Not Letting Panic Guide Us: Chief Medical Officer Alma Möller On How Iceland Is Dealing With COVID-19

As some countries close their borders, screenings and tests are either too expensive or impossible to get a hold of, and even some world leaders take up science-denying rhetoric, Iceland has distinguished itself in its fight against the spread of the novel coronavirus. This has involved a concerted effort by the Department of Civil Protection and Emergency Management, local and national authorities, and the office which oversees Iceland’s healthcare system, the Directorate of Health.

As Chief Medical Officer Alma Möller heads this office, and has been at the front lines in Iceland’s fight against the virus from the start. She’s been a part of the daily press briefings that have kept the country informed, the screening and quarantine operations that have helped slow the virus’ spread, and the creation of the information site—covid.is—which is loaded with helpful resources in both Icelandic and English.

Iceland’s advantage

Contrary to what you might have heard elsewhere, the novel coronavirus is not like the flu; in many ways, it’s worse.

“It’s a new virus that we haven’t seen before, and it’s always cause for concern when a new epidemic arises,” Alma tells us. “We know that this virus is more contagious than influenza, and we know that it results in more people becoming seriously ill. There isn’t any vaccine or cure. We see what’s happening in China and what’s happening in northern Italy, and this has caused us concern and prompted us to take more extensive measures.”

Iceland’s edge in the fight against the novel coronavirus is a combination of both policy choices and its small size.

“What’s good about Iceland is our small size, and how easy it is to reach people. It might also be good to be a small nation, as it can make the health care system more extensive and exact.”

“What makes Iceland special is that we have this good civic protection system, and a good emergency response system,” Alma says. “[Also good are] our small size, and how easy it is to reach people. It might also be good to be a small nation, as it can make the health care system more extensive and exact. Our response in Iceland has actually been growing a lot since the end of January, while other nations have maybe not taken any large-scale responses. We started by educating the general public, and have been doing so for a long time now. Then we’ve been trying to test for the virus early, and put people [who test positive] into isolation. We’ve tracked paths of transmission while having people go into home quarantine. Isolation is for people who test positive, and quarantine is for those who may have had contact with the virus without us yet knowing.”

“Now we’ve gone a bit further in our response, by instituting this public gatherings ban,” Alma explains, referring to the ban of gatherings of more than 100 people that went into effect on March 16th. It has since been amended to limit gatherings to no more than 20 people, maintaining a two metre distance between people at all times “We’re also protecting those who are the most sensitive to COVID-19; the elderly, and those with certain pre-existing medical conditions. We want to protect those from infection as best we can. All of these responses are to slow down the spread of this epidemic, so that we don’t get many cases in just a few days.”

Alma points out the oft-touted “flattening the curve” approach; that protective measures help keep the number of people treated within numbers that any given country’s health care system can handle. This has been a central theme in the Icelandic response.

Photo by Art Bicnick

The deCODE screenings

In mid-March, prior to a shortage of testing pins, deCODE Genetics was taking samples from roughly 1,000 Icelanders per day. Preliminary results from testing the general public indicate that the novel coronavirus is not widespread in the country, and could be as low as less than 1%. In fact, deCODE CEO Kári Stefánsson speculates that “it’s likely that those who have reason to believe they may have contracted or come in contact with the virus are more likely to come to us.”

Alma, for her part, remains cautiously optimistic.

“This is a small sample size that deCODE [has collected], but it indicates that under 1% of those in the greater Reykjavík area are carrying the virus,” Alma says. “It’s difficult to comment definitively at this time, but if this percentage bears out, then it’s perhaps lower than we expected. This also encourages us to continue on with the same measures we’ve already been taking. It shows that they’re working; that the virus isn’t spreading out. So it would be wise to continue with what we’ve been doing; screening early, quarantining and isolating. It’s just not known anywhere in the world what percentage of the general population has the virus; we only know how many people have gotten very ill. As it’s a new epidemic, it’s very important to get better information.”

The criticism

Alma emphasises that there are as yet no plans to increase or intensify the measures Icelandic authorities have already taken, saying, “This screening is ongoing and we’ve already done a great deal, and it’s working, but we are continuously assessing the situation.”

“Our goal is to tell the truth, and we make decisions based on the facts that we have. It’s very easy to judge after the fact, but all the decisions we make are based on the best knowledge we have at that given time.”

Not everyone has been satisfied, though. Across social media, armchair diagnosticians have called for Iceland to raise the threat level, take more drastic measures, or even shut its borders entirely. Alma advises that people look at the situation accurately and not lose their heads.

“I think the numbers that we have here [on rate of infection in the general population] don’t support that criticism,” she says. “But of course, we always welcome criticism, and continue to assess the situation. As things stand now, our measures have been working, and no decisions have been taken in a state of panic.”

Please don’t break quarantine

Up until now, those who have been placed in quarantine have been advised to stay home. They are not kept in isolation—as has been said, isolation is for those who test positive, while quarantine is for those who may have caught the virus but are still waiting on results. There have been some dubious reports of people breaking quarantine, and at the time of this writing authorities have just announced that they will be doing phone checks to make sure people in quarantine stay home. In addition to breaking quarantine potentially endangering the general public, those who do so may face criminal penalties.

“There have been some tips to the police that someone has broken quarantine, and in a very few cases that has been the case,” Alma tells us. If someone does break quarantine, then according to Icelandic law on infectious disease, it is possible to enforce penal law. But thus far we haven’t had to do that, as people are in general doing well and listening to orders, as this is something everyone should do.”

“Our goal is to tell the truth”

Regardless of Iceland’s effective approach, Alma maintains that the emphasis on personal responsibility is not unique to Iceland.

“As things stand now, our measures have been working, and no decisions have been taken in a state of panic.”

“We’ve maybe acted sooner in getting these health guidelines out to people, but I think this is the key component,” she says. “And I think it’s easy for us to get this information to the public, because we’re so few. Our goal is to tell the truth, and we make decisions based on the facts that we have. It’s very easy to judge after the fact, but all the decisions we make are based on the best knowledge we have at that given time.”

She also points out the website, covid.is, which is a veritable wealth of information on how to stay safe and keep others safe as well.

There’s no telling how long this situation may last. Things may get better, and they may get worse. The situation changes from day to day. At the very least, however, Icelanders are not kept in the dark about the current state of things, they have full access to the country’s health services, and all the information one might need is just a few clicks away.

As ever, those looking for more information or advice should go to the Icelandic Government’s excellent COVID-19 help page.

Tune into our daily COVID-Cast for a deeper dive into the day’s developments.

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