The COVID-19 pandemic and the timing of government response: A comparison of four Nordic countries March-June 2020.

OBJECTIVES: The aim is to compare Sweden, Denmark, Finland and Norway regarding government response to the COVID-19 pandemic in mid-March-June 2020 using the Oxford Government Response Tracker. STUDY DESIGN: Descriptive longitudinal ecological study. METHODS: Descriptive analysis of time series data. RESULTS: Sweden displayed a far lower response index in March. By late April indexes were similar. In May-June, response indexes were lower in Finland and Norway than in Sweden. The average response index in mid-March-June was similar in Sweden, Finland and Norway. CONCLUSIONS: The government response in the four countries indicates that timing of response was essential. Sweden's slow and weak initial government response in March-April was followed by less loosening of government response in May-June compared with, especially, Finland and Norway, which resulted in similar average government response in mid-March-June for the three countries. As a comparison, COVID-19 mortality per capita was 10 times higher in Sweden than in Finland and Norway, and five times higher than in Denmark during the same period.

The quantification of vaccine uptake in the Nordic countries and impact on key indicators of COVID-19 severity and healthcare stress level via age range comparative analysis.

In this paper we analyze the impact of vaccinations on spread of the COVID-19 virus for different age groups. More specifically, we examine the deployment of vaccines in the Nordic countries in a comparative analysis where we focus on factors such as healthcare stress level and severity of disease through new infections, hospitalizations, intensive care unit (ICU) occupancy and deaths. Moreover, we analyze the impact of the various vaccine types, vaccination rate on the spread of the virus in each age group for Denmark, Finland, Iceland, Norway and Sweden from the start of the vaccination period in December 2020 until the end of September 2021. We perform a threefold analysis: (i) frequency analysis of infections and vaccine rates by age groups; (ii) rolling correlations between vaccination strategies, severity of COVID-19 and healthcare stress level and; (iii) we also employ the epidemic Renormalization Group (eRG) framework. The eRG is used to mathematically model wave structures, as well as the impact of vaccinations on wave dynamics. We further compare the Nordic countries with England. Our main results outline the quantification of the impact of the vaccination campaigns on age groups epidemiological data, across countries with high vaccine uptake. The data clearly shows that vaccines markedly reduce the number of new cases and the risk of serious illness.

Political stringency, infection rates, and higher education students' adherence to government measures in the Nordic countries and the UK during the first wave of the COVID-19 outbreak.

Understanding predictors of adherence to governmental measures to prevent the spread of the COVID-19 is fundamental to guide health communication. This study examined whether political stringency and infection rates during the first wave of the pandemic were associated with higher education students' adherence to COVID-19 government measures in the Nordic countries (Denmark, Finland, Norway, Iceland, and Sweden) and the United Kingdom. Both individual- and country-level data were used in present study. An international cross-sectional subsample (n = 10,345) of higher-education students was conducted in May-June 2020 to collect individual-level information on socio-demographics, study information, living arrangements, health behaviors, stress, and COVID-19-related concerns, including adherence to government measures. Country-level data on political stringency from the Oxford COVID-19 Government Response Tracker and national infection rates were added to individual-level data. Multiple linear regression analyses stratified by country were conducted. Around 66% of students reported adhering to government measures, with the highest adherence in the UK (73%) followed by Iceland (72%), Denmark (69%), Norway (67%), Finland (64%) and Sweden (49%). Main predictors for higher adherence were older age, being female and being worried about getting infected with COVID-19 (individual-level), an increase in number of days since lockdown, political stringency, and information about COVID-19 mortality rates (country-level). However, incidence rate was an inconsistent predictor, which may be explained by imperfect data quality during the onset of the pandemic. We conclude that shorter lockdown periods and political stringency are associated with adherence to government measures among higher education students at the outset of the COVID-19 pandemic.

Coronavirus pandemic in the Nordic countries: Health policy and economy trade-off.

