 Welcome everyone. I think we will get started. It's two o'clock and welcome everybody to the session on the COVID-19 response here in Norway. My name is Anna Tusheng. I work at the University of Oslo. We're starting off with some nice pictures from Norway. We're a small population up here north in Europe with around five million people and we distributed both in cities and in quite rural areas, as you can see on the pictures, among fjords and oceans and mountains up here. Our country is split in 356 municipalities, local governments, and they're all individually responsible for testing and contact tracing in their area. And so while the HIS-2 is mainly used in Africa and Asia and also Latin America, Norway is now using the HIS-2 for COVID and we're very excited about that. As many other countries, Norway saw their first cases on the coronavirus this spring and as all other countries, Norway is constantly working hard to ensure that the infection spread is kept to a minimum through testing and contact tracing. In Norway, we currently have two main solutions for contact tracing and a couple smaller ones. Two of these main solutions are based off of the HIS-2 and today we will hear about one of them and I'm very excited to have three very interesting speakers today. So first off we have Umar Nasir from the Norwegian Institute of Public Health. Umar is a medical microbiologist and a senior scientist and he is heavily involved in Norway's response on testing and contact tracing and he will give us the perspective of the Norwegian Institute of Public Health and how they work with policy, routine, and support to the municipalities. After Umar, we will have Haydish Luxval. She is coming from the Norwegian Association of Local and Regional Authorities. She is the project manager for one of these digital solutions for contact tracing based off of the HIS-2 that is offered to the Norwegian municipalities. She will describe their role and how they have been working to provide this tool to the Norwegian municipalities who work with testing and contact tracing. And finally, we have Dr Mira Greb. She is the district medical officer from one of the larger municipalities here close to the capital and she will give us an insight into the life of those managing this pandemic day to day. And I'm very much looking forward to this session. If there is any time at the end, we will have room for questions that is posted in the COP or in the chat. And you can also go to the COVID-19 site on the DHIS-2 website to learn more about what we do on COVID-19. And finally, I just want to say that this session is being recorded. So then I will hand it over to Umar from the Norwegian Institute of Public Health. Thank you so much. Let's see if I can, of course, it's not there now. Let me just share my screen somehow. Of course, there has to be some technical difficulties. Otherwise, it would not be a perfect session. I thought I had it there. Let's try this one share. And so, yes, okay. Thank you so much. I'm sorry for the little technical glitch in the beginning here. So first of all, thank you very much for this invitation and this opportunity to present on the topic of the need of digital contact tracing tool in the context of the Norwegian response to COVID-19. And as Umar said, I am a senior scientist at the Norwegian Institute of Public Health. And I thought for this presentation, this talk, that I'll briefly just go into four main kind of topics, very briefly just to see where we are on the COVID-19 status in Norway right now and how contact tracing fits into the Norwegian TISC strategy. What TISC stands for, we will go a bit more into in the later slides. And then the establishment of a new unit or a team, which I've translated here into the Norwegian COVID response team. This is not the official translation of that team. But for the purpose of this presentation, this is what I've named it or titled it. And then at the very end, I'll also go into how the Norwegian from the perspective of the Norwegian response team and how we've been in contact with different municipalities, we see the need of a digital contact tracing tool to be in place in the municipalities to be able to respond in an appropriate way and in an efficient way in the municipalities to this pandemic. So these are data from our 21st of September in Norway. We have about 13,000 confirmed cases so far in the epidemic. We performed more than a hundred or close to a million tests and we've recorded 256 deaths. So if you look at the curve on the right here, we see we had, of course, in the beginning in springtime in March, we have this huge top of cases which were brought under control after lockdown of a lot of the main functions of the society. And we went into a summer months where we had little or no cases and predicted as it was as the summer came to an end and the autumn is coming up, we are seeing the second wave. Although we are seeing a second wave, I think it's worth mentioning that the relativity of the waves are not necessarily proportionate due to many factors. Number one, share this strategy of TISC which we'll get into that there are much more people who are being tested right now. So the testing strategies is way different than it was back in March and April. So we do see a lot more cases now just because they are being caught. So and also in terms of the severity of illness, we're also seeing something which is I think also mirrored in many of the European countries that now the population is much more younger. There are less of the serious cases which are coming up and it can also be just a result of that. We're