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In the almost polar north of Iceland, an island dotted with fjords and lit by the northern lights, shows a peculiar approach to the fight against coronavirus.
While the number of deaths and infections is increasing every day in neighboring countries and almost the entire planet, the northern nation managed to keep covid-19, at least in fear: in almost two months, it reported only four deaths. and about 1,500 cases.
And for this, it was not necessary to introduce quarantine or mandatory conditions of detention: although the meetings of more than 20 people were suspended, many shops and enterprises are still open, and children at some levels of education continue to go to schools.
“This is the result of a strategy that I consider very successful and which I believe the only one in the world as far as I know, “BBC World is told by Icelandic epidemiologist Kristana Asbjornnsdottir, professor at Washington University, USA.
The starting point of the Icelandic approach was one of the main recommendations World Health Organization (WHO) Since the coronavirus began to spread everywhere “Tests, tests and other tests” and, based on this, make decisions.
But unlike other countries, not only suspicious cases, potential infections, or people at risk are tested in Iceland: the country offers a coronavirus test to everyone who wants to do this, and for free.
“The main strategy in Iceland is based on comprehensive testing of not only people with a high level of risk or symptoms, but also the population as a whole,” explains Johanna Jacobsdottir, professor of biostatistics at the Center for the Science of Science. Public health from the University of Iceland and part of the covid-19 response team in the country.
But free mass testing was not the only approach that allowed Iceland to offer a concrete answer. to coronavirus: innovative measures to detect and localize new infections have also been part of the strategy.
New vision
When the first case of Covid-19 was discovered in Iceland last February, for several weeks he tested the virus among tourists or people returning from a trip to the country.
According to experts advised by the BBC Mundo, A “vigilant” approach to trying to attack a disease before it even shows in society, this was a decisive step.
“I think we went the only country in the world that tested a long time before the first caseKari Stefansson, Director DeCode Geneticsa biotechnology company that leads efforts to conduct large-scale coronavirus tests in collaboration with the Ministry of Health.
Unlike what happened in other countries where people already went to the hospital, in Iceland, authorities asked those who entered the island to report to medical centers for testing, even if they did not have symptoms.
But in mid-March, when the number of cases increased, DeCode Genetics decided to open the spectrum, and not just test potential infections or people with symptoms or a history of trips to risk areas: whoever wanted to, could be screened for coronavirus.
“We did it because we realized that you needed to know how fast the virus spreads people and thus be able to develop methods to contain this disease, ”says Stefansson.
Initially, the sample was voluntary, but since last week the company even began to randomly call Iceland’s phone book numbers to invite the respondent to its branches for testing.
And although this is possible largely due to the demographic characteristics of the country –Iceland’s population is around 360,000 Experts believe that the scope of this approach may be useful for countries with large populations.
“The population of Iceland is very small, but I think that the results of this approach can clarify many of our scientific questions about the true extent of the spread of the virus,” says Asbjornnsdottir.
Other strategies
According to Jacobsdottir, mass testing of the population has become the basis for other strategies and political decisions adopted by the country to curb the spread of the virus.
According to him, as soon as cases are identified, the authorities begin to carefully monitor contacts with infected people who are in custody regardless of their health status.
“Currently, about 50% of new cases are alreadyabaquarantine during the diagnosis, “he says.
Another element, in his opinion, was that the authorities decided to isolate risk groups from detecting the first infections.
“Nursing homes and hospitals were closed to visitors on the first occasion, so Iceland was able to protect better than many other countries, with a higher risk of serious complications,” he says.
According to government data, Iceland has only 20 intensive care respiratory beds designed to treat potential cases of Covid-19, so there is an urgent need to avoid an increase in the number of infections.
To detect new infections, the Icelandic authorities used “police” strategies that were already used in other Asian countries, such as Singapore: using detectives and criminal investigators to identify potential new cases.
“This is another important element: public authorities were very efficiently tracks potential cases and they encourage everyone who has had contact with sick people to be quarantined even before symptoms appear, ”says Asbjørnsdottir.
Stefansson agrees that this strategy was also decisive given that almost half Of the cases that tested positive in the tests conducted by his laboratory, there were no symptoms during the test (although many developed them later).
“Studying the general population and those without symptoms gives a more accurate picture of how widespread the virus is in Icelandic society and how it spreads,” he says.
For several weeks, medical authorities in several countries have warned about the role of asymptomatic patients in transmission of covid-19 and that coronavirus spreads even before the onset of the first symptoms.
The importance of testing
Iceland tested coronavirus before Monday 6% of its inhabitantshighest population survey rate in the world, according to WHO.
To give you an idea, until last Friday (the latest available data), the United States, although it had a quantitatively larger number of residents, tested only 0.4% of its population, most of which already had symptoms.
While South Korea, the country that conducted most of the tests (almost half a million), had tested 0.7% of its residents before Monday and continued to do so only with suspected cases or people in risky circumstances.
“By conducting large-scale demographic tests, like in Iceland, you can get a more accurate picture of what the general status of the infection is and how widespread the virus is in the community,” says Asbjørnsdottir.
“If the tests are available only to those who are very serious, this overestimates what is actually happening,” he adds.
Stefansson agrees that, knowing better the state of spread of the virus among the population, it’s easier to have reliable pace data mortality or incidence (how contagious it is).
“Our data on the effects of coronavirus in the world are unreliable, because no one has a real assessment of the impact on the population as a whole, given that only serious cases are checked,” he said.
“So far, the only country in the world that can offer the true number of coronavirus deaths is Iceland,” he says.
Virus sequence
The expert notes that another striking element in Iceland’s response is that the virus was sequenced in all cases that tested positive for covid-19 in the country.
“It showed that since the coronavirus spread so widely, many mutations“Although he has a low mutation rate compared to other viruses, such as the flu,” he says.
Stefanson, who was a professor at Harvard University, says that studying these variations of the viral genetic sequence can be used to track the origin and spread of covid-19 in individual cases.
“It helps when it comes to tracking infection, when you want to know how it spreads in society. You can determine if people have been infected by the same person by simply arranging the virus and putting it in context. about how a mutation moves, “he argues.
According to the expert, to date, his laboratory has detected very specific mutations of viruses that come from countries or regions of Austria, Italy, the UK or from the west coast of the United States.
And in this sense, he guarantees that one of the issues it remains to be decided why someinThese mutations are more aggressive and deadly than others.,
Teachings of Iceland
Jacobsdottir believes that after three weeks of intense testing, the Icelandic scientific community is optimistic that the strategy, at least for the moment, is working.
“As of March 23, the number of cases seemed to grow exponentially, but we saw that we deviated from this path and now the growth seems more linear,” he says.
However, he believes that even It will take some time for the number of infections to begin to decrease.
Nevertheless, he is optimistic that the data so far indicate that the island “is on the right track without giving very transcendent draconian answers.”
“The strategies implemented in Iceland were political and scientific. On the other hand, politicians used their energy where they should when developing and implementing economic and social policies for the inevitable consequences of a pandemic. ”
“The most important message of Iceland’s strategy is that decisions must be based on science.”
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