Opioid Crisis: Over 1,730 Doses of Naloxone Distributed

A procedural change to the delivery of naloxone, a medication used to reverse or reduce the effects of opioids, has greatly increased its distribution; over 1,730 doses of naloxone nasal spray have been distributed to companies and organisations assisting individuals struggling with opioid addiction since the new procedure was implemented last year.

“Life-saving” medicine

As noted in a press release on the government’s website, a life-saving nasal spray containing naloxone is now more accessible nationwide as a first response to opioid overdoses. The revised delivery arrangement allows individuals to obtain the medicine at no cost. Opioid-containing substances, such as heroin, methadone, fentanyl, oxycodone, buprenorphine, and morphine, are examples of drugs where naloxone can be administered.

As noted by the press release, naloxone previously required a prescription directly from a doctor to the patient. Following a modification to the procedure last year, doctors have been allowed to prescribe the drug to companies or organisations assisting individuals struggling with opioid addiction and/or their relatives.

Furthermore, the Ministry of Health has covered all costs of the drug through a tender by the National University Hospital (Landspítali), responsible for inventory and distribution. Various entities, including health institutions, police departments, homeless shelters, the Icelandic Red Cross, and Reykjavík City’s Welfare Division, have benefitted from this arrangement. “Over 1,730 doses of naloxone nasal spray have been distributed to these parties since the new procedure was implemented.”

The press release further notes that to combat the growing problem of opioid overuse, the government recently announced that it had approved Minister of Health Willum Þórs Þórsson’s proposals, including an increased budget for expanded distribution of naloxone nasal spray.

“Following successful examples from other countries, the Ministry of Health aims to replicate their success in reducing opioid overdose deaths. Emergency responders and service providers assisting individuals with opioid addiction are encouraged to keep emergency doses of naloxone on hand for immediate treatment while emphasising the importance of seeking medical care afterwards for further treatment.”

Which languages are required to work as a nurse in Iceland?

Nurses Hospital Landsspítalinn við Hringbraut

For some years now, there has been a shortage in healthcare professionals in Iceland. In fact, despite the relatively high standard of public healthcare, Iceland has some of the lowest ratios of nurses and general practitioners to the population in Europe, meaning that working in healthcare in Iceland is a high-demand field.

Partially in response to these staffing shortages, previous requirements to speak Icelandic have been lifted in the last years. There are, however, some things to keep in mind.

The Icelandic Directorate of Health issues licenses to practice as a registered nurse in Iceland. On the application for applicants who have studied in an EEA country or Switzerland there is no specific requirement regarding language requirements. However, the applications are only available in Icelandic and English on their website. Applicants who have studied in countries outside the EEA or Switzerland are required to submit a course syllabus, or a detailed description of the classes concerned, in Icelandic and English.

In addition to that, individual employers can require job applicants to speak Icelandic. It varies between hospitals and institutions. If you have specific questions, it’s best to refer them to the employer in question.

If you are interested in a career in healthcare in Iceland. you may find the following resources helpful:

National Hospital Expects Continued Strain

Iceland National Hospital COVID-19

Intensive care units are at “a breaking point,” according to a memorandum sent to the Minister of Health from the National University Hospital on August 16. While the healthcare authorities believe the current wave of infections may have reached its peak, it is unlikely that the strain on the hospital will decrease for another two to three weeks.

Various measures have been implemented

According to a memorandum sent to the Minister of Health from Páll Matthíasson, Director of the National University Hospital, on August 16, the state of the hospital’s ICU and emergency room is dire; if the hospital’s most pessimistic forecast becomes a reality, it will be unable to respond to other emergencies that may occur, with staff exhaustion being a “real risk,” well. At the time that the memorandum was composed, 20 hospital employees were quarantining and a further 90 were self-isolating.

To accommodate the strain caused by the current wave of COVID-19 in Iceland, the country’s largest to date, the National University Hospital has implemented various measures. These include transferring patients out of the hospital to other healthcare institutions and calling in staff from summer vacations. The Ministry of Health has also contracted staff from private healthcare institutions in order to ease the strain on public healthcare staff.

Despite these measures, the hospital’s intensive care units are “more than full,” according to the memorandum. The biggest challenge in providing care is a shortage of trained staff, particularly anesthesiologists and intensive care nurses. The strain caused by the pandemic has also led to many elective surgeries being postponed. Not all patients waiting for such operations can wait indefinitely.

