Covid Update from Norway

Official Numbers from Week 47 (22-28 Nov. 2021): "Breakthrough hospitalisations" are up 15% over week 46. Also: it appears that there isn't influenza this year either.

Another mid-week update from the Institute of Public Health (IPH), which means it’s time to have fun with graphs and numbers, Norwegian style.

Before we get started, here’s what’s in this post:

1. A brief explanatory note on the recent changes

2. Covid-19 on the website of the IPH

3. Sideshow: Influenza Season in Norway

4. Details on Covid-19 in week 47

5. Fun with Graphs and Numbers

Explanatory Comment

In recent weeks, the IPH frequently changed the layout of its weekly reports, including the addition of ‘new’ (different) graphs in its reports. If you’re new to these Norwegian updates, I recommend a look at my more recent updates (see here for a review of updates from weeks 41-45; see here for week 45; see here for week 46; and here for the second version of the report from week 46).

Note that the layout and reporting differs between the English-language summary (provided always with respect to the current week) and the Norwegian version. Obviously, the latter is more informative and nuanced, hence if you don’t at least read Norwegian, I recommend using either Google Translate or Chrome; as far as I’m concerned, Google does a fairly o.k. job of rendering Norwegian into something resembling understandable English.

Further, note that until last week (46, 15-21 Nov. 2021), these weekly updates included references to the ‘vaccination status’ of newly hospitalised patients. While these statements on both the English and Norwegian websites are inconsistent with the data provided in the Norwegian-only weekly reports (see here a takedown of this mismatch in week 46), week 47 brought a major change: the IPH’s dedicated website no longer mentions the vaccination status of newly hospitalised patients.

Note, finally, that as the website changes, so do the reports. While the main data points are the same, their layout and the way these data are presented in tables and graphs shifts considerably. This has become particularly noticeable over the course of the past couple of weeks (check the above-referenced reports for weeks 45, 46, and 47, if you care to assess this yourself).

That said, let’s look at the update for week 47.

Covid-19 in Week 47: Website Edition

In its most recent available report, the IPH published the following main findings:

• 164 new admissions with Covid-19 as the main cause were reported, up from 151 in week 46, but at about the same level as week 45 (n = 163).

• Admissions among 18-44yo numbered 40, up from 25 in week 46.

• There was a clear increase in ICU admissions this week, which numbered 34, up from 20 in week 46.

• 42 Covid-associated deaths were registered in week 47 (there were 46 such deaths in week 46). In week 47, the median age of the deceased was 81 years (lower-upper quartile: 78-85 years).

As mentioned above, the front page does not provide any more details on ‘vaccination status’ (more on this further below), but the following statements are provided:

‘The incidence of hospitalisations and overall deaths in recent weeks is significantly higher for the unvaccinated than the fully vaccinated. Among people aged 65 and over, the incidence is clearly lower in the groups that have received three doses. The incidence of fully vaccinated people over 65 has levelled off. The incidence is increasing among unvaccinated people aged 45-64.’

Two more bits of information of relevance concern changing testing efforts and the Omicron variant. As regards the former, the front page cautions that

‘there have been major changes in test strategy throughout the autumn with increased use of self-tests and regular testing in some groups, especially in schools. This affects how many are tested and detected. Data on reported cases are therefore not directly comparable over time.’

In plain English: forget about relating any testing data henceforth to earlier iterations. How comfortable to know that we’re (again) in kind of uncharted territories with respect to testing. As an aside: why do we test for this anyways?

As regards ‘Omicron’ and ‘Delta’, here’s the IPH on this (my emphases):

‘Sporadic cases have been seen in at least 24 countries, of which 12 are European. Some cases cannot be traced back to southern Africa… so far 2 cases have been confirmed in Norway…Delta is currently dominant in over 99% of cases in Norway and most other countries.’

