Sigrún Davíðsdóttir's Icelog

COVID-19 in Iceland – medical success (so far) but what do Icelanders really want?

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The Icelandic COVID-19 policy was less severe than in Denmark and, belatedly, in the UK. Iceland followed WHO guidelines to test, trace and then isolate – and COVID-19 cases have next to disappeared. The economy was in a healthy state at the beginning of the year, but the economic outlook is now bleak as the country’s three main sources of revenue are facing serious challenges: international tourism has been suspended, the market for fresh fish is seriously hit as restaurants in Iceland’s main markets are closed and price for aluminium is record low. With COVID-19 cases almost extinct, Icelanders are again out and about but now is the time for the existential questions: if Iceland should not aim for something more sustainable for the nation than the windfall of international tourism?

As a nation used to natural disasters, Icelanders have a well-developed rapid reaction team, Almannavarnir, recently tested by COVID-19 – and, as most Icelanders will tell you proudly, the team and the authorities have, so far, done well in beating the virus. The success strategy has been tracking, testing and isolating confirmed cases. One myth has already risen: that every Icelander has been tested. That is not the case but by 7 June, 62,795 tests had been carried out, in a population of 364,000; equivalent to having tested almost 1/6 of the population, probably the highest ration in any country.

The Icelandic name Almannavarnir is familiar to every Icelander and rather more appealing than its English name, Department of Civil Protection and Emergency Management, DCPEM. The Civil Protection responsibilities at the national level are delegated to the National Commissioner of the Icelandic Police, NCIP. This Department, together with Landlæknir, Directorate of Health, DoH, has orchestrated action against the Covid-19 transmission.

The three, by now, famous faces in Iceland leading the virus team – Alma Möller head of DoH, her colleague Þórólfur Guðnason Chief Epidemiologist and Chief Superintendent of the NCIP Víðir Reynisson – conducted daily televised press briefings. To add some fun during the Icelandic lock-down, the COVID-troika joined Icelandic musicians, singing about travelling inside our houses and maybe, if adventurous, camping in the garage. It was not the government but this troika that every day told Icelanders what they could and could not do, gave good advice on mental health and on the whole, informed the nation in a kind and caring way.

Knowing the pattern of social interaction in Iceland, where distances are short, car ownership high and social networks tight, it was not surprising that once the virus was spreading in Iceland – the first case was confirmed on 28 February – the initial transmission was ominously rapid. The policy was to track, test – and then isolate those who were infected.

The measures have not been as drastic as in Denmark and the UK but more severe than in Sweden. The first measures, by mid-March, encouraged social distance and limited social events. By now, June 7, Iceland seems more or less COVID-free; there have been 1807 confirmed cases, with 10 deaths. The webpage covid.19 (also in English) provides information on everything related to the virus in Iceland.

For the time being, anyone arriving in Iceland has to go into quarantine for two weeks. From June 15, anyone arriving in Iceland has the option of paying ISK15,000 (EUR100 / GBP90) or go into quarantine. Tourists are few and far between and their disappearance is already very visible: in April last year, 474,000 tourists visited Iceland; this year they were 3,000, a fall of 99,3%. Icelanders will be able to travel outside their own homes this summer, but they might enjoy the novel experience of mostly having their country to themselves.

A far-away-virus, rapidly very close

At the WHO headquarters in Geneva, the year 2020 began with an alert: on January 1, WHO set up an Incident Management Support Team, responding to an outbreak, reported on the last day of 2019 by Wuhan Municipal Health Commission where doctors had noticed a cluster of pneumonia cases. The first case might have sprung up in early December. On January 12, Chinese authorities had shared the genetic sequence of a new corona virus, Corona Virus Disease 2019 or COVID-19.

On January 13, the first case outside of China was confirmed, in Thailand. On that day the Icelandic DoH put out its first press release on the new virus, also sent to all health institutions in Iceland. The DoH pointed out that both the WHO and European Centre for Disease Prevention and Control, ECDC, had published notes on a pneumonia epidemy in Wuhan, caused by a coronavirus, but different from SARS and MERS.