testing more people and we're actually catching more of the tip than we did in the first phase of the outbreak. So and it kind of goes back to the contact tracing as a TISC strategy and the Norwegian TISC strategy which stands for Testing Isolation Smith Disputing which is Contact Tracing and Quarantine Decay in Norwegian for Karamterna. This is a comprehensive strategy which was launched right after the first shutdown to kind of with had the main idea was to be able to preempt and prevent nationwide lockdowns in the future and based of course on the basic idea and the evidence which is in literature that the contact tracing is one of the best measures we have in terms of being able to control or at least slow down the spread of any infectious disease. And as Anna also explained, I mean the response in Norway and the way it is the way the response is kind of in terms of responsibility is put, it is a bottom-down approach where the municipalities, the 356 municipalities in Norway have with their municipality doctors and their contact tracing teams are responsible for dealing with local outbreaks in their municipalities and to contain them to their best of their abilities. Of course, this is all done in close collaboration and with advice from the national authorities which are the Norwegian Institute of Public Health. As such, there was of course a need to have a contact tracing tool at least for the many of the bigger municipalities which had a lot more cases, bigger populations to be able to construct and coordinate their efforts and also to be able to get a quick and a good overview of the situation in their municipalities. And of course it also requires that the municipalities have healthcare service people who were trained to be able to be able to handle the challenges which came with this epidemic. So early, as I said, this was already stipulated early in one of the risk assessments that FHI did in April where we made it very clear that the measures for testing, isolation, contact tracing and follow-up should be strengthened throughout the country and that would actually entail that we would be able to lift these broader infection control measures and avoid implementings of measures in the future. And also in addition to that we see that the contact tracing tools when they are applied or contact tracing when it's applied in the municipalities, the reporting of the data which is collected through this one system to the national system which would allow the Norwegian epidemic response to be much better. We will get a much better idea of where the spread in the community happens and also which groups of populations are more affected and thus it will help inform the policies which were to come in the future for how to handle and how to manage this epidemic. So within that risk assessment it followed some initiatives. The initiatives were basically mainly on three different levels. You had the strengthening guidance of training of contact tracers in the municipalities. So basic training regime for the contact tracing teams in the municipalities. And the second was to make sure that there were available contact tracing tools, digital tools that could simplify the work for registration, documenting and reporting of contact tracing data for the municipalities. And lastly we also had a branch where we looked into new technology where we investigate the usefulness of using mobile phone applications to identify close contacts. But for this purpose of this presentation we'll just focus on the second bullet point here. And I see I'm also running short of time so I'm going to go a bit quick through this. So as I said there was a establishment of a Norwegian COVID Response Unit or National Smith Disputing Team was put in place just recently at the end of the summer. And this team had basically three major tasks. Number one was to support the municipalities and health trusts in the work of managing local outbreaks. And also secondly to coordinate response and infection control of outbreaks which involved more than one municipality as the municipalities were pretty responsible, have responsibility within their municipalities. And also to perform contact tracing directly in relation to positive cases of public transports. And this would came very much so an issue when we had the Hurtirutin outbreak and the outbreaks concerned linked to different ships and boats and cruises and also with airline and air travel. So I just wanted to just highlight that these are just since the first of since July and August the Norwegian COVID Response Unit has been involved in many small outbreaks from advice to data collection and analysis and advice and guidelines. And these are just some of them where we've been actively involved with the municipalities in containing these minor outbreaks in these municipalities. I think for the purpose of why we need digital tools, these are actually some of our kind of experiences and learning points from going into these outbreaks. One is of course why do these minor outbreaks occur and why and where do they occur. It seems that of course there are gatherings of many people often indoors and over time which are kind of the epicenters of these smaller outbreaks. It can be private social gatherings in parties, schools and places of work, training centers and sports centers, religious gatherings and also as I said you have the ships, these cruise ships or ships with a lot of passengers which can almost be like a small cohort or a small private gathering in itself. But also what is it that we see in terms of what the municipality needs? So what we've from