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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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FOOD AND DRINK

OPINION: Are tips in Sweden becoming the norm?

Should you tip in Sweden? Habits are changing fast thanks to new technology and a hard-pressed restaurant trade, writes James Savage.

OPINION: Are tips in Sweden becoming the norm?

The Local’s guide to tipping in Sweden is clear: tip for good service if you want to, but don’t feel the pressure: where servers in the US, for instance, rely on tips to live, waiters in Sweden have collectively bargained salaries with long vacations and generous benefits. 

But there are signs that this is changing, and the change is being accelerated by card machines. Now, many machines offer three preset gratuity percentages, usually starting with five percent and going up to fifteen or twenty. Previously they just asked the customer to fill in the total amount they wanted to pay.

This subtle change to a user interface sends a not-so-subtle message to customers: that tipping is expected and that most people are probably doing it. The button for not tipping is either a large-lettered ‘No Tip’ or a more subtle ‘Fortsätt’ or ‘Continue’ (it turns out you can continue without selecting a tip amount, but it’s not immediately clear to the user). 

I’ll confess, when I was first presented with this I was mildly irked: I usually tip if I’ve had table service, but waiting staff are treated as professionals and paid properly, guaranteed by deals with unions; menu prices are correspondingly high. The tip was a genuine token of appreciation.

But when I tweeted something to this effect (a tweet that went strangely viral), the responses I got made me think. Many people pointed out that the restaurant trade in Sweden is under enormous pressure, with rising costs, the after-effects of Covid and difficulties recruiting. And as Sweden has become more cosmopolitain, adding ten percent to the bill comes naturally to many.

Boulebar, a restaurant and bar chain with branches around Sweden and Denmark, had a longstanding policy of not accepting tips at all, reasoning that they were outdated and put diners in an uncomfortable position. But in 2021 CEO Henrik Kruse decided to change tack:

“It was a purely financial decision. We were under pressure due to Covid, and we had to keep wages down, so bringing back tips was the solution,” he said, adding that he has a collective agreement and staff also get a union bargained salary, before tips.

Yet for Kruse the new machines, with their pre-set tipping percentages, take things too far:

“We don’t use it, because it makes it even clearer that you’re asking for money. The guest should feel free not to tip. It’s more important for us that the guest feels free to tell people they’re satisfied.”

But for those restaurants that have adopted the new interfaces, the effect has been dramatic. Card processing company Kassacentralen, which was one of the first to launch this feature in Sweden, told Svenska Dagbladet this week that the feature had led to tips for the average establishment doubling, with some places seeing them rise six-fold.

Even unions are relaxed about tipping these days, perhaps understanding that they’re a significant extra income for their members. Union representatives have often in the past spoken out against tipping, arguing that the practice is demeaning to staff and that tips were spread unevenly, with staff in cafés or fast food joints getting nothing at all. But when I called the Swedish Hotel and Restaurant Union (HRF), a spokesman said that the union had no view on the practice, and it was a matter for staff, business owners and customers to decide.

So is tipping now expected in Sweden? The old advice probably still stands; waiters are still not as reliant on tips as staff in many other countries, so a lavish tip is not necessary. But as Swedes start to tip more generously, you might stick out if you leave nothing at all.

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