Icelanders were informed that anyone who had been in Wuhan and developed fever and cold should contact a doctor but only if the symptoms were severe. An updated DoH press release that same day added five advices: wash hands; stay away from people who show signs of cold; stay away from animals, also wild animals; sneeze into a handkerchief; contact health workers if symptoms developed after a trip to China.

Late January: Icelandic authorities fully expect the new virus to reach Iceland

On January 24, DoH announced it was responding to the new virus according to Icelandic law and WHO guidelines. Three measures were put in place: 1) Information on hand at Keflavík Airport, for passengers who had been in Wuhan the previous two weeks; 2) Icelandic health institutions were being informed on preparedness. 3) A COVID-19 website with daily updates was opened, both for health workers and the general public.

On January 27, noting the transmission of the new virus to Taiwan, Thailand, Australia, Malaysia, Singapore, France, Japan, South-Korea, US, Vietnam, Cambodia, Nepal, as well as China, DoH underlined that it fully expected the virus to reach Iceland. At the time, there were 2800 confirmed cases worldwide, 2775 in China, the rest in single-digit numbers spread over the other twelve countries.

By January 29 the DoH advice was: don’t travel to Wuhan and avoid all unnecessary travel. On February 24, the focus changed: the COVID risk had reached Europe and DoH now advised against unnecessary travel to four Italian regions: Lombardy, Emilia Romagna, Veneto and Piemonte.

Two days later, the China and the four Italian regions were defined as risk zone. No one should travel there but anyone who had been there recently should go into quarantine. Any non-essential travel to South Korea and Iran should be avoided and those visiting other parts of Italy should take great care as well as those visiting Japan, Singapore, Hong Kong and Tenerife, where thousands of Icelanders, especially older people spend weeks and months over the winter. Also, people were now told to contact doctors by phone if they showed symptoms instead of going to the A&E or other health institutions.

First confirmed COVID-19 case in Iceland: February 28

By late February, the DoH was releasing COVId-information almost daily. On February 27, Icelandic health officials started testing for COVID-19 in Iceland among people who were returning from risk zones. That was also the day when the Icelandic COVID-troika, Alma, Þórólfur and Víðir, held their first press conference, streamed live in the Icelandic media. After testing 111 people on February 27 and 28, an Icelander who had been skiing in Northern Italy was confirmed positive on the 28th.

On February 29, a plane from Verona was met by health workers; passengers showing symptoms were tested. By March 1, there were two additional cases confirmed, again people returning from skiing trips on flights from Verona and Munich. The DoH defined the whole of Italy as a risk zone.

There were now 300 people in quarantine: passengers on the same flights as those, testing positive, were asked to isolate at home for two weeks. Foreigners travelling to Iceland on these flights were not asked to isolate since they would be less likely to interact with Icelanders in care homes and hospitals, the main causes for concern.

DoH was testing avidly: on March 2, 150 were tested, 180 the following day, as part of the program already in place of testing, tracing and isolating.

On March 4 ten people tested positive for COVID-19, bringing confirmed cases to 26. Since all of them had recently returned from Northern Italy and Austria they were already in quarantine. At this point, 380 people were in quarantine and testing facilities were being scaled up. So far, there was no confirmed community transmission of the virus, but the rapidly rising number of infected people was ominous.

Famously, on March 4, prime minister Boris Johnson said at a press conference he had shaken hands with people as he visited a hospital with COVID patients. That day, there were 87 confirmed COVID cases in the UK and rising rapidly.

DCPEM pointed out there was as yet no ban on social gatherings but stressed the importance that those who had been to risk zones respected the advice on quarantine. Contrary to the message Johnson was giving, the DCPEM asked people to avoid touch; no shaking hands or hugging.