A high proportion of foreign tourists in intensive care

The recent increase in tourists arriving in Iceland has also affected the hospital, the memorandum notes: 15% of patients being monitored by the COVID-19 ward are foreign tourists, with 25-40% of patients in the ICU belonging to this group. The state of the ICU is currently the hospital’s biggest challenge, considering that is “that aspect of the hospital’s operations” that will most influence its ability to perform large, exigent elective surgeries.

The memorandum further highlights the recent strain on the hospital’s emergency room, in which those individuals arriving with COVID-like symptoms must be isolated until a diagnosis is at hand. This process greatly slows the transfer of individuals into and between the hospital’s inpatient units. Similarly, owing to the above-mentioned circumstances, patients (mainly those suffering from cardiac problems) are being transferred to inpatient units at a faster rate than normal. Under normal circumstances, these patients would be monitored in the emergency room for a longer period of time.

The memorandum concludes with the following plea: “It is imperative that the authorities implement all of the necessary societal measures in order to reduce the strain on the hospital.”

Health Ministry Considers Returning Cervical Screening Processing to Iceland

Minister of Health Svandís Svavarsdóttir

Minister of Health Svandís Svavarsdóttir says the Ministry is considering processing cervical scans in Iceland once more after transferring the procedure to Denmark has not gone as smoothly as planned. Such a decision would require a great deal of preparation on the part of the National University Hospital, which would be processing the samples.

At the end of last year, cervical screening was transferred from the Cancer Society to capital area healthcare centres following a human error that led to several misdiagnoses at the Cancer Society. Authorities decided to send the samples to Denmark for viral and cellular analysis, which has been harshly criticized by women, gynecologists, and oncologists. There have been cases of women having to wait months for results even in cases where cellular changes had been detected.

In a radio interview this morning, Svandís stated that the processing time of the samples abroad was too lengthy and that it was concerning how little trust society had toward the changes made at the end of last year. “And that’s why we have been discussing with the Health Centres and the National University Hospital about the possibility of moving that research part back here.”

The process would require significant planning, according to the Health Minister, including ensuring staffing, equipment, and housing was available to process the samples. “In fact, we have always thought that it would be best if this was done here, but that requires preparation. It is not as if the National Hospital could take this over in a day.” Svandís stated she hoped the ministry and healthcare centres would be able to report more details on the issue in the next few days.

COVID-19 in Iceland: Regulations Relaxed Domestically, Tightened at Border

keflavik airport COVID-19 testing

Iceland will relax domestic COVID-19 restrictions from Wednesday, January 13 as it tightens restrictions at the border. In a briefing today, the country’s Chief Epidemiologist Þórólfur Guðnason celebrated Iceland’s success in keeping the pandemic at bay and stated it was time to relax domestic restrictions to ease the burden on individuals and businesses. He expressed concern, however, at the high number of cases being diagnosed at the border. Þórólfur has proposed tightened border restrictions that could involve mandatory border testing or quarantine in government facilities.

Gathering Limit Up to 20

Iceland will relax domestic restrictions this Wednesday, lifting the gathering limit from ten to 20 people and reopening gyms. Additional restrictions on athletic and cultural events will also be relaxed. Though the pandemic is under control domestically, a high number of COVID-19 cases are being diagnosed among travellers arriving in Iceland. Most arriving travellers undergo testing at the border, five-day quarantine, and a follow-up test. Those who refuse testing may currently undergo 14-day quarantine instead, but there have been indications of a few individuals breaching quarantine regulations while on 14-day quarantine.

Mandatory Testing or Hotel Quarantine

To prevent the spread of cases arriving from abroad, Þórólfur has recommended making border testing mandatory for all arriving passengers. The Ministry of Health is currently reviewing whether Icelandic law supports such a measure. If it does not, Þórólfur has suggested requiring those who choose 14-day quarantine stay at government-run quarantine facilities. As of Wednesday, children arriving in the country will also be required to quarantine along with their parents or guardians (they were previously not required to do so), though they will continue to be exempt from testing barring extenuating circumstances.

