Zdrowie Publiczne i Zarządzanie 2020; 18 (1): 59–64

www.ejournals.eu/Zdrowie-Publiczne-i-Zarzadzanie, doi:10.4467/20842627OZ.20.005.12659

Norway’s strategy to cope with Corona pandemics

Danuta A. Tomczak

Østfold University College, associate professor dr, Halden, Norway

Address for correspondence: [email protected]

Abstract

Pandemics sudden influx claimed reaction from national authorities to protect their societies and ensure an operative functioning of the public health
care. This article explains how the Norwegian government reacted in this unpredictable situation, which lockdown option was chosen and what eco-
nomic consequences the applied measures might bring. How to weight public health against economic offers and future downturn? Trade-offs are
compound and it is too early to conclude which country has made the best choice.

Key words: health care, pandemic, state policies, globalisation failures

Słowa kluczowe: ochrona zdrowia, epidemia, polityka rządu, błędy globalizacji

Introduction is not obliged to follow the given recommendations, and

makes decisions out of its own assessment of the required
Norway – as many other countries, chosen to lockdown security. The RCU members are: The Norwegian Institute
the country from 12th of March to prevent spread of in- of Public Health and The Norwegian Health Directorate,
fection by COVID-19 virus, but comparing with other represented by the Director-General of each, and the
Nordic neighbours the regulations framework was `in government members – the respective ministers and the
between` – less restrictive than in Denmark and Finland, prime-minister. Institute of Public Health (www.fhi.no)
but more restrictive than in Sweden and Iceland. Since and Health Directorate (www.helsedirektorate.no) work
the 11th of April and so beginning of May several restric- out professional analyses and conducts research, submit-
tions have been removed or eased, to attempt return to ting their expert opinions to the Ministry of Health and
“normal life”. Here the introduced regulations, economic Social Care. The current information on number of tests,
support, and their impact so far, are presented. The large infected persons, hospitalized patients, patients under
number of hasty decisions and actions raised up the de- intensive treatment and number of deaths are reported
bates on outcomes of the above for public health and the by local authorities – the municipal physician – to the
society. Institute of Public Health. Institute is under Ministry of
Health and Social Care.
1. The pandemics regulations and decision-making The decisions made 12th of March to cope with pan-
demics were following:
authorities • Closing kindergartens, schools and other educational
The decisions on strategy towards public health protec- institutions; distance learning
tion, rules for regulations and economic support, due to • Home-based office for personnel of most institutions
pandemics, have been made by the government, repre- • Closing training centres, hairdressers, theatres etc
sented by prime minister and relevant ministers (of health • No sport- and cultural arrangements
&social care, justice, education, finance). • No visits in older people homes & nursing institutions
Actions and decisions are prepared and discussed in • No more than 5 persons together, keeping 2 m distance
the RCU – The Government Corona Board, where par- • No flights abroad and limited capacity of local flights
ticipated Health institutions give their professional rec- • No travel to leisure houses outside own municipality
ommendations, but government decides. The government and closing of skiing centres

