Policy responses for Iceland - HSRM

Iceland


Policy responses for Iceland

1.2 Physical distancing

At a press conference April 14th, the Prime Minister, the Minister of Health, and the Minister of Justice introduced steps to lift the restrictions currently in place in Iceland due to the COVID-19 outbreak. The Minister of Health announced her decision to ease restrictions on larger gatherings and limitations on schools and preschools.
As of 4 May, larger gatherings will be limited to 50 people, instead of 20, and service providers, such as hair salons and dentists, will be able to open their doors again. High schools and universities will reopen with certain limitations, while elementary schools and preschools will return to normal. The decision is based on the recommendations of the Chief Epidemiologist.
The Main changes from May 4th :
1. Limits on large gatherings will go from 20 to 50 people. The two-meter social distancing rule will still be in effect.
2. Schools and preschools will operate normally.
3. High schools and universities will reopen, but the 50-person limit and two-meter social distancing measures apply.
4. Various services: Hair salons, massage parlours, physical therapy clinics, beauty parlours, museums, and other similar services can reopen, but are to maintain the two-meter social distancing rule as possible.
5. Healthcare: Healthcare and dental practices (elective surgery excluded) will resume.
6. Organized sports activities for children are permitted outdoors with limitations:
a) Groups will be limited to no more than 50 children.
b) Participants are to keep two meters apart as possible, especially in older age groups.
7. Other organized sports activities are permitted outdoors with limitations:
a) No more than four individuals can train or play together.
b) Touching is prohibited, and individuals are to stay two meters apart.
c) The use of shared equipment should be limited, and all equipment sanitized after every use.
The following measures will remain in effect:
• Exemptions for economically significant companies will remain unchanged.
• As before, grocery stores and pharmacies can allow up to 100 people to enter their establishments simultaneously.
• Swimming pools and gym facilities will remain closed.
• Nightclubs, bars, and similar businesses will remain closed.
• The Directorate of Health’s instructions regarding the postponement of elective surgeries will remain in effect.

May 12th 2020

Further transitional measures

Since the begining of May, there has been a significant decrease in number of COVID-19 infected individuals, with many days in a row with no one testing positive for the virus (COVID.is). It seems that Iceland is over the „first wave“, but there is much work being done into designing transition measures for and exit strategy on how to lift social restriction. Lockdown was never implemented in Iceland, so Iceland has been experiencing softer measures than other countries.

On May 6th two individuals tested positive for COVID-19 in Iceland. Since then, no one has tested positive. In this period 1.930 individuals were tested, of which 350 symptomatic and thus tested in Primary care settings, and 1.580 asymptomatic tested in deCode genetics.
Around 15% of the population has been tested so far.
Due to the sharp decrease in incidence of COVID-19, further transition measures were put in place in order to ease restrictions previously implemented.

As from May 4th, larger gatherings were limited to 50 people, instead of 20, and service providers, such as hair salons and dentists, were able to reopen their doors. High schools and universities reopened with certain limitations, while elementary schools and preschools have gradually returned to normal. The rule of two meters distance remains wherever possible. The decision regarding reopening school and its new format is based on the recommendations of the Chief Epidemiologist.
From May 4th all health care visits and services including dental care reopened Elective surgeries and associated diagnostic exams remained on hold. Restrictions on dental services were also lifted on May 4th. 

From May 4th, serologic antibody testing has started in Iceland and tests were being validated for their ability to accurately detect any evidence of immunity. Serologic testing was not widespread and Iceland’s Chief Epidemiologist has asked individuals undergoing blood draws to donate a separate sample for serologic screening. This is not considered to be a research project and patients may refuse. However, patients are unable to independently request to undergo a serologic test.
Further reopening of restrictions to public life:
1. The regulations Iceland temporarily introduced from April 24th to May 15th of Schengen border control and 14-day quarantine for international arrival are being reconsidered and are expected to be extended until June 15th (to be announced).
2. Reopening of Swimming pools is under consideration and a formal consent might be given on May 18th, contingent to precautionary measures not yet decided.



On May 15th 2020:
In an announcement published by the Ministry of Health, the Minister of Health approved the Chief Epidemiologist´s recommendations on further easing of restrictions posed due to the COVID-19 . The Chief Epidemiologist´s MEMO including the recommendations to the Minister was published simultaneously. From May 18th, public swimming pools and spas will reopen however with a restriction on number of visitors. Visitors should not exceed 50% of officially licensed number of guests for the respected facility, children born after 2015 not included. Guidelines regarding the reopening including strong emphasis on proper hygiene and sanitizing measures follow to all relevant parties. The two metres rule does not apply in swimming pools but visitors are expected to keep that measures where ever possible.

