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.

Infection Rate of Unvaccinated 13 Times Higher

vaccination Laugardalshöll

Unvaccinated people in Iceland are 13 times more likely to contract COVID-19 than those who are fully vaccinated and have received a booster shot, RÚV reports. Half of all hospitalisations in Iceland’s current wave of infection have been unvaccinated people, who represent less than 24% of the population and less than 10% of those eligible for vaccination.

Over 90% of eligible Icelanders, or those 12 years of age and over, have been fully vaccinated against COVID-19. Over 110,000 people have also received a booster shot, or nearly a third of the total population of 370,000. Vaccination rates vary somewhat between age demographics. Nearly 100% of those 70 and older are fully vaccinated in Iceland (most with booster shots as well). The figure drops to just over 90% for those 50-59 years of age, to around 85% for those 40-49, and to roughly 75% for those 16-39. Nearly 70% of children 12-15 years old in Iceland have been fully vaccinated against COVID-19.

Official data from Iceland shows the difference in 14-day incidence rates by age group and vaccination status. These figures show a consistently higher rate of infection among children and adults that are not fully vaccinated as compared to those who are. The current incidence rate for adults who are not fully vaccinated is 780.4, as compared to 465.8 for fully vaccinated adults. The current incidence rate of those who have received a booster shot is just 59.8. Iceland’s Chief Epidemiologist has stated that widespread booster shots could help Iceland reach herd immunity.

Iceland’s new Minister of Health Willum Þór Þórsson received his booster shot yesterday. “I just do what the scientists have told us and encouraged us to do. That helps the fight,” he stated on the occasion. “But we have to respect the point of view of those who, for all sorts of reasons, are afraid of it or will not get vaccinated.”

COVID-19 Booster Shots Could Help Iceland Reach Herd Immunity

COVID-19 briefing Iceland Chief Epidemiologist Þórólfur Guðnason

Of the 30,000 people who have received a booster shot in Iceland, only 10 have contracted COVID, around 0.03%. Of the 270,000-280,000 that are fully vaccinated, 4,500 people have contracted COVID, around 1.6%. Iceland’s Chief Epidemiologist stated there is strong evidence that booster shots could create herd immunity in Iceland.

Three doses 90% more effective than two

In an interview on TV program Kastljós last night, Þórólfur explained that experts initially hoped herd immunity would be achieved when the majority of a population was fully vaccinated with two doses of COVID-19 vaccine. That hope was based on research with early variants of SARS-CoV-2. The Delta variant of COVID-19, however, proved more infectious than experts anticipated.

While vaccination has significantly lowered rates of infection, transmission, and serious illness in Iceland, it still does not prevent large waves of infection. “Now it has come to light that two doses are not quite good enough,” Þórólfur stated. “For example in Israel, it came to light that the third dose given 5-6 months after dose two works very well, is 90% more effective than dose two in preventing infection, transmission, and serious illness.” He added: “I think there are all indications for us to hope that dose number three will create herd immunity here or at least significantly [reduce the spread of COVID].”

Booster shots administered over next five months

Iceland’s health authorities will begin administering booster shots en masse next week and expect to administer 120,000 before the end of the year. All eligible residents are expected to be offered a booster shot by the end of March 2022. “We hope that people will show up because the booster shot not only protects the individual from infection and serious illness, but also from spreading infection. That way we should be able to get out of COVID, if everything works as it seems like it will.”

Over 76% of Iceland’s total population is fully vaccinated against COVID-19. Þórólfur stated that around 11% of those eligible for COVID-19 vaccination in Iceland (those 12 years and older) have yet to be vaccinated.

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.

Iceland’s Chief Epidemiologist: Curbing Infections Remains the Goal

Chief Epidemiologist Þórólfur Guðnason

Iceland’s authorities will continue to protect at-risk groups from COVID-19 and work to curb infection rates in the current wave, says the country’s Chief Epidemiologist Þórólfur Guðnason. Þórólfur made headlines for his statements in a radio interview yesterday morning that herd immunity would be reached by letting the virus spread through society while preventing the hospital from collapse. Later that day, he told reporters that his words were misinterpreted and authorities’ policy toward the ongoing pandemic remains unchanged.