First Vaccines from Moderna to Arrive Tomorrow

Iceland is expected to receive 1,200 doses of the Moderna COVID-19 vaccine tomorrow, its first doses from the manufacturer. They will be used to complete vaccination of frontline healthcare workers in the Reykjavík capital area. Moderna is expected to send an additional 1,200 doses to Iceland every two weeks until the end of March. Iceland is scheduled to receive an additional 5,000 doses of COVID-19 vaccine from Pfizer this month.

Below is a lightly-edited transcription of Iceland Review’s live-tweeting of today’s COVID-19 briefing.

 

On the panel: Chief Epidemiologist Þórólfur Guðnason, Director of Health Alma Möller, and Rögnvaldur Ólafsson, Assistant to the Director of Civil Protection. Special guest: Gylfi Þór Þorsteinsson, supervisor of Iceland’s quarantine hotels.

From January 13, arriving travellers who refuse testing at the border will be required to complete their 14-day quarantine in government facilities. Less than 1% of arriving travellers have refused border testing since it was implemented last year. Passengers will continue to have the option of undergoing double testing and five-day quarantine at a private location.

Yesterday’s numbers have been updated on covid.is. Iceland reported 3 new domestic cases yesterday (all in quarantine) and 17 at the border. Total active cases: 143. 20 in hospital, none in ICU.

The briefing has begun. Rögnvaldur begins by disclosing that on Wednesday, the pandemic risk colour code will likely be lowered from red to orange. Þórólfur takes over and states that the situation over the weekend was good, few diagnoses and most in quarantine at the time of diagnosis. We’re still seeing high numbers of cases at the border, says Þórólfur. There were 17 yesterday, most of them were legal residents of Iceland just as border cases have generally been. Just over 140 active cases are in isolation. None of those in hospital due to COVID-19 have an active infection.

I’m happy to see so few domestic cases and especially how few test positive out of quarantine, but I’m still worried about the number of people testing positive at the border, says Þórólfur. In light of the situation, I have presented recommendations to the Minister of Health to ease restrictions domestically. Updated infection prevention regulations take effect January 13. The actions taken have proven successful at keeping the pandemic at bay and that’s why I think it’s time to allow sports, culture and businesses to get back to normal. Þórólfur emphasises that relaxed restrictions are not an encouragement for people to gather in groups. “We must keep up our personal infection prevention.”

I have sent recommendations to the Minister suggesting that border testing be made mandatory. If that’s not possible, I recommend everyone who chooses the 14-day quarantine (instead of testing) be required to stay at quarantine hotels. Children arriving in the country will be required to quarantine with their parents from January 13. [Children were previously not required to quarantine.]

I encourage locals to not travel abroad if they don’t have a pressing need to do so, says Þórólfur. The pandemic is rising in countries abroad and people can get sick and bring infections to the country when they return.

Þórólfur goes over the numbers of vaccine doses scheduled to arrive in the next few weeks. 1,200 doses of the Moderna vaccine are expected to arrive tomorrow. They will be used to complete vaccination of frontline healthcare workers in the Reykjavík capital area. Following that, Iceland will receive 1,200 doses from the manufacturer every other week until the end of March. They will be used to vaccinate the country’s older generations. The AstraZeneca vaccine is expected to receive conditional market authorisation in January and the Janssen vaccine sometime after, the distribution schedules will likely be made available shortly thereafter.

Alma takes over and goes over the investigation of four deaths following COVID-19 vaccinations at nursing homes. The investigation is performed in three stages. It involves a thorough investigation of patients’ medical history and nursing home death statistics. Nothing points to suspicious events or an increase in deaths due to vaccination. The Directorate of Health has also sent requests for data to other Scandinavian countries and they report no suspicious increase in deaths following vaccinations either. Alma stresses the importance of monitoring vaccine side effects as it’s a new drug on the market.

Gylfi takes over to discuss the country’s official quarantine hotels. The Red Cross has operated five quarantine hotels throughout the pandemic, 3 in Reykjavík, 1 in Akureyri and 1 in Egilsstaðir. Right now, there’s only one quarantine hotel in active use [in Reykjavík], but it just filled up so another one will be opened later today. Around 1,200 people have stayed in quarantine hotels in Iceland in the past year, around 530 of them had active COVID-19 infections. Red Cross volunteers have been assisting at the quarantine hotels and they should be thanked for their efforts, says Gylfi.

