Evidence-based advice processes for long-term care facilities in the COVID-19 pandemic : report from the after-action review (AAR) in Norway during the emergence of the Omicron variant of concern of SARS-CoV-2

This focused After-Action Review (AAR) investigates the use of evidence in the Norwegian advice-making process for long-term care facilities (LTCFs) during the emergence of the Omicron variant of concern (VOC) between November 2021 and April 2022. The Omicron variant wave initially led to a renewed sense of scientific uncertainty and general anxiety in Norway. However, as new evidence emerged suggesting that the new variant was not only highly transmissible but also caused less severe clinical disease, these concerns were replaced with more lenient recommendations for the LTCFs and society in general. The purpose of this AAR is to shed light on the advicemaking process underlying these decisions. How was evidence used to inform advice for LTCFs during the initial Omicron period? The focused AAR's core methodology is a process-driven learning exercise that builds on a qualitative review of a delimitated situation, in this case the advice-making process for LTCFs during the emergence of Omicron VOC. The case study approach allows for in-depth explorations of how key advice is produced across relevant organisations as well as how it changes over time considering new evidence. This involves identifying and making explicit any external pressures, informal practices, and networks (both within and across agencies) that affect the advicemaking process. Data gathering consisted of a two-day consultation with key stakeholders (identified by the Norwegian Institute of Public Health (NIPH)) together with semi-structured interviews. The advice-making process in Norway was influenced by international evidence (primarily from Denmark and Public Health Scotland), experience-based evidence from the doctors and leaders of the LTCFs, and, most importantly, the availability of daily epidemiological data across all Norwegian municipalities. NIPH and the Norwegian Directorate of Health (NDH) were also able to draw on many other types of relevant evidence and practices, allowing them to make the necessary evidence-informed changes to their advice: international evidence, peer-reviewed evidence, multidisciplinary practices, communication inputs upstream and experience-based evidence from LTCFs and the municipal authorities. The staff from the health agencies would have liked to include more strongly the voice of the LTCF residents and family members and behavioural science in the advice-making process.