Policy responses for Norway - HSRM

Norway


Policy responses for Norway

1.5 Testing

The Directorate of Health (DoH) is preparing for large scale testing of the population, aiming to test 5% of the population per week. The municipalities have been asked to prepare for this, both in terms of organizing the logistics and providing necessary personnel training. According to a report by the Ministry of Health and Care Services on testing capacities in the municipalities, the aim is to test 1.5% of the population during the summer months and 5% in the autumn. The volume of testing is determined by the infection rate in the country, which is currently low.

A new testing method to test for COVID-19, based on sampling of saliva, is being developed. It will be piloted in three test sites in Oslo, starting on 15 June, before being introduced nationwide. The new test requires less use of PPE, is easier to administer and uses less human resources (Source: Government press conference from 3 June).

The DOH’s strategy for reopening the society is based on a TICQ-strategy (Testing-Isolation-Contact tracing and Quarantine), and thus depends on effective testing and contact tracing measures, as well as adherence to regulations on isolation and quarantine.

On 4 June the Norwegian Institute of Public Health (NIPH) reinstated the general rule that everyone with symptoms or who are suspected (by a doctor) to have the infection should be tested. Symptoms include acute respiratory tract infection and one or more of the following symptoms: fever, cough, shortness of breath, loss of sense of smell and taste. In some circumstances, it may be necessary to test people without symptoms. If there is a lack of testing capacity, population groups should be tested in the following order of priority:
1. Patient in need of hospital admission;
2. Patient / resident in a nursing home or other healthcare institution;
3. Employee in the healthcare service with work that puts them in the vicinity of patients;
4. Person in a risk group and their relatives;
5. Person in quarantine because of being in close contact with a confirmed case of COVID-19, or after travel;
6. Employee, child or pupil in a re-opened childcare centre, school or after-school programme;
7. Others with suspected COVID-19 disease;
8. Certain groups of people without symptoms (see below).

Categories 1-3 should be tested on a broad indication. Categories 6-7 should preferably monitor symptoms at home for 2 days before considering testing if symptoms continue. Positive test results in people without symptoms who have not been exposed should be confirmed with a new test to improve the predictive value. Even though the test in use has a high sensitivity, there will be cases of false positive test. The consequence of a false positive test result is significant, not just for people who are tested but for their close contacts who may have to be quarantined for 10 days.

As of 24 June the NIPH recommends testing everyone with suspected COVID-19 disease symptoms as quickly as possible. Everyone who has been tested should stay at home until they receive a negative test result and are symptom-free.

Symptoms include acute respiratory tract infection and one or more of the following symptoms: fever, cough, shortness of breath, loss of sense of smell and taste, or other symptoms that a doctor suspects are caused by COVID-19. For residents in a nursing home, there should be a low threshold for suspicion of COVID-19. For children under 10 years with mild symptoms of respiratory tract infection, their symptoms can be observed at home for a couple of days before testing. Children with a runny nose as the only symptom, who are otherwise in good health without other signs of a newly arisen respiratory tract infection, do not need to stay at home or be tested. For people who do not need medical attention but who have other symptoms that are not typical for COVID-19, the symptoms can be observed at home before they are considered for testing. In some cases, it may be necessary to test people without symptoms.

If testing capacity is insufficient, the following groups should be prioritized for testing (in this order):

1. Patients in need of hospital admission;
2. Patients / residents in nursing homes or other healthcare institutions;
3. Healthcare sector employees who work in the vicinity of patients;
4. Persons over 65 years old, or adults with serious or poorly managed chronic conditions including cardiovascular disease, diabetes, or who are morbidly obese, have a chronic renal failure, of significantly impaired lung function etc.
5. Persons in quarantine because of being in close contact with a confirmed case of COVID-19 or after travel;
6. Employees, children or pupils in a re-opened childcare centre, school or after-school programme;
7. Other persons with suspected COVID-19 disease;
8. Certain groups of people without symptoms (see below).

Persons in categories 1-3 should be tested upon a broad indication. Persons in categories 6-7 are advised to monitor symptoms at home for 2 days before considering testing if their symptoms continue.

For people with a negative test result but with a strong clinical suspicion of COVID-19, re-testing should be considered.

When the infection burden in the society is low, people who tested positively and who have not been in close contact with other people should be re-tested when they no longer have symptoms.

Asymptomatic persons are usually not tested. However, exceptions and local adaptations can be made, for example, before specialist elective surgery or as part of scientific studies.

From 2 July, test results analysed in medical microbiological laboratories have been made available in the online patients summary care records as soon as they are released from the laboratory.

For deaths in healthcare institutions where a doctor suspects that the patient had COVID-19, post-mortem tests for COVID-19 should be performed.

Testing of medical personnel arriving from Sweden is described in the section titled Transition measures: workforce.

Sources: https://www.fhi.no/en/op/novel-coronavirus-facts-advice/advice-to-health-personnel/test-criteria-for-coronavirus/?term=&h=1 

From 17 July, healthcare personnel working in close proximity to patients who have visited a country on the green list should be tested within 10 days after their trip even if they are asymptomatic.

