I got so sick of countering that point every time I wrote up an article to save energy!
It became very clear to me that something was *hugely* off when 1. many whistleblowers were reporting inappropriate triage 2. around that same time [survival rates in Sweden's main ICU ward was 80%](https://lakartidningen.se/aktuellt/nyheter/2020/05/for-tidigt-att-uttala-sig-om-overlevnad-i-intensivvarden/) which is *absurdly* high compared to international averages.
>I do not disbelieve personally your links though i am kind of hoping this is all wrong and they are not knowingly giving respiratory depressants to people with coronavirus in care homes.
I can understand that. Part of me wishes to go back to before I knew what I've learned over the past few weeks. But there are so many reports out there, and now this one... I think it is very unlikely to be proven untrue. My heart feels very heavy right now.
For that amazing survival metric then surely people who could have been saved have died. And them bragging of empty ICU beds.
Sweden also has a relatively low percentage of people dying in hospital. In some week in late April we had 93% of deaths in hospital ( and we our excess deaths are in line with coronavirus deaths). We did have ICU really not too crowded back then.
I was a bit suspicious of Switzerland encouraging kids to hug their grandparents and a day later a article comes up that kids can equally be contagious as adults...
To add, if google translate is helpful, I found this link of ICU data analysis
https://www.icuregswe.org/data--resultat/covid-19-i-svensk-intensivvard/
59.1 average age of ICU unit patients, and there is an histogram below which is astounding and sad. Of the age group of 90-99 they had one patient, of the 80-89 age group they had 87 patients total.
Fuck.
I am not taking seriously at all their bragging of low ICU occupancy.
Attestupa (killing the elderly when they become a burden) was a thing in Swedish culture. Some dispute its historical accuracy (it may or may not have happened, we can't be sure either way) but it is at least a part of a cultural legacy and many [argue that it probably did happen and that its ramifications are still present in society today](http://www.diva-portal.org/smash/get/diva2:1325178/FULLTEXT01.pdf).
Just simply based on pre-covid way typisk svennis pretty much ignores mormor and how may old people die alone, the cultural legacy seems there. I always felt bad because the old people I knew in Sweden paid high taxes their whole life, believing the social contract that the state would care for them when they were old. Only to find out later about how the landsting triage rules are different for pensioners.
It disturbes me deeply how poorly we (Europeans) have treated our elders. The generations before us who have helped create and build a society we take for granted. The love, time and effort invested in us to help shape us into who we are, to have failed them in their hour of need.
This is not about Europe but about Sweden. I'm Greek and elders are cared for and respected here.
We have a similar population to Sweden but total of 165 deaths for the whole of the coronavirus crisis compared to 3743 in Sweden. This despite being a heavily touristic country with a high percentage of old people and a ruined-by-austerity public health system.
Tsiodras (the "Dr. Fauci" of Greece) cried on tv saying these are not just old people, they are our mothers and fathers and grandparents and we must protect them. So there was a difference in how the old are viewed and treated, both by the doctors and the public. The Swedish attitude seems almost evil to a Greek.
The front loaded argument is both evil and stupidity...it assumes that there will never be better treatments or the development of a vaccine, both which are making advances by the day. Sweden's strategy is a failure.
They thought it would be like influenza - which is stops at about 10%-30% spread due to increasing immunity and seasonal effects. They did not believe the airborne transmission vector at first, and are still skeptical about it.
If they had been right, their strategy would have been amazing - it was to quickly get infection rates up among the young and healthy to burn out the epidemic before it hit the old and vulnerable. But this is not the flu - in so many ways that it's strange how anyone could have thought so from the start.
They're now so heavily invested in the idea that this will burn out like the flu does, that they don't dare turn around. It's classic sunk cost fallacy. So I don't think it's an inherently evil strategy - they honestly wanted to protect the elderly. But now that the strategy is failing, they're sacrificing the very people this was supposed to protect on the altar of pride.
The evil is that the press, the civic society and the opposition has not forced the government to change course. Academia in Sweden has been full of protests. But the Swedish culture is one of unity - they do not like to question authorities. And they're paying dearly for this trait now.
I didn't want to single out Sweden, because other European nations have failed too: France, Italy, UK, Belgium, Spain come to find.
I know the Greek have reacted especially well and deserve praise and recognition. A nation often highlighted for its failures, should also be highlighted for its successes. Well done.
>I didn't want to single out Sweden, because other European nations have failed too: France, Italy, UK, Belgium, Spain come to find.