Iceland and the Ischgl saga

Icelandic authorities were quick to spot a pattern: Icelandic skiers returning from Ischgl were particularly likely to have caught the virus. DoH added Ischgl to its list of risk zones on March 5. On that same day, the Chief Epidemiologist wrote to Austrian health authorities, pointing out that this popular skiing destination seemed the hot spot for the Icelandic COVID-19 cases.

It turns out that the Icelandic concern was the first indication from abroad to Austrian authorities that something was seriously wrong in the Tyrol skiing village. The Ischgl COVID-19 saga is clearly central in the spread of the virus in Europe: not only skiers from Iceland but also from the other Nordic countries, Germany and the UK, caught the virus there and transported it back home just as Europe was waking up to the fact that not only in Italy was the virus spreading rapidly.

Austrian health authorities later concluded that Ischgl was the largest virus cluster in Austria, infecting as many as 800 Austrians and twice as many foreign visitors, who then transmitted the virus to friends and family on returning home.

Small groups of friends and colleagues seem to have been the major part of the skiers who visited Ischgl, a merry crowd as can be seen on numerous pictures and videos on the internet. Sharing whistles to call for more beverages was part of the fun. This was a very lucrative business for the 1600 inhabitants who during the ski season welcome around 500,000 tourists.

Total denial was the first response from Tyrol authorities to the Icelandic letter: no, there was no indication of the virus spreading in Ischgl; most likely the Icelandic skiers had been infected on the plane, among skiers returning from Italy. – However, the Icelandic authorities were absolutely sure: the travellers had been ill as they boarded or became ill during or immediately after their return trip, which excluded transmission on the plane.

Change of heart: no more “Ibiza of the Alps”

On March 7 health authorities in Tyrol reluctantly confirmed that a bar tender at one of the most popular bars, Kitzloch, had tested positive but their conclusion was that there was no reason for further tests. Instead of seeing the bar tender as a super-spreader, the Tyrolians concluded, with no clear arguments, that it was unlikely he had spread the virus. It took two more days to order Kitzloch closed, on March 9.

By now, pressure on the Ischgl Municipality to react was growing. On March 12, a week after the letter from Iceland, the Ischgl Municipality announced that all ski facilities, hotels and restaurants would close, at least until Mid-May. The next day, the police were guarding road blocks on all roads to the village. And so, the ski season ended early in Tyrol this year, with a lockdown.

The source of contagion in Tyrol has been a hot dispute in Austria: Austrian health authorities now believe that the Patient Zero in Ischgl was a waitress who fell ill already on February 8. Tyrolian authorities have stuck to the story of the first case March 7. British media claim that an Englishman, who visited Ischgl with two friends, fell ill with COVID-19-like symptoms on returning home January 19, as did his two friends, from Denmark and the US. All of them spread the virus in their communities.

The Austrian Consumer Protection Association, VSV is now preparing a class action lawsuit against both public authorities in Tyrol and owners of hotels and bars in the resort; five thousand people, who were in Ischgl at the time of the breakout, have signed up, most of them Germans but also Dutch and British people and one Icelander.

In the European COVID-19 saga, Ischgl has become the prime example of a place where economic interests took precedence to the safety of people, both inhabitants and visitors. Following this sorry saga and the lockdown, the inhabitants of Ischgl have had a rethink: they now want to cater to quality tourism instead of the rowdy party tourism of “Ibiza of the Alps.”

Iceland: ban on social gatherings announced March 11

Back to Iceland where DoH and DCPEM were rapidly preparing measures to come to grips with the transmission. On March 6, when two community transmitted cases were confirmed with no obvious links to travels abroad, a state of emergency was declared but so far, nothing much changed. Not yet.

On March 13 emergency measures were announced, to be in place two days later, from Monday March 16, for four weeks, until Monday April 14. A lockdown yes, but not quite as harsh as the UK lockdown announced whole ten days later, from March 23. From March 16 the general outlines in Iceland were no social gatherings of more than hundred people and 2 metre social distancing.

