Third dose mRNA vaccination against SARS-CoV-2 reduces medical complaints seen in primary care: a matched cohort study.

BACKGROUND: SARS-CoV-2 mRNA vaccination has been associated with both side effects and a reduction in COVID-related complaints due to the decrease in COVID-19 incidence. We aimed to investigate if individuals who received three doses of SARS-CoV-2 mRNA vaccines had a lower incidence of (a) medical complaints and (b) COVID-19-related medical complaints, both as seen in primary care, when compared to individuals who received two doses. METHODS: We conducted a daily longitudinal exact one-to-one matching study based on a set of covariates. We obtained a matched sample of 315,650 individuals aged 18-70 years who received the 3rd dose at 20-30 weeks after the 2nd dose and an equally large control group who did not. Outcome variables were diagnostic codes as reported by general practitioners or emergency wards, both alone and in combination with diagnostic codes of confirmed COVID-19. For each outcome, we estimated cumulative incidence functions with hospitalization and death as competing events. RESULTS: We found that the number of medical complaints was lower in individuals aged 18-44 years who received three doses compared to those who received two doses. The differences in estimates per 100,000 vaccinated were as follows: fatigue 458 less (95% confidence interval: 355-539), musculoskeletal pain 171 less (48-292), cough 118 less (65-173), heart palpitations 57 less (22-98), shortness of breath 118 less (81-149), and brain fog 31 less (8-55). We also found a lower number of COVID-19-related medical complaints: per 100,000 individuals aged 18-44 years vaccinated with three doses, there were 102 (76-125) fewer individuals with fatigue, 32 (18-45) fewer with musculoskeletal pain, 30 (14-45) fewer with cough, and 36 (22-48) fewer with shortness of breath. There were no or fewer differences in heart palpitations (8 (1-16)) or brain fog (0 (- 1-8)). We observed similar results, though more uncertain, for individuals aged 45-70 years, both for medical complaints and for medical complaints that were COVID-19 related. CONCLUSIONS: Our findings suggest that a 3rd dose of SARS-CoV-2 mRNA vaccine administered 20-30 weeks after the 2nd dose may reduce the incidence of medical complaints. It may also reduce the COVID-19-related burden on primary healthcare services.

Feedback reports to the general practitioner (GP) on the patients' experiences: are GPs interested, and is this interest associated with GP factors and patient experience scores?

BACKGROUND: Patient experience feedback is key in patient centred health systems, but empirical evidence of general practitioner (GP) interest in it is sparse. We aimed to: (i) quantitatively estimate the level of GP interest for feedback reports on patient experience; (ii) explore determinants of such interest; and (iii) examine potential association between a priori interest and patient experience. METHODS: The patient experience survey included maximum 300 randomly selected patients for each of 50 randomly selected GPs (response rate 41.4%, n = 5,623). GPs were sent a postal letter offering feedback reports and were grouped according to their replies: (i) interested in the report; (ii) not interested. Associations between interest and GP variables were assessed with Chi-square tests and multivariate logistic regression, while associations between interest and scores for 5 patient experiences scales were assessed with multilevel regression models. RESULTS: About half (n = 21; 45.7%) of the GPs showed interest in the report by asking to receive the report. The only GP variable associated with a priori interest was being a specialist in general practice (58.6% vs. 23.5% for those without) (P = 0.021). Interest was significantly associated with the practice patient experience scale (4.1 higher score compared with those not interested, P = 0.048). Interest in the report had small and nonsignificant associations with the remaining patient experience scales. CONCLUSIONS: Almost half of the GPs, and almost 3 in 5 of specialists in general practice, were interested in receiving a GP-specific feedback report on patient experiences. Interest in the report was generally not related to patient experience scores.

Health care use after severe respiratory tract infections in children aged 0 to 5 years.

