Flatten the Curve - Iceland Battles COVID-19 Epidemic — Journalist & Photographer Iceland

Data last updated on June 14th.

Reykjavik is empty. Most Icelanders are starting to practice social distancing. Daily news is devoted to the COVID-19 pandemic.

Paranoia but with good reason? Are you disinfecting your hands so often that they are beginning to dry up and chap? Is the gentle tickle in your throat just that, or is it a dry cough for something more serious? Do you also feel like saying “bless you” has lost its meaning when you actually have to fight the urge to shun the one who just sneezed?

Apart from the weather, coronavirus is the most popular talking point in Iceland right now, with 473 COVID-19 cases confirmed in Iceland by March 21st. The outbreak that devastated a major city in China has found its way to mainland Europe and now to Iceland. People here are worried. In mainland Europe, supermarkets are empty and fights are breaking out over the last toilet paper.

Tuesday, March 17, 2020. Two people were sitting on a beach in downtown Reykjavik in a sunny afternoon. The city looked empty. [Photo by Christine Einarsson (Tína) | Tína Einars photography]

Iceland’s Curve

Iceland started testing for COVID-19 on February 1st, with the first COVID-19 case being confirmed four weeks later, on February 28th. A male in his forties who had recently returned from Northern Italy.

Subsequently, the National Commissioner of the Icelandic Police activated the ‘Department of Civil Protection and Emergency Management’ alert phase in consultation with Iceland’s Chief Epidemiologist. On March 6th, local transmission in Iceland was confirmed.

Iceland has to join the battle to flatten the curve.

“Flatten the curve” is an expression derived from the widely-used graphic in this epidemic. The goal is to use collaborative efforts, including practicing social distancing, so we have fewer and fewer newly confirmed cases and protect the most vulnerable so that when the outbreak reaches its peak, the number of people who are confirmed with COVID-19 remains below the health care capacity. It’s a successful strategy implemented in most affected countries. As the epidemic develops in Iceland, the chart below will be updated accordingly.

Watching a global pandemic on this scale unfold, where every day holds multiple new Coronavirus-related news stories, can be hard on your mental health. I personally experienced the impact of the virus during the initial coronavirus outbreak in China. I wasn’t directly in the concentrated area of Wuhan, but my parents live on the east coast of China (if you are into beer brands, you might have heard the name Tsingtao). I visited them during the Lunar New Year, that’s also when the outbreak started to unravel and increase drastically.

Isolation in China

For two weeks, I stayed at home in isolation with my parents, only making essential outings for groceries, prepared with masks on our faces, hand-sanitizers in our pockets, and stress on our minds. Wherever we went we had to have our temperatures taken before we went in. We had our names, IDs, temperatures and the time written down. If people came in a group, only one person from the group would write down all the information and then have their hands sanitized - I thought it was very efficient both in saving resource (only one person touched the shared pen so one person needed the sanitizer) and keeping track of things.

The city, Qingdao, has a dense population of more than six million residents and so far it has 61 confirmed cases, one of whom is a student returning from overseas. In all these cases, the local press release put out information on the chain of transmission so when a case was confirmed, their whereabouts were traced and people in close contact alerted and quarantined.

Needlessly to say, it’s a lot of work. People put life on hold only to focus on fighting this battle. Now, it’s contained, and everyone contributed.

Feburary 3, 2020. An empty street in Qingdao, Shandong, China, where a police van was parked on the side of the road. [Photo by Yanshu Li]

In early February Finnair canceled all its flights to and from Beijing starting February 6th. My flight was scheduled on February 5th, so that was lucky!

First Self-Quarantine in Iceland

I was told to self-quarantine right away after I arrived home in Iceland. After writing an email to Landlaeknir, they suggested I contact a local health care provider if I develop symptoms, which thankfully I didn’t need to do as I was fine. Two weeks passed just like that. It wasn’t too difficult.

My quarantine ended on February 20th and by that time, Iceland had zero cases. Italy had four- all traceable. The United States had 1 but China had 75,465.

My parents thought I went back to a safer place so they were relieved.

Exactly one month from that day, the world has completely changed. The epicenter shifted to Europe and soon the United States.

February 3,2020. One of the busiest streets in Qingdao was void of the usual buzz, only deliveryman were on duty as they were a big help during the difficult time. [Photo by Yanshu Li]

March 16, 2020. A man walking on an empty street in downtown Reykjavik, where it’s supposed to have more traffic. [Photo by Christine Einarsson (Tína) | Tína Einars photography]

Outbreak in Iceland

Alma Möller from Landlaeknir, the Directorate of Health in Iceland, stated in a program at RÚV with great reservations that the epidemic is expected to peak on April 10th, give or take five days. Until then, there will be 1,200 to 2,000 infections cumulatively. Iceland has 26 ventilators in Reykjavik and three in Akureyri, besides 15 donated by Icelanders living in the United States, and another nine coming soon. If her prediction is somehow correct, and when more infections lead to more people in the need of intense care, Iceland’s medical resources will be scrambling to have things under control, especially if people don’t abide harsher rules for social distancing.

If you want to see how it’s spreading globally, here are some maps by The New York Times which constantly updates the current situation, and the newspaper’s COVID-19 coverage is outside the paywall.

Back in Iceland, the testing effort was solely from the Department of Microbiology at the National University Hospital of Iceland. On March 14th, deCODE, a private company joined the force, with the intent of screening the entire Icelandic population for the coronavirus.

