COVID-19 in Iceland: Hospital Staffing Main Challenge in Current Wave Skip to content
Iceland National Hospital COVID-19
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COVID-19 in Iceland: Hospital Staffing Main Challenge in Current Wave

Social restrictions have prevented Iceland’s current wave of COVID-19 infection from growing exponentially, but it continues to show linear growth, the country’s Chief Epidemiologist Þórólfur Guðnason stated in a briefing in Reykjavík this morning. Authorities’ main concern is the healthcare system’s capacity, which is at its limits, particularly when it comes to staffing. Þórólfur stated that if National University Hospital administration informs him that the hospital is being overwhelmed, it will be necessary to tighten domestic restrictions.

Despite high case numbers, data clearly showed that vaccinations were preventing infection, serious illness, and hospitalisation due to COVID-19 in Iceland, Þórólfur stated. Unvaccinated people were three times more likely to contract COVID-19, four times more likely to be hospitalised, and five times more likely to require intensive care in this wave, Þórólfur stated.

The Chief Epidemiologist encouraged all those who have not yet been vaccinated to do so next week. Laugardalshöll in Reykjavík will host drop-in vaccination days from Monday to Thursday between 10:00 AM and 3:00 PM. Those who have received a single dose of the Pfizer or Janssen COVID-19 vaccines are also welcome to receive a second shot of Pfizer during these times.

The following is a lightly-edited transcription of Iceland Review’s live-tweeting of today’s briefing.

 

On the panel: Chief Epidemiologist Þórólfur Guðnason, Director of Civil Protection Víðir Reynisson, and Director of the National University Hospital Páll Matthíasson.

Last Tuesday, Iceland’s authorities announced that current COVID-19 restrictions, including a 200-person gathering limit and mask use, would be extended for an additional two weeks, until August 27. Government representatives are meeting with school administrators today to discuss the implementation of these restrictions in schools, which welcome students back next week.

Yesterday’s numbers have been updated on covid.is. Iceland reported 119 domestic cases (39 in quarantine) and 1 border case. Total active cases: 1,302. 27 are in hospital. Note: authorities have been updating daily case numbers twice as PCR test samples are processed. That in mind, according to current figures, active cases and hospitalisations dropped between August 10 and 11.

Health authorities have announced that all residents who are still unvaccinated are welcome to drop in to Laugardalshöll in Reykjavík next week between Monday and Thursday between 10:00 AM and 3:00 PM to receive their first shot, as well as those who have only received one shot of Pfizer or the single-dose Janssen vaccine.

The briefing has begun. Viðir begins by going over the rules governing who is put into quarantine when an individual has tested positive for COVID-19. The main rule is that people who have had contact with an infected individual the day before they showed symptoms need to go into quarantine. Víðir asks workplaces to keep this in mind when they are organising office space. Close contact means meetings, coffee breaks together, and other work interactions, so we encourage companies to organise their staff interactions so that they can minimise quarantine, Víðir says.

Þórólfur takes over. He states that 4-5 variants have accounted for most cases in this current wave. Those variants can be traced to Icelanders’ trips abroad as well as nightlife in downtown Reykjavík. The current wave in Iceland is largely carried by the Delta variant. The current restrictions, implemented on July 24, have ensured that the pandemic is not growing exponentially but we’re still not seeing signs of it waning. The wave is still exhibiting linear growth.

Þórólfur discusses vaccination: It’s normal to wonder about the success of vaccinations and if we’re doing enough to curb the spread of the pandemic. The data clearly shows that contracting, spreading, and falling ill from the virus is much less likely when vaccinated. This data should serve as an encouragement to everyone to get vaccinated or complete their vaccinations if they have not done so, Þórólfur says.

How are we curbing the spread of the virus? There are social restrictions in place as well as border measures, and booster vaccinations are being offered to people with underlying illnesses and other vulnerable individuals. Þórólfur: The current wave is nevertheless straining the hospital and as soon as hospital administration makes it known that they are in danger of being overwhelmed, we will implement further restrictions that we have used in the past and which have proven effective.

Þórólfur: When covid will end is hard to say, but I believe it is likely it will be with us for at least the next months if not year. Þórólfur says he has turned in recommendations and ideas for long-term infection prevention measures to the Ministry of Health. This is not a fun situation but we’re going to have to keep doing our part, minding our personal infection preventions, washing our hands and keeping our social distance, Þórólfur says.

