Sweden's public health agency will this week start working with regions battling the worst coronavirus outbreaks to bring in local restrictions, as the country toughens its approach to ward off a resurgence in infections. The rules, which come into force on Monday, empower regional health authorities to instruct citizens to avoid shopping centres, museums, libraries, swimming pools, gyms, sports training, sports matches, and concerts. It also empowers them, in consultation with the agency, to instruct people to avoid public transport or to avoid visiting the elderly and others in risk groups. "It's more of a lockdown situation - but a local lockdown," said Johan Nojd, who leads the infectious diseases department in Uppsala. The number of cases in Uppsala has soared ten-fold in recent weeks, with 185 cases per 100,000 over the past fortnight. The number of new cases in Sweden has been climbing since the start of September, with a seven-day average of 65 per million people per day reported to the European Centre for Disease Prevention and Control on Friday, compared to 71, 40 and 25 cases per million in Denmark, Finland and Norway respectively. Dr Nojd will hold a meeting with Sweden's state epidemiologist Anders Tegnell on Monday to discuss which of the available measures to put in place. He said he was currently considering instructing people not to visit the elderly or others in a risk group, and also to avoid unnecessary journeys, particularly on public transport. If contract tracing were to show links between infections and other places or activities, he said he would not hesitate to impose further measures. "Perhaps tomorrow we will have several talking about concerts or restaurants and then perhaps one could say, 'in Uppsala now for two or three weeks it is the Public Health Agency's advice not to sit in restaurants late at night'." Bitte Brastad, chief legal officer at the agency, described the new measures as "something in between regulations and recommendations". They are the strongest recommendation the authorities can make but - unlike in other countries - do not bring fines for non-compliance. Dr Joacim Rocklov, professor of epidemiology at Umea University, said that the new local measures showed Sweden quietly shifting strategy. "What's happened in the last couple of weeks is a movement towards a similar model to what has been used in Norway and many other countries," he said. "It's very obvious that it's a new strategy, but still the newspapers report on 'the Swedish strategy' as if it were fixed in March." Norway in March closed down restaurants, cafés, bars, and hairdressers, with those that defied the order fined for non-compliance. That would not be the case under Sweden's new approach, although if a city issued a strong recommendation not to visit restaurants or hairdressers, many might close. Dr Rocklov said that he believed that the resurgence in infections in Stockholm and other cities that suffered many cases in the spring, such as Milan and Madrid, had challenged the Public Health Agency's belief that immunity in the population might soon start to suppress the pandemic. "I think they must have been shocked by that, after all these strong claims that we were closing in on immunity in April and May. They must have realised that that's not really the case." Dr Tegnell said on Thursday that the autumn resurgence in infections had changed his agency's understanding. "I think the obvious conclusion is that the level of immunity in those cities is not at all as high as we have, as maybe some people, have believed," he said. "I think what we are seeing is very much a consequence of the very heterogeneous spread that this disease has, which means that even if you feel like there have been a lot of cases in some big cities, there are still huge pockets of people who have not been affected yet." A preprint study published last week by Stockholm University maths professor Tom Britton - one of Sweden's foremost epidemiological modellers - found that even with more than 20 percent of the city's population immune, the city still needed to impose preventive measures to prevent a resurgence in cases. "Immunity is a little bit on our on our side, but there is still a substantial risk for future outbreaks in Sweden," Dr Britton said. "If we did not care anything about any restrictions or preventive measures, then I think we would see a big second wave, not as big as in the spring, but still a big one.