COVID-19 the Likeliest Explanation for Excess Mortality in 2022

From the night shift at the COVID-19 ward.

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

COVID-19 deaths on the rise again

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

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

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

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

More deaths in January 2023 than in all of 2021

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

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

More infections = more deaths

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

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

Lower Mortality Rate in Latest COVID-19 Wave

landspítali hospital

COVID-19 continues to spread through the community, but a closer look at the data presents a silver lining to the latest wave. While far more Icelanders diagnosed with the coronavirus have died in recent months, the mortality rate is actually lower than in prior waves.

During earlier waves of the pandemic, roughly 0.5 percent of those diagnosed with COVID-19 succumbed to the virus. However, since the Delta variant arrived in the country in the summer of 2021 the mortality rate dropped to 0.03 or 0.04 percent, a 10 or 15 percent decrease, RÚV reports.

Chief Epidemiologist Þórólfur Guðnason attributes the lower mortality rate to high uptake of vaccinations in the country.

Over the course of the pandemic, 93 deaths have been associated with COVID-19 infection, 56 of which have occurred this year.

The country appears to have reached the peak of the latest wave, driven by the highly transmissible Omicron variant, though an average of 1,500 new cases are being diagnosed daily through PCR and rapid testing.

Hospitals examining their alert levels

Landspítali’s Epidemic Committee is looking at how the hospital can scale back its alert level in a safe manner after weeks of operating at an emergency alert level, RÚV reports.

There are 72 patients currently in hospital with COVID-19, 64 of whom are in isolation and four are on respirators. Six children are currently being hospitalised for COVID-19.

A lot of illness going around

Despite COVID-19 cases trending in the right direction, there is a lot of illness circulating in the community, Óskar Reykdalsson, director of the capital area health care centres, told RÚV.

In addition to the coronavirus, influenza is spreading rapidly. Thanks to health measures in place to prevent the spread of COVID-19, less flu had been spreading in Iceland over the past two years.

Óskar said that it is typical that the flu is more widespread after years of lower instances. Health facilities ordered more influenza vaccine this year in anticipation of higher numbers, but demand hasn’t met supply.

“I was actually quite surprised that it was not just all used up and finished,” Óskar told Channel 2 radio. “95,000 doses were ordered for the country and 67,000 doses have been used.”

Asked whether people would be able to distinguish between having COVID-19 or influenza, Óskar said that there were differences between the pace of the diseases. With influenza, people suddenly get a high fever and headache and then the cold creeps in. With COVID-19, on the other hand, symptoms start rather mildly but then the disease grows.

Fewer Deaths Than Expected Despite Widespread Infections

Kamilla Jósefsdóttir

More people have died from COVID-19 during the first three months of 2022 than during the entirety of 2020 and 2021, Fréttablaðið reports. Ninety-one deaths have been reported from COVID-19 since the start of the pandemic in Iceland, 54 of which occurred during the new year. The newest wave of the pandemic has, however, seen fewer deaths than expected. 

Thirty-seven deaths in 2020 and 2021

Twenty-nine individuals died from COVID-19 in 2020, according to a report from the Directorate of Health. By the end of 2021, eight more individuals had passed away from the disease, or a total of 37. Since the start of the new year, 54 COVID-related deaths have been reported.

“We count deaths that doctors report as being connected to COVID-19,” Kamilla Sigríður Jósefsdóttir, Deputy Chief Epidemiologist, noted in an interview with Fréttablaðið yesterday. “We’re unable to make a further distinction. If the death is believed to have originated from an entirely different cause, then it should not be reported.”

Fewer deaths than expected

The most recent wave of the pandemic – primarily attributed to the spread of the Omicron variant – has proven especially infectious (two weeks ago, it was estimated that 70% of Icelanders had already been infected); given the number of cases, however, there have been fewer deaths than expected as compared to previous waves of the pandemic.

With a spike in cases, many vulnerable individuals – the elderly and those with underlying conditions, for example – have become infected with the disease. In an interview with Viljinn on Monday, Kamilla maintained that most of those who died from COVID-19 recently – but not everyone – suffered from underlying conditions, which influences the seriousness of the illness.

“One of the reasons why social restrictions were lifted was that Omicron was causing less serious illness compared to earlier variants, which meant that there was less need for restrictions than before,” Kamilla stated. Despite the relative benignity of the Omicron variant, there is still ample reason to practice personal disease-prevention measures:

“Avoiding contact with vulnerable individuals if you’re symptomatic and/or using a mask when close contact is unavoidable and when conditions allow. Washing your hands – etc.,” Kamilla observed. 