May 22nd 2020:
In an announcement published by the Ministry of Health, the Minister of Health approved the Chief Epidemiologist´s recommendations on further easing of restrictions posed due to the COVID-19 . The Chief Epidemiologist´s MEMO including the recommendations to the Minister was published simultaneously. From May 25th 2020, restrictions on gatherings will change from maximum 50 people to 200, and gyms and fitness centres will reopen with similar requirements as for swimming pools and spas, i.e. visitors should not exceed 50% of the officially licensed number of visitors for the respected facility. Restaurants, bars and casinos are allowed to stay open until 11:00PM. Although people are advised to maintain the two metres rule of physical distancing, the way this rule is now being implemented was changed as of May 25th. This means that there (for instance in theatres, cinemas, restaurants etc.) should always been an option for those who choose to keep the two metres rule, to keep that distance. As of May 22nd only 5 new cases have tested positive from the beginning of May which seems to suggest that the first phase of easing of restrictions that took place on May 4th has not lead to increased number of positive tests.
Arrangements and procedures for the implementation of opening of borders on June 15th prepared by the Government´s Task force to be announced.

May 25th 2020:
It has been declared the end of the state of emergency due to COVID-19.
The daily public information briefs provided by the Civil Protection, the Chief epidemiologist and the Medical Director of Health will come to an end. However, these public briefings will resume if COVID-19 starts testing positive in the society again.

June 24th 2020:
Further lifting of physical distancing measures
1. On June 15, the Minister of Health announced a further relaxation of the restrictions of gatherings that have been in place due to COVID-19. The main change is that larger gatherings will now be limited to 500 people, up from 200 people since May 25th. The existing restrictions for swimming pools and fitness centres at 75% of the maximum capacity will also expire on June 15th.
2. The rate of infections has decreased significantly over the past few weeks. Twelve new cases have been diagnosed in May and June, with only four active infections remaining as per June 19th. Therefore, the restrictions originally put in place in March have been gradually lifted since the beginning of May. With these last changes, the remaining restrictions concern the 500-person limit on gathering and the limited opening hours for bars, nightclubs, and game rooms, which must close at 11 PM. No increase in infection has been observed following these reductions. Guidelines on handwashing, the use of hand sanitizers, and social distancing remain in place and are considered essential for the continued containment of the virus.

September 10th, 2020
On September 4, the Minister of Health announced a relaxation of restrictions on gatherings, which took effect on September 7. This included the following: the so-called social distancing rule was relaxed from 2 metres to 1 metre and the maximum size of gatherings was increased from 100 to 200 people. The Minister of Health issued these new measures following guidelines proposed by the Chief Epidemiologist.
Other changes to restrictions on meetings under the new regulations include:
(a) the maximum capacity of guests permitted at any one time in swimming pools, bathing facilities and fitness centres will be raised from 50% to 75% of what is permitted under their operating licences
(b) sports activities, stage performances and other cultural events may take place despite the 1 metre rule; i.e., those involved will be permitted to have physical contact. Spectators or audiences at these activities are subject to the general rules of 1 metre’s distance and a maximum of 200 persons may be in a restricted area. These rules apply until September 27, 2020, but will be revised on a regular basis.
Prior to this change, a measure had been issued on August 21 requiring a facemask covering for the mouth and nose in all workplaces and in other operations where the distance rule between persons could not be followed. Exemptions from this measure at the time were secondary schools and universities where 1 metre between persons without using facemask was permitted.
The latest closing time of premises with alcohol licences remains 11 p.m. (23.00 hrs).

On September 18, 2020, the Minister of Health accepted a proposal from the Chief Epidemiologist to close clubs, bars and pubs temporarily for 4 days from September 18 to September 21. This measure was taken to hamper the spread of COVID-19 and avoid a new outbreak. The reason, as stated by the Chief Epidemiologist, was 38 people had tested positive for COVID-19 in the 3 days prior to the closure and that at least 25% of them can be traced to people visiting one particular pub in Reykjavik a prior. The decision applied to clubs, bars and pubs in the Capital Region only. 