The panel opens for questions. Þórólfur is asked about tightened restrictions at the border. Are they supported by Icelandic law? Þórólfur points to the Health Ministry, which issues regulations according to laws in effect.

Gylfi is asked about people who will be required to stay at quarantine hotels because they object to being tested at the borders. He does not think many people will opt for staying at a quarantine hotel or that it will be problematic to carry out.

Þóróflur is asked about vaccination distribution and political criticism of Iceland’s decision to acquire vaccines through the EU. He does not think that was a mistake and points to the Ministry of Health for further information.

This morning, it was reported that direct negotiations with other vaccine producers were ongoing and Þóróflur was asked about the status of those negotiations. He says informal discussions are ongoing with several parties but there is nothing to disclose yet.

Gylfi is asked to describe conditions in quarantine hotels. He states that people are isolated in their rooms and receive 3 meals per day and basic services. The volunteers try to supply human interaction to the extent that it is possible but it’s “no celestial stay.”

Are you making any other efforts to get vaccines than through the EU? Þórólfur replies that authorities are trying to accelerate the process as much as possible and also to supply valid scientific data to vaccine production. Þórólfur adds that he is not personally aware of all of the government’s efforts regarding vaccine acquisition but it is being worked on.

Þórólfur states that border testing has been instrumental in curbing the spread of the pandemic in Iceland. “If we hadn’t done that, things would have been much much worse.” How it will be this summer, following some vaccination, we can’t say for sure, and that’s the research we want to do and have been presenting to vaccine producers, says Þórólfur. The more people we vaccinate, the more we can relax restrictions, says Þórólfur.

How many infections can be traced to New Year’s celebrations on the one hand and Christmas on the other? Þórólfur says very few, we’ve had very few infections recently.

Rögnvaldur takes over to close the briefing: as Þóróflur says, we hope new restrictions will make life easier for people and companies. But they are not a message that we can go back to normal or throw parties. “Don’t fall into the trap of trying to interpret the rules to make them fit what you want to do,” says Rögnvaldur. If we start behaving like we did before the pandemic, the cases will go up again and we’ll have to tighten the rules again. “We know how this works and what we have to do. Let’s wash our hands and keep our distance, we’re all in this together.” The briefing has ended.

Iceland Review will live-tweet authorities’ next COVID-19 briefing on Thursday, January 14.

COVID-19 in Iceland: Gathering Restrictions to Be Relaxed, Gyms to Reopen

Chief Epidemiologist Þórólfur Guðnason

From January 13 on, infection prevention restrictions in Iceland will be relaxed, if the pandemic’s spread continues to be at a low. According to a press release from the Ministry of Health, gathering limits will go from 10 to 20, and athletes and amateurs alike will be able to resume their sports training, albeit under strict conditions.

The maximum gathering limit will be 20 people, gyms and sports clubs will be allowed to reopen under strict conditions, and ski slopes as well. Sports training for children and adults alike will be allowed to resume as well, and competitions and tournaments can go ahead, although spectators won’t be allowed. For stage performances, 50 people can be on stage, with audiences of 100 adults and 100 children. The same applies to other cultural events. Gathering limits and opening hour restrictions for restaurants and bars will remain unchanged. These are the main changes to infection prevention regulations introduced at the government’s meeting today. The changes are set to be in effect from January 13 to February 17.

Chief epidemiologist Þórólfur Guðnason suggests these changes to the restrictions, due to our success in fighting the spread of COVID-19 in Iceland. He points out that in several countries close to us the pandemic is growing, due to a strain of the virus that is yet to spread in Iceland. For that reason, he presents his suggestions with a proviso that the pandemic’s development won’t get worse. In order to preserve the success Icelanders have had in fighting the spread of the pandemic, the Chief Epidemiologist and the Ministry of Health are considering changes to border regulations making the double border testing mandatory or at least requiring the people who choose the 14-day quarantine over the free double test to remain at quarantine hotels for the period of their quarantine. The number of people choosing the 14-day quarantine is under 1 % of travellers through Iceland’s borders.

The main changes to the infection prevention regulations set to take effect on January 13.

