In August 2018, my husband and I left London for the colder, darker, but Brexit-free, climes of Sweden. With rose-tinted glasses firmly on, we were excited to live in a country famed for its keen sense of equity, entrepreneurial spirit and pragmatic stylishness. With our own mushroom foraging spot identified, a firm opinion on the best fika and matching Sandqvist bags, we were viewing houses with a firm 3 to 5-year plan for our life in Sweden… and then came COVID-19. How quickly the traits we admired so much, had become so alien in light of a pandemic !

I am an infectious disease epidemiologist. I work on diagnosis and management of paediatric pneumonia in low-income settings for nearly 8 years. Epidemiologists are having a moment, CMO’s and State Epidemiologists have suddenly become household names!  So while this global tragedy is unfolding, I’ll admit, I have not felt so academically stimulated or inspired in a long time. I was ready to dive in.

So why am I spending most of my time shouting on Twitter instead of saving the world? What happened to my image of holding governments to account, engaging in effective communication of epidemiological concepts, consolidating student learning through real time discourse on the politics of public health? Without a family in Sweden, or a wide network of Swedish friends, my main outlet for human interaction and assimilating with local culture was work. As we have been working from home, I’ve lost my anchoring in the Swedish perspective and miss the ability to informally sense-check what is happening. And so, like many, I have taken to social media to look for elusive answers and  debate on key issues in the Swedish COVID-19 response. I sit at home reading the calm and confident local media next to growing death counts and increasingly think I am being gas lit by a whole culture. Coupled with genuine concern for the preventable deaths if Sweden continues on its current course, I can feel my shouting getting more and more frustrated. I wonder, have I become a troll in this culture?

Sweden has a strong culture of trusting authority, and trust seems to be equated with not questioning. As a Brit, trust of authority is not necessarily something that comes easily/ Criticising politicians with a drink in hand is practically the national pastime. However, I can adapt to be more trusting, after all Sweden ranks highly in terms of equity and corruption, so I have little reason to distrust the authorities here. However, I find it harder to adopt a culture of trust without question. I want to hash it out, look at the data, clarify things I don’t understand, put forward alternative hypotheses. This is what epidemiologists have been trained to do! But in a culture where standing out is frowned upon, at what point does asking difficult questions make you seem like a trouble-maker and not a good scientist?

My research has been predominately based in Malawi, Nigeria and Bangladesh, always working in partnership with local NGOs and academic institutions, who lead public dialogue and engagement with government. I have always felt these are open and constructive partnerships, and deferring to local expertise when ensuring the science is acceptable and relevant to the context. We have had disagreements, I’ve had my assumptions challenged, been told the protocol won’t work in that setting, and asked for things that in retrospect were inappropriate. But all of these conversations, whether comfortable or not, have not only been welcomed but ultimately enjoyed. Because to me, this is science. Transparent and critical but always respectful.

Even though I see myself as scientist, and not troll or troublemaker, I keep coming back to the thought that it should be Swede’s leading these challenges. I would not challenge a government position directly in Nigeria or Bangladesh, so why would I think I can do it in Sweden? The difference in this case is that I am employed in a Swedish academic institute, which confers an element of power and responsibility. COVID-19 will need strong institutions to lead, innovate and importantly advocate for evidence-based policies. So while the lack of cultural grounding is a disadvantage, I do  believe that when arguments are scientifically sound, they are more valid. Indeed, wouldn’t the inclusion of more marginalised and outside perspectives enrich the discussion? Stockholm, like many global academic hubs is multi-cultural and reaps the benefits of this, and I can see no reason why a national COVID-19 response would not want to use the full potential on its doorstep. But I’m sure I’m not be the only epidemiologist far from home who feels out at sea…

About the author:

Carina King is an Infectious Disease Epidemiologist . Carina is based at the Department of Global Public Health, Karolinska Institute in Stockholm and affiliated to the Institute for Global Health, University College London. Her research focuses on improving the diagnosis and cases management of paediatric pneumonia in low-income settings (@CarinaTKing).

 Competing interests:

I have read and understood the BMJ Group policy on declaration of interests and declare that I have none.