Opinion: Sweden, don’t gamble with patients’ coronavirus symptoms

Swedish healthcare professionals must be careful not to dismiss the experience of coronavirus patients since we still know so little about the virus, writes Lisa Bjurwald in her column for The Local.

Opinion: Sweden, don't gamble with patients' coronavirus symptoms
File photo of a rehabilitation clinic for coronavirus patients in Sweden. Photo: Pontus Lundahl/TT

62 days. 78 days. 90 days. Weeks, then months of being bed-ridden with a high fever and chest pains, out of breath from trying to grab a glass of water. A large, unknown number of Swedish residents are suffering from drawn-out cases of confirmed or suspected Covid-19.

Now, as journalist colleague Agnes Arpi and I can report in today's ETC daily newspaper, there's another factor to add to their mutual list of ailments: doctors brushing off their symptoms as anxiety or stress.

Swedish healthcare has a high overall standard. Indeed, many foreign residents (not least those coming from countries where specialist care is expensive or inaccessible) still extol the virtues of Sweden's mostly free healthcare, even though it has simultaneously fallen to the bottom of many international surveys.

A case in point: Before the pandemic, Sweden had the lowest number of available hospital beds relative to population in the entire European Union, something the Swedish Medical Association has slammed as “a disaster”.

There's also been a large increase in the time you have to wait for planned surgery. According to the so-called Vårdgarantin ('care guarantee'), the maximum waiting time is supposed to be 90 days. In 2019, almost a third of patients (29 percent) had waited longer than that – up from 12 percent in 2012.

But when the Swedish healthcare system works, it often works brilliantly. That's why this phenomenon is so shocking.

A temporary coronavirus testing tent set up outside Södertälje Hospital. Photo: Pontus Lundahl/TT

In Facebook groups for Covid sufferers and our extensive interviews, affected men and women of all ages and backgrounds share nightmarish stories of having their Covid symptoms ignored and put down to anxiety, stress or depression by the medical profession. One recent poster was even sent to the emergency psychiatric ward.

This in the middle of a pandemic now declared the worst global health emergency the WHO has ever faced. Many of the displayed symptoms should be well-known by doctors and nurses by now, and many are hard if not impossible to fake, such as low oxygen levels, fever and a lack of taste and smell.

“You just don't want to go to work, do you?” pre-school teacher Åsa was humiliatingly told by her local GP. “But I love my work,” she exclaims in our interview. “I even miss ‘my' kindergarten kids when I'm on holiday!”.

Another woman, a young Stockholm-based mother of two, was formally diagnosed with anxiety. After insisting for months, sometimes despairing and even agreeing to try online therapy at one point, she was finally allowed a lung x-ray examination. It turns out she was likely to have had several blood clots in one of her lungs (a well-reported sign of Covid-19). As one interviewed doctor admits, undiagnosed and untreated blood clots in the lungs could result in death.

Coronavirus antibody tests. Photo: Johan Nilsson/TT

Whether all of the numerous long-term sufferers can be proven infected or not is beside the point. For starters, the current antibody tests and the conclusions drawn from them have come under heavy criticism lately, as they seem to fail to pick up a sign of infection in those who fell ill at the beginning of the outbreak.

American scientists have even reported that the tests we have to make do with for now can fail to detect an ongoing infection. Many of those who've been sick for months have beaten the virus itself, but are suffering from the severe after-effects science is only just beginning to chart and understand, ranging from lingering tiredness to frightening neurological damage.

All of this means that the experience of patients should carry more weight than in normal, non-pandemic times. The Swedish medical profession needs to be humble in the face of this. They should admit that they're still learning about the virus, keep an open mind, and show empathy for the afflicted.

And here's the part where the individual resident in Sweden can make a difference.

Almost all of our interviewees tell us that they've hesitated seeking help because they didn't want to burden the Swedish healthcare system. Having seen the media's dramatic footage of people gasping for air hooked up on ventilators, they all reasoned that “well, I'm not actually dying, so I'll wait a little longer…”.

It's a sympathetic attitude, of course, but counter-productive. Better safe than sorry, especially now that our emergency wards aren't as strained as during the first stretch of the pandemic.

From a societal standpoint, it's a bad idea not to keep track of thousands of individuals who could be contagious. Every single person sent back to work like Åsa risks infecting several others, even starting a local cluster of Covid infections.