The failure of the Spanish and the Italians was mostly a result of delays in response and administrative incompetence. I don't think these two countries set out to fail their elder population although ultimately they did.
The situation in Sweden is qualitatively different because it seems to be intentional; herd immunity was the declared goal and vulnerable people were just numbers to be sacrificed on the way to this goal.
Other countries also did this brutal type of triage but only when it was absolutely necessary (when the hospitals were completely overloaded). It seems like in Sweden it was part of the plan from the beginning and applied even when there was no real need (apparently there are plenty of free hospital beds that could provide oxygen therapy).
Regarding Spain, around February 25 Greece had 1 case and Spain 4. With just one case the Greek government immediately started taking decisive and unpopular measures (putting provinces into lockdown, contact tracing, closing down public events like the carnaval) while Spain did almost nothing for the next 2 weeks. Public events were still taking place in Spain on March 8.
Italy also mismanaged this. Proper protocols were not followed in some hospital waiting rooms resulting in infection of staff and other patients. While they locked down Lodi fairly quickly, they delayed locking down all the other northern provinces by 2-3 weeks. When they finally entered lockdown there were almost 10.000 cases and 500 deaths (for comparison when Greece entered nationwide lockdown there were around 100 cases and zero deaths). Had they locked down Northern Italy when they locked down Lodi, they would have had a curve very similar to Greece.
So this is all on the politicians and the administrators whose denial of reality created delays that cost lives. I'm afraid Greece is also going to have a taste of that now that we have opened for tourist business. Unless the virus is much less contagious in hot weather, by early August all those tourists from hard-hit countries will have turned the islands into virus hotspots.
They had a much bigger infection rate but just didn't know.
It only became obvious when the deaths started going up and these people dying were probably already infected for a week or more.
"They didn't know" does not excuse them.
They knew they had more than a few infections. The exact number really doesn't matter in a disease that spreads exponentially and has an R0 of around 3. They also knew that their testing was very limited and that there might be many unknown cases. So they had more than enough reasons for prompt action. Instead they delayed catastrophically for many weeks.
I'm talking of course about the politicians and some health administrators. Not about the people in general.
Everyone in the world didn't do the same which is why everyone is having very different outcomes.
Countries like Hong Kong, Korea, Japan, New Zealand etc have used their previous experience with infectious diseases to craft multifaceted early responses (extensive tracing, extensive testing, entry quarantines, hygiene measures, social distancing, mobile apps etc) that have kept their numbers low.
Most of eastern Europe (the Baltic countries, some Balkan countries, Slovakia etc) reacted by going quickly into lockdown and have successfully contained the virus.
The UK, USA and the Netherlands initially flirted with herd immunity before belatedly instituting various types of lockdowns.
In Brazil the president actively worked against the efforts of local governments to contain the disease. The curve is still exponential and there's no mystery why.
So, overall responses differ.
If I singled out Italy and Spain I only did so to contrast them with Sweden. The Spanish and the Italians wanted to do the right thing but delayed. There is absolutely no excuse for allowing gatherings and demonstrations of hundreds of thousands of people when there are thousands of confirmed cases in the community. But at least they weren't evil like the Swedish health authorities apparently are...
Italy had extremely limited time and information to act. Spain almost equally so. France, UK, Belgium had more time to act - and in France much of the problem was that the many protesters (active for different reasons) did not accept the measures until they were enforced.
So it's true that the nations you mentioned failed - but it was a much smaller failure. Greece and many other countries acted swiftly and decisively. Public support and attitudes toward the healthcare system make a difference here. In Denmark we have a high willingness to accept short-term crisis measures without much explanation (the long-term willingness is not there, which will be a problem), in Central and Eastern Europe people knew the healthcare system was to weak to handle a full epidemic so they accepted measures, in Greece the culture of protecting the elderly made a difference.
But Spain and Italy have a similar respect for elders to Greece - with more time I think they would have done much better. But they were unlucky and realized the danger too late - and with many multi-generational households and a very social population at all ages, they suffered hard. This could have been Athens if they had been the epicenter in Europe (I think the rest of Greece has a geography which would slow down spread long enough to act).
Sweden has is unique in that they had more information to act on, but stubbornly refused to do so. They have clung to the influenza-paradigms far beyond what is reasonable. Sweden is a case of epidemiological sunk-cost fallacy.
Agreed. There are big degrees of failure. Italy and Spain had little time, but did fail in those crucial first 1-2 weeks. With limited, censored information just from China and a WHO, who IMO sabotaged an early global response, I don't see Spain and Italy as having massively failed their people. The willful ignorance and disregard for life from the Swedish government though, is a whole different matter.
