Even as Covid-19-infection rates skyrocket, Iceland – the North Atlantic island nation that once believed it could test and isolate to ensure the safety of its citizens until the Covid-19 causing SARS-CoV-2 virus was eliminated – has finally given in to the global pandemic.
As of Friday, all restrictions imposed with the intent of stopping the spread of the disease in the country have been lifted.
Morgunblaðið, Icelandic for “the morning paper” and the most popular news site in the tiny but much-visited nation of 366,000, reported the change in policy this way:
“The main reason for eliminating everything is that the spread of infection is so great that restrictions do not seem to be able to keep up with it. There are also indications that there are significantly more people who have been infected than official figures can confirm.”
The action came on the same day the U.S. Centers for Disease Control (CDC) dropped its recommendation for masks in most of the U.S.
“So what do these updated metrics mean for where we are as a country? As of today, more than half of counties representing about 70 percent of Americans are in areas with low- or medium0COVID 19 community levels. This is an increase from about one-third of counties at low or medium community levels last week, and we continue to see indicators improve in many communities.”
In Iceland, it was reported that the country’s political leaders had decided to leave it to Icelanders to manage their own health.
“The ministers…agreed that most Icelanders had now come to know the disease so well that they would not have difficulty behaving sensibly,” the newspaper reported.
Politics or science?
The CDC’s reasons for its decision were less clear. When a Chicago Tribune reporter asked if the agency was being “pulled along” by governors who’ve already said they’re killing mask mandates, CDC Director Dr. Rochelle Walensky dodged.
“Now we’ve been talking about this for some time,” she said before arguing that many governors had ordered “phased-in” unmasking.
“So I would say our guidance actually probably very much intersects exactly where many of those phase approaches are going to be in that many of those governors, when their policies are at play, will coincide with exactly what we are recommending,” Walensky said.
No mention was made of a random controlled trial (RCT) of masks in Denmark in April and May 2020 that found no statistically significant benefit to masking when the levels of circulating SARS-CoV-2 viruses were moderate to low. RCTs are considered the gold standard of medical research.
The study’s findings were wildly controversial at the time with the authors suggesting they had problems finding a journal willing to publish. The document finally made it into the peer-reviewed Annals of Internal Medicine where it was reported that 4,862 of the 6,024 people originally enrolled as maskers or controls “completed the study.
“Infection with SARS-CoV-2 occurred in 42 participants recommended masks (1.8 percent) and 53 control participants (2.1 percent). The between-group difference was −0.3 percentage points.
“The recommendation to wear surgical masks to supplement other public health measures did not reduce the SARS-CoV-2 infection rate among wearers by more than 50 percent in a community with modest infection rates, some degree of social distancing, and uncommon general mask use.”
Much was made of the 50 percent level being too high, and of the possibility masks might be more meaningful with the virus running rampant, a point the authors of the study conceded.
The CDC said Friday that masking should continue in parts of the U.S. where high rates of Covid-19 hospitalizations indicate a high rate of SARS-CoV-2 in circulation, and they said masking could be suggested for other parts of the country as the Covid-19 situations changes week to week.
Iceland officials likewise said they might reinstate restrictions if the virus spins off a deadlier variant than the now widely circulating Omicron, but for now they suggested Icelanders get back to life as normal.
No mentions were made of the economics of the pandemic, but it is hard to ignore the likelihood that economics – along with vaccines highly successful at reducing hospitalization and the arrival of the less virulent Omicron variant of SARS-CoV-2 – are playing some role in decisions to reduce so-called nonpharmaceutical interventions at a time when infection rates are far higher than when the pandemic began.
The Worldometer Covid-19 tracker on Friday showed a seven-day average infection rate of more than 3,000 cases in Iceland. From the beginning of the pandemic through early summer 2021, the rate had never gone above 100, and it didn’t top 500 until December 2021. It has since skyrocketed.
The situation is different in the U.S. where Omicron burned through the population hot and fast. The nationwide, seven-day average infection rate went from 125,000 per day in mid-December to a peak of more than 800,000 – a better than sixfold increase – in mid-January before plummeting to about 78,000 as of Friday, according to the Worldometer tracker.
Deadly for tourism
Tourism is a mainstay of the Iceland economy, and the tourist industry there has struggled badly since the pandemic began in early 2020 and the world started locking down. Two million visitors still made it to Iceland that year, Morgunblaðið reported, but the number fell to 486,000, about a quarter of that, in 2020.
Iceland’s experience parallels that of Alaska, where the Alaska Travel Industry Association reported visitors numbers falling from 2.4 million in 2019 to 427,000 in 2020, largely because of a decision by most cruise ship lines to abandon the state.
Tourism in Alaska, as in Iceland, was rebounding in 2021, but annual numbers are not yet available and are not expected to be anywhere near the 2.5 million that would have been projected for an industry that had witnessed steady annual growth every year from 2010 until the start of the pandemicis which is far from over, officially or otherwise.