our experiences that the municipalities have to have the ability to quickly scale up their response and that is the kind of the kind of the benchmark or bench line for where they say okay we are here now and how can we actually quickly scale up our response to an outbreak. And to be able to do that they need to have routine and procedures for detecting and managing all of possible outbreaks. They need necessary personnel, test capacity, agreements with neighboring municipalities, how to deal with positive tests and so on and also a proper management of a TISC response which would prevent the use of broader infection control measures. And in all these the focus here we saw is that the need of good data, systemized data is pivotal in being able to even in all these phases to be able to detect, to be able to prevent and to be able to also follow up all the contexts in a timely manner to be able to reduce the impact of an outbreak. A tool which helps the municipality to do that is essential. So to summarize we see that there are at least a couple of tools and this DHIS too is of course one of the first tools which were launched into the Norwegian Cova response. We see that it has many benefits both on a local level and on a national level. First of all in the locally on a municipality level it can create and connect electronic databases of cases and close contacts which may exist separately in the municipalities without this digital tool and it will allow the municipality to be able to follow up work closely with the contacts. They can produce simple statistical overviews for the municipalities. Many of them statistical overviews are important for reporting procedures both to the national institutes and to the direct rate and not to mention the media and how they communicate with the results from to the public. And compiling reports for sharing internally externally is an important feature as well to have in a digital tool and through a long time use of digital tool they can get a better overview of a spread of infection in the municipality. They can even see where if there are any hotspots if there are any target groups if there are any geographical link linkages within those areas where infection occurs and to be able to thereby also identify clusters and resolve outbreaks quickly. And that also feed into the national overview as well. So I will not use more time I see I'm over the time already so I lastly we think the need for a digital tool in the contact tracing in the municipalities and an important feature for an appropriate and good COVID-19 response. Thank you. Thank you so much Umar for your very interesting presentation. I will now give the word over to Heidi if you are ready. Yes hello everybody. I hope I'm up and running. Yes yes the presentation. Thank you for invitation to tell about COAS in moment in in contact tracing. I will start first to tell about COAS who we are and our role before I say more about our involvement in contact tracing. All the region municipalities and county councils are members of COAS. From 2020 11 counties and 356 municipalities. There is a huge workforce in the local government sector almost half a million employees and more than 11,000 committed local politicians politicians whose common goal is to provide what residents need. COAS is here for their sake. By joining forces a great deal can be achieved. New region municipalities exist in a challenging intersection between local autonomy and national legislation and regulation with a financial framework determined by the start thing. COAS and the government agree therefore that the good dialogue between the state and the local government sector is highly important and in the picture here you can see a scene from the constitution jubilee in 2014 where all the country's majors were invited to Oslo for a ceremony at the castle. As I mentioned there is enormous workforce in our sector. Altogether we have in fact four times as many as apple. We all agree firmly that we should do more together and COAS plays a central role in coordinating the sector in regard to digitalization. COAS works to enable the municipal sector to take part in decision-making and for the state and the local councils to be equal partners. COAS creates schemes to enable the municipal sector jointly to develop secure and efficient solutions. COAS as an example develops administers joint municipal architecture and share component such as varut and now contact tracing. Through commit municipalities and counties assist in managing our digitalization. The commit council is an advisory organ with COAS within COAS for digitalization and smart use of technology. The council aims to facilitate joint solutions and promote the interests of the municipal sector. In the picture here you can see a common digitalization strategy signed by the government and COAS where we work together to degilize public sector. And now I would tell a little about more about contact tracing and what we call fixed manufacturing COAS system. In the end of March and the beginning of April we were contacted by municipalities. They wanted COAS to see if it was possible to make a common digital tool for contract tracing. In this situation that nowhere was in there was not the best solution to let everybody every municipalities do this by their own. We contacted some more municipalities and discussed the case in our governance model for digitalization commit. They supported that COAS took a role in finding a common solution for the municipalities. And we also work together with the Norwegian institute of public health in this process. After some