Covid in Norway--Big News from Up North: Kids are better off getting infected than vaccinated

Finally, the IPH admits risk stratifies according to age: seniors have an almost 1,000X higher risk of dying of Covid than kids; also, IPH estimates that 3-4m Norwegians will be infected by Omicron

The other day, the Institute of Public Health (IPH) came out with an updated risk assessment for the next couple of weeks. You can find the file here, and to spare you sifting through yet another document full of (badly written and mainly pseudo-) academic prose, I took a look for you.

Before we get started, two brief words about Norwegian domestic Covid policies are required, I’m afraid.

First, ‘despite’ skyrocketing positive ‘cases’, the government has determined to (finally) end most Covid-related mandates and measures. This is, in my opinion, an avenue for which the authorities should be commended. Still, citizens should be ever more vigilant now, as no government ‘likes’ to give up (emergency) powers, and the Norwegian government is certainly no exception, as reported by Aftenposten.

‘There will be continued need for some mandates’, explains Health Minister Ingvild Kjerkol, ‘to prevent too many people from falling sick at the same time’.

Second, there’s also mention that Norway, despite (because of) its long shared history with Denmark, shall, in fact, ‘follow’ its southern neighbour’s policies. In practice, this means that ‘Covid-the-disease’ will now be ‘conflated [sammenligner] with influenza’, with government officials expecting some 20% of the population to become infected.

All told, things appear to be looking better, at least judging from this tentative ‘return’ of sanity and reason to public policy.

That said, the below piece will first deal with the IPH’s most recent risk assessment; if you’d like more context on the current Covid state, do check out my take on the IPH’s weekly assessment (see here). I do have a couple of other points to make, which will follow below.

The IPH’s Current Risk Assessment

One brief note before we dive into the file: there’s, of course, a news bulletin over at the IPH’s website, but it is heavy on words and very light on content, hence I’m referring directly to the risk assessment. I shall do so by offering references to page numbers and the like throughout, and you may access the source directly by clicking here.

First of all, let it be known that the risk assessment clocks in at 60 pages, which is to say that it’s shorter than the IPH’s last weekly report. Now, I don’t know if this means that last week’s report is overly long (or the risk assessment ludicrously short), but I would say that this is quite odd. Still, I’m not complaining because all these reports are badly written in terms of style, argument, and logic, to say nothing about the dire need for writing classes and formatting training that should be held at the IPH. But I digress.

There’s a kind of ‘executive summary’ on pp. 5-6, followed by quite an extensive treatment of the ‘background’ (pp. 7-17). Basically, the first quarter of the report consists of lots of words and little substance. Then there are chapters on Omicron (pp. 17-28) and the risk assessment until March (pp. 28-33), which will be the first main part of my piece, with additional materials on ‘future handling of the epidemic’ (pp. 33-44) as second main part of this piece.

I won’t be going over the same ground covered in this week’s update (see here), hence we’ll (almost) directly move to the section on Omicron.

A Pandemic of the Oslo Metro Area

Before we do so, one brief note to make: Norway is a comparatively large country with a relatively small population (c. 5.9m), which is distributed quite unevenly throughout. The main population cluster is found in the country’s south-eastern province—the Oslo metro area. It is there that the majority of cases, infections, and hospitalisations occur (p.13). I’ve said this before: respiratory illnesses spread more easily in population centres, hence it’s hard to escape the fact that by far most cases, infections, and hospitalisations occur in the Oslo metro area.

If anything, Covid-the-disease requires localised or regionalised measures to avoid over-crowding of healthcare services in those areas most affected. One-size-fits-all measures are never a good idea, and with this respiratory illness, this is doubly true. I’m sorry, dear people of the Oslo metro area, but the data is crystal clear: don’t make the rest of the country suffer under whatever mandates because there’s simply more sick people in larger population centres.

A Word or two about Vaccination against Covid-19

This is perhaps the most controversial part of my reading of the assessment. On p. 14, there’s a very informative chart about the current state of vaccination:

Yet, this section, while self-congratulatory in itself (and needlessly so), won’t tell you much about the future. Skipping over the IPH’s rendition of Omicron data from other countries (pp. 14-24), here’s what I think is one of the main take-aways. Summarised in table 2 (p. 25), the IPH—finally—released an easy-to-understand compilation of the state of affairs:

Death: everyone under age 60 is basically as safe as can be in western societies from Covid-the-disease. I mean, look at the numbers: 0.15 per 100,000 inhabitants vs. the older age brackets, for once helpfully stratified according to age. Do note that if you’re in the age cohort 60-69, your risk of dying from Covid-19 is already more than a magnitude higher (1.5 per 100,000) than in the younger cohorts. If you’re 70-79, your risk is still roughly twice that number, but the risk of dying from Covid-19 really only skyrockets in the 80+ cohort: 14 per 100,000, which is to say that if you’re 80+ years of age, your risk of dying from Covid-19 is almost 1,000 times higher than if you’re below 60.

While those who read studies know this, it’s nice that the IPH finally admits age-related risk. Needless to say, mainstream media won’t emphasis this part of the assessment (not directly, on which see my below comment).

ICU and Hospitalisation risk rates aren’t as starkly divergent as the risk of death, but still these numbers are telling: in terms of ICU admission, if you’re below 40, you have roughly a quarter of the risk of ending up in the ICU (0.48 per 100,000 vs. 2.0 per 100,000 for the 70+ cohorts). General admission rates are, again, more clearly indicative of the enormous role age plays in all of this: 0-19yo (kids and teens) are hospitalised at a rate of 2.8 per 100,000; risk roughly triples for adults aged 40-69 (10 per 100,000); and it, again, takes off to 22 per 100,000 in the 80+ cohort, which is to say that being very old constitutes a risk 7-8 times higher than for kids and teens.

