Coronavirus

What We Should Have Learned From Iceland's Response to COVID-19

Early and wide testing helps curtail the epidemic while casting light on the prevalence and lethality of the virus.

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As epidemiologists around the world try to get a handle on COVID-19's actual prevalence and its true case fatality rate (CFR), Iceland seems to be the only country that is doing the sort of testing that is necessary to estimate those crucial variables. As of midnight, Iceland had tested more than 22,000 people for the COVID-19 virus, more than 6 percent of the country's population. Crucially, that number includes seemingly healthy, asymptomatic individuals as well as patients worried that they might have COVID-19.

Those tests, conducted by the National University Hospital of Iceland and the Reykjavík-based biopharmaceutical company deCODE Genetics, have detected 1,364 infections so far. Iceland, which is still in the early stages of its epidemic, has reported just four COVID-19 deaths, making its crude CFR (reported deaths as a share of confirmed cases) at this point 0.3 percent, much lower than the rates indicated by the official numbers from the vast majority of countries. Right now the crude CFR in the United States is 2.6 percent. It is 1.4 percent in Germany, 9.1 percent in France, 9.3 percent in Spain, 9.4 percent in the U.K., and 12.3 percent in Italy.

The epidemic is further along in all of those countries, so we should not make too much of the contrast with Iceland. The death toll in Iceland is bound to rise, and the crude CFR probably will too, as it has in Europe and the United States. But Israel, which had its first confirmed COVID-19 case around the same time as Iceland did and has implemented severe restrictions on visitors coupled with a general lockdown, currently has a crude CFR of 0.5 percent, two-thirds higher than Iceland's. In Greece, which reported its first COVID-19 case two days before Iceland did, the crude CFR is currently 3.8 percent.

As of Tuesday, deCODE Genetics, which ultimately expects to screen at least 50,000 people in Iceland, had tested about 9,000 volunteers from the general population, of whom around 1 percent tested positive. About half of the people who tested positive reported no symptoms, underlining the importance of general testing in estimating the prevalence of infection.

The deCODE sample is self-selected, so it may not be nationally representative. But assuming the sample's infection rate applies to the general population, it means that something like 3,400 Icelanders already have been infected, implying a current CFR (including mild and asymptomatic cases) of around 0.1 percent, which would make COVID-19 in Iceland about as deadly as the seasonal flu. Even assuming that Iceland in a month has as many COVID-19 deaths, as a proportion of its population, as the United States does now, the CFR would still be remarkably low.

If the CFR for COVID-19 in Iceland turns out to be only slightly higher than the CFR for the flu, it would be near the low end of the estimate range that U.S. public health officials consider reasonable. By comparison, projections by the U.S. Centers for Disease Control and Prevention (CDC) imply a CFR of 0.8 percent, while the model used by researchers at Imperial College in London assumes it is 0.9 percent. Today Brendan Murphy, Australia's chief medical officer, said as many as 10 million people may already be infected worldwide—nearly 10 times the official tally. Based on the 58,000 deaths reported so far, that estimate implies a true global CFR of about 0.6 percent.

It would be risky to draw broad conclusions from the data for Iceland, which has a small population (about 340,000) and unusual demographics. Ninety-three percent of Icelanders are ethnically Icelandic, while 3 percent are of Polish origin. The population is also younger than those of many other developed countries, with a median age of 36.5, compared to 45.5 in Italy, 42.7 in Spain, 47.1 in Germany, 40.5 in the U.K., and 38.1 in the United States. That fact is potentially significant, since the elderly are especially susceptible to COVID-19.

Iceland's response to COVID-19—which features aggressive testing, contact tracing, and quarantines of infected people but no general lockdown—is also strikingly different from the response in the United States, where the federal government squandered the opportunity to take a more proactive and targeted approach. Iceland began testing people in early February, weeks before its first confirmed case.