Schools, from primary schools to universities, could now have no more than 20 pupils in a classroom. The groups were to be segregated at all times, also during breaks, meaning that there had to be staggered lessons and division in all spaces. Nurseries were not restricted by numbers but advised to keep the children in as small groups as possible.

In principle, nothing needed to be locked completely, so long as these measures were met, meaning that restaurants, gyms and swimming pools were still open. Shops were never closed down but had to respect social distancing and crowds, in case of supermarkets.

The deCode testing

deCode is a genomic company, set up in Iceland in 1996, now owned by Amgen. deCode’s operations in Iceland have long been controversial and the same counts for the COVID-screening.

From March 13 people could apply for free screening. It caused some anger when it turned out that the testing site was in the largest office block in the Reykjavík area, where plenty of people still came in to work everyday. Also, those who were tested did not have to sign any informed consent form.

In an article April 14 in the New England Journal of Medicine, co-authored by both the Icelandic Chief Medical Officer, Alma Möller and the Chief Epidemiologist Þórólfur Guðnason, the conclusion is that the virus has infected 0.8% of the population. As known from elsewhere, children under 10 years of age were unlikely to be infected and females less likely than males.

Further, deCode has concluded that 0.5% of Icelanders got infected. Antibody test done by deCode shows however that around 1% of those who were tested but shown not to have the virus and who did not go into quarantine have COVID-19 antibodies. The deCode conclusion is that three times the number of those who were confirmed infected did get the virus and a large number of them did not fall ill. Another finding is that 90% of those who did get infected by the virus have antibodies. Two percent of those who did go into quarantine but tested negative for the virus do have antibodies.

With these results in mind, Amgen lab in Canada is working on a vaccine, partly made from blood from Icelandic COVID-patients. If successful, this vaccine would be used to help patients already ill with the virus.

A biting ban, from March 24

The second and harsher lockdown was announced March 22, due to start two days later: social gatherings of more than twenty people were now banned; the beloved public swimming pools – the Icelandic agora – were now closed, as well as gyms and museums, churches and cinemas and all events and public gatherings forbidden. Any form of public sport or sport in sport clubs was banned as well as work needing physical contact such as hairdressing and massage. Still, restaurants and cafés could remain open but could max have twenty guests, socially distant, at any one time.

Older people were advised to self-isolate as much as possible, staying away from children, grandchildren and other relatives. In Iceland, where family meetings are a large part of people’s social life this meant a huge change. Anecdotal evidence shows that most people followed this religiously, even from early March, before the measures taken.

The modelling

The first COVID-19 casualty in Iceland was on March 16: a tourist who came to the hospital in Húsavík on that day, already severely ill. On March 21, 473 cases of COVID-19 had been diagnosed in Iceland. Ten of them were hospitalised, one in intensive care.

According to a model by Lýðheilsustofnun, the Centre for Public Health, at the University of Iceland, the prognosis was that the disease would peak in early April, with 600 to 1200 cases, thirty to 130 would need to go to hospital and ten to thirty need intensive care. The intensified measures on March 22 were put in place in order to avoid the worst case scenario, which by 23 March were 2000 cases, at a peak in early April, but possibly as many as 4500 (see here on the UoI modelling).

The public policy and people’s efforts have paid off. In total, by 7 June, confirmed COVID-19 cases were 1807. In May there were only seven new cases, in June one so far; 1794 have recovered, 3 were still isolating; 922 are now in quarantine, 21,217 have been in quarantine. In total, there have been 62,795 tests. In a population of 360,000 this level of testing is probably unique. No COVID-19 patient is now in hospital. In total, ten people have died of COVID-19 in Iceland.

