COVID surges in one of world’s most vaccinated nations

Jolyon Attwooll

9/08/2021 5:09:45 PM

But while case numbers in Iceland are at record levels, no deaths have been attributed to the most recent wave and hospitalisations remain low.

Icelandic countryside with social distancing sign.
Despite the rise in cases, there were only 18 hospitalised COVID cases nationwide at the time of publication.

At the end of June, the Iceland Government took steps that were a precursor to strategies in the UK and elsewhere.
With a high level of vaccination in the country – almost nine in every 10 adults had received at least one dose of a COVID-19 vaccine – authorities decided the time had come to open up.
Restrictions on the number of people allowed at gatherings were lifted, as were mask-wearing and social distancing requirements.
Since then, vaccinations have increased, with more than 85% of the adult population in Iceland now fully vaccinated. It is higher than the 80% target agreed by National Cabinet which would allow Australia into the so-called phase C of a plan to allow more freedoms.
With Iceland having succeeded in reducing community transmission down to almost zero this year, its situation could provide clues as to what might happen in Australia when border restrictions are eased.
Six weeks on, and the impact of the measures are beginning to show. The country, which has a total population estimated at 366,425, has seen the number of new COVID-19 cases spiking to their highest ever level in the past fortnight.
More positive cases are currently being recorded than during the first and second waves in the country last year. The seven-day average according to the Reuters tracker shows the number of cases averaging around 205 per 100,000 people (the United States currently stands at around 230 per 100,000).
Conspiracy theorists have used the data to support their criticisms of the vaccines’ efficacy – pointing to the level of vaccinated people who