Who Are We?

Kári Stefánsson - CEO of DeCode Genetics

The Icelandic nation’s identity is built on being a Nordic nation, descendants of Vikings. A nation that for centuries was isolated from other countries. Their homogeneity has been used for political purposes since the fight for independence, to explain Iceland’s uniqueness and justify its right to sovereignty. For some, this homo­geneity is even something to be protected, and the common knowledge of the nation’s origin is the foundation for that belief. But history is never as simple as “common knowledge” suggests.

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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.

Proposed Nationwide Pfizer Vaccine Study Off the Table

deCode Genetics CEO Kári Stefánsson

Iceland will not be a part of a Pfizer vaccine study, stated both Chief epidemiologist Þórólfur Guðnason and deCode CEO Kári Stefánsson after a meeting with Pfizer representatives yesterday afternoon. Iceland’s success in curbing the spread of the virus means that there are too few cases for the trial to yield noteworthy results to shed light on herd immunity against the virus.

Kári told RÚV: “We discussed a variety of possibilities of gaining new knowledge by performing such a study in Iceland and the conclusion was that we have too few cases for it to be possible. That’s indisputable. We’re victims of our own success.”

He states that we cant’ forget that the only justification for sending 500,000 doses of the vaccine to Iceland, ahead of others in Europe, would be if we could learn something from the research that would benefit the rest of the world. “Because the cases are so few, that would probably prove difficult.” Kári added that while this was known beforehand, “during the meeting, we went over all the knowledge that could be gained from such a trial in Iceland. Once we’d gone over that, the people in the meeting didn’t believe that was noteworthy enough to justify such an experiment.”

Kári further stated that the result was not a surprise to him and that they would not be seeking cooperation with other vaccine producers. “We can’t justify encouraging people to send vaccine to Iceland ahead of others if we can’t do a decent study.”

The proposed study would have shed light on herd immunity against the virus. When asked what sort of research had been proposed, Chief Epidemiologist Þórólfur Guðnason told RÚV that it could have been data-based research, which would not have required informed consent from all participants, or a clinical trial, which requires such consent. Any mass vaccinations under the conditions of a Pfizer agreement would have constituted academic research.

Minister of Health Svandís Svavarsdóttir has stated that the Pfizer negotiations have always been informal and she had been prepared for the possibility that nothing would come of them. She told RÚV: “The fact is that this had never gone further than informal talks between scientists and was intended first and foremost as an academic study. There were never any papers on the table.” She added that a Pfizer vaccine trial was never a part of the government’s plan of action in dealing with the pandemic. “We’ve been working according to our plan which is to take great care with domestic infection prevention and border restrictions, and follow through on our vaccination efforts.”

The proposed vaccine study was first brought up shortly before the new year when Þórólfur and Kári brought up the possibility of such research to Pfizer representatives. Since then, there’s been a great deal of speculation on when and how such a study would work. Þórólfur told RÚV in December that Iceland offered great conditions for such a study as all infections variants discovered here underwent sequence analysis and the border was under close scrutiny.

 

COVID-19 Antibodies Last for Months, Icelandic Research Shows

COVID-19 test tubes

An Icelandic study published in the New England Journal of Medicine has found that COVID-19 antibodies last at least four months without declining. The research suggests there is little likelihood of developing COVID-19 twice. It also suggests vaccines could be effective in preventing infection over a long period, even with just one or two doses.

The study measured antibodies in samples from 30,576 people, including 1,237 who had recovered from SARS-CoV-2 infection. Among those who had recovered, antibodies proved higher in older people and those who were hospitalised. Men tended to develop more antibodies than women, and there was a positive correlation between the severity of illness and the amount of antibodies. Those who showed only slight symptoms or were asymptomatic general developed fewer antibodies to SARS-CoV-2.

One- or Two-Dose Vaccine

Kári Stefánsson, CEO of DeCODE genetics, which conducted the study, told RÚV that in light of the study results, a vaccine could provide relatively long-term protection from infection. “This indicates that antibodies formed during vaccination should be able to last considerably,” Kári stated. “You do not need to be vaccinated more than once or maybe twice, but in any case, it seems to last considerably.”

Read More: Iceland to Buy 550,000 Doses of COVID-19 Vaccine

Reports of Reinfection Not the Norm

Kári stated that rare reports of cases abroad where individuals are believed to have been infected more than once should not cause alarm for the average person. “When 25 million people have been infected with this virus, it must have reached people who are diverse when it comes to the immune system. But that doesn’t mean that ordinary people who have been infected are at high risk of reinfection.”