Over 69% of Iceland’s population is fully vaccinated against COVID-19. While the vaccination is preventing serious illness and hospitalisation, it is not preventing infection with or transmission of COVID-19 as much as experts had hoped. Iceland’s COVID-19 incidence rate is at a record high, though proportionally fewer are becoming seriously ill than in previous waves. The change has led Icelandic authorities to review their approach to tackling the pandemic.

Herd immunity through vaccination

“The policy of the epidemiological authorities is that we are reviewing the chapter that we are entering now and I have written a memorandum to the Health Minister on how to proceed, how we should behave in the coming months,” Þórólfur told RÚV. “Now of course the main task is to curb this wave that is ongoing now and we can do that in many ways. Especially by tightening our grip at the border and minimising the flow of the virus into [the country] and trying to curb the domestic wave here although it may not be with the harshest measures we have implemented thus far. Hopefully we will be able to curb it without having to resort to that.”

Þórólfur confirmed that along with border restrictions, Iceland would need to continue to have domestic restrictions in place to prevent the spread of the virus. Achieving herd immunity is, however, still a goal and the Chief Epidemiologist stated that Iceland has come a long way toward it. “The aim is to achieve herd immunity in one way or another through vaccination, and we have tried that. Half of those who are vaccinated are immune so we have achieved herd immunity among them. In order to develop herd immunity here in the community, more people need to be immune to the virus and it’s not possible to do that in any way other than vaccinating with this third dose, revaccinating those who are the most vulnerable.”

Þórólfur asserted that authorities would not be implementing a policy of aiming for herd immunity through mass infection. “Just letting the virus spread freely through society, no one said that. We need to have some restrictions both at the border and domestically.”

Three More Weeks of Vaccination Until Staff Vacation

bólusetning mass vaccination Laugardalshöll

Icelandic authorities have published the full schedule for COVID-19 vaccination in the Reykjavík capital area until July 13, 2021, when the vaccination team will go on summer vacation. Those who have not yet received the jab can now register to receive the Janssen (Johnson & Johnson) vaccine using the online chat service on heilsuvera.is. Vaccination dates for this group will be scheduled based on how many requests are received.

As of the time of writing, 52.6% of Icelandic residents 16 and over are fully vaccinated against COVID-19 while an additional 28.8% have received one dose and 2.2% have recovered from COVID-19 infection or have antibodies. Iceland’s Chief Epidemiologist has stated that the country has already achieved herd immunity, though group outbreaks can still occur among unvaccinated people and it remains important to keep up personal protective measures such as distancing and handwashing.

Around 12,000 doses of Pfizer vaccine will be administered at Laugardalshöll mass vaccination centre today to the final age groups (16 and over) that have yet to receive their first dose. From June 28 to July 13, only second doses will be administered according to the following schedule.

Week 26

  • Monday, June 28 – Moderna
  • Tuesday, June 29 – Pfizer
  • Wednesday, June 30 – AstraZeneca
  • Thursday, July 1 – AstraZeneca

Week 27

  • Tuesday, July 6 – Pfizer
  • Wednesday, July 7 – AstraZeneca (if required; this date is not confirmed)

Week 28

  • Tuesday, July 13 (morning) – Pfizer
  • Tuesday, July 13 (afternoon) – Moderna

Vaccinations will restart again in mid-August after vaccination staff has had their summer vacation. Until now, residents in Iceland have been called in for vaccination and have been unable to book appointments themselves. A notice from capital area healthcare centres says a different procedure will be used when vaccination resumes in mid-August.

Iceland Has Reached Herd Immunity, Says Chief Epidemiologist

Þórólfur Guðnason

Iceland has vaccinated enough of its population against COVID-19 to avoid a local epidemic, though group outbreaks could still occur among those who have not received the jab, says Þórólfur Guðnason, the country’s Chief Epidemiologist. Iceland has thus achieved herd immunity, Þórólfur told RÚV, despite having not yet reached authorities’ stated goal of fully vaccinating 75% of the population. Over 52% of Icelandic residents ages 16 and over are fully vaccinated while another 28.8% have received one dose.

With just 15 active cases in the country, Iceland has not reported any new domestic cases of COVID-19 in five days. Þórólfur states that there is reason to further relax social restrictions, which currently limit gatherings to 300 people or less and require mask use for seated events and activities that require contact, such as hairdressing.

