Introduction

This report describes the impact of the COVID-19 pandemic on loneliness and social isolation among younger and older adults living in the Nordic countries. The social distancing regulations and lockdowns have had a deep impact on people’s social lives.
In March 2020, the World Health Organization declared the COVID-19 outbreak, which started in December 2019, to be a global health crisis. In the more than two years following this declaration, governments in the Nordic countries, as well as in the rest of the world, took a series of measures to slow down the spread of the virus and help hospitals, which had been pushed to the edge of their capacities by the surge of COVID patients.
Schools and public places closed, hospitals and nursing homes did not allow family and other visitors, social gatherings were heavily limited, and movement within and across borders was restricted. This had major consequences on people’s social lives, and many were disconnected from family, friends, and the wider society.

Aim of the report and research questions

The Nordic Council of Ministers is now interested in the social consequences of the COVID-19 pandemic, specifically with respect to the impact on loneliness and social isolation. They asked the Nordic Welfare Centre (NWC) to provide this knowledge. This report will do so by answering the following four questions:
  1. What was the impact of the pandemic on loneliness and social isolation among different groups living in the Nordic countries?
  2. Which groups were particularly susceptible to loneliness and social isolation during the COVID-19 measures?
  3. What were the (typical) mechanisms through which COVID-19 measures affected loneliness and social isolation in each group?
  4. Did the findings vary across the Nordic countries? How?
Our answers to these questions are based on a literature review of recent empirical studies on COVID-19 in the Nordic region, including Denmark, Finland, Iceland, Norway, and Sweden, and, if data is available, the Faroe Islands, Greenland, and Åland. Public databases such as Our World in Data provided information about the number of cases, deaths, intensive care unit (ICU) admissions, and excess mortality rates. Research papers on children, refugees, and immigrants were excluded as these groups are studied in more detail in other projects at the Nordic Welfare Centre.

Defining terms

To interpret the study results and to design interventions, we need a clear understanding of the key concepts of loneliness and social isolation, and how they differ from being alone. While the terms are sometimes used as synonyms, they are in fact rather different. Loneliness is a subjective feeling that is different from being alone. People can feel lonely in a crowd, and those who are alone are not always lonely. Social isolation, in turn, is an objective state of being alone as a consequence of regulations or other people’s behaviour that excludes people, or makes them exclude themselves from other people and society. In line with current scientific practice, we use the following definitions:
Loneliness is
"… a situation experienced by the individual as one where there is an unpleasant or inadmissible lack of quality of certain relationships. This includes situations in which the number of existing relationships (or quantity) is smaller than is considered desirable or admissible, as well as situations where the intimacy (or quality) one wishes for has not been realized (de Jong Gierveld, 1987, p. 120)."
Sometimes, a distinction is made between social and emotional loneliness as two qualitative distinct types of loneliness. Social loneliness occurs when the number of social relations is too small, whereas emotional loneliness refers to the lack of an attachment figure or an intimate relation such as a partner (Weiss, 1973). A third type of loneliness, existential loneliness, is increasingly being recognised as a type of loneliness associated with a general lack of meaning in life (van Tilburg, 2022).
Social isolation is an objective state of being alone marked by few or infrequent social contacts, which is the outcome of processes and regulations in the society in which people live that exclude people or force people to exclude themselves.
Being alone refers to the objective situation in which people have no contact with other people for a relatively short period of time. It is a necessary but not sufficient condition for social isolation. Being alone can be a positive situation if people want to be alone, in solitude (Cacioppo et al., 2010).

Developments in COVID cases in Nordic countries from January 2020 to April 2022

To contextualise this report, we will first provide a short overview of the COVID-19 statistics in the Nordic countries and highlight measures that may have affected the social functioning of people during the first 28 months of the pandemic (January 2020 to April 2022). For a more detailed overview of the developments of the pandemic, see State of the Nordic Region 2022.
The first cases of COVID-19 in the Nordic countries were detected in Finland and Sweden at the end of January 2020. The virus started to spread more visibly a month later when people took the virus with them on their return from winter holidays. On March 11, 2020, the World Health Organization (WHO) declared COVID-19 to be a pandemic. At this point more than 2500 cases were observed in the Nordic countries, mainly in Norway (912) and Denmark (755). The SARS-CoV-2 coronavirus that dominated during the first wave gradually mutated from Alpha, Beta, Gamma, and Delta into Omicron, which is currently the dominant variant (https://www.who.int/activities/tracking-SARS-CoV-2-variants). The virus grew more contagious, but the symptoms became less severe. Consequently, the number of daily cases rose exponentially in the period between October 2021 and April 2022, while the number of ICU admissions remained low.