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• Border controls, no access for persons not living or 2. The pandemic expansion
working in Norway
• Home quarantine to weeks after arriving from abroad There is no clear picture neither in Norway nor in any
or being in contact with a virus-infected person country of virus dissemination, because number of done
• Staying at home, not travelling, limited using of pub- tests is not sufficiently high. Only people with clear Co-
lic transport was recommended rona-symptoms, hospital personnel, military, have been
Shops, coffees, restaurants could decide self to keep tested. There is also proved that some infected persons do
open or close, but have to introduce new routines for not have symptoms and do not get sick. Virus has been
cleaning, disinfection and control of distance between transferred to Norway from crowded bars in Ischgl, Tirol,
customers/limiting number of available tables/sitting Austrian Alps by skiers, most of them from Oslo region,
places. It was and still is obligatory to wash hands before in February. Hospitals were ordered to prepare special
entering a shop, pharmacy, coffee bar. subdivisions for COVID-19 infected, and increase ca-
It was allowed to go out, walk outside without time pacity by postponing scheduled ordinary patients’ treat-
limit, go shopping, going to restaurant if rules for keep- ment. As the storage of protection outfits and equipment,
ing distance and number of people together were hold. mostly imported, has been quickly drained, so local com-
Citizens are currently informed on pandemic spread panies shifted to production of protection dresses, face
in their home location. Local municipality authorities masks, shields. Neither in Norway nor in Sweden face
and the municipal physician send link to phones of the masks have been imposed to be applied in public plac-
inhabitants where they find updated information on es. In the health authority’s opinion face masks do not
municipality`s virus spread, current rules to follow, num- help against spreading of virus, and may have the oppo-
bers of tested persons, numbers of infected, hospitalized site effect, because people wearing mask touch face with
and dead of virus. There is also information on how to hands much more often than otherwise, and can transmit
contact health centre in case of suspected infection and virus from hands to mouths, eyes and body.
testing options, and where to call with questions. For per- Communication of facts, due to media diversity, is not
sons with no symptoms, family doctors are available for a simple task, a lot of false or unofficial info circulates
consultations as before, just following the new manda- in social media. Even if officially presented numbers are
tory safety procedures. correct, so the context and relative values are missing, as
The applied lockdown strategy, in a lighter version what models have been applied in calculations or how pre-
than the Spanish or Italian ones, has been accepted and dictions have been made. Announcing the number of sick/
respected by majority of citizens – 90% of public opinion dead people does not say much when the listener is not
informed how many inhabitants a country or a city has.
respondents agreed with that the government approach
First- number of tested persons helps to judge how
was correct. Anyway, it raised debates in both direc-
good proved the number of infected persons might be.
tions – for more restrictive and much less restrictive tac-
It is tempting to conclude that the lockdown strategies
tic should have been applied.
were more effective than the “Swedish model” – prevent,
Easing of restrictions 7th of April and 7th of May:
not lock, to breed the flock immunity - but, in my opin-
• Pandemics regarded under control 7.04. – kindergar-
ion, it is too early to evaluate the reasons for differences
ten opened from 20.04. and schools 1–4 class from
and results for each listed society. We need additional
27.04., all primary schools from 11.05.
factors to analyse and longer observation period to get
• Hairdressers, physiotherapist, dentists a.o. can open
the credible explanation. Age-structure of population
from 27.04.
might be one of these factors, urbanization and composi-
• Travel to leisure places allowed from 20th of April
tion of population another ones. Hans Bergstrom points
• Cinema, theatres, concerts can be hold from May 15th out (Bergstrom 2020) that 25% of Swedish population
for max 50 people is of non-Swedish descent, and immigrants are highly
• From June number of participants of organized ar- overrepresented among COVID-19 death. It is just an
rangements can increases to 200 example, which may contribute to explain higher death
• Sports training is allowed under safety regulations, frequency in Sweden.
and football games without public from June 15th Concerning Norwegian lockdown strategy, it was
• From 15th of May private meetings at home can gath- recently debated and questioned why the government
er up to 20 people, keeping 1 m distance decided to force much stronger restrictions than recom-
For all the above apply rules on hand hygiene, dis- mended by the health authorities. They did not recom-
tance of 1m between persons who are not living in the mend closing of schools and kindergartens, and after
same household, and washing and disinfection of com- closing recommended to re-open 23rd of March. The
mon areas. Groups of children in kindergartens should Prime Minister answer was that the government must
not be bigger than 6 pr assistant, at school 15 (classes consider not only health, but also other factors to guaran-
1–4) and 20 (classes 5–7) pr. teacher, banks placed 1 m tee security. Another not followed recommendation has
in between. That means new organization of teaching at been the quarantine period – 14 days rule, while 10 days
schools, new classrooms and more teachers/cleaning per- recommended by Public Health Institute.
sonnel to be employed. In general, there is high level of trust to government
and public institutions, so the society followed the strin-
gent rules, believing that authorities do the best.

60 Zeszyty Naukowe Ochrony Zdrowia

 Raport 4: NORWEGIA

Norway`s Health and Social Cares minister Bent Hoeye declared that epidemic was under control 7th of April, and the government decided to
open-up gradually.
Next – what numbers are relevant for evaluating of pandemics strategies. Let us look to Nordic countries statistics.

