Policy responses for Norway - HSRM


Policy responses for Norway

1.2 Physical distancing

Easing of restrictions started on 7 April, when a plan for a gradual reopening of day-care centres and schools, lifting the ban on overnight stay at holiday properties, and gradual reopening of one-to-one services was announced. Sector specific infection control standards will be developed. These must be implemented before any facilities may reopen.

April 20: Day-care centres/nurseries were permitted to reopen but have to follow guidelines developed by the Directorate of Education and the Norwegian Institute of Public Health (NIPH) and published by the Directorate of Health (DoH) to prevent further spread of COVID-19. Information, including a video for small children, was made available (https://www.udir.no/kvalitet-og-kompetanse/sikkerhet-og-beredskap/informasjon-om-koronaviruset/Smittevernveileder). Ban on overnight stay at holiday properties is lifted.

Physiotherapy, mental health therapy and other one to one health services are allowed to reopen if the services may be provided in accordance with guidelines for infection control standards.

April 27: Schools were allowed reopen for 1-4 grade pupils. Universities and higher education institutions are allowed to reopen for some graduate students and staff, to facilitate access to special equipment at the facilities (e.g. labs) but physical distancing must be practiced and working from home continues to be advised. Hairdressers and beauty-salons will be allowed to reopen as long as they observe COVID-19 recommendations. 

Hair- and skin-care salons are allowed to reopen if they comply with appropriate infection control standards.

April 30: Social distancing rule is reduced from 2 to 1 meter.

May 4: The ban on cultural activities was modified: public gatherings that are no larger than 50 persons may resume from 7 May under the condition that the physical distancing rule of 1 meter can be observed and that they are appropriately managed (attendance is monitored, physical distancing measures are adhered to). Private gatherings remain limited to 5 persons.

For the summer of 2020, there is an official advice against sport and culture events that gather more than 500 people. Advice applies from 15 June until 31 August but is expected to be reassessed by 7 May.

May 7: The following changes are announced by the government:

Changes effective immediately:
• People are allowed to gather in groups of up to 20 people (up from 5 previously), provided that they can keep at least a metre apart. 
• Sports training and other sports activities in groups of up to 20 people are allowed, provided that people can keep at least one metre apart. Recommendations issued by the DoH and relevant sports associations apply and should be followed.
• Sports halls may be opened but the use of changing facilities in these halls is prohibited.
• Events with up to 50 participants may be held in public places provided that the participants can keep a social distance of at least one metre and there is an event organiser responsible for ensuring that the rules are respected. This applies to all types of events, including sports events such as cups and matches. An employee or person contracted to organise an event in a public place is not counted as a participant in the event. The precise role of the organiser should be clarified in guidelines for the different sectors.
• Employers should ensure that their employees can remain at least one metre apart throughout working hours. In areas where employees need to use public transport, employers are urged to facilitate working from home and virtual meetings as far as possible, and not require people to be physically present unless this is necessary. This applies particularly in the Oslo region and other cities where public transport can become congested.

Changes effective from 11 May :
• All schools are to open for all school years by 15 May. Schools must follow the infection control rules, which means that it may not be possible for all pupils to be at school at the same time.
• Educational programmes for adults and immigrants may restart. This applies to educational programmes for newly arrived immigrants under the Introduction Act, programmes under Chapter 4 of the Adult Education Act, and short courses offered by the folk high schools (https://www.folkehogskole.no/en/about). These programmes can be restarted provided that they can comply with infection control guidelines.
• Driving schools may reopen. They must follow the same infection control rules as other services where there is one-to-one contact.
• Universities, university colleges and vocational technical colleges are to continue remote teaching. Students who need to be at their institution to maintain progression in their study programmes may be granted access, but they must comply with infection control guidelines.
• Courses run by adult education associations and Skills Norway are to continue remote teaching. Students who need to be at their institution to maintain progression in their study programmes may be granted access, but they must comply with infection control guidelines.
• Sports activities for children and young people that involve physical contact, such as football, can resume, for example, children and young people will be allowed to play sports matches in their teams. This must be organised in compliance with infection control standards.