Iceland – opening up to a new reality

On April 21 the COVID-troika announced that the first steps towards easing earlier restrictions would be taken on May 4, thus giving schools and businesses the time to prepare. The major change on 4 May was that social gatherings of 50 people were now allowed, up from the previous figure of 20. The luxury of a hair-cut and massage returned. All restrictions on nurseries and schools offering the obligatory education (to age of 16) were lifted. Colleges (from age of 16), universities and other schools could now open.

May 18 was a day of celebration in Iceland: the swimming pools could open on midnight. Many pools did just that, opened at midnight and kept the pool open through the night. People started queueing up early evening.

As of May 25, social gatherings of up to 200 people are again allowed. Gyms are now open and, as the swimming pools, only allowed to take half the number of people they have the license for.

Icelanders are urged to stick to social distancing of 2 metres where possible but the emphasis is now on protecting vulnerable people, whereas the general public should be prudent and take care of itself. Social distancing is no longer a requirement at restaurants, cinemas and theatres, but vulnerable people should be able to require seats with social distance. The Icelandic Symphony Orchestra has already given three public concerts at Harpa, the concert house by the harbour. Families and groups of people could by seats together, but there were two empty seats between each cluster.

For the time being, there is a mandatory two weeks quarantine for everyone coming to Iceland, whether a visitor or living in Iceland. This restriction is due to end 15 June but will be replaced by COVID-19 test at the airport, at ISK15,000 (EUR100 / GBP90), for everyone born before 2005. Those unwilling or unable to pay, will have to go into quarantine.

After introducing the new COVID-19 regime on Monday May 25, after 73 daily meetings, the Icelandic COVID-troika decided the meeting that day should be the last such meeting. Iceland is not entirely back to normal, but the restrictions are less obvious than earlier.

“Two tourists spotted by Mývatn”

By late April, tourists had become a rarity in Iceland as elsewhere. The hotel manager in Mývatn told Rúv that normally at that time of the year he would have been welcoming groups of tourists and new staff, busily preparing for the summer. Instead, the hotel had not had a single guest for a month, but as the headline indicated, he had spotted two tourists in the area. That was all.

In late May, an Icelander sent me a photo of his car at the parking lot by Gullfoss, even in winter always with many buses and cars. This time, his car was the only vehicle there.

As other countries, Icelanders are still trying to figure out what the near future will be like. One thing seems certain: tourists are not out-crowding Icelanders in Iceland this summer. Tourists are few and far between. For those who dream of Iceland like it once was, being alone at Þingvellir or Gullfoss, this is the summer to go to Iceland.

The Icelandic tourist sector is preparing to receive Icelandic customers this summer. Tourist information, mostly available only in English, is being translated into Icelandic. And, from anecdotal evidence, prices are being cut, by as much as a third.

That will be popular among Icelanders who tend to be continuously upset by prices when travelling at home. One commentator said Icelanders were almost too stingy to go swimming when travelling in their home country. Interestingly, Brits travelling in the UK, only spend a third of what they spend once they have left their island; Icelanders might be similar.

Icelanders already planning trips abroad

In addition to Icelandair, SAS, Transavia and Wizz Air have put Iceland on their flight schedule this summer. It seems that from Mid-June there will be plenty of flights to choose from, though obviously nothing like before. The Advantage Travel Partnership, one of many to protest the UK government’s obligatory quarantine for everyone entering the UK from June 8, have put Iceland as number 8 on the list of countries with which they would like to see the UK negotiate an air corridor, with Spain, Greece and Turkey topping the list.

A poll shows that  13% of Icelanders plan to travel abroad already now in summer, with that figure up to 25% in autumn. Half of Icelanders intend to wait until next year, ten percent have no travel plans.

Denmark has lifted travel ban on Norwegian, Finnish and Icelandic tourists, but really does not care to have the Swedes coming over. Iceland is part of the Schengen area, where Germany and many other countries plan on easing travel bans by June 15, also expanding the choice of travel for Icelanders.