More than 76,000 new cases were reported in the U.S. alone. That’s about equal to the number of cases identified around the world in April 2020, according to the Worldometer tracker. In April 2020, many Western governments were already in panic mode.
By then the Spanish government had imposed a lockdown that ordered everyone but essentially workers to stay in their homes unless they needed to go out to get food to survive. Many other countries soon followed suit.
A peer-reviewed meta-analysis of lockdown studies published at PLOS-One in 2020 found these lockdowns appeared to slow the spread of infections by a little under 5 percent per day and cut the increase in “daily death growth rates” by 1.9 percent,
But the pandemic continued to grow on the global scale. The Worldometer tracker now shows four distinct, global waves of the disease with the biggest peaking with a seven-day moving average of almost 3.4 million infections on Jan. 26 of this year.
The pre-print of “A Literature Review and Meta-Analysis of the Effects of Lockdowns on Covid-19 Mortality” authored by a group of researchers led by economists from John Hopkins University in January of this year concluded that “that lockdowns in Europe and the United States only reduced Covid-19 mortality by 0.2 percent on average.
“While this meta-analysis concludes that lockdowns have had little to no public health effects, they have imposed enormous economic and social costs where they have been adopted,” it said. “In consequence, lockdown policies are ill-founded and should be rejected as a pandemic policy instrument.”
The study proved highly controversial. It was widely criticized, largely because the main authors were neither epidemiologists nor political Progressives. Lead author Steve Hanke “is an applied economist, not an epidemiologist, public health expert, or medical doctor,” reporter Kristina Fiore wrote at MedPage Today. “Hanke is also a senior fellow at the Cato Institute, a libertarian think tank.
“Hanke’s co-authors are Jonas Herby, MS, a ‘specialist consultant’ at the Center for Political Studies in Copenhagen, and Lars Jonung, PhD, professor emeritus of economics at Lund University in Sweden — a country that famously opted out of lockdowns and only recommended masks in public. Again, neither Herby nor Jonung are medical or public health experts.
“The trio are ‘highly regarded economists who have also been extremely anti-lockdown since March 2020,; tweeted Gideon Meyerowitz-Katz, PhD, an epidemiologist at the University of Wollongong in Australia, who posted a thorough critique of the paper.”
Fiore’s report touched off a firestorm of debate between health professionals in the MedPage comments section. Suffice to say, the medical community like much of the rest of the world seems split between those of the opinion that everything and anything possible must be done “if it saves even one life” and those who believe life must go on because people cannot psychologically survive lockdowns for years.
Iceland’s political leaders appear to have sided with the latter group, which also includes many who do not like masks either while others do.
Walensky and Massetti in their telebriefing made a point of highlighting that with mask recommendations being lifted, anti-maskers should not try to ostracize those who want to continue to wear masks as those who favored masks once did with those who didn’t.
“We should all keep in mind that some people may choose to wear a mask at any time based on personal preference,” Massetti said. “And importantly, people who wear high-quality masks are well protected, even if others around you are not masking. And there are some situations where people should always wear a mask. For example, if they have symptoms, if they tested positive for COVID 19, or if they have been exposed to someone with COVID 19.”
A 2021 report published by the CDC but not peer-reviewed concluded that properly fitted N95 or KN95 mask, the gold-standard of masks, lowered the odds of a Covid-19 infection by 83 percent, but there were, unfortunatel, some serious confounders in the study.
The authors conceded their examination “did not account for other preventive behaviors that could influence risk for acquiring infection, including adherence to physical distancing recommendations,” or avoiding bars and restaurants which other studies have shown to be hotspots for Covid-19 infections.
The study was also conducted before Omicron, “which is more transmissible than earlier variants,” the authors wrote, and ” face mask or respirator use was self-reported, which could introduce social desirability bias.”
In other words, the people who avoided infection might have significantly over-reported their use of masks or respirators to comply with the social mores in place at the time the study was being conducted in California.
The mask debate is still being sorted out, but what is clear is that what works best to slow the spread of any infectious disease is for the sick to stay away from the healthy.
Along those lines, authorities in Iceland had a much better recommendation than Massetti’s suggested masking for those who experienced symptoms of Covid-19, tested positive or had been exposed to someone with the disease: Stay home.
Long before the latest pandemic, medical researchers were warning that “preseneetism” – the need to be at work or elsewhere when sick – was driving the spread of respiratory infections. The focus then, before Sars-CoV-2, was on the flu and a 2013 study published in the American Journal of Public Health reported presenteeism was a key factor driving flu outbreaks.
This is equally true for Covid-19 and maybe more so, but there are still those who think going to work while sick is a noble act.
CORRECTION: This is updated version of the original story which in two places wrongly dated the beginning of the pandemic.