Fewer Deaths Associated with Omicron than Delta

fatal accident Iceland

Most of the COVID-related deaths at the National University Hospital during the current wave of the pandemic have been due to the delta variant, RÚV reports.

Over the course of last year and the first 20 days of January, there have been twelve COVID-related deaths at the hospital. Of those, three individuals had the omicron variant. Two of those patients were men, one was a woman; all three were in their 90s and none had been admitted to intensive care. Another patient who died within this time frame had omicron as well as another illness, the latter of which had caused the person to be admitted to the hospital in the first place.

Per the press conference that Civil Defense held on Friday, upwards of 90% of the daily COVID infections in Iceland are omicron infections. Proportionally, however, fewer of these infected individuals require hospitalization than people who have been infected with the delta variant. According to data shared by the hospital, once omicron became the dominant variant, the percentage of people aged 50-74 who need to be admitted to the hospital following infection dropped from 6-8% to less than 1%.

Patients who fall ill with omicron tend to have milder symptoms and less serious lung infections than those who get delta and are less likely to require intensive care or respirators. At time of writing, no children had been admitted to the hospital due to omicron, but children now make up as much as half of existing infections.

COVID-19 in Iceland: Domestic Restrictions to Continue Unchanged

Iceland’s current domestic restrictions, including a 20-person gathering limit, will be extended for an additional three weeks, Health Minister Willum Þór Þórsson announced following a cabinet meeting this morning. Authorities will monitor developments closely in the coming days, Willum stated, to determine whether further measures are necessary to contain the wave of infection. The country’s goal should be to bring daily infections down to 500 in order to protect the healthcare system, Chief Epidemiologist Þórólfur Guðnason has stated.

There are currently over 10,000 active COVID-19 infections in Iceland and over 10,000 others are in quarantine. The country has reported around 1,000 daily cases since late December, its largest wave since the start of the pandemic. Iceland’s domestic restrictions were tightened on December 23, 2021 due to rising infection rates, and include a general gathering limit of 20, two-metre social distancing, and mandatory mask use in shops, on public transport, and in services requiring contact. Restaurants, bars, and clubs must close by 10:00 PM, while swimming pools and gyms may not operate above 50% capacity. These restrictions, set to expire on January 12, have now been extended until early February.

Delta variant still straining hospital

Willum emphasised that the coming days were critical in the development of this wave of infection, particularly in ensuring the healthcare system does not get overwhelmed. Prime Minister Katrín Jakobsdóttir stated that while evidence showed the Omicron variant caused less serious illness than previous variants, the sheer number of cases is nevertheless straining the healthcare system. Furthermore, the Delta variant continues to be widespread in Iceland, causing serious illness and hospitalisation at higher rates than Omicron.

1,000 daily cases until February

Iceland’s Chief Epidemiologist Þórólfur Guðnason and Head Physician of Iceland’s COVID-19 Ward Már Kristjánsson met with the Parliamentary Welfare Committee this morning, where they provided MPs with the latest data and projections on the developing wave of infection. Modelling shows that daily infections will remain around 1,000 until February, and around 90 COVID-19 patients will be in hospital by the end of the month, with 20 of them requiring intensive care. Þórólfur stated that daily infections would need to be brought down to 500 in order to protect the healthcare system. 

Þórólfur said that booster shots and COVID-19 infection would eventually increase COVID-19 immunity in Iceland, but it would take weeks or even months for the effects to make an impact, even if the situation remains unchanged.

Quarantine Regulations Eased for Vaxxed and Boosted Individuals

Minister of Health Willum Þór Þórsson

Quarantine regulations will be eased for individuals who have both been fully vaccinated and received a booster, as well as for fully vaccinated people who have recovered from a previously confirmed COVID infection. The changes were announced by Minister of Health Willum Þór Þórsson on Friday on the government’s website.

Willum Þór made the decision to loosen regulations on the recommendation of Chief Epidemiologist Þórólfur Guðnason, who cited research from the UK and Denmark that indicates that fully vaccinated and boosted individuals are much less likely to become infected with COVID, particularly the delta strain. The research shows that boosted individuals are also less susceptible to omicron infection, although vaccination has been shown to be less effective against omicron than delta.

