COVID-19 in Iceland: “We’re nearing the limits of our infrastructure”
A heavy mood characterised the COVID-19 briefing held by Icelandic authorities in Reykjavík today. Director of Civil Protection Víðir Reynisson stated the growing number of infections is pushing infrastructure close to its limit. According to Deputy Chief Epidemiologist Kamilla S. Jósefsdóttir, if the rate of infection continues to grow, contact tracing will become impossible, which will only further boost the spread of infection and increase the likelihood that the COVID-19 ward will have to turn away patients in need.
Iceland has two tasks on its hands: to plan how it will deal with the pandemic in the long term and to curb the current wave of infection, Director of the National University Hospital Páll Matthíasson stated at the briefing. All three panel members agreed on the need for continued solidarity, stating that a collapse of the healthcare system would have not only short-term but also long-term effects on Icelandic society.
The following is a lightly-edited transcription of Iceland Review’s live-tweeting of the briefing.
On the panel: Deputy Chief Epidemiologist Kamilla S. Jósefsdóttir and Director of Civil Protection Víðir Reynisson. Director of the National University Hospital Páll Matthíasson will also be present at the briefing to discuss the situation at the hospital in light of the rise in COVID-19 cases and hospitalisations.
Iceland is now labelled red in the weekly COVID-19 travel map issued by the ECDC today. This affects travel and quarantine regulations in many European countries for those arriving from Iceland.
Yesterday’s numbers have been updated on covid.is. Iceland reported 151 new domestic cases (68 in quarantine) and 3 at the border. Total active cases: 1,388. 18 are in hospital. Fully vaccinated: 68.85% of population. 55 of yesterday’s 151 domestic cases of COVID-19 were among unvaccinated people, the highest number since the current wave began in mid-July.
The briefing has begun. It may be noted that Víðir has pride flags on his podium: Reykjavík’s Pride festival began yesterday. Kamilla goes over the numbers. 154 new cases yesterday and 1,391 active cases, more than reported on covid.is.
She goes over the booster shot vaccinations that will be offered in the coming weeks to school workers and those who received the Janssen vaccine. Vaccinations for 12-15 years old are being prepared. Those who want to get vaccinated but have previously contracted COVID-19, it is important to wait for a significant period before receiving vaccination because it will not be considered valid. Those who were previously vaccinated and have since contracted COVID-19 will not receive a booster shot: the infection has a similar effect of a booster shot.
Páll takes over to discuss the situation at the hospital. 3 people are in the ICU, none on ventilators at the moment. A significant number of people are at risk of needing hospitalisation due to COVID-19 at the moment.
Páll: What does that mean for the hospital? It is a challenge to make space for COVID-19 patients and requires moving other patients. There are many reasons this is challenging for the hospital. We are usually at 95-105% capacity in emergency wards so it is difficult when additional strain is added. There are also dozens of people on waiting lists for these beds already, as has been the case in previous waves.
New beds have been opened at a facility on Slétturvegur which has helped created more room and flexibility. We have a staffing shortage and our staff is burnt out. We encouraged staff to take vacation before this wave began and many are still on vacation.
Previous experience and data tell us that this wave has not reached its peak yet, says Páll. There have been no optional surgeries due to summer vacations at the hospital and they may be delayed further if necessary. We have asked some staff to return from summer vacation if possible, as difficult as that is, since the absolutely deserve a vacation, Páll says.
All of these are big challenges but we know how we can tackle them. We have good collaborations with other healthcare institutions and must ensure that patients can be transferred or discharged as quickly as possible. We must also practice triage from the beginning and ensure no one is hospitalised unless they absolutely need to be.
But all of that is not enough. We need to consider, and society needs to consider how to curb this wave of infection in other ways. “This and other pandemics are here to stay,” Páll says. “We must strengthen the healthcare system so that it is not always on the brink of collapse.” We are all in the same boat in this society. It’s a pretty good boat despite everything, but we must work together to ensure success, Páll says.
The panel opens for questions. “Are you seeing large group infections or are the recent infections emerging in smaller groups?” Víðir says both are happening. There are very few people that don’t infect anyone else, infections tend to happen in groups or clusters.
“Did any patients admitted to hospital recently go straight to ICU? Are there any factors that patients that have required hospitalisation have in common?” Páll says that the reason for hospitalisation is always COVID-19, though there are underlying illnesses that can play a part.
“The Pfizer vaccine was approved for 12- to 15-year-olds months ago in Europe and it will take them weeks to develop immunity, isn’t it very late to be vaccinating them?” Kamilla says that at the same time it was approved, there were reports of side effects that authorities wanted to research better, particularly among younger demographics. Now we know that most of these side effects are mild and at the same time COVID-19 has returned in full force so it makes sense to vaccinate 12- to 15-year-olds now.
“What are the effects of the restrictions that were imposed just under two weeks ago?” Víðir says the wave is continuing its upward trajectory and we haven’t thus seen any effect from those restrictions. Kamilla says that we have rarely been at testing capacity for quite so long. Some samples are being pushed to the next day to be processed. That is a cause for concern.
“There are two residents of the nursing home Grund that have now been released from isolation and had very mild or no symptoms. Is it possible to draw any conclusions from this?” Kamilla says that is very positive but there is not enough data to make general conclusions.
“You’ve stated that vaccination hasn’t achieved herd immunity as well as hoped. Is there any other way to create herd immunity other than for more people to contract COVID-19?”
Kamilla says it will depend on vaccine manufacturers developing vaccines that are more effective against the Delta variant and other variants that may be of concern. Pfizer has begun tweaking their vaccine to be more effective against the Delta variant.
Asked about sending vaccines to other countries in need, Kamilla says we must consider that if we have tools in our hands to protect others then we must use them. However authorities will continue to prioritise the Icelandic nation and infrastructure in Iceland.
Regarding the borders, Víðir says it’s clear our first line of protection is ensuring the virus doesn’t cross the borders and we are considering all ways to protect the nation at the borders.
“How serious can the situation become at the hospital if this wave continues to grow?” Páll says it is important that staff are able to go on vacation to avoid burnout. But it is clear that more staff is needed right now. That is why the difficult decision was made to call some staff in from vacation. “We are concerned about how the wave will develop in the next days and weeks,” Páll says.
“We know that to curb the wave we need domestic restrictions, but the government has not imposed any yet. Are we just hoping for the best?” Kamilla: If infection rates keep increase, then it’s clear that the infrastructure we have will fail to provide the best care to those who need it. Contact tracing will become impossible. If that happens, then infection rates will continue to increase because people who should be in quarantine will not be placed in quarantine. Kamilla: If things continue to develop in that direction then it is possible that the hospital will reach capacity and will not be able to admit patients who need intensive care.
Páll: We really have two different projects here. We have to plan how we will react to this pandemic in the long term. But we must curb this current wave right now.
Víðir takes over and agrees with Kamilla and Páll. It is also important to consider the long-term effects of measures. However, if our infrastructure collapses that can have a massive long-term effect on our society as well. And we are considering all of this.
In conclusion, we are waiting for the work that has been done in the past weeks to be completed and to see the long-term plan that is forming come to light. Not taking action is not an option at this point, says Víðir. We must continue our fight, there’s no other option. The virus is the enemy. There’s nothing else we can do than stand together. That’s the only way forward. The briefing has ended.
https://www.icelandreview.com/society/covid-19-in-iceland-were-nearing-the-limits-of-our-infrastructure/
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