How We Dealt with Coronavirus: Norway

Norway’s prime minister says she regrets closing schools, but should she have gone all the way and embraced the Swedish approach? Let’s ask state epidemiologist FRODE FORLAND and Nordic reporter RICHARD ORANGE…

Frode Forland

Norway’s State Epidemiologist

I think we always had in mind that a new pandemic would spread like an influenza epidemic: that 25 per cent of the population would get seriously ill and the spread would eventually cover maybe 70 per cent of the population until you get herd immunity.  But when China imposed a strict lockdown on Wuhan, and the strategy was copied by other Asian countries, our team began to have second thoughts.  We thought: ‘this is working’. When that knowledge filtered into our systems, we had to revise our models. We thought, ‘there are other ways of dealing with this than just letting it go’.  

We saw there were a number of things there that were different in this epidemic from a normal influenza pandemic: It was much more contagious, and it was much more serious: the fatality was maybe being five times as high, and the infectiousness was maybe three times as high. There was also growing evidence of asymptomatic transmission. These discussions were taking place in early March between the Norwegian Institute of Public Health, the Directorate of Health, the Health Ministry, and the country’s advisory forum for preparedness.  But then Norway’s Prime Minister Erna Solberg, perhaps after seeing the decisive actions taken by her Danish counterpart, took the decision to seize control and put Monica Mæland, the Minister of Justice, in charge.  There was this lifting of the whole issue to the government, and then they said we need to take a whole of government approach and close down society, using a precautionary principle, to get control.

Richard Orange

Nordic reporter for The Telegraph

Last month, Norway’s prime minister, Erna Solberg, admitted it wasn’t necessary to close schools. “I probably took many of the decisions out of fear,” she admitted, reminding people of the terrifying images then flooding in from Italy. She is not the first Norwegian to conclude that closing schools and nurseries, making everyone work from home, or limiting gatherings to a maximum of five people might have been excessive. “Our assessment now is that we could possibly have achieved the same effects and avoided some of the unfortunate impacts by not locking down, but by instead keeping open but with infection control measures,” Camilla Stoltenberg, NIPH’s Director General (and the sister of NATO head Jens Stoltenberg) said in an interview last month.

Nobody doubts Norway’s success in bringing the virus under control, but this success has come at a prohibitive social and economic cost. An expert committee charged with carrying out a cost-benefit analysis into the lockdown measures in April estimated that they had together cost Norway 27 billion NOK (£2.3bn) every month. With only 0.7 per cent of Norwegians infected, according to NIPH estimates, there is almost no immunity in the population. An expert committee concluded last Friday that the country should avoid lockdown if there is a second wave of infections. Norway’s current strategy, using testing, contact tracing and home isolation, would be best, a report concluded. But if this ‘keep down’ strategy fails to prevent a surge in cases, a ‘brake strategy’, which aims to suppress the rate of transmission but not bring it below 1, would be preferable to a lockdown. According to the report, a brake strategy would cost as much as 234 billion NOK (£20bn) less than an ‘unstable keep-down’ scenario, if you assume that those infected gain immunity and that no vaccine is developed until 2023. But it would also lead to a little over three thousand additional deaths.  

One measure that no one thinks should be reimposed is school closures. The committee estimated in April that the measure had cost 6.7 billion NOK (£520m) a month, while at best having ‘little impact’ on the spread of infection. NIPH has gone further, suggesting school closures may even have increased the spread. Margrethe Greve-Isdahl, the doctor who is NIPH’s expert on infections in schools, said that if schools hadn’t been closed, they could have played a role in informing people in immigrant communities, which were hit disproportionately hard by the epidemic, of hygiene and social distancing rules. “They can learn these measures in school and teach their parents and grandparents, so at least for some of these hard-to-reach minorities, there might be a positive effect from keeping kids in school,” she said. There were also fears in late March and April that adolescents were spreading the virus more out of schools than they would have been in them. But perhaps the main reason Norway is unlikely to close schools again, whatever happens in future waves of infection, is the recognition of the impact on the most vulnerable pupils. “There’s now a lot of information available on how it has impacted negatively on the economy and on vulnerable children. Their whole care system has kind of collapsed,” Greve-Isdahl says. “I think there would be it would be difficult to impose heavy restrictions again.”

Norway, it seems, has already decided a second lockdown is not the way to go, however much the infection flares up again. But that does not mean its prime minister has any regrets. “I think it was the right to do at the time,” she said. “Based on the information we had, we took a precautionary strategy.” It will probably never be possible to know, she added, which of the lockdown measures Norway imposed caused the number of infections to drop away so sharply, if any.

FRODE FORLAND is Norway’s State Epidemiologist.

RICHARD ORANGE is a Nordic reporter for The Telegraph.

For the latest Nordic news, follow @FikaOnlineBlog on Twitter.

Extracts of this article have also been published in The Telegraph

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