Background: Countries making up the Nordic region - Denmark, Finland, Iceland, Norway, and Sweden - have minimal socioeconomic, cultural, and geographical differences between them, allowing for a fair comparative analysis of the health policy and economy trade-off in their national approaches towards mitigating the impact of the COVID-19 pandemic. Methods: This study utilized publicly available COVID-19 data of the Nordic countries from January 2020 to January 3, 2021. COVID-19 epidemiology, public health and health policy, health system capacity, and macroeconomic data were analysed for each Nordic country. Joinpoint regression analysis was performed to identify changes in temporal trends using average monthly percent change (AMPC) and average weekly percent change (AWPC). Results: Sweden's health policy, being by far the most relaxed response to COVID-19, was found to have the largest COVID-19 incidence and mortality, and the highest AWPC increases for both indicators (13.5, 95% CI = 5.6, 22.0, P < 0.001; 6.3, 95% CI = 3.5, 9.1, P < 0.001). Denmark had the highest number of COVID-19 tests per capita, consistent with their approach of increased testing as a preventive strategy for disease transmission. Iceland had the second-highest number of tests per capita due to their mass-testing, contact tracing, quarantine and isolation response. Only Norway had a significant increase in unemployment (AMPC = 2.8%, 95% CI = 0.7-4.9, P < 0.009) while the percentage change in real Gross Domestic Product (GDP) was insignificant for all countries. Conclusions: There was no trade-off between public health policy and economy during the COVID-19 pandemic in the Nordic region. Sweden's relaxed and delayed COVID-19 health policy response did not benefit the economy in the short term, while leading to disproportionate COVID-19 hospitalizations and mortality.

Which factors are associated with COVID-19 infection incidence in care services for older people in Nordic countries? A cross-sectional survey.

AIMS: To investigate the differences between Sweden, Denmark, Finland and Norway regarding residential/home care units' and frontline managers' background factors, the resources allocated and measures taken during the initial phases of the COVID-19 pandemic, and whether and how these differences were associated with COVID-19 among older people in residential/home units. METHODS: Register- and survey-based data. Responses from managers in municipal and private residential/home units. Number of municipal COVID-19 cases from national registries. Multilevel logistic multivariate regression analysis with presence of COVID-19 among older people in residential/home units as the outcome variable. RESULTS: The proportions of residential/home units with client COVID-19 cases, mid-March-April 2020 were Denmark 22.7%, Finland 9.0%, Norway 9.7% and Sweden 38.8%, most cases found in clusters. The proportions were similar among employees. Client likelihood of having COVID-19 was six-fold higher if the employees had COVID-19. Mean client cases per residential/home unit were Denmark 0.78, Finland 0.46, Norway 0.22 and Sweden 1.23. For the same municipal infection incidence class, Sweden's mean client infection levels were three-fold those of other countries. The regression analysis variables country, municipal COVID-19 incidence proportion, and care type were associated with client cases at p ⩽ .001. Compared with Denmark, the odds ratios (ORs) for Sweden, Norway and Finland were 1.86, 0.41 and 0.35 respectively. The variable difficulties in preventive testing had an OR of 1.56, p ⩽ .05. CONCLUSIONS: Municipal COVID-19 incidence, employee cases, and the lack of testing resources somewhat explained the confirmed COVID-19 cases among older people in residential/home units. A two- to five-fold unexplained inter-country difference in ORs in the multivariate analyses was notable. The level of protection of vulnerable older clients in municipal and private residential/home units differed between the included countries.

The impact of the COVID-19 pandemic on cancer diagnosis based on pathology notifications: A comparison across the Nordic countries during 2020.

