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Health Policy and Technology
journalhomepage:www.elsevier.com/locate/hlpt
The COVID-19 pandemic in Norway: The dominance of social implications in framing the policy response
Gøril Ursin
a,∗, Ingunn Skjesol
b, Jonathan Tritter
caFaculty of Nursing and Health Sciences, Nord University, P.O. Box 1490, 8049 Bodo, Norway
bFaculty of Nursing and Health Sciences, Nord University, Finn Christiansens veg 1, 7804 Namsos, Norway
cSchool of Humanities and Social Sciences, Aston University, Birmingham B4 7ET, United Kingdom
a rt i c l e i n f o
Article history:
Available online xxx Keywords:
Norway COVID-19 Policy Social impact
a b s t r a c t
Objectives: TodescribetheimpactandpolicyresponsetotheCOVID-19PandemiconNorwayandthe implicationsthishasforfuturepolicydevelopmentandNorwegiansociety.
Methods: Documentary analysis of publicly available statistics, government documents and media sources.
Results: ThreedifferentagendasmotivatedNorwegianpolicy:stemmingthespreadofthevirusdomes- tically,mitigatingtheimpactontheeconomyandaddressingthesocialcostsofthepolicyresponse.
Conclusions: TheoilandgasindustryandtheSovereignWealthFundhavepermittedNorwaytomanage thecostsofthepandemic. Butmay alsoleadtoashiftingovernmentprioritiesinhealth,social and economicpolicy.
© 2020FellowshipofPostgraduateMedicine.PublishedbyElsevierLtd.
ThisisanopenaccessarticleundertheCCBYlicense(http://creativecommons.org/licenses/by/4.0/)
Introduction
This article describes the response to the COVID-19 epidemic in Norway.The Norwegian contextprovides a numberofdistinc- tiveelementsthatmakeitaninterestingcaseforconsideringgov- ernmentthinking,thepolicyresponseandtheengagementofthe publicinaglobalcrisis.Norwayhasaspecialrelationshipwiththe otherNordiccountries(Denmark,Finland,IcelandandSweden)in- cluding significant policy transfer and favourable treatment on a rangeofissues.WhileoperatingaBevridgeanpubliclyfundedna- tional healthsystem, the dispersed populationof Norwaycreates particular challenges in terms of travel, provision and access. In commonwiththe otherNordiccountries, the Norwegianpopula- tion exercisessignificant trustin thestate whichoperates within aconsensualformofpolicymaking.Finally,theoilandgassector isextremely importanttotheNorwegian economyconstitutingin 2018 18% ofGDP and62% of exports. As the seventh largest ex- porter ofcrudeoilinternationally,thecollapseoftheoilpricein- evitably hasimplications forgovernment policy responses to the COVID-19crisis.
∗ Corresponding author.
E-mail addresses: goril.ursin@nord.no (G. Ursin), ingunn.skjesol@nord.no (I. Skjesol), j.tritter@aston.ac.uk (J. Tritter).
InitiallywedescribethecharacteristicsofNorwayanditspopu- lationbeforeconsideringtheorganisationandutilisationofhealth services.We goontodetailthepolicyresponsestotheCOVID-19 crisis beforereflectingon theimplications anddistinctiveaspects of the Norwegian policy response. In particular, we consider the justificationfortheevolutionofthegovernmentresponseandthe waythatthesocialimplicationsoflockdownshapedthepolicydis- course.
NorwayandtheNorwegianhealthsystem
Norwayisa prosperous countrywitha populationof5.3 mil- lionandaGDPpercapitaof€43,900.Itisahightaxeconomywith thetop personal incometax rateof 47.8% andcorporatetax rate of22%andanoveralltaxburdenof38.2%ofdomesticincome.Life expectancyatbirthisthethirdhighestintheEUat82.7[1]witha smalleducationgap,althoughwomenliveanaverageof3.3years longerthanmen.Theover-65-yearold’smakeup17%ofthepopu- lationwithamedianageof39.5andanelderlydependencyrateof 26.9[1].Mostofthepopulationisconcentratedinthesouthofthe countryand83%liveinurban areasbuttherearesignificant dis- persedpopulations astheoverall populationdensityin2016 was 14.3peoplepersquarekilometreoflandarea[2].