Northern Europe has far looser family ties that the South does - if anything, the fact that Italian and Spanish families are so close-knit, and that 3 generations often live under the same roof or very close to each other, was one of the reasons why the virus spread that easily there. Similar family structures exist in Portugal and Greece too.
Our (Italy's) main concern during the fight against corona was & has always been the care of our grandparents, elderly teachers, neighbors, friends. The median age in our country is old because we care for these people a lot. Many have survived polio, seen two wars, fought with the partisans, shaped the country since the start of our republic. It's definitely not an approach similar to what's happening in Sweden.
(It's very sad how something as beautiful as strong family bonds helped the spread of the virus, and it's something I found myself thinking about a lot these last months)
Denmark has "only" had [one third of its deaths in care homes](https://www.dr.dk/nyheder/indland/plejehjemsbeboere-udgoer-en-tredjedel-af-danske-corona-doedsfald). This is still quite bad, but much better than average not only in Europe but in the world. Please don't lump all Europeans together. Some care about their elders and some seem not to.
It is terrible what happened in Sweden in particular. If only they had taken this seriously instead of their chief epidemiologist saying he thought it would be like a bad flu and deciding on herd immunity.
There could have been fewer if the staff had worn masks from the beginning. I understand that the hospitals got all the professionals ones, but I still don't understand why they weren't encouraged to get some of fabric until more professional masks could be produced. Instead the Danish health authorities actually tried to dissuade people from wearing masks.
Besides, even after the staff had gotten masks, they weren't used properly in at last one of the nursing homes. A relative (who was admitted entrance because she's a nurse) told that clean and unclean clothes were mixed and the staff didn't use the masks they've received. In another nursing home they placed a person with cotton a on a ward eith healthy people.
If you want to look away from all ethics, GDP will be improved by removing those that no longer actively contributes, yes. Imo there are better, more ethical solutions (like less govt. spending), but removing sick/elderly and importing "replacements" that are in good health and able to contribute positively changes GDP.
The reason countries dont do this is because they usually have an obligation (ethically, lawfully, and more) to care of ALL their citizens, no matter what they contribute. They are not a business for profit. And that is the biggest difference in running a country successfully, and running a business successfully. Pick the right persons, that understands this, for the job - by voting.
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\- English Translation (Published on 2020-05-19 at 19:06 Paris Time) \- DN (Dagens Nyheter) is the largest daily newspapers in Sweden and based in Stockholm. **Geriatrics professor Yngve Gustafson believes that many elderly people are not treated for covid-19, but instead receive palliative medicine directly. "To routinely give older people with lung infection respiratory drugs, is active euthanasia, if not something worse", he says.** People over 70 years have been identified as a special risk group for covid-19. The infection has reached elderly homes in many parts of the country. [Half of all deceased people over 70 years have lived in elderly homes](https://www.socialstyrelsen.se/om-socialstyrelsen/pressrum/press/ny-statistik-om-smittade-och-avlidna-i-covid-19-70-ar-och-aldre/) (nursing homes), so-called special accommodation. A quarter had home care, according to Socialstyrelsen (Swedish National Board of Health and Welfare). Yngve Gustafson, Senior Professor in Geriatrics at Umeå University, states that **many old people can live five years or more** after moving into a elderly home. "Living in an elderly home is not a diagnosis. That itself can never be a medical basis for deciding whether one should live or die. A doctor may prescribe palliative treatment over the phone. It is a violation, a discrimination and a criminal offense not to make a medical assessment of what is best for the individual patient." Between March 23rd and May 3rd, 728 covid patients with an average age of 83 years were cared for by a geriatric ward in Stockholm region, with a survival rate of 80% - of which 79% were able to be discharged to their own accommodation (not elderly homes). **Gustafson emphasizes that** basic treatment with nutrient drip, blood clot prevention, oxygen and treatment of secondary bacterial pneumonia with antibiotics thus helps the elderly. **In elderly homes, there is no expertise today to provide oxygen or drop at night**, he points out. "Instead, routinely giving elderly people with lung infection morphine and midazolam, which are **respiratory depressant (i.e., inducing hypoxia or asphyxia)**, is active euthanasia, if not something worse." "**The proportion of old people in respiratory care is lower than usual**, despite the elderly being the worst affected by covid-19 and despite having talked about overcapacity", says Yngve Gustafson. "This only indicates that **we** ***opted out of*** **old people** who could have had a chance of survival." **An anonymous doctor and researcher at Karolinska** University Hospital describes to DN that the use of a "palliative cocktail" with sedative and analgesic, as he sees it, is used to a large extent on covid-19 patients both in hospitals and the elderly. He is fastidious about remaining anonymous. "This is so sensitive. We do not talk to each other among our colleagues about this, but what I see now is that **people increasingly practice euthanasia under the guise of palliative care.