The severity of the COVID-19 pandemic and subsequent mitigation strategies have varied across the Nordic countries. In a joint Nordic population-based effort, we compared patterns of new cancer cases and notifications between the Nordic countries during 2020. We used pathology notifications to cancer registries in Denmark, the Faroe Islands, Finland, Iceland, Norway and Sweden to determine monthly numbers of pathology notifications of malignant and in situ tumours from January to December 2020 compared to 2019 (2017-2019 for Iceland and the Faroe Islands). We compared new cancer cases per month based on unique individuals with pathology notifications. In April and May 2020, the numbers of new malignant cases declined in all Nordic countries, except the Faroe Islands, compared to previous year(s). The largest reduction was observed in Sweden (May: -31.2%, 95% CI -33.9, -28.3), followed by significant declines in Finland, Denmark and Norway, and a nonsignificant decline in Iceland. In Denmark, Norway, Sweden and Finland the reporting rates during the second half of 2020 rose to almost the same level as in 2019. However, in Sweden and Finland, the increase did not compensate for the spring decline (annual reduction -6.2% and -3.6%, respectively). Overall, similar patterns were observed for in situ tumours. The COVID-19 pandemic led to a decline in rates of new cancer cases in Sweden, Finland, Denmark and Norway, with the most pronounced reduction in Sweden. Possible explanations include the severity of the pandemic, temporary halting of screening activities and changes in healthcare seeking behaviour.

Nordic responses to Covid-19: Governance and policy measures in the early phases of the pandemic.

This paper explores and compares health system responses to the COVID-19 pandemic in Denmark, Finland, Iceland, Norway and Sweden, in the context of existing governance features. Content compiled in the Covid-19 Health System Response Monitor combined with other publicly available country information serve as the foundation for this analysis. The analysis mainly covers early response until August 2020, but includes some key policy and epidemiological developments up until December 2020. Our findings suggest that despite the many similarities in adopted policy measures, the five countries display differences in implementation as well as outcomes. Declaration of state of emergency has differed in the Nordic region, whereas the emphasis on specialist advisory agencies in the decision-making process is a common feature. There may be differences in how respective populations complied with the recommended measures, and we suggest that other structural and circumstantial factors may have an important role in variations in outcomes across the Nordic countries. The high incidence rates among migrant populations and temporary migrant workers, as well as differences in working conditions are important factors to explore further. An important question for future research is how the COVID-19 epidemic will influence legislation and key principles of governance in the Nordic countries.

The Corona crisis: a wicked problem.

The aim of this paper is to analyse the current Corona crisis from the perspective of the theory of wicked problems. The analysis is based on a combination of observation of national and global effects of the pandemic and a study of relevant theoretical contributions. The findings confirm that the crisis is of a kind that corresponds to the main characteristics of the wicked problems theory. The conclusion is that the pandemic cannot be approached by standardised analytical techniques, because it, like other wicked problems, represents a unique challenge and because all possible solutions may lead to unknown negative consequences.

COVID-19 in pregnancy-characteristics and outcomes of pregnant women admitted to hospital because of SARS-CoV-2 infection in the Nordic countries.

INTRODUCTION: Population-based studies about the consequences of SARS-CoV-2 infection (COVID-19) in pregnancy are few and have limited generalizability to the Nordic population and healthcare systems. MATERIAL AND METHODS: This study examines pregnant women with COVID-19 in the five Nordic countries. Pregnant women were included if they were admitted to hospital between 1 March and 30 June 2020 and had a positive SARS-CoV-2 PCR test ≤14 days prior to admission. Cause of admission was classified as obstetric or COVID-19-related. RESULTS: In the study areas, 214 pregnant women with a positive test were admitted to hospital, of which 56 women required hospital care due to COVID-19. The risk of admission due to COVID-19 was 0.4/1000 deliveries in Denmark, Finland and Norway, and 3.8/1000 deliveries in the Swedish regions. Women hospitalized because of COVID-19 were more frequently obese (p < 0.001) and had a migrant background (p < 0.001) compared with the total population of women who delivered in 2018. Twelve women (21.4%) needed intensive care. Among the 56 women admitted due to COVID-19, 48 women delivered 51 infants. Preterm delivery (n = 12, 25%, p < 0.001) and cesarean delivery (n = 21, 43.8%, p < 0.001) were more frequent in women with COVID-19 compared with women who delivered in 2018. No maternal deaths, stillbirths or neonatal deaths were reported. CONCLUSIONS: The risk of admission due to COVID-19 disease in pregnancy was low in the Nordic countries. A fifth of the women required intensive care and we observed higher rates of preterm and cesarean deliveries. National public health policies appear to have had an impact on the risk of admission due to severe COVID-19 disease in pregnancy. Nordic collaboration is important in collecting robust data and assessing rare outcomes.