Norwayhas a healthy population withlimited health dispari- ties,butischemicheartdiseaseisthesinglelargestcauseofdeath.
https://doi.org/10.1016/j.hlpt.2020.08.004
2211-8837/© 2020 Fellowship of Postgraduate Medicine. Published by Elsevier Ltd. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ )
Fig. 1. Number of reported COVID-19 cases by date as of 13 August 2020.
(a) (b)
Fig. 2. a: Deaths by age and gender compared to total Norwegian population by age and gender Fig. 2 b.
Fig. 3. Number of confirmed COVID-19 cases by age and gender as of 13 August 2020.
Oneinsevenadultsisobese,therearelowlevelsofsmoking(10%
ofadults) butother formsoftobacco usehaverisen overthelast 20years[1].Inpart,duetohightaxation,alcoholconsumptionfor adultsandadolescentsislowatjustundersevenlitresperperson peryear.
Like other Nordic countries and the United Kingdom, Spain, Italy and New Zealand, Norway has a public financed national healthcaresystem(aBevridgeansystem) providinguniversal cov- erage for all residents financed through general taxation (74%), thenationalinsurancescheme(11%)andprivateexpenditure(15%) whileprivate health insuranceis marginal covering less than 5%
of elective services [1]. Co-payment is capped but relates pri-
marily to dental care and outpatient pharmaceuticals. In 2017, Norway spent 10.4% of GDP on health or €4,545 per capita [1].
Adecentralisedsystem,thegovernmentownsthefourregional healthauthoritiesthatmanagehospital servicesandemploystaff.
Themunicipalitiesmanageprimarycare,long-termcareandsocial servicesandgeneralpractitionersareself-employedbutintegrated intothepublic systemvia contracts.The for-profithospital sector istinyprovidinglessthan0.2%ofhospitalstaysand7%ofdaytime stays[1].
PriortothePandemictherewere2.9physicians(2018WB),3.9 hospitalbeds(2013WB)and18.2nursesandmidwives(2018WB)
Fig. 4. New patients admitted to ICU by date as of 13 August 2020.
Table 1
Norwegian government COVID-19 policies (issued 12 March 2020).
Government recommendations Hand hygiene and cough etiquette
Wash hands frequently and thoroughly
Avoid shaking hands and hugging people you do not live with.
Cough or sneeze into a paper tissue or the crook of your elbow.
Work from home Home working should be used if possible Public transport Use of public transport should be avoided Domestic travel Limit leisure travel in Norway
Health institutions No visits to members of vulnerable groups Mandated by law with potential sanctions
Stay at Home People with respiratory tract infection symptoms must stay at home until at least 1 day after they feel completely well.
Home Quarantine People who travelled abroad must quarantine in their home for 14 days from the day they returned to the country. Backdated to 27.02.2020. Exception for travel from Finland and Sweden.
People who have been in close contact with someone with a confirmed case of COVID-19 must home quarantine for 14 days.
Those in quarantine must remain at home and not attend school or work. They can go outside, carry out necessary shopping maintaining social distancing of at least 1 metre but not use public transport.
People who live in the same household are not quarantined.
Home isolation People with confirmed COVID-19 must be isolated at home or in a healthcare institution else. The isolation lasts until 3 days after you have recovered and at least 8 days after you became ill.
They can go outside in private garden or balcony and should try to maintain social distance from others in their household; people in the same household are in quarantine.
Closure Educational institutions (from Kindergarten to Higher Education) Exception: Open to children of key workers up to 10, and children with special needs
Restaurants, bars, pubs and clubs. Exception: If they can serve food to customers maintaining social distancing of 1 metre.
Fitness centres, swimming pools and waterparks.
Hairdressers, tattoo and piercing parlours, massage studios, spas and beauty parlours.
Cancelled/postponed All organised sports activities, competitions and cultural events.
International travel ban Applies to healthcare professionals with patient contact.
per1,000population.In2010,Norwayhadapproximately300ICU beds[3].
COVID-19trendsinNorway
The National Institute of Public Health started testing for COVID-19on23January,registeredthefirstincidenceon26Febru- ary and the first death caused by COVID-19 on 12 March 2020.