Civil Defense Working Around the Clock to Field Gathering Ban Exemption Requests

COVID-19 Press conference Þórólfur Guðnason Alma Möller V'iðir Reynisson

Requests for exemptions to gathering limitations are putting a great deal of strain on the Department of Civil Protection and Emergency Management, Vísir reports. These requests are pouring in as authorities work to get a handle on several group infections and as some—most prominently deCode director Kári Stefánsson—call for Iceland’s borders to be closed until the current outbreaks can be fully contained.

“This is the most onerous of our tasks right now, all these requests for exemptions,” said Chief Epidemiologist Þórólfur Guðnason, who said that Civil Defense is fielding requests from both individuals and companies alike. The department currently has people working full time, every day of the week, just to deal with these requests. Even so, Þórólfur is sympathetic to the general sense of urgency. “It’s understandable,” he remarked, “because this is a big financial issue for a lot of people.”

Time to take stock

“Personally, it would be my choice to close the borders for the moment and try to get a handle on the epidemic that is underway right now and then make a decision after that,” Kári Stefánsson remarked on a radio interview this weekend.

“I think the big question that we have to face up to is whether we should continue to deal with it like this, to take the blow when an infection of this kind flares up and deal with it. This means we can’t live the kind of cultural life that we’d like to, that it will be difficult to keep schools open in the way that we’re accustomed to, and so on.”

“Or should we close the country,” Kári continued, “demand that everyone who comes here is first tested, quarantined for five days, and then sent back for another test? The price that we’d pay for that is that the tourism industry would suffer but this is a choice we have to face up to.”

Þórólfur was more circumspect in his reply during the same interview, saying that he believes the virus will be a part of life until a vaccine is available, although he agreed that some stocktaking needs to be done on the part of the government. “What I need to do as the Chief Epidemiologist is to give the government a choice,” he said, “[to explain] what the epidemiological nature of each choice is.”

Even if the country did close its borders for the time being, however, Þórólfur said that Civil Defense would still need to deal with a large number of exemption requests. “A lot of work within the country is dependent on foreign labour of many different kinds,” he said, emphasizing the importance of continuing to screen carefully at the borders.

Three domestic infections were confirmed in Iceland on Saturday, and one inactive infection was diagnosed at the border, although results are still pending as to whether the individual has antibodies.

DeCODE to Restart COVID-19 Screening of General Population

keflavik airport COVID-19 testing

Private biopharmaceutical company deCODE genetics will restart screening the general population for COVID-19. The company conducted COVID-19 testing of the general, asymptomatic population for around eight weeks this spring to determine how widespread the SARS-CoV-2 virus was in Icelandic society. Following a new cluster of community transmissions in Iceland, CEO of deCODE Kári Stefánsson decided to restart the initiative in order to determine whether the novel coronavirus is spreading in Iceland anew.

There are currently 21 active cases of COVID-19 in Iceland, around half of which are community transmissions. Contact tracing has revealed that a few of the infections have a common, as yet unknown source, leading experts to believe there are more infected, possibly asymptomatic individuals, yet to be found.

New Cases Suggest Virus is Spreading Again

“In the past few days, infections have sprung up with such a pattern that it has caused a bit of anxiety among us [at deCODE] and others,” Kári told RÚV. “For example, there are three people in the community who are infected with a virus with the same mutations that indicate that they come from the same source. And these are people who are not aware of having been connected in any way, and that leads one to the conclusion that there must be individuals between these parties, therefore there are more people out in the community infected with the same strain of this virus.”

Kári says that some of the individuals newly diagnosed had large amounts of the virus in their bodies and were therefore highly contagious. Added to that, there is a possibility that some individuals who attended a football tournament in Reykjavík were infected at the event. “And when you put all that together, it suggests that the virus has picked up again.”

Authorities Delay Loosening Restrictions

Health authorities have decided to delay the planned relaxing of COVID-19 restrictions by two weeks, from August 4 to August 18. Infectious diseases expert Kamilla Sigríður Jósefsdóttir stated that authorities were also considering tightening restrictions, both locally and at Iceland’s borders. An announcement on the matter is expected from authorities later today.