On 15 May the NIPH updated its guidelines on physical distancing. Currently, the rate of infection in Norway is low and the general advice to the population is to maintain good hand hygiene and cough etiquette, limit the number of social contacts and keep physical distance of one metre. Further guidelines were issued for various risk populations:

• People with a slightly increased risk are recommended to live like the rest of the population, as long as they follow the official advice on hygiene and physical distancing, especially towards people who are not their family/friends. Should the rate of infection increase, people in this group should consider taking more care when travelling and with other activities.
• People with a definitively elevated risk might travel, work and socialize, but have to take additional precautionary measures such as limit the number of close contacts, avoid crowded places (i.e. public transport, shopping malls etc.). Should the rate of infection increase, people in this group are discouraged to travel and should maintain distance of 2 metres and have fewer contacts.

Also from 15 May hotels, holiday apartments and campsites have been allowed to reopen as long as they adhere to infection control guidelines for the hospitality sector.

On 21 May an update has been issued on hygiene measures noting that hand disinfectants may substitute for hand washing if the latter is not feasible. Caution must however be taken as hand disinfectant has a limited effect when hands are dirty or wet, with hand washing being the best hygiene measure in those situations. The NIPH does not recommend routine use of disposable gloves for the general public, as the risk of transmission with and without gloves is the same.

On 25 May guidelines for dentists were updated to facilitate resuming regular provisions of services.

On 27 May the ban on visits to LTC facilities and hospitals has been lifted and new recommendations have been issued on how to facilitate visits. Day care activities for older people are to reopen. There will be local adaptation to the general recommendations for the LTC facilities. Flexibility and involvement of patients and their next of kin is essential since guidelines for people with slightly elevated risk and for people with definitively elevated risk and infection rates differ among the localities and there are different.

Infection control rules for schools and day childcare centres/nurseries have been updated. A system of traffic-lights has been introduced with red, yellow and green lights representing different risks of infection. Green light means an ordinary level of activity; yellow light indicates that distancing and hygiene measures should be followed. For the lower school grades the 1 metre distance rule has been lifted so that younger children can play and sit closer together, but the 1 metre distancing remains in force in high schools. Previous infection control measures for schools reflect the red level of risk, measures from 27 May reflect the yellow level of risk. The health authorities are responsible for deciding on the colour codes in the local areas

Changes effective from 1 June:
• Bars and other establishments that serve drinks but not food may open provided they can ensure compliance with the 1 metre physical distancing rule. Requirements regarding seating and table service will be set out in regulations.
• Amusement parks may reopen.
• Organised swimming activities, including school swimming lessons, have been permitted. 
• The Norwegian Directorate of Health and the Norwegian Institute of Public Health has drawn up new advice on holiday and leisure travel, which applies from 1 June.

On 2 June the NIPH updated their advice on physical distancing measures. Current general advice is to follow good cough etiquette and good hand hygiene. People can interact normally with others in their closest circle; people with respiratory tract symptoms are advised to stay at home, and should be tested if they become symptomatic. Everybody should keep an increased distance from all persons outside their closest circle. Distance should be at least 1 metre, and distance between faces is the most important. Standing in a line and standing back-to-back is associated with a lower risk of transmission. 

For persons who are categorised as ‘close contacts’ of those who tested positive the advice differs according to their relationship with the confirmed case. Those in the same household (or equivalent) should quarantine for ten days, whereas others should be followed up closely for ten days, tested as soon as possible, and then re-tested within 2-3 days. They may attend school and work, but if they are healthcare workers or are otherwise in touch with patients as part of their work, they must take advice from the employer on the matter. All people categorized as ‘close contacts’ should limit their contact with other people.

Changes effective from 15 June:

• Events with 50-200 participants have been permitted.
• Gyms and fitness centres, as well as parks and swimming pools may reopen for the general public, but have to ensure compliance with infection control standards.
• Matches in the top division of the Norwegian football league are permitted from 16 June under an exemption from the COVID-19 regulations.