As mentioned above, the website doesn’t list the relation between ‘vaccinated’ vs. ‘unvaccinated’ hospitalisations anymore, instead we learn about ‘vaccine uptake’ as follows (data as of 28 Nov.; my emphases):

71% of the total population, 87% (16+ yo), and 88% (18+ yo) have received 2 doses of coronavirus vaccine [no details on which one].

91% of the population aged 18 and older are considered protected, either through vaccination or from being infected [this means, apparently, that a mere 3% of 18+ yo are recorded as having had ‘only’ Covid-19, as opposed to a probably higher share who before or after infection received two doeses].

A total of 92% of 16-17 yo and 74% of 12-15 yo are vaccinated with 1 dose; 50% of 16-17 yo received 2 doses.

These are the main points, now let’s have a detailed look at the data provided.

Sideshow: Influenza in Norway 2021-21

On p. 4 of the Covid-19 update, we find references to a new category of status reports on—influenza season.

Oh goodie, this is ‘fun’, for here’s the main take-away to contextualise the assumed impact of Covid-19 (my emphases):

‘This winter season’s increase in hospitalisations with respiratory infections

has started abnormally early and has been of a magnitude that can usually be seen around Christmas. This early peak of admissions with respiratory infections appear to be mainly due to admissions due to RS [respiratory syncytial] virus in children.

In week 46, the distribution of admissions with the different groups of respiratory infections the following: lower respiratory tract infections 43%, RS virus 33%, Covid-19 14%, upper respiratory tract infections 9% and influenza <1%.’

I clicked on the linked ‘influenza season update’ and found this beautiful graph (on p. 3 of the influenza report for week 47), which offers comparative influenza surveillance data from 2016 through 2021.

Further below in the influenza update, one may also learn about the following ‘other’ seasonal illnesses (my emphasis):

‘Positive and negative test results for adenovirus, Bordetella pertussis, Chlamydophila pneumoniae, metapneumovirus, Mycoplasma pneumoniae, parainfluenza virus, RS virus (respiratory syncytial virus) and rhinovirus from the country’s medical microbiological laboratories are continuously reported electronically to the MSIS lab database…This report is based on data current as of 24 Nov. 2021. The figures in the report are based on sample dates and present the number of PCR analyses performed for the infectious substances mentioned above. A person may have been tested several times, and will thus be counted several times. A sample may have been analysed for more infectious substances, and will thus also be counted several times. Adjustments may occur [I haven’t seen comparable disclaimers in any of the Covid-19 reports].

The content of the report can vary from week to week, depending on which infectious substances are circulating.’

Once you stopped face-palming, here’s the main table 4 (on p. 12 of the influenza update), for those who are inclined to contextualise the impact of Covid-19:

With these side-shows addressed, we’re ready for the main course.

Covid-19 in Norway, 21-28 Nov. 2021

Under the header ‘Assessment’ (p. 4 in the Covid weekly update), we read that ‘severe Covid-19 now particularly affects very old fully vaccinated individuals and middle-aged unvaccinated persons’. While ‘vaccination protects well against serious progression after SARS-CoV-2 infection, it is therefore crucial for the further development that the unvaccinated [i.e., 12% of the total population 18+ yo] starts their vaccination and that people over 65+ receive their booster dose’.

(A brief ‘discursive’ comment: I may be too stupid to understand this, but if the vaccines are working so well, why might it be ‘crucial’ that the 65+ cohort shall receive a booster?)

Having clarified this, let’s have ourselves some fun with graphs and numbers in that report. As mention in last week’s updates (here and here), I highlighted that despite rising confirmed ‘cases’ of Covid-related hospitalisations of ‘unvaccinated’, the overall numbers in these reports didn’t reflect this. As I wrote about the cumulative data since 28 Dec. 2020 (the beginning of the vaccination campaign in Norway),

• in week 45, this number was 2,815 admissions of ‘unvaccinated’ patients;

• in week 46 (v1), this number was—still—2,815 admissions of ‘unvaccinated’ patients;

• in week 46 (v2), this number was—still—2,815 admissions of ‘unvaccinated’ patients;