The new quarantine regulations for boosted and fully vaccinated/previously infected individuals will go into effect immediately.

It is hoped that the easing of quarantine regulations will make a significant impact in boosting the economy and making day-to-day life easier in Iceland, where around 160,000 people—roughly 43% of the population—has received a COVID 19 booster.

“We need to keep society going as much as possible,” said Willum Þór, “whether we’re looking at schools, welfare services, or various economic activities. As it stands now, this response is absolutely necessary.”

Per the announcement on the government’s website, qualifying individuals who are otherwise subject to quarantine are now:

  • permitted to go to work and/or seek out necessary services, such as health services, as well as go to grocery stores and pharmacies, and use public transportation
  • not permitted to attend gatherings or locations where there are 20 or more people present except in the specific instances mentioned above
  • required to wear a mask when in the company of anyone except their closest contacts (i.e. family or people they live with); masks are required even when a distance of two metres is observed
  • not permitted to visit healthcare institutions such as nursing homes without special permission from the institution in question
  • required to avoid contact with persons who have a high risk of serious illness if they contract COVID-19

Qualifying individuals are expected to observe quarantine under the above protocols for five days; their quarantine ends on Day 5, provided that they receive a negative result on a PCR test. Individuals who notice symptoms of COVID during their five-day quarantine are urged to get a PCR test without delay. Quarantine remains a minimum of five days.

Why has vaccination not led to herd immunity in Iceland? What is Iceland’s strategy for tackling COVID now?

Icelandic healthcare system

The short answers to these questions are: the Delta variant of SARS-CoV-2 has proved more infectious than experts hoped; and Icelandic authorities have adopted a policy of curbing the spread of infection with mild social restrictions rather than aiming to eliminate the virus entirely with harsh restrictions. This policy allows Icelandic society to operate as “normally” as possible at any given time.

Now for a longer answer: Icelandic health authorities began administering vaccines against COVID-19 at the end of 2020. The country lifted all domestic restrictions due to COVID-19 on June 26, 2021, when around 88% of the population 16 and over had received one or both doses of the COVID-19 vaccine. Before that point, the newer Delta variant of the SARS-CoV-2 virus had not spread widely in Iceland. Just four weeks after restrictions were lifted, they were reimposed due to rising case numbers.

The Delta variant of SARS-CoV-2 was responsible for the wave of infection that followed, Iceland’s largest until that point. Iceland’s Chief Epidemiologist Þórólfur Guðnason, like many other health experts, had hoped that vaccines against COVID-19 would not only reduce rates of serious illness but would also reduce transmission rates until the virus was no longer a threat to public health. Unfortunately, vaccines proved less effective against the Delta variant than the variants they had been developed for, and Iceland learned that vaccinated individuals could still contract and transmit SARS-CoV-2 at high enough rates to kickstart a larger wave of infection.

It bears noting that vaccination has had a significant impact in reducing rates of serious illness, hospitalisation, and even infection due to COVID-19 in Iceland and has therefore significantly reduced strain on Iceland’s healthcare system. Local data revealed unvaccinated individuals were four times as likely to be hospitalised due to COVID-19 infection and six or seven times more likely to end up in the ICU than those who are vaccinated in the most recent wave of infection. This is clear in the continually updated data on Iceland’s official COVID-19 website.

Though vaccination has been moderately effective, COVID-19 remains a public health threat in Iceland. Authorities’ approach is to minimise the spread of infection using the mildest restrictions possible at any given time. This allows society to operate as openly as possible and avoids lockdowns. Iceland also maintains border restrictions including testing and quarantine depending on the vaccination status of arriving travellers to prevent COVID-19 cases from entering the country.

COVID-19 in Iceland: Vaccination Has Not Led to Herd Immunity, Says Chief Epidemiologist

Chief Epidemiologist Þórólfur Guðnason

While data shows vaccination is reducing the rate of serious illness due to COVID-19 in Iceland, the country’s Chief Epidemiologist Þórólfur Guðnason says it has not led to the herd immunity that experts hoped for. In the past two to three weeks, the Delta variant has outstripped all others in Iceland and it has become clear that vaccinated people can easily contract it as well as spread it to others, Þórólfur stated in a briefing this morning.

