In Sweden, COVID-19 patients are being treated in the specialized clinics of the leading university hospital

HUDDINGE (Aftenposten): At the long virus reception outside Stockholm, they screen 400-500 patients a year with severe symptoms. In Norway, the sanitary areas clause is used sparingly.

Anna Bjork, 42, walks slowly across the hall. Her roommate is there. He carries her shocking pink bag. There are 14 offices and examination rooms respectively. All covid patients reserved long ago.

She is one of the patients who have been examined and treated here in the Post-Covid Clinic of the Karolinska University Hospital. Here they meet specialists and are examined by a doctor, psychologist, physiotherapist and occupational therapist.

This May Day, I went to see a doctor at the reception. the day before with a psychiatrist with whom you meet regularly.

Björk suffered from COVID-19 two and a half years ago. She is still ill and unable to work. She had a fever almost every day.

In the past six to seven weeks, she has had a worsening of her symptoms. It rises and falls in periods.

Taking a shower is such an effort that she has to sleep for several hours afterward – even if she’s just sitting on a stool in the shower. Before that, she ran 8 km in the morning five days a week.

– Now I have 10 percent of the energy that I usually have.

She says quietly:

– I’m not me anymore. You have become another person.

The author is fumbled for words

Before she fell ill, Björk was a well-known cultural journalist, music critic and author in Sweden.

– When did you get corona? I don’t remember, she says, looking askance at her partner Matthias Bigmo.

— just before Christmas in 2020, he says.

The disease has outgrown concentration, memory and words. Too bad for Björk, who lives off language.

– I have a very poor short-term memory. And I find it difficult to hold the string when I speak. I find the words, and I can’t find what to say.

Bjork speaks in short sentences. During the interview, she squinted her eyes several times to be able to focus.

Only the sickest people are allowed to come to the reception

Long-starved patients who come to the reception are the sickest. The condition is strict. They must have at least 50% disability due to illness. (see factbox)

“They have a great need, not only to investigate, but also to understand,” says infectious disease physician Christer Liedman.

I’ve worked at the front desk for two years. At most, he has four to five patients a day, on whom he spends an hour on the first examination. Most of them are women between the ages of 40 and 50. Most of them are highly educated. They were very active and lived to the fullest before they got sick.

– There are women who want a lot in life, says the doctor.

The offer in Norway is of little use

In Norway, there was a similar multidisciplinary presentation for chronic COVID-19 patients in every health district. Several specialists collaborated in examining patients with complex complaints.

At Southeastern Health, patients are receiving patients at the Coastal Hospital in Vestfold Hospital. 313 patients were examined/treated last year.

– In the past year, the supply has not been used in health districts, says Espen Nakstad, assistant director of health.

– We’re not sure if that’s because the need was covered in other health services, or if the population experiencing long-term effects has decreased over time, he says.

Nakstad says that people with long-term complaints after an injury are usually referred to the specialist health service by their GP, depending on which complaints are prevalent.

Bad overview

– We still lack a lot of knowledge about what is the best treatment and rehabilitation for the long-term effects after COVID-19, says Nakstad.

He points out that they had a poor overview of how many people had long-term effects after a milder course of the disease.

This is partly due to the fact that diseases are highly variable, so that different diagnostic codes are used. In part, we don’t know how many people have sought healthcare.

He says they are working to improve this mapping. Among other things, new diagnostic codes have been introduced for GPs and in the Specialist Health Service, which they hope will provide a better overview.

Norway recommends betting

In Karolinska, the doctor at a post-Covid reception believes there are many positives in having a separate reception for patients at the largest university hospital. He finds it doubtful that Norway does not have the same.

– We collect experiences around the group of patients in various professional fields. There are many research projects going on here in which our patients are involved. Although we haven’t progressed that far in treatment, we’ve learned a lot about relieving symptoms, says Liedman.

Among other things, Karolinska has started a research project where COVID-19 patients will be treated with antiviral drugs.

Why is there such a big difference between the two countries?

• In Sweden, 10,372 patients with chronic HIV were diagnosed in the specialized health care service as of May 9, 2023. Significant progress has also been made in the primary health care service in Sweden.
• In Norway, the diagnostic code is Post-infection status after COVID-19 It was used 131 times in a specialist healthcare service in 2022 and 77 times so far this year.

According to the health authorities, there may be an even greater underreporting in Norway. But it is also possible that Sweden may have more cases because more people were sick before they were vaccinated. The offer may also be well known in the neighboring country, and people have a minimum to use it.

Perhaps the coding system was not sufficiently known throughout the health service. We know there was a difference in code usage. Perhaps this is due, among other things, to the fact that it is difficult to distinguish the symptoms of other pathological conditions from the Covid-19 virus. There may also be patients with coronavirus-related illnesses without knowing if they have COVID-19, Nakstad says.

Therefore, the diagnosis becomes difficult in many cases, especially after a long time has passed.

Norwegian Covid Association: – Swedes are more offensive

According to the Norwegian Covid Association, there are several possible reasons why patients do not come to long-term Covid clinics of healthcare institutions.

– The first thing you should check when patients do not show up is their special offer. Based on the experiences we hear about, it seems a bit haphazard in how clinics prepare for treatment.

This is what the chair of the board of directors of the association, Britta Schedd-Bjornstad, said.

in April He gave the Swedish government a task It is about promoting and gathering knowledge about the diagnosis, treatment and rehabilitation of patients with late effects of COVID-19 and other communicable diseases. The establishment of a national knowledge center will be investigated. The Minister of Social Affairs said in the press conference that not enough work has been done for this category of patients.

Bjørnstad believes that the Swedes have a more aggressive attitude towards the long-running coronavirus, both when it comes to investigation, treatment and research.

Sweden seems to be more interested in the fact that the COVID-19 virus often brings with it sequelae that can and should be treated.

He notes a slight improvement in brain symptoms

Back in Huddinge, the experienced infectious disease doctor sees patients not getting better in a steadily rising streak.

– Goes up and down. We have no explanation for this.

He believes that many of the symptoms of ME and covid are quite the same.

– But breathing problems, memory loss, and smell/taste symptoms are special symptoms for prolonged starving patients. Unlike patients with ME, we see that they get better, albeit slowly.

But one thing is the lack of improvement for some COVID-19 patients:

Brain symptoms, such as memory and concentration deficits. Doctors see little difference in patients who have been with them for more than three years.

– I find it very unfortunate, he says.

Norwegian researchers also highlight amnesia as a clear symptom.

Christer Liedmann was a physician when the last breakthrough for a combination drug against HIV came in the mid-1990s. The deadly virus has been brought under control.

– I hope this hack will last for a long time, too.

Difficult to think about the future

Annah Björk wrote a book about what it was like to live with the virus for the long haul: I’m not here, it’s not happening. A daunting project based on a short diary of when she was ill. I manage to write five to ten minutes a day.

She hopes and believes that One must find out how long term covid patients can be helped.

– I have to believe it, and a lot of research is being done on this topic. But it’s hard to think about the future. It is not certain that it will improve over time. It is very uncertain.