September 21st 2020

The Minister of Health approved a proposal by the Chief Epidemiologist to extend the temporary closure of bars and nightclubs up to and including Sunday, 27 September. The closure continued to affect bars and nightclubs in Reykjavík, Mosfellsbær, Hafnarfjörður, Garðabær, Kópavogur, Kjósarhreppur and Seltjarnarnes.

September 25th 2020

The Minister of Health approved a proposal from the Chief Epidemiologist obliging all premises with alcoholic beverage licences to provide seats for all guests, with guests to be seated as is the case in restaurants and cafes. A regulation setting this out took effect on Monday, 28 September, which also signaled the lifting of the temporary closure of bars and nightclubs in the metropolitan area, though with the condition that such enterprises observe the seating requirement. In accordance with the Chief Epidemiologist’s recommendations, the other restrictions on gatherings have been extended without amendment for the next three weeks, until and including 18 October.

October 5th 2020

New regulations setting out stricter measures to combat the spread of COVID-19 were approved by the Minister of Health and took effect at midnight on 4 October. With certain exceptions, the size of gatherings is now restricted to 20 persons. Following below is a summary of the main changes:

Gatherings are restricted to 20 persons. Fitness centres, bars, nightclubs and gaming establishments are closed. The number of guests in swimming pools may not exceed 50% of the maximum permitted in their operating licences. The social distance requirement remains 1 metre; where it is not possible to maintain this, the use of facemasks is obligatory.

Exemptions from the 20-person limit on gatherings:

Exemptions from the maximum of 20 persons at a gathering are as follows. Here, as elsewhere, the use of facemasks is obligatory where it is not possible to meet the social distance requirement of 1 metre.
• The functioning of the Althingi (parliament) is exempt from the restriction on numbers.
• Courts of justice are not subject to the restriction when exercising their judicial functions.
• Response teams, such as the police, fire brigades, search and rescue teams and health service workers, are not subject to number restrictions when engaged in their work.
• The maximum permitted number attending funerals is 50 persons.
• Shops with premises smaller than 1,000 m2 may admit up to 100 persons into the same space at any one time and one additional customer for every additional 10 m2 of floor space over 1,000 m2, though never more than 200 people in total.
• Performing arts: Events may be held where the audience is divided into groups of up to 100 persons together in separate areas. Seats are to be numbered, the names of those sitting in them must be recorded and all members of the audience are obliged to wear face-masks.
• The maximum size of classes in upper secondary schools and universities is 30 persons.

Competitive sports involving physical contact are permitted, with a maximum of 50 participants, subject to certain conditions.
Spectators at sporting events: Spectators are not permitted at indoor sporting events. Spectators may attend outdoor sporting events, divided into groups of up to 100, sitting in separate areas. Seats shall be numbered, the names of those sitting in them must be recorded and all spectators are required to wear facemasks.
Pre-schools and junior schools: No number restrictions apply to children born in 2005 or later. For those born prior to 2005, the maximum of 30 persons applies to each class, with a social distance of 1 metre; facemasks shall be worn if it is not possible to observe the social distance rule.

October 7th 2020
The current procedure of double screening for COVID-19 at the border for all passengers arriving in Iceland is to remain in place until 1 December, unless circumstances warrant earlier easing. These precautions are considered appropriate in light of an increased number of domestic cases diagnosed in Iceland in the past two weeks. Further decisions will take into account the status of the pandemic domestically and internationally, as well as other criteria identified by the Chief Epidemiologist (including testing capacity, the severity of the disease, status of the health care system and other measures and developments).

The Minister of Health accepted the recommendations of the Chief Epidemiologist for stricter limits on the size of gatherings in the metropolitan area. These took effect on 7 October. The restrictions announced on 5 October remain unchanged in other parts of the country. The restrictions announced here remain in force until 19 October.

The metropolitan area includes: Reykjavík, Seltjarnarnesbær, Mosfellsbær, Kjósarhreppur, Hafnarfjarðarkaupstaður, Garðabær and Kópavogur.