The current social restrictions will remain in place until August 13. The Chief Epidemiologist says the government must make the final call on next steps in response to the current wave of infection. Health authorities have sent a formal memorandum to the government expressing concern about the heavy strain on the healthcare system cause by the current record rate of infection.

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 numbers have been updated on covid.is. Iceland reported 108 domestic cases (38 in quarantine) and 1 at the border. Total active cases are at a record 1,304. 16 are in hospital.

The briefing has begun. Víðir begins by saying that the long weekend has passed without any large violations of regulations but it will only come to light in a week or two whether the gatherings last weekend have led to infections.

Þórólfur takes over. He reviews the reason restrictions were lifted last June: at the time infection rates were very low, a majority of the nation was vaccinated and there were regulations at the border ensuring a minimum of infections would cross the border. Vaccination rates are high in most groups, though only 10% of those 12-16 have been vaccinated.

What has happened in the past two to three weeks is that the Delta variant has taken over all other variants in Iceland. And it has come to light that vaccinated individuals can contract it relatively easily and spread infection. Sequencing has shown us that the origin of most domestic infections can be traced to group events such as clubbing in downtown Reykjavík or group trips abroad. We’ll have to wait and see whether the current restrictions will suffice in curbing this current wave.

There are however indications that vaccination is preventing serious illness. Around 24 have had to be hospitalised in this wave, just over 1%. In previous waves, that figure was 4-5%. However, 2.4% of unvaccinated people that contract COVID-19 now are hospitalised.

Authorities have decided to offer those who received the Janssen vaccine a booster shot of Pfizer. There are plans to offer 12- to 15-year-olds vaccination in the near future as well. There are still some 30,000 unvaccinated people among older groups and they are more at risk. That could cause strain on the healthcare system. We must also consider that there is additional strain on other patients when there are lots of COVID cases, says Þórólfur.

Þórólfur says we must remember that the COVID-19 pandemic is not close to being over and will not be over until it’s over everywhere. We must be ready to face new challenges that come up in the process. We know what works to curb infection. We can fight COVID-19 if we stand together and reach a consensus on what needs to be done.

The panel opens for questions. “What needs to happen for you to tighten restrictions, Þórólfur? You don’t sound very positive at the moment.” Þórólfur says he has not decided on measures beyond August 13. He is in discussions with the Health Minister, and it is the government that must decide whether it is necessary to impose tighter restrictions. Þórólfur adds that at this time he will likely make recommendations in a different format than the memorandums he has previously sent to the Health Minister.

“Can you give us information about how many people were vaccinated among those who have been hospitalised in this wave?” Þórólfur says around half of those hospitalised have been vaccinated. The two that have been placed in the ICU are unvaccinated. It’s not possible to draw broad conclusions from this data but vaccination appears to reduce serious illness generally.

“What is the reason that you are considering vaccinating children at this time?” Þórólfur says that he has discussed it for some time and children in at-risk groups have already been vaccinated. There is also evidence that the Delta variant causes more serious illness among them.

“Is there a possibility that children that contract the Delta variant will need hospitalisation?” Þórólfur says that children generally have milder symptoms and none in Iceland have been hospitalised in this wave. However, there is data from abroad of children needing to be hospitalised due to COVID-19.

“Do you not want to urge the government to strengthen the healthcare system?” Þórólfur says of course, and the Director of Health has discussed that often at these briefings but it doesn’t happen overnight. What we can do in the short term is to curb infection rates, which will reduce strain on the healthcare system. Þórólfur says: We must keep in mind that people can develop long-term symptoms despite not needing hospitalisation from COVID-19 infection. That’s something that we don’t have long-term data for yet but will come to light.

Þórólfur says health officials have sent a formal memorandum to the government expressing concerns regarding strain on the healthcare system and the National University Hospital. Þórólfur expresses disappointment in the discourse regarding the National University Hospital, he feels the media has been dismissing healthcare workers’ concerns. Healthcare workers are those best positioned to evaluate the hospital’s strain and capacity, he says.