DeCODE Extends Participation in COVID-19 Border Testing as Tourist Numbers Strain Capacity

keflavik airport COVID-19 testing

Private biopharmaceutical company deCODE will extend its participation in Iceland’s border testing program by one week, RÚV reports. The company’s CEO Kári Stefánsson had announced deCODE would pull out of the border testing program after today, citing dissatisfaction in relations with the government and the urgency of resuming the company’s regular operations. DeCODE’s testing capacity is around three times that of the National University Hospital’s Virology Department – the only other facility in the country that can test COVID-19 samples.

Last week, deCODE genetics announced it would halt its participation in Iceland’s COVID-19 border testing after July 13, leading many to question whether the nation would be able to continue screening travellers entering from abroad for COVID-19. Following deCODE’s announcement, the National Hospital’s Virology Department began preparations to increase their testing capacity from around 500 samples per day to 2,000. The challenged proved insurmountable and deCODE has now agreed to extend their participation until the Virology Department completes the massive efforts required to increase its testing capacity.

Limited Testing Capacity May Lead to Flight Cancellations

The number of travellers entering Iceland has been steadily increasing since the country implemented COVID-19 tests at its borders as an alternative to mandatory quarantine on June 15. With deCODE genetics’ participation, the country has tested between 500 and 2,000 arriving travellers per day, setting a daily record of 2,118 yesterday, July 13.

These numbers have reached the upper limits of the country’s testing capacity, and RÚV reports that some airlines may be asked to cancel flights in the next two weeks in order to avoid exceeding daily testing limits. Icelandic authorities are meeting today to discuss the matter. The Virology Department’s intention to test COVID-19 samples in groups of 10 could presumably prevent such cancellations if implemented soon.

Authorities Consider Other Options

The border testing program has only found 12 individuals with active COVID-19 infections, of some 30,000 tested. These low positive rates mean that it may be possible to exempt travellers from certain areas from testing and quarantine and thus accept more travellers from abroad – currently only those arriving in Iceland from Greenland and the Faroe Islands are exempt from testing and quarantine. Iceland’s Chief Epidemiologist has said, however, that more countries will not be added to this list until August. Authorities are also considering accepting foreign COVID-19 test certificates in lieu of border testing or quarantine.

deCODE to Halt Participation in COVID-19 Testing, CEO Says

In an open letter to Prime Minister Katrín Jakobsdóttir published in Vísir today, CEO of deCODE Kári Stefánsson urges the government to establish an Institute of Epidemiology, claiming his biopharmaceutical company will halt its participation in the country’s COVID-19 testing after July 13. DeCODE has tested around five times as many people for the novel coronavirus as Iceland’s National University Hospital, the only other institution in the country equipped to process viral samples, according to Kári. Iceland’s Director of Health says the country’s border screening initiative will have to be rethought.

Iceland’s first case of COVID-19 was diagnosed on February 28. Shortly after, DeCODE offered to conduct COVID-19 screening of the general (asymptomatic) population in order to determine how widespread the virus was in Icelandic society. “Unfortunately, the only viral laboratory within the healthcare system got into trouble as the epidemic developed, so we ended up handling almost all of the screening in the country for a period of a few weeks whether of the sick or healthy,” Kári writes. “It is therefore not unlikely that disease prevention would have proved difficult without our involvement.”

Criticises Government’s Failure to Involve deCODE in Planning

Kári points out that deCODE has not only administered and processed COVID-19 tests, but also assisted the Chief Epidemiologist and other authorities in analysing the results, as well as being the only institution to test for COVID-19 antibodies in Iceland. Yet, Kári says, when the epidemic subsided locally and the government started making plans to reopen its borders, it did so without consulting deCODE. Despite no efforts to involve the company in planning, “it was assumed in the plan that was put together that deCODE would offer to handle all sorts of aspects of the screening. We agreed to take part in the beginning (not forever), but when we did not see any real plans for someone to take over for us who had the ability to do so, we became uneasy,” Kári writes.

Proposes Institute to Address Limits of Healthcare System

Kári then reproduces a letter he sent to the government of Iceland, dated July 1, 2020, in which he advocated for the establishment of an Institute of Epidemiology. Such an institute would be able to redress the healthcare system’s current lack of capacity for COVID-19 testing, while also analysing results, processing data, and assisting in decision making regarding the current pandemic and future ones. Kári suggested the institute should be under the Directorate of Health, and offered deCODE’s assistance in establishing it, including housing it in the company’s headquarters.