From 23 July, people returning from countries which, after their return, were categorised as ‘red’ should be given priority for testing.

From 12 August, anyone who suspects that they have COVID-19 should have the opportunity to be tested. If a person without symptoms and who has not been exposed to COVID-19 tests positive, the result must be confirmed with a second test. The following groups should be tested:
• Everyone with acute respiratory tract infection or other symptoms of COVID-19;
• Everyone who has been exposed to COVID-19 infection, either as a close contact or after traveling to countries or regions with high COVID-19 incidence during the last 10 days;
• Other groups can be tested after assessment by a doctor. If an asymptomatic person who has not been exposed to VOVID-19 tests positive, the result must be confirmed with a second test. Groups who may be tested includes:
o Healthcare employees who work close to patients, including new employees and temporary staff who have been travelling outside of Norway during the last 10 days;
o Testing may be appropriate before new residents move into a nursing home. Testing is recommended if the nursing home resident has been travelling outside of Norway;
o Testing may be appropriate prior to certain hospital stays or procedures. The hospitals themselves establish rules for this.
o The Municipal Medical Officer may consider giving an indication for testing for persons moving into particularly dense living or work environments with a high risk of infection, e.g. arrival centres, military camps, slaughterhouses and prisons.
o Participants in research projects.
• Others who want to be tested, but who do not have symptoms and do not suspect that they are infected can also be tested if capacity is available. The test will then usually not be covered by the public sector. This may, for example, apply for health certificates.

From 12 August, travellers from abroad get the opportunity to be tested for COVID-19 upon their arrival in Norway. Test sites have been established at international air-terminals and at some border crossings.  Testing is free for all, regardless of citizenship or membership in the Norwegian Insurance Scheme (folketrygden). Travellers arriving from areas with high contamination rates must go into quarantine when their reach their travel destination.  

24 September: Testing capacity using the testing method developed by the Norwegian University of Science and Technology (NTNU) has increased and is sufficiently high to be shared with the international market (Denmark and India were the first international customers).

13 October: It was announced that COVID-19 vaccination will be free of charge for all citizens when introduced. All vaccination related costs for hospitals will be covered.

16 October: Testing at border crossing has been evaluated. Roadside testing at border crossings is not recommended to be continued due to the low volume (only 1.3% of cars crossing the borders used this opportunity). Testing at ferry-sites and international air-terminals is to be continued, however testing at ferry terminals will only be conducted when the volume of travellers increase.

The national reference laboratory for COVID-19 is located at the Norwegian Institute of Public Health (NIPH). In addition, there are 18 laboratories, mainly at hospitals, which can now test for SARS-CoV-2 (COVID-19).

Two Cobas-6800 testing machines have also been acquired and placed at the two largest university hospitals in the South-Eastern Regional Health Authority (RHA). They have been in operation since mid-March. Their total testing capacity is 2,880 tests per day.

Testing capacity for COVID-19 virus increased significantly since April. A new testing method has been developed by the Norwegian University of Science and Technology (NTNU) in collaboration with St. Olavs Hospital. This method uses nanoparticles to extract RNA from a solution containing a sample from the patient and compares it with the genetic code from the sample with coronavirus. This test has been found to be more sensitive than commercial tests and from 20 April has been brought to university laboratories across Norway. This increased testing capacity from about 30,000 a week to 100,000 a week. By the end of May testing capacity has reached 300,000 tests per week. As of 21 October, a total of 1,522,163 tests were conducted in Norway, whereof 16,771  were positive. The total number of COVID-related deaths was 279.

Initially, people with severe symptoms or those who are more vulnerable and thus at greater risk are referred to testing. Testing is recommended for people with acute respiratory tract infection with fever, cough or breathing difficulties, in the following order of priority: 
1) Patients in need of hospital admission;
2) Patients in health institutions;
3) Healthcare employees who work in the vicinity of patients;
4) People over the age of 65 with chronic underlying diseases, such as cardiovascular disease or with high blood pressure, will be considered for testing even when they have milder acute respiratory symptoms with no other probable cause that have lasted for more than 2 days;
5) People who have been in close contact with a confirmed case of COVID-19 are also considered eligible for testing.

Currently, the NIPH recommends testing everyone with suspected COVID-19 disease symptoms as quickly as possible (see Transition measures: testing).

Sources:
https://www.fhi.no/nettpub/coronavirus
https://www.healthtalk.no/alle-artikler/ny-coronavirus-test-som-er-10-ganger-raskere-er-n%C3%A5-godkjent
https://medium.com/helseaktuelt/disse-korona-nyhetene-b%C3%B8r-du-f%C3%A5-med-deg-denne-uken-1717ba56b3b8
https://norwegianscitechnews.com/2020/04/from-thousands-of-tiny-magnetic-balls-to-150000-covid-19-tests-per-week
https://medium.com/helseaktuelt/disse-korona-nyhetene-b%C3%B8r-du-f%C3%A5-med-deg-denne-uken-1717ba56b3b8