TheNorwegianNationalInstituteofPublicHealth(NIPH)hasover- seen all data collection and measurements since COVID-19 was firstlistedasanotifiable diseaseinNorwayon31January.Bythe 13 AugustNIPHhaspublished11reportsupdatingCovid-19data.
Municipalitiesareresponsiblefordetecting,reportingandsurveil- ing the spread of infectious diseases therefore, the Municipality Director of PublicHealth haslocal oversight over COVID-19 test-
ingwhichisperformedbya nasopharynxandthroattestorby a bloodtest,andanalysedusingPCR-technology[4].Initiallytesting took placeinhospitals, butlater specialtesting siteswere estab- lishedinmunicipalities,butallthesampleswereanalysedinhos- pitallaboratoriesandthe resultssubmitted electronically directly totheNorwegianSurveillanceSystemforCommunicableDiseases (MSIS)Laboratorydatabase.Thereislittleevidenceofdelaysinac- cesstotestsorresults.
Thefirstnationally televisedpressconferencewasheldby the governmenton10 March2020andcontinued dailyuntil8 April.
Thereafter, press conferences were held three times a week and from 15 June were only held when needed but at least once a week.The Prime-Minister, HealthMinister andHeadoftheNIPH wereall presentinitially,while laterthe panelincluded theMin- isterofEducation andIntegrationandtheMinister ofJusticeand
Public Security. Links to streamedpress conferences, written in- formationandreportsareavailable throughgovernmentwebsites withdailyupdates.Whiledataisavailable atregionalandcounty level,municipalitieshavebeenactiveinadoptingarangeofcom- municationsstrategies inordertoreach their citizensusing daily pressconferences,localnewspapers,radioandtwitter.
PlottingthecourseofCOVID-19inNorway
The NIPH monitors the evolution of COVID-19 and has pub- lisheddailyreportssince12Marchontheirwebsite.Asof13Au- gust,atotal518,893(seeFig.1)peoplehavebeentested[5].
As of 13 August, 257 COVID-19 related deaths had been re- portedor5.4per100,000population[6].Theaverageageofdeath is82years.ThepeakofdeathsassociatedwithCOVID-19wasthe weekof6Aprilandincludesthose whodiedofandwithCOVID- 19.Intotal,moremenhavediedthanwomenbutduetotheinter- actionbetweenageandgendertherehavebeenmorefemalethan maledeathsamong90+(seeFig.2)[6].
By13ofAugust9783casesofCOVID-19hadbeenreportedand atotalof1233patientsadmittedtohospitalinNorway,180cases per100,000[6].Thisfiguregrewfrom8383totalcasesby29April butexhibitslittleobviousgenderpattern(SeeFig.3).Withanav- erageageof59the230patientsadmittedtoICUup to13August (4.3per100,000population)(SeeFig.4),were 75%maleand63%
hadatleastone risk factor such asage,obesity (BMI>30), gen- der,comorbidity,ethnicityandlowsocioeconomicstatus[6].There is no available data on length of hospital stay. According to the NIPHmodellingpublishedon12Augustthescenariobasedonan R=1.1 suggests a peak of Covid-19 patients in hospitalsand pa- tientsinhospital needingventilatortreatmentinApril-May2021;
the current R value is 1 [7]. The first reportedcases in Norway wereamong those whohad travelled abroadwhile thefirst case withoutdirectcontactwasreportedon9March[6].On28Febru- arytwomedicaldoctorswere infectedbuttherearenopublished statisticsonthenumberofhealthcareprofessionalswithCOVID- 19.Oslo (the capitaland largestcity inNorway) hasthe highest level of infection (24,2 per 100,000 population), double the na- tionalaverage (10,4 per 100,000 population) [8](see Fig. 5). Far higherratesofinfectionhavebeenrecordedamongthosenotborn inNorway.Between13Julyand2August43%ofallCovid-19cases wereassociatedwiththeimmigrantpopulation[6].
Norwegianpolicyroadmap
On 12March theNorwegian Governmentpresentednewpoli- ciesintendedtolimitanddelaytheCOVID-19outbreak[9].Regula- tionsrangedfromadviceonavoidinginfectionthroughrestrictions totravelandgroup meetingsandenforced closureofrestaurants, coffeeshopsandpubsifsocialdistancingbetweencustomerswas notmaintained (See Table 1) [10]. Violations were punishableby finesorimprisonmentforup tosixmonths,butthere havebeen veryfewcasesoftheauthoritiesissuingfines.