Kári included a response to his letter, sent by the Prime Minister three days later. In the letter, Katrín thanks Kári for his contribution to the efforts in preventing the spread of COVID-19 in Iceland, and states the government will take his proposal into consideration. She also tells Kári that a project manager will be hired to “analyse how to strengthen the healthcare system’s infrastructure to cope with epidemics of the future, taking into account your proposal and the experience we have gained in the struggle against COVID-19.” The project manager will also “assist the Chief Epidemiologist to curb the current pandemic in close collaboration with you and your company.”

Says deCODE Will Stop COVID-19 Testing After July 13

“It is clear from this answer of yours that this problem is not as urgent for you as it is for us,” Kári continues in his letter. “Our view is that all of your conduct toward deCODE and that of the Minister of Health in this issue has been marked by disrespect for us, our contribution, and the task we have undertaken in this epidemic.”

Kári then goes on to state that deCODE will cease all communications regarding SARS-CoV-2 with the Chief Epidemiologist and Director of Health today, and will not process any COVID-19 tests received after next Monday, July 13.

Kári is known for lambasting politicians in open letters and articles published in Icelandic media. In 2016, he called former Prime Minister Sigmundur Davíð’s decision to build a new National Hospital elsewhere than planned a “declaration of war,” going on to criticise his performance as Prime Minister. That same year, he demanded former President Ólafur Ragnar Grímsson divulge information on his and his wife’s finances. He had expressed dissatisfaction with Iceland’s Minister of Health in a televised interview earlier this year.

Director of Health, Chief Epidemiologist Respond

Both Iceland’s Director of Health Alma Möller and Chief Epidemiologist Þórólfur Guðnason stated that in light of Kári’s announcement, the country’s border screening program would need to be rethought. They both praised deCODE for the company’s contribution to Iceland’s fight against COVID-19. “They have done a great job for all of us,” stated Þórólfur. Both officials said they could not yet say how authorities would respond to the situation.

A Very Small Minority of Icelanders Immune to COVID-19

New data provided by deCODE Genetics shows that .9% of the Icelandic nation has antibodies for the COVID-19 virus, RÚV reports. The data excludes people who are currently infected with the virus or under quarantine.

Kári Stefánsson, the CEO of deCODE, explained that the data indicates that the vast majority of Icelanders is still susceptible to the COVID-19 virus. “A very small minority has become immune to the virus,” he remarked, “such that if we have a resurgence of infections, we’ll have to respond very quickly and decisively.”

DeCODE is currently working with Canadian scientists to try and create antibodies for the COVID-19 virus. Kári says the experiments have been enjoyable thus far. In theory, this involves isolating “[w]hite blood cells, which create antibodies in patients…We’ll then take proteins from the virus to make the selection and make antibodies that the white blood cells have formed, replicate it, and use to make antibodies in really large quantities.”

Kári said that he had no doubt that they would eventually succeed in making antibodies, but that it was simply a question of how long the process would take.

Iceland’s Coronavirus Testing Could Help Global Pandemic Response

In addition to the Icelandic healthcare system’s screening of those who present symptoms of COVID-19, Iceland has been screening the general population for coronavirus. These screenings are carried out by deCODE genetics, a medical research company headquartered in Reykjavík and a global leader in analysing and understanding the human genome.

DeCODE’s findings are already shedding light on the virus’ movement and many mutations. But the data also raise further questions, such as why some groups appear to be more at risk of contracting the virus or falling seriously ill. Iceland Review spoke to deCODE CEO Dr. Kári Stefánsson about the data that are emerging from the screenings and how they could support the global response to the COVID-19 pandemic.

Insight into the virus’ movement

Screening the general population and those who are asymptomatic gives a more accurate picture of how widespread the virus is in Icelandic society as well as how it is moving, Kári explains.

“DeCODE has now screened 10,401 individuals in Iceland. Of those, 92 were positive. So about 0.9% of those who we screened in the general population turned out to be positive. And that is probably the upper limit of the distribution of the virus in society in general.” The sample of those screened is self-selected, meaning people volunteer to be tested, but Kári believes that the data gathered are nevertheless a fairly accurate representation of how widespread the virus is in Iceland.

“The testing has been going on for 15 days – there was a little pause in the middle because we were missing swabs – but all of these 15 days, the rate of positives has been a little bit below one percent, which makes it likely that this is the true population prevalence. Today we are calling in people randomly, just selecting at random from the telephone directory. There is probably no perfect way to get a random sample. But I think it is very likely that the number is going to turn out in the end to be somewhat close to this number, probably somewhere between 0.5-1%.”

