During the spread of the COVID-19 pandemic in 2020, no
vaccines or antiviral medicines were available. Governments, health
politicians, national institutes of public health, and other stakeholders
therefore relied on the use of non-pharmaceutical interventions (NPIs) to
reduce the spread of the disease. Whether and to what extent people changed
behavior and followed public health advice of, for example, washing their hands
more often, increasing their distance from others, working more from home, and
using less public transportation was therefore fundamental for reducing infections,
hospitalizations, and mortality.
Several studies on European countries and the USA reported substantial social, ethnic, and racial disparities in COVID-19 pandemic outcomes. A study analyzing all COVID-19 related deaths in Sweden found that there were independently higher risks for those with lower disposable incomes and lower education levels, as well as those who were immigrants from a low- or middle-income country. Analyses of in-hospital mortality in the UK showed that deprivation and people from Asian and Black populations had higher risks, with little of the excess risks for these groups explained respectively by co-morbidities or deprivation. Most studies on deprivation, ethnic, and social inequalities have not had data to identify the drivers of these associations.
One reason for social disparities in COVID-19 pandemic outcomes in 2020 may have been social disparities in compliance with NPIs. In this article, we use survey data from a representative sample of Norwegian workers to investigate socioeconomic differences in self-reported NPI use during the diffusion of COVID-19 in the winter and spring of 2020 in Norway, which enforced an early and encompassing lockdown. To our knowledge, this is the first study on this issue for a Scandinavian welfare state which, along with Denmark and Finland, succeeded in keeping morbidity and mortality at a very low level and with little to no excess all-cause mortality due to COVID-19, at least during the first phases of the pandemic. The success in these countries may be due to strict lockdowns. Sweden, the last of the four Scandinavian welfare states, introduced a less strict lockdown and had one of the highest pandemic mortality tolls per capita internationally. This comparison shows that even a high-income welfare state can experience high mortality in a situation without vaccines, strict lockdowns, and high compliance with NPIs.
Results from a survey on NPI use in a high-income country with early and strict lockdown such as Norway may bear important implications and insights for low-income countries, which may not be able to afford vaccines for all, and for settings that did not gather survey data on the course of the pandemic and the role of NPIs on the disease burden in 2020. Increased knowledge about these measures could prevent severe pandemic outcomes in the next waves of COVID-19 in 2021 and beyond or other future pandemics.