AIM: To explore whether children in specialist care with COVID-19 have increased post-discharge health care use when compared with children in specialist care with 1) respiratory syncytial virus (RSV) infection, and 2) other respiratory tract infections (RTIs). METHODS: In 34,214 children aged 1 month to 5 years who were registered as having one or more hospital visit (outpatient or inpatient) with a diagnosis of COVID-19 (N = 128), RSV infection (N = 4,009), or other RTIs (N = 34,458) from 2017 to 2021, we used a difference-in-differences study design to investigate individual all-cause primary and specialist health care use from 12 weeks prior to 12 weeks after the hospital visit, stratified by infants (1 to 11 months) and children (1 to 5 years). RESULTS: We found a slight increase in primary health care use in the first 4 weeks after the hospital visit for infants with COVID-19 when compared with infants with RSV infection (6 per 10,000; 95% CI [2, 13], a 0.52% relative increase). For infants diagnosed with COVID-19, we found a similar post-visit increase in inpatients when compared with infants with RSV infection, which lasted for 12 weeks. CONCLUSIONS: Our findings imply a slightly increased health care use among infants after a hospital visit for COVID-19 than among infants with other RTIs, the potential etiological mechanisms of which deserve future clinical research. Severe COVID-19 in young children will not represent any markedly increased burden on the health services.

Effect of hospital assignment on mortality for AMI patients.

BACKGROUND: International guidelines recommend percutaneous coronary intervention (PCI) to treat acute myocardial infarction (AMI) if PCI can be performed within two hours. PCI is a centralized treatment, and therefore a common trade-off is whether to send AMI patients directly to a hospital that performs PCI, or postpone a potential PCI-treatment by first receiving acute treatment at a local hospital that can not perform PCI. In this paper, we estimate the effect of sending patients directly to a PCI-hospital on AMI mortality. METHODS: Using nation-wide individual-level data from 2010 to 2015, we studied mortality rates for AMI patients sent directly to a hospital that performs PCI (N=20 336) compared to AMI patients sent to a hospital not performing PCI (N=33 437). Since the underlying health of patients may affect both hospital assignment and mortality, estimates from traditional multivariate risk adjustment models are likely biased. We therefore apply an instrumental variable (IV) model using the historical municipal share sent directly to a PCI-hospital as an instrument for being sent directly to a PCI-hospital. RESULTS: Patients sent directly to a PCI-hospital are younger and have fewer comorbidities than patients who are first sent to a non-PCI-hospital. IV results suggest that those initially sent to PCI-hospitals have 4.8 percentage points decrease (95% CI (- 18.1)-8.5) in mortality after one month compared to those initially sent to non-PCI-hospitals. CONCLUSION: Our IV results suggest that there is a non-significant decrease in mortality for AMI patients sent directly to a PCI hospital. The estimates are too imprecise to conclude that health personnel should change their practice and send more patients directly to a PCI-hospital. Moreover, the results may be taken to suggest that health personnel navigate AMI patients to the best treatment option.

Preterm birth after the introduction of COVID-19 mitigation measures in Norway, Sweden, and Denmark: a registry-based difference-in-differences study.

BACKGROUND: Although some studies have reported a decrease in preterm birth following the start of the COVID-19 pandemic, the findings are inconsistent. OBJECTIVE: This study aimed to compare the incidences of preterm birth before and after the introduction of COVID-19 mitigation measures in Scandinavian countries using robust population-based registry data. STUDY DESIGN: This was a registry-based difference-in-differences study using births from January 2014 through December 2020 in Norway, Sweden, and Denmark. The changes in the preterm birth (<37 weeks) rates before and after the introduction of COVID-19 mitigation measures (set to March 12, 2020) were compared with the changes in preterm birth before and after March 12 from 2014 to 2019. The differences per 1000 births were calculated for 2-, 4-, 8-, 12-, and 16-week intervals before and after March 12. The secondary analyses included medically indicated preterm birth, spontaneous preterm birth, and very preterm (<32 weeks) birth. RESULTS: A total of 1,519,521 births were included in this study. During the study period, 5.6% of the births were preterm in Norway and Sweden, and 5.7% were preterm in Denmark. There was a seasonal variation in the incidence of preterm birth, with the highest incidence during winter. In all the 3 countries, there was a slight overall decline in preterm births from 2014 to 2020. There was no consistent evidence of a change in the preterm birth rates following the introduction of COVID-19 mitigation measures, with difference-in-differences estimates ranging from 3.7 per 1000 births (95% confidence interval, -3.8 to 11.1) for the first 2 weeks after March 12, 2020, to -1.8 per 1000 births (95% confidence interval, -4.6 to 1.1) in the 16 weeks after March 12, 2020. Similarly, there was no evidence of an impact on medically indicated preterm birth, spontaneous preterm birth, or very preterm birth. CONCLUSION: Using high-quality national data on births in 3 Scandinavian countries, each of which implemented different approaches to address the pandemic, there was no evidence of a decline in preterm births following the introduction of COVID-19 mitigation measures.