  • A general gathering limit of 20 people.
  • Shops – Instead of the current tule allowing 5 customers per 10m2, the new regulations allow for one customer per 4m2, but no more than 100 customers in one space.
  • Gyms – Allowed to reopen under strict conditions. The number of visitors can’t exceed 50% of the gym’s operating license. If no number is specified in the operation license, the number of visitors can’t exceed 50% of the changing room’s capacity. Only group sessions are allowed, with a maximum of 20 registered participants. Changing rooms shall be closed. Children born 2005 or later will not be counted with the number of visitors. The Chief Epidemiologist will issue detailed instructions for infection prevention at gyms and sports clubs.
  • Sports training – Sports training of children and adults, with and without contact, will be allowed, indoors and outdoors. No more than 50 people can be in one space at a time.
  • Sports competitions – Sports competitions for children and adults will be allowed without spectators.
  • Ski Slopes – Ski slopes will be allowed to open with limitations. Solo skiers will not share ski lifts with others, a social distance of two metres shall be maintained, and the same rules apply to mask use as elsewhere.
  • Performance arts, cinemas, and other cultural events – Up to 50 people can be on stage during rehearsals and shows. Masks should be worn wherever possible, and a social distance of two metres should be kept whenever possible. Seated guests can be up to 100 adults and 100 children born in 2005 and later. Seated guests should be registered by name, and adults shall wear masks.

Iceland to Receive 5,000 Doses of Moderna Vaccine Through February

According to the Ministry of Health’s vaccine distribution schedule, Iceland will receive 5,000 doses of the Moderna vaccine in January and February but after that, distribution will increase. This is proportional to the amount of vaccine distributed to other nations in the EU vaccine negotiations, based on population. It is hoped that the Moderna vaccine will receive its marketing license today from the European Medicines Agency. Iceland is expecting 128,000 doses of the Moderna vaccine total, enough to vaccinate 64,000 people.

Before the end of last year, Iceland received 10,000 doses of the Pfizer vaccine. According to distribution schedules, Iceland will receive a minimum of 45,000 additional doses from Pfizer in the first quarter of 2021. The next shipment is scheduled for January 20 and it is expected to be similarly sized. Shortly before the end of the year, Iceland signed another deal with Pfizer securing 80,000 doses in addition to the 170,000 doses previously negotiated. According to a release from the Ministry of Health, there is also a chance Iceland might receive more of the Pfizer vaccine during the first quarter due to the new deal.

Iceland to Prioritise Healthcare Workers, Elderly in COVID-19 Vaccination

Healthcare workers and nursing home residents will be prioritised access to a COVID-19 vaccine when one becomes available in Iceland. The Minister of Health has confirmed regulations defining ten priority groups for COVID-19 vaccination. Children born in 2006 or later will not be vaccinated unless they belong to risk groups.

The priority groups were defined in consideration of the World Health Organisation’s recommendations as well as perspectives that have emerged in neighbouring countries. Emphasis is placed on healthcare workers on the frontlines of the pandemic. The groups are prioritised in the following order:

  1. Healthcare workers and other employees that work in the emergency wards of the National University Hospital in Reykjavík and Akureyri Hospital in North Iceland.
  2. Healthcare workers and other employees of the National Hospital’s COVID-19 ward and inpatient ward as well as comparable wards at Akureyri Hospital; healthcare workers and other staff at health clinics as well as those who administer COVID-19 tests; and staff at nursing homes and retirement homes.
  3. Residents of nursing homes, retirement homes, and hospital geriatric wards.
  4. Licenced EMTs and paramedics that work in ambulance services; Coast Guard staff that work in the field; firefighters that work in the field; prison wardens; and police officers that work in the field.
  5. Other healthcare staff that have direct contact with patients “and require COVID-19 vaccination according to further decisions by the Chief Epidemiologist.”
  6. Individuals 60 years of age or older. Those who belong to this group and are also inpatients at healthcare institutions will be given priority.
  7. Individuals with underlying chronic illnesses that belong to particular high-risk groups for COVID-19 as further determined by the Chief Epidemiologist.
  8. Staff of preschools, primary schools, and junior colleges. Community and welfare service staff that have direct contact with users, including those that provide in-home services.
  9. Individuals that are vulnerable due to social or economic factors and are at particular risk.
  10. All others who wish to be vaccinated against COVID-19 according to further decisions by the Chief Epidemiologist.

The first five groups on this list number around 20,000 individuals, according to RÚV.