Another set ofpolicies relatedto the economic impact ofthe COVID-19 pandemic and the consequences of the movement re- strictions:awork furlough schemeandloan guaranteesfor busi- nesses. On 13 March, the government announced a 20-day fur- loughscheme tobe implementedon 20March.Usually whenan employeeismaderedundant,theemployerisresponsibleforpay- ingthefirst15days;fortheemployee,followingathree-daystop inpaytheycanreceiveunemploymentbenefitsfromthestate.The new furlough scheme reduced the period the employer was re- sponsibletopaytotwodays,followedbyan18-dayperiodwhere thestateprovidedthepayment;beyondthe20-dayperiodan in- dividualcould apply for unemploymentbenefits. The notification periodto the employee wascut from 14to two days to support
Fig. 5. Confirmed COVID-19 cases country heatmap as of 13 August 2020.
businessesthatwereshutdownovernight.Afurtherflexibilityfor employerswasthatemployeescould befurloughedpart-time(up to 50%) and therefore could continue to be in contact withand contributingtotheirworkplace.Theintentionwastosupportcom- paniestorotatestaff onfurlough withina businessto tryto limit unemployment.
TheNorwegiangovernmentresponsealsoreliesheavilyonloan guarantees to theprivate sector. Government loanguarantees for smallandmediumenterpriseswereannouncedon15March,pre- sented to Parliament on the 20th and implemented on the 27th. Thisschemewasextendedtoallprivatefirmsincludingthosewith morethan250employeeson2April.Onthe19th ofMarch6bil- lionNOKloanguaranteesfortheaviationindustrywereagreedin- cludingspecificprotectionforparticulardomesticroutesandaboli- tionoftheair-passengertaxfrom1January-31Octoberwhileair- port taxespaidby the carrierswere cancelledfrom1 January-31 June.
On29MaytheGovernmentinitiatedanewpolicyphase,where movementcontrolmeasureswerescaledback,andeconomicmea- sureswererevisedtoincrease economicactivityandhelptheun- employed return to work. The new measures were; 1) a tempo- rary subsidy schemeforcompanies to take back temporarilylaid off workers,2) measures to underpinactivity inthe construction sector,3)agreentransitionpackage,4)governmentpurchaseofair
Table 2
COVID-19 testing criteria and prioritization by date of implementation.
Date implemented Priority Testing where there is suspect COVID-19 8 February 1 Patients in need of hospital admission
2 Patients/residents of nursing homes or healthcare facilities 3 Patient-facing healthcare professionals
4 At risk population: 65 + , serious or poorly managed long-term conditions 5 Individuals quarantined due to close contact with a confirmed case of COVID-19 or
after international travel
20 April 6 Employee, child or pupil in a re-opened childcare centre, school or after-school programme
24 April Post-mortem tests where there is suspicion of COVID-19 7 May 7 Others with suspected COVID-19 disease
Those on priority 6-7 tested after home monitoring of symptoms for 2 days 25 May 8 Nursing home residents who are asymptomatic
10 June All those with suspected COVID-19 should be tested.
andtrainroutesfromprivateproviders,5)acompensationscheme forstatutorymaintenanceexpensesinseasonalbusinesseswithse- vereincomeloss,6)increasededucationfundingand7)measures to strengthenintegration.Fig.6 providesa diagram oftheevolu- tionofthefullrangeofNorwegianCOVID-19policies.
Inthepressconferenceon7Maythegovernmentpresenteda plan to gradually open the nationalborders fortravel, emphasis- ingthatitwouldbethedevelopmentofthepandemicthatwould regulatewhichcountrieswouldbepermittedaccessfortravel.The first step wastobe opening travel betweentheNordic countries on15June. On12Junea newsystemtocommunicatetravel per- mittedwithoutquarantinerestrictionswaslaunched.Travelaccess wasbasedonasetofcriteriaandregions assessedassafewould bepublishedeveryotherweekintheformofamap[11].Thefirst assessment resulted in opening borders to all the Nordic coun- triesexcept Sweden.Initially travel tothe islandof Gotland,part ofSweden,withoutquarantinewaspermittedalthoughon15June allofSwedenwasexcludedfromquarantinefreetravel(seeFig.7).