COVID-19 infection among bartenders and waiters before and after pub lockdown.

OBJECTIVE: To assess how different bans on serving alcohol in Norwegian bars and restaurants were related to the detection of SARS-CoV-2 in bartenders and waiters and in persons in any occupation. METHODS: In 25 392 bartenders and waiters and 1 496 328 persons with other occupations (mean (SD) age 42.0 (12.9) years and 51.8% men), we examined the weekly rates of workers tested and detected with SARS-CoV-2, 1-10 weeks before and 1-5 weeks after implementation of different degrees of bans on serving alcohol in pubs and restaurants, across 102 Norwegian municipalities with: (1) full blanket ban, (2) partial ban with hourly restrictions (eg, from 22:00 hours) or (3) no ban, adjusted for age, sex, testing behaviour and population size. RESULTS: By 4 weeks after the implementation of ban, COVID-19 infection among bartenders and waiters had been reduced by 60% (from 2.8 (95% CI 2.0 to 3.6) to 1.1 (95% CI 0.5 to 1.6) per 1000) in municipalities introducing full ban, and by almost 50% (from 2.5 (95% CI 1.5 to 3.5) to 1.3 (95% CI 0.4 to 2.2) per 1000) in municipalities introducing partial ban. A similar reduction within 4 weeks was also observed for workers in all occupations, both in municipalities with full (from 1.3 (95% CI 1.3 to 1.4) to 0.9 (95% CI 0.9 to 1.0)) and partial bans (from 1.2 (95% CI 1.1 to 1.3) to 0.5 (95% CI 0.5 to 0.6)). CONCLUSION: Partial bans on serving alcohol in bars and restaurants may be similarly associated with declines in confirmed COVID-19 infection as full bans.

COVID-19 vaccination rates among healthcare workers by immigrant background: A nation-wide registry study from Norway.

AIMS: Studies have suggested that some minority groups tend to have lower vaccination rates than the overall population. This study aims to examine COVID-19 vaccination rates among healthcare workers in Norway, according to immigrant background. METHODS: We used individual-level, nation-wide registry data from Norway to identify all healthcare workers employed full time at 1 December 2020. We examined the relationship between country of birth and COVID-19 vaccination from December 2020 to August 2021, both crude and adjusted for, for example, age, sex, municipality of residence and detailed occupation codes in logistic regression models. RESULTS: Among all healthcare workers in Norway, immigrants had a 9 percentage point lower vaccination rate (85%) than healthcare workers without an immigrant background (94%) at 31 August 2021. The overall vaccination rate varied by country of birth, with immigrants born in Russia (71%), Serbia (72%), Lithuania (72%), Romania (75%), Poland (76%), Eritrea (77%) and Somalia (78%) having the lowest crude vaccination rates. When we adjusted for demographics and detailed occupational codes, immigrant groups that more often worked as healthcare assistants, such as immigrants from Eritrea and Somalia, increased their vaccination rates. CONCLUSIONS: Substantial differences in vaccination rates among immigrant groups employed in the healthcare sector in Norway indicate that measures to improve vaccine uptake should focus on specific immigrant groups rather than all immigrants together. Lower vaccination rates in some immigrant groups appear to be largely driven by the occupational composition, suggesting that some of the differences in vaccine rates can be attributed to variation in vaccine access.

SARS-CoV-2 infections and hospitalisations among immigrants in Norway-significance of occupation, household crowding, education, household income and medical risk: a nationwide register study.

BACKGROUND: As in other countries, the COVID-19 pandemic has affected Norway's immigrant population disproportionately, with significantly higher infection rates and hospitalisations. The reasons for this are uncertain. METHODS: Through the national emergency preparedness register, BeredtC19, we have studied laboratory-confirmed infections with SARS-CoV-2 and related hospitalisations in the entire Norwegian population, by birth-country background for the period 15 June 2020 to 31 March 2021, excluding the first wave due to limited test capacity and restrictive test criteria. Straightforward linkage of individual-level data allowed adjustment for demographics, socioeconomic factors (occupation, household crowding, education and household income), and underlying medical risk for severe COVID-19 in regression models. RESULTS: The sample comprised 5.49 million persons, of which 0.91 million were born outside of Norway, there were 82,532 confirmed cases and 3088 hospitalisations. Confirmed infections in this period (per 100,000): foreign-born 3140, Norwegian-born with foreign-born parents 4799 and Norwegian-born with Norwegian-born parent(s) 1011. Hospitalisations (per 100,000): foreign-born 147, Norwegian-born with foreign-born parents 47 and Norwegian-born with Norwegian-born parent(s) 37. The addition of socioeconomic and medical factors to the base model (age, sex, municipality of residence) attenuated excess infection rates by 12.0% and hospitalisations by 3.8% among foreign-born, and 10.9% and 46.2%, respectively, among Norwegian-born with foreign parents, compared to Norwegian-born with Norwegian-born parent(s). CONCLUSIONS: There were large differences in infection rates and hospitalisations by country background, and these do not appear to be fully explained by socioeconomic and medical factors. Our results may have implications for health policy, including the targeting of mitigation strategies.