"The only reason that we are doing better is that we were even more vigilant," deCODE founder Kári Stefánsson told CNN. "We took seriously the news of an epidemic starting in China. We didn't shrug our shoulders and say, 'This is not going to be anything remarkable.'"

In the United States, by contrast, a government-engineered testing fiasco left public officials scrambling to prevent hospitals from being overwhelmed by COVID-19 cases, leading to a panoply of business closure and stay-at-home orders. Even now, we have managed to test just 0.4 percent of the population, and those tests have been limited mainly to people with symptoms severe enough to seek treatment. Iceland has tested 16 times as many people as a share of its population, and it has made a deliberate effort to sample people with mild or no symptoms.

Because of the failure to conduct wide testing, we have no idea how many Americans are infected with COVID-19 or what the true CFR in the United States might be. In these circumstances, it is not much of a stretch to lay the blame for the country's ever-worsening, self-inflicted economic crisis at the feet of the CDC and the Food and Drug Administration, which obstructed access to COVID-19 tests through a combination of shortsightedness, ineptitude, and bureaucratic intransigence.

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  1. So Iceland has tested 22K, US has tested 1.4M according to the numbers above. But the US gets bitch slapped for some reason?

    1. In fairness, 22k is 6% of Iceland’s population, the whole of which (364k) is less than the population of the city of Oakland, CA (390k).

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    2. Iceland has tested 6% of it’s total population.

      The US has tested 0.4% of it’s population.

      1. They are kind of limited by crucial chemicals needed for the tests. It has a scalability issue at the moment.

        https://www.statnews.com/2020/03/10/shortage-crucial-chemicals-us-coronavirus-testing/

        It’s comparing a medium US City to a country. It’s a stupid comparison. It is also a healthier, homogenic country compared to fat ass melted cheese pot america.

    3. Most importantly: what is the ratio of ambulance chasing lawyers practicing within the confines of Iceland?
      YOU CAN’T DISCOUNT the volume of frivolous liability suits threatened and brought by our illustrious law professionals.
      Leverage fair researched medicines without fear of bankruptcy.

    4. It’s kinda like how after the first death occurs, the news will exclaim that virus deaths have doubled in 24 hours.

      Lies, damned lies, and coronavirus lies.

  2. STOP with the hysteria.

    The KungFlu is less deadly than the seasonal Flu/Cold.

    58,243 deaths Worldwide from Wuhanvirus so far since October 2019.

    You hysterics have mental problems.

    1. They’re just being paranoid.

      WHO SAID THAT?!?!?

      1. Me

      2. The only thing worse than being paranoid is finding out you’re not.

        1. Paranoia = the delusion that EVERYONE is out to get you.

          Just because you are paranoid, that doesn’t mean that no one is out to get you.

          Likewise, just because someone is/was out to get you, that doesn’t prove you aren’t paranoid.

      3. Hey, just because you’re paranoid doesn’t mean they’re not out to get you…

    2. What’s that German word for feeling embarrassed on others’ behalf?

      1. Fremdschämen, according to Urban Dictionary. Also, according to UD, DIRTY TALIA is “When a man ejaculates on a woman’s toe then she proceeds to finger his butt with her big toe.”

        1. Finally, I can ask the wife to repeat the wedding night. Didn’t know how to ask.

    3. It seems to me also that it is not frequently pointed out that there is a good side to it being asymptomatic — That is, most people’s immune systems are fighting it off with little difficulty.

    4. The fundamental issue is the media is only reporting negative numbers that are large, and the average gullible American can’t do math, so they assume it’s a large number. In the greater scheme of things, it’s really incredibly small and irrelevant.

      1. Well, America is nothing more than a bunch of dumb motherf*ckers run by a bunch of conniving dumb motherf*ckers.

        As George Carlin pointed out, “Just think how stupid the average person is….now consider that half of all people are dumber than that.”

      2. This is exactly right. The media is only reporting number of cases, deaths, and extraordinary deaths that people latch on to.

