Inside Iceland's unique response to combating coronavirus

Inside Iceland's unique response to combating coronavirus

REYKJAVIK, Iceland – Gestur Palmason has shut down leads and profiled suspects in recent weeks, but those followed by the experienced policeman are not criminals but coronavirus carriers.

The 40-year-old with a shaved head is part of a team of “contact tracers” who work at the Icelandic National Crisis Coordination Center, the heart of this small country’s unique strategy to fight COVID-19, the disease-causing coronavirus.

“Somebody gets infected every second, so we obviously want to infect as few people as possible,” he told NBC News. “As soon as possible, we need to reach out to anyone who may have been in contact with someone who is positive and try to stop them before they come into contact with more people.”

Gestur PalmasonNBC News

Along with dozens of other top detectives, Palmason tried to find people who were in close proximity to known carriers of the virus – often just a few minutes after the original carriers received a positive diagnosis. The people he identified are placed in quarantine almost immediately to prevent further transmission.

In this remote and rough island nation with just over 364,000 inhabitants, on Friday morning there were almost 10,000 men, women and children – this corresponds to 9 million Americans – under this form of state-enforced lock and key.

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These contact tracking and quarantine measures are only part of what makes Iceland unique in its response to the pandemic. It is also being extensively and proactively tested in a way few other countries can, so rescuers can make informed decisions that they hope will minimize the effects of the corona virus. Officials and scientists are also leading the coronavirus response as the country’s politicians take a back seat.

Search and separate

A quick diagnosis is critical to the effectiveness of Chief Inspector Palmason’s work. Earlier this week, it was his turn to be tested on the fourth floor of a glass office building in the Icelandic capital.

Medical personnel in full personal protective equipment wiped their throat and nose deep before returning to their temporarily assigned work area, where various shift patterns separate their team from other employees to avoid cross-contamination. He later said he tested negative.

Last week up to 1,800 people were tested in a single day. Iceland has tested a far larger proportion of its population than anywhere else on Earth, including South Korea – another country touted for its effective response to the pandemic.

However, what makes Iceland unique is that test samples are not only taken from high-risk individuals who have shown symptoms, have come into contact with well-known transport companies or have returned from countries such as China and Italy, but are also offered to thousands of normal members the general population who are not symptomatic.

The data derived from these widespread tests show that almost a fifth of those from the high-risk population are positive for COVID-19, but that about 1 percent of the general population also carries the virus “asymptomatically” – without showing any obvious signs or experiencing the disease.

The early detection of these invisible and ignorant carriers has helped to break the transmission chains in Iceland. But it could also provide scientists in many other countries with important information about the pathology of the virus.

Deserted streets in Reykjavik, Iceland.Willem Marx / NBC News

A combination of contact tracking and genetic sequencing of each sample generates virus transmission data that researchers can then analyze to better understand the role of asymptomatic carriers, the point at which these carriers are most infectious, and the point of overall transmission rates this theoretically low risk population.

Unlikely media star

Common Icelanders praise the actions and behavior of the man responsible for the tests, the Icelandic chief epidemiologist Thorolfur Gudnason, who has become an unlikely media star thanks to his daily television updates. As a pediatrician specializing in infectious diseases, his country had been preparing for such a pandemic for years.

“We have prepared response plans for this event,” he said in an interview. “We have prepared various partners in society for this, so it is relatively easy for us to activate the plan.” A recent survey found that more than 90 percent of the residents surveyed largely supported the country’s current approach.

But the relentless nature of the virus could soon test this support. The country’s first positive diagnosis was in late February when an Icelander brought the virus home from a vacation in northern Italy. The island country’s remote geography and low population density may have helped protect the population slightly since then, but this week the authorities recorded the first death of an Icelandic resident, a grim milestone.

Officials involved in coordinating efforts to fight the pandemic insist that centuries of physical hardship have cemented a strong esprit de corps in the communities here and are causing trouble for Icelanders.

“When the going gets tough, we’re used to sticking together,” said Vidir Reynisson, chief superintendent of the National Commissioner for Icelandic Police, who is the commander-in-chief of the national response effort. “If we have something that connects us, we stick together, even if it’s in a difficult situation.”

And even if the aggressive tests reveal an increasing number of confirmed cases, chief epidemiologist Gudnason says that many of these new cases are identified among the cases that are already quarantined.

“We will probably have a more common disease because we test so many. This will affect our forecasting modeling, ”he explains. However, it is crucial for healthcare decision-makers to know how the virus can spread and spread. “This will affect how we assume how many patients we need to admit to hospitals and how many patients we need to admit to intensive care units.”

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The country’s health director, Dr. Alma Moeller says the epidemic is expected to peak in mid-April. In the worst case, based on current models, up to 20 intensive care beds with ventilators may be required to treat patients at the same time. At the moment, the whole country only has “13 or 14” places, so she focuses on increasing this capacity and increasing her workforce.

Closed shops in Reykjavik, Iceland.Willem Marx / NBC News

Tell stories through science

In addition to this impact on Icelandic healthcare, another aspect of efforts for scientists and policy makers around the world could prove useful. DeCODE, a biotech company based in Reykjavik, led the test drive among the “non-symptomatic” patients, but also volunteered for the genetic sequencing of each sample of the virus in its advanced laboratories and scientific team.

The company’s founder and CEO, Kari Stefansson, says this has expanded global knowledge of the virus by highlighting differences between different strains arriving in Iceland from different case clusters in Italy, Austria, the United Kingdom and the United States.

“I am blessed enough to be able to participate in the response to this crisis and not have to sit on the sidelines uselessly,” said Stefansson. As a sharp-tongued scientist with a dry sense of humor, his company has been a leader in genetic sequencing and research for more than a decade.

“Throughout my life, I wanted to tell stories through my science,” he says.

Now that his team is sequencing the molecular structure of each virus sample, he’s helping tell the story of the worst pandemic in a century. They found out what he calls the virus’ unique “barcode” and how it has changed over time and in different regions.

“These mutations not only give us a barcode, they may also give us an indication of how the virus is changing,” he says, “and may become more virulent” – that is, more contagious or deadly.

The former professor of neuroscience at Harvard University says a better scenario is that this coronavirus instead mutates into “a seasonal phenomenon like influenza.” He plans to release some of his team’s results shortly so that colleagues around the world can learn more about the virus as Iceland continues its own efforts to follow the Test, Test, Test strategy proposed by the World Health Organization.

“I won’t be proud until this is over,” said Moeller, the health director, a former intensive care specialist. “There is no best way to do this. But we use science and the best evidence there is – every moment. “


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