Never More Strain on Hospital, Chief Physician Says

Emergency room

New rules took effect today at Iceland’s National University Hospital of Iceland due to increased strain and an outbreak of respiratory infections. Mask use is once again mandatory for outpatients and visitors, and visiting hours have been reduced. Chief Physician of the Infectious Diseases Ward Már Kristjánsson told RÚV it is “the most strain that we have ever seen the hospital under.”

Mandatory mask use

Mask use is mandatory in all interactions with patients as of today, January 4. Inpatients are not required to wear masks, but outpatients and their chaperones are required to do so. Visitors and others entering the hospital are also required to wear surgical masks. In departments where COVID-19 outbreaks occur, staff are required to wear fine particle (FFP2) masks.

Visiting hours have been shortened and will be between 4:30 and 7:30 PM on weekdays and 2:30-7:30 PM on weekends. The hospital recommends guests come one at a time and wash their hands upon entering the hospital.

Exceptions may be granted

Sibling visits to the children’s hospital are only permitted in consultation with the children’s ward staff. Exceptions to all of the new infection prevention regulations can be granted by department or shift managers.

Read more about the National Hospital’s persistent problem of patient flow.

Rise in COVID-19 Cases in Iceland

Confirmed COVID-19 infections have been increasing in Iceland over the past four weeks, Chief Epidemiologist Guðrún Aspelund told RÚV. “We’re talking about going from around 10 cases per week to around 30,” she stated. Guðrún says seniors and those with underlying health issues will be offered COVID-19 booster shots this fall.

The numbers Guðrún cites are numbers of COVID-19 cases confirmed via PCR tests in hospitals and they do not give a complete picture of the spread of COVID-19 in the general population. “There are lots of people who don’t have to seek out healthcare services, who are home, test at home, or are just sick at home. Hospitals test those who go in and those inpatients who have symptoms. That’s where we’re getting these notifications from,” Guðrún explained.

At-risk groups offered boosters this fall

While COVID-19 vaccinations are available at health clinics in Iceland, there has been no ongoing vaccination campaign. Those in at-risk groups will be offered booster shots this fall. “There will be clearer guidelines on that in September, it would be at the same time as the flu shot. There we’re targeting, as was stated in the guidelines that were released last spring, the 60+ demographic, and then at-risk groups and also healthcare staff who are more exposed.”

COVID-19 the Likeliest Explanation for Excess Mortality in 2022

From the night shift at the COVID-19 ward.

Chief Epidemiologist Guðrún Aspelund believes that COVID-19 is the only possible explanation for excess mortality in Iceland last year, RÚV reports. Guðrún emphasised that vaccinations had in all likelihood reduced mortality and that the number of deaths was to be explained by a large number of infections.

COVID-19 deaths on the rise again

After a significant decline last autumn, the number of deaths due to COVID-19 has begun to rise once again; thirteen individuals died from COVID-19 in Iceland in January 2023, compared to an average monthly mortality rate of three between the months of August and October last year.

Yesterday’s RÚV reported that there had been an inordinate number of excess deaths last year, which suggests that twice as many people – or about 400 – had died from COVID-19 last year than previously thought.

Chief Epidemiologist Guðrún Aspelund told RÚV that COVID-19 was really the only explanation: “There were excess deaths in 2022 at around the same time as the big omicron wave hit between February and March. And then there was another smaller wave in July, which was when the excess mortality rate rose again,” Guðrún remarked. “And there is no other explanation for these deaths other than COVID-19.”

As noted by RÚV, excess mortality also increased in other countries after waves of COVID-19 passed. Guðrún noted that the pandemic could also have had an indirect effect on mortality: “It could mean reduced access to the healthcare system in some countries, or some other societal trends,” Guðrún observed.

More deaths in January 2023 than in all of 2021

In 2020, there were 31 confirmed COVID-19 deaths, while in 2021, the number decreased to 8. Last year year, however, there were 211 confirmed COVID-19 deaths, but as previously mentioned, the deaths last year were probably closer to 400. The latest available data from the health authorities are from January, 2023, which indicate that thirteen individuals died from COVID-19 during the first month of the year. This number exceeds the total number of deaths for all of 2021.

