Coronavirus 1 (C1): resa, Sveriges läkarförbund, och den coronavirus: travel, Sweden's healthcare system and the coronavirus

This is a post about the coronavirus and what it looks like from Sweden. It also represents a chance to think through what we've experienced (and offers a few resources at the end). 

Travel is always an adventure, particularly so this year. As I noted in posts about sportlov, the Swedish "sport's break," this year the Swedish authorities were particularly concerned about those coming back from places with the coronavirus (like Italy). 

News of the coronavirus has obviously been mounting for weeks but hasn't seemed to have been a big deal in Europe until the last two weeks. 

Three weeks ago, my dad called, worried about coming from Oregon. A handful of British Airways flight from San Francisco to London had been temporarily quarantined on the runway due to coronavirus concerns- this would be the flight he'd be taking in a few days. We told him that while officials were tracking the coronavirus, it didn't seem to be a big deal in Europe. We left it up to him on whether he wanted to travel. He came, enjoyed the vasaloppet, headed back to Oregon, we headed to France. 

I track a lot of scientists on twitter (the positive side of twitter). I appreciate getting direct information from a range of people, including lately epidemiologists. After doing a lot of reading, I'd bought a lot of hand soap. Our apartment in France ran out of handsoap; we bought more. 

Outside skiing all day- not too worried. News of Italy started to break-- the Mount Blanc tunnel has 5,000 vehicles a day between Italy and where we were located in France. On Wednesday of our sportlov week, France closed the Louvre for cleaning. Originally, the Alps region of Italy and France didn't seem to be too affected, then a chalet of people on the Italian side were diagnosed. By the end of our week skiing, the electronic sign at the end of the ski lift listed the symptoms of the coronavirus. 

Also on Wednesday of our ski week, we'd had a crazy powder day. Chris reported feeling like he got snow in his lungs. Saturday when we went cross country skiing, Colter, Chris and Stephen raced around a bit-- Chris felt the impact to his breathing. Sunday, Colter & Chris went back country skiing- hiking up a mountain to start, with Chris feeling vague pressure in his chest. No major coughing, no fever, no other symptoms of anything wrong. Do we stay? We have no housing, no back up system. Does he drive home? It would take forever (21 hours of driving, more than 2,000 km). By this point, we'd also received about 4 messages from the kids' school about the coronavirus and what we should do (if we'd been to Italy, the kids were NOT to come to school for 14 days even if they showed no symptoms. Stephen's friend Douglas has been quarantined home due to his Italian travel). 

Monday, 2 March comes- we're due to fly home and the coronavirus news is everywhere. We washed our hands a lot, took the shuttle to the Geneva airport (arriving 4 hours early for our flight, found a corner of the waiting room, washing the seats down with hand sanitizer). Sign (pictured left) again lists the symptoms of the coronavirus. Lots of people in masks. Anyone coughs? Everyone stares... It was a long wait, but then we boarded and off we went to Paris. More masks. Onto our flight to Stockholm- not so many masks on that flight. Took the Arlanda Express to the central station, then a bus home. Between smelly ski clothes and everything we were wearing, we had a pile of laundry (and our washer is not so very big-- so this was about 20 loads?). Showers all around.

Tuesday comes- kids head off to school. Chris thinks he needs to teach a class. Goes in, realizes the class is in April. Still wonders about his tight chest. Still no other symptoms. 

In Sweden, if you need healthcare, you are supposed to call a number (1177) and ask them what you should do and where to seek medical care if you need it. Chris tried calling on Tuesday- waits on hold for a while. Leaves his number. No call back. Calls again later. It takes him until Saturday night at 11 PM to reach someone- trying every once in a while. In the meantime, he figured better to be safe than sorry and stays home to work. 

We'd already been fascinated by both the Swedish healthcare system and societal expectations. Taking these in reverse order, the societal expectations are that if you are sick (in the slightest), you don't come in. Period. Full stop. Slight sniffle? Stay home. Cough? Stay home? Kid sick? Stay home. 

This works better due to the coverage provided to people. I wrote in February about "Vabruari" - VAB is the initials of the Swedish benefit that pays you to stay home. For each kid aged 8 months to 12 years, you are entitled to 120 days of paid sick leave, with time off paid by the national health care system (the assumption that is if your kid is younger than 8 months, one parent is home on fully paid parental leave). If you are home sick, your employer pays the first 14 days of sick leave, then one is entitled to apply for additional sick leave (provided you are covered by Swedish benefits). 

As we noted in a much earlier post, all benefits are tied to one's personnummer. If you are in Sweden and have this number, you are well covered. If you are in Sweden and don't have this number, good luck to you. We had navigated the system and received personnummers. 

