COVID-19 in Iceland: “We’re nearing the limits of our infrastructure”

Emergency room

A heavy mood characterised the COVID-19 briefing held by Icelandic authorities in Reykjavík today. Director of Civil Protection Víðir Reynisson stated the growing number of infections is pushing infrastructure close to its limit. According to Deputy Chief Epidemiologist Kamilla S. Jósefsdóttir, if the rate of infection continues to grow, contact tracing will become impossible, which will only further boost the spread of infection and increase the likelihood that the COVID-19 ward will have to turn away patients in need.

Iceland has two tasks on its hands: to plan how it will deal with the pandemic in the long term and to curb the current wave of infection, Director of the National University Hospital Páll Matthíasson stated at the briefing. All three panel members agreed on the need for continued solidarity, stating that a collapse of the healthcare system would have not only short-term but also long-term effects on Icelandic society.

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

 

On the panel: Deputy Chief Epidemiologist Kamilla S. Jósefsdóttir and Director of Civil Protection Víðir Reynisson. Director of the National University Hospital Páll Matthíasson will also be present at the briefing to discuss the situation at the hospital in light of the rise in COVID-19 cases and hospitalisations.

Iceland is now labelled red in the weekly COVID-19 travel map issued by the ECDC today. This affects travel and quarantine regulations in many European countries for those arriving from Iceland.

Yesterday’s numbers have been updated on covid.is. Iceland reported 151 new domestic cases (68 in quarantine) and 3 at the border. Total active cases: 1,388. 18 are in hospital. Fully vaccinated: 68.85% of population. 55 of yesterday’s 151 domestic cases of COVID-19 were among unvaccinated people, the highest number since the current wave began in mid-July.

The briefing has begun. It may be noted that Víðir has pride flags on his podium: Reykjavík’s Pride festival began yesterday. Kamilla goes over the numbers. 154 new cases yesterday and 1,391 active cases, more than reported on covid.is.

She goes over the booster shot vaccinations that will be offered in the coming weeks to school workers and those who received the Janssen vaccine. Vaccinations for 12-15 years old are being prepared. Those who want to get vaccinated but have previously contracted COVID-19, it is important to wait for a significant period before receiving vaccination because it will not be considered valid. Those who were previously vaccinated and have since contracted COVID-19 will not receive a booster shot: the infection has a similar effect of a booster shot.

Páll takes over to discuss the situation at the hospital. 3 people are in the ICU, none on ventilators at the moment. A significant number of people are at risk of needing hospitalisation due to COVID-19 at the moment.

Páll: What does that mean for the hospital? It is a challenge to make space for COVID-19 patients and requires moving other patients. There are many reasons this is challenging for the hospital. We are usually at 95-105% capacity in emergency wards so it is difficult when additional strain is added. There are also dozens of people on waiting lists for these beds already, as has been the case in previous waves.

New beds have been opened at a facility on Slétturvegur which has helped created more room and flexibility. We have a staffing shortage and our staff is burnt out. We encouraged staff to take vacation before this wave began and many are still on vacation.

Previous experience and data tell us that this wave has not reached its peak yet, says Páll. There have been no optional surgeries due to summer vacations at the hospital and they may be delayed further if necessary. We have asked some staff to return from summer vacation if possible, as difficult as that is, since the absolutely deserve a vacation, Páll says.

All of these are big challenges but we know how we can tackle them. We have good collaborations with other healthcare institutions and must ensure that patients can be transferred or discharged as quickly as possible. We must also practice triage from the beginning and ensure no one is hospitalised unless they absolutely need to be.

But all of that is not enough. We need to consider, and society needs to consider how to curb this wave of infection in other ways. “This and other pandemics are here to stay,” Páll says. “We must strengthen the healthcare system so that it is not always on the brink of collapse.” We are all in the same boat in this society. It’s a pretty good boat despite everything, but we must work together to ensure success, Páll says.

The panel opens for questions. “Are you seeing large group infections or are the recent infections emerging in smaller groups?” Víðir says both are happening. There are very few people that don’t infect anyone else, infections tend to happen in groups or clusters.

“Did any patients admitted to hospital recently go straight to ICU? Are there any factors that patients that have required hospitalisation have in common?” Páll says that the reason for hospitalisation is always COVID-19, though there are underlying illnesses that can play a part.

“The Pfizer vaccine was approved for 12- to 15-year-olds months ago in Europe and it will take them weeks to develop immunity, isn’t it very late to be vaccinating them?” Kamilla says that at the same time it was approved, there were reports of side effects that authorities wanted to research better, particularly among younger demographics. Now we know that most of these side effects are mild and at the same time COVID-19 has returned in full force so it makes sense to vaccinate 12- to 15-year-olds now.