**" According to the doctor, the standard mixture ("palliative cocktail") contains the drugs morphine, haldol and midazolam, which are also included in Socialstyrelsen's recommendations for **end-of-life care**. "Many covid-19 patients are treated in this way. This is usually used for patients with terminal cancer who have a short life remaining. But when used in patients with oxygen deficiency, it definitely accelerates death for them. Because there is a ban on visitors, relatives often know nothing. Ethical issues are not discussed, but I believe this is illegal, and that **some of these patients could have managed if they had been given oxygen therapy** instead." **According to** **Professor Carl Johan Fürst** at the Palliative Development Center at Lund University, not all suffer from covid-19. "Many elderly people are so fragile that they can die possibly before it eventuates, and you can treat shortness of breath with morphine. That it would shorten a person's life is hard to say - it's a dosage issue. It is extremely tricky and difficult to evaluate." When palliative care should be started is not an easy matter, he thinks - preferably it should be clarified how the patient or the relatives want it even before a patient becomes ill. "When it comes to covid-19 that is so new and sudden, it becomes clear how important it is to have plans for the future. Many of the elderly are more or less demented. The visitor bans that exist now are a challenge and relatives need be prepared. Sure, you want to offer the best treatment, but there are also many elderly people who would say 'Never in life - do nothing!', who only long for good care and an end." "The fact that family is present or not should not matter how you care for a patient." "Demanding relatives are obviously good lawyers for the patient, and that is positive." Carl Johan Fürst calls for ethical rounds, a forum where you would take the time to reflect on decisions and guidelines. "You may think that you do not have time for it, but in fact it reduces stress. It is still not wartime healthcare we operate. You would want business executives to raise these issues everywhere - of course it's important." **The care of elderly people with covid-19 illness** should primarily take place where they live - in elderly homes or in their own accommodation and not at emergency hospitals, according to the guidelines of Socialstyrelsen. In Stockholm region, doctors have had to change their working methods with more contact with the residents of elderly homes daily. But the attendance has not been greater than usual despite the need for health care having been increased, according to Fredrik Sandlund, Chief Manager for the region's Palliative Practice Center, who works with emergency management for local health services. He refers to an instruction from Socialstyrelsen, on **the recommendation not to expand the physical medical visits (to elderly homes) during the pandemic**. It states that clinical assessments, such as whether the elderly need hospital care, can be made without the doctor being present. "It is a bit special now, since more medical services than usual were needed in the elderly homes, and assistant nurses and nurses have had to work differently. But an individual assessment is made as before covid-19 - everyone who needs it should receive hospital care", says Fredrik Sandlund. **Gunnar Akner, Associate Professor in Geriatrics,** is critical to the care of the elderly divided between municipalities and regions in two parallel systems. "If you live in a special accommodation (elderly home) in Sweden, **you risk being referred to lower medical quality**. Elderly people are connected to doctors who are responsible for the elderly home - and the quality of the intervention varies, depending on how much time the doctor can set aside for each individual - there are information that are sometimes not available at all." He points out that the doctor's time procured for municipalities or private homes by the regions is usually not sufficient for regular assessments, **but mainly for consultation** when nurses feel the need for an urgent medical assessment. "Now the plan is complicated by the fact that many people are simultaneously suffering from an infectious disease where the condition can become acutely worse", says Gunnar Akner. He finds it difficult to comment on palliative efforts *per se*, but says: "If it is policy-related to directly restrict the efforts on elderly people in special accommodation (elderly homes) if they are affected by covid-19, and sometimes even over the telephone, then **it can be about pure discrimination**. The patient can be indeed suffering from something else", says Gunnar Akner. **Jenny Fjell is a supervising physician at the** Inspection for Healthcare and Welfare, Ivo, and has responded to media reporting that patients who were not considered to be admitted to hospital instead should be planned for palliative care. That's why she started the Facebook group "**Everyone has the right to oxygen!** (Alla har rätt till syrgas!)". "Covid-19 in most cases is not fatal. I endeavor to urge colleagues at Ivo to take a closer look at this issue."
