About these Norwegian Covid Updates

A Second Look at the Report from Weeks 41 through 45

For a few weeks I’ve been posting the highlights from the Norwegian Institute of Public Health’s weekly reports (the most recent update is here, the below summary is from the same source):

Week 45 (8-14 Nov. 2021, details on p. 3): number of new hospitalisations (158) is almost 3 times the number five weeks earlier (+298 %).

Now, it occurred to me to take a second look at the weekly report, and the contents further below p. 3 are very interesting, indeed, and they come in three categories:

1. Definitions (to be found on p. 51 of the 66 page-long document).

2. Hospitalisations in Norway broken down by age cohorts.

3. Hospital admissions by ‘vaccination’ status.

4. An enquiry into recent trends of both hospitalisations and ‘vaccination’ status.

Let’s go and have a look.

Definitions

In a grey box (p. 11), there’s the definition of ‘vaccinated’ etc.:

‘Vaccine status among patients admitted to hospital is calculated based on the patient’s test date. Therefore, we include only patients who can be connected to MSIS [the Surveillance System for Communicable Diseases] in this analysis. In addition, vaccinated with D-number [temporary residency number] and non-residents are excluded from the analysis as these individuals cannot be followed with certainty over time. For definitions of vaccination status see section “definitions of vaccination status for protected individuals: unvaccinated, partial vaccinated, and fully vaccinated” [p. 51]. In this section, “unvaccinated” are persons who have not received a dose of vaccine, and “partially vaccinated” is anyone who received a dose at least 21 days before the test date, no matter how much time has passed between it first dose and test date.’

Having noted this, here’s the detailed definitions (p. 51, my emphasis):

‘Those who are considered partially vaccinated are:

• Those who have received the first vaccine dose. Status as partially vaccinated applies from 3 weeks after the [first] vaccine dose.

• Those who have received a second dose of vaccine, which is still considered partially vaccinated after the first dose, and where 1 week has not yet passed since the second dose of vaccine.

Those who are considered fully vaccinated are:

• Those who have received a second dose of vaccine. Status as fully vaccinated applies from 1 week after other valid vaccine dose.

• Those who have been vaccinated with a single-dose vaccine, with effect from 3 weeks after vaccination.

• Those who have received a dose of vaccine before or after undergoing illness, more specifically:
  a) Those who have received the first dose of vaccine and then, at least 3 weeks later, have been diagnosed with Covid-19 infection. The status of fully vaccinated is here set at 10 days after proven infection.
  b) Those who have undergone illness and at least 3 weeks later have received a dose of vaccine. Status as fully vaccinated applies from 1 week after the vaccine dose.
  c) Those who have been detected by approved laboratory method antibodies to SARS-CoV-2 (with antibody serology at the microbiology laboratory), and then received a dose of vaccine at the earliest on the same day as the test date. Status as fully vaccinated applies from 1 week after vaccine dose.’

With these definitions clarified, let’s look at the data for week 45.

Hospitalisations by Age

On p. 10, there’s fig. 4, which shows the number of new hospitalisations for Covid-19 as main cause, broken down according to age brackets, for the period from 23 Aug. through 14 Nov. 2021:

This is mirrored by table 3, which gives the numbers and share of these hospitalisations and allows for a more refined understanding of the past four weeks. During the entire period from 2 March 2020 through 14 Nov. 2021, the shares of 75-84yo and 85y+ seniors were 13.3% and 5.7%, respectively (second column)—but in the past four weeks (18 Oct. through 14 Nov. 2021), these shares increased to 24.2% and 14.7%, respectively.

Let that sink in: these numbers almost doubled for the age bracket 75-84yo and almost tripled for the 85y+ cohort. In other words: these two age brackets alone—which were ‘vaccinated’ first—constituted a whooping 38.9% of all hospitalisations with Covid-19 as main cause during the past four weeks.

Table 4 (p. 11) shows the breakdown of ICU admissions for this period. While the differences aren’t that stark, what is noticeable is that the past four weeks saw and increase of ICU admissions among the 75-84yo cohort, which now stands at 20% (up from 15.4% for the entire period from 2 March 2020 through 14 Nov. 2021).

Hospitalisation by ‘Vaccination’ Status

First, a disclaimer, of sorts, for on p. 11 we read that ‘it is impossible to connect all patients in NoPaR [Norwegian Patient Registry] and NIR [Norwegian Intensive-Care Registry] with other registers, therefore the numerical basis is different from that presented above’, i.e., from the data on age cohorts (my emphasis). The data below come from these two repositories, the above-mentioned MSIS [Surveillance System for Communicable Diseases] and ‘from the National Vaccination Register SYSVAK’, which are cross-referenced with ‘data from the National Population Register’. The latter data is the Tax Administration’s (Treasury, or Exchequer) database of every resident of Norway.

Now that we know these particulars, what does this information mean?—It means that the basis for these updates is data coming from the following institutions:

1. NoPaR and NIR are data streams that come from the country’s ten regions, whose public health directorates run the public hospitals (there are a few private clinics, but very little easily available information; go here for an introduction and here for the leading Scandinavian private healthcare, Aleris, which claims a ‘staff of 1,100 people working at public hospitals’ and ‘an annual turnover of 1.5 billion Norwegian crowns’, or about 150m € or $).

2. MSIS and SYSVAK are run by the health ministry’s Institute of Public Health, i.e., a nation-wide government agency equivalent to the American CDC.