“What are the effects of the restrictions that were imposed just under two weeks ago?” Víðir says the wave is continuing its upward trajectory and we haven’t thus seen any effect from those restrictions. Kamilla says that we have rarely been at testing capacity for quite so long. Some samples are being pushed to the next day to be processed. That is a cause for concern.

“There are two residents of the nursing home Grund that have now been released from isolation and had very mild or no symptoms. Is it possible to draw any conclusions from this?” Kamilla says that is very positive but there is not enough data to make general conclusions.

“You’ve stated that vaccination hasn’t achieved herd immunity as well as hoped. Is there any other way to create herd immunity other than for more people to contract COVID-19?”

Kamilla says it will depend on vaccine manufacturers developing vaccines that are more effective against the Delta variant and other variants that may be of concern. Pfizer has begun tweaking their vaccine to be more effective against the Delta variant.

Asked about sending vaccines to other countries in need, Kamilla says we must consider that if we have tools in our hands to protect others then we must use them. However authorities will continue to prioritise the Icelandic nation and infrastructure in Iceland.

Regarding the borders, Víðir says it’s clear our first line of protection is ensuring the virus doesn’t cross the borders and we are considering all ways to protect the nation at the borders.

“How serious can the situation become at the hospital if this wave continues to grow?” Páll says it is important that staff are able to go on vacation to avoid burnout. But it is clear that more staff is needed right now. That is why the difficult decision was made to call some staff in from vacation. “We are concerned about how the wave will develop in the next days and weeks,” Páll says.

“We know that to curb the wave we need domestic restrictions, but the government has not imposed any yet. Are we just hoping for the best?” Kamilla: If infection rates keep increase, then it’s clear that the infrastructure we have will fail to provide the best care to those who need it. Contact tracing will become impossible. If that happens, then infection rates will continue to increase because people who should be in quarantine will not be placed in quarantine. Kamilla: If things continue to develop in that direction then it is possible that the hospital will reach capacity and will not be able to admit patients who need intensive care.

Páll: We really have two different projects here. We have to plan how we will react to this pandemic in the long term. But we must curb this current wave right now.

Víðir takes over and agrees with Kamilla and Páll. It is also important to consider the long-term effects of measures. However, if our infrastructure collapses that can have a massive long-term effect on our society as well. And we are considering all of this.

In conclusion, we are waiting for the work that has been done in the past weeks to be completed and to see the long-term plan that is forming come to light. Not taking action is not an option at this point, says Víðir. We must continue our fight, there’s no other option. The virus is the enemy. There’s nothing else we can do than stand together. That’s the only way forward. The briefing has ended.

Two Domestic Infections Outside Quarantine Yesterday

COVID-19 test tubes

Two COVID-19 infections were diagnosed within Iceland yesterday, both outside of quarantine at the time of diagnosis, according to a press release from Iceland’s Civil Protection and Emergency Management Department. Both of the infected individuals were vaccinated. One attended Reykjavík’s Bankastræti Club last weekend, and club management encourages any attendees experiencing symptoms to get tested.

According to Hjördís Guðmundsdóttir, director of communications for the Civil Protection Department, a number of people have been placed in quarantine in connection with the two infections. Contact tracing is still ongoing and is expected to take a few days.

Hjördís encouraged the public to download the Icelandic government’s official contact tracing app, Rakning C-19. “The app can help the contact tracing team to track infections and it can be said that it plays a key role now as there are no social restrictions in place in Iceland,” Hjördís wrote. “Let’s continue to be careful and get tested if we notice symptoms, both vaccinated individuals and unvaccinated.”

Vaccination is widespread in Iceland: 92% of women and 88% of men aged 16 and over in Iceland have received one or both shots of COVID-19 vaccine. Of the total population, 64.8% is fully vaccinated while 71.6% have received one or both shots.

Iceland’s Chief Epidemiologist Þórólfur Guðnason told RÚV the two infections are not connected to each other or to any cases recently diagnosed at the border.

COVID-19 in Iceland: Weekend Partygoers Reminded to Show Caution

bar

Make sure you register your attendance at restaurants and download the updated contact tracing app Rakning C-19: these were the two directions that Director of Civil Protection Víðir Reynisson had for the Icelandic public at today’s COVID-19 briefing in Reykjavík. Víðir stated that he understood people’s desire to let loose particularly in light of lifted restrictions this week, but a group infection in Reykjavík proves the virus is still out there and caution remains necessary.

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

 

On the panel: Director of Civil Protection Víðir Reynisson and Chief Epidemiologist Þórólfur Guðnason.