Has vaccination alleviated the strain on hospitals due to COVID-19? A combined difference-in-difference and simulation approach.

BACKGROUND: Serious measures, including mass vaccination, have been taken to ensure sufficient hospital capacity during the COVID-19 pandemic. Due to high hospitalization risk in the oldest age groups, most countries prioritized elderly for vaccines. The aim of this study is to broaden the understanding of how vaccination in younger age groups relieved the strain on hospitals during the pandemic. METHODS: To determine the impact of vaccination on hospitalization, we relied on individual level data on health care use and vaccination from the Norwegian Emergency Preparedness Register Beredt C19. Using a pre-post design, we estimated the increase in hospitalization days from before to after confirmed COVID-19 for individuals aged 18-64 who were fully vaccinated (N=2 419) or unvaccinated (N=55 168) with comparison groups of vaccinated (N=4 818) and unvaccinated (N= 97 126) individuals without COVID-19. To evaluate whether vaccination itself contributed to a strain in hospitals, we use a similar design to study hospitalization rates before and after vaccination by comparing individuals vaccinated with the first dose (N=67 687) to unvaccinated individuals (N=130 769). These estimates were incorporated into a simulation of hospitalization days with different vaccine scenarios to show how the estimated results might have mattered for the hospitals and their capacity. RESULTS: Hospitalization days increased by 0.96 percentage point each day during the first week and 1.57 percentage points during the second week after testing positive for COVID-19 for unvaccinated individuals. The corresponding increase was 0.46 and 0.32 for vaccinated individuals, i.e., a substantial difference. The increase was significantly higher for those aged 45-64 than for those aged 18-25. We find no increase in hospitalization days due to vaccination. Simulation results show that vaccination reduced hospitalization days by 25 percent, mainly driven by age 45-64. CONCLUSION: Our findings indicate that vaccination of individuals aged 18-64 did alleviate pressure on hospitals. Whereas there was a substantial relieve from vaccinating the 45-64 age group, there was no such contribution from vaccinating the 18-25 age group. Our study highlights how simulation models can be useful when evaluating alternative vaccine strategies.

Secondary attack rates of COVID-19 in Norwegian families: a nation-wide register-based study.

To characterize the family index case for detected SARS-CoV-2 and describe testing and secondary attack rates in the family, we used individual-level administrative data of all families and all PCR tests for SARS-CoV-2 in Norway in 2020. All families with at least one parent and one child below the age of 20 who lived at the same address (N = 662,582), where at least one member, i.e. the index case, tested positive for SARS-CoV-2 in 2020, were included. Secondary attack rates (SAR7) were defined as the share of non-index family members with a positive PCR test within 7 days after the date when the index case tested positive. SARs were calculated separately for parent- and child-index cases, and for parent- and child-secondary cases. We identified 7548 families with an index case, comprising 26,991 individuals (12,184 parents, 14,808 children). The index was a parent in 66% of the cases. Among index children, 42% were in the age group 17-20 and only 8% in the age group 0-6. When the index was a parent, SAR7 was 24% (95% CI 24-25), whilst SAR7 was 14% (95% CI 13-15) when the index was a child. However, SAR7 was 24% (95% CI 20-28) when the index was a child aged 0-6 years and declined with increasing age of the index child. SAR7 from index parent to other parent was 35% (95% CI 33-36), and from index child to other children 12% (95% CI 11-13). SAR7 from index child aged 0-6 to parents was 27% (95% CI 22-33). The percent of non-index family members tested within 7 days after the index case, increased from about 20% in April to 80% in December, however, SAR7 stabilized at about 20% from May. We conclude that parents and older children are most often index cases for SARS-CoV-2 in families in Norway, while parents and young children more often transmit the virus within the family. This study suggests that whilst the absolute infection numbers are low for young children because of their low introduction rate, when infected, young children and parents transmit the virus to the same extent within the family.