Iceland’s Chief Epidemiologist Þórólfur Guðnason has encouraged people who receive a phone call from deCODE to accept the offer of testing.

Because we are sequencing the virus from everyone who tests positive in Iceland, we can basically determine the geographic origin of the virus in everyone who gets infected.”

Sequencing the virus

DeCODE has sequenced every single positive case of the virus in Iceland, not just from their own screenings, but also those diagnosed at the National Hospital. A large number of mutations have come up, despite the virus having a low mutation rate compared to, for example, influenza. “Even though the rate of mutation is relatively slow, there are a lot of mutations because the virus is spreading so widely. There are so many that get infected that there is an enormous collection of mutations in this virus in our society.”

These mutations can be used to track the origin and spread of the virus down to individual cases. “What is interesting is that there is a string of mutations that is fairly specific for Austria, another for Italy, a third for England, a fourth for the west coast of the United States. Because we are sequencing the virus from everyone who tests positive in Iceland, we can basically determine the geographic origin of the virus in everyone who gets infected. And that is of help when it comes to tracking the infection, when you want to figure out how it moves through society, because you can determine whether people have gotten infected from the same individual by just sequencing the virus, and in that way place it in the context of how the mutation moves.”

Women, children fare better than men

Following how the virus changes and moves has given insight into which groups are more at risk. “One of the interesting things that we have seen is that not only are women less likely to get infected, if they get infected the disease is not as severe as in men. So they are better protected than men in two different ways. The same applies to children: they are less likely to get infected than adults, and if they get infected they are less likely to get seriously ill.”

“Then if you leave aside children versus adults or men versus women and just look at the response to the virus, there is a tremendous diversity in response to the virus. There are some people who tell me that the disease was just like a mild cold, and others end up on a respirator and die. This tremendous diversity in response to the virus raises all kinds of questions. Is it because of the genetic makeup of people? Are you genetically protected or are you genetically vulnerable? The other possibility is that the diversity is rooted in the diversity in the sequence of the virus. We have a soup of viruses in our society: are some of them relatively mild, some of them more severe? Or is it a combination of the two: the sequence of the virus and the sequence of the genome of the patient? This is one of the things that we are vigorously studying these days.”

The only way in which you can calculate lethality is to know the spread of the virus in the community in general.”

As the data accumulate, some questions are answered, but new ones emerge. “There are a lot of answers we have gotten from our screening and sequencing but these questions are almost like a tree in a fairy tale: you cut off one branch and three branches grow out in its place. You answer one question and the answer to that one question begets another three or four questions.”

Helping the global response

DeCODE researchers are working at unprecedented speeds to make the data they are gathering available to other countries in the hopes that they will help them respond to the COVID-19 pandemic more effectively. They have produced a study, currently under review, that will be published shortly in a major scientific journal. Kári hopes that the data from deCODE are useful to other countries, particularly in having a more accurate picture of the virus’ lethality.

“I hope that the results we have generated will prove useful for others, that we can provide the numbers to put into their models. The only way in which you can calculate lethality is to know the spread of the virus in the community in general. It’s not enough just to have the numbers for those who are already sick or at great risk, because if you use those numbers you’re likely to inflate the lethality of the disease dramatically.”

Icelanders’ genetic information could shed further light on virus

In the longer term, deCODE is particularly well set up to make the most of the data they are gathering through screening – their previous research has created extensive databases of Icelanders’ genetic material. “We have gotten permission from the Ethics Committee to begin to use all of our existing data in this context, so we are ploughing very deeply into all our past studies.” Those data could prove crucial to the very survival of our species, says Kári.

“If you think about it, this epidemic is probably the biggest threat mankind has faced in a very long time. You have a virus that is spreading very rapidly all over the world, and because it has spread so widely, there is an enormous accumulation of mutations, in spite of having a lower mutation rate than many other viruses. And these mutations can potentially end up creating a virus that is even more lethal than the one we have now. So it is incredibly important to contain the epidemic as soon as possible to diminish the probability that this will happen.”

“There is also another thing: every year there is a new flu vaccine developed because the influenza virus is mutating and is getting around the immunity of the year before. The same thing could happen with this virus. There are so many ways in which this story could end, and it’s very important for us as a species to try to have an influence on the way in which it ends. So I think we should do everything in our power to contain it, to understand it, and try to prevent it from coming again.”