No lockdown: The experience of a researcher in the neuropsychology of aging in Sweden during the coronavirus (COVID-19) outbreak

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Journal Identiﬁcation = NRP Article Identiﬁcation = 0599 Date: June 21, 2021 Time: 5:3 pm

doi:10.1684/nrp.2020.0599

REVUE DE NEUROPSYCHOLOGIE

NEUROSCIENCES COGNITIVES ET CLINIQUES

105 Point of view

Rev Neuropsychol

2020 ; 12 (S1) : 105-7

No lockdown: The experience

of a researcher in the neuropsychology of aging in Sweden during

the coronavirus (COVID-19) outbreak ^*

Le conﬁnement n’a pas eu lieu : expérience d’une enseignante- chercheuse en neuropsychologie du vieillissement en Suède pendant la crise du Coronavirus Covid-19

Grégoria Kalpouzos

Aging Research Center (ARC), Department of Neurobiology, Care Sciences and Society, Karolinska Institutet & Stockholm University, Tomtebodavägen 18A, 17165 Solna, Suède

<gregoria.kalpouzos@ki.se>

To cite this article: Kalpouzos G. No lockdown: The experience of a researcher in the neuropsychology of aging in Sweden during the coronavirus (COVID-19) outbreak.Rev Neuropsychol2020;12(S1):105-7 doi:10.1684/nrp.2020.0599

S

ince 2008, I work as a researcher in Sweden in the ﬁeld of neurocognitive aging. Although Sweden did not impose a lockdown to its population, some decisions taken by the government and facing myself to my responsibilities put me in a singular position during this period.

Context

Sweden is one of the few countries where the population was not forced to a lockdown during the initial stages of Covid-19 pandemic. Instead, health recommendations have been provided to the population to limit virus propagation, such as social distancing, working from home if possible, avoiding traveling within the country and abroad, sneezing and coughing in bent elbow, washing hands often, and stay- ing at home in the presence of symptoms, even mild ones.

Persons aged above 70 years old have been particularly urged to stay home. Although the streets in Stockholm do not seem as empty as in other capitals of the world where a strict lockdown has been carried out, the population generally

∗This article is an English language translation of the following article: Kalpouzos G. Le conﬁnement n’a pas eu lieu : expérience d’une enseignante-chercheuse en neuropsychologie du vieillissement en Suède pendant la crise du Covid-19.Rev Neuropsychol2020 ; 12 (2) : 229-31 doi:10.1684/nrp.2020.0579.

Correspondence:

G. Kalpouzos

follows the recommendations of the government. This com- pliance comes from the trust that the people have toward its government and vice versa: the inhabitants, informed of the risks, take their own responsibilities.

More targeted decisions have nevertheless been taken in the country, such as for instance the closing of the universities for the students, the ban of public gathering of more than 50 individuals, the ban of visiting nursing homes, and strict safety rules for bars and restaurants.

At the University

Closing of the universitiesdoes not mean that all activ- ities have stopped: interrupted on-site teaching was traded for distance teaching if possible. Hence, most teachers had to adjust quickly to another style of teaching, myself included. This is one of the two points I expand on fur- ther below. The Karolinska Institute is a medical university with intensive research activity. Researchers have been rec- ommended, not forced, to work from home. Besides, no recommendations have been provided to researchers who were collecting data face to face from human subjects (the second point I will expand on). Each laboratory at the institute had to make its own decisions, or, at least, provide recommendations to its employees.

At the Aging Research Center (ARC), we discussed promptly about our ongoing research protocols in the neu- roscience of aging and epidemiology ﬁelds, as we had to make decisions, particularly given the fact that our protocols mostly include older individuals.

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106 Point of view

Interrupted research

Making the decision to interrupt my data collection has been difficult and frustrating. I have not been forced to do so, but made this personal decision based on discussions I had with the epidemiologists of the center as soon as the first covid-19 cases were detected in the country. The main argument has been that, from an ethical perspective, it was not acceptable to expose our participants to such a risk (when they take the public transportation to come to us, for example). Decision making has been simultaneously gradual and fast. I appreciated the open and continuous discussion I had with the director of ARC about this decision making. I first cancelled data collection of participants aged above 70 years old, but maintained all the other, younger individuals. The day after, I changed the age limit to 65 years (and then to 60, later in the day). The day after, I cancelled all younger adults who were booked but had not had any visit yet, although I maintained those who were in the middle of data collection (each participant undergoes 3 visits on separate days, one at ARC, one at the memory clinic, and one at the neuroimaging center). The day after, I cancelled everybody; indeed, there were just a couple of subjects left on our schedule. Despite the frustration I felt from stopping abruptly data collection, I also felt relieved, because I was not going to feel guilty for a participant who could have been infected, then sick, who could have died even.