Several Vaccines and Access for Everyone

Vaccination will be free of charge. The Chief Epidemiologist is responsible for further prioritisation within each group and can also make exceptions to the regulations outlined above, but must provide reasoning to the Health Minister.

The Chief Epidemiologist is also responsible for determining which groups receive which vaccine. It is likely that locals in Iceland will be vaccinated using several different vaccines. The Icelandic government has made a deal with AstraZeneca to purchase the COVID-19 vaccine the company is developing, and will have access to other COVID-19 vaccines currently in development through the European Union. Chief Epidemiologist Þórólfur Guðnason has stated that Icelandic authorities also have the option to negotiate with vaccine developer Pfizer. In a briefing in Reykjavík last Thursday, Þórólfur stated Iceland should have access to enough vaccines for everyone. He added that there was as of yet no definite information on when a vaccine would be available in Iceland.

City Council Wants to Open Safe Injection Spaces in Reykjavík

City of Reykjavík strike

The Reykjavík City Council unanimously passed a motion yesterday to open talks between the municipality and the Ministry of Health on opening a safe injection site in Reykjavík. This spring, Alþingi passed laws that permit the opening of safe injection sites. An estimated 700 people use intravenous drugs.

A report attached to the motion states that the Welfare Committee passed a policy last summer for homeless people with a great and complex need for support. The policy contains proposals such as establishing a facility for women with concurrent disorders (both a mental illness and a substance use problem), reinforcing the city’s on-location advisory team, allocating 20-25 small houses, purchasing more apartments, establishing a new emergency shelter, looking specifically into women’s position and increasing education and knowledge of issues facing people with substance use problems.

The report also states that the Reykjavík Department of Welfare considers it a positive step to legalise safe injection spaces for intravenous users. Damage reduction is essential, and it’s vital to provide a safe location for these individuals to avoid further harm, sickness or even death.

“according to the ministry’s data, intravenous users experience a great deal of prejudice, also from within the public health care system, which only adds to their predicament, increasing the risk of them not asking for help and support. For the safe injection space to work as it should, it isn’t enough, as many have said, to open a room where people can go, absolutely not. These individuals’ basic needs need to be taken into consideration. They should be able to come in from the street and have access to clean facilities, nourishment, hygiene facilities, clothes, and clean and safe space,” said Heiða Björg Hilmarsdóttir at a city council meeting.

The majority’s entry to the meeting’s minutes read: “By passing this motion, we want to get a safe injection site in Reykjavík, as research has shown that damage reduction-focused actions decrease the negative and dangerous effects of substance abuse. It is our goal to introduce damage reduction ideology into the city’s service, but for safe injection spaces to become a reality, cooperation with the Ministry of Health to provide necessary healthcare is needed. Experience from other countries shows that opening a safe injection site decreases outdoor substance use, thereby improving the local community.”

The laws on safe injection sites were passed in parliament last May, giving municipalities the option to open safe spaces for intravenous substance users. Left-green MP Ólafur Þór Gunnarsson hoped the first such spaces would open this year and called the law “the first step towards decriminalisation of substance use.”

Gathering Ban Extended

Minister of Health Svandís Svavarsdóttir

Minister of Health Svandís Svavarsdóttir has approved an extension to the gathering ban and restrictions on school operations until May 4. The decision was made following a proposal put forth by Chief Epidemiologist Þórólfur Guðnason.

The gathering ban first went into effect on March 16 and was initially supposed to end on April 13. “Although controlling the spread of infection has gone well, there are concerns about how quickly the number of severely ill patients in need intensive care has increased,” read the announcement on the Ministry of Health’s website. “It’s crucial that we continue to stand together as one, follow the instructions of our best professionals, and thus prevent the burden on the health care system from crossing the bearable limit.”

As Þórólfur stated in his memo to the Minister of Health, the many different actions already taken, including the gathering ban, have resulted in restricted growth of COVID-19 infections. Until now, the infection increase has been in accordance with the most optimistic forecasts. However, the number of seriously ill patients has risen quickly, resulting in strain on the National Hospital’s ICU. It is clear that a further increase in infection, with an added number of seriously ill patients, could create issues within the healthcare system and make it harder for it to fulfil its essential purpose.

When deemed safe to do so, these restrictions will be lifted in stages, concludes the announcement. The Ministry of Health hopes to announce a plan for rolling back restrictions by the end of April.