research we ended up with we ended up with DGI's too. That was in already in use in some of the municipalities. We used the COVID-19 package, we customized it to Norwegian conditions and we started a national pilot in May with three municipalities where Oscar is one of them and we'll talk later. COAS is hosting the solution and we have a very good collaboration with the university in Oslo. We have made some documents that the municipalities can use, training materials but also important documents for information security and general data protection regulation. That is very important. We went in production in the beginning of June. We couldn't have done this without the collaboration with the municipalities that took a central role in getting this to the place and of course the university in Oslo. Today's use is a little situation report. There is two main systems. We have one that have 100 uses by today. We like to do further development to increase ease of use and also new wanted functionality that municipality wants. We are developing the system together with the municipalities and we meet up with eight municipalities two times a month. COAS wants that all municipalities regarding their system, their use, benefit of new common component that COAS develop together and together with national government in contact tracing or other areas. Thank you. Thank you very much Heidi for your very interesting presentation from COAS. I will now give the word to Dr. Mira Gref in Asked Municipality, one of the municipalities that was early starters of this system. Hi and thank you Anna. I'm Mira Gref, the chief district medical officer in Oskar municipality in Norway and I would like to tell you the story about how we went from an urgent need to a technical solution in six weeks. At the moment I am working almost only with the COVID-19 response which has been the main subject in my life for the last six months. Here we go. The status at the beginning of COVID-19, this was the headline in a large Norwegian newspaper, often Posten, in the end of May. Norway, which is one of the most digitized countries in the world, was still using pen and paper and why didn't Norway have a digital tool before? Mainly because we don't have a high number of infectious diseases usually. Pen and paper is okay when maybe one or two persons are working together and there are only a few infected persons. One loses control as soon as more people work together and there are many infected persons in outbreaks. The pandemic has changed the numbers. We also needed a shared overview of the status and we had a need to communicate with others doing the same work on one outbreak or cluster, for example, neighboring municipalities. So our main goal is infection detection and control. We want to detect infectious individuals as soon as possible and stop the chain of infection. We need to systematically interview the infected person to identify close contacts as soon as possible and to keep infected persons or their contacts in the imposed quarantine length. We also need to monitor infected persons and their close contacts to find the second and third infection chain links and stop the spread through quarantine. Lastly, the infected persons need monitoring from clinicians in case of a severe development of their infection. One of the main subjects which is important here is trust. It's important that the individuals trust us since we need all information on close contacts, whether the contact is the wife, the lover or an illegal contact. So how to solve these challenges? We needed a digitally based program for quality assured information capture and even if routines and process and legal frameworks for contact tracing in general is in place and we have a lot of knowledge. A lot of the organizational work was focused on scaling things up, medical equipment, medical staff and so on. But one thing that was missing for solving this challenge was the digital tool to enable efficiency and capacity. To get this done, we need a flexible interview guide which can be adjusted according to the individual you are talking to. We needed a guide with decision making support because there are different individuals doing the interviews. We needed a guide that would allow capture of information for many individuals simultaneously. And of course, we needed to compile information into reports that could give us an overview of outbreaks. So what happened? In the middle of the first wave of COVID-19, how did we manage to get a solution in place so quickly in Asker, now looking in the rear mirror? Well, we had some luck. There was some planning and some preconditions. A cross-competence support team was in the beginning of March assembled to support crisis management in our municipality. The crisis management and of course also the chief medical officer had an urgent need to get hold of numbers about how many infected we have, how many are in quarantine, how many are tested and how many of the tests are positive. This was directed to the IT and rerouted to the cross-competence support team. We identified that the route course was the process of capture and organization of data. After pen and paper, we were using spreadsheets and spreadsheets are simply not good enough to be able to give good quality information about infected quarantines and testeds. We also have a strategy in Asker of using national common components for technical solutions so we quickly contacted the national authorities. We were also quite clear that we wanted to have a forward-leaning and pragmatic approach from the medical officers and the contact tracing team