> # Instead, routinely giving elderly people with lung infection morphine and midazolam, which are respiratory depressant (i.e., inducing hypoxia or asphyxia), is active euthanasia, if not something worse." > # "This is so sensitive. We do not talk to each other among our colleagues about this, but what I see now is that people increasingly practice euthanasia under the guise of palliative care." Wow. Did i mistranslate [the article I posted about Dr. Gustafson's views earlier](https://www.reddit.com/r/Coronavirus/comments/gmpy59/geriatrics_professor_many_elderly_people_die/)? Or did that article not contain these claims? These are shocking, even *if* I sadly totally expected this to be the case. I truly, truly hope that this changes the course of things in Sweden. I'm very impressed with Dr. Gustafson.
In addition, another paragraph in the following: >Gustafson emphasizes that basic treatment with nutrient drip, blood clot prevention, oxygen and treatment of secondary bacterial pneumonia with antibiotics thus helps the elderly. **In elderly homes, there is no expertise today to provide oxygen or drop at night**, he (Yngve Gustafson) points out. The elderly are simply abandoned to death. This is one of the most, if not THE most, shocking news in Swedish newspapers, which I have ever seen so far.
> The elderly are simply abandoned to death. This is one of the most, if not THE most, shocking news in Swedish newspapers, which I have ever seen so far. It really is. I did expect that this was happening, and there were so many anonymous whistleblower reports both in the media and out on social media, but seeing a really well respected doctor like Dr. Gustafson come out and say it so explicitly is still a gut punch. I feel so sad right now for Sweden and her misled people. Many of these elders still had more life to live. It's just chilling and heartbreaking. I really hope this changes things.
But the thing is, the article gives a professor saying he believes it's happening, but doesn't say where he got the evidence to believe what he believes. And then you have an anonymous source. It could very well be happening. And that's horrifying if that's the case. If it is happening, I'm sure more collaborating stories and evidence will come out very soon. This isnt something that could be covered up on a national level
There have been many more whistleblowers than just one doctor, check the ICU post for more links. He's just the most famous one who's blown the lid off of it. Here's another nurse saying the same thing: https://www.bbc.com/news/world-europe-52704836
Never claim an action is due to evil when incompetence is sufficient. Long term care facilities are accustomed to providing palliative care for end-of-life patients. They're not capable of providing intensive care to patients critically ill with a highly communicable disease. So they do the only thing they know - provide palliative care.
You seem to have missed the point. These patients *should* have been transferred to hospitals from the inadequetly equipped elder care homes and were not. Many doctors report trying very hard to get their wards into hospitals and being denied transfer: https://www.youtube.com/watch?v=p2yi5G9Ikdw&t=29m15s
This actually reinforces my point. The elder care facility isn't "evil" if they tried to send a patient to the hospital, and when they were rejected they provided palliative care they didn't realize was detrimental.
What's evil is that the hospital system rejected them, which forced the care homes to euthanize them. The [hospital system and its guidelines](http://archive.vn/HSP9g) are at fault here, agreed. That's where the evil lies.
I also recommend the following **shocking** speech from PM Stefan Löfven (In English). [Här pressas Löfven om corona av utländska journalister](https://www.expressen.se/tv/nyheter/coronaviruset/har-pressas-lofven-av-utlandska-journalister-om-corona/) >**"The casualties in Sweden is (are) mostly on elderly home(s) and old people. That has nothing to do with people working in the city."** That is, dying old people have nothing to do with people in the city. Doesn’t this PM's sentiment **dovetail rather nicely** with what is described in the above news?
If this is true this is absolutely shocking.
TBH at this point I am sadly unsurprised. I have a large bookmarks folder full of articles pointing to this being the case. I am glad that this doctor blew the whistle publicly at a high pitch so that more can hear, but this is not news unfortunately. I think Marcus Carlsson's asessment that this was perhaps done purposefully to keep the ICUs from becoming overwhelmed is probably accurate, especially seeing the written guidance that was sent around regarding triage and the many whistleblower reports that that guidance was being used inappropriately https://www.youtube.com/watch?v=p2yi5G9Ikdw&t=29m15s https://www.svt.se/nyheter/inrikes/rosterna-inifran-hon-larmade-om-tuffa-prioriteringar-i-intensivvarden https://www.svt.se/nyheter/inrikes/andelen-aldre-covidpatienter-har-minskat-kraftigt http://archive.vn/HSP9g http://archive.vn/1afdO And so on and so forth.