Not comparable to flu season

When asked if the current wave of COVID-19 was comparable to the flu season, Kamilla replied that the death rate for COVID-19 was much higher. If such an analogy were to be made, then it should be compared with influenza pandemics, which are much more serious.

According to Kamilla, the mortality rate from COVID-19 during this most recent Omicron wave is nine times greater per 100,000 residents than the mortality rate during the annual flu season in the United States. It’s also 2.5 times higher than the mortality rate in the US during the 2009 swine flu pandemic.

Iceland Significantly Relaxes COVID-19 Quarantine Regulations

Individuals who have been potentially exposed to COVID-19 outside of their home or place of residence in Iceland will no longer be required to quarantine, and will instead be required to take special infection precaution (smitgát). Individuals who have potentially been exposed to COVID-19 in their home or place of residence will still be required to quarantine, except those who are triple-vaccinated, who will only need to take special infection precaution and undergo a COVID-19 test. Primary- and preschool-aged children are exempt from special infection precaution but must quarantine if someone in their home has tested positive for COVID-19.

Decreased absence from school for children

These sweeping changes to Iceland’s quarantine regulations take effect at midnight. They were implemented by Health Minister Willum Þór Þórsson and are in line with recommendations from Iceland’s Chief Epidemiologist Þórólfur Guðnason. The changes aim to reduce strain on testing centres and lessen the impact Iceland’s current wave of infection is having on workplaces and schools. The changes will affect school operations significantly, as children who have potentially been exposed to COVID-19 at school will no longer be required to quarantine as a result.

Chief Epidemiologist: Restrictions must be relaxed in stages

The Omicron variant is responsible for more than 90% of infections in Iceland’s current wave, and the Delta variant for under 10%. Local data shows the Omicron variant leads to much lower rates of hospitalisation as compared to the Delta variant (0.2-0.3% versus 2%), which has led many to call for relaxing social restrictions, including deCODE genetics CEO Kári Stefánsson. The Chief Epidemiologist has emphasised the importance of relaxing restrictions in stages to avoid a spike in case numbers that could place additional strain on the healthcare system.

Infections likely to increase

In his memorandum to the Health Minister, Þórólfur stated that the changes to quarantine regulations “will likely increase infections in schools and among families with preschool- and primary school-aged children.” Relaxing social restrictions would, on the other hand, be likely to lead to increased infections among older demographics. “It is important, however, that this increase does not lead to an increase in serious illness and hospitalisation,” Þórólfur added. If strain on the hospital increases, authorities “must be ready to apply countermeasures.”

Iceland’s current domestic restrictions include a 10-person gathering limit, mandated closure of bars and nightclubs, and mandatory mask use in shops and on public transit. They are currently valid until February 2. The Health Minister has stated he will present a plan for relaxing restrictions in stages this Friday.

New deCODE Data Supports Relaxing COVID Regulations

deCode Genetics CEO Kári Stefánsson

According to research from deCODE genetics, at least 20% of Icelanders under 40 have already contracted COVID-19 and as many as 135,000 may have already had it. The company’s CEO Kári Stefánsson has called for abolishing all domestic restrictions in Iceland, including isolation and quarantine, in light of the low rate of serious illness caused by Omicron infections. “We have to respond to the data and I think the data is telling us that now is the time to see whether we can’t live a fine life without using quarantine or isolation,” Kári stated.

As elsewhere in the world, the Omicron variant has led to Iceland’s biggest wave of COVID-19 infection since the start of the pandemic. While the domestic infection rate remains high, the number of COVID-19 patients in hospital has begun falling. Local data shows the rates of hospitalisation due to Omicron infection are much lower than the rates associated with the Delta variant (0.2-0.3% for Omicron versus 2% for Delta).

Chief Epidemiologist: we must proceed slowly

When asked to comment, the Chief Epidemiologist did not oppose Kári’s thoughts on lifting domestic restrictions, including quarantine and isolation, but stressed the importance of proceeding in stages. “I think it’s wiser to proceed slowly rather than go too fast and then have to take a step backwards,” Þórólfur stated. “It would be a little tricky and difficult to do that.”

Iceland’s current domestic restrictions are valid until February 2. They include a 10-person gathering limit, mandatory mask use in shops and public transport, and the mandated closure of all bars and clubs. Þórólfur says he plans to submit recommendations to relax domestic restrictions next week. Health Minister Willum Þór Þórsson has given indications that he would be willing to relax them even sooner.

