Are measures designed to control the spread of Coronavirus working? And at what cost?

It was barely a month ago, on 26 February, that the first confirmed case of coronavirus was identified in Norway. Since then, Norwegian society has been turned on its head.

Emergency preventative measures were enacted by the Norwegian government 12 March. Schools, universities and most businesses were closed. Travel restrictions in and out of the country were introduced and social distancing measures were implemented. The current measures will be in force until at least 14 April.

There has been some disagreement among public health authorities about which strategy—suppression or mitigation—Norway should pursue. For now, the stated aim of the preventative measures is to suppress the virus, rather than seeking to slow its spread.

Expertise in demand

Most people’s personal and professional lives have undergone significant changes since the onset of the coronavirus outbreak, and Svenn-Erik Mamelund is no exception. A demographer by training, Mamelund is a research professor based out of the Work Research Institute (AFI) at OsloMet and currently heads a Horizon 2020 project that examines the impact of the 1918 influenza pandemic on emergency preparedness policies. Mamelund's area of speciality has made him a sought-after authority on the current pandemic.

“To be honest, I’m pretty exhausted," Mamelund admits. He makes no secret of the fact that watching how the situation has played out over the past few weeks online and on television has brought him to the verge of tears.

As one of the few social scientists who has dedicated his career to understanding the dynamics of pandemics and their impact on societies as well as ordinary people, Mamelund has spent the past month fielding inquiries from Norwegian and international media. As intense as the past month has been, the OsloMet researcher considers it his duty to share what he knows about pandemics with the wider public.

While I do believe that this is the right thing to do, there is no doubt that the price we are paying and are going to wind up paying is incredibly high. – Svenn-Erik Mamelund

An extraordinary request

In addition to media inquiries, regular work duties and adjusting to life under the new restrictions, Mamelund has been busy working on a research funding application unlike any other he has encountered. The Research Council of Norway (NFR) released an emergency call for applications on 6 March for an extraordinary project that seeks to provide answers to questions of broad, societal importance related to the coronavirus pandemic.

Mamelund and his colleagues have advanced to the final round of the accelerated selection process and will be notified if their proposal has received funding just after the Easter holiday.

"I’ve never experienced anything quite like this," Mamelund tells us. "To the best of my knowledge, this is the first time the Norwegian authorities have sought to mobilise researchers on such short notice."

Are the preventative measures working?

A central feature of the call for proposals issued by NFR is a critical assessment of whether the drastic measures implemented by the Norwegian authorities are working as intended. 

 "The authorities are desperate to know: are the measures that have been implemented working?” Mamelund explains. “If we as a society are to bear the severe social and economic consequences of these measures, we at least need to know whether they are achieving their desired effect."

Whether or not they are awarded NFR funding, Mamelund and his team at AFI have every intention of contributing research-based knowledge to the ongoing response to the coronavirus pandemic. Their proposal centres on designing and distributing a questionnaire to map self-reported sickness in the population during the current pandemic. Their hope is that the questionnaire will shed light on who has fallen ill, who has been working from home, and what kinds of measures people have implemented in their own lives, such as practising social distancing.

"We also hope to demonstrate which groups in society are paying the highest price for the measures currently in place, for example through job loss," Mamelund explains.

Mamelund hopes that he and his team will be able to provide the authorities with timely answers to the question of whether the current measures are helping contain the virus, as well as how best to help those workers hardest hit by the economic impact of the restrictions.

"As things stand today, we cannot say anything conclusive about causality,” he warns, “so we need to look for associations instead."

The authorities are desperate to know: are the measures that have been implemented working? – Svenn-Erik Mamelund

Communicating research to the public

With 25 years of research into pandemics under his belt, Mamelund is keen to share what he knows about these kinds of crises with the broader public.

 "As one of the few social scientists working in this field, I have no doubt that I need to do what I can to correct some of what I'm reading in the comments sections of online news articles, to give one example” the OsloMet researcher tells us. “In situations like the one we’re in today, it is downright dangerous to let the comments sections go unchallenged, so I feel a certain responsibility for conveying what I know."

As Mamelund sees it, perhaps his most important contribution is to help contextualise the current situation, particularly from a social, historical and epidemiological perspective.

"Research is a slow-moving enterprise—neither social scientists nor academics from any other fields are trained to provide immediate answers to problems as they arise," he explains.

Mamelund stresses that nothing can be said with much certainty at this time, and he is therefore reluctant to say anything about whether the coronavirus will evolve or develop in any particular way.

Pandemics, Mamelund explains, tend to recur three of four times per century. As such, it is only those of us born after World War II who have been spared the experience of something "strange and sinister" in their lives like the coronavirus pandemic we are currently living through.