Thus, you could argue that it's your moral responsibility to get any symptoms of Covid-19 checked up. And if the doctor claims your headache, cough and high fever are probably just stress-related? Call the press – why not The Local.

Lisa Bjurwald is a Swedish journalist and author covering current affairs, culture and politics since the mid-1990s. Her latest work BB-krisen, on the Swedish maternity care crisis, was dubbed Best reportage book of 2019 by Aftonbladet daily newspaper. She is also an external columnist for The Local – read her columns here. Do you agree or disagree? Share your thoughts in the comments below.

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OPINION: How I learned that Sweden is a nation of secret queue-jumpers

Swedes have a reputation as a nation of orderly queuers. But it doesn't take long living here before you realise that for things that matter - housing, schools, health treatment - there are ways of jumping the line.

OPINION: How I learned that Sweden is a nation of secret queue-jumpers

Soon after my daughter was born, I emailed Malmö’s sought after daycare cooperatives to get on their waiting lists. 

I didn’t get an answer from any of them, so a year later, I began dropping her off at the daycare allotted to us by the municipality. 

It was housed in a concrete structure so grim-looking that it was used as the gritty backdrop to the police station in The Bridge, the Scandinavian Noir crime drama based in Malmö. Getting there involved taking a lift that frequently smelled of urine. The rooftop playground was (after we had left) used by local dealers to stash drugs.

But to be fair, it was close to our house and in other ways, perfectly adequate. 

A year later, though, I got a call from one of the cooperatives I had emailed. My daughter Eira was next in line. Did I want to come to meet the staff and existing parents?

When I arrived, I discovered I wasn’t alone. My friend, a Swede looking to establish herself in Malmö after a decade in London, was there, as were several others.

Listen to a discussion about queue-jumping on Sweden in Focus, The Local’s podcast. 

Click HERE to listen to Sweden in Focus on Apple Podcasts, Spotify or Google Podcasts.

I soon had a distinct feeling of being outmanoeuvered, as I watched her identify the parents in charge of new intakes and get to work on them, asking intelligent questions, demonstrating her engagement, and generally turning on the charm. 

A few days later I discovered that, even though I’d been told Eira was top of the list, my friend’s son had got the place. 

This was my first lesson in Swedish queuing, and it is a pattern I’ve seen time and time again.

Swedes, I’ve learned, generally respect a queue if it’s visible, physical, and not about anything particularly important. But when it comes to waiting lists for things such as housing, schools, and healthcare, many people, perhaps even most, will work their contacts, pull strings, find loopholes, if it helps them jump the line. 

When it was time for the children of the parents I knew to go to school, several of them — all otherwise upstanding law-abiding people — temporarily registered themselves at the addresses of friends who lived near the desirable municipal options, and then, after their children got places, moved back.

When I protested weakly that by doing this were depriving someone else’s child of their rightful place, they simply shrugged. 

When Eira joined Malmöflickorna, a dance gymnastics troupe that is a kind of Malmö institution, the other parents whispered to me that joining the troupe helped you get your child into Bladins, Malmö’s most exclusive free school, as the troupe had longstanding links. 

When it comes to accessing health treatment, I’ve learned, it doesn’t pay to stoically wait in line. When I was recently sent for a scan, I immediately rang up the clinic my primary health care centre had chosen for me. The receptionist spotted a time that had just become free the next day, and slotted me in, saving what could have been months of waiting. 

If you’re looking to buy a house, I’m told it pays to develop good relationships with estate agents, as sometimes they will sell a house without even listing it. And there are all sorts of ways to jump the long rental queues in Swedish cities, some involving paying money, some simply exploiting contacts. 

I’m not, myself, much of an operator, but I’ve also learned to take advantage of any opportunities that crop up. 

A year after we had lost our battle for the daycare place, the same Swedish friend got in touch. She had managed to upgrade to an even more sought-after cooperative. (This one has had world-famous novelists and Oscar-contending film directors as present and former parents.)

There was a place free, and she was in charge of the queue. Did we want it for Eira? The queue at this daycare, I soon discovered, was pure fiction. The municipality has since cracked down, but at the time, places went to the friends and contacts of whichever parents happened to be on the board, or failing that, to people in the queue who seemed the right kind of person. 

It didn’t seem right, but of course, we took the place.