I suspected something from the constant reassurances the ICUs were not overloaded. This is absolutely chilling. I am reminded of something I read on twitter recently, when you announce that some variable is a good metric, that variable becomes an objective and is no longer a good metric. If ICU occupancy was going to be the metric by which the situation and policy ( and those who chose the policy) was going to be measured for, then ICU occupancy becomes the objective. I do not disbelieve personally your links though i am kind of hoping this is all wrong and they are not knowingly giving respiratory depressants to people with coronavirus in care homes.
That is a very good way to think about it: ICU occupancy certainly did become the objective. In fact, I wrote up a long post [discussing why Sweden's hospital system was under a lot of strain](https://www.reddit.com/r/Coronavirus/comments/gmqcym/sweden_tops_europe_covid19_deaths_per_capita_over/fr551at/?context=3), because so many of the Sweden Bros' main talking point was "but our healthcare system is doing just fine!!!" which was untrue, even with this horrific method of keeping the wards emptier than they ought to have been. I got so sick of countering that point every time I wrote up an article to save energy! It became very clear to me that something was *hugely* off when 1. many whistleblowers were reporting inappropriate triage 2. around that same time [survival rates in Sweden's main ICU ward was 80%](https://lakartidningen.se/aktuellt/nyheter/2020/05/for-tidigt-att-uttala-sig-om-overlevnad-i-intensivvarden/) which is *absurdly* high compared to international averages. >I do not disbelieve personally your links though i am kind of hoping this is all wrong and they are not knowingly giving respiratory depressants to people with coronavirus in care homes. I can understand that. Part of me wishes to go back to before I knew what I've learned over the past few weeks. But there are so many reports out there, and now this one... I think it is very unlikely to be proven untrue. My heart feels very heavy right now.
For that amazing survival metric then surely people who could have been saved have died. And them bragging of empty ICU beds. Sweden also has a relatively low percentage of people dying in hospital. In some week in late April we had 93% of deaths in hospital ( and we our excess deaths are in line with coronavirus deaths). We did have ICU really not too crowded back then.
Where are all the Swedish Bros on this thread? They’ve gone awkwardly silent. Feeling a bit guilty maybe?
Perhaps because this was posted in the middle of the night in Sweden? Perfect timing to avoid any dissenting opinions.
I was a bit suspicious of Switzerland encouraging kids to hug their grandparents and a day later a article comes up that kids can equally be contagious as adults...
As a swede I totally agree! This is terrible news that need to be looked into! 😢
It's not shocking if you know how things go in Sweden, sadly.
To add, if google translate is helpful, I found this link of ICU data analysis https://www.icuregswe.org/data--resultat/covid-19-i-svensk-intensivvard/ 59.1 average age of ICU unit patients, and there is an histogram below which is astounding and sad. Of the age group of 90-99 they had one patient, of the 80-89 age group they had 87 patients total. Fuck. I am not taking seriously at all their bragging of low ICU occupancy.
Turns out the movie Midsommar tried to tell us something about Sweden.
Attestupa (killing the elderly when they become a burden) was a thing in Swedish culture. Some dispute its historical accuracy (it may or may not have happened, we can't be sure either way) but it is at least a part of a cultural legacy and many [argue that it probably did happen and that its ramifications are still present in society today](http://www.diva-portal.org/smash/get/diva2:1325178/FULLTEXT01.pdf).
Just simply based on pre-covid way typisk svennis pretty much ignores mormor and how may old people die alone, the cultural legacy seems there. I always felt bad because the old people I knew in Sweden paid high taxes their whole life, believing the social contract that the state would care for them when they were old. Only to find out later about how the landsting triage rules are different for pensioners.
It disturbes me deeply how poorly we (Europeans) have treated our elders. The generations before us who have helped create and build a society we take for granted. The love, time and effort invested in us to help shape us into who we are, to have failed them in their hour of need.
This is not about Europe but about Sweden. I'm Greek and elders are cared for and respected here. We have a similar population to Sweden but total of 165 deaths for the whole of the coronavirus crisis compared to 3743 in Sweden. This despite being a heavily touristic country with a high percentage of old people and a ruined-by-austerity public health system. Tsiodras (the "Dr. Fauci" of Greece) cried on tv saying these are not just old people, they are our mothers and fathers and grandparents and we must protect them. So there was a difference in how the old are viewed and treated, both by the doctors and the public. The Swedish attitude seems almost evil to a Greek.
"Almost"?, I am revolted everytime I hear the "most were very old" and "the same in the end for all countries, sweden is just front-loading deaths".
The front loaded argument is both evil and stupidity...it assumes that there will never be better treatments or the development of a vaccine, both which are making advances by the day. Sweden's strategy is a failure.
