Preprint Excess primary healthcare consultations in Norway in 2024 compared to pre-COVID-19-pandemic baseline trends, White et al, 2025

Kalliope

Kalliope

Senior Member (Voting Rights)

Abstract​


Background​

The risk of post-acute sequelae of COVID-19 is estimated at 3–6% per infection in 2024. Our previous study identified substantial increases in Norwegian primary healthcare consultations in 2023—compared to pre-pandemic levels—for conditions associated with acute and post-acute COVID-19 sequelae. This study extends that analysis to 2024 and includes age- and sex-specific analyses.

Methods​

We used data from the Norwegian Syndromic Surveillance System (NorSySS), which captures primary healthcare consultations coded using 101 ICPC-2 codes. Bayesian linear regression models were fitted to 2010–2019 trends, adjusting for population changes, to estimate expected values for 2024. Excess consultations were calculated and stratified by age and sex.

Results​

In 2024, there were 17,170,953 consultations.

This corresponds to an excess of 836,033 consultations (90% PI: 559,609 to 1,109,762), or a 5.1% relative excess (90% PI: 3.4–6.9%) compared to expected levels.

The 10 code combinations with largest absolute excess in 2024 were respiratory infections (261,168 excess consultations, 16% relative excess), fatigue (185,774 excess consultations, 63% relative excess), psychological symptom/complaint other (170,943 excess consultations, 79% relative excess), acute stress reaction (162,642 excess consultations, 68% relative excess), depression (119,120 excess consultations, 125% relative excess), hyperkinetic disorder (102,250 excess consultations, 106% relative excess), abdominal pain/cramps general (74,623 excess consultations, 26% relative excess), memory disturbance (36,521 excess consultations, 59% relative excess), conjunctivitis (31,744 excess consultations, 54% relative excess), and infectious disease other/NOS (30,379 excess consultations, 73% relative excess).

Deviations from expected pre-pandemic trends worsened dramatically from 2022, coinciding with the Norwegian government’s lifting of all COVID-19 preventative measures. Increases typically occurred 3–6 months after COVID-19 waves. Women, children, adolescents, and young adults were disproportionately affected by cognitive issues.

Conclusions​

Primary healthcare consultations in 2024 significantly exceeded pre-pandemic expectations, especially for conditions linked to post-acute sequelae of COVID-19. The findings suggest ongoing population-level health impacts associated with repeated SARS-CoV-2 infections, particularly among women, children, adolescents, and young adults. These effects have emerged under a national COVID-19 strategy that does not account for post-acute consequences of SARS-CoV-2 infection.


Excess primary healthcare consultations in Norway in 2024 compared to pre-COVID-19-pandemic baseline trends

BackgroundThe risk of post-acute sequelae of COVID-19 is estimated at 3–6% per infection in 2024. Our previous study identified substantial increases in Norwegian primary healthcare consultations in 2023—compared to pre-pandemic levels—for conditions associated with ...
www.researchsquare.com www.researchsquare.com
 
The first author is Richard Aubrey White. He works at FHI, the home of Flottorp, Rørtveit, Larun, etc. He has been very vocal in the media about how FHI and the Norwegian Government is completely ignoring Covid and science in general.

It’s good to see more data on this, and that they’ve done a proper analysis of the years prior to the pandemic. The Norwegian Government and FHI have a tendency to play with the statistics and chose the wrong periods to compare with.
 
Utsikt said:
The first author is Richard Aubrey White. He works at FHI, the home of Flottorp, Rørtveit, Larun, etc. He has been very vocal in the media about how FHI and the Norwegian Government is completely ignoring Covid and science in general.

It’s good to see more data on this, and that they’ve done a proper analysis of the years prior to the pandemic. The Norwegian Government and FHI have a tendency to play with the statistics and chose the wrong periods to compare with.
Click to expand...
It’s sadly very easy to lie with statistics.
 
How refreshing to read something this honest. (From the "Background" section of the paper):

The COVID-19 pandemic has altered global healthcare utilization patterns, with impacts extending far beyond the acute phase of infection. Post-acute sequelae of COVID-19 (PASC) is now recognized as a systemic, multi-organ disorder, often causing prolonged fatigue, cognitive and neurological dysfunction, cardiovascular complications, and other disabling symptoms (1).

