Policy responses for Norway - HSRM

Norway


Policy responses for Norway

1.4 Monitoring and surveillance

Contact tracing after air-travel (both international and domestic) was abandoned on 12 March. It was reintroduced on 15 June when domestic and international travel-ban was eased.

The Norwegian Institute of Public Health (NIPH) advised on following changes to the COVID-19 regulations, effective from 7 May:
• Definition of ‘close contact’ is changed from 24 hours before the onset of symptoms to 48 hours. This is in line with WHO and ECDC recommendations.
• The period of quarantine after coming into contact with a confirmed case is reduced from 14 to 10 days.
• People who have previously tested positive for COVID-19 are exempt from quarantine for 6 months after testing. 
The Norwegian Association of Local and Regional Authorities (KS) has, in collaboration with the WHO, the University of Oslo and the NIPH, adapted the DHIS2 COVID-19 Surveillance Package for use in Norway. The surveillance system is available for download and installation from the KS webpage (https://www.ks.no/fagomrader/digitalisering/felleslosninger/elektronisk-losning-for-smittesporing/).

28 September: The mobile app for contact tracing developed in the spring and halted in June is to be abandoned. The decision was motivated by concerns over privacy issues of data storage. A new app based on solutions developed by Apple and Google will be developed for the Norwegian market. It is expected to take eight weeks before the new app is ready for implementation.

20 October: the mobile app for contact tracing developed for Denmark will be further developed for the Norwegian market. It is expected to be delivered by the 21st of December 2020.

The Norwegian definitions of close contact to confirmed cases of coronavirus COVID-19 are based on definitions from the European Centre for Disease Control (ECDC). A distinction is made between ‘close contacts’ who have been exposed to infection and ‘low risk contacts’ who may have been exposed.

‘Close contacts’ are defined as people who have been in close contact with a person with confirmed COVID-19 disease from 48 hours before the start of symptoms. One is considered to be a close contact for 14 days from and including the last contact with the confirmed case, meaning they:

• have lived in the same household as a person with confirmed COVID-19 disease;
• have been in direct physical contact (e.g. has shaken hands) with someone with confirmed COVID-19 disease;
• have been in direct contact with saliva (e.g. through a cough) from someone with confirmed COVID-19 disease;
• have been in close contact with, or been near (closer than 2 metres) a person with confirmed COVID-19 disease for more than 15 minutes;
• have been in an enclosed space (e.g. a classroom, meeting room, waiting room, etc.) with a person with confirmed COVID-19 disease for more than 15 minutes and closer than 2 metres;
• have nursed / treated a patient, handled sample material from, or otherwise had close physical contact with a person with confirmed COVID-19 disease, without using the recommended protective equipment;
• have sat near (within two rows of seats in all directions) a person with confirmed COVID-19 disease on a plane, or near other close contacts on a plane;
• have been in the same travel group as a person with confirmed COVID-19 disease.

Contact tracing has been used since the first case was reported on 26 February. General practitioners (GPs) in the municipalities are, in cooperation with the Norwegian Institute of Public Health (NIPH) which can obtain contact details of air passengers, responsible for tracing contacts for all patients with confirmed COVID-19 disease. The Norwegian Surveillance System for Communicable Diseases (MSIS) collects data about notifiable infectious diseases, including COVID-19, that are submitted to the NIPH. In most cases, it is more practical for the Municipal Medical Officers to take over the responsibility for contact tracing from the GPs. In such cases, they should maintain regular contact with the hospital serving their municipality. The municipalities need to have contractual agreements with other municipalities in order to carry out, if and when this is necessary, contact tracing outside their municipal borders. Person who has tested positive for COVID-19 (the so-called index-person) has a duty to provide information on their close contacts, but they may not be prosecuted if they deny to do so. Close contacts have a duty to get tested for COVID-19, but they may not be prosecuted if they deny to do so. 
 
In hospitals, the physician in charge of infection control will follow implemented procedures for identification of patients who have been in contact with a confirmed case, near contacts and exposed health personnel. Data from Norwegian hospitals that are included in the intensive care registry will feed into the Norwegian Intensive Care and Pandemic Registry and provide the basis for reports to the NIPH and the Directorate of Health (DoH) as part of COVID-19 monitoring in Norway. Such data may be used to keep track of critical care capacity.

Contact tracing in long-term care institutions should be coordinated with the Municipal Medical Officer.

Contact tracing in connection to public transport is executed with the assistance of the Norwegian Institute of Public Health.

Contact tracing on ships: the ship’s captain is responsible for contact tracing and other necessary measures. They have a duty to report any suspected cases of COVID-19 to the next harbour they enter. The Municipal Medical Officer should be in dialogue with the ship’s medical officer who is responsible for any follow-up and action.

A mobile app for contact tracing developed by the NIPH was launched on 16 April. By 18 April 1.2 million people (22% of the population) had downloaded the app. On 5 May, the App had just below 750 000 active users. There have been concerns about privacy issues due to the use of GPS-tracking, including from the Norwegian Data Protection Agency, and the number of active app users has been declining. Following the criticism, on 15 June, the NIPH decided to halt the use of the contact tracing app and will delete all data collected so far.

Coronavirus modelling used by the NIPH for situational awareness and forecasting of the coronavirus outbreak in Norway based on a stochastic SEIR-type model with a local transmission process in each municipality was applied in the period from March to end of June. From the end of June, a new model of the Norwegian COVID-19 pandemic, a Sequential Monte Carlo (SMC model), has been applied to estimate the parameters in the SEIR-model. The model allows for a daily variation in the reproduction number, and is based on a 7-days moving average.

The spread between municipalities is modelled by following how people travel between municipalities. Information on travel between the different municipalities is based on mobile phone data.
Sources:
https://www.fhi.no/en/op/novel-coronavirus-facts-advice/advice-to-health-personnel/definitions-of-probable-and-confirmed-cases-of-coronavirus-covid-19-and-con/
https://helse-bergen.no/norsk-pandemiregister#om-norsk-pandemiregister