Steps taken to relax quarantine and isolation regulations

Þórólfur Guðnason, Iceland’s Chief Epidemiologist, will submit a memorandum to the Health Minister today that recommends relaxing the regulations on COVID-19 quarantine. According to Þórólfur, the recommendations allow for more people to be exempt from having to quarantine in the case of possible exposure to COVID. Þórólfur states that conditions are in place to relax social restrictions in Iceland, but it is important to do so in stages.

“What we are working on now with the [Health] Ministry and the Minister is to simplify quarantine rules and simplify testing. And I think it’s wise to start there,” Þórólfur stated. Authorities have already taken steps to relax quarantine and isolation restrictions, including by shortening mandatory isolation from 10 to seven days and exempting triple-vaccinated individuals (and double-vaccinated individuals who have recovered from COVID) from mandatory quarantine in the case of potential exposure. Regulations on isolation have also been relaxed, allowing individuals to leave their place of isolation for walks.

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: Chief Epidemiologist Preaches Patience as Authorities Adapt to Omicron Impact

Chief Epidemiologist Iceland Þórólfur Guðnason

Icelandic health authorities are reviewing their pandemic response measures to adapt to the impact of the Omicron variant, the country’s Chief Epidemiologist Þórólfur Guðnason stated at a briefing in Reykjavík this morning. Children are no longer required to submit to a nasal swab when they are tested for COVID-19, and authorities have loosened quarantine regulations for triple-vaccinated people. Þórólfur stated that isolation and quarantine regulations were under continuous review.

 

The Omicron variant now accounts for over 90% of COVID-19 infections in Iceland, the Chef Epidemiologist stated. As a result, hospitalisation rates due to COVID have dropped to 0.2-0.3%, down from around 2% when the Delta strain was dominant in Iceland. Nevertheless, Iceland’s National University Hospital is experiencing strain due to the sheer number of cases. Work has begun on researching and assessing the changing nature of COVID-19 illness as a result of the Omicron variant, which will help authorities refine their response efforts.

 

Þórólfur stated he would likely not recommend changes to Iceland’s domestic restrictions before the current restrictions are set to expire, on February 2. He emphasised the importance of proceeding slowly, as loosening restrictions too early could backfire and lead to a surge in infection rates.

 

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

 

On the panel: Chief Epidemiologist Þórólfur Guðnason and Director of Civil Protection Víðir Reynisson. The special guest at today’s briefing is Selma Barðdal Reynisdóttir, who will discuss how pandemic measures impact children and schools. 

 

Iceland reported 1,488 domestic cases yesterday (50% in quarantine) and 93 border cases, a total case number that has only once been higher, on December 30, 2021. Hospitalisations have, however, decreased in recent days. 

 

The briefing has begun. Viðir starts the briefing by introducing the panel and complimenting school staff and parents for their perseverance in keeping schools operating throughout the pandemic. Víðir says there is a “light at the end of the tunnel” and turns the briefing over to the Chief Epidemiologist. 

 

Þórólfur takes over and goes over the day’s numbers. With an increase in new cases but fewer people in hospital, the Omicron variant is still dominant in Iceland, at around 90% of new cases. The hospitalisation rate among COVID-19 cases is at 0.2-0.3%. When the Delta variant was dominant, it was at 2%. COVID-19 hospitalisations fall into three groups: people with severe COVID illness; people hospitalised for other issues who contract COVID at the hospital; and people hospitalised with other diseases where it isn’t clear if they’re related to COVID or not. 

 

The spread of COVID in Icelandic society has caused a great deal of interruption in the economy even if serious illness is now rare, Þórólfur says. Tightened restrictions took effect five days ago to temper the spread of infections. Þórólfur: we still haven’t seen success from the new restrictions, but in the past, we haven’t seen the effect of tightened restrictions until a week has passed. 

 

If infections are around 1,000 per day, we can expect 54 hospitalisations, according to one projection model, Þórólfur says. Another model of 2,000 infections per day and a 0.3% hospitalisation rate would have around 60 people hospitalised by the end of this month. The number of community infections affects the number of people who have to be hospitalised or require intensive care. Þórólfur emphasises that projection models always have a margin of error, one of the reasons we must try to minimise the spread of infection. 

 

Work is in progress to analyse the nature of the illnesses requiring hospitalisation to better assess which infection prevention restrictions will prove most effective in Iceland. Some modifications have already been made: children’s COVID tests no longer include nasal swabs, and quarantine regulations for those who are triple vaccinated have been relaxed. 

 

Þórólfur addresses criticism on his recommendations to the government, noting the extensive cooperation and consultation his work involves before each assessment is made. The list of collaborators includes healthcare workers, scientists, and university researchers, as well as police and international colleagues. While we wait for the tightened restrictions to make an impact, we must ensure to minimise the number of community infections in order to protect the healthcare system, Þórólfur says. 