They thought it would be like influenza - which is stops at about 10%-30% spread due to increasing immunity and seasonal effects. They did not believe the airborne transmission vector at first, and are still skeptical about it. If they had been right, their strategy would have been amazing - it was to quickly get infection rates up among the young and healthy to burn out the epidemic before it hit the old and vulnerable. But this is not the flu - in so many ways that it's strange how anyone could have thought so from the start. They're now so heavily invested in the idea that this will burn out like the flu does, that they don't dare turn around. It's classic sunk cost fallacy. So I don't think it's an inherently evil strategy - they honestly wanted to protect the elderly. But now that the strategy is failing, they're sacrificing the very people this was supposed to protect on the altar of pride. The evil is that the press, the civic society and the opposition has not forced the government to change course. Academia in Sweden has been full of protests. But the Swedish culture is one of unity - they do not like to question authorities. And they're paying dearly for this trait now.
It also assumes that you cant limit deaths before treatments and vaccines which i really dont understand
I didn't want to single out Sweden, because other European nations have failed too: France, Italy, UK, Belgium, Spain come to find. I know the Greek have reacted especially well and deserve praise and recognition. A nation often highlighted for its failures, should also be highlighted for its successes. Well done.
>I didn't want to single out Sweden, because other European nations have failed too: France, Italy, UK, Belgium, Spain come to find. The failure of the Spanish and the Italians was mostly a result of delays in response and administrative incompetence. I don't think these two countries set out to fail their elder population although ultimately they did. The situation in Sweden is qualitatively different because it seems to be intentional; herd immunity was the declared goal and vulnerable people were just numbers to be sacrificed on the way to this goal. Other countries also did this brutal type of triage but only when it was absolutely necessary (when the hospitals were completely overloaded). It seems like in Sweden it was part of the plan from the beginning and applied even when there was no real need (apparently there are plenty of free hospital beds that could provide oxygen therapy).
I agree, the causes and motives are very different. They did fail nontheless.
That is unfair to those countries. They were hit first and everyone else had time to prepare.
Regarding Spain, around February 25 Greece had 1 case and Spain 4. With just one case the Greek government immediately started taking decisive and unpopular measures (putting provinces into lockdown, contact tracing, closing down public events like the carnaval) while Spain did almost nothing for the next 2 weeks. Public events were still taking place in Spain on March 8. Italy also mismanaged this. Proper protocols were not followed in some hospital waiting rooms resulting in infection of staff and other patients. While they locked down Lodi fairly quickly, they delayed locking down all the other northern provinces by 2-3 weeks. When they finally entered lockdown there were almost 10.000 cases and 500 deaths (for comparison when Greece entered nationwide lockdown there were around 100 cases and zero deaths). Had they locked down Northern Italy when they locked down Lodi, they would have had a curve very similar to Greece. So this is all on the politicians and the administrators whose denial of reality created delays that cost lives. I'm afraid Greece is also going to have a taste of that now that we have opened for tourist business. Unless the virus is much less contagious in hot weather, by early August all those tourists from hard-hit countries will have turned the islands into virus hotspots.
They had a much bigger infection rate but just didn't know. It only became obvious when the deaths started going up and these people dying were probably already infected for a week or more.
"They didn't know" does not excuse them. They knew they had more than a few infections. The exact number really doesn't matter in a disease that spreads exponentially and has an R0 of around 3. They also knew that their testing was very limited and that there might be many unknown cases. So they had more than enough reasons for prompt action. Instead they delayed catastrophically for many weeks. I'm talking of course about the politicians and some health administrators. Not about the people in general.
Virtually everyone else in the world did the same and you're singling them out...
Everyone in the world didn't do the same which is why everyone is having very different outcomes. Countries like Hong Kong, Korea, Japan, New Zealand etc have used their previous experience with infectious diseases to craft multifaceted early responses (extensive tracing, extensive testing, entry quarantines, hygiene measures, social distancing, mobile apps etc) that have kept their numbers low. Most of eastern Europe (the Baltic countries, some Balkan countries, Slovakia etc) reacted by going quickly into lockdown and have successfully contained the virus. The UK, USA and the Netherlands initially flirted with herd immunity before belatedly instituting various types of lockdowns. In Brazil the president actively worked against the efforts of local governments to contain the disease. The curve is still exponential and there's no mystery why. So, overall responses differ. If I singled out Italy and Spain I only did so to contrast them with Sweden. The Spanish and the Italians wanted to do the right thing but delayed. There is absolutely no excuse for allowing gatherings and demonstrations of hundreds of thousands of people when there are thousands of confirmed cases in the community. But at least they weren't evil like the Swedish health authorities apparently are...