In Focus: How Iceland Beat the First Wave of COVID-19

Þórólfur says the Icelandic nation has achieved herd immunity to COVID-19, though group outbreaks may still occur. He points out that herd immunity cannot be defined as a specific number, rather the collective immunity within the community that prevents a large epidemic. While 80-100% of older demographics are now fully vaccinated, Þórólfur points out that the rates remain lower among young people and they are therefore still at risk of infection and group outbreaks.

While participation in COVID-19 vaccination has been high in Iceland, the Chief Epidemiologist says the nation must continue to administer the jab and vaccinate as many people as possible. By the end of this week, all Icelanders 16 years of age and older will have been invited to receive their first dose and the vast majority should be fully vaccinated by mid-July. Authorities are also now administering vaccines to children aged 12-15 who have underlying illnesses. A decision has not been made on whether all children in this demographic will be offered vaccination against COVID-19.

COVID-19 in Iceland: Randomised Vaccination Likely Begins This Week

Icelandic healthcare system

Icelandic health authorities expect to administer 14,000 doses of COVID-19 vaccine in the Reykjavík capital area this week, aiming to complete vaccination of remaining priority groups and all residents born before 1975, RÚV reports. If there are leftover doses on scheduled vaccination days, authorities will begin to call in the general population using a randomised selection system. Ragnheiður Ósk Erlendsdóttir, director of nursing at capital area healthcare centres, stated that randomised vaccination among the remaining age groups would begin across the country in the coming days.

Pfizer, Moderna, and Janssen COVID-19 vaccines will be administered in the capital area on Tuesday, Wednesday, and Thursday this week respectively. While Pfizer and Moderna vaccines will be administered to remaining priority group members such as those with underlying illnesses, the Janssen vaccine will be administered to school staff. A notice from capital area healthcare centres states that authorities will aim to complete vaccination of all those born 1975 or earlier this week if supplies allow. Individuals will be invited for vaccination via SMS. “There are no open vaccination days on the schedule in the near future,” the notice stated.

Vaccination Lottery for Remaining Population

Health authorities are now completing vaccination of priority groups, including the elderly and frontline workers. An Icelandic study presented in early May found that randomised COVID-19 vaccination in the remaining population would be a faster route to herd immunity than vaccination by descending age groups. In an interview last Friday, Ragnheiður stated that the names would literally be pulled out of a hat after being grouped by birth year and sex.  “We’re going to put all these individuals together on the basis of birth year, and then we’re going to pull them out of a hat, or a mug, with either women or men from the given year of birth being selected,” she stated.

Another 20,000 doses of COVID-19 vaccine are expected to be administered in Iceland next week. Over 46% of Iceland’s population has received one or both doses of vaccine while just under 25% has been fully vaccinated. Health authorities have stated that they are on track to vaccinate 75% of the population (280,000 people) with at least one dose by the end of June.

COVID-19 in Iceland: Randomise Vaccination to Achieve Herd Immunity Sooner

When Icelandic authorities finishing vaccination of priority groups, the general public will not be offered the jab by descending age groups, but will instead be randomly selected. Iceland’s Chief Epidemiologist confirmed this to mbl.is today. A recently published study from deCODE genetics found that this strategy would achieve herd immunity to COVID-19 sooner than vaccinating the population from oldest to youngest.

So far 29.89% of Iceland’s population have received one or both shots of COVID-19 vaccine. While vaccination efforts got off to a slow start on December 29, they have accelerated in pace with vaccine rollout. Icelandic authorities have stated they are on target to reach their goal of vaccinating 75% of the population (with at least one dose) by the end of July.

Priority Group Seven Out of Ten Now Being Vaccinated

In Iceland, COVID-19 vaccines have been administered according to priority groups defined by the Chief Epidemiologist. The first groups were front line healthcare workers and nursing home residents, followed by the oldest demographics. Currently, inoculations are being offered to the seventh priority group: individuals of all ages with chronic illnesses. The remaining three groups are school and welfare service staff; individuals vulnerable due to social or economic factors (such as homelessness); and the general population. These groups will not be invited to inoculation in descending age groups, but randomly.