Yesterday’s COVID-19 numbers are in on covid.is.
New domestic cases: 3
New border cases: 3
Total active cases: 39
Hospitalised: 0
Vaccinated w/ at least one dose: 169,570 (45.8% of population)
Fully vaccinated: 80,464 (21.8% of population)

The briefing has begun. Víðir begins by discussing the cases being diagnosed out of quarantine within Iceland. He underlines the importance of maintaining personal preventative measures despite regulations being loosened this week. He encourages people to take care when registering their presence at restaurants and bars as it helps with contact tracing if it becomes necessary. He also encourages the public to update to the latest version of the official contact tracing app.

Þórólfur takes over to discuss the numbers. There were three infections diagnosed yesterday, two in quarantine at the time of diagnosis. For the past week, nine people have tested positive, four out of quarantine. They are connected to the group infection at the downtown location of H&M. Around 100 people are in quarantine and Þórólfur expects more infections to arise from that group. The infections are of the UK variant of the virus. Border cases have fluctuated over the past week but there is not much increase. One person is currently hospitalised due to COVID-19, none in the ICU. In the past week, one person died after a month in hospital due to COVID-19. That brings the total number of Iceland’s COVID-19 fatalities to 30.

A recent wave of infection in the Faroe Islands has led Icelandic authorities to remove the Faroe Islands from the list of low-risk regions. Restrictions were relaxed considerably in the past week and Þórólfur has noticed some unrest and worry among the public. Þórólfur says that authorities believe that if people continue to mind their personal infection prevention, we should be fine and should be able to tackle the group infections that will occur. Vaccinations are going well though fewer were vaccinated this week due to smaller shipments. They should increase again next week, says Þórólfur.

Þórólfur mentions the AstraZeneca vaccine, stating that while it is safe to get one dose each from two different vaccines, cases of serious side effects are rarer after the second shot of one vaccine. People are generally encouraged to get the same vaccine for their second shot. The vaccines we are using now protect against the Indian variant, which appears to be more infectious than previous variants of the virus. (The Indian variant has been diagnosed at the border but has not spread domestically in Iceland.)

The panel opens for questions. Þórólfur is asked about herd immunity and replies that percentages of vaccinated individuals to reach herd immunity varies for each virus but we won’t have contained the virus until global vaccinations have reached a certain point. As for other contagious diseases, such as measles, Iceland has had luck with keeping them at bay with general vaccinations and Þórólfur doesn’t think that COVID-19 will be any different.

The government has announced that mandatory stays in government-run quarantine facilities for those arriving from high-risk areas will end next month. People will still have to prove that they have adequate access to housing that fulfills quarantine requirements. Víðir notes that while mandatory stays in quarantine facilities will end, the facilities will remain open for people who don’t have access to adequate quarantine facilities at home or where they are staying in Iceland. He mentions migrant workers specifically. If people break quarantine, they will also be required to quarantine in the government’s quarantine facilities.

Þórólfur is asked about Janssen and the AstraZeneca vaccine and states that few countries have stopped using these vaccines altogether but most are using them with restrictions. That is also what the Icelandic healthcare system is doing, in order to take the utmost care. Þórólfur is asked about young women who received the first dose of the AstraZeneca vaccine before authorities stopped using it for their demographic. Þórólfur replies that people need to make their own decision, they can get a second dose of AZ or another vaccine.

When asked about vaccination certificates for those who have received doses of two different vaccines, Víðir answers that at first, such certificates weren’t being issued due to a glitch but it has now been fixed. Everyone should now be able to get a certificate. Þórólfur adds that such certificates will be accepted among travellers arriving in Iceland and he can see no reason why other countries should reject such certificates, as many nations are using two different vaccines to vaccinate people.

Asked about vaccine side effect research in Norway, Þórólfur states that they are monitoring all such research and will proceed based on the results of investigations. Any time a large mass of people receives vaccines, it is likely that some of them will develop symptoms that could be unrelated to the vaccines. Statistically speaking, there have been no spikes in health issues overall.

Víðir states that there’s no suspicion that the current group infection can be traced to quarantine violations.

Víðir closes the briefing by warning partygoers and people who are planning to enjoy themselves this weekend to be careful, remember to register at bars and restaurants, and have the latest version of the contact tracing app. The briefing has ended.

COVID-19 in Iceland: Updated Tracing App Unveiled

rakning c-19 app

Locals in Iceland should expect some level of social restrictions until 60-70% of the population is vaccinated, Iceland’s Chief Epidemiologist Þórólfur Guðnason stated at a briefing in Reykjavík this morning. Though nearly 40% of Icelanders have received at least one dose and over 16% are fully vaccinated, those figures are far from what is necessary to achieve herd immunity, Þórólfur reminded.

