Public adherence to COVID-19 guidelines in Norway: a case study

Governments have proposed alternative and combined interventions worldwide to mitigate the new coronavirus disease 2019 (COVID-19) spread. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative pathogen of COVID-19, has infected more than 76.2 million cases and claimed over 1.7 million lives, as reported to the World Health Organization (WHO).

In a short span, the virus spread across the globe. However, a disaster more extensive than the current one was averted solely by the governments and the public's interventions. Epidemic modeling studies help plan, evaluate, and execute the required policies for arresting this virus in the absence of any pharmacological intervention.

To evaluate and understand the adherence to public health actions recommended by the government, a team in Norway undertook a study funded in part by the Norwegian Research Council’s Centres of Excellence Funding Scheme and by the project: A realtime analytical pipeline for preparedness, planning, and response during the COVID-19 pandemic in Norway.

The team recently published their results on the preprint medRxiv* server. They found that the public adherences to the follow-by norms regarding the quarantine and testing for COVID-19 are below the expected outcomes. Especially for a country with high trust in the government, this study shows there is considerable room for improvement in adherence - which may be improved by communicating better with the public and possibly reducing restrictive interventions.

In this study, the authors presented the questionnaires every 14 days since March 2020 to participants from two ongoing cohorts, the Norwegian Mother, Father and Child Cohort Study (MoBa) and The Norwegian Influenza Pregnancy Cohort (NorFlu).

MoBa is an ongoing nationwide study with more than 114,000 children and their parents recruited during weeks 15-18 of gestation between 1999 and 2008. They are followed up through questionnaires and linkages to registries.

One of the main strengths of our study is the continued high participation rates over more than seven months, particularly among the NorFlu cohort members. Both cohorts are population-based, and both sexes and all parts of the country are well represented in the study population.”

The participation rate in this study was approximately 40%. About 150,000 adult participants were invited from MoBa as well as nearly 4,500 women from NorFlu. The questions were regarding illness, testing for COVID-19, quarantine, and more. The questionnaire information was also linked to previous data from MoBa and NorFlu, to obtain educational level information.

The recommendations to be practiced were the following:

  1. Respiratory symptoms should lead to testing
  2. Confirmed or suspected COVID-19 should be followed by quarantine. The authors estimated the adherence to these guidelines in the responses from cohort participants during August to October 2020.

With an average of 85,000 respondents, they found relatively low adherence to government recommendations regarding testing for SARS-CoV-2 when ill and to quarantine after receiving a diagnosis of suspected or confirmed COVID-19.

Surprisingly, though the adherence was mostly unaffected by age, the lowest adherence to the testing recommendations was among men and women with the highest education levels. Because the testing varied somewhat by county of residence, the local availability of guidelines may affect the decision to get tested.

In this study, even among those who got tested for SARS-CoV-2, less than two-thirds reported to have been in quarantine/self-isolation. Likewise, those with symptoms during the previous 14 days also did not adhere to the quarantine norms.

Despite high trust in Norway's government, the public did not follow the recommendations as expected in this specific population. This suggests that adherence to essential recommendations may be even lower in other countries. Policies and action plans for health during this COVID-19 period should be taken with these results in mind.

Here, Ellen Øen Carlsen et al. aimed to evaluate two governmental recommendations given to Norwegian citizens from August onwards: to test for SARS-CoV-2 when having respiratory symptoms and to go into quarantine after a confirmed or suspected diagnosis of COVID-19 was made.

They found that the adherence to testing and quarantine recommendations is lower than expected in a country with high trust in the government and a relatively low infection pressure during the study period. The educational level, age, gender, or county of residence also did not influence the adherence to any large degree.

The findings suggest that there is much to gain from stronger incentives for adhering to recommendations, which may alleviate the need for new lockdown situations, the authors write.

*Important Notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:
Dr. Ramya Dwivedi

Written by

Dr. Ramya Dwivedi

Ramya has a Ph.D. in Biotechnology from the National Chemical Laboratories (CSIR-NCL), in Pune. Her work consisted of functionalizing nanoparticles with different molecules of biological interest, studying the reaction system and establishing useful applications.


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