Learnings from the country that has tested the most
Some say that economists should leave the considerations related to the corona to the epidemiologists and focus on measures needed when time is ripe to restart the economy.
However, as the epidemiologists themselves discuss and as the economic consequences are immense, it appears legitimate that we all engage; To understand the pandemic, the impact of the lock-down, the effectiveness of each measure to combat the virus and how our economies again can be restarted.
No country has tested a larger part of population than Iceland. Here about 14% of the populations has been tested, as compared to 4% in Denmark, 3% in Norway and Germany, 2% in the US and 1,6% in the UK.
The learnings from Iceland should thus carry quite some weight.
The corona-virus entered Iceland end-February, partly as skiing tourists returned from Austria. First the virus spread, then it was fought with social distancing and closures. However, kindergartens and primary schools were kept open.
Iceland has two testing systems; one run by the National University Hospital (NUHI) and one run by a private firm, deCODE Geneticts. The first focused on those with symptoms and health care workers. The second ran voluntary testing. None of the two tested purely random samples.
In Iceland the number of infections soon peaked and then declined, ref. exhibit 1. Barely any new infections have been registered the last days, normally only 1-3 per day. However, still about 800 are tested daily.
Also, in Iceland some may have been infected without becoming registered. Hence, the ratios of hospitalized, in ICU and the mortality ratio that follows may be overstated.
To date, to my knowledge, no antibody tests have been conducted in Iceland. DeCODE is reviewing alternative testing methodologies, in search for one that can be relied upon.
The Iceland-case (and similar observations from the Italian village of Vó, and for that matter China and South Korea) shows that the virus can be contained.
The Iceland case, though, does not answer how the virus can be contained in an open society with open borders, also towards countries with infection.
The chart summarizes the key ratios as observed in Iceland:
- More than half of those infected show no symptoms,
- Some patients get very ill, requiring (lengthy) ICU-care (1-1,5% of all),
- With the right care 99,9% of those infected aged 30 to 60 years recover,
- Excess mortality is again seen among the elderly, especially those previously hospitalized. In Denmark 83% of those who died had been hospitalized last 5 years,
- The virus has been found in 40 versions. Hence, repeat exposure poses additional risk.
Exhibit 2 summarizes the main figures from Icalnd. Some questions remain unanswered; How many get infected as ratio of those exposed and how many were actually infected?
Some answers are confirmed by the Iceland-figures; With the high ICU-rates effective measures are needed to avoid that the hospital systems are overwhelmed, the elderly must be protected, and, not least, the virus can be “taken out”.
But, in an economy dependent on tourism, as Iceland, closed border to the UK, the European continent and the US is hardly an option. The data thus point to the need for even more effective measures to track and test, ideally real time, even in the country that tests the most.
Comparing Iceland and other “testers” to other countries one sees to what extent the practices and outcome differs, see exhibit 3.
Here Iceland joins Australia, UAE, Taiwan and South Korea. In these countries extensive testing and quarantine of those identified as infected helps to contain the virus, despite a less strict lock-down as compared to many of the non-testers, ref. exhibit 4.
The US, sadly, finds itself in a challenging territory. It tests few as compared to the number of infected, ref. exhibit 3. Also, its lock-down, that some now wants to ease, is modest as compared to countries equally severely hit.