Mobility and COVID-19 mortality across Scandinavia: A modeling study.

BACKGROUND: In response to COVID-19, the Swedish government imposed few travel and mobility restrictions. This contrasted with its Scandinavian neighbours which implemented stringent restrictions. The influence these different approaches had on mobility, and thus on COVID-19 mortality was investigated. METHODS: Datasets indicating restriction severity and community mobility were examined; Google's 'Community Movement Reports' (CMR) show activity at key location categories; the Oxford COVID-19 Government Response Tracker collates legislative restrictions into a 'Stringency Index' (SI). RESULTS: CMR mobility categories were negatively correlated with COVID-19 mortality. The strongest correlations were obtained by negatively time lagging mortality data, suggesting restrictions had a delayed influence. During the 'first wave' a model using SI (AIC 632.87) proved favorable to one using contemporaneous CMR data and SI (AIC 1193.84), or lagged CMR data and SI (AIC 642.35). Validation using 'second wave' data confirmed this; the model using SI solely again being optimal (RMSE: 0.2486 vs. 0.522 and 104.62). Cross-country differences were apparent in all models; Swedish data, independent of SI and CMR, proved significant throughout. There was a significant association for Sweden and the death number across models. CONCLUSION: SI may provide a broader, more accurate, representation of changes in movement in response to COVID-19 restrictions.

COVID-19: A Comprehensive Review of Epidemiology and Public Health System Response in Nordic Region.

This paper investigates the epidemiology and public health response of novel coronavirus infection (COVID-19) in the Nordic region. The data on cases and deaths due to COVID-19 were drawn from the European Centre for Disease Prevention and Control. The data on age- and sex-wise cases, deaths and intensive care unit (ICU) admissions, and public health interventions in the Nordic region through November 10, 2020, were obtained from respective countries' health ministries. Sweden accounted for 60.59% of cases (162 240 of 267 768 cases) and 81% of deaths (6057 of 7477 cases) in the Nordic region. The incidence rate for the Nordic region was 989.59 per 100 000, varying from 327.30 per 100 000 in Finland to 1616.51 per 100 000 in Sweden, and the mortality rate for the region was 27.63 per 100 000, ranging from 5.3 per 100 000 in Norway to 60.35 per 100 000 in Sweden. The case-fatality ratio of the Nordic region was 2.79%. Females were more susceptible to COVID-19 infection than males (52.30% vs 47.66%), while males had a greater proportion of deaths (54.7%) and ICU need (71.99%) than females. It is imperative to continue with social distancing, mandatory masks, testing, prohibition of mass gatherings, isolation of confirmed cases, and preventing the importation of cases from other countries to avoid the further resurgence of cases.

Lower ST-elevation myocardial infarction incidence during COVID-19 epidemic in Northern Europe.

We compared the ST elevation myocardial infarction (STEMI) incidence during COVID-19 pandemic (March 2020) to January-February 2020 and to same time period in earlier years 2017-2019 in five Nordic-Baltic tertiary centers. During 2017-2019, there were no marked differences in STEMI incidence between January, February and March. During 2020, there was an average drop of 32% in STEMI incidence in March. The isolation measures may decrease the risk for respiratory virus infection and contribute to the lower STEMI incidence and that we might benefit from firmer suggestions on hand hygiene and social distancing during flu season at least among high-risk individuals.