The COVID-19 triple whammy on the Icelandic economy

The prospect for the economy is not very bright, mainly because Iceland is very dependent on the economic wellbeing of its main trading partners. The Icelandic crisis benchmark has been the banking collapse in October 2008: after a savage contraction of 6.6% of GDP in 2009 and 4% in 2010, Iceland jumped to 3% growth already in 2011.

Sadly, the COVID-19 hit on the economy might be much worse. In addition, it is a triple whammy hitting the three main Icelandic export sectors: tourism, aluminium production and fish export. Tourism could contract by 27%, aluminium export by 2% and fish export by 8%.

The outlook for last year was a slight contraction of 0.2-0.5%. It now seems the real outcome was rather better, or a growth of GDP of 1.9%. A mid-May forecast (in Icelandic) from Landsbankinn for this year, envisages a contraction of the economy by 9% of GDP, turning into 5% growth in 2021 and 3% the following year, admittedly all with great uncertainty.

Given that tourism, directly and indirectly, has been a major source of employment in Iceland, unemployment has shot up. The forecast for this year is a peak of 13% in summer, 9% by the end of the year, with 7% and 6% in respectively 2021 and 2022. All shockingly high figures for a country that has had a fairly steady employment for the last several years: since summer 2016, unemployment has been hovering around 3%, down from just under 5% in January 2013.

Of other key indicators, the Landsbankinn forecasts big negative movements: private consumption contracting by 7%, import by 23% but balance of payment still positive because of reduced import and hardly any foreign travels.

Nothing like the 2010 Eyjafjalljökull eruption

After the April 2010 eruption of the famous glacier with the unpronounceable name, Icelanders feared the eruption would scare tourists away and devastate the fast-developing Icelandic tourism.

In hindsight, the eruption had the opposite effect: it died out quickly and the spectacular photos captured the imagination. After all, Iceland had already enchanted travel writers and adventurous travellers. The eruption came less than two years after the October 2008 banking collapse, which also created many headlines since Iceland was the first country brought to its knees by the financial crisis. The banking crisis was widely reported on with glorious landscape photos and many foreign journalists gave the Icelandic crisis saga a heroic twist, not recognised in Iceland.

This time, Iceland is not alone to suffer; most countries do, though to a varying degree. But this time, as following the financial crisis, Iceland has a rather good story to tell, actually a much better one than many other countries: the Icelandic authorities did not dither but took action very early. This will all later be scrutinised but though the measures were harsh, it was not a lockdown since schools and nurseries were not completely closed. Iceland certainly slowed down but did not come to a standstill and though the main emphasis was on working from home, most workplaces did remain open.

Now, Iceland can offer virus-weary tourists the possibility to take a vacation in a, so far, relatively safe environment. Some health workers think the government is slightly too keen to open up the country. There is also a hefty debate in Iceland, to some degree similar as the one in Ischgl: do Icelanders really want so many foreign tourists in Iceland? Is this the best path to a sustainable economy? Hopefully this healthy debate might be starting, another saga for another day.

Follow me on Twitter for running updates.

Written by Sigrún Davídsdóttir

June 7th, 2020 at 10:08 pm

Posted in Uncategorised

One Response to 'COVID-19 in Iceland – medical success (so far) but what do Icelanders really want?'

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  1. Based on my experience in my homeland Goa, I had foreseen deleterious effects of runaway, uncontrolled tourism in a comment on this blog in 2010 (http://uti.is/2010/12/iceland-bubbling-with-creativity/#comment-114). And that comment was made much before the advent of the Instagram era (2014 onwards) and the birth of the ‘bucket list’ hordes.

    Alas, what was envisaged did come to pass – the Disneyfication of Iceland. I don’t think the genie can be (or will be) put back into the bottle. From what I hear, they have bigger plans for even more footfalls.

    Mass tourism is a stupid, lazy approach to undergird a country. It ruins not only the land but also the character of the host society.

    Rajan Parrikar

    25 Jun 20 at 2:31 pm

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