The burden of PASC is substantial (1–4); an estimated 400 million individuals require support globally (5), with estimates attributing an annual economic loss of approximately 0.5% of gross domestic product (6,7).

Given this substantial burden, countries have adopted varying approaches to managing ongoing COVID-19 transmission. Norway’s current COVID-19 strategy (8), implemented since 2022, differs notably from World Health Organization and other international guidelines (9) and is dependent upon the Norwegian population being repeatedly reinfected with SARS-CoV-2.

The Norwegian Institute of Public Health (NIPH) outlines the rationale behind Norway’s COVID-19 strategy: “It is now mainly population immunity that is keeping the epidemic in check ... Stronger measures to limit the spread of infection have two important disadvantages.

Firstly, the measures can be resource-intensive, restrict freedoms and weaken the economy and perhaps public health. Secondly, maintaining population immunity depends on the virus circulating in the population” (10).

This strategy creates conditions where repeated SARS-CoV-2 reinfections are common across the
population. Although reinfection increases cumulative PASC risk (11–13), the Norwegian government's COVID-19 strategy (8) and NIPH’s risk assessment of the strategy focused exclusively on acute consequences, with no mention of PASC (10).

Elsewhere, NIPH has claimed that frequent reinfection by SARS-CoV-2 is beneficial for reducing the risk of PASC (14), a view that contrasts with
prevailing scientific consensus (15).
 
Kalliope said:
Elsewhere, NIPH has claimed that frequent reinfection by SARS-CoV-2 is beneficial for reducing the risk of PASC (14), a view that contrasts with
prevailing scientific consensus (15).
Click to expand...
14 is an interview with Aavitsland at FHI where he says that the best way to protect the Norwegian people from negative long term consequences of Covid is for them to be regularly infected with Covid.

I struggle to understand the worldview someone must have to come to that conclusion.
 
It might only be a translation thing, but "excess consultations" makes my kneecaps twitch.

It sounds far too much like "unnecessary consultations", especially as seeing no increase in primary care consultations after a pandemic would be frankly astonishing.
 
Just noticed that Nyborg is also involved. She received a lot of pushback when she tried to warn about Covid right at the start of the pandemic. She was unable to find work in Norway for a few years because of it, and the then prime minister labeled her as among the biggest disappointments that year in her new year’s speech..
 
I don’t think it’s a translation thing as much as a field-specific term. If public health would own up to its failure to see these consequences of the pandemic, there wouldn’t necessarily be a need to call them «excess». Now the term serve to highlight that there are in fact an increase seen after the pandemic (when comparing to what we would expect if covid didn’t enter our environment).
 
Another quote from the paper:

Clinical perspectives and diagnostic coding in Norway

Despite growing international recognition of PASC as a multi-organ disorder with serious functional consequences, prevailing perspectives within the Norwegian healthcare system may contribute to its under-recognition. In particular, PASC is often framed as a psychosocial condition—driven more by anxiety and perception than by persistent physiological damage (31–33).

The “Oslo Chronic Fatigue Consortium”—an influential group of mostly Norwegian clinicians and researchers—has described PASC and other post-infectious disorders as “likely to reflect the brain's response to a range of biological, psychological, and social factors, rather than a specific disease process” (34).

Similar views have dominated official guidelines and medical literature for decades—without yielding significant clinical progress or improved outcomes for patients with post-infectious conditions (35–37). This psychosocial framing of PASC may influence clinical practice, diagnostic coding, and how symptoms are perceived by both patients and providers.
 
Adding some more quotes:

Fatigue
Fatigue is one of the most well-documented post-acute sequelae of COVID-19 (15,53).

A systematic review of 50 controlled studies including over 14 million participants found that non- hospitalized COVID-19 patients had significantly increased risks of fatigue (RR 1.58; 95% CI: 1.25 to 1.96) (54).