In situations like the one we’re in today, it is downright dangerous to let the comments sections go unchallenged, so I feel a certain responsibility for conveying what I know. – Svenn-Erik Mamelund

Taking ethical concerns seriously

The OsloMet researcher is acutely aware that the preventative measures currently in place in Norway and elsewhere—including extended quarantines—may have serious negative effects on individuals and society more broadly.

"I just really wonder how this will turn out," says Mamelund. "We have never before experienced anything quite like this—history holds no examples of anything similar, so it simply is not possible to draw any parallels."

Mamelund emphasises, however, that he supports the measures Norwegian authorities are pursuing to suppress the virus’ spread wholeheartedly.

"In a situation when we have no drugs or vaccines to deal with the virus,” he says, “this is the only thing we as a society can in good conscience do.”

At the same time, Mamelund is keen to underscore that the measures initiated have major social and economic impacts.

"There are humanitarian and ethical issues involved, after all. We are willing to spend vast amounts of money and jeopardise large parts of the labour market in order to save the sick and vulnerable, while being perfectly aware that many people will suffer from the after-effects. While I do believe that this is the right thing to do, there is no doubt that the price we are paying and are going to wind up paying is incredibly high."

There are fewer people than usual in the streets of Oslo, with most businesses and offices closed and social distancing measures in force until at least 14 April. Photo: Lise Åserud / NTB scanpix

The unique perspective of the social scientist

The view that social science had something distinctive to offer to the field of pandemic preparedness was only just starting to take hold when Mamelund finished his master’s degree in human geography in 1998.

After submitting his master’s thesis on the spread of influenza in Norway during the 1918-1919 influenza pandemic, commonly referred to as "the Spanish flu", Mamelund was on the lookout for opportunities to apply his newly acquired insights. It did not take long before Mamelund found himself working on Norway's first preparedness plan for influenza pandemics, which was released in 1999.

What this comes down to is that public health authorities need to cease regarding at-risk groups as internally consistent medical entities. – Svenn-Erik Mamelund

"I had gathered from news reports that such a plan was in the making and immediately started asking, um, who are they going to have working on that plan?”

The public agency responsible, Norwegian Institute of Public Health (FHI), had, unsurprisingly, appointed medical experts, virologists, immunologists and others with backgrounds from the health sciences to draw up the new plan. Mamelund, the recent graduate, was struck by the absence of social science experts involved in the process. So he decided to do something about it.

"I figured that, with my background, I could probably contribute in some way. So I called FHI and said: "You know what? You guys need help and I happen to have studied the history of pandemics. And now I want to help you.”

And that is how, fresh off his master’s degree, Mamelund landed a summer job researching and writing about the possible social and economic impacts of an influenza pandemic against the backdrop of the history of pandemics and epidemiology.

When he reported for work at the Institute, Mamelund found that some work had been done on the social and economic impacts, but much remained to be done.

"The social science perspective just isn’t the most interesting to those who work in this field," Mamelund concludes. "That is as true today as it was then.”

Social inequality plays a role 

Mamelund tells us that, throughout his career, he has sought to convince both public health authorities as well as fellow researchers around the world to modify their view of which groups in society qualify as ‘at-risk’. Pandemics and the ways in which they can be contained have largely been considered strictly medical concerns, with the consequence that the vital role of social science perspectives tends to get overlooked.

"What this comes down to is that public health authorities need to stop regarding at-risk groups as internally consistent medical entities.”

By way of illustration, Mamelund points to the two groups identified as the most vulnerable in the current epidemic: the elderly and people with underlying medical conditions. What we need now, the OsloMet researcher argues, is a greater awareness of how socio-economic status affects members of various at-risk groups during public health crises like the current one.

"Medical conditions may well be more prevalent among people with lower socio-economic status, but isolating the relevant factors at play is difficult work, so we are trying our best to come to grips with what the underlying mechanisms are. Mechanisms, after all, are what we sociologists understand best."

As of this writing, Mamelund is honing in on three mechanisms: exposure; vulnerability; and access to medical assistance and information about available healthcare.

"We are currently pursuing reliable data relating to these three mechanisms that will make it easier for us to understand the chain of causation that produces unequal health outcomes related to socioeconomic status, serious illness and death," Mamelund explains.

Vaccinate—people’s lives may depend on it

Mamelund goes out of his way to emphasise how important it is that more people get the influenza vaccine before every flu season. At the same time, the price and availability of the vaccine must not be a barrier to accessing it.

"If more people had gotten the flu vaccine this year, more intensive care beds currently occupied by regular influenza patients would have been freed up and available to coronavirus patients in need of intensive care,” the researcher notes by way of conclusion.

A version of this piece originally appeared in Norwegian in the online journal Sosiologen.