“It will be somewhat random in relation to age,” Chief Epidemiologist Þórólfur Guðnason stated. “It will also be like that when for example teachers and people in social services are called in; it won’t be divided by age groups, it won’t go down from the oldest demographic, rather it will be somewhat random. We will try to hit two birds with one stone, that is to say to reach prioritised individuals and at the same time work toward herd immunity as well as possible.”

Herd Immunity Reached Sooner By Vaccinating Young People First

A study conducted by deCODE and presented to Icelandic authorities on April 29 concluded that herd immunity would be reached fastest in Iceland if the age groups who have yet to receive vaccination would be invited from youngest to oldest, in the opposite order from what Iceland, and most other countries, have been doing.

Katrín Jakobsdóttir COVID-19 mask
deCODE genetics. Prime Minister Katrín Jakobsdóttir and other government ministers at the presentation of a deCODE study on vaccination against COVID-19, April 29, 2021.

Vaccinating younger people would limit the spread of the SARS-CoV-2 virus more than vaccinating older groups. “In order to limit the epidemic to 100 people (assuming strict gathering regulations remained in place) we would have to vaccinate 75% of adults,” stated Páll Melsted, one of the scientists behind the study. “But if we start by vaccinating teenagers then we get to that point after vaccinating 55%. If we are going to get to that point sooner, we should start with those who are younger. We also achieve a similar goal if we do it completely randomly. Well, maybe it would be better politically to vaccinate both downwards and randomly, but I don’t intent to promote that.”

DeCODE CEO Kári Stefánsson warned against lifting restrictions quickly before herd immunity was achieved. “I think we should stick to the restrictions and be more Catholic than the Pope for a few more weeks and then we’ll come out of this well,” he stated.

COVID-19 in Iceland: Vaccination Update

Nearly 100% of Icelandic residents over 80 are now fully vaccinated against COVID-19. By the end of today, 90% of staff at Iceland’s largest hospital will have received at least one dose of COVID-19 vaccine. Iceland is still far from reaching herd immunity against COVID-19, however: just 5.6% of the population of 368,590 have been fully vaccinated against COVID-19 while an additional 6.7% have received one dose.

Janssen Vaccine Expected in April

Iceland began administering COVID-19 vaccines on December 29, 2020. Since then, 45,422 have received at least one dose of either the Moderna, Pfizer, or AstraZeneca COVID-19 vaccines, which Icelandic authorities acquired via collective contracts through the European Commission. The European Medicines Agency recently approved a fourth COVID-19 vaccine produced by Janssen (Johnson & Johnson) and Iceland expects to receive 4,800 doses from the manufacturer in April. That will be enough to vaccinate 4,800 people, as the Janssen vaccine is administered in a single dose. Icelandic health authorities aim to vaccinate over 50% of the population by the end of July. Vaccine delivery is expected to speed up in the coming months as manufacturers ramp up production.

90% of Hospital Staff Have Begun Vaccination

The National University Hospital is not only Iceland’s largest hospital and location of its COVID-19 Ward, it is also the country’s largest workplace, with some 6,000 employees. Around 90% of the hospital’s staff have received at least one dose of COVID-19 vaccine or will receive their first dose today. The hospital paused vaccination of its staff when Icelandic authorities suspended use of the AstraZeneca vaccine earlier this month. Iceland made the move alongside several other European countries while the European Medicines Agency investigated instances of blood clots among individuals who had received the vaccine. Further research showed the benefits of the vaccine outweighed the risks. Icelandic authorities decided last week to resume use of the AstraZeneca vaccine on those 70 and older, as new research had shown its safety and efficacy among the demographic. At a briefing last week, Chief Epidemiologist Þórólfur Guðnason stated that the rare blood clot issues that may be linked to the vaccine were limited to younger people.

Some 340 Hospital Staff in Vaccine Limbo

The decision to limit the use of AstraZeneca’s COVID-19 vaccine to the older demographic leaves some hospital staff in limbo. RÚV reports that around 340 staff members of the National University Hospital who received one dose of AstraZeneca earlier this month are in the age group that’s now considered too young to receive the vaccine. Hildur Helgadóttir, project manager of the hospital’s epidemic committee, stated the hospital is waiting for a decision from the Chief Epidemiologist on how to proceed with the vaccination of those staff members. She noted, however, that a single dose of the AstraZeneca vaccine provides considerable protection against contracting the SARS-CoV-2 as well as developing serious illness.