Inapressconferenceon10JulyTheMinistryofForeignAffairs presented new regulations on travel permitting quarantine-free travelfrom15JulyforallcountrieswithintheSchengenarea/EEA exceptforPortugal,Bosnia-Herzegovina,Croatia,Hungary,Bulgaria andRomania. Applying thesame setof criteriaasforthe Nordic region,thegovernmentwillcontinue,every otherweek,toassess any changes in the list of countries that can be visited without quarantinerestrictions.
Initially the nationally provided informationon COVID-19 was primarily aboutsymptoms,thespreadofthedisease andpreven- tion strategies. On 12 March, the government launched multiple strategiestocontainthevirusbyclosingnationalborders,schools and nurseries, prohibiting cultural and sports events and estab- lishing nationalquarantine regulations.Theseresponses were en- shrinedin atime-limitedCoronaLawon 18Marchthat extended theauthorityofthePrimeMinistertoactduringthecrisis.
From 14 March, there was a shift in the content and nature oftheinformationdisseminatedfocusingmoreongovernmentre- sponsestotheeconomicconsequencesofthepandemicandquar- antineregulationssuchastheworkfurloughschemeorthelossof seasonalagriculturalworkers.Increasingly,thesocialconsequences ofthesituationhavebecomethefocusofgovernmentcommunica- tionandthepoliticaldiscourseunderpinning thepolicy response;
loneliness, isolation, insecurity and the impact on young people and the delaysin processingwelfare claims andespecially those associatedwithunemploymentandthefurloughscheme.
Alongside the evolution of policy there were also changes in COVID-19 testingcriteria (See Table 2) [12]. Due to the low lev- elsofCOVID-19virusinNorwaylarge-scalepopulationtestingwas neverrecommendedbytheNIPH.Until25May,peoplewhowere asymptomatic were not testedas a negativeresultmightnot in-
dicatethatan individualisintheincubationperiod,andtherefore mightgiveafalsesenseofsecurity.Testingwithnasopharyngealor oropharyngealswabsrequirestrainedpersonnelandclosecontact betweenthepersonbeingtestedandhealthpersonnel,thisisre- sourceintensiveandrisksfurtherspreadingthedisease.Therefore, from15JunetheNorwegianHealthDirectoratetogetherwithOslo municipalitypilotedatestusingself-collectedsalivasamples.This non-invasivetestrequiresminimalequipmentandnoclosecontact betweentestsubjectandthehealthpersonnel[13].Municipalities wereinformedon9Augustthatfrom12Augusttestingshouldbe availabletoanypersonwithsuspectedinfectionwithoutrequiring aphysician referral. Some municipalitiesprovide drop-inservices fortesting,whileothersrequireabookedappointment.
Norwegianhealthcaresystemresponse
Norwayhas250ICUbeds,and500bedsthatcanbeupgraded to criticalcare [14]. Current modellingsuggests that the peak of theepidemicwilloccurbetweenMayandOctoberpotentially re- quiring600-1200ICUbeds[14].Hospitalsweregivenauthorityto cancelplannedactivityandreallocatebedstoincreasethenumber ofICU beds,thishasledto asignificant increase inwaitinglists.
There hasbeen verylittle attentionto the response toCOVID-19 fromprimarycare.Therehasbeenlittlepublicorgovernmentdis- cussion,apartfromrestrictionsonhomevisitsandnoreallocation ofworkorstaff.
Providingcriticalcarerequiresspeciallytrainedhealthcarepro- fessionals, especially nurses. Many hospitals created digital edu- cationon infectioncontrol andforhealth care professionalswho werenotindailypracticeinordertoreallocatenursesfromother wardstoICU[15].Nursingstudentsintheirfinalyearofanunder- graduatedegreewerepermittedtoapplyfortemporaryauthoriza- tiontowork inhospitalstoincrease thesize ofthehealthwork- force;thiswasparalleltotheexistingopportunityavailabletofinal yearmedicalstudents[16].
