Policy responses for Iceland - HSRM

Iceland


Policy responses for Iceland

1.4 Monitoring and surveillance

Icelandic health authorities have adopted the risk definition of the European Centre for Disease Prevention and Control (ECDC). In the joint work plan of DCPEM, DoH and CE, responses to COVID-19 are according to the Icelandic Pandemic Influenza Preparedness Plan. The emergency responses are co-ordinated by the Department of Civil Protection and Emergency Management (DCPEM) within the National Commissioner of Icelandic Police (NCIP) in collaboration with the Directorate of Health (DoH)/ the Chief Epidemiologist (CE) mandated by the Minister of Health (MoH). The responses of the Icelandic authorities are aimed at preventing the occurrence of disease and the spread of the virus as much as possible, protecting vulnerable groups, ensuring health services for ill individuals and maintaining the necessary domestic activities. Samples are only taken from individuals with symptoms of illness and not from asymptomatic individuals (except for a screening project at deCODE Genetics in collaboration with the DoH and Landspitali University Hospital). The strategy is to ensure early diagnosis, isolation, as well as quarantining in order to slow the spread as much as possible and to minimize the burden on the health-care system. The actions taken are: Testing – isolating – contact tracing – quarantine, alongside sharing information and educating the public, encouraging physical distancing and implementing the ban on mass gathering and restrictions of businesses. The main aim is to reduce the pressure on the health care system by flattening the epidemiological curve and to protect vulnerable senior citizens and individuals with underlying illnesses. This Pandemic Influenza Preparedness plan was updated on March the 5th 2020.
The DoH and the CE provided case definitions to assist surveillance and monitoring.COVID-19 cases is defined in three categories:
i. A possible case: Patients with symptoms of acute respiratory infection including cough, fever and weaknesses, coming in from high-risk areas but no connection to confirmed cases.
ii. A likely case: Patients with symptoms of acute respiratory infection including cough, fever and weaknesses and have been close to a confirmed COVID case within 14 days from the onset of the symptoms.
iii. Confirmed case: A person who has a confirmed diagnosis of COVID-19 from a laboratory irrespective of symptoms.
Each person diagnosed positive for COVID-19 is isolated at home, unless he/she needs to be admitted to hospital. In parallel, and according to the authorization of the DCPEM and DE, extensive contract tracing is conducted in order to find individuals who have been in close contact with the confirmed case, who are then quarantined. On April 2nd a contract tracing app “Rakning C-19” was launched. The DoH and the CE encouraged the population to use the app and become “a strong link in the chain” of containing the spread of COVID-19. A new slogan was added to the previous ones, “Contagion tracing is a community affair”, emphasizing that “now we are all Civil Protection”.
From mid-March deCODE genetics, an Icelandic firm subsidiary of Amgen, in co-operation with the DoH and the CE, started massive screening for COVID-19 on the basis of voluntary self-referrals in order to identify the spread among the general population in society. Screening is performed on any volunteer regardless his/her health status. On average, according to the pre-defined categories mentioned above, around 10% of clinical tests are positive for the virus of which about 50% were in quarantine at the time of diagnosis (www.covid.is ). On average nearly 1% tested by deCODE genetics have tested positive for the virus.
Detailed statistical information on the number being tested and where, number of confirmed cases, how many are in quarantine or isolation, how many are admitted to hospital, and in intensive care, is provided on a daily basis at www.covid.is in 8 different languages. As of April 5th, 27.880 samples had been tested (about 7,7% of the total population in Iceland)


- Monitoring Long-Term Care facilities

In Iceland, ten individuals have died from COVID-19 of which two deaths were reported from the same long-term care facility. Reporting and updates regarding COVID-19 cases and deaths are all inclusive, i.e. they include all the population irrespective of where individuals live, at home or in institutions.

On April 22nd the Directorate of Health announced that from May 4th the ban on visits to nursing homes and long-term care facilities will start to be lifted gradually, but there will remain restrictions with regard to the number of visitors at each time. The lifting of the ban has to follow strict guidelines from the Chief Epidemiologist, administered by managers and staff on site and adapted to local circumstances and implemented in co-operation with families and relatives.


Sources:
DCPEM March 31st 2020 https://www.almannavarnir.is/english/pandemic-influenza/  
Governement of Icleand website march 6th 2020 https://www.stjornarradid.is/efst-a-baugi/frettir/stok-frett/2020/03/06/Vidbragdsaaetlun-almannavarna-Heimsfaraldur-Landsaaetlun/
DoH, definition of COVID-19, https://www.landlaeknir.is/um-embaettid/greinar/grein/item39202/Skilgreining-a-COVID-19-tilfelli
Public Broadcasting Service. News March 12th 2020. https://www.ruv.is/frett/skimun-fyrir-covid-19-hefst-i-fyrramalid