3. The National Population Register contains personal data on every resident collected by the Police (Dept. of the Interior), which is administered by the Tax Administration (i.e., the Treasury in U.S. parlance or the Exchequer in U.K. lingo).

Enough with this, let’s look at the data:

In week 45, there were 151 new hospitalisations with Covid-19 as the main cause, of whom 57 (38 %) were unvaccinated, 4 (3%) were partially vaccinated, and 90 (60%) were fully vaccinated in accordance with the above definitions. In other words: 94 of these 151 admissions (63%) were among the partially and fully vaccinated.

Furthermore, to their credit, the authors include the following clarification: the ‘share of new patients per week who have been fully vaccinated [note the exclusion of the partially vaccinated] have been higher than the share of unvaccinated since week 41, which is expected and in line with increasing vaccination coverage’.

The report continues to note that ‘there has been an increase in incidence in recent weeks in especially among those over 75 years of age and for the unvaccinated between 45-64 years’. This is summarised in fig. 7 (p. 13):

While the first part of that statement is clearly visible in the above data discussed before, the second claim looks a bit more problematic. As shown in the above table 4 (p. 11), the cumulative share of these age cohorts (brackets 45-54 plus 55-64) is 20.7% and 25.4%, respectively (2 March 2020 through 14 Nov. 2021), with their ‘share in the past 4 weeks [18 Oct. through 14 Nov. 2021’ is given as 13.3% and 21.1%, respectively, i.e., roughly a third and quarter lower.

These numerical oddities aside, there’s an additional disclaimer, which explains that ‘the figure shows a two-week moving average, i.e., changes in incidence will show up somewhat delayed…We have calculated the incidence in the figure by taking into account the number in the various vaccine [unvaccinated, partially, and fully vaccinated] categories every day.’ Note, however, that the ‘partially vaccinated’ category is absent from the figure.

Moving on to admissions, we learn, again, the cumulative numbers (shares added) through 14 Nov. 2021: ‘A total of 514 [15%] fully vaccinated, 92 partially vaccinated [3%] and 2,815 unvaccinated [82%]’ were hospitalised with Covid-19 as the main cause ‘since the beginning of the vaccination program’ on 28 Dec. 2020. Furthermore (my emphasis), it is explained that

‘the main reason for hospitalisation is a higher median age, and a larger proportion of those admitted have risk factors which present a moderate or high risk of severe course of Covid-19, compared with the unvaccinated.’

This is summarised in table 5 (p. 12), which provides an overview of the median age of the three categories (un-, partially, and fully ‘vaccinated’), which reveals, in the second column from the right, the ‘number of admissions with a high risk of a severe course of Covid-19’. Among the ‘fully vaccinated’, the median age was 77 years, and of these 514 admissions 398 (77%) were at risk of a ‘severe course’.

While these data show the close correlation between age and severity of Covid-19, there’s one more point that is worth highlighting (which is also why I’ve elected to keep the paragraph in Norwegian below table 5, with my emphasis added), which reads:

‘Of a total of 514 new admissions of fully vaccinated, 68 (13%) have been admitted to the intensive care unit. Of a total of 92 new admissions among the partially vaccinated, 9 (10%) have been admitted to the intensive care unit. In comparison, 499 (18%) of 2,815 unvaccinated patients have been admitted to the intensive care unit since week 53 of 2020.’

In other words, ‘fully vaccinated’ and ‘partially vaccinated’ made up 23% of all ICU admissions since 28 Dec. 2020.

Yet, there’s one more thing to discuss, and that is the recent changes—for most data presented in a fairly transparent way is cumulative data since either 2 March 2020 (the beginning of record-keeping of all things Covid-related) or 28 Dec. 2020 when it comes to ‘vaccination tracking’. Here’s fig. 6 (p. 12) from the same source, which does show clearly diverging trend lines of hospitalisations between ‘fully vaccinated’ and ‘unvaccinated’ admissions (sadly, no data on ‘partially vaccinated’, but if they were included, the trend lines would certainly be even more distinct):

So, what is to be done to learn about these issues? While I’m sure the government agencies have these data well-prepared somewhere, they won’t publish it. So I did the next best thing and resorted to the data provided in the report from week 41 for answers, which brings us to the fourth and final part of this already very long post.

Shifting Trends in Hospitalisation and ICU Admissions

According to that report from week 41, there were ‘a total of 249 fully vaccinated and 70 partially vaccinated hospital admissions with Covid-19 as the main cause…since the beginning of Covid-19 vaccination program’ on 28 Dec. 2020.

In other words, until week 41 (11-17 Oct. 2021), there were 249 ‘fully vaccinated’ hospital admissions, while in weeks 42-45 (18 Oct. through 14 Nov.), there were 265 ‘fully vaccinated’ hospital admissions. This is tantamount to an increase of admissions among the ‘fully vaccinated’ of 106% in the past four weeks.

The data is a bit ‘better’ for the ‘partially vaccinated’, whose admissions stood at 70 until week 41 and increased to 92 by week 45, i.e., an increase 31% in the past four weeks.

While there were no changes to the median age (77) and the share of high-risk groups (77%) in the past four weeks, it is worth mentioning the trend shifted decisively in the past four weeks, with the expectation to accentuate further in coming weeks.

From the data available, however, the increase of hospital admissions—in particular ‘fully vaccinated’ ICU admissions—is nothing short of dramatic, and if this continues, it’ll be quite hard to hide from the prying eyes of the public (I expect the media to catch on last).

Stay tuned for updates from Norway next week.