        “You see?!?! It’s very dangerous! The news reported a healthy guy in his 30s died!!”

        Of course if it makes news in that way, it’s a sure bet that it’s an anomaly. It’s rare enough that it bears reporting. The exception to the rule, that they’re trying to bend in to the rule.

        And the sheep eat that shit up.

        Have you seen comments in most other places? People are BEGGING for more restrictions, more business closures.

        Of course most of these cries come from wine mom types who either don’t work or are working from home. They have absolutely no worldview in that there are millions who can’t stay home from work and feed their families at the same time.

    5. People are scared – and rightfully so. Humans don’t have time to think independently, so they outsource their thinking to trusted media. And the media is using a fear campaign intentionally to justify decimating the economy.

      The dems and media and many corporations have decided that “the enemy of my enemy is my friend,” so they work in lockstep with the CCP – which has all but declared war by saturating our social media with propagandists and bots.

      The result is truly fascinating to behold. The continuous dosages of fear coupled with the same talking points being stated over and over, has proven the majority of the US (and the world) virtually catatonic.

      Speaking with any of these numb-nutted, missing links about your skepticism of the narrative will be met with fierce denial, followed by a lock-jawed flow of regurgitated, and sophomorically incoherent media produced drivel.

      Remaining sentient skeptics studying this phenomenon have noted that the innate herd behaviors have already calcified the narrative into a fully functioning belief system, complete with coupling to their group (herd) identity.

      No longer are these shit-for-brains proselytes of pandemonium capable of rational or critical thought. Any paradigm shifting suggestions presented are perceived as an attack on their very (vacuous) egos.

      If you push too hard by presenting concrete facts and credible sources, these clinically dead, piles of rotting flesh will shutdown and resort to testifying to their implicit faith in the media narrative – not unlike the new religious movements (cults) that have exploited some of our more credulous citizens throughout US history.

      I’ve personally had quite the time introducing them to rounds of cognitive dissonance by comparing covid-19 to the flu. In nearly all cases, these beagle-brained bovine will begin denying similarities by spewing random numbers – and they are always the same: 10-20%, millions (never thousands), 3.4%, and short phrases like “34 times” or “24 hours.”

      These pitiful excuses for neuronally-challenged, excrement devouring protozoa are incapable of acknowledging any fact incongruent with their new faith. They simply do not hear a word that you’re saying.

      Consequently, It is my recommendation to allow nature to take its course, while continuing to study these flat-lined, walking corpses dying off in their natural habitat.

      1. 100 thumbs up.

  3. Iceland does not have Trump. The EU have a population of about 446 million, the US about 330 million. Yesterday there were 33,100 deaths from coronavirus in the EU and 5,140 in the US. If the deaths were proportional to population, the US would have 24,500 dead. Instead, there are about one fifth that many. And almost every country in the EU has free national healthcare.
    But Trump!

    1. Not to nitpick, but Iceland is not part of the EU.

      1. Believe he was just using a closer comparative of population sizes to show how silly the Iceland comparison is.

        1. That’s the way I read it; it also gets a comparison somewhere close the the US medical care quality and (our former) level of prosperity.

  4. it is not much of a stretch to lay the blame for the country’s ever-worsening, self-inflicted economic crisis at the feet of the CDC and the Food and Drug Administration

    “CDC and FDA Employee Morale at New Low”

    1. This is after 2 years of asking all of us to trust the deep state bureaucracy.

      1. And after a full year of the FDA and CDC actively lying about the vaping deaths from last year.

        They are every bit as agenda driven as any other office of government.

  5. I just *heard* that new CDC data show “the curve is being flattened” in that the number of cases is doubling every five days now, instead of every three days.

    1. That’s not flattening. What we’ve done is caught up in our detection/testing. The doubling every five days (roughly 15%/day) is the virus’ rough RO growth rate.

      Getting it below that is the tough part. You can see that same rate for a week or two with Italy, France, Spain, Germany, etc. With the deaths lagging by a week or two (still growing at mid/high-20%/day) until they too drop down to the +-15%/day

      1. Where’s your PANIC!!! flag?

      2. None of what you say actually shows up in the data. But keep confabulating.

        1. It shows up in every single country outside Asia – at that point where those countries ‘catch up’ in testing. And Asia never played ‘catch up’ because they took it seriously to begin with and started flattening much earlier

          1. So you brought your PANIC!!! flag and are lying so people might buy your bullshit?
            Dishonest piece of lefty slime.

          2. Hey, JFree!
            Take a look at this, scumbag:
            “Does an Economic Downturn Lead to an Increasing Mortality Rate?”
            […]
            “…South African data on mortality rates by income level highlights the huge differences where those in the lowest income class are subject to between 7 and 10 times worse mortality than those in the highest income levels…”
            https://www.genre.com/knowledge/blog/does-an-economic-downturn-lead-to-an-increasing-mortality-rate-en.html

            Those 10,000,000 newly unemployed are largely due to the PANIC promoted by you and your asshole cohorts.
            Proud of yourself?

          3. JFree! Tell us about your hopes millions of people die from the flu! We have evidence that the results of the PANIC you promote may well do worse:
            “Strong Correlation Between Unemployment & Mortality Revealed”
            […]
            “McGill University (Canada) researchers find that unemployment may increase the risk of premature death by 63%.”
            https://www.worldhealth.net/news/strong-correlation-between-unemployment-mortality-/

            Let’s see, 63% of 10,000,000, uh…
            Proud of yourself now, lefty scumbag?
            Believe me, there’s tons of those sorts of studies and I’m going to jam them in your face every chance I get, you pathetic piece of shit.

            1. As much as JFree deserves a verbal bitch slap, your math is wrong.

              63% increased risk of premature death isn’t a 63% risk. It’s 63% higher than the risk under normal times, whatever that happens to be. Now, that’s still going to be significant, but not *that* big.

          4. It shows up in every single country outside Asia

            Where does it show up? Look at the data; there is no transition from “unnatural” to “natural R0”. In fact, the very concept of a “natural R0” is bogus.

            And Asia never played ‘catch up’ because they took it seriously to begin with and started flattening much earlier

            Yeah, that’s what you want our government to become, right? A communist dictatorship.

            1. The transition is ‘catching up’. Whatever the country is using as the definition of ‘cases’, there comes a point when they catch up on backlog, communicate that criteria to dr/hosp, etc – and their testing plateaus. At that point, the new caseload is driven by the virus itself – not the detection/testing. And that has been in that ‘doubling every five days’ region everywhere.

              Until they redefine/communicate/test a new strategy that requires another ramp up and catch up of testing. Turns out not too many places are really doing that. Or at least not very quickly. Whatever their plan A is, they’re sticking with it. Can speculate as to why but still too early for comparative post-mortems

              that’s what you want our government to become, right? A communist dictatorship.

              You fucking DeRps are all the same. Can’t tell the difference between the normative and the descriptive. And can’t tell the difference between say S Korea, Singapore, Japan, Taiwan, China, Vietnam, Thailand. All just a bunch of slant-eyed commie gooks to you right?

              1. You keep postulating the existence of “plateaus” and inflection points; they aren’t there in the data.

                And yes, I can tell the difference between those countries, having been to all of them. Have you? The only reliable data we have is for a few of them, and those countries impose totalitarian or authoritarian restrictions on their citizens.

                You’re the commie here, you’re the one advocating authoritarianism. I’m perfectly happy having the federal and state government issue strongly worded “stay at home” recommendations and let the chips fall where they may.

    2. Actually the incidence data — https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html#epi-curve — show incidence peaked almost THREE WEEKS AGO, i.e. before the extreme isolation measures in the USA.

  6. “It would be risky to draw broad conclusions from the data for Iceland, which has a small population (about 340,000) and unusual demographics.”

    But you’re going to go ahead and do it anyway apparently. Iceland has the population of one small American city.

  7. We don’t actually know for sure what the crude CFR in those other countries is either, because we don’t know how many of them are following Italy’s example and lying about it to make it seem much deadlier than it really is. Too bad nobody in a position to get an answer is interested in asking that question.

    https://www.telegraph.co.uk/global-health/science-and-disease/have-many-coronavirus-patients-died-italy/

  8. Yeah, the U.S. is just like Iceland, except for policy!

    Just when you thought Sullum couldn’t get any more stupid and ignorant, he proves you wrong again.

    1. Yeah, the U.S. is just like Iceland, except for policy!

      And except for everyone in the country being so closely related that Icelanders have apps to make sure they’re not dating too close a cousin.

    2. How many direct flights to China do you suppose Iceland has?

      Think *ICE*land has a booming tourist industry in the middle of winter?

      How does their population density compare to NYC? How does their number of foreign travelers per day compare?

      Finally, it’s no end of amusing how the “diversity is our strength” crowd *always* points to countries with blindingly white demographics as their ideal societies.

      1. Finally, it’s no end of amusing how the “diversity is our strength” crowd *always* points to countries with blindingly white demographics as their ideal societies.

        Leading Democrats live like the old white plantation owners, in expensive mansions where only wealthy white folks are permitted, except for the servants. As Bill Clinton put it: “A few years ago, this guy (Obama) would be getting us coffee.”

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  10. Iceland has a small population and the majority of their country lives in one metro area. Might be a bit easier for them to be efficient in testing.

    1. Sorta like comparing how the Danes and the US deal with the social safety net; not close for good reason.

  11. Didn’t we just have an article earlier this week about how the tests are having a 25-50% false negative rate? Or did that one get memory holed like the article praising China for how open and transparent it was about Covid?

    1. They’re pinning their hopes on blaming Trump for the lack of testing.

  12. Well, better late than never:
    Trump says enough PANIC!:

    “The CDC recommends people wear cloth masks in public – but Trump says he won’t”
    […]
    “…”The CDC is advising the use of nonmedical cloth face covering as a voluntary health measure,” Trump said during his Friday briefing. “It is voluntary. They suggested for a period of time. This is voluntary.”…”
    https://www.aol.com/article/news/2020/04/03/the-cdc-recommends-people-wear-cloth-masks-in-public-but-trump-says-he-wont/23969440/

    Perhaps if the local and state tin-pot dictators, along with most all “news” organizations would stop fanning the flames, some rationality might return.

    1. Well after all, he is literally Hitler.
      And literal Hitler is dead, so he can’t possibly infect anyone.

  13. excellent article, quite complete

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  15. Iceland has already test 6% of its population while us 0.4%…but not to forget that US has way more population than Iceland

    1. Right now we can only get our hands on X tests per week. Consider two populations one with ~300K and the other 3 orders of magnitude higher at ~300m. Since the numerator is basically fixed for the moment, of course the country with 300k pop is going to have a higher per capita tested number. Until the number of tests available equals 1000X will the larger company catch up in a per capita sense.

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  18. What can a minuscule, homogeneous, physically isolated country teach us about disease and disease prevention?

    Nothing. Nothing at all.

  19. Of course, to test 6% of the U.S. population would take around 20 million test kits, and labs to process them. I believe that’s a few more than the 22,000 tested in Iceland.

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  21. These articles comparatively chiding the U.S. for its actions / inactions invariably seem to be fodder for white nationalists.

    “Small, homogeneously Caucasian nation state is more easily administered than pluralist shit show” maybe an alternate headline.

  22. We know this: Highly infectious, non lethal virus in healthy populations. Very serious aggravating factor compromised individuals and the elderly. Help the vulnerable to isolate. Healthy people should live normally.

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