The days following interruption of data collection, I was quite confident; I was thinking that the situation was not going to last long, and that I could resume data collection soon enough. Concurrently, the memory clinic announced that it was closing “until things get better”; in contrast, the neuroimaging center remained open. This specific situation of mine reflects the general policy of the country, where each structure decides to close or remain open, or to remain open with restrictions. Hence, even if I had made the decision to continue data collection, I would not have been able to proceed with blood sampling at the memory clinic.

Days and weeks had passed, and the situation was not getting better. Did I imagine that suddenly, one day, they were going to tell us “It is finished now, there is no risk anymore, you can go back to normal life”? As many people, I check every day the graphs showing the number of dead and those in intensive care. The progression seems so slow, and I wonder whether I have to wait that all figures drop to zero to be able to resume my data collection. Do I have the right to resume it and not feel guilty if all figures have not completely reached zero?Theyalso speculate about a second wave. Will Sweden escape? Will I have the time to collect some data in between the first and second waves?

There are so many questions without a clear-cut answer.

Inertia prevents me from making the decision to resume my research protocol.

France just came out of its lockdown, but here in Swe- den, nothing has changed. The last update on the Karolinska

Institute website is from April 7 and is about general recommendations. I postpone to next week my decision making about my protocol.

Teaching

I am in charge of a one-week doctoral course on normal and pathological aging. This course is open to all doctoral students and postdocs of the world. Created in 2015, it takes place once a year at ARC. This year, the course was planned for 11-15 May. Fifteen students had signed up, eight were students at the Karolinska Institute (one of them physically being in the USA), ﬁve others from other Swedish towns, one from Scotland and one from Finland.

Here too, when the university announced, in March, the shift from on-site to distance course, we thought that there was time for things to come back to normal, and our course would take place as planned on-site at ARC. Week after week, we started to realize that the course would not take place on-site. I had the choice to either cancel the course, or to shift quickly to an online version of it. This is a very active course with several seminars involving group discussions and presentations, as well as hands-on exercises where the students conduct neuroimaging analyses. At ﬁrst glance, the teaching methods for this course do not look compatible with distance teaching. Cancelling the course felt like an easy solution, although I would have considered it as a fail- ure. And if something else happens next year, would I have to cancel the course again?

After a discussion with all teachers who accepted the challenge, I announced to the administration and the students that the course was going to shift to an on-line format.

Everybody was pleased with this decision. Without going into the detail of the reorganization of the course (it was hell!), let me summarize it as follows: the technological tools we have at our disposal via the internet have been decisive.

Today, we had the second day of the course, dedicated to hands-on tasks. It was the part of the course where I had doubts about its success. Will students manage to download and install all the softwares and perform the analyses? The answer is yes. I have been amazed that all went according to plan. With the help of tutorial videos and on-line demon- strations, the hands-on actually worked better this time than on previous on-site occasions. I am conﬁdent for the rest of the course.

Last week, with colleagues from the department, we discussed the possibility for the future to perform “hybrid”

courses, where teaching can take place both on-site and online. I do not see any obstacle in doing the course as a complete distance one. We have discovered several advantages, notably the possibility to record lectures and seminars, so those who cannot attend or those with a major time difference could watch videos at a more appropriate time for them. This teaching system opens up to the rest of the world, where students from anywhere can attend without having to travel.

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107 Point of view Conclusion

In Sweden in general, and at ARC in particular, rules are not all imposed by the government or the head of the university, and this makes personal decisions difﬁcult in some cases. At the level of responsibilities, things might have been easier if the university had simply ordered me to stop my data collection, and then resume it. What is unquestionable in the ﬁeld of neuropsychology is that there is no choice in how to collect data, we need to meet face to face with the

subjects and patients. In contrast, a choice is possible for teaching methods, namely distance teaching. I believe that this type of teaching will be more used in the future, allow- ing better accessibility to higher education throughout the world.

Conﬂict of interest none.