According to statistics, in the latest census, Iceland’s population reached 364,134 by 1 January 2020, a 2% increase from the previous year. At the end of 2019, the Capital Region of Iceland had 233,140 inhabitants, which is roughly 64% of Iceland’s entire population. The Capital Region has more confirmed coronavirus cases.

There are eight regions according to covid.is data. The map below shows the confirmed cases in each region, a larger circle means more cases. Hovering on the circle, numbers will pop up. A comprehensive version of the maps can be found here.

Please note that, to date (March 20), there are 7 confirmed cases and 20 people in self-quarantine whose locations are unknown, while 4 people are in quarantine abroad, according to covid.is.

Donald McNeil, a science and health journalist who has covered epidemics including AIDS, Ebola, and SARS, said in a news program at MSNBC that the most effective way to contain the virus is by testing and breaking the chain of transmission. By diagnosing those infected as soon as possible, isolating them, and asking the rest of the population to stay at home (social distancing) we can work to mend the sickened and protect the healthy. One key point he mentioned, which was also a strategy Wuhan, China has later implemented, is keeping suspected cases away from their families and to separate suspected cases into self-quarantine away from their healthy family members.

I haven’t heard any news about Iceland using this approach.

Second Self-Quarantine in Iceland

I visited the States for a journalist conference in early March and went back to Iceland on March 9th. One day later I received an email from the conference saying that one attendee was confirmed with coronavirus. I called 1700 (Iceland's designated hotline in this epidemic) in the afternoon and I was the 40th in the queue.

After about 45 minutes of waiting, I got through. The nurse suggested I call my local health care provider to see if a test was needed. The local clinic suggested I quarantine at home for two weeks since my symptoms (sore throat, congested nose, and slight chest pain) can be either from my previous, not entirely recovered bad cough, or a mild COVID-19 infection. It wasn’t enough to make the cut for the actual test. So I had to stay home for two weeks - for the second time - in self-quarantine.

A magical time, once again. I didn’t predict that schools would be closed that week and the neighborhood kids would be so loud, but now I know! Working from home wasn’t the peaceful tranquility I expected to process all of this new information in but it was crazy to think that the kids playing outside had no idea of the magnitude of this global crisis.

March 21, 2020. The view from my study’s tiny window. Self-quarantine has been a magical time. [Photo by Yanshu Li]

My doctor at the local clinic called me to follow up on my symptoms. By that time, I felt alright, the previous symptoms had gone, and I had no fever the whole time. my doctor was happy to hear I was doing okay and I was somewhat relieved as well but I was unable to go out into crowds so I couldn’t book the deCODE testing.

Yet Iceland has been doing a lot of testing. In fact, based on data from ourworldindata.com, Iceland ranks top one among the European and North American countries for coronavirus tests per million people.

When testing is the key to identify infected from healthy crowds, Iceland is doing a great job. With a relatively small population, the testing rate is still impressive, although no matter how you test, with one confirmed case or one test conducted, let’s just say in all countries, it naturally puts Iceland on a higher place on the chart since the population number is smaller than most countries. So I also need to ask someone in the field that what this number really means.

coronavirus tests per million people.png

What happens next?

The question is, just by testing aggressively, is it enough to contain the outbreak?

What about separating suspected cases from other healthy ones, not letting them share the same space. That’s been proven effective in China.

That’s why I want to know how many infections are transmitted from a suspected (later confirmed) case to its healthy family members during self-quarantine at home. What’s that number in Iceland?

When the epidemic first hit Iceland, we could still get information about the confirmed cases; who they are, where they visited, and how they are doing, as there were so few.

Then things start to escalate and get worse. More people are getting confirmed diagnoses every day. They call it exponential growth. Every day we hear statistics and numbers. We no longer hear their stories.

Numbers without context can’t be scary. When confirmed cases are in three-digit, quarantine cases in four, and Iceland’s entire population is merely a six- digit number, it’s worrisome.

On the official information site, the donut chart for the origin of infection has three segments, the segment for ‘unknown origin’ just keeps getting bigger.

Chart credit to covid.is by The Directorate of Health and The Department of Civil Protection and Emergency Management [Date of the chart: March 21, 2020]

Updated on April 9th:

The numbers for daily new confirmed cases in Iceland have been going down continuously and today is the fourth day for this trend, while the testing efforts are still robust.
The hopeful days for more people recovering than being tested positive are finally here. The Icelandic hardworking health care workers are just like any other nations in the world, fighting around the clock, making our home a safe and peaceful place to live again.

Since the blog published, I’ve been updating the numbers daily and watching closely. Iceland’s aggressive testing and diligently identifying the origin of transmission are paying off. And today, the donut chart for Origin of infection only has one case with unknown origin. If we keep staying at home to do our parts, we are helping the health care workers break the chain of transmission.
I hope other parts of the world will see light at the end of the COVID-19 tunnel very soon.

Chart credit to covid.is by The Directorate of Health and The Department of Civil Protection and Emergency Management [Date of the chart: April 9, 2020]

While people have confidence in the authority’s capability and information transparency, there are so many questions that need to be asked. If the pandemic spreads the mild cases get more severe, self-quarantine at home with healthy family members is not an effective approach. Patients need hospital beds and medical equipment if more protective measures are needed for medical workers.

Do we have answers for these questions? Is Iceland prepared to handle the epidemic?

Reykjavik’s peaceful summer night. [Photo by Yanshu Li]

Flatten the Curve - Iceland Battles COVID-19 Epidemic