Figure 1. Tested persons in Norway

Table I. COVID-19 overview for Nordic countries (until the 19th of May 2020)

Country Population in million Number infected Infected per 100 000 Number of Death Death per million
Sweden 10,3 30 377 234 3 698 363
Norway 5,4 8 249 155 233 43
Denmark 5,8 10 968 189 548 95
Finland 5,5 6 380 116 300 54
Iceland 0, 364 1 802 510 10 28

Source: Norwegian Institute of public Health; https://www.fhi.no/en/id/infectious-diseases/coronavirus/ downloaded 19.05.2020.

and SSB, own selection of data.

3. Economic consequences of pandemics actions Economists were concerned for costs of the lockdown
strategy. Already 7th of April the expert group, appointed
It is obvious, that sudden lockdown decisions had to be by the Directorate of Health, and led by prof. Steinar
followed with compensation for activity stop, and gov- Holden from University of Oslo, presented the report
ernment was quick and generous. To get the right picture “Socio-economic evaluation of infection control meas-
of state support, a quick notice about the Norwegian wel- ures – covid-19”. The group analysed results for three
fare state system: all people living in Norway are mem- strategies of infection control: 1. turn down, 2. turn down
bers of public health insurance system and get free access and hold, 3. slow down. The calculated costs are high,
to all medical treatment. Public schools, including tertial stretching over decennium, highest for strategy 2.
education, are free of charge, students get low-interest The Ministry of Finance presented Revised National
loan and scholarship, kindergartens are free of charge Budget for 2020 on 12th of May, with essential chang-
for low-income families; 90% of children 1–6 are in es. Deficit increases from 227,6 bill NOK to 479,6 bill
kindergartens. Employees have right to compensation of NOK, unemployment rate goes up from predicted 2,2%
62,5% of wage/salary if personnel are directed on leave to 5,9%, GNP fall is expected to be – 4%. This means
or terminated (unemployment benefit 2 years). Job seek- that Corona-related expenses, as support to business,
ers can also get state support up to three years to enhance culture, sport, tourism, municipalities a.m., are predict-
qualifications for new job. ed to be 252 billion NOK in 2020, (105 billion PZN or
The government settled hasty support packages to 24 billon US dollars). https://www.regjeringen.no/en/
almost all suffering from lockdown units, billions of aktuelt/a-budget-to-help-us-safely-reclaim-ordinary-life/
crowns run out daily, not always best targeted. id2701787/ (downloaded 13.05.2020).

Zdrowie Publiczne i Zarządzanie 2020; 18 (1)

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 Raport 4: NORWEGIA

400

300

200

100

2002 2004 2006 2008 2010 2012 2014 2016 2018

Figure 2. Norway’s money transfers from petroleum fund to the state budget (Billion NOK, current prices)
Source: Grafikk: Petter Winther/DN • Kilde Revidert statsbudsjett 12.05.2020.

Fortunately, Norway owns a  big oil fund (Govern- of schools- and kindergartens closing for future labour
ment Pension Fund Global), where incomes from petro- market. In newly published article Løken and Salvanes
leum sector have been located since 1970s, so govern- estimate the total cost of closed schools in 20 days for 11
ment has reserves to cover the worsen state budget deficit billion NOK ([9]: 19), due to lost learning. They assume
(https://www.nbim.no/en/). that the weakest groups in the society will carry most of
The current debates on government strategies for these costs.
control over pandemics, distribution of financial backing Compensation to business has also been criticised
up, plans to return to “normal life” are split over diverse as not properly targeted, especially state`s taking over
issues, so here those of common attention will be shortly labour costs of employees on leave (state pays 80% of
stated. wage from day 3) and 80% of fix costs when firms keep
closed. Many economists warn that this generous support
4. Were government’s decisions and measures against encourages to close or reduce activity instead of making
effort to keep it running. They propose to give compensa-
pandemics adequate? tion to salary budget instead of, because the lower costs
The Government has got special rights for imposing of labour for the company will stimulate to activity and
hasty Corona-decisions – the authority to add to or de- contribute to economic growth (Henriksen, [5]: 9).
part from certain legislation as far as is necessary to safe- The government`s answers emphasise that lock-
guard the intention of the law. It was passed unanimously down prevented spread of infection. Up to 18th of May
in the Norwegian parliament – Storting – on Saturday 198.362 people were tested, 8.249 reported infected, 233
21st March, first valid for 4 weeks, later prolonged to died (152 in age over 80). The R-number, which shows
27th of May. (https://stortinget.no/en/In-English/About- how many people one infected infects, fell to 0,61 (for
the-Storting/News-archive/Front-page-news/2019-2020/ 20.04. – 18.05.).
corona-act-extended-until-late-may). Parliament has A new tool for preventing infection spreading has
also made several budgetary decisions on support of been applied, a  contact-tracing mobile app “Infection
health sector and economy, due to problems related to Stop”, developed by state company Simula Research
pandemics. (https://stortinget.no/en/In-English/About- Laboratory, available for downloading 17th of April from
the-Storting/News-archive/Front-page-news/2019-2020/ Apple App Store og Google Play Store. Downloading of
the-stortings-decisions-relating-to-the-coronavirus-and- the app is voluntary. The app should give the user in-
the-economy/). formation if he/she was in contact with Corona-infected
The closing of schools and kindergarten has been con- person and also give the Health authorities data on us-
troversial, as the health authorities did not recommend ers’ movements and data on infected persons in different
it, so it was the solely government`s decision. Ministry regions via GPS and Bluetooth, for better geographi-
of Children & Families got the report from Directorate cally targeted measures of prevention and for further
for Children, Families and Youth on 20th of April, point- research. Central server holds collected data. In the first
ing out challenging condition for vulnerable children, as days around 1,6 mill users downloaded application, later
not all parents can assist their children in home learn- the number has gone down to 0,69 mill (8th of May) by
ing, and, in addition, children can be exposed for out- unlike reasons fell to 0,61 (https://www.fhi.no/en/id/in-
rage. Researchers are concerned with long-term effects fectious-diseases/coronavirus/daily-reports/daily-reports-