[As a side note, at this point, this may mean at least I have 4 types of health insurance: my US health insurance (useless here), an international policy provided by Penn State (maybe useful- haven't tried it), international insurance from Fulbright (works when I'm "working" but not on vacation), and the Swedish health care system. Presumably, the rest of the family has three of these insurances. Our main hope was to not need any of them].

Saturday comes- Elizabeth is invited on a playdate to Leo's Lekland- a kid's indoor play park. I'd been there in the fall with her for a birthday party and even then I had a visceral reaction to the germfest this must be; we declined the playdate and instead went wandering around the neighborhood to find flowers and kids playing soccer and parkour (more photos of this below). It helps that the weather has shifted from snow & sleet on Tuesday to a bit of sunshine- we are in the variable season. 

Late Saturday night, Chris finally reached someone on the 1177 number- the nurse listens to Chris and says that staying home is the right thing to do, but she's not worried that he has the coronavirus. She notes that there is a lot of flu post-sportlov and everyone traveling, but less coronavirus than may be feared. She has no worry with our kids going to school. A quiet weekend for us- lots of cleaning, movies, reading, games, blogging, sleeping, and downtime. Even some painting!


In the meantime on the European coronavirus front, the numbers keep going up, particularly in France: now 900, with four areas of clustered hot spots (one being the Haut Savoie region of the Alps, where we were- the brighter red area in the lower right). 

Cases have also been increasing in Sweden- as of Saturday, more than 3,000 people have been tested, with 161 coming back positive. One kid was diagnosed in the same school as the 8 year old daughter of the crown princess- that made the news. Sweden has broadened its testing in recent days

As well as testing those who are showing symptoms after travel abroad or who have been in close contact with confirmed cases, now the agency has recommended that all of Sweden's laboratories that are carrying out coronavirus tests look into routinely testing patients with respiratory symptoms without a known cause, with the highest priority being the most severely ill patients.

While the 1177 call in number has been jammed, the reaction in Sweden seems to be more muted- if unsure of one's health, the full societal expectation is to stay home. For example, a faculty member at Uppsala was just diagnosed with the virus-- this is part of the email I received about it from Uppsala University: 

They were infected by the coronavirus following a skiing holiday in northern Italy. They are receiving care at home and are well, considering the circumstances. They have not been at work since falling ill. Communicable Disease Control Uppsala has therefore decided that contact tracing is not necessary. Communicable disease control personnel will make direct contact with individuals that the person is known to have had contact with. Communicable Disease Control Uppsala will let Uppsala University know if the University needs to take action. As things stand, the University has not received any such instructions.

Staying home is backed by at least partial payment of one's wages, which of course helps. Contrast this to the U.S. situation and one can definitely see the benefit of universal health care and a social safety net to ensure that even the most vulnerable have access to care and get paid if they are not working.

At the point, we've also received a lot of information: from the kids' school, from each of the universities we're affiliated with, from the Fulbright program, and now, from Penn State. I have no idea how many emails I've received about what we should do- more than 20? 

It doesn't meant that adjustments aren't awkward- on Thursday, I gave a talk at a nearby university. Meeting people for the first time and then refusing to shake their hands leads of course to a conversation about the coronavirus. I think no one is quite sure how to engage with each other. 

What does this look like going forward? Perhaps for us, more of the same: working on projects from home if needed, going into the office when we can. Like with everyone, this situation does affect our potential travel going forward- a trip to southern Italy (maybe not) and Greece (on a sail boat- can we get there?) is up in the air, as are other more local trips for work purposes. We had already been contemplating some spring bike trips on weekends- seems like it may be a good way to poke around. 

In the meantime, we have plenty of outdoor areas to explore- a newly established parkour course near our apartment may be a place we spend a lot of time on for a while. 


Anyway, if you are contemplating travel to Europe for a conference, there has been a wave of cancellations- many meetings and gatherings are outright canceled or being moved online. If you are traveling for personal reasons, I'd check the local conditions. 

Planes are apparently quite empty (Chris' cousin Bob posted a picture of him on a plane by himself) but airlines are flying empty planes due to European rules about maintaining their "flight slots" at local airports; pressure is underway to change this to avoid burning fuel unnecessarily. A colleague planning to fly to the U.S. in a few weeks received a call from his airline canceling his flight (and offering a refund) to consolidate flights. Change is afoot. 

Again, I'd recommend "The Local" in whatever country you might be contemplating travel to as a good source of information. I've also found the following sources of info helpful.
More I'm sure on this, but thought it might be interesting to hear what is happening on this end.