As noted by RÚV, there were also excess deaths in January: 70 deaths per 100,000 inhabitants, while deaths in January are, on average, usually around 60 per 100,000 inhabitants. Guðrún noted that around the turn of the year, there was a great number of covid infections. “But then there were also other infections, like influenza and RS.”

More infections = more deaths

82% of the population, aged five and over, are fully vaccinated against COVID-19, and more than 55% of the nation has been diagnosed with the disease. Given this, a reporter from RÚV asked why the number of COVID-19 deaths had increased last year.

Guðrún replied that a rise in the number of deaths could not be attributed to vaccinations. “On the contrary, I think the situation would have been much worse if there had been no vaccinations … the omicron wave was, of course, much bigger than others that had preceded it, and, as a result, more people got sick,” Guðrún remarked.

No Further Restrictions for Chinese Travellers

Keflavík airport Icelandair

A recent memorandum by epidemiologist Guðrún Aspelund to Icelandic Minister of Health, Willum Þór Þórsson, has recommended against the introduction of border measures aimed at travellers from China.

In light of recent spikes there following the relaxation of China’s strict “No COVID” policy, the possibility of re-introducing border screening for Chinese travellers had been discussed, in line with similar measures taken by nations such as the United States, United Kingdom, and India.

Read more: Possible Restrictions for Travellers from China

The memorandum followed the January 4 meeting of the European Union’s Integrated Political Crisis Response (IPCR) council, which aimed at coordinating the European response to the spread of COVID-19 in China.

However, Guðrún Aspelund’s recent memorandum on the matter concluded that she found no reason to introduce border restrictions at this time: “As it stands today, the evidence does not, in my opinion, recommend the introduction of measures at the border due to COVID-19 to protect public health, nor measures specifically aimed at passengers with China as a country of departure. We will update and distribute relevant guidelines to travellers. Sampling of random passengers arriving in Keflavík may be considered if there is evidence of a new variant that should be monitored.”

Guðrún Aspelung likewise pointed out that a majority of the Icelandic population has now received three doses of the vaccine, while a majority of the elderly population has received a fourth dose, further lessening the need for restrictions.

The memorandum also states that increased international monitoring and information collected by European nations with direct flight connections to China may give cause for a reassessment of the risk level in the coming weeks.

Possible Restrictions for Travelers from China

keflavik airport COVID-19 testing

Epidemiologist Guðrún Aspelund says that border screenings are being considered for travelers from China, given the recent rise in infections there.

In a recent statement, Guðrún indicated that healthcare systems throughout Europe are under stress, and that possible measures at the Icelandic border may be taken to relieve pressure other nations as well.

Regulations on travel are set to be lifted soon in China, meaning that Chinese residents will no longer have to quarantine upon arrival in China from foreign travel. This relaxation has healthcare experts throughout Europe concerned that a wave of Chinese travelers may take advantage of the relaxed regulations. The recent easing of restrictions has contributed to the uptick in infections, and some Western nations have also expressed concerns that authorities there have systematically under-reported figures.

Guðrún further stated: “We have less information coming from there regarding numbers for infections, hospitalizations, and cases. There is concern that the situation in China is quite bad and that it could affect Europe. There are also concerns of new varieties coming from China, though it is entirely possible that they may have other origins as well.”

Other nations, including the US, India, and the UK have also introduced mandatory testing for Chinese travelers. Chinese authorities have criticized these travel restrictions as being politically motivated.

A final decision on the possible restrictions is expected by the weekend.

 

 

 

 

 

Record Number of Coronavirus Deaths Since Start of 2022

vaccination Laugardalshöll

Deaths from COVID-19 have hit a record high, Vísir reports, with 188 people having died from the coronavirus since the beginning of 2022. According to Chief Epidemiologist Guðrún Aspelund, the effect of COVID-19 far outweighs the effects of other infectious diseases such as influenza.

