Wednesday, January 19

FHI did not believe in the crisis figures – so they struck

STRONG WINTER: Norwegian hospitals have handled a tough wave of delta admissions so far this winter.

This autumn, FHI presented worst-case scenarios for the winter wave, which they did not think would occur. They did.

– Based on an overall assessment, we believe it is likely that we will get a wave through the winter, but not as big as the scenario with 60 inpatients every day. But we do not know this, so we must also be prepared for a bigger wave than what we expect to be able to handle well, said Camilla Stoltenberg when FHI presented scenarios for the winter wave in October.

In the report, FHI had calculated in several ways the winter wave could develop, and they outlined a worst-case and best-case scenario. At the same time, Stoltenberg emphasized:

– This does not mean that we believe that it will happen, most likely none of the scenarios will work. Either because they are unlikely, or because we do something to prevent them. They give us a presentation that allows us to plan, have good preparedness and act further.

Since then, admission numbers have continued to climb. Now reality shows that they have followed the worst-case scenario – in fact, they were well above it for a while. It is only in the last three days that the admissions are lower than the worst case curve.

This is the development in admissions with the delta virus. Omikron, which is now spreading in Norway, is in addition.

In December, omikron appeared in Norway. This has had major consequences. The government introduced strong measures nationally to get an overview and control, which has been followed up with even stricter measures over Christmas.

But already a month before omikron announced its arrival, several hospitals announced that they were under severe pressure. “At the breaking point,” described a chief physician at the intensive care unit at Ahus. The Norwegian Directorate of Health then recommended stricter measures, but the government did not follow all their advice.

– This development in the number of corona admissions has not come as a surprise to you, if you have followed it up against the scenarios you have previously created?

– Our assessment in October was that it was perhaps most realistic with an infection development that was not as serious as in the most serious scenario. We follow up the scenarios with weekly modeling that says something about the development in a short time, but FHI is not responsible for following up hospital capacity, answers FHI department head Line Vold.

She emphasizes that FHI does modeling to show scenarios ahead given certain assumptions, and there is great uncertainty associated with these – but that they are useful for exploring what influences development further, and what one should prepare for.

– An important reason why the development has been different from what we considered most likely is related to assumptions about the duration of the vaccine effect, and that it has decreased faster than expected – which affects the effective R-number so that it has become higher than we thought was the most likely development, says Vold.

Now she says FHI has more knowledge about the duration of immunity after vaccination. It has declined faster than they thought in terms of immunity to transmission, but the vaccines still have a good effect against serious illness.

– As I said, there is always great uncertainty associated with the scenarios, and we choose to illustrate a wide range of possible scenarios. Especially when there is great uncertainty associated with further development, this is useful, she says.

– Most often, we consider it most likely that we will not see the development that is on the fringes of outlined scenarios. This was also the case for the modeling that was done around the reopening.

NIPH has recently published new scenarios about the consequences omikron may have in the future. But there is even more uncertainty than usual – it is too early to know enough about omikron’s infectivity, and FHI also does not know enough about how current measures affect omikron.

There, the worst-case scenario peaks at up to 5,000 admissions at a time, while the optimism is between around 700. The admission record so far is 383.

MONITOR: FHI monitors and analyzes how the infection develops.

VG has also asked the government what they were prepared for:

– The fact that it has not been hit harder to stop the development in the graphics above earlier (ie before omikron) – does that mean that you think the hospitals have been able to handle the curve that has been about to hit? Or that you did not think the development would be like this?

– We have assessed the situation on an ongoing basis, and the government has received situation reports and advice from the agencies. We have introduced and adjusted the infection control measures based on those advice, writes State Secretary Ole Henrik Krat Bjørkholt to VG.

He says the government has always considered the proportionality between capacity and the introduction of measures, and that it is important to look at the capacity in the entire health service, including the municipality, in addition to the capacity to solve other tasks such as TISK and vaccination.

– There have been hospitalizations due to other respiratory infections – in addition to covid-19. There has also been a high level of sick leave among employees. For the health service, all these factors have also contributed in terms of capacity, not just covid-19. In the strategy, we have stated that we do not want a situation with a great deal of pressure on the primary health care service, many hospitalizations and the spread of infection that affects society to a great extent. We have therefore made several tightenings and implemented strong infection control measures based on professional advice.

When asked if it came as a surprise to the government that the development was as negative as described in FHI’s worst case scenario, he answers that the government has planned for both the positive and negative scenarios because the development in the pandemic has been uncertain all along.

– We must always be ready for the pandemic to develop in a more negative direction. We therefore have a strategy that facilitates possible upward adjustment of infection control measures if necessary. The hospitals have continuously adjusted their capacity depending on how the infection situation and the frequency of hospitalizations have been, especially with a view to postponing planned operations and treatments.

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