Factors associated with hospitalization, invasive mechanical ventilation treatment and death among all confirmed COVID-19 cases in Norway: Prospective cohort study.

Aims: For everyone with a positive test for SARS-CoV-2 in Norway, we studied whether age, sex, comorbidity, continent of birth and nursing home residency were risk factors for hospitalization, invasive mechanical ventilation treatment and death. Methods: Data for everyone who had tested positive for SARS-CoV-2 in Norway by end of June 2020 (N = 8569) were linked at the individual level to hospitalization, receipt of invasive mechanical ventilation treatment and death measured to end of July 2020. Underlying comorbidity was proxied by hospital-based in- or outpatient treatment during the two months before the SARS-CoV-2 test. Multivariable generalized linear models were used to assess risk ratios (RRs). Results: Risk of hospitalization was particularly high for elderly (for those aged 90 and above: RR 9.5; 95% confidence interval (CI) 7.1-12.7; comparison group aged below 50), Norwegian residents born in Asia, Africa or Latin-America (RR 2.1; 95% CI 1.9-2.4; comparison group born in Norway), patients with underlying comorbidity (RR 1.6; 95% CI 1.4-1.8) and men (RR 1.3; 95% CI 1.2-1.5). Men and residents born in Africa, Asia and Latin-America were also at higher risk of receiving ventilation treatment and dying, but the mortality risk was especially high for the elderly (for those aged 90 and above: RR 607.9; 95% CI 145.5-2540.1; comparison group aged below 50) and residents in nursing homes (RR 4.2; 95% CI 3.1-5.7). Conclusions: High age was the most important predictor of severe disease and death if infected with SARS-CoV-2, and nursing home residents were at particularly high risk of death.

COVID-19 among immigrants in Norway, notified infections, related hospitalizations and associated mortality: A register-based study.

Aim: Research concerning COVID-19 among immigrants is limited. We present epidemiological data for all notified cases of COVID-19 among the 17 largest immigrant groups in Norway, and related hospitalizations and mortality. Methods: We used data on all notified COVID-19 cases in Norway up to 18 October 2020, and associated hospitalizations and mortality, from the emergency preparedness register (including Norwegian Surveillance System for Communicable Diseases) set up by The Norwegian Institute of Public Health to handle the pandemic. We report numbers and rates per 100,000 people for notified COVID-19 cases, and related hospitalizations and mortality in the 17 largest immigrant groups in Norway, crude and with age adjustment. Results: The notification, hospitalization and mortality rates per 100,000 were 251, 21 and five, respectively, for non-immigrants; 567, 62 and four among immigrants; 408, 27 and two, respectively, for immigrants from Europe, North-America and Oceania; and 773, 106 and six, respectively for immigrants from Africa, Asia and South America. The notification rate was highest among immigrants from Somalia (2057), Pakistan (1868) and Iraq (1616). Differences between immigrants and non-immigrants increased when adjusting for age, especially for mortality. Immigrants had a high number of hospitalizations relative to notified cases compared to non-immigrants. Although the overall COVID-19 notification rate was higher in Oslo than outside of Oslo, the notification rate among immigrants compared to non-immigrants was not higher in Oslo than outside. Conclusions: We observed a higher COVID-19 notification rate in immigrants compared to non-immigrants and much higher hospitalization rate, with major differences between different immigrant groups. Somali-, Pakistani- and Iraqi-born immigrants had especially high rates.

Admissions to Norwegian Hospitals during the COVID-19 Pandemic.

BACKGROUND: In mid-March 2020, the Norwegian government implemented measures to contain the coronavirus disease 2019 (COVID-19) pandemic, and hospitals prepared to handle an unpredictable inflow of patients with COVID-19. AIM: The study was performed to describe the changes in hospital admissions during the first phase of the pandemic. METHODS: The Norwegian Institute of Public Health established a national preparedness register with daily updates on COVID-19 cases and the use of health services. We used individual-level information on inpatients from the electronic journal systems for all hospitals in Norway to estimate daily hospital admissions. RESULTS: Before the onset of the pandemic in March, there was an average of 2400 inpatient admissions per day in Norway, which decreased to approximately 1500 in the first few days after lockdown measures were implemented. The relative magnitudes of the decreases were similar in men and women and across all age groups. The decreases were substantial for both elective (54%) and emergency (29%) inpatient care. The admission rate gradually increased and reached pre-pandemic levels in June. However, the reductions in admissions for pneumonia and chronic obstructive pulmonary disease seemed to persist. CONCLUSIONS: The elective and emergency inpatient admission rates were substantially reduced a few days after the pandemic response measures were implemented. The ways in which the lack or postponement of care may have affected the health and well-being of patients is an important issue to be addressed in future research.