 

Selma Barðdal Reynisdóttir takes over to discuss schools and children. The situation in schools varies across the country, from good to very difficult. Everyone is doing their best to keep up the daily routine for children and keep schools open. Luckily, quarantine and isolation usually only affects schools temporarily, but some have had to close for days due to infections. Staffing is a challenge in smaller municipalities, Selma says. The goal is always to keep up as much of normal services as possible, communication is key, says Selma. 

 

Selma maintains that for children and teenagers, including her own, the biggest threat of the pandemic is that schools will close and sports training will be cancelled, although she notes that there’s a difference between the capital area and smaller towns. Voices from the capital area, where the situation in schools is tougher, have been louder than in smaller societies where there are fewer difficulties in keeping schools open. 

 

Selma discusses her work on the surveillance team (vöktunarteymi), a helpful resource for schools, that is a ministry-run cooperative team with representatives from several educational institutions and municipalities. The team ensures oversight over the pandemic situation as it affects children, and meets regularly to keep an eye on things. Víðir takes over and agrees on the importance of this cooperative platform. 

 

The panel opens for questions. 

 

“Are you considering relaxing quarantine restrictions for fully vaccinated children?” Þórólfur says authorities are already making changes, such as not requiring nasal swabs for children’s COVID-19 testing. He agrees the situation must be monitored daily and updates implemented regularly. 

 

Þórólfur is asked if he is willing to reconsider his position to wait to issue new recommendations until the current regulations are set to expire on February 2. Þórólfur states that the work has already begun, with quarantines and testing processes being revised. It’s important not to move too quickly, as relaxing restrictions can backfire and lead to a surge in infections. 

 

Þórólfur is asked about the mandatory isolation period of at least 7 days: are you considering shortening periods, relying instead on quarantine and lighter options? Þórólfur met with Nordic colleagues this morning, who he says have imposed very similar rules to Iceland, though opinions differ on whether isolation can be shortened. But this is part and parcel of the ongoing process of rethinking quarantine and isolation, Þórólfur says. 

 

The National Hospital is working on assessing changes in the virus and associated illness, with more hospitalisations but fewer patients requiring intensive care, the hospital’s challenges are changing. The change in the virus’ behaviour due to the Omicron variant taking over is leading to changes in how healthcare authorities deal with the situation. 

 

Selma is asked about remote learning. Many schools offer options for remote learning and counselling, but that adds to teachers’ workload, and not all schools are able to offer it. 

 

Þóróflur is asked if the tightened restrictions last week were an overreaction. He replies that hospital management has consistently pointed out the strain on the hospital. While some doctors have offered other opinions, healthcare authorities’ message has remained consistent. Þórólfur also notes that all of Iceland’s healthcare institutions are now working according to contingency plans. 

 

Þórólfur is asked about vaccine safety, replying that the Iceland Medicine Agency issues marketing licenses after all requirements have been met. He denies accusations that the public is participating in “drug experiments”. Víðir closes the briefing by restating the authorities’ goals of tempering infections and protecting the healthcare system. The briefing has ended.

Iceland Tightens Domestic COVID-19 Restrictions

Minister of Health Willum Þór Þórsson

Tighter domestic COVID-19 restrictions take effect in Iceland at midnight, Health Minister Willum Þór Þórsson and Prime Minister Katrín Jakobsdóttir announced following a cabinet meeting this morning. The general gathering limit will be lowered from 20 to 10 people, and bars and clubs will be closed. Events and performances will not be permitted under the new rules – previously up to 200 guests could attend an event provided they presented a negative rapid test. The new rules will remain in force until February 2. 

At the press conference, Katrín Jakobsdóttir also announced that the government was preparing response measures to support tourism operators and event organisers. Insurance and tax deadlines for restaurants would also be postponed in order to ease financial strain in the restaurant industry. 

Iceland reported 1,113 new domestic cases yesterday and a total of 9,671 active cases. Chief Epidemiologist Þórólfur Guðnason has stated that daily case number must be reduced to 500 in order to protect the healthcare system. There are currently 43 patients in hospital due to COVID-19, eight of whom are in intensive care. Some 140 hospital staff are in isolation due to COVID-19 infection. While Omicron has become the dominant variant in Iceland, the Delta variant continues to cause cases of serious illness, causing additional strain on the National University Hospital’s COVID-19 ward.

Swimming pools and gyms may continue to operate at 50% capacity as before. Regulations for schools and after-school centres will remain unchanged, although the Health Minister stated that authorities would monitor the situation daily and respond to changes as necessary. 

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.