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| Iceland’s ‘Test Everyone’ Goal Has Skeptics, but It May Be Working | Iceland’s ‘Test Everyone’ Goal Has Skeptics, but It May Be Working |
| (32 minutes later) | |
| With its small population and isolated location, Iceland has earned praise and headlines for its plan to test as many people as possible for exposure to the new coronavirus. Why, some wondered, couldn’t other countries be like Iceland? | With its small population and isolated location, Iceland has earned praise and headlines for its plan to test as many people as possible for exposure to the new coronavirus. Why, some wondered, couldn’t other countries be like Iceland? |
| But critics inside the country have called this rosy picture misleading. | But critics inside the country have called this rosy picture misleading. |
| They say the tiny Nordic island country of 360,000 people has not done enough to suppress new cases of Covid-19, the disease caused by the virus. Primary schools and day-care centers remain open, as do some restaurants with limited seating. Tourists are still allowed to arrive and travel without quarantine. The authorities at first limited gatherings to 100 people, then changed that to 20, long after other countries were imposing greater social isolation. | They say the tiny Nordic island country of 360,000 people has not done enough to suppress new cases of Covid-19, the disease caused by the virus. Primary schools and day-care centers remain open, as do some restaurants with limited seating. Tourists are still allowed to arrive and travel without quarantine. The authorities at first limited gatherings to 100 people, then changed that to 20, long after other countries were imposing greater social isolation. |
| Iceland’s goal of testing everyone faces the same logistical hurdles that all countries face, the critics point out. It does not have enough medical personnel, supplies or hours in the day to test hundreds of thousands of people in a few weeks or months. They have warned of false optimism that will ultimately lead to more infections and death. | Iceland’s goal of testing everyone faces the same logistical hurdles that all countries face, the critics point out. It does not have enough medical personnel, supplies or hours in the day to test hundreds of thousands of people in a few weeks or months. They have warned of false optimism that will ultimately lead to more infections and death. |
| But Kjartan Hreinn Njalsson, the assistant to Iceland’s director of health, touted what he called a landmark moment on Wednesday: “More people are now getting better than getting infected.” In fact, he said, government officials believe cases may have peaked. “We are not over the hill, but close to it.” | But Kjartan Hreinn Njalsson, the assistant to Iceland’s director of health, touted what he called a landmark moment on Wednesday: “More people are now getting better than getting infected.” In fact, he said, government officials believe cases may have peaked. “We are not over the hill, but close to it.” |
| Mr. Njalsson also said the country is well stocked with testing swabs and other necessary materials. “We know that we will eventually need more viral swabs,” he added, “and that every country in the world is trying to secure stocks.” | Mr. Njalsson also said the country is well stocked with testing swabs and other necessary materials. “We know that we will eventually need more viral swabs,” he added, “and that every country in the world is trying to secure stocks.” |
| But so far Iceland has been steadily testing people with and without symptoms, with the help of deCODE genetics, a company that has long operated in the country and is a subsidiary of Amgen. The country has one of the highest proportions of tests performed by any country for the coronavirus, according to government officials. They have tracked the origins of different infections, traced contacts and even looked at the virus’s different strains. | But so far Iceland has been steadily testing people with and without symptoms, with the help of deCODE genetics, a company that has long operated in the country and is a subsidiary of Amgen. The country has one of the highest proportions of tests performed by any country for the coronavirus, according to government officials. They have tracked the origins of different infections, traced contacts and even looked at the virus’s different strains. |
| As of Wednesday, at least 30,000 samples had been tested, according to officials, and the country had at least 1,600 confirmed Covid-19 cases. Iceland confirmed its first case on Feb. 28. Six people have died. | As of Wednesday, at least 30,000 samples had been tested, according to officials, and the country had at least 1,600 confirmed Covid-19 cases. Iceland confirmed its first case on Feb. 28. Six people have died. |
| To get tested at a hospital or clinic, individuals must meet certain criteria, such as having symptoms like a fever or being a member of a high-risk group. Health care workers, people who have traveled from high-risk areas, and those in quarantine are also able to get tested at a hospital or clinic. | To get tested at a hospital or clinic, individuals must meet certain criteria, such as having symptoms like a fever or being a member of a high-risk group. Health care workers, people who have traveled from high-risk areas, and those in quarantine are also able to get tested at a hospital or clinic. |
| Nearly everyone else can sign up to be tested by deCODE. | Nearly everyone else can sign up to be tested by deCODE. |
| Dr. Kari Stefansson, the chief executive of deCODE, said the testing and sequencing that his company had provided indicates that, with a cohesive screening approach, “you can slow the spread of the virus, you can make it manageable for society.” The company has called for testing asymptomatic people as a way of finding undetected cases and stopping the spread of the disease. | Dr. Kari Stefansson, the chief executive of deCODE, said the testing and sequencing that his company had provided indicates that, with a cohesive screening approach, “you can slow the spread of the virus, you can make it manageable for society.” The company has called for testing asymptomatic people as a way of finding undetected cases and stopping the spread of the disease. |
| Dagur B. Eggertsson, the mayor of Reykjavik, credited the country’s large-scale testing and daily briefings about the results with getting average citizens engaged with preparations. “We can’t use force,” the mayor said. “We have to use arguments and voice of reason to get people to work together.” | Dagur B. Eggertsson, the mayor of Reykjavik, credited the country’s large-scale testing and daily briefings about the results with getting average citizens engaged with preparations. “We can’t use force,” the mayor said. “We have to use arguments and voice of reason to get people to work together.” |
| But a few dissenters have said extreme restrictions were exactly what Iceland needed to stop the outbreak entirely. They warned, for example, that keeping schools open could contribute to the virus spreading. | But a few dissenters have said extreme restrictions were exactly what Iceland needed to stop the outbreak entirely. They warned, for example, that keeping schools open could contribute to the virus spreading. |
