INTERVIEW: ‘My belief is that Norway won’t have a big second wave’

At the start of March, Norway was ready to put into action a pandemic plan quite similar to the one Sweden has had run over the past two months. But on March 12, the country changed course and went into strict lockdown. The Local asked Norway's state epidemiologist what happened.
According to Frode Forland, Specialist Director of Infectious Diseases and Global Health at the Norwegian Institute of Public Health, the Norwegian pandemic preparedness plan published in 2014 had been based largely on what had happened during the 2009 swine flu pandemic. 
 
“It had some of the same scenarios as the pandemic planning in the rest of the Western European world,” he explained in an interview with The Local.
 
“And I think we always had in mind that a new pandemic would spread like an influenza epidemic: that 25 percent of the population would get seriously ill and that the the spread would eventually cover maybe 70 percent of the population until you get herd immunity.” 
 
But when China imposed a strict lockdown on Wuhan, and the strategy was then copied by other Asian countries, Forland's team at the Norwegian Institute of Public Health began to have second thoughts. 
 
“We thought: 'this is working'. They were able to close down societies, first in China, then in Korea, then in Singapore, then in Japan. When that knowledge filtered into our systems, we had to revise our models. We thought, 'there are other ways of dealing with this than just letting it go'”. 
 
Forland and his colleagues also began to take into account how differently coronavirus was behaving from an influenza virus. 
 
“We saw there were a number of things there that were different in this epidemic from a normal influenza pandemic: It was much more contagious, and it was much more serious — the fatality was maybe being five times as high, and the infectiousness was maybe three times as high.” 
 
He said there was also growing evidence of asymptomatic transmission, which is not the case with influenza, meaning simply telling people to stay home if they are sick, as Sweden has done, would not work.
 
These discussions were taking place in early March between the Norwegian Institute of Public Health, the Directorate of Health, the Health Ministry, and the country's advisory forum for preparedness. 
 
But then Norway's Prime Minister Erna Solberg — perhaps after seeing the decisive actions taken by her Danish counterpart Mette Frederiksen — took the decision to seize control, putting Monica Mæland, the Minister of Justice in charge of the epidemic. 
 
“There was this lifting of the whole issue to the government, and then they said, 'we need to take a whole of government approach and close down society, using a precautionary principle, to get control. And that was because we saw this rapid rise in the number of cases.” 
 
 
Under control or kicking the can? 
 
In the two and half months since March 12, Norway's lockdown measures, which included closing schools and kindergartens, closing borders, banning people from staying at their holiday homes, asking people to work from home, and limiting gatherings to just five people, have been strikingly successful. 
 
There are now only 51 people being treated in hospital with coronavirus, the same number as in the first week of the lockdown. Only 234 people have died with coronavirus in Norway, compared with 3,831 in Sweden, a country with less than double the population. 
 
If you listen to Anders Tegnell, Sweden's state epidemiologist, or his predecessor Johan Giesecke, Norway has done little but postpone the inevitable. With as few as one percent of the Norway's population having been infected with coronavirus, they argue, the country is vulnerable to a second wave. 
 
But Forland is not so certain. 
 
“I think the uncertainties here have been huge, and that's why I said to Johan Giesecke that I think he shouldn't be that super-certain about what he's saying, and that he should show a little bit more, kind of, carefulness in saying all other strategies are wrong apart from the Swedish one,” he said. 
 
Giesecke's combative approach has clearly struck a nerve. 
 
“He has been on the first page of the Norwegian newspapers again and again, saying Norway's doing wrong and Sweden is doing right.” 
 
Sweden, Forland argued, had been too wedded to the plans it put in place long before the pandemic broke out, and had failed to adapt to new information as it came in. 
 
“I think Sweden has maybe stuck to that kind of scenario for a bit too long,” he said of the influenza model. “They were thinking, as far as I can understand, a bit too much in line with what has happened before.” 
 
 
Second wave
 
This is not to say that the fact that a much smaller proportion of Norwegians who have been infected with coronavirus than in Sweden does not make it more vulnerable.   
 
“I think we are maybe a little bit more vulnerable,” he admitted.
 
But he said he was increasingly confident that Norway could prevent a second wave anyway. 
 
“My belief is that we won't have a big second wave, because we've shown that these these measures we have taken have been very effective. But if we lose our grip, if the virus changes and becomes more virulent, you know, more infectious, there might be a bigger wave”. 
 
“Our hope is that we now will now rather be having small bumps of waves that we can knock down again by very active testing and contact tracing and isolation, which is the hope for the rest of the year, until we have a cure or vaccine.”
 
Forland said that while this might be a challenge, he was sceptical about the possibility of reaching herd immunity without an unacceptably high death toll in society. 
 
He said it now looked like Sweden's prediction of some form of herd immunity in Stockholm by May would not come to pass. 
 
“We're at the end of May now, and I think the preliminary results of different Swedish population studies show that it's a very low number of people who are actually infected,” he said. 
 
Sweden's first antibody tests, taken in Stockholm in the week ending May 3rd, showed that just 7.3 percent of the samples had been infected, Sweden's Public Health Agency said on Wednesday.  
 
Even in Spain, one of the hardest hit countries in Europe, Forland pointed out, only about five percent of the population appeared to have been infected. 
 
“That's extremely far away from something which can be called herd immunity, and  I think the danger of letting this slow until we get to herd immunity is that you are causing a lot of people to die.” 
 
 
Vaccine 
 
Forland is also more optimistic about a vaccine being developed than his Swedish counterparts. 
 
“We think there are good prospects for that, as we see the development now with at least around 10 candidates being tested on humans and a hundred more in the pipeline. So the whole of the world is working to get that vaccine up and running.” 
 
He said the success of the suppression strategies in Norway and elsewhere had also increased his confidence that it might be possible to keep the virus under control. 
 
“We've seen that the I think that the more easy infection prevention control measures have been super-effective: cleaning hands, keeping distance, having good etiquette for coughing and sneezing, and that's something that can last.” 
 
Can Norway open the border with Sweden? 
 
The big question this week has been whether, with the different infection rates in Sweden and Norway, it can possibly make sense to end border restrictions. This is something Forland will not be drawn into in too much detail. 
 
“I think there is an infectious disease logic in having border closures so long as there is a big difference in the infection rate between countries. It will flatten out after a while but for the time being, there is a certain difference between Sweden and Norway.” 
 
The decision, he said, was ultimately a political one. 
 
Counting when the dealing's done
 
For all his criticism of Sweden's inflexible approach, Forland was unwilling to mirror Giesecke and claim that Norway's strategy had already been vindicated. Sweden, he acknowledged, could still turn out to be right. 
 
“They still think and hope that this is the strategy that will lead to the lowest number of deaths and to the lowest number of closed shops and factories on a one to two-year perspective, and that has still to be proven,” he said. 
 
“I fully agree with them when they say we need to count it at the end of the epidemic and not now” 
 

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  1. I think that Sweden began the second week of March with many, many more infected people both in absolute numbers and inproportion to their population because so many hundreds of Stockholmers spent their vacation ‘winter sports week’ in what would prove to be the places in Italy and, Switzerland and Austria which had the greatest number of infected people. Until we know these numbers … if we ever do … we won’t know what effect the differences in health measures taken had.

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