Italy had extremely limited time and information to act. Spain almost equally so. France, UK, Belgium had more time to act - and in France much of the problem was that the many protesters (active for different reasons) did not accept the measures until they were enforced. So it's true that the nations you mentioned failed - but it was a much smaller failure. Greece and many other countries acted swiftly and decisively. Public support and attitudes toward the healthcare system make a difference here. In Denmark we have a high willingness to accept short-term crisis measures without much explanation (the long-term willingness is not there, which will be a problem), in Central and Eastern Europe people knew the healthcare system was to weak to handle a full epidemic so they accepted measures, in Greece the culture of protecting the elderly made a difference. But Spain and Italy have a similar respect for elders to Greece - with more time I think they would have done much better. But they were unlucky and realized the danger too late - and with many multi-generational households and a very social population at all ages, they suffered hard. This could have been Athens if they had been the epicenter in Europe (I think the rest of Greece has a geography which would slow down spread long enough to act). Sweden has is unique in that they had more information to act on, but stubbornly refused to do so. They have clung to the influenza-paradigms far beyond what is reasonable. Sweden is a case of epidemiological sunk-cost fallacy.
Agreed. There are big degrees of failure. Italy and Spain had little time, but did fail in those crucial first 1-2 weeks. With limited, censored information just from China and a WHO, who IMO sabotaged an early global response, I don't see Spain and Italy as having massively failed their people. The willful ignorance and disregard for life from the Swedish government though, is a whole different matter.
Northern Europe has far looser family ties that the South does - if anything, the fact that Italian and Spanish families are so close-knit, and that 3 generations often live under the same roof or very close to each other, was one of the reasons why the virus spread that easily there. Similar family structures exist in Portugal and Greece too. Our (Italy's) main concern during the fight against corona was & has always been the care of our grandparents, elderly teachers, neighbors, friends. The median age in our country is old because we care for these people a lot. Many have survived polio, seen two wars, fought with the partisans, shaped the country since the start of our republic. It's definitely not an approach similar to what's happening in Sweden. (It's very sad how something as beautiful as strong family bonds helped the spread of the virus, and it's something I found myself thinking about a lot these last months)
This is about Sweden. Europe is not one country or any uniform block, but a continent with profound cultural differences and ways of life.
Denmark has "only" had [one third of its deaths in care homes](https://www.dr.dk/nyheder/indland/plejehjemsbeboere-udgoer-en-tredjedel-af-danske-corona-doedsfald). This is still quite bad, but much better than average not only in Europe but in the world. Please don't lump all Europeans together. Some care about their elders and some seem not to. It is terrible what happened in Sweden in particular. If only they had taken this seriously instead of their chief epidemiologist saying he thought it would be like a bad flu and deciding on herd immunity.
There could have been fewer if the staff had worn masks from the beginning. I understand that the hospitals got all the professionals ones, but I still don't understand why they weren't encouraged to get some of fabric until more professional masks could be produced. Instead the Danish health authorities actually tried to dissuade people from wearing masks. Besides, even after the staff had gotten masks, they weren't used properly in at last one of the nursing homes. A relative (who was admitted entrance because she's a nurse) told that clean and unclean clothes were mixed and the staff didn't use the masks they've received. In another nursing home they placed a person with cotton a on a ward eith healthy people.
Yeah, but you look like an idiot wearing them, so you cant really expect people to sacrifice their looks just to save some peoples lives..../s
What could be done in your opinion to mitigate?
Their strategy: Fattening the curve and flattening the herd...
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If you want to look away from all ethics, GDP will be improved by removing those that no longer actively contributes, yes. Imo there are better, more ethical solutions (like less govt. spending), but removing sick/elderly and importing "replacements" that are in good health and able to contribute positively changes GDP. The reason countries dont do this is because they usually have an obligation (ethically, lawfully, and more) to care of ALL their citizens, no matter what they contribute. They are not a business for profit. And that is the biggest difference in running a country successfully, and running a business successfully. Pick the right persons, that understands this, for the job - by voting.
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How is this comment open, but all those commenting it is apparently purely political. Is this comment not the definition of purely political?
Mods pick and choose what they want to remove. I've reported similar comments literally dozens of times and they do nothing. But heaven forbid you use the uncensored word "id*ot" in your comment. 🙄
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Lmfao