Þórólfur: our main project now is this wave that we have to tackle. Regarding the borders, we must think long-term about how we can minimise infections crossing the border. Then we must consider how we want things to be domestically and what people’s tolerance is for restrictions. But it’s a fact that the more this wave of infection spreads the harder it will be to contain.

Víðir takes over to close the briefing. We know what we have to do: prevent infections, and protect the borders so that we can live as freely as possible within Iceland. We can see that many people are out of patience toward restrictions but unfortunately, this is not over. We don’t have to agree on everything but our message must be clear. It is the virus that is the enemy. We must be good to each other and be patient, try to understand where others are coming from, Víðir says. The briefing has ended.

COVID-19 in Iceland: Restrictions Imposed to Combat Delta Variant Uncertainty

Kamilla Sigríður Jósefsdóttir infectious disease specialist

While there is data showing vaccinations prevent serious illness due to COVID-19, there is uncertainty regarding how the rapidly spreading Delta variant will affect Iceland’s majority-vaccinated population, Director of Health Alma Möller stated in a briefing in Reykjavík this morning. Authorities reimposed domestic restrictions in the country last weekend in response to rising infection rates. According to Alma, the goal of the restrictions is to protect the healthcare system as well as vulnerable groups.

Iceland reported 96 new domestic cases yesterday and the number may rise yet, as samples from the day are still being processed. Total active cases thus number at least 709, up from 60 just under two weeks ago.

Pregnant women in the Reykjavík capital area will be invited for vaccination at Suðurlandsbraut 34 this Thursday. Authorities encourages residents of Iceland returning from abroad to register for testing on heilsuvera.is, whether or not it was officially required in their case.

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

 

On the panel: Kamilla S. Jósefsdóttir Deputy Chief Epidemiologist, Director of Health Alma Möller and Director of Civil Protection Víðir Reynisson.

Yesterday’s numbers are up on covid.is. Iceland reported 82 new domestic cases (23 in quarantine) and 4 border cases. Total active cases: 695. Two are in hospital. 68.58% of the population is fully vaccinated. Pregnant women have been encouraged to get vaccinated due to rising case numbers. They will receive an invitation for the Pfizer vaccine in Reykjavík at Suðurlandsbraut 34 this Thursday, Vísir reports.

The briefing has begun. Víðir begins by reviewing the border regulations that are currently in force. He encourages all residents of Iceland and those who have a social network within Iceland to get tested upon arrival to the country though it is not an official requirement.

Kamilla takes over to review the numbers. There were 96 new domestic cases yesterday, a higher number than previously reported as some cases were added later. Kamilla reviews that quarantine regulations have been updated. The same regulations will apply to vaccinated and unvaccinated people in terms of the length of their quarantine. There are few cases with serious symptoms, which shows that vaccines are working in preventing serious illness among those infected with COVID-19, Kamilla says. Kamilla adds that pregnant women in the Reykjavík capital area will be invited for vaccination this Thursday.

Alma takes over. She discusses the Delta variant of SARS-CoV-2, spreading now in Iceland. It binds better to cells and multiplies faster. It is also believed to cause more serious illness and even more fatalities than other variants of the virus. She says that vaccinations are however very effective in preventing serious illness, including from the Delta variant [among those unvaccinated]. There is also published research on the effectiveness of Moderna vaccines against the variant.

We imposed domestic restrictions due to the uncertainty, Alma says. We do not know how many serious illnesses the Delta variant will cause in a majority-vaccinated country like Iceland. We are monitoring other countries that are at a similar place regarding vaccinations, especially the UK and Israel.

The reserve force in the healthcare system has been activated now for the third time and Alma encourages people with healthcare credentials who are not currently working in the healthcare system to register. There is also a reserve force for welfare services and a need for other types of workers in the healthcare system, such as in kitchens and to assist with testing. Alma concludes by saying there’s nothing else for us to do but continue onward, continue to gather information, particularly on the Delta variant, and do our best to protect those at risk and the healthcare system.

The panel opens for questions. “Is it necessary to tighten restrictions once more considering the numbers of cases being diagnosed?” It’s too early to say at this point, Kamilla responds. If more patients are hospitalised, then we will of course have to reconsider measures, says Alma.

