The New Yorker June 8 & 15, 2020 pp25-30 LETTER FROM REYKJAVIK “INDEPENDENT PEOPLE” “How Iceland managed to beat the curve” By Elizabeth Kolbert
Interesting letter from Reykjavik by Elizabeth Kolbert. Kolbert met with key leaders of the Icelandic successful campaign to contain COVID-19.
Why has Iceland been so effective in stopping COVID-19?
For starters, Iceland has some strategic, social and experiential advantages that prepared them to fight COVID-19. The island country is geographically isolated and is inhabited by only 365,000 residents that share a common ancestry.
Icelanders trace their roots almost exclusively to migration from Norway and the British Isles during the ninth century.
Iceland, with such a well-defined demographic, leveraged this unique advantage by establishing the deCODE database. deCODE consists of genetic data derived from about one-half of their population. This enables the ability to locate relatives and to study the impact of genetics on disease.
Iceland has few ports of entry-closing the border is easy.
Because Iceland is challenged often with catastrophes like avalanches, earthquakes, eruptions etc. they already have a crises-management mindset. Government is trusted and residents cooperate by doing their part.
Tactically, public health (PH) leaders acutely monitored news of COVID-19 in China. There heard about bodies in the streets etc., assumed they would not be spared of the coronavirus and so rapidly began coordinated planning for another catastrophe.
Even before the first case of the coronavirus, the nation’s political leaders understood that this was a medical science problem and that it should be led entirely by PH. PH developed a highly detailed and rigorous plan of action.
They recognized immediately that current supplies and the replenishment rate of PPE would be insufficient for maintaining safe working conditions for healthcare workers as the pandemic took hold. Procurement kicked in.
To give an example of the detailed procedures, Kolbert, was allowed to enter Iceland under a “modified quarantine for journalists"-the instructions consisted of four single-spaced pages of specific guidance including provisions on how to use…or not use…public restrooms”.
Testing was mandatory for people having signs and symptoms of COVID-19. If testing was positive for the coronavirus detailed contact tracing was accomplished immediately. A 14-Day quarantine was imposed on all COVID-19 positive patients and their contacts. Contacts varied from few to 200. PH officials went to great extremes to identify contacts. If the index case had been to a reception they used all their resources to contact all attendees and then required them to get tested and quarantine. The number of staff performing the tracing and contact work increased to more than 50 at the peak. When needed, the deCode database helped track relatives of the index cases and was effective in identifying additional asymptomatic cases. Those cases and their contacts were subjected to testing and mandatory quarantine as well. In all more that 15% of the population has been tested.
Besides testing for the presence or absence of COVID-19, PH went further by evaluating the RNA nucleotide sequence from all positive cases. Viruses mutate frequently and usually without impact on viral function, infectivity or pathology. These otherwise “silent changes” help PH develop tactics for fighting coronavirus by tracing the virus’ movement from people, place, and through time.
Besides testing and tracing, patients were contacted by phone; infected individuals were called daily if symptomatic and several times a week if without symptoms. The healthcare calls ask detailed questions regarding symptoms-getting better, getting worse and provided prescriptive guidance-no need for hospital or hospital is needed etc. The approach reduced confusion, helped comfort patients, reduced hospitalizations and death. In all the Icelandic mortality rate is only 0.56%-one of the lowest worldwide (See Figure Below).
Interestingly, Iceland’s successful approach did not call for public masking-useful they feel for symptomatic individuals-but they should not be about and they only imposed a ban on gatherings at the height of their outbreak.
Lastly, daily nationwide conferences with PH experts were broadcasted (See Below). The conferences dispensed factual, apolitical information. The PH leaders were frank in acknowledging they didn’t know all about the virus or exactly what would happen next.
(Source icelandreview.com) Press Conference with the leaders but the "Holy Trinity" Director of Emergency Management (Vior Reynisson), Chief Epidemiologist (Porolfur Gudnason) and Director of Health (Alma Moller).
The data. (NUHI National University Hospital of Iceland). Note Iceland has universal healthcare 85% paid by taxes and 15% by service fees (Source Wikipedia).
As of June, along with other European nations, Iceland is beginning to develop plans for loosening travel restrictions. This may start in mid-June “under which” foreigners have three options; be certified as COVID-19 negative from recent testing, be screened in Iceland with COVID-19 RNA testing, or being under 14 day quarantine.