Norwegian studies have also consistently demonstrated this association: one study of more than 57,000 participants found that even among people with three vaccine doses, Omicron infection was associated with a 70% higher risk of fatigue lasting at least three months (16).

Among those with only two vaccine doses, the risk was even higher (178% for women and 107% for men).

A separate Norwegian study of 140,000 participants showed that people who tested positive for the Delta and Omicron variants of SARS-CoV-2 were more likely to seek healthcare for fatigue in the 126 days post-infection compared to those who tested negative (55).

ME/CFS is a serious complication that develops in a subset of patients with PASC (56). A study commissioned by the Norwegian Directorate of Health identified that a variety of ICPC-2 codes are used by Norwegian primary care physicians when suspecting ME/CFS; these codes include A04 (weakness/tiredness general) (57).

The Norwegian Labour and Welfare Administration found that people with medically certified sick leave due to COVID-19 had substantially increased risks of subsequent sick leave for A04 (weakness/tiredness general, 182% increased risk) in the following 12 weeks compared to those on sick leave for non-COVID-19 reasons (58).

Psychological symptom/complaint other

The ICPC-2 code P29 (Psychological symptom/complaint other) is used for psychological issues without an obvious source (22).

For example, the Norwegian Directorate of Health’s guidance to primary healthcare doctors regarding “burnout” is to record it under P29 (59).

When using the Norwegian Directorate of Health’s “Find Code” tool, searching for the term “slitenhet” (Norwegian for “fatigue”) returns the code P29 as the only suggestion (60). Norwegian primary care physicians employ various ICPC-2 codes when suspecting ME/CFS,.

These codes include P29 (psychological symptom/complaint other) (57).

In the Norwegian Labour and Welfare Administration’s study, people with medically certified sick leave due to COVID-19 had substantially increased risks of subsequent sick leave for P29 (psychological symptom/complaint other, 18% increased risk) in the following 12 weeks compared to those on sick leave for non-COVID-19 reasons (58).
 
Conclusions
Substantial increases were observed in primary healthcare consultations in 2024 compared to pre-pandemic levels.

Many of the conditions with the greatest excess are associated with post-acute COVID-19 sequelae.

The findings suggest ongoing population-level health impacts associated with repeated SARS-CoV-2 infections, particularly among women, children, adolescents, and young adults.

Evidence from this study suggests that children in Norway experience excess morbidity related to a lack of protection from SARS-CoV-2 vaccines.

Given that Norway's COVID-19 strategy and risk assessments do not address PASC, this information provides critical evidence for
understanding the population health consequences of policies that encourage repeated SARS-CoV-2 infections.

The results from this and our previous study suggest that inaction in the face of these signals may institutionalize chronic illness within the population, with far-reaching consequences for workforce participation, healthcare capacity, and national economic stability.
 
Something the public health field also should discuss is how the increase of "vague" symptoms such as fatigue could be the sign of worse health outcomes in the years to come, as evidenced by the studies that show pwMS have higher levels of health care consultations years prior to more diagnostically viable MS symptoms. We also know viruses might cause health issues that's not evident until years after the initial exposure.
 
Midnattsol said:
Something the public health field also should discuss is how the increase of "vague" symptoms such as fatigue could be the sign of worse health outcomes in the years to come, as evidenced by the studies that show pwMS have higher levels of health care consultations years prior to more diagnostically viable MS symptoms.
Click to expand...
Unfortunately for many diseases the first symptoms the patient experiences are often vague generic stuff, like fatigue or aches or cognitive-sensory issues, which are too easily and frequently misinterpreted by clinicians as being of psycho-social origin.

A friend of mine had gastrointestinal symptoms repeatedly dismissed as psycho-social, until bowel cancer was finally diagnosed, and too late to be effectively treated.

My friend was, of course, female, with the added biasing factor of not being white.

Dead at just 35, due to medical incompetence and prejudice.

Midnattsol said:
Although I think it still highlights which codes a doctor unknown with ME/CFS would think fits the symptoms.
Click to expand...
Do you mean 'unfamiliar'?
 
You must log in or register to reply here.
Back
Top Bottom