| “It’s true that many people got tested,” said Frosti Sigurjonsson, a former member of Parliament who has been critical of the government response. “It’s more than in most countries, let’s say that, but it is certainly not true that everybody can get tested. It’s not feasible.” | “It’s true that many people got tested,” said Frosti Sigurjonsson, a former member of Parliament who has been critical of the government response. “It’s more than in most countries, let’s say that, but it is certainly not true that everybody can get tested. It’s not feasible.” |
| Mr. Sigurjonsson and another veteran parliamentarian had written an open letter calling on the government to be more aggressive. For example, he had suggested that Iceland close to tourism and isolate infected people from their families in the empty hotel rooms. “If you can save a life, save it,” he said. “Don’t think about the cost.” | Mr. Sigurjonsson and another veteran parliamentarian had written an open letter calling on the government to be more aggressive. For example, he had suggested that Iceland close to tourism and isolate infected people from their families in the empty hotel rooms. “If you can save a life, save it,” he said. “Don’t think about the cost.” |
| But on Wednesday he said he had been made hopeful by the latest statistics. “The growth has certainly slowed and new cases are now becoming fewer every day,” he said. “So yes. It could have reached its peak.” He suggested that the government had taken his criticism to heart. | But on Wednesday he said he had been made hopeful by the latest statistics. “The growth has certainly slowed and new cases are now becoming fewer every day,” he said. “So yes. It could have reached its peak.” He suggested that the government had taken his criticism to heart. |
| But another critic of the government strategy, Chris McClure, an entrepreneur and trained social-behavioral epidemiologist who has worked on epidemic efforts in Connecticut and Florida in the past, said he believed the government should still take tougher steps, such as closing primary schools and day-care centers. He noted that children can be asymptomatic carriers, adding that Iceland now has confirmed cases in children. | But another critic of the government strategy, Chris McClure, an entrepreneur and trained social-behavioral epidemiologist who has worked on epidemic efforts in Connecticut and Florida in the past, said he believed the government should still take tougher steps, such as closing primary schools and day-care centers. He noted that children can be asymptomatic carriers, adding that Iceland now has confirmed cases in children. |
| Updated June 22, 2020 | Updated June 22, 2020 |
| A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico. | A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico. |
| The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. | The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. |
| The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. | The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. |
| So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. | So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. |
| Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. | Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. |
| A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. | A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. |
| The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. | The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April. |
| States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. | States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people. |
| Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. | Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. |
| If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) | If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) |
| If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. | If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. |
| If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. | If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. |
| He did acknowledge that new cases have reached a plateau. “But this does not mean it will decrease,” he said. | |
| The evidence has shown that closing schools in other countries worked, Mr. McClure wrote in a Medium post. And while Iceland is testing about 1,000 people a day, he said, testing everyone would still take at least the rest of the year. | |
| “Iceland started off out of the gate doing quite well,” he said during a phone interview, but “as you see occurring everywhere in the world, there is an absolute scarcity of everything. Tests, respirators, everything.” | “Iceland started off out of the gate doing quite well,” he said during a phone interview, but “as you see occurring everywhere in the world, there is an absolute scarcity of everything. Tests, respirators, everything.” |
| Thorolfur Gudnason, the chief epidemiologist in Iceland, said the country was using both mitigation and suppression efforts. “We are using extreme measures with rapid detection,” he said, noting that the majority of new cases found have come from people already in quarantine. The stricter ban on gatherings took effect on March 24, and it was extended to include swimming pools, gyms, pubs and museums, which were closed. People have also been instructed to stay six feet apart. | Thorolfur Gudnason, the chief epidemiologist in Iceland, said the country was using both mitigation and suppression efforts. “We are using extreme measures with rapid detection,” he said, noting that the majority of new cases found have come from people already in quarantine. The stricter ban on gatherings took effect on March 24, and it was extended to include swimming pools, gyms, pubs and museums, which were closed. People have also been instructed to stay six feet apart. |
| He said primary schools and day care centers could remain open with limited class sizes and social distancing by teachers because studies have shown “infection in children is rare.” But in fact the most recent research shows children do get Covid-19 and some have died, according to preliminary report by the U.S. Centers for Disease Control and Prevention. Their symptoms tend to be milder but that means they could be spreading the virus to others in their families and communities. | He said primary schools and day care centers could remain open with limited class sizes and social distancing by teachers because studies have shown “infection in children is rare.” But in fact the most recent research shows children do get Covid-19 and some have died, according to preliminary report by the U.S. Centers for Disease Control and Prevention. Their symptoms tend to be milder but that means they could be spreading the virus to others in their families and communities. |
| Iceland has not prohibited tourists or placed them into quarantine, Dr. Gudnason said, because “we think they’re not mixing that much with the population.” They stay with their own groups and leave after a few days, he said. | Iceland has not prohibited tourists or placed them into quarantine, Dr. Gudnason said, because “we think they’re not mixing that much with the population.” They stay with their own groups and leave after a few days, he said. |
| “You would cause a lot of problems to the functions in society, and I don’t know if people would accept that for months and months,” he said. “It’s going to be interesting to see what’s happening in countries using extreme measures.” | “You would cause a lot of problems to the functions in society, and I don’t know if people would accept that for months and months,” he said. “It’s going to be interesting to see what’s happening in countries using extreme measures.” |