Effective infection control requires personal protection equip- ment such asfacemasks, glovesandface shields. Many hospitals and health care facilities had very little infection control equip- ment atthe beginning of March,orders and distribution ofsuch equipmentwasthen centralisedto prioritizeinstitutionswiththe greatestneed [17]. Municipal health carefacilities (primarilyres- identialelderly care) andhome careservices, andgeneralpracti- tionershadtosubmittheirordersthoughanationalcontactpoint alongwithhospitals[18].Private initiativestoassist inproducing facemasksand shields were encouraged to increase the available supplyofPPEforuseinhealthcarefacilities.
Eventhoughthe governmentprioritizedthe transportoffood, suppliesandpharmaceuticals,manypeople livingwithlong-term conditions feared for their own health. Because of limited sup-
Fig. 6. The evolution of Norwegian COVID-19 policies.
Fig. 7. Regions opened for travel without requiring a quarantine period.
pliesandtocombathoardingtheavailabilityofsevenpharmaceu- ticals was restricted: oxazepam (Xanax), insulin, metformin, Az- itromcin (antiboticum), prednisolon, plaquentil and Paracetamol [19].
Norwayis partofan internationalcollaborationforthe devel- opmentofvaccines(TheCoalitionofEpidemicpreparednessinno- vations) that startedworkdevelopinga vaccineagainst COVID-19 inJanuary.NorwayhasdonatedNOK36milliontodevelopthevac- cines[20].
Healthtechnologyresponse
Norway’stechnologyresponsewasprimarilyfocussedandtrack andtrace.Inpartthisisduetotheexistinghighlydevelopedelec- tronic recordssystem inNorway and thetechnology that under- pins thecentralisedhealth informationsystem. The“Smittestopp”
app wasreleased on 16 April.The appcollects anonymised data about movement patterns as well as notifies users if they have beeninclosecontactwithapersonthat laterisconfirmedasin- fected with COVID-19. This requires that those who are infected alsodownloadandregisterwiththeapp.By19Marchmorethan 1.5million people haddownloaded theapp[21].An expertcom- mitteeassessedthetechnologyandconcludedthatitrequiresfur- therdevelopmentasitstoredtoomuchpersonalinformation[22]. On 12 June theNorwegian Data Protection Authority warnedthe government that continuing to collect data that was not being analysed dueto theextremely low numbersof infectionscontra- vened thelaw.Inresponse,on15 June,theNIPH announcedthat alldatacollectionwasbeingstopped,dataalreadycollectedwould
be deletedandadvising members ofthe publicto deactivate the app.
The key role of municipalities in detecting, reporting and surveilingthe spread of the pandemic prompteddigital solution tomakingtherelevantdataavailabletoinformpolicyatbothna- tional and regional levels. The NIPH collaborated with The Nor- wegianAssociationofLocal andRegional Authorities(KS)andse- lected theDistrictHealth InformationSoftware2 (DHIS2).A mo- bile phoneapplicationthat permitsoffline datacapture DHIS2 is an open source,web-based healthmanagement information sys- templatform,thatmakesitpossibletogenerateanalysesfromdata in real time [23]. Previously the software wasused by low and middleincome countriesto trackinfectiondisease butin collab- orationwiththe WHOa group led by theUniversity of Oslode- velopedamodulespecificallyfortheCOVID-19pandemic[24].All municipalitiesweregivenaccesstotheNorwegianversionthrough anationalwebpageon5June.
Economicandfinancialfluctuation
Norway, likeso many other countrieshas faced thechallenge ofthe loss ofrevenuesdue to thedramatic decline ofthe econ- omyaswellasthecostofdeliveringincreasedlevelsofhealthser- vicesandschemestosupportemployersandemployees.However, Norway has also faced a significant decline in the oil pricethat createsa direct challenge tothe national budget frompetroleum and tax revenues and an indirect challenge related to the con- tractionof a significantindustrial sector. Table 3summarizes the estimatedcosts of thepolicies put inplace tosupport the econ-
Table 3
Estimated costs of economic stimulus measures (NOK billions) (as of 8 June 2020).
Mitigate income loss for businesses including compensation for large losses 74.1 Aviation sector loss provision and guarantee scheme 14.1 Government guaranteed loans to businesses through the banking system 10.0
Counteract loss of income for individuals 27.3
Strengthening critical infrastructure sectors 23.3
Other compensation schemes 7.2
Other measures 6.1
Increased spending on unemployment benefits 23.9
Total 186.0
Fig. 8. Number of unemployed by type of unemployment 3 March - 5 May.
omy[25].Overall,itisestimatedthattaxrevenueswilldeclineby NOK59.4bnwhile the government budget balance is expectedto weakenbyNOK245.4bn.