Páll Matthíasson takes over to discuss the situation in the National University Hospital. There are 27 currently in hospital due to COVID-19. Four out of the five ICU patients are on ventilators. The average age of those who are hospitalised is 64 and the average age of those who have been discharged is 50. This is older than the average age of active cases in the current wave.

Doctors monitor all COVID patients, constantly reassessing their condition and evaluating when they need further medical care. The result of this close monitoring is that in Iceland, fewer people have required hospitalisation, somewhat preventing strain on the hospital. When infection rates are high, it can take longer to discover infections, meaning people are in a worse state when they come under the care of doctors, making hospitalisations more likely. Thus Páll encourages people with any symptoms to get tested.

He discusses patient flow within the hospital. COVID patients require more staff and infection prevention measures in general as well. According to hospital administration, the weakest link in staffing is the ICU, which requires highly-trained staff. Páll: “It’s self-evident that when the hospital is under strain, less urgent operations take a back seat.” We’re worried that people will need to wait too long for these operations, says Páll.

Additionally, society is operating at normal speed during this wave of infections (unlike previous waves), meaning rates of injury are illness in general are higher compared to during previous waves. Hospital staff has been called in from summer vacations, which they desperately needed. The hospital is working with other healthcare institutions to stave off reaching its operational limits. But as mentioned earlier, at the moment, the weakest link is ensuring enough staff for the ICU. Páll thanks hospital staff for their incredible contributions and perseverance.

The panel opens for questions. When asked about reports of long lines and crowing at Keflavík Airport, Víðir responds that there is a group working on solutions, trying to streamline processes, ensure safety, and improve flow through the building. Þórólfur agrees with Víðir that it’s not good that large crowds are forming at the airport and we need to make sure we’re taking the utmost care at the border. However, it is not easy to do considering the limits of the facilities and staff.

Þórólfur is asked about reported changes to menstrual cycles following vaccination, which are being researched in Iceland, and if there’s a risk of such side effects in adolescents as children’s vaccinations are now imminent. He replies that there has been no evidence of such side effects but authorities will continue to monitor the situation.

Þórólfur is asked about vaccine efficacy among the different vaccines. While most vaccinated individuals infected in this wave received the Janssen (J&J) vaccine, he notes that the data can’t be trusted entirely. Most of the vaccinated people getting infected in this wave are young people: they are more out and about in society than older demographics and they simply happen to be the demographic that was mostly offered the Janssen vaccine. However, those who have received the Janssen vaccine are being offered a booster shot of Pfizer or Moderna to boost their immunity. Þórólfur does not consider a booster shot to be necessary for those who received the AstraZeneca vaccine.

Páll is asked about his comments that the hospital is currently managing the load but it won’t work under this strain in the long term. He states that short-term solutions won’t work in the long term, they’re simply buying time when it comes to staffing and patient flow. He can’t say how long they can operate under these conditions but their main goal is to ensure the health and safety of everyone who needs medical care. The hospital’s main concern at the moment is ensuring adequate staffing, Páll reiterates.

Þórólfur is asked about school operations in light of the current restrictions, including quarantine and isolation. Authorities are working with schools to find solutions, says Þórólfur, and mentions that schools have been operating in this pandemic for a while so they know how they can and should proceed. No “shortcuts” will be given when it comes to quarantine and isolation for school staff or students: experience has shown us that this is our number one tool in keeping the pandemic at bay, says Þórólfur.

Þórólfur is asked if it was a mistake for Iceland to use the AstraZeneca and Janssen vaccines, which other Scandinavian countries rejected. He states that all the vaccines have comparable efficacy, his only concern is for those who only received the one-dose Janssen vaccine. Páll is asked about the measures the hospital is taking to make sure the healthcare system doesn’t get overwhelmed. He replies that they’re using their facilities to the best they can and reorganising their buildings to ensure patient flow and infection prevention. Still, their Achilles heel is staffing.

Páll is asked about patient flow, often mentioned as a source of strain on the hospital, where older patients can’t be discharged as they have no adequate care options outside of hospital. This is a long-term societal problem as our population ages, Páll says. There is will within the government to work on this problem, but it will require substantial funding and creative solutions.

Víðir closes the briefing by reaffirming authorities’ goals in fighting the pandemic: protecting the healthcare system, protecting vulnerable groups, minimising risk of infections crossing the border, and lowering domestic infection rates. The briefing has ended.

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