COVID-19 Public Response and Rapid-Cycle Re-Implementation of Activities

The project is still ongoing and we expect to end the project June 2022. -Hospital admission We investigated non-Covid-19 emergency hospital admissions for acute myocardial infarction, acute abdominal conditions, cerebrovascular diseases, infections and injuries and in-hospital fatality during lock-down week 12-22, 2020. We compared the rates of hospital admissions to the admission the previous three years. We found reduction in admissions for acute myocardial infarction by 18%, cerebrovascular diseases by 10%, infections by 49 %, and injuries by 19%. Admissions for acute abdominal conditions was not changed. There was a 34% reduction in in-hospital fatality due to acute myocardial infarction and 19% due to infections. Even though fewer patients were emergently admitted to hospital, there was no increase in in-hospital fatality or population mortality, indicating that those who were most in need still received adequate care. -Threats, trus and impact on daily life in Norway and Sweden Anonymous web-based surveys for individuals age 15 or older distributed through Facebook using the snowball method, in Norway and Sweden from mid-March to mid-April, 2020. We found participants to have high trust in the health services, but differed in the degree of trust in their government (High trust in Norway 17%; Sweden 37%). More Norwegians than Swedes agreed that school closure was a good measure (Norway 66%; Sweden 18%), that countries with open schools were irresponsible (Norway 65%; Sweden 23%), and that the threat from repercussions of the mitigation measures were large or very large (Norway 71%; Sweden 56%). Both countries had a high compliance with infection preventive measures (> 98%). Many lived a more sedentary life (Norway 69%; Sweden 50%) and ate more (Norway 44%; Sweden 33%) during the pandemic. Sweden had more trust in the authorities, while Norwegians reported a more negative lifestyle during the pandemic. The level of trust in the health care system and self-reported compliance with preventive measures was high in both countries despite the differences in infection control measures. -All cause mortality In Norway, all-cause mortality was stable from 2015 to 2019 (mean mortality rate 14.9 per 100,000 person-weeks) and was 3% lower in 2020 (mortality rate 14.4). In Sweden, all-cause mortality was stable from 2015 to 2018 (mean mortality rate 17.1) and similar to that in 2020 (mortality rate 17.6), but lower in 2019 (mortality rate 16.2). Compared with the years 2015-2019, all-cause mortality in the pandemic year was 3% higher due to the lower rate in 2019 (MRR 1.03; 95% CI 1.02-1.04). Excess mortality was confined to people aged ?70 years in Sweden compared with previous years. The COVID-19-associated mortality rates per 100,000 person-weeks during the first wave of the pandemic were 0.3 in Norway and 2.9 in Sweden. All-cause mortality in 2020 decreased in Norway and increased in Sweden compared with previous years. The observed excess deaths in Sweden during the pandemic may, in part, be explained by mortality displacement due to the low all-cause mortality in the previous year. - Trainingfacilities We assessed whether training at fitness centers increases the risk of SARS-CoV-2 virus infection. 3764 individuals were randomized; 1896 to the training arm and 1868 to the no-training arm. In the training arm, 81.8% trained at least once, and 38.5% trained ?six times. Of 3016 individuals who returned the SARS-CoV-2 RNA tests (80.5%), there was one positive test in the training arm, and none in the no-training arm (risk difference 0.053%). Eleven individuals in the training arm (0.8% of tested) and 27 in the no-training arm (2.4% of tested) tested positive for SARS-CoV-2 antibodies (risk difference - 0.87%). No outpatient visits or hospital admissions due to Covid-19 occurred in either arm. Provided good hygiene and physical distancing measures and low population prevalence of SARS-CoV-2 infection, there was no increased infection risk of SARS-CoV-2 in fitness centers in Oslo, Norway for individuals without Covid-19-relevant comorbidities. In addition to the described project, we preformed semi-structured interviews with different population-groups in Norway, individuals living in rural areas, individuals older than 65 y, individuals aged 50, individuals with chronic disease, parents to young children, youths and health personnel, during the first lock down (March 16-22 2020) and a second interview 3-4 weeks later. Data from these interviews are collected and the analytical work has begun. Vi expect to finish two scientific publications in 2023 regarding "no time for critique" and "fear and insecurity".

Our aim was to provide the public and decision makers with high-quality, evidence-based real-time advice, we proved it was possible to do RCTs on non-pharmaceutical interventions. However, there is a high demand for educating the public and policy makers in the role of science during a pandemic. Only to a limited extent was science used as basis for decision making during the pandemic, and little to nothing was done to facilitate real time access to public registries and research using a randomized design.

This project aims at disentangling the following two overarching and important questions related to the current COVID -19 pandemic: 1. What are the implications of the decisions by authorities in Norway during the COVID-19 pandemic in Norway 2. How can we rapidly and safely re-open important public activities without increasing risk of disease? Working packages 1 will answer question 1 by: • Real-time analysis of the events as they are unfolding by feeling the pulse of the population through group interviews and questionnaires during the outbreak to understand fears, trust, and opinions. • Estimate effects of these measures on health outcomes in the population by linkage to Norwegian registries after the outbreak Working packages 2 will answer question 2 by: • Rapid-cycle randomized testing of re-opening training facilities at Studentsamskipnaden i Oslo with close monitoring of disease activity. We will find the safest and fasted way to relieve society from the burden of restrictive COVID-19 measures. Our aim is to provide the public and decision makers with high-quality, evidence-based real-time advice on the most crucial decisions they will need to make during and after the COVID-19 outbreak.