Guidelines for aviation from 16 June advise to leave the middle seat free between passengers if this is possible and that passengers should use face coverings. The guidelines allow for an exemption of the 1-metre distancing rule during the flight but stress the importance of strict adherence to boarding procedures and physical distancing in the waiting area.

On 25 June advice was issued that the 1 metre distancing rule for children participating in sports activities will be lifted from 1 August, thus enabling games and competitions to take place.

Changes from 15 July:
• Buffet style serving of food will be allowed as long as it is in compliance with infection control standards for serving of food. 

Changes from 13 August:
• Using face masks is not generally recommended, nor advised against, when there is little or no transmission in the community (below 20 cases per 100 000 inhabitants in the prior 14 days).
• If the number of cases increases above 20 per 100 000 inhabitants, face masks are recommended on public transport when it is not possible to keep 1 meter distance. Face masks are not recommended for children in primary school (below 12-13 years of age). Physical distancing of at least 1 meter continues to be the most important measure to be followed by the population. Due to the increased incidence-rate in Oslo and some south-eastern municipalities people are advised to wear face masks on public transport.
• The distinction between close contacts living in the same household and other close contacts is removed, i.e. all close contact are now treated in the same way.
• Colour-coding of countries

Changes from 4 September:
• The visiting ban in long-term care institutions introduced in March was lifted later in the spring if the conditions allowed it. The Government now emphasises the importance of enabling visits to older people, the importance of them not being isolated. The County Medical Officers will be responsible for ensuring that the local rules and regulations are aligned with the national recommendations.

Changes from 18 September:
• Regional measures were updated in Oslo and Bergen: use of facemask is recommended on public transport when social distancing is not possible, with exemptions made for children below age of 12; use of facemask on public transport in Oslo will be mandatory from 29 September.

Changes from 23 September:
• The traffic light model introduced for children’s sports activities is abandoned and replaced with general guidelines for sports activities.

Changes from 12 October
• Outdoor events of up to 600 persons are allowed under the following conditions: participants are to be organised in groups with up to 200 people in a group, and the distance between the groups must at all times be at least 2 meters at all times. For events with fixed seating arrangements the capacity should be filled at 50%, with one free seat between every visitor. Families may sit next to each other.

The first strict physical distancing measures were announced on 12 February when healthcare professionals working in patient care were restricted from travelling abroad. This restriction applies to any travel, for business or leisure. Two weeks later, on 27 February, the Norwegian health authorities issued official advice on preventive measures (hand hygiene) and identified the Norwegian Institute of Health (NIPH) as the source for updated advice on preventive measures and travel. At the time, the first confirmed COVID-19 patient was identified in Norway and more than 50 people were in quarantine. People were advised to call the local after-hours emergency services for information.

History of measures taken since then:

February 29: Advice on COVID-19 and preventive measures for long-term care (LTC) facilities / nursing homes is published by the NIPH.

March 1: Employees in the healthcare sector who have visited COVID-19 afflicted areas are required to quarantine at home (not attend work) for 14-days after their return from these areas. This is effective for everybody who returned from these areas after 17 February. Employees who develop symptoms must be isolated at home for 14 days. The delay in identifying ‘afflicted areas’ is thought to have contributed to the spread of the virus at the start of the pandemic.

March 2: The Directorate of Health (DoH) launches an informational video for children and youth highlighting the importance of distancing for those who are infected (who are advised to stay at home with their family) as well as proper hand hygiene and respiratory etiquette.

March 2: All institutions providing essential services (health and social care, defence, etc.) are requested to consider implementing travel restrictions.

March 3: Advice is issued to restrict visits to LTC-facilities for relatives and friends who have visited COVID-19 afflicted areas.

March 7: Home quarantine is extended to all travellers who have visited COVID-19 afflicted areas. Recommendations reinforce the importance of avoiding handshakes and hugs, which are common forms of greeting in Norway. It is advised that any gatherings of people should be reconsidered and avoided. All travel, including domestic travel and visits to holiday homes and hotels, should also be avoided.