Restrictions under the new rules are as follows:
a) Social distance of 2 metres: People not closely related or connected are required to maintain a social distance of 2 metres. This also applies in all schools, though not to pupils born in or after 2005.
b) Services requiring physical contact or close proximity: Activities and services that call for physical contact, or involve the risk of contact between persons, or close physical proximity, are prohibited. This applies, for example, to hairdressers’ salons, beauty parlours, massage parlours, tattoo parlours and other comparable activities. These restrictions do not apply regarding health service workers when giving their services; however, they are required to use facemasks when doing so.
c) Shops: Where it is not possible to ensure a social distance of 2 metres between persons who are not closely related or connected, the use of facemasks in shops is obligatory.
d) Swimming pools and bathing establishments: Swimming pools and bathing establishments are closed.
e) Indoor sports and physical fitness activities are prohibited. Fitness training, bodybuilding, sports and comparable activities that involve physical contact or the risk of physical contact, or close proximity, or where the shared use of equipment could entail a risk of infection, may not be pursued indoors.
f) Outdoor sports: Outdoor sporting activities are permitted, but spectators at outdoor sporting events must be divided into separate groups of not more than 20 persons. They must wear facemasks and sit in numbered seats.
g) Performing arts: Audiences at performances in venues such as theatres, cinemas, concerts, etc., may not consist of more than 20 persons. They must wear face-masks and sit in numbered seats.
h) Restaurants: Restaurants that are permitted to open (NB bars and night-clubs are to be closed) may not remain open after 9 p.m. (21.00).

For children born in or after 2005:
• School swimming lessons: Notwithstanding the general closure of swimming pools, school swimming lessons may go ahead for children born in or after 2005.
• Sports, and youth and leisure activities for children born in or after 2005 are permitted.
• Competitive events: Competitive events for children born in or after 2005 involving a risk of contact between groups that do not normally meet for practices are not permitted.
• Social distancing and restrictions on numbers: As before, no social distancing rules or restrictions on gathering sizes apply to children born in or after 2005.

On March 6th the CE published guidelines to ban on visitations to residents and patients in nursing homes, long-term care facilities and hospitals.
As measures of containments, the Minister of Health (MoH) on the advice of the CE declared on March 13th restrictions on gatherings and partial closures of educational institutions. This restriction involved a ban on mass gathering of more than 100 individuals whether in public or private settings, including conferences, seminars, meetings, theatre, concerts, cinemas, sport events and social gatherings as well as various religious activities. Wherever people gather within those restrictions the number of people should never exceed the requirement to maintain 2 meters between individuals. Simultaneously, all universities, colleges and high schools were closed. Primary and elementary schools were allowed to stay open but with certain restrictions regarding maximum number in the classroom, teaching in smaller groups and with instructions on thorough cleaning and sanitizing of all facilities daily. This ban took effect at midnight March 16th.
On March 22nd the ban on mass gatherings was further limited to a maximum number of 20 instead of 100, and these restrictions should also apply to public transport. The rule of 2 meters between people was reiterated with closure of businesses and services, public and private, involving close contact or proximity of less than 2 meters between individuals. All non-essential businesses and services should be closed. This included hair and make-up salons, massages, and the like. Swimming pools, gyms, museums and galleries were closed. The ban took effect at midnight March 23rd. Working from home should be arranged wherever possible. Necessary and urgent health care services were excluded and the restrictions did not apply to international airports, ports, aircraft or ships.
Public spaces should all be thoroughly cleaned. Supermarkets and pharmacies were allowed to stay open but had to adhere to: (1) the two meters’ physical distance rule, (2) rules of the maximum amount of people allowed depending on space available, and (3) needed to provide hand sanitizers at the entrance and by the cashpoints.
People are urged to “stay home” and “travel indoors” during the Easter break now coming up.
On April 3rd the ban on mass gatherings was extended to May 4th.

Sources:
Directorate of Health/Chief Epidemiologist, March 7th  https://www.landlaeknir.is/um-embaettid/frettir/frett/item39476/leidbeiningar-fyrir-einstaklinga-med-ahaettuthaetti-vegna-covid-19
National Broadcasting Service. News, March 7th https://www.ruv.is/frett/hvetja-hjukrunarheimili-til-ad-banna-gestagang
Press release Ministry of Health https://www.stjornarradid.is/efst-a-baugi/frettir/stok-frett/2020/03/13/Takmarkanir-a-samkomu-og-skolahaldi-til-ad-haegja-a-utbreidslu-Covid-19/ 
Ministry of Health. Press release April 3rd 2020. Ban on mass gatherings extended, https://www.stjornarradid.is/efst-a-baugi/frettir/stok-frett/2020/04/03/Samkomubann-framlengt-til-ad-hefta-utbreidslu-Covid-19/
Directorate of Health February 28th News and Announcements    https://www.landlaeknir.is/um-embaettid/frettir/frett/item39280/fyrsta-tilfelli-covid-19-koronaveiru-greinist-a-islandi