Corona, Coronavirus | NIPH summit: – Not meaningful to treat the whole country equally

– If the infection tracking fails, there is a risk of entering a negative spiral, warns FHI-top and presents a three-step strategy for the municipalities.

OSLO (Nettavisen): -Infectious tracking is the Achilles’ heel in the fight to beat down the infection, says chief physician and FHI top Preben Aavitsland in this interview with Nettavisen.

– If it does not work fast enough, you will soon fall behind, he warns.


Aavitsland presents a three-step strategy for how municipalities should meet outbreaks and regain control.

– Probably over the top

On Wednesday, the National Institute of Public Health came with good news and said that the national reproduction figure is down to 1.0.

– Expected and happy, says Aavitsland to Nettavisen and dares to make a prediction:

– We are now probably over the top of this wave. Last week, 11 per cent fewer cases were detected, despite the fact that testing increased by 4 per cent. The number of new admissions was down 13 percent, as is expected when there has been a decline over time, he says.

Here the R number is 1.9

But the good news about infection development does not apply to all counties:

In Vestland county, the reproduction rate is estimated at 1.9 and the trend in the number of cases is increasing. It is also increasing in Viken county, where the R-number is estimated at 1.2. For Agder, Møre og Romsdal, Nordland and Trøndelag, the situation is described as uncertain, while for Rogaland it is «likely to increase», according to FHI.

FHI warns against lowering its shoulders and still describes the situation as “unstable”.

– In VG on Tuesday, you spoke out for a different strategy for combating infection in a Norway where there is great geographical variation in infection pressure. What can such a strategy look like?

– The government’s strategy has always been to have targeted measures that are in proportion to the spread of the epidemic in the area in question. In connection with Easter, there are strict measures all over the country, but we will return to a situation with locally adapted measures, says Preben Aavitsland and lists three categories of municipalities in Korona-Norway and how they should find their way back to normal.

Read also: A small municipality has the country’s highest infection pressure

– It does not make sense to treat the country equally

– The pattern has long been a significant difference between the country’s municipalities. For example, districts in Oslo have over fifty times as high an incidence of new cases as Trondheim. It is therefore not so meaningful to treat the whole country equally. We must continue to have measures adapted to the municipality’s situation, Aavitsland emphasizes.

He is chief physician and professor and has both the job as municipal chief physician in Arendal at the same time as he is in the management of infection control at the National Institute of Public Health.

In the three-step strategy outlined by the FHI summit, the overall goal is to get all municipalities down to category 3:

1. Municipalities with a long-term, widespread epidemic

These municipalities account for the majority of cases in the country.

– Three quarters of the epidemic is in Oslo and Viken. There is a persistently high incidence in most municipalities in an arc from Halden and towards Oslo and the neighboring municipalities and then down to Drammen, says Aavitsland.

– The epidemic has taken hold despite strong efforts. Many infected people have an unknown infection situation, he says about the situation in municipalities such as Oslo, Halden, Sarpsborg, Fredrikstad, Moss, Nordre Follo, Lillestrøm, Lørenskog, Rælingen, Bærum and Drammen.

Aavitsland points out that some districts in Oslo and Drammen has an epidemic on a par with the worst countries in Europe.

– These municipalities must continue the hard work of pushing down the epidemic through testing and infection tracking and many contact-reducing measures. Repeated testing of large groups, such as students and pupils, may be relevant. It is absolutely crucial that these municipalities have good infection tracking capacity. If the trace of infection fails, there is a risk of entering a negative spiral where close contacts are not informed, says Aavitsland.

The development in these municipalities is of great importance for the whole country, Aavitsland points out.

– We see some positive signs, but the situation is unstable, he emphasizes.

2. Municipalities with current outbreaks

These are municipalities that normally have a low incidence, but which in recent weeks have experienced one or more outbreaks that are now being dealt with. Here we find exactly Tønsberg, Sandefjord, Horten, Færder, Haugesund, Karmøy, Tysvær, Stavanger, Askøy, Bergen, Stord and Ålesund, Ålesund and Fjord.

– These municipalities must immediately mobilize large resources for infection detection and broad testing of close contacts and relevant environments (workplaces, gyms, religious communities, schools) where there has been a spread of infection. In addition, extensive communication with the population is needed. Coordination with neighboring municipalities makes sense. Such outbreaks should normally be able to be stopped completely within three to four weeks. In some cases, targeted, contact-reducing measures are also needed.

Municipalities with no or few sporadic cases

These are municipalities that have no cases or that have some sporadic cases, often imported from other parts of the country, or that have small outbreaks that are quickly brought under control. Here we find the vast majority of the country’s municipalities.

– These municipalities must first and foremost be very vigilant and have some testing going on as well as follow what is happening in the neighboring municipalities. Every case should be detected and handled very seriously through immediate infection detection. The goal must be to get back to zero and preserve it that way.

– Relief at a different pace

He further believes that the goal is to get all the municipalities down to category 3. This means that category 2 municipalities must gain control of their outbreaks and return to category 3 before the epidemic takes hold and they risk going up to category 1:

– It also means that the significant relief towards the summer may go at different rates.

– We see large local variations in infection pressure almost from day to day. Today (Tuesday 30 March), Rælingen has ended up at the top of the list with the highest infection pressure in the country – after a negative development over the weekend. Where is the Achilles’ heel on effective infection management in the municipalities? What is the success criterion?

– The most important thing is that they have a good capacity to detect and handle outbreaks. The municipalities must immediately mobilize large resources for infection detection and broad testing of close contacts and relevant environments (workplaces, gyms, religious communities, schools) where there has been a spread of infection. In addition, extensive communication with the population is needed. Coordination with neighboring municipalities makes sense. Such outbreaks should normally be able to be stopped completely within three to four weeks. In some cases, targeted, contact-reducing measures are also needed, Aavitsland answers.

also read

Here is Norway’s new vaccine plan

Akilleshælen

– Infection tracing is the Achilles heel. If it does not work fast enough, you quickly fall behind, he emphasizes and refers to a comment published in Fædrelandsvennen on Saturday. Here he explains why infection tracking is difficult.

– The main problem with the corona epidemic is that many infected people do not know that they are contagious. If you become infected, you can infect others after two or three days. It is usually a couple of days before you notice any symptoms, and those symptoms can be so mild that you do not realize you are sick and contagious. Thus, there are many unknown sources of infection out there. The epidemic can thus spread quite covertly, especially among children and young people, who in many cases get very mild symptoms, the superior emphasizes.

Provides advice to the municipalities

When asked what kind of assistance the municipalities receive, Aavitsland answers that the municipalities receive advice from the National Institute of Public Health.

– We have weekly meetings with 10-30 municipalities that handle outbreaks.

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