Sweden is facing a shortage of health-care workers as the number of resignations ticks up after a relentless year of caring for coronavirus patients.
Meanwhile, Italy on Sunday surpassed the U.K. for the most covid-19 deaths in Europe.
Sineva Ribeiro, the chairwoman of the Swedish Association of Health Professionals, says the situation is "terrible."
Even before the first wave of the pandemic back in March, there was "a shortage of specialist nurses, including at ICUs," she said in a phone interview.
The development shows that even countries with universal health-care systems are struggling to keep up with the covid-19 crisis. Last week, Stockholm's intensive care capacity hit 99%, sending the city into a panic and prompting calls for outside help.
But even if more ICU beds are provided, the bigger concern now is whether Sweden has enough health-care workers with the skills needed to look after the country's sickest patients.
Ribeiro says that already back in May, members of her union "warned of an untenable situation." There are fewer qualified people available now than there were in the spring, "which makes it harder to expand ICU capacity," she said.
Health-care professionals have emerged as the heroes of the pandemic, often drawing cheers from grateful onlookers as they emerge from hospitals after long and grueling shifts.
But increasingly, staff are so desperate for some real time off that they see resignation as the only way out, Ribeiro said. A survey by broadcaster TV4 showed that in 13 of Sweden's 21 regions, resignations in the health-care profession are now up from a year ago, at as many as 500 a month.
Stockholm County Mayor Irene Svenonius says the situation is "extremely tense." In an interview with Dagens Nyheter on Friday, she acknowledged that health-care workers are overworked, and that there's a need to add staff. "There's fatigue," she said. "You can't ignore that, so it's extremely important to get more people."
It's uncertain where that extra capacity will come from. Stockholm has asked for additional health-care staff from Sweden's armed forces, but it's not clear the military has the resources to help. In the meantime, over 100 staff from a children's hospital have reportedly been redeployed to intensive care units, meaning that children who had been due to receive non-emergency surgery will now be forced to wait.
Italy on Sunday eclipsed Britain to become the nation with the worst official coronavirus death toll in Europe.
Italy, where the continent's pandemic began, registered 484 covid-19 deaths in one day, one of its lowest one-day death counts in about a month.
Still, those latest deaths pushed Italy's official toll up to 64,520, while Britain's stood at 64,267, according to a tally by Johns Hopkins University.
Both numbers understate the true toll of the pandemic. Counting criteria differ in the two countries, and many coronavirus deaths, especially early in the pandemic, are believed to have gone undetected, including those of elderly people in nursing homes who were not tested for covid-19.
Among the reasons cited for Italy's high death toll was that it was the first country in Europe to be slammed in the pandemic, leaving health workers to grapple with a largely unknown virus. Italy also has a lower ratio of medical staff to patients compared with other European nations.
On Sunday, Italy reported another 17,938 coronavirus infections to raise its official tally to 1.84 million.
Separately, German Chancellor Angela Merkel announced Sunday that the country will be forced into a strict lockdown over Christmas after weeks of milder restrictions on public life failed to slow the spread of the coronavirus, leading to record numbers of new infections and deaths.
Starting Wednesday, nonessential stores, schools and hairdressers will be required to close, and companies will be encouraged to offer employees an extended holiday break or allow them to work from home. The number of people allowed to meet privately will also be further tightened. New Year's celebrations outdoors will be all but prohibited, with the sale of fireworks and public gatherings banned.
"All of this will impact the holidays, we know that, but we have been forced to take action and that is what we are doing now," Merkel said at a news conference announcing the measures, which are to remain in place through Jan. 10.
Germany earned widespread recognition for its success in halting the spread of the virus in the spring through an aggressive approach carried out through contact tracing, early and aggressive testing and coordinated nationwide restrictions. But since then, the country has stumbled, allowing a false sense of complacency to set in. Leaders of Germany's 16 states have also been resistant to following calls from the chancellor and medical experts for another lockdown this fall.
In September, Merkel warned that if Germany did not take more radical action, the numbers of new infections could rise to 19,000 per day. Roughly one month later, the chancellor's warning came to pass as the country experienced more than 21,500 new infections within a 24-hour period.
Information for this article was contributed by Niclas Rolander of Bloomberg News; by Frances D'Emilio of The Associated Press; and by Melissa Eddy of The New York Times.