martes, junio 4, 2024

How Iceland Beat the Coronavirus

On the morning of Friday, February 28th, Ævar Pálmi Pálmason, a detective with the Reykjavík police department, was summoned by his boss. Iceland did not yet have a confirmed case of covid-19, but the country’s Department of Civil Protection and Emergency Management wanted to be prepared. Suppose somebody tested positive? A team would be needed to track down everyone with whom that person had been in contact. Pálmason’s supervisor told him he was going to lead that team.

“We were just talking: ‘If and when the first case happens—it could be this week, we just don’t know,’ ” Pálmason recalled. “And then, two hours later, we got the call.” A man who’d recently been skiing in the Dolomites had become the country’s first known coronavirus patient.

Two other cops, two nurses, and a criminologist had been assigned to Pálmason’s team. “With our detective techniques to find people, we began to gather some information from the case,” Pálmason told me. The man, the team learned, had been back in Iceland for several days before he’d been diagnosed. During that time, he’d done all the things people normally do—gone to work, met with colleagues, run errands.

Anyone who’d spent more than fifteen minutes near the man in the days before he’d experienced his first symptoms was considered potentially infected. (“Near” was defined as within a radius of two metres, or just over six feet.) The team came up with a list of fifty-six names. By midnight, all fifty-six contacts had been located and ordered to quarantine themselves for fourteen days.

The first case was followed by three more cases, then by six, and then by an onslaught. By mid-March, confirmed covid cases in Iceland were increasing at a rate of sixty, seventy, even a hundred a day. As a proportion of the country’s population, this was far faster than the rate at which cases in the United States were growing. The number of people the tracing team was tracking down, meanwhile, was rising even more quickly. An infected person might have been near five other people, or fifty-six, or more. One young woman was so active before she tested positive—going to classes, rehearsing a play, attending choir practice—that her contacts numbered close to two hundred. All were sent into quarantine.

The tracing team, too, kept growing, until it had fifty-two members. They worked in shifts out of conference rooms in a Reykjavík hotel that had closed for lack of tourists. To find people who had been exposed, team members scanned airplane manifests and security-camera footage. They tried to pinpoint who was sitting next to whom on buses and in lecture halls. One man who fell ill had recently attended a concert. The only person he remembered having had contact with while there was his wife. But the tracing team did some sleuthing and found that after the concert there had been a reception.

“In this gathering, people were hugging, and eating from the same trays,” Pálmason told me. “So the decision was made—all of them go into quarantine.” If you were returning to Iceland from overseas, you also got a call: put yourself in quarantine. At the same time, the country was aggressively testing for the virus—on a per-capita basis, at the highest rate in the world.

Iceland never imposed a lockdown. Only a few types of businesses—night clubs and hair salons, for example—were ever ordered closed. Hardly anyone in Reykjavík wears a mask. And yet, by mid-May, when I went to talk to Pálmason, the tracing team had almost no one left to track. During the previous week, in all of Iceland, only two new coronavirus cases had been confirmed. The country hadn’t just managed to flatten the curve; it had, it seemed, virtually eliminated it.

Ihad initially planned to go to Iceland in March, for a story unconnected to the coronavirus. Suddenly, the trip was called off. The European Union was barring Americans from entering, and the United States was barring Europeans. Flights were being cancelled. There didn’t seem any way to resurrect the trip, until it occurred to me: what if I wrote about Iceland’s response to covid-19?

I looked online and learned that all those entering the country were required to submit a form outlining how they planned to quarantine for two weeks. I applied to the Ministry for Foreign Affairs for an exemption as a journalist. The answer came back: no.

I did some e-mailing and phoning around. Iceland, which has three hundred and sixty-five thousand residents—about half the population of Denver—is a famously tight-knit country. Almost everyone, quite literally, is related to everyone else, and if two people want to know how exactly their families are intertwined they can consult a genealogy database run by an Icelandic biotech firm called deCODE Genetics. Iceland was able to test so many people because, at the height of the outbreak, deCODE turned its state-of-the-art facilities over to screening for the virus. I got in touch with the head of the firm, Kári Stefánsson, a neurologist and a national celebrity. He told me that he would work things out.

A few days later, the no became a yes, with qualifications. I’d have to enter a “modified” quarantine for journalists. The list of rules ran four single-spaced pages and included provisos on how to use—or, really, not use—public rest rooms. It laid out a half-dozen scenarios—“interview of a public figure in a private company setting,” “interview of any person in a private setting out of doors”—with detailed instructions for how each one should be handled. An “interview of a public servant in the workplace” was allowed, but with numerous conditions. (“The director of the public entity must be informed and assent to the interview even if they are not the interviewee. . . . The journalist should not explore the site, even with a guide, but only visit the space designated for the interview.”)

Icelandair had, by this time, suspended service from the United States, except for sporadic flights out of Boston. The day I left, a Saturday, the international terminal at Logan was as solemn and silent as a mausoleum. Not a single ticket desk was open. On the plane, I counted fourteen seats occupied, out of nearly two hundred. I spoke briefly with a woman seated a few rows in front of me. She was going to visit her fiancé, an Icelandic soccer player, and was unhappy that they would be spending the first two weeks of her stay in separate apartments.