Continued diagnosis of domestic cases means the SARS-CoV-2 virus is still out in the community and we must proceed carefully, the Chief Epidemiologist underlined. The Indian variant of the virus has been detected in two individuals in Iceland who are currently in government isolation facilities.

Director of Health Alma Möller discussed the update to the government’s official tracing app Rakning C-19. Unlike the previous version of the app, which used GPS, this new update uses Bluetooth technology, allowing authorities to notify people if they’ve been in the vicinity of an infected individual without compromising privacy. Current users of the app will need to update to the latest version.

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

 

On the panel: Chief Epidemiologist Þórólfur Guðnason, Director of Health Alma Möller, and Director of the Civil Protection Department Víðir Reynisson.

Yesterday’s numbers have been updated on covid.is. Iceland reported 3 new domestic cases (2 in quarantine) and 1 at the border. Total active cases have dropped to 75; 3 are in hospital. Iceland’s latest COVID-19 vaccination data: 16.89% of the population are fully vaccinated. 39.28% have received at least one dose.

The briefing has started. Víðir begins by addressing the alert phase due to wildfires in the southwest quadrant of the country. He asks the public to do their part in preventing fire. Even a small spark can cause a large wildfire in these dry conditions. Víðir says that the emergency phase due to COVID-19 will be lowered to an alert phase today. He says solidarity has helped us prevent a large group infection.

Þórólfur goes over the number. One individual who tested positive yesterday domestically arrived in the country recently. There’s a possibility their infection was undetected by border tests. There are fewer infections being diagnosed at the border, perhaps because current border measures might discourage people liable to be infected from travel, speculates Þórólfur. Two people have tested positive for the Indian variant of the virus. They’re in isolation in government facilities. Two patients are in hospital due to COVID-19. One of them in the ICU but not on a ventilator. We’re still finding new cases domestically so the virus is still out there as we’ve repeatedly stated.

There’s an increase in tourism in the coming weeks and that presents a great challenge to ensure proper infection prevention at the border. This challenge will last throughout June or July, until we expect vaccinations to be widespread enough that we don’t have to fear if infections cross the border. We’re not at that point currently, Þórólfur states. We need to stick to our proven methods, which include lifting restrictions slowly. Þórólfur notes that restrictions were last eased at the beginning of this week.

Alma takes over to discuss the latest update to the official government COVID-19 tracing app. She adds that the app will have increasing importance in the coming weeks as we start to relax restrictions further. Unlike the previous version of the app, which used GPS, this new update uses Bluetooth technology, allowing authorities to notify people if they’ve been in the vicinity of an infected individual without compromising privacy. Data will not be stored in clouds and will only be stored for 14 days.

The app is available in English, Icelandic, and Polish. Those who have the original version of the app installed on their phones will need to update it. The app will notify you if you’ve been in close contact with an infected individual and will guide you on the proper steps to take if that happens. This will not replace the COVID-19 tracing team but is an addition to the current system, says Alma. The app was created for the government but an independent investigation was conducted to ensure its privacy and appropriate handling of personal data. Alma particularly encourages young people who are out and about to update the app.

The panel opens for questions. Q: More young people are now being called in for vaccinations, has randomised vaccination begun? A from Þórólfur: No, but the last priority groups aren’t called in based on age but rather risk factors. Also, many young people work in healthcare for ex. nursing homes. Þórólfur believes that once 60-70% herd immunity is reached, hopefully in June/July, we might still experience group infections but not epidemics that carry the risk of overpowering the healthcare system.

The second AstraZeneca shots will likely be administered 2 months after the first one, not 3. That depends on vaccine stocks, says Þórólfur. Þóróflur is asked about the Indian variant of the virus. He states that it is being detected in several countries and as such it is normal that we have detected it here. We don’t know much about the Indian variant, says Þórólfur, for example whether it is more contagious than others or resistant to vaccinations. When asked why there aren’t more vaccinations scheduled this week, Þórólfur replies that it’s because we don’t have more vaccine. “We always use all the vaccine that we receive each week.”

Some vaccine distribution schedules aren’t yet available and others change regularly, Þórólfur adds. Þórólfur is asked about the Sputnik V vaccine, now being evaluated by the European Medicines Agency. He states that Iceland will base its decision on the EMA’s but that he’s seen promising research on the vaccine. Víðir closes the briefing on an optimistic note, praising the nation’s solidarity. The briefing has ended.

Group Infection Traced to Downtown Bar

At a bar in Reykjavík Iceland, drinking beer.