that we were willing to start with minimum requirements parallel with actually the first wave of infected persons in March. This is just to show you the timeline of how we were working. Actually already just about two weeks after the shutdown, we realized that we needed to have a better digital tool than what we did have if we were going to be able to manage the pandemic. So already at that time we contacted the national authorities and just in two weeks, actually 10 days, in the 38th of March, we were ready to try out the DHIS-2. We did this parallel with using the spreadsheets together with a couple of other municipalities. This testing of the system gave continuous feedback to DHIS-2 developers about what was necessary to change so that it actually could work in practice in the municipalities. So in the 4th of May the national platform was ready for testing and we decided to train our contact trackers by registering all the previous cases, which was a good way of working as our experience. And then it was put in production in the 3rd of June. So it was quite important that we started this work while the pandemic was still rising because when we were ready to test it, we needed to do it when the infection was lower so that we had the capacity and time to be able to test it. So the timing was also important. Managing digital solutions for contract tracing is of course in a municipal context. There are quite a lot of different participants with roles in different administrative levels and different individuals. There are many reporting lines and we realised there were quite a few who had experience in how the legal frameworks intertwined for sharing of data, for instance. When is there enough data for contact tracing? But maybe too much when it comes to an individual's privacy. Here strong democracy and openness as values is important. We realised that we had to work with separate government agencies, as I said, there were many administrative levels. We had to scale our staffing according to the infection load. We needed a tool which would help us with that. We needed to balance the privacy, as I was also saying. I just said that well, we need to know whether the wife and the lover and whoever it is is on, but we do need to balance it towards the privacy of people also who is able to read what we are registering. And in that instance, the GDPR privacy laws has been a challenge in being able to put this DHSI into more than a minimum version. So which kind of learning points has our municipality been able to have? Well, we have certainly seen an increased quality on contact tracing. Also, in case detection, we have better situation reporting to our crisis leadership. We have an active surveillance and response for COVID-19. We have a more secure technical platform with contact with national governance and framework. Our team shows us that there is a better efficiency and workflow much better support during case registration, which means that one can use people of different education levels and different professions to do the contact tracing and still keep the quality and statistics and the equal treatment for all cases. We track and visualize outbreaks and of course, shared work lists mean that we can have a lower vulnerability and more independence for individual contact tracers. The fact that more people needed access to the same picture of the situation was invaluable and especially also since the measures that are taken and restrictions which were given were adjusted on a daily basis according to where the pandemic was, how many people were infected. As I was saying, this is a minimum system, a minimum requirement that we were willing to start up with very quickly, but it's very important to get the full effect of a digital tool that further requirements and demands are met. The TISC strategy, which was talked about earlier on, means that there's a lot of people who have to be contact tracing continuously and also across borders, especially between municipalities. People living in Asker, they are quite often in other places as well and we need to be able to in a safe and secure way communicate with other municipalities. We think that a mandatory use of electronic contact tracing systems should be there. We would like a more streamlined and automatic reporting to government health agencies. We are still using too much time and reporting, time which we could use on contact tracing. And we need to prepare for being able to get automatic lab results, more efficient registration through self-registration of symptoms, being able to follow up clusters, especially when the clusters are across borders. And of course, as we all know, there are new challenges coming up with mass vaccination and new types of lab results, for example in spit sample logistics. But Asker is ready to implement necessary change again and we're looking forward to that. Thank you. Thank you so much, Mira, for your presentation. I've certainly learned a lot working with you on the small details and the complexities of doing contact tracing. So I hope everybody here on the session also learned something new today. I don't think there'll be time to answer any questions in this session, but please, I urge you all to look at the link in the chat here. There is a link to our community of practice where we have a separate thread for this session and everybody is welcome to engage there and ask the questions that you do have and we will answer and divert them to the right people and make sure you get your answers. Thank you very much and I wish you all a nice conference and thank you very much. Bye-bye.