- The Journal of Developing Societies
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.
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