62 Zeszyty Naukowe Ochrony Zdrowia

 Raport 4: NORWEGIA

1000
Women Men

Number of reported cases

800

600

400

200

0
0–9 10–19 20–29 30–39 40–49 50–59 60–69 70–79 80–89 90+
Age group (years)

Figure 3. Number of conrmed COVID-19 cases by age and sex in Norway

Source: https://www.fhi.no/en/id/infectious-diseases/coronavirus/daily-reports/daily-reports-COVID19/ 18.05.

COVID19/ as 18.05.2020). Norwegian Data Protection only 18 are net exporters. However, according to Mel-
Authority claimed from Public Health Institute to develop chior concentration of production is observed only in
rules of protection, due to not allowed surveillance and selected products, so Covid-19 triggered demand shock,
registering of users’ movements. The app also consumes and was not an effect of market supremacy ([10]: 2–4).
much battery power, so phones need frequent charging. As the hospitals had to release many beds in emergency
So, up to now, the app has not been, as expected, an ef- for Corona-infected, so 250.000 consultations and opera-
fective measure of advanced virus protection tool. tions were postponed, while most of these beds stayed
empty. It costs…
Globalisation process, rapidly progressing since
5. What the pandemics disclosed 1990s, has also increased financialization of national
Each disaster – whether it is a deep crisis or epidemics, economies, due to free and massive capital movements,
should give us valuable experience and new knowledge. ongoing privatization of state property, public services
It is too early yet for Corona pandemic suppositions, but and trading with data. These changes have also affected
some statements can be already sat: the health sector. Economic pressure forced hospitals to
• Globalisation, run by multinational companies, has reduce number of intensive treatment beds – as for ex-
shown its crooked face ample Italy reduced these from 922 per 100.000 inhabit-
• Health sector has been partly managed as business, ants in 1980 to 275 in 2020 ([7]: 12). The similar process
not only as a social good has been running in Norway – many local hospitals were
closed down, limiting proximity of available health ser-
• Ecological balance and social fairness have been dis-
vices in small places. Outsourcing of services to private
torted in run for profit
actors made a divide between modest and severe sickness
When hospitals and other health institutions regis-
treatment institutions, so care dispersal resulted in skewed
tered insufficient storage of protective kit and equipment
distribution of resources, in favour of private easy-care
or lack of medicines, so leverages were stuck, as most of
and disease tests suppliers. Public hospitals are pressed,
items in last years have been imported from Asia. Sud-
use all capacity of available beds for scheduled patients,
denly the problem of local production of essential prod-
as they get paid per patient/treatment. Generally, 15–20%
ucts, in emergency, came up. In week when the lockdown beds should be kept in reserve for emergency purpose,
of the country was announced, 12th of March, Norway as COVID-19 proved the lack of, but hospitals have no
has had infection protective equipment for 4–40 weeks: resources to keep empty beds or many expensive respira-
surgical mouth bands and surgical hats for 4  weeks, tors in emergency. Since 1980s the number of hospitals
gloves for 7, dresses for 18 weeks (Stortinget.no, pub- in Norway has been reduced by 50% and the health sec-
lished in Aftenposten 14.05.2020, p. 5). Later prices tor emergency has been mistreated, what several doctors
jumped up, forged products arrived, exposing medical expressed ([6]: 10). Lack of emergency reserves caused
personnel and patients to danger. Local production had to the panic in hospitals, pressing lockdown solutions, much
be started. It became obvious, that not only unit costs of costlier than keeping emergency reserves. Professor of
production, but also national security, climate protection epidemiology dr Eivind Lund proposes to open up the
against transport emissions, and other factors have to be society and only protect high risk groups, what in case
considered for safe location of production. Numberless of Corona are people in nursing homes, where 59% of
chains of production of parts for a  single product are Covid-19s death in Norway occurred, giving the death
profitable for owners, mainly multinational companies, rate there 346/100.000, against 4,3/100.000 for Norway
but high social costs for citizens, what pandemics has ([8]: 38). Similar proportions of death cases apply also
revealed. Most of the countries import their medicines, to Sweden.