Utilization of health care services before and after media attention about fatal side effects of the AstraZeneca vaccine: a nation-wide register-based event study.

BACKGROUND: Survey studies have found that vaccinated persons tend to report more side effects after being given information about side effects rather than benefits. However, the impact of high media attention about vaccine-related side effects on the utilization of health care is unknown. We aimed to assess whether utilization of health care services for newly vaccinated health care workers changed after media attention about fatal side effects of the AstraZeneca vaccine on March 11th, 2021, and whether changes differed by age, sex, or occupation. METHODS: We utilized individual-level data on health care use, vaccination, employment, and demographics available in the Norwegian emergency preparedness register Beredt C19. In all 99,899 health care workers in Norway who were vaccinated with AstraZeneca between February 11th and March 11th, we used an event-study design with a matched comparison group to compare the change in primary and inpatient specialist care use from 14 days before to 14 days after the information shock on March 11th, 2021. RESULTS: Primary health care use increased with 8.2 daily consultations per 1000 health care workers (95% CI 7.51 to 8.89) the week following March 11th for those vaccinated with AstraZeneca (n = 99,899), compared with no increase for the unvaccinated comparison group (n = 186,885). Utilization of inpatient care also increased with 0.8 daily hospitalizations per 1000 health care workers (95% CI 0.37 to 1.23) in week two after March 11th. The sharpest increase in daily primary health care use in the first week after March 11th was found for women aged 18-44 (10.6 consultations per 1000, 95% CI 9.52 to 11.68) and for cleaners working in the health care sector (9.8 consultations per 1000, 95% CI 3.41 to 16.19). CONCLUSIONS: Health care use was higher after the media reports of a few cases of fatal or severe side effects of the AstraZeneca vaccine. Our results suggest that the reports did not only lead vaccinated individuals to contact primary health care more, but also that physicians referred and treated more cases to specialist care after the new information.

Occupational risk of COVID-19 in the first versus second epidemic wave in Norway, 2020.

BackgroundThe occupational risk of COVID-19 may be different in the first versus second epidemic wave.AimTo study whether employees in occupations that typically entail close contact with others were at higher risk of SARS-CoV-2 infection and COVID-19-related hospitalisation during the first and second epidemic wave before and after 18 July 2020, in Norway.MethodsWe included individuals in occupations working with patients, children, students, or customers using Standard Classification of Occupations (ISCO-08) codes. We compared residents (3,559,694 on 1 January 2020) in such occupations aged 20-70 years (mean: 44.1; standard deviation: 14.3 years; 51% men) to age-matched individuals in other professions using logistic regression adjusted for age, sex, birth country and marital status.ResultsNurses, physicians, dentists and physiotherapists had 2-3.5 times the odds of COVID-19 during the first wave when compared with others of working age. In the second wave, bartenders, waiters, food counter attendants, transport conductors, travel stewards, childcare workers, preschool and primary school teachers had ca 1.25-2 times the odds of infection. Bus, tram and taxi drivers had an increased odds of infection in both waves (odds ratio: 1.2-2.1). Occupation was of limited relevance for the odds of severe infection, here studied as hospitalisation with the disease.ConclusionOur findings from the entire Norwegian population may be of relevance to national and regional authorities in handling the epidemic. Also, we provide a knowledge foundation for more targeted future studies of lockdowns and disease control measures.

Impact of the COVID-19 pandemic on emergency and elective hip surgeries in Norway.