“Europe will soon release a new COVID-19 map, what colour will Iceland be?” Víðir says according to the data it will be labelled orange.

Alma says that of course it is disappointing to be in the situation once more where we must impose restrictions but there is data from abroad showing that vaccinations are minimising the rate of hospitalisation, which is positive.

“Is it the Janssen vaccine that is not proving as effective as others?” It’s not fair to judge according to this current wave, says Alma, as in this wave it is mostly young people that are contracting COVID-19 and they are more active in society. More young people happened to receive Janssen so it is not accurate to assume that it is less effective than other vaccines administered in Iceland.

Alma says the short-term goal of restrictions is to curb infections and buy time but there is uncertainty regarding the effects of the Delta variant regarding how much serious illness it will cause, especially among vaccinated people.

“Is it not disappointing that our restrictions-free summer has been cut short?” Víðir says all crises are characterised by uncertainty and unpredictability. Hopefully we will have more good times as many people did over the past few weeks.

“What’s the status of research on vaccinations for children? Is vaccination safer than infection with COVID-19 for children?” Kamilla says that depends on the situation in each country. We have been lucky in that there have been low infection rates so we haven’t been vaccinating all children even though the Pfizer vaccine has been approved for older children. There are certain side effects of course so we must proceed carefully, but considering that we are in a wave right now, it will likely happen that we will recommend vaccinations for children 12-15 at some point in the future.

As for younger children, the chances of serious illness from COVID-19 is low and there is not data on the effects of vaccination for that group as of yet. Much of preschool staff received the Janssen vaccine, and plans are in place to offer them a booster shot. We hope the timeline will be such that they will have additional protection when the fall season begins.

“There are four people in Iceland being monitored because they appear to have been infected a second time with COVID-19. Are they exceptions and have they been vaccinated?” Kamilla says that none of the four had been vaccinated. It has been a relatively long time since they were infected the first time. We know from cases abroad that there have been reinfections of COVID-19. Such reinfections are more common among people who have immune disorders, Kamilla says. Alma adds that reinfection is however generally rare.

“In the US and UK, they have 7-10 day isolation for people who are infected with COVID and we have 14 days. Are you considering shortening this period or offering testing to people to minimise the time they have to spend in isolation?” Kamilla: Testing doesn’t help in that context because people can test positive for a long time after infection. Regarding shortening the isolation period, we have done that before but we reversed that decision when the Alpha variant took over as symptoms lasted longer.

Víðir takes over to close the briefing. We still have the same goals: protecting vulnerable groups and the healthcare system. We will do everything we can to limit infections crossing the border and curb infections within the community so we can minimise restrictions. Keep washing your hands, use hand sanitiser, compartmentalise workspaces, social distance. Residents returning to the country from abroad can register for testing on heilsuvera.is. Víðir encourages them to do so even if testing is not officially required in their case. The briefing has ended.

COVID-19 in Iceland: Exponential Rise in Cases, Domestic Restrictions Imminent

mask use social distancing

COVID-19 cases are rising at an exponential rate in Iceland, the country’s Chief Epidemiologist Þórólfur Guðnason stated at a briefing in Reykjavík this morning. Þórólfur will submit a memorandum regarding domestic restrictions to the Health Minister later today. Iceland lifted all domestic restrictions last June 26 after a majority of the population had been vaccinated. Þórólfur says however that vaccinations are not proving as effective against the Delta variant as experts had hoped. While he declined to discuss the details of the domestic restrictions he will suggest, Þórólfur stated that solidarity has been Iceland’s biggest weapon in curbing infection so far, and will continue to be so.

Iceland loosened border restrictions on July 1, allowing travellers with proof of vaccination or previous infection to enter the country without testing or quarantine. Since that date, 236 people have tested positive for COVID-19 domestically, 213 of them in the past week. These numbers show that infections rates are rising exponentially, Þórólfur stated at the briefing, despite widespread vaccination. The majority of infected people are fully vaccinated.

As of Monday, all travellers to Iceland will be required to present a negative PCR test or antigen test before departure, regardless of their vaccination status. Víðir Reynisson, Director of Civil Protection, encouraged locals arriving from abroad to also get tested for COVID-19 upon arrival though it is not an official requirement. Locals can already register for testing online.

