Sweden is being offered help by its Nordic neighbours to cope with an increase in Covid-19 cases that threatens to overwhelm hospitals.
Stockholm reported that 99 per cent of the region’s intensive care beds are full, sending the city into a panic and prompting calls for outside help.
The country's death toll exceeded 7,500 last week and its death rate per capita is several times higher than that of its Nordic neighbours but lower than several European countries that opted for lockdowns.
Stockholm is the Swedish region hardest hit by Covid-19, accounting for more than a third of the country's death toll from the virus.
Before Sweden draws on help from Finland and Norway, it will try to use available intensive care unit capacity in parts of the country that are less burdened.
Stockholm asked for additional healthcare staff from Sweden's armed forces, but it is not clear if the military has the resources to help.
In the meantime, more than 100 staff from a children's hospital were reportedly sent to ICUs, meaning children who were scheduled to receive non-emergency surgery will now be forced to wait.
However, neighbouring nations said they are ready to assist by freeing up space for Swedish ICU patients.
Sten Rubertsson, staff doctor at the National Board of Health and Welfare, told Dagens Medicin he was unsure if ICU beds can reach the 1,100 mark seen in the spring without outside help. "People are exhausted," Dr Rubertsson said.
Johanna Sandwall, who works for the health board, said Sweden’s regions have not yet hit their maximum capacity, but should that prove insufficient, “we can ask for help”.
Nordic countries have a co-operation agreement to share medical assistance at short notice in a crisis.
"We have not received an official request for help, but we assess on a daily basis what the hospital situation looks like and we are, of course, ready to help Sweden if we can," Kirsi Varhila, permanent secretary at Finland's ministry of social affairs and health, told Svenska Dagbladet newspaper.
Her Norwegian counterpart Maria Jahrmann Bjerke said: “If the Swedish authorities turn to us for assistance, we would have a positive attitude to it.”
On top of the pressure on ICUs, Sweden faces a shortage of healthcare workers as the number of resignations increases after a relentless year of caring for Covid-19 patients.
Sineva Ribeiro, chairwoman of the Swedish Association of Health Professionals, said the situation was terrible. Even before the first wave of the pandemic, in March, there was “a shortage of specialist nurses, including at ICUs”, she said.
Even if more ICU beds are provided, the bigger concern now is whether Sweden has enough healthcare workers with the skills needed to look after the country’s sickest patients.
Ms Ribeiro said that in May, members of her union described the situation as untenable. There are fewer qualified people available now than there were in the spring, making it more difficult to expand ICU capacity, she said.
Healthcare professionals emerged as the heroes of the Covid-19 crisis, often drawing cheers from grateful onlookers as they emerge from hospitals after long, gruelling shifts.
But, increasingly, staff are so desperate for some time off that they see resignation as the only way out, Ms Ribeiro said. A survey by broadcaster TV4 showed that in 13 of Sweden’s 21 regions, resignations in the healthcare profession are now up from a year ago, at as many as 500 a month.
Stockholm county mayor Irene Svenonius said the situation is "extremely tense". In an interview with the Dagens Nyheter daily newspaper, she acknowledged that healthcare staff are overworked and that there is a need for extra recruitment. "There's fatigue," she said. "You can't ignore that so it's extremely important to get more people."
The worry is that despite scientific strides that allow medics to better understand and treat Covid-19, there are not enough professionals left to put that knowledge into practice.
“We don’t have the staff to do it,” Ms Ribeiro said, describing the healthcare crisis facing the country as unprecedented.
Part of the problem is that nurses in particular are increasingly unwilling to subject themselves to the hours and conditions facing them during the crisis, given the average pay level.
Sara Nordin, once an assistant nurse at an ICU, told Bloomberg in October that she quit because she could not make ends meet on the $33,600 basic annual salary she received.
“I talked to members in August who said they would resign because it was the only way to get some time off and recover,” Ms Ribeiro said. “We see high rates of sickness, symptoms of exhaustion and members who have been infected.”
Sweden has yet to impose a lockdown, with its citizens encouraged to exercise common sense, but the country is now backtracking. The architect of its herd immunity policy, epidemiologist Anders Tegnell, appears to have been sidelined by his government.
Authorities said on Friday all pupils aged 14 to 16 in Stockholm will switch to remote learning for the rest of this year to help stem the second wave. It is the first time Sweden has recommended distance education for significant numbers of secondary school pupils.