Background and purpose - Many countries implemented strict lockdown policies to control the COVID-19 pandemic during March 2020. The impacts of lockdown policies on joint surgeries are unknown. Therefore, we assessed the effects of COVID-19 pandemic lockdown restrictions on the number of emergency and elective hip joint surgeries, and explored whether these procedures are more/less affected by lockdown restrictions than other hospital care.Patients and methods - In 1,344,355 persons aged ≥ 35 years in the Norwegian emergency preparedness (BEREDT C19) register, we studied the daily number of persons having (1) emergency surgeries due to hip fractures, and (2) electively planned surgeries due to hip osteoarthritis before and after COVID-19 lockdown restrictions were implemented nationally on March 13, 2020, for different age and sex groups. Incidence rate ratios (IRR) reflect the after-lockdown number of surgeries divided by the before-lockdown number of surgeries.Results - After-lockdown elective hip surgeries comprised one-third the number of before-lockdown (IRR ∼0.3), which is a greater drop than that seen in all-cause elective hospital care (IRR ∼0.6). Men aged 35-69 had half the number of emergency hip fracture surgeries (IRR ∼0.6), whereas women aged ≥ 70 had the same number of emergency hip fracture surgeries after lockdown (IRR ∼1). Only women aged 35-69 and men aged ≥ 70 had emergency hip fracture surgery rates after lockdown comparable to what may be expected based on analyses of all-cause acute care (IRR ∼0.80)Interpretation - It is important to note for future pandemics management that lockdown restrictions may impact more on scheduled joint surgery than other scheduled hospital care. Lockdown may also impact the number of emergency joint surgeries for men aged ≥ 35 but not those for women aged ≥ 70.

SARS-CoV-2 in health and care staff in Norway, 2020. / SARS-CoV-2 blant ansatte i helse- og omsorgstjenesten.

BACKGROUND: The COVID-19 pandemic is placing considerable pressure on health services around the world. In Norway, the incidence rate among the working-age population (20-69 years) for the whole of 2020 was 1.11 %. In this study, we describe diagnosed infection among staff in the health service, based on register data. MATERIAL AND METHOD: From the emergency preparedness register, Beredt C19, we identified 382 332 persons employed in selected occupational groups in the health service in week 9 of 2020, and investigated incidence and testing activity for diagnosed SARS-CoV-2 according to occupation, age, sex, country of birth, place of residence and place of work, for the whole of 2020. RESULTS: The incidence in the health service for the entire period was 1.48 % (5673/382 332). Diagnosed infection was highest among ambulance personnel and nursing home staff, with an incidence of 1.83 % (95/5203) and 1.86 % (1534/82 776), respectively. Doctors were tested most frequently (1.45 tests per person), and the proportion of positive tests was highest among cleaners (2.78 %) and ambulance personnel (1.57 %). Imported infection was highest for dentists (14.3 %), psychologists (12.8 %) and doctors (10.8 %). INTERPRETATION: There are variations in the incidence of diagnosed infections among employees in the health service. Some of this can likely be viewed in connection with high testing activity, imported infection, age and sex distribution, place of residence and country of birth, and outbreaks in different health services. More research and data are needed to ascertain whether occupational practice is associated with increased risk of SARS-CoV-2 infection.

Hospitalisations for COVID-19 - a comparison of different data sources. / Sykehusinnleggelser med covid-19 ‒ en sammenligning av ulike datakilder.

BACKGROUND: Three different data sources exist for monitoring COVID-19-associated hospitalisations in Norway: The Directorate of Health, the Norwegian Intensive Care and Pandemic Registry (NIPaR), and the linking of the Norwegian Patient Registry (NPR) and the Norwegian Surveillance System for Communicable Diseases (MSIS). A comparison of results from different data sources is important to increase understanding of the data and to further optimise current and future surveillance. We compared results from the three data sources from March to June 2020. MATERIAL AND METHOD: We analysed the number of new admissions, as well as the total number of hospitalised patients and those on ventilatory support, reported per day and by regional health authority. The analysis was descriptive. RESULTS: The cumulative number of new admissions according to NPR-MSIS (n=1260) was higher than NIPaR (n=1153). The discrepancy was high early in the epidemic (93 as of 29 March). The trend in the number of hospitalised patients was similar for all three sources throughout the study period. NPR-MSIS overestimated the number of hospitalised patients on ventilatory support. INTERPRETATION: The discrepancy in new admissions between NIPaR and NPR-MSIS is primarily due to missing registrations for some patients admitted before NIPaR became operational. Basic information retrieved daily by the Directorate of Health give comparable results to more comprehensive daily information retrieval undertaken in NIPaR and NPR-MSIS, adjusted retrospectively. Further analysis is necessary regarding whether NIPaR and NPR-MSIS provide timely data and function as required in an emergency preparedness situation.