And now for the kicker, tucked away in the last category of the table: the numbers and shares of previous infection with Covid-19 among the total population. Only some 4,139 per 100,000 have had Covid-19 (I’m among them, and so are my wife and our two kids).

Still, look at the shares of the total population: 4 out of 10 kids and teens already had Covid; little over a third of the 20-39yo and slightly less than a quarter of the 40-59yo were exposed to Sars-Cov-2 by now. The most stunning information here are the insanely low infection rates among seniors: 2.7% of all 60-69yo, 1% of 70-79yo, and less than 0.5% of 80+ yo. This means, above all, that Norway has done an admirable job of actually protecting the elderly who are, as clearly shown by the above numbers, those who are most at-risk from Covid-19. On the other hand, it also means that those most at-risk of Covid-19 are highly Covid-naïve, and if they should ever be exposed to Sars-Cov-2, they also stand to be disproportionately affected by its serious consequences.

To wrap up this section: good for the IPH to strongly come out on this one, but shame on them for doing so in late January 2022. This is data that certainly was available a year ago, which should have informed public policy makers (although the government here hasn’t gone completely bonkers in terms of kindergarten and school policies), but the main question to legacy media is this: why didn’t you do your job and point this out?

How Serious is Omicron?

Here, the IPH spends a good many words, but points out the obvious (p. 25; my emphases and comments):

Omicron immune evasion and protection against infection is higher than with Delta. This means that Omicron infects more people who have been vaccinated or infected before [the first part is apparent, the latter aspect is a hypothesis], but those affected become less seriously ill as several parts of the acquired immune response, such as the T-cell response, which offers protection against severe illness against Omicron [it’s nice that natural immunity suddenly becomes noticed]. Thus, Omicron appears milder because the denominator in the admission proportion is larger, not because the counter is lower [here, the IPH obscurely notices that hospitalisations may become actually higher than with Delta due to Omicron’s higher contagiousness]. Crucial is thus not the virus’ inherent virulence, but who is infected with Omicron [pointing out the obvious]. If this is an important explanation for the observations, the course of the disease may vary between countries according to their population immunity, both due to infection or vaccination.

Oh, look at that: two years into the all affair and the IPH finally ‘discovered’ natural immunity. I’m not going to gloat about this, instead I’d like to say: at long last, some of the people over at the IPH remembered to pick up a textbook and do some reading.

Also, there’s much more here (p. 25):

Illness after infection is more severe for the older cohorts than for the younger age brackets (irrespective of vaccination).

And the darker musings I mentioned above are also expressed in so many words (p. 26):

Now that the epidemic is wide-spread, one can expect it to spread into hospitals [and nursing homes, omitted here], which is to say that Sars-Cov-2, including the Omicron variant, can cause severe illness and death. While Omicron as so far spread barely among the elderly population, it is unclear how severe the course of illness [among them] will be.

Now you see why I cautioned against celebration, if you’re older than 60: we don’t know whether or not Omicron will actually be milder for the seniors as well. Combined with the exceptionally low levels of prior infection among specifically these age cohorts, we shall soon find out about that, won’t we, but it’ll be the hard way.

Assessment until March 2022

The IPH’s main points (p. 29) are thus summarised:

There will be a significant Omicron wave that will spread widely, the IPH doesn’t know how big it’ll eventually be, and the IPH doesn’t know what role the BA-2 variant of Omicron will play.

The size and width of the Omicron wave will depend on transmissibility, vaccine efficacy, and the various government-mandated and individual behavioural precautions.

Consequences for society at-large and individuals may vary, with the main take-away perhaps being that ‘individually, one may be infected rather sooner than wished for [sic], but Omicron brings with it a lesser risk of severe illness’.

We [the IPH] expect that the Omicron wave will infect 3-4m Norwegians, of whom some 12-13,000 will require hospitalisation. The longer we keep up mandates and measures, the longer the epidemic will last. The aim of these mandates and measures is to reduce the severity of the infection peak, but they will do little to reduce the number of infections. We expect the peak of infections to occur in the second half of February and the first half of March with between 25-300 new hospitalisations and 40,000-125,000 new infections per day; there may thus be between 300-1,000 hospitalisations at the same time. We estimate the number of patients requiring mechanical ventilation not to exceed 175 at the same time.

So, there you have it: nothing we mandate will do anything. To the contrary, whatever mandates and measures are still in place, they will only prolong the epidemic.

This concludes my reading of the report for now (and I shall follow-up on this with some comments on the extensive appendix soon), so let’s move on to the most significant media echo now.

Kids should get infected rather than get vaccinated

Based on the above assessment, immunologist Gunnar Gødeland argues that natural immunity after infection is to be preferred, according to Aftenposten. VG also noted that kids are better protected than adults after infection (doh).

Still, this is huge, and while both media outlets are owned by the Schibsted group, it is worth reiterating that this is literally ‘hot off the presses’: the VG piece was posted online at 1:46 a.m., the Aftenposten piece went online at 7:05 a.m.

Still, part of the medical establishment is visibly shifting.

This is great news, for it appears that, while it took them about two years to arrive at this insight, Norwegians seem to have concluded that their future (children) is actually something to think about twice.

Let’s hope this gets heard about all over the western world.