March 12: A list of official measures with immediate effect is published. The following measures are emphasised:
• People must maintain physical distance from one another, practice good hand hygiene and cough in paper tissues or their elbow. Indoors, people should keep at least two metres distance from one another, though this does not apply to family or household members. When outside, there should be no more than five people in a group (except for members of a family or the same household). Distance of at least one metre from other people should be observed in public spaces.
• Those who have been in close contact with someone who tested positive for coronavirus (SARS-CoV-2) must quarantine for 14 days. This is longer than the 7 days allowed by §4.1 in the Act on the control of communicable diseases (which remains in force).
• People must immediately quarantine for 14 days after returning from travel abroad (from any country exempt for Sweden and Finland). Persons diagnosed with coronavirus (SARS-CoV-2) or those being tested for it, are to be isolated.
• Foreign nationals who do not live or work in Norway will be rejected at the border.
• Healthcare professionals working with patients are prohibited from travelling abroad. This prohibition applies to both business and private travel, with effect through April 2020.
• All day-care centres, primary schools, lower- and upper-secondary schools, universities and university colleges and other educational institutions are closed. Children of key workers (people performing critical public functions) will continue to receive day-care and lower primary school services.
• Cultural events, sporting events and organised sporting activities, both indoors and outdoors, are prohibited.
• All restaurants (included those offering buffet-style serving), bars, pubs and other social establishments are to remain closed. An exception is made for establishments where visitors can keep a distance of at least 1 metre.
• Fitness centres, swimming pools, water parks and similar establishments are closed.
• Establishments that provide hairdressing, skin care, massage, body care, tattooing, piercing and similar services are closed.
• Stay at holiday properties continues to be prohibited.
• All drivers and vehicle licencing offices are closed.
• Public transport services are to remain in operation.

March 14: Persons arriving into Norway from countries other than Sweden or Finland must quarantine for 14 days after arrival (exemption for Finland and Sweden is maintained but restricted to people who travel for work purposes). These restrictions apply to persons who have arrived in Norway after 27 February. Symptomatic persons arriving in Norway must immediately undergo isolation in a place designated by the municipal medical officer. Symptomatic persons may not use public transport to reach the place designated for their isolation.

March 14: All visits to LTC facilities (by relatives and friends) are banned. Visits to hospitals are also restricted.

March 14: Advice was issued against all non-essential travel abroad. The list of institutions to be closed is extended to: physiotherapy and manual therapy offices, chiropractors offices, opticians offices, chiropody offices, speech therapy offices, psychologists offices, facilities performing complementary and alternative medicine. Dentists are requested to close their clinics for all non-acute patients.

March 16: The Directorate of the Norwegian Correctional Service (KDI) decided to use early releases as a means to reduce the number of inmates in Norwegian prisons. An immediate suspension of visits (to prisons), leaves and day leaves (by inmates) is enforced.

March 17: Borders are closed for foreign nationals who do not have a residence permit to stay in Norway (exemptions for people coming from Finland or Sweden are abolished). Temporary entry and exit controls will be introduced at the internal Schengen border. Norwegian airports remain open. All Norwegian citizens and persons who live or work in Norway will continue to be let into the country.

March 30: Brochure on how to keep social distances made available in multiple languages by the NIPH:

April 3: The Foreign Ministry decides to uphold current travel restrictions until further notice. (Travel restrictions from 12 March were first set to be valid until April 13.)

April 17: Municipalities must ensure availability of facilities for home isolation that meet regulations regarding preventing further spread. In some cases, the person in isolation (or they families) may have to be relocated to a hotel or other facility offered by the municipalities. The municipalities must then cover the cost.

Sports and cultural activities, indoor as well as outdoor, were prohibited for groups of more than 5 people and for all groups that are not able to observe physical distance of 2 meters. Furthermore, sports activities were prohibited until 15 June if the use of sports equipment or facilities might increase the risk of contamination.