In part, thesecosts are due to the significant increase in lev- els of unemployment which has doubled since the outbreak of COVID-19 andas of3 July 232,734 individuals were fully unem- ployed[26].Thisisapparent inFig.8 asfollowingtheexpansion ofthe furlough schemeon 24March the numberoffully unem- ployed declined while those in partial unemployment (including thoseon thefurlough scheme)increased. Despitetheseinterven- tionsthenumberoffullyunemployedremains morethan double thenumberatthebeginningofMarch2020andtheseasonallyad- justedunemploymentrate(averagefromApril-June)is4.6%.
Inresponsetothesignificantcostsincurredbypoliciesandthe dropin oil revenueson 12 Maythe Government proposed a re- vised state budget for 2020. The new budget entails the use of NOK382bn(€34.6bn) fromthe SovereignWealthfundratherthan theplannedNOK3.9bninflowtothefund. Therevisedbudget in- cludes the structural oil-corrected budget deficit, or the amount of petroleum revenue included in the budget has increased to NOK419.6bnfromtheNOK243.6bnannouncedintheOctoberbud- get[27].The revisedbudget wasconsideredby parliamenton 19 June.
TherehasalsobeenasignificantimpactontheNorwegianeco- nomic andfinancial context dueto the COVID-19 pandemic (see Fig.9).TheNorwegianstockmarket,OSEAXfellbymorethan34%
buthas rallied in line withother international financial markets butremains 10% below the level atthe beginning of2020. Nor- wegiancurrency marketshavealsobeenaffected,therateagainst the US$ dropped by 26% to a historic low on 22 March and re- mains3%belowthestartoftheyear.AgainsttheEurothepattern
is similar with the Norwegian Kronaweakening over the course ofthepandemicreachingalowpointon22Marchbeforerallying but remaining almost 7% below the first of January level. In re- sponsetheNorwegiancentralbank,NorgesBank,is“Continuously consideringwhetherthereisaneedtointerveneinthemarketby purchasingNorwegianKroner”[28].Thishasbeenfollowedbythe centralbankcuttinginterestratestoarecordlowofzeroandfore- castthat they wouldremain there until atleast2023. The 0.25%
cutwaspartofa1.5%cutovertheperiodsinceMarch[29]. Theoil andgasindustry iscentralto theNorwegian economy andtheoilpricecrashcontinuestohaveasignificantimpact.Nor- wayproduces2% oftheworld’soilsupplybuton29ApriltheOil andEnergyMinister,TinaBru,announcedthat Norwaywouldcut oil production by 13%in June; the first cut in production for18 years. Norway’s state-owned operator Equinor announced capital expenditureandexplorationcutsaspartofits£3billionCOVID-19 action plan,the suspension of a sharebuyback program, andset up a department with theaim of preservingproduction andthe jobsitsupportsintheNorthSea[30].
Conclusionsandpolicyimplications
Norway actedquicklyto stemthe spreadof thevirus domes- tically, and limit infection from abroad while increasing health servicecapacity. The policy emphasis quickly shifted to concerns abouteconomicimpacts,theneedtobuttressbothemployersand employees and support specific industries such as domestic air travel.Mostrecently,concernsaboutthesocialcost oftheimple- mentation ofthelockdownprocedures andtheneed tomitigate theconsequenceshasshapedpoliciesrelatingtotheeasingoflock downprocedures.Thisattentiontothesocialaspects,andtheabil-
Fig. 9. Financial market reaction to major policy events in Norway (in percentage change from 1 January 2020).
ity to fund these, we believe, is a key differentiator of the Nor- wegian response.As theNorwegian PrimeMinister, ErnaSolberg, reflected,“The governmenthaschosento prioritisechildren,then workinglife,andfinallyotheractivities.”[31].