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Therefore, in my opinion, pandemics should be an 3. Information on `state of affairs` was good and avai-
incentive to new ideas of health and care services or- lable in several languages, both locally, by Municipal
ganization and financial system, including public-private Doctor messages, and centrally on Institute of Public
service tasks detachment and nursing treatment concepts Health Institute pages
for elderly generation. Perhaps another form of handling 4. The numbers of infected, sick and dead is low, higher
of old people than nursing homes is desirable? in Oslo, very low in North; the hospitals capacity has
The imposed lockdown measures have been positive been adapted and sufficient for treatment of infected
for environment, as the travelling and transport got lim- 5. There are controversies around government’s strategy
ited, so the use of fuels and emissions. Restrictions and of lockdown, since health authorities did not recom-
staying at home forced many to reflect over the current mend closing of schools and long quarantine
life style and its necessary modification, to slow the roll- 6. The government was generous in support of closed
ing climate disaster. The plan for future pollution control down business and employees who lost jobs, but
must be settled and followed up. economists point out that not all initiatives have been
Not all information on consequence of virus infec-
properly targeted
tion is yet sorted out and analysed, but it is quite clear
7. The costs – now and in coming years – are calculated;
that pandemics hit hardest the low-income groups of the
this are just projections which have to be revised the-
society. They seldom have jobs which can be done from
reafter, but no doubt, the costs are high
home-office, live in densely populated city blocks, can-
8. International cooperation calls for revised patterns of
not help children with distant teaching. Several children
might be also exposed to violence, either in family or flows and rules
neighbourhood. According to statistics, up to 8th of May, It is questionable why Corona has got so much at-
462.000 people in Norway applied for unemployment tention and set out all other important subjects and prob-
benefit, three times as many as in the entire 2019. It takes lems from media and politics apart. I feel overwhelmed
time to process so many applications, so pay-outs are de- of all details on infections here and there, or number of
layed, again, the exposed families are struck. died of virus, unrelated to population and normal yearly
death rates, which show that the relative numbers are still
low, even for the most exposed countries. Is this medias
6. Conclusions overreaction pushed by social media, fake news, massive
It is extremely difficult to conclude on effects, as the fear? There is no doubt that Corona virus brings rapid
facts are often incomplete or not verified, but some cau- spread of infection, but several doctors explain that high
tious deductions can be made. death rate of the sick older patients is caused by bacterial
1. Norway is a country with high level of trust to gover- infection afterwards, due to antibiotics resistance, not vi-
ning institutions, so people accepted rus itself. Since in Norway antibiotics use and resistance
and followed restrictions and rules given by government against is low, much lower than, for example, in Italy, so
due to pandemics high number of deaths could be the result of antibiotics
2. The government`s lockdown strategy, with social resistance, not predominantly COVID-19 virus infection?
distancing, but freedom to move outside, has been Experience and further analyses will hopefully give us
relieved gradually in April and May the answer in near future.

References
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