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 (left) and Chief Epidemiologist Þórólfur Guðnason.

Yesterday’s numbers have been updated on covid.is. Iceland reported 78 new domestic infections yesterday, 59 out of quarantine and 52 among fully-vaccinated people. No infections were detected at the border. Total active infections have risen to 287.

The briefing has begun. Víðir opens by saying we are facing a new reality now with the changing situation. But we know what we can do and what we must do to tackle the virus. New border regulations take effect on Monday. It is already possible for people returning to the country to register for testing even if they are vaccinated and it is not required. Víðir encourages all locals to get tested upon returning to the country.

Þórólfur takes over. Since the beginning of the month, 236 have tested positive for COVID-19 and 213 in the past week. It is clear therefore that the rate of infection is exponential, he says. Most of the infections are of the Delta variant and differing subvariants. We know the Delta variant is more infectious and causes more serious illness than earlier variants, Þórólfur says.

Data from Israel on the effectiveness of vaccination shows that protection against the Delta variant is lower than previously believed. The Delta variant is spreading fast abroad, both among vaccinated and unvaccinated people. Despite high rates of vaccination in Iceland, Þórólfur says we could see higher rates of infection as well as serious illness. Whether that happens will come to light in the coming weeks.

Nearly 300 are being monitored by the COVID-19 ward though only one is in hospital right now. 6 people are being monitored closely and may require hospitalisation soon. It is clear that the virus has spread rapidly in Iceland despite vaccination, showing that vaccines’ effectiveness in preventing infection is lesser with the Delta variant than we had hoped, Þórólfur states.

Þórólfur reviews the border regulations that take effect on Monday: all travellers, including those vaccinated, will be required to present a negative PCR test before boarding a flight to Iceland. “That measure alone will not stop the spread that is happening domestically,” Þórólfur says. He will send a memorandum to the Health Minister today regarding imposing domestic restrictions. Þórólfur is not ready to discuss what restrictions he will suggest at this time, but he says we know what measures work best to curb the spread.

People who have received the Janssen vaccine will be invited to receive a booster shot of the Pfizer vaccine. These vaccinations will be given starting in late August.

The battle against COVID-19 is not close to being over, Þórólfur says, even though we can celebrate our successes from time to time. New variants and situations with vaccination can come up, as we are seeing now. We need to use the measures we know work. Solidarity has been our biggest weapon so far and will continue to be so, Þórólfur says.

The panel opens for questions. “Should we have imposed border restrictions sooner?” Þórólfur: we can always debate after the fact what the best decision would have been. But it’s good to impose restrictions as soon as possible.

Þórólfur says 4-6 weeks must pass between receiving vaccination and then a follow-up booster shot, as will be offered to those who have received the Janssen vaccine.

“What are the reasons that we are imposing restrictions, considering that the majority of locals are vaccinated?” Þórólfur says there is a rise in hospitalisations and extreme symptoms. It is better to react now rather than wait until we have an epidemic of hospitalisations, says Þórólfur. We have had many measures in place previously that have been successful in curbing previous waves and we will do so again. This is nothing new, says Þórólfur.

Þórólfur says there are no concrete numbers released regarding hospitalisations or deaths due to COVID-19 in other countries with high vaccination rates such as the UK and Israel. Those figures are developing in real time right now.

“Will we face tightening and loosening restrictions for the foreseeable future?” Þórólfur says that the pandemic is not over until it is over everywhere. That could be more many more months. This is a long battle and we have to face that fact, says Þórólfur.

“Will authorities test people heading to the Westman Islands Þjóðhátíð festival?” Þórólfur says Iceland does not have the manpower to test everyone heading to the festival and other festivals across the country during the upcoming July-August long weekend. Víðir agrees: there are tens of thousands of people heading to festivals that weekend across the country. Local police departments are overseeing and discussing measures for such big events but no changes have been planned for the time being.

Víðir closes the briefing by reminding the public to use personal prevention measures, such as keeping a distance, washing hands, and getting tested if symptoms present themselves. Locals arriving home from abroad can register for testing upon arrival and Víðir encourages them to do so. The briefing has ended.