Services for vulnerable children and youth were considerably reduced duringthe first stage of fighting the pandemic. Mostof the low thresholdservices for children and young people where closedduetosocialdistancingandmanyofthesocialcareworkers intheseserviceswerereallocatedtootherpartsofthehealthsys- tem. Inaddition,therateofreferralstochildwelfareservicesde- clineddramatically,andcollaborationacrossserviceswasreported asmoreproblematic[32].Despitethedeclineinprovisionandfor- mal demand a large-scale epidemiological investigation assessing the prevalenceofdepression andanxietyassociated withCOVID- 19 mitigation strategies found a two to threefold increase in de- pressiveandanxietysymptomsinindividualsexperiencingthere- strictions [33].Astudyofquality oflifebetween9and29March showedthatpeopleweremoreconcernedaftertheCOVID-19out- break regulations were implemented. The groups expressing the greatestincreaseinlevelofconcernweresinglepeopleunderthe ageof45andimmigrants,followedbyparentswithchildrenunder theageof17[34].Thishasimplicationsforfuturehealthpolicies.
Olderpeopleandthosewithcompromisedimmunesystemsor withlong-termconditionshavealsobeenparticularlyaffected by theregulations.Forthefamiliesofmanyofthese,beingunableto visit, orfinding that those theyloved died alonehas beena sig- nificant source ofanxietyand furthergrief. Toaddress thisissue and relieve social stress, the government announced on 27 May thatvisitsbyfamilymemberstoresidentialfacilitiesandtoattend birthswouldbepermitted.
The significant outbreak of COVID-19 cases among the immi- grantpopulationespeciallyinOslowas, atleastinpartrelatedto thecommunicationstrategy thathadbeenadopted.Theresponse, theprovisionofinformationina rangeofminoritylanguagesand engagement with community information as part of an engage- ment strategygenerated significant success.Thishasforced are- flectionbyhealthauthoritiesontheneedtoconsiderindirectpro- cessesofdiscriminationsuchasdefininganimmigrantcommunity as‘problematic’. Asa consequence,healthauthorities nowrecog- nise theimportance ofengagingwithsuchcommunities ina dif- ferentway.
Despitetheseareasofconcern,theNorwegian policyresponse toCOVID-19isconsideredasuccessnationallyandinternationally.
Whilethereisalowlevelofcommunityinfectionrelyingonherd immunityhasneverbeenanaspectoftheNorwegianstrategy.As thePrimeMinisterexplainedon7May“upuntilnow,thestrategy hasbeentostopthespreadofthevirus.Wearenowtransitioning toa controlstrategy. Wehavehadthesameaimall along,toen- surethat thehealthservices havethecapacitytoassist everyone
thatneeds it,both patientsin needofhealthcareduetoCOVID- 19 and patientsthat need health care due to other reasons and diseases.” Itisunclear whetherthispolicywill needtochangein responseto currentmodelling suggestinga second wave peaking inMay2021[7].
Norwayis a rich country, andthe strength ofthe oil andgas industry over the last 20 years, generatingthe Sovereign Wealth fund,has provideda bufferto theeconomic consequences ofthe crisis. Indeed, the need to draw on these reserves may also re- shapethegovernment’sorientation tothecountry’seconomicde- pendenceonthisindustrialsector.
The27ofFebruary,theCEOoftheNorwegiancentralbank,Yn- gve Slyngstad, argues that Norway needed to shift from“an oil- dependent nationto an oil fund nation”[35].This echoed state- ments by NorgeBank governor, OysteinOlsen who inhis annual speechstated, “Ifthis transitiontoa lessoil-dependent economy could happen gradually, I’m very optimistic. If you have a more abrupt changes in conditions or policies…that…would make the transitionmorechallenging”[36].PerhapsCOVID-19 provides the impetusforthistransition,atransitionandacontextthatall,poli- cymakers,businessleadersandthepopulation,feelischallenging.
There will inevitablybe shifts in healthpolicy, to ensuregreater sensitivityand responsiveness to immigrant populations, support forvulnerable young people andgreater attention to the mental health consequences of isolation. But as telling will be the fall- out both from the economic consequences, the impact on em- ploymentparticularlyamongst youngpeopleandthechallenge to SwedishpolicyleadershipacrosstheNordiccountries.TheSwedish responseto COVID-19 hasexposed a fracture inNordic solidarity apparent in the continued closure of borders; a fracture that is likelytoechoinotheraspectsofpolicy.
Funding None.
Ethicalapproval Notrequired.
DeclarationofCompetingInterest
Nonedeclared.
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