Mainly individuals 70 years and older

Deaths from COVID-19 have surged since the start of 2022, Vísir reports. Thirty-one people died from the coronavirus in 2020 compared to eight in 2021. During the first ten months of 2022, however, that number has risen to 188.

According to Chief Epidemiologist Guðrún Aspelund, this upswing in cases owes primarily to the highly infectious Omicron variant and the fact that no social restrictions are in place. Deaths have mainly occurred among individuals seventy years and older.

“Which is why we’re encouraging older people, everyone sixty years and older, and those who are at risk, to get their booster shots. That’s the best form of protection,” Guðrún remarked, adding that protection from vaccines diminishes over a period of a few months.

“We’ve also got new vaccines now that offer protection against the original variant of coronavirus and Omicron, which offers better protection. We need to repeat these vaccinations to enter into winter with good protection.”

Read More: Long-form Interview with former chief epidemiologist Þórólfur Guðnason

Guðrún observed that Iceland’s neighbouring countries have also been seeing a rise in cases in 2022. “Confirmed deaths from COVID-19 are believed to be around six and a half million. But there are many who believe that those figures are at least twice as high – thousands of people are still dying from coronavirus every week.”

According to Guðrún, deaths from coronavirus are significantly higher than deaths from influenza. Coronavirus deaths in Iceland are, however, lower when compared to other countries, with Iceland having the lowest death toll among the Nordic countries.

When asked to speculate why, Guðrún pointed to Iceland’s speedy vaccination campaign, its social restrictions, and the fact that the healthcare system had responded well. “I think we can chalk up this achievement to these factors along with the participation of the citizenry.”

Fourth Vaccination To Be Offered In Laugardalshöll

bólusetning mass vaccination Laugardalshöll

The latest vaccination campaign will begin in Laugardalshöll today, September 27, offering the fourth COVID-19 booster shot and influenza vaccines to individuals 60 and over.

Health care professionals state that some 30,000 in the capital are eligible for this newest round, and expect up to 4,000 per day. Similar services are also being provided outside of the capital region.

The current round of vaccinations will run until October 7, every weekday between 11am and 3pm.

Read more: 80+ Offered Fourth Dose

In April of this year, individuals 80 and over were offered their fourth shot. With much of this demographic covered, it is hoped to increase protection for other vulnerable segments of the population.

Ragnheiður Ósk Erlendsdóttir, director of nursing in the Capital Region Healthcare System, stated to Vísir that this round of vaccinations will have a slightly different format than before, with both the booster vaccine and also influenza vaccine offered.

“People can come here and kill two birds with one stone, get both or one of them depending on what suits them,” she said. “We are going to have three booths, one will only be influenza and one will only be COVID-19, and then there will be one booth that will be both.”

According to the latest statistics from covid.is, 78% of the population is considered fully vaccinated, and 27,644 individuals have received their fourth dose of the vaccine.

Imposing COVID Restrictions Now Would Have Limited Effect, Chief Epidemiologist Says

Chief Epidemiologist Iceland Þórólfur Guðnason

Iceland’s Chief Epidemiologist Þórólfur Guðnason told Kjarninn that imposing COVID-19 restrictions in Iceland now would have limited effect on the spread of the SARS-CoV-2 virus. The currently dominant variant, BA.5, is more contagious than the omicron variant, and a newer variant that is emerging elsewhere in the world, BA.2.75, appears to be still more contagious. Very strict measures would be needed to prevent the spread of these varieties, and their success would be far from guaranteed.

Most re-infections among those who caught the virus early

COVID reinfections in Iceland are by far most common among those who were infected early in the pandemic: before the Omicron variant became widespread. The reinfection rate among people who were infected with the Omicron variant is under 1%. Þórólfur says this could change, however, with the arrival of new variants that could be evading previous immunity. The Chief Epidemiologist noted that in almost all cases, reinfections have been milder than the initial infection.

