Data_Sheet_2_COVID-19 Testing in Sweden During 2020–Split Responsibilities and Multi-Level Challenges.PDF

Sweden's use of soft response measures early in the COVID-19 pandemic received a good deal of international attention. Within Sweden, one of the most debated aspects of the pandemic response has been COVID-19 testing and the time it took to increase testing capacity. In this article, the development of and the debate surrounding COVID-19 testing in Sweden during 2020 is described in detail, with a particular focus on the coordination between national and regional actors in the decentralised healthcare system. A qualitative case study was carried out based on qualitative document analysis with a chronological presentation. To understand COVID-19 testing in Sweden, two aspects of its public administration model emerged as particularly important: (i) the large and independent government agencies and (ii) self-governing regions and municipalities. In addition, the responsibility principle in Swedish crisis management was crucial. Overall, the results show that mass testing was a new area for coordination and involved a number of national and regional actors with partly different views on their respective roles, responsibilities and interpretations of the laws and regulations. The description shows the ambiguities in the purpose of testing and the shortcomings in communication and cooperation during the first half of 2020, but after that an increasing consistency among the crucial actors. During the first half of 2020, testing capacity in Sweden was limited and reserved to protect the most vulnerable in society. Because mass testing for viruses is not normally carried out by the 21 self-governing regions responsible for healthcare and communicable disease prevention, and the Public Health Agency of Sweden stated that there was no medical reason to test members of the public falling ill with COVID-like symptoms, the responsibility for mass testing fell through the cracks during the first few months of the pandemic. This article thus illustrates problems associated with multi-level governance in healthcare during a crisis and illustrates the discrepancy between the health service's focus on the individual and the public health-oriented work carried out within communicable disease control.新冠疫情早期瑞典推行的温和防疫举措，曾引发国际社会广泛关注。在瑞典国内，疫情防控工作中最具争议的议题之一，便是新冠病毒检测以及提升检测能力所需的时间问题。本文详细阐述了2020年瑞典新冠病毒检测工作的发展历程与相关争议，重点聚焦于分权式医疗体系中国家与区域行为体之间的协同机制。本研究采用质性文档分析方法开展质性案例研究，并按时间顺序呈现研究内容。要理解瑞典的新冠病毒检测工作，其公共行政模式的两大核心特征尤为关键：一是规模庞大且独立的政府机构，二是拥有自治权限的郡与市镇。此外，瑞典危机管理中的责任原则也发挥了至关重要的作用。整体研究结果表明，大规模检测对于协同协作而言是全新领域，涉及众多国家与区域行为体，各方对自身角色、责任边界以及法律法规的解读存在一定分歧。研究阐明了2020年上半年新冠检测目标存在的模糊性，以及沟通与协作层面的诸多短板，但此后核心行为体之间的共识逐步提升。2020年上半年，瑞典的检测能力十分有限，仅用于保护社会中最脆弱的群体。由于负责医疗保健与传染病防控的21个自治郡通常并不开展大规模病毒检测工作，且瑞典公共卫生局（Public Health Agency of Sweden）曾指出，对于出现新冠类症状的普通民众并无医学检测的必要，因此疫情最初数月间，大规模检测的责任归属陷入了模糊真空状态。因此，本文阐释了危机期间医疗领域多层级治理面临的诸多问题，并揭示了医疗服务以个体为中心的服务导向与传染病防控领域以公共卫生为导向的工作之间存在的显著差异。