Authorities have traced the source of one of two group infections currently active in Iceland, Vísir reports. Six or seven people recently infected with COVID-19 were found to have visited the same bar in downtown Reykjavík on the same day in July.

The bar has not been identified but is said to have some ‘contact surfaces’ within it. The individuals who became infected there are all relatively young. They were not there at the same time, but rather visited in a few small groups.

Authorities were quick to respond to the infection, including placing those who had come into close contact with the infected individuals under quarantine. Nevertheless, 17 people were diagnosed with domestic infections on Friday and there is now one person on a ventilator in intensive care. Chief Epidemiologist Þórólfur Guðnason has remarked that it’s likely that more stringent social distancing measures will be put in place once more in order to combat the spread of the virus.

University Students Assist Contact Tracing Team

Háskóli Íslands University of Iceland

One hundred health sciences students at the University of Iceland are assisting the Department of Civil Defense’s contact tracing team, RÚV reports.

Auður Kristjánsdóttir, a Master’s student in the physiotherapy department, is one of the students participating in contact tracing efforts. “We are just calling people and finding out if they’re aware that they should be in quarantine and checking on how they’re feeling, whether they are symptomatic and then [if so] directing them to call their local health clinic or 1700 [Iceland’s COVID-19 hotline],” she explained.

Auður said that she was just at home working on her thesis project when the contract tracing team reached out for student volunteers. “I thought I could help,” she said. “It’s gone well – we get a standard interview script that we go through and the interviews are, of course, confidential. People have responded well, they’ve been willing to provide their information in order to try and curtail the spread of the virus.”

Icelanders Can Download App to Help With Coronavirus Contact Tracing

COVID-19 tracking app Iceland

Icelandic authorities have launched an app that tracks users’ movements in order to help with contract tracking coronavirus cases. The app, called Rakning C-19, is currently only available in the Apple Store, but Android phone users will hopefully not have to wait long. The app is under review for launch in the Google Play store, and authorities are expecting to receive the final approval shortly.

The app is a joint project of Iceland’s Department of Civil Protection and Emergency Management and Directorate of Health. It collects data about other phones in the area, making it easier to trace whom an individual was in contact with if they are later diagnosed with coronavirus.

The goal of the app is to speed up coronavirus contact tracing, and authorities have clarified that it will not replace the contact tracing team, which will continue to work with individuals directly when infection comes up.

The app was developed in collaboration with data security experts. The data gathered by the software is only stored locally, and users must grant permission to Icelandic authorities to access it.

Effective contact tracing and quarantine of those who have been at risk of infection have proven to be effective tools in slowing the spread of COVIC-19 in Iceland. Over half of those who have been confirmed with the virus, or 54%, were already in quarantine when their infection was confirmed.

Tracking App May Assist Iceland With Coronavirus Contact Tracing

Icelandic authorities are creating an app to help contact trace coronavirus cases, RÚV reports. Residents of the country would be asked to install the app on their phones, and if they contract coronavirus, the data it collects could be used to help identify others they came into contact with. The app is expected to launch next week.

The app collects data about other phones in the area, making it easier to trace whom an individual was in contact with leading up to their coronavirus diagnosis. The initiative is a joint project of the Department of Civil Protection and Emergency Management and the Directorate of Health.

Víðir Reynisson, Chief Superintendent of the National Police Commissioner’s Office says the goal of the app is to speed up the contact tracing process. It will not replace the contact tracing team, which will continue to speak to those infected and work to map their contact with others around them.

Users control data access

Víðir says the data collected by the app will be in the ownership of the Directorate of Health and the same data protection rules will apply to it as to other databases in the health sector. App users will need to grant permission for the data collection upon downloading the app and then grant separate permission to healthcare authorities to access the data if an infection comes up. The data will be deleted once contact tracing is complete. Similar software has been used in South Korea and Singapore.

Hólmar Örn Finsson, a data protection representative at the Directorate of Health, told Vísir that the public does not have to worry that their data will be misused. “I just want to point out that we have got security experts with us in this. That’s why we based it on this double permission. You agree to download the app yourself. And if we need the data from you, you also agree to share it. Only then is it shared with the Department of Civil Protection’s contact tracing team.” Hólmar explains that the data will only be stored for a short time, likely just a couple of weeks. “No one should be able to access this data any more than any other data on your phone.”

Contact tracing has slowed spread of COVID-19

Effective contact tracing and quarantine of those who have been at risk of infection have proven to be effective tools in slowing the spread of COVIC-19 in Iceland. Nearly half of those who have been confirmed with the virus, or 49%, were already in quarantine when their infection was confirmed.