The Chief Epidemiologist observed that likely neither the Icelandic public nor the government is likely to welcome restrictions at this time, but luckily the COVID-19 situation in Iceland has been relatively stable. Around 30 people in Iceland are in hospital due to a COVID-19 infection, most infected for the first time, and one or two of them in the ICU.

Þórólfur expressed his hope that immunity against COVID-19 would continue to build up and infection rates and rates of serious illness would begin to decrease soon. Iceland’s herd immunity is already very high, he added, and fourth doses are not recommended except for at-risk groups.

Chairman of Medical Association Warns of Doctor Shortage

Nurses Hospital Landsspítalinn við Hringbraut

Chairman of the Icelandic Medical Association, Steinunn Þórðardóttir, stated in a recent interview with Fréttablaðið that Iceland faces one of the lowest ratios of general practitioners to the population in Europe, raising concerns over both adequate healthcare for patients and excessive workload for doctors.

Iceland only has 60 general practitioners for every 100,000 inhabitants. Averages for Western Europe are generally around 100 per 100,000, with most other Scandinavian nations having double or more of the Icelandic ratio. According to Steinunn, this lack is especially felt in pediatrics.

Because the Icelandic medical system lacks specialized facilities, many doctors must go abroad for medical school to finish their training. Some 847 Icelandic doctors are currently employed abroad, and Steinunn blames difficult working conditions as a major reason why these doctors do not choose to work here in Iceland. In order to retain the doctors that do train in Iceland, and entice doctors working abroad to work in Iceland, the medical system must make improvements to the working conditions.

In her interview, she states that because of a shortage of specialists in other fields, doctors must often work as psychiatrists and social workers as well. The unclear nature of the work further adds to the burden of an already heightened workload.

Central to the problem is the fact that Iceland simply produces too few doctors and nurses. An average of 60 are admitted to the University of Iceland’s medical school every year, but significant amounts of Icelandic medical students also choose to study abroad. According to Steinunn, Iceland cannot rely on other countries to fill this gap, and it is critical for the University of Iceland’s medical school to expand both its capacity and specialized facilities.

The shortage of trained professionals is by no means limited to general practitioners. Iceland is also experiencing a nursing shortage, with increased strain during COVID a major reason why nurses have left the field.

Similarly, Magnús Þór Jónsson, chairman of the Icelandic Teachers’ Association, has described the difficulty in recruiting and retaining teachers for this coming Fall. During the pandemic, teachers often had to adapt to a changing environment with increased responsibilities and workload. Citing these deteriorating conditions, Magnús states that many teachers have left the profession, either to temporarily work in other fields or else permanently in favour of better conditions.

 

Hospital Reinstates Mask Requirements Due to Increase in COVID Cases

mask use social distancing

The spread of COVID-19 has increased in the past few days, as around 200 people test positive for Covid daily. The number of people with COVID Is likely a lot higher as many test positive at home, don’t get their results confirmed with the healthcare clinics, and are not counted in the healthcare system’s official numbers. The Directorate of Health stated that most new infections are in people who have not had covid, while people who have already had COVID and are infected again amount to under 10% of cases.

Just under 30 people are hospitalised in the National Hospital with COVID-19, and two are in ICU, one of which requires a ventilator. Most hospitalised people are over 70, but severe illness is most common in people who have had three or fewer vaccinations.

The public, especially those over 80 years old, is encouraged to keep up personal infection preventions and get vaccinated if they haven’t already had their shot. People over 80 and those living in nursing homes are encouraged to receive their second booster shot.

The National Hospital is reinstating its mask requirements and limiting the number of visitors due to the increase in new COVID cases. All guests and staff at the hospital are required to wear masks, and visiting hours are limited to one visitor for one hour per patient.

In an interview with RÚV, Chief Epidemiologist Þórólfur GUðnason stated that authorities will not be responding to the increase in infections by reinstating infection prevention restrictions just yet. “It’s crystal clear that the nation is not inclined to reinstate restrictions. It’s the government that has the final say in these matters,” Þórólfur told RÚV.