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The Norwegian Government has revised its long-term strategy and emergency preparedness plan for the management of the COVID-19 pandemic. It has called the phase after Step 4 ‘Normal everyday life, with increased preparedness’.
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The Norwegian Government’s management strategy for the COVID-19 pandemic is to ensure that we remain in control of the transmission at all times, so that the infection rate remains manageable and does not exceed the capacity of the health and care services.
After Step 4
‘After we are done with Step 4, we will move from a control strategy to a preparedness strategy. The earliest point at which we can assess whether we are ready to move to the phase which we call “Normal everyday life, with increased preparedness”, will be in September,’ says Prime Minister Erna Solberg.
The phase ‘Normal everyday life, with increased preparedness’ can be summarised in two points:
- The population’s everyday lives will be affected by the pandemic to little extent. Good hand hygiene and cough etiquette will continue to be important, people must be more willing to stay home if they are ill, and everybody should take a test in accordance with the official guidance. However, the special COVID-19 measures will end.
- The local and national authorities will continue to closely monitor developments, so that measures can be introduced quickly if the situation changes. The Norwegian Government, the health authorities, the hospitals, and the municipalities will have a higher level of surveillance and preparedness.
‘We will continue to pursue our objectives of protecting people’s health, reducing societal disruption, and protecting the economy. Children and young people will continue to be our top priority, followed by jobs, and the business sector,’ states Ms Solberg.
The COVID-19 vaccination programme in Norway continues at speed, and more than 60% of people in Norway over the age of 18 have now had their first vaccine dose. The population’s vaccine immunity will probably be adequate to keep the epidemic under control, and will eventually replace the social-distancing measures, the TISK strategy (testing, isolation, contact tracing and quarantine), and most of the entry measures.
‘Increased vaccination coverage means that the measures to manage the pandemic can gradually be reduced and society will be able to return to normal. Nevertheless, the local and national authorities must remain alert and closely monitor developments so that measures can be implemented quickly if the situation changes. There will be a need for increased surveillance and preparedness so that infection control measures can be stepped up again at short notice,’ says Minister of Health and Care Services Bent Høie.
The municipalities and other players should plan to keep the necessary expertise and preparedness in autumn 2021, to enable them to quickly upscale their personnel if the infection rate rises and the burden of disease increases. For some time going forward, the municipalities will require additional capacity to cope with vaccinating their populations and simultaneously implementing TISK measures.
Scenarios for autumn/winter 2021
The Norwegian Institute of Public Health and the Norwegian Directorate of Health have prepared thee possible scenarios for autumn/winter 2021. The scenarios are not forecasts, but illustrate how the pandemic could develop under certain conditions. Scenario 2 is considered the most realistic scenario, but scenario 1 is also probable. If scenario 3 materialises, Norway will have to substantially change its management of the pandemic.
The scenarios are not mutually exclusive:
Vaccinating the recommended population groups has a good and long-term effect on transmission and morbidity. Vaccination uptake is very good. Increasing vaccination coverage in Europe, and solutions are found internationally that advance access to vaccines in low-income and middle-income countries. Measures to combat the number of imported cases of COVID-19 can be eased gradually.
No new virus variants arise that challenge the immunity of the fully-vaccinated parts of the population. The health and care services have the capacity for virtually normal operations, but there may be many cases of the flu and other respiratory infections. There are few outbreaks among people who are not vaccinated, especially among the younger parts of the population, and there are few serious cases. The outbreaks are handled effectively by the municipalities, applying local measures. COVID-19 is eventually managed in the same way as other endemic respiratory infections (including the flu), with surveillance, vaccination, and general hygiene measures.
The municipalities dedicate considerable efforts to the vaccination campaign, which continues apace through the summer. Towards the end of the summer, there are few outbreaks in Norway, and infection rates continue to fall in the European countries that have high vaccination coverage. A new variant, for which vaccines are less effective, causes concern internationally. Entry measures may be required. One or more virus variants that are more contagious, against which vaccines are less effective, and which give slightly greater risk of hospitalisation, spread in Norway.
Transmission in Norwegian society rises, especially among the younger population. There are several outbreaks in nursing homes. At the same time, a season with high rates of the flu and other respiratory infections puts pressure on the health and care services. The municipalities’ resources are under pressure, but outbreaks of COVID-19 are managed effectively with local measures.
The vaccination uptake among the younger parts of the population is significantly lower than among older people. A new variant, against which vaccines are significantly less effective, is circulating internationally. Entry measures are required. Large demonstrations are held in Europe due to infection control fatigue. A virus variant, against which the vaccines are less effective, and which leads to more serious disease, becomes dominant in Norway during the autumn.
All age groups are hit by an autumn wave of the pandemic, with potential for a significant disease burden. There are outbreaks in many municipalities. As there are high rates of seasonal flu and other respiratory infections at the same time, the health and care services are put under considerable pressure. Invasive infection control measures have to be introduced nationwide to avoid overburdening the health and care services and the municipalities, as enhanced TISK is re-introduced.
In addition, there is considerable fatigue in the face of measures to combat the pandemic, and there are protests. All vaccinated people need to be offered a booster vaccination. These vaccines only become available at the beginning of 2022 and, when they do, quantities are limited, so that vaccines again have to be allocated in order of priority.