And these numbers weren’t changed in the respective tables 5 in these reports despite the increase of ‘unvaccinated’ admissions was 57 (week 45) and 45 (week 46), respectively. These admissions along should have pushed the above numbers up to 2,872 (by week 45) and 2,917 (by week 46), respectively. Instead, this is what table 5 in week 46 (v2) looks:

In week 47, the number of new hospital admissions with Covid-19 as main cause was 164, up from 151 in week 46. Of these, as shown in Table 1, 85 (52%) were fully vaccinated and 65 (38%) were ‘unvaccinated’. No data is available for the remaining 10%.*

If we go to p. 11, however, we get different numbers:

Here’s my translation:

‘In week 47, among 133 new patients admitted to hospitals in Norway with Covid-19 as the main cause, 47 (35%) were unvaccinated and 80 (60%) fully vaccinated. Of these 85, 9 had received 1 dose. Four patients were partially vaccinated. The proportion of new patients per week who have been fully vaccinated has been higher than the proportion unvaccinated since week 41, which is expected and in line with increasing vaccination coverage.’

Look at that screenshot: it looks as if John-or-Jane-the-intern was allowed to monkey with the report prior to publication: there’s an additional blank in the sentence ‘Av disse 85 hadde 9 mottatt en  dose’ (Of these 85 [which ones?], 9 had received 1 dose), and the numbers here aren’t the same as cited above.

Then, there’s table 5 (p. 12), which looks like this in week 47:

Notice that the cumulative number of ‘unvaccinated’ from 28 Dec. 2020 through week 47 of 2021 is now 2,930 vs. 687 for the ‘fully vaccinated’. For comparisons, here’s the same table 5 from last week’s (46) report:

The numbers were 2,815 ‘unvaccinated’ vs. 598 ‘fully vaccinated’ hospitalisations from 28 Dec. 2020 through week 46.

It looks as if the ‘unvaccinated’ category rose by 115 admissions (4%) from week 46 to week 47 (I arrived at that number by subtracting last week’s 2,815 from this week’s 2,930 = 115, which I then divided by 28.15).

It looks also that the ‘fully vaccinated’ category grew by 89 admissions (15%) from week 46 to week 47 (I arrived at that number by subtracting last week’s 598 from this week’s 687 = 89, which I then divided by 5.98).

Note further that in the category ‘last 4 weeks’ (siste 4 uker, i.e., the four columns on the right-hand side of the above tables) we find 200 ‘unvaccinated’ admissions in weeks 43-46 vs. 307 ‘fully vaccinated’.

In the category for weeks 44-47, the numbers are 233 ‘unvaccinated’ vs. 330 ‘fully vaccinated’.

Fun with Graphs and Numbers

Finally, some fun with graphs in this week’s update. On p. 13, we find figure 7, which visualizes the number and shares of new hospitalisations with Covid-19 as main cause from week 36 through 47 (6 Sept.-28 Nov. 2021). Now, I don’t know which numbers are correct—but apparently no-one over at the IPH does either—but if I take those data in table 5*, the ‘unvaccinated’ share (the thin blue line) should be at 35% vs. the ‘vaccinated’ share (the thin red line) should be at 60%.

There, I fixed that for you. You’re welcome.

*Why, you may ask, do I need to point this out, allege ineptitude on part of the IPH, and settle for data in table 5 (p. 11) to correct—‘fact-check’—these reports? Table 1 (p. 3) doesn’t cite any source, while both table 5 and figure 7 (p. 12) do. Why the IPH does it, well, I’d have to speculate (which I hate to do), but I lean towards ineptitude as explanation (it might be premeditation to mislead the casual reader who prefers graphs over text, but that’s speculation).

That’s it for this one so far. The bottom line is that the IPH, while it’s still fairly transparent, comparatively speaking, is making more and more mistakes and glitches. If these are intentional or simply caused by careless editing, I don’t know. It certainly doesn’t bode well when it comes to the reliability of these data.