At the European Union of General Practitioners (UEMO) General Assembly in mid-June 2020, the Finnish delegation reported that the covid-19 pandemic was relatively under control in Finland. Lockdown was easing and life in Finland was returning to closer to normal than in other parts of the world.
Cases have since spiked in August, with 284 new cases since the start of the month, causing concerns of a second wave. However, during the first wave, the Finnish government made good and timely decisions. They acted early and decisively, instituting lockdown when the case numbers of covid-19 victims were small. The question now is whether this will stand the country in good stead in case of a potential second wave, and also what can be learnt from their experience.
The Finnish Delegation to UEMO stated that one advantage of being in Europe is that other countries provide examples of what to do—and indeed of what not to do. In February, the Italian Delegation had informed UEMO and the media of what was happening in Lombardy and of the death of the first GP in that region. In Finland this message was heard and heeded. The epidemic reached Finland and other north European countries later than the infections in Italy and Spain, and they took the time to prepare. The constitution in Finland allowed for the government to use an Emergency Act (last used in WWII) to implement measures to control the pandemic. In neighbouring countries, such as Sweden, it was harder to implement these kinds of changes as the constitution only allows for emergency measures in a time of war, not a pandemic.
Apart from the decision to quickly stop social contacts to limit the spread of the virus, the country also had the advantage of clear communications. Finland’s prime minister, Sanna Marin, and four cabinet officers gave weekly public briefings with press conferences and open questions. One conference was devoted to queries from children. The message was simple: stay at home, if at all possible. Citizens over 70 years of age were asked not to meet other people and anyone who could work from home was encouraged to do so. Originally this directive was going to continue until September but, because infection rates fell rapidly, remote working finished at the end of July. In light of the recent rise in cases this has now been reimplemented and workers are encouraged to work from home again, wherever possible.
Physical distancing measures may have been easier to implement in Finland as a survey in April found that 75% of the population only met 2.5 people in one day so instructions to stay apart were possibly easier to enforce than in other nations. Voluntary groups sprang up to assist older residents or those who were at risk by helping to access food or medicine supplies. A law, last used in the Second World War, (The Emergency Powers Act)1, allowed suspension of normal working hours and holidays, making life flexible for restaurants and bars and allowing them some leeway in how they deployed their workers. It also allowed businesses the same flexibility in altering their working patterns. There are limits to the time patients can be cared for in hospital and these were suspended, as were holidays for medical staff. It also allowed relaxation of the medical working hours. Where infection rates were high, in the capital and surrounding county, the county border was closed and guarded by the army, with travel allowed within the county borders, but not outside which restricted the normal Finnish pattern of journeys to summer homes.
Schools and day care centres closed, although there were arrangements in place to care for the children of healthcare workers. All children in Finland get free school meals so stopping these caused some concern.
There were restrictions on those arriving in Finland from abroad. Medical personnel met people arriving at airports. In the initial phase, they were there to ensure that travellers knew about the quarantine rules and to offer transport to those who needed it. Travellers were taken to their home in taxis. A two week quarantine was imposed on all incoming visitors and they are now testing travellers for covid-19 as well.
Like other countries, Finland organised “Corona Units” where, with adequate PPE, suspected cases were assessed to determine if they were infected. All other contacts were done remotely, if possible. Finland’s medical records system made it possible for secondary care, as well as primary care, to contact patients by phone, even those on a hospital ward.2 Dental services were completely shut down because of the danger of aerosol spread.
The government also set up a “test and track” service. The chief physician of the Epidemiological Operations Unit in Helsinki, Sanna Isosomppi, said “In Finland, we currently encourage every person, with even mild covid-19 symptoms, to be tested. Covid-19 is listed as a “generally hazardous communicable disease by communicable diseases decree.” Laboratories notify the local epidemiological unit about positive findings to make sure no case is missed. Each confirmed case is then contacted swiftly by the local epidemiological unit for contact tracing. Confirmed cases are placed in mandatory isolation until they are no longer infectious and all close contacts are quarantined for 14 days. Loss of income is compensated by the state both for adults and for the guardians of children under 16 years of age. In Finland’s decentralised system these local units are responsible for both contact tracing and imposing quarantine rules. Collaboration and regular online meetings between local units, regional units (hospital districts) and those at national level is vital.
At present, for a population of 5.5 million, Finland has had 8,002 cases and 334 deaths,3 a rate of 60 deaths per million population.
The UK death rate is more than ten times that figure per million population (695 per million).
Finnish doctors attribute their success, in dealing with the covid-19 virus, to clear communication which encouraged people to follow the rules, the relative remoteness of Finland, with the ability to close borders, and to some extent, good luck.
Finland has a more equal society than other countries and a government which is respected and heeded. Their good communications and clear messaging, along with their early decisive action was, we feel, the main driver of their success.
Jaana Puhakka, Finland Delegation to UEMO, Chair General Practitioners of Finland, Vice President Finnish Medical Association, City of Helsinki Social Services and Health Care Division, Finland.
Mary McCarthy, Vice President UEMO, UK Delegation to UEMO, BMA Council, RCGP Midland Faculty, Belvidere Medical Practice, UK.
Competing interests: none declared.