Absolute and relative number of cases

Until April 2022, there were three waves or periods with steep increases in the number of cases in the Nordic countries. The first wave was from March to July 2020, the second from November 2020 until roughly June 2021, and the third from late October 2021 until April 2022. On April 25, 2022, the cumulative number of cases in the Nordic countries since the start of the pandemic was 8,228,503, of which 31,417 (0.38 per cent) died due to COVID-19.
Denmark and Sweden were the two Nordic countries with the highest absolute number of cases (> 3 million and 2.5 million cases, respectively), followed by Norway (1.4 million), Finland (1.0 million), Iceland (185,000), Faroe Islands (34,000) , Greenland (12,000), and Åland (9,508). However, the Faroe Islands, Iceland, and Denmark had the highest proportion of people infected in the whole population (64 per cent, 50 per cent, and 50 per cent, respectively). (Data comes from Our World in Data and WHO for all countries, except for Faroe Islands (data derived from korona.fo, and updated until 22/2/2022) and Åland (data derived from Reuters, updated until July 2022).)

Number of deaths

The cumulative number of COVID-19 deaths per million people until April 25, 2022 was highest in Sweden (1,785) and Denmark (1,046) and lowest in Greenland (373), Iceland (321), and Åland (no reported deaths). Note that the number of cases or deaths only gives an impression of the magnitude of the problem within the countries. It cannot be used to compare countries (Fitzpatrick, 2021), as cases and the number of deaths depend, among others, on demographic factors such as age distribution and population density, number of tests per person, registration practice, and ethnicity, which tend to be rather diverse in the different Nordic countries.

Admissions to intensive care and excess mortality rate

A better way of making between-country comparisons is to compare the number of ICU admissions and the excess mortality rate, which give an impression of the severity of the disease. According to Our World in Data, the COVID-19 disease was most severe in Sweden and Denmark with 50 and 25 admissions, respectively, per million during the first wave and 40 and 22, respectively, during the second wave. Information was not available from Norway. In Iceland, the severity was especially high during the third wave.
The excess mortality rate is the number of deaths during a crisis above and beyond what is expected under normal conditions (Fitzpatrick, 2021). All Nordic countries except Greenland and the Faroe Islands had an excess mortality of +3 per cent to +5 per cent, indicating more deaths than normal. At the beginning of the pandemic, Sweden had the highest excess mortality rate (+10 per cent), but the rate went down as the pandemic progressed. The negative percentages observed in Greenland and the Faroe Islands (fewer deaths than normal) may be a consequence of the small number of inhabitants, leading to more uncertain estimations. This finding should therefore be interpreted with caution.

COVID-19 measures

In response to the COVID-19 pandemic, all Nordic governments took measures to curb the transmission of the virus, albeit in different intensity and with different timing. The most impactful responses both for individuals and societies were the worldwide development of vaccines, introduction of vaccination programmes, social distancing, and lockdowns. Sweden differed from the other Nordic countries by later introduction of lockdowns. This may explain why the number of cases in Sweden rose quite quicky and why, among the Nordic countries, the disease was the most severe in Sweden. Regulations which had the strongest social consequences were without doubt the social distancing measures such as the closing of hospitals and care homes for visitors; closing schools, restaurants, cafes, and other public places; remote working; and the self-isolation of older adults (in Sweden, for people aged 70+); quarantine for people with symptoms; and travel restrictions both between and within countries.

After(?) the pandemic

After April 2022, most of the measures were lifted in all Nordic countries, as the number of new cases was low and the symptoms were on average mild. Currently (September 2022), the 7-day average of cases lies between 0 (Faroe Islands and Greenland) and 800 in most other Nordic countries, which is lower than in August 2022. But we have already seen that the situation can change rapidly, and it is unlikely that the pandemic is over. On July 19, 2022, the WHO warned of ‘rapidly escalating COVID-19 cases’ in the whole European region in the autumn and winter of 2022. Lessons learned from the first two years of the pandemic may nevertheless inform future interventions to lower the impact on the social lives of citizens in the Nordic countries.
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