The in-flight magazine, which apparently hadn’t been replaced for several months, was filled with pictures of vacationers in the snow. It read like an illuminated manuscript—a relic from another era. One of the crew members told me that he and almost all of his colleagues, including the pilots, had been given three months’ notice; they were working only occasional flights. Despite the generalized gloom, it was thrilling to be going somewhere; for the previous eight weeks, the farthest I’d travelled was to the liquor store.

When we landed at Keflavík, Iceland’s international airport, I faced my first crisis of conscience. Among the many proscribed activities for me, I knew, was shopping. But it was nearly 10 p.m., and Icelandair had cancelled the flight’s meal service. Was I allowed into the duty-free store? I decided that I was. Dinner that night was beer and licorice.

Stefánsson, who is seventy-one, is tall and broad-shouldered, with white hair and a white, Hemingwayesque beard. For most of the eighties and nineties, he lived in the U.S., teaching first at the University of Chicago and then at Harvard. He returned to Iceland with the notion of using the country’s small, inbred population to study the connection between disease and genetic variation. This was before the human genome had been fully sequenced, and Stefánsson was sailing into uncharted waters. He founded deCODE, and it grew into a large company, which, like much of the rest of Iceland, went bankrupt following the financial crisis of 2008. DeCODE is now owned by an American biotech company, Amgen; its offices are in a sleek, metal-clad building not far from Reykjavík’s municipal airport. Refrigerated storage rooms in the basement hold blood samples from a hundred and eighty thousand Icelanders—roughly one of every two people in the country.

Stefánsson told me that he’d decided to get involved in covid-19 research a few days after Iceland’s first case was announced. He was driving to his office one morning when he heard on the radio an estimate of the virus’s fatality rate. “They predicted that 3.4 per cent of those who were infected would die,” Stefánsson recalled. “And I couldn’t understand how they could calculate the death rate, not knowing the distribution of the virus in society. So when I came to work I sat down with my colleagues. And I told them we should offer to screen the general population in Iceland.”

Iceland’s university hospital was already testing people who had symptoms of covid-19. But by testing people who had no symptoms, or only very mild ones, deCODE picked up many cases that otherwise would have been missed. These cases, too, were referred to the tracing team. By May 17th, Iceland had tested 15.5 per cent of its population for the virus. In the U.S., the figure was 3.4 per cent.

Meanwhile, deCODE was also sequencing the virus from every Icelander whose test had come back positive. As the virus is passed from person to person, it picks up random mutations. By analyzing these, geneticists can map the disease’s spread. At the beginning of the outbreak, travellers returning to Iceland from the Italian Alps seemed to be the primary source of infections. But researchers at deCODE found that, while attention had been focussed on Italy, the virus had been quietly slipping into the country from several other nations, including Britain. Travellers from the West Coast of the U.S. had brought in one strain, and travellers from the East Coast another. The East Coast strain had been imported to America from Italy or Austria, then exported back to Europe.

By sequencing the virus from every person infected, researchers at deCODE could also make inferences about how it had spread. “One of the very interesting things is that, in all our data, there are only two examples where a child infected a parent,” Stefánsson told me. “But there are lots of examples where parents infected children.”

Stefánsson is a frequent critic of the Icelandic government. He often fires off opinion pieces to newspapers, on subjects ranging from the management of fisheries to hospital financing. (A few years ago, he circulated a petition demanding that the government spend more on health care, and a third of the country’s adult population signed it.) At any given moment, he’s almost sure to be wrangling with one ministry or another; in March, when the Icelandic Data Protection Authority said that it couldn’t rule immediately on a request from deCODE, Stefánsson issued a lengthy denunciation on Facebook. But, when I asked Stefánsson about the Icelandic government’s response to covid-19, he had only kind words.

“This was done in an extremely balanced way,” he said at one point. “And I think the authorities did pretty much everything right.” At another point, he told me, “The remarkable thing in this whole affair is that in Iceland it has been run entirely by the public-health authorities. They came up with the plan, and they just instituted it. And we were fortunate that our politicians managed to control themselves.”

In Reykjavík, I stayed at one of the few hotels that were open, in an Art Deco building not far from the parliament. One evening, upon returning to the hotel, I found a film crew and a jumble of equipment blocking the hallway. In front of the cameras stood two middle-aged men and a woman, all dressed in white terry-cloth bathrobes. Though I’d been in Iceland for only two days, I recognized them. They were the team who had guided Iceland’s response to covid-19: the country’s director of emergency management, Víðir Reynisson; its chief epidemiologist, Þórólfur Guðnason; and its director of health, Alma Möller.

Reynisson, Guðnason, and Möller worked together out of an improvised covid command center in the offices of the Icelandic Coast Guard. Through March, April, and much of May, they gave a joint briefing every day at 2 p.m., at which they discussed, matter-of-factly, what they knew and what they didn’t. Sometimes they invited guests, such as a psychologist who spoke about how to talk to kids about the pandemic. On occasion, they warned about misinformation—for instance, the potentially fatal consequences of attempting to fight the virus by drinking bleach. Three-quarters of Icelanders tuned in at some point. Reynisson, Guðnason, and Möller became so well known that they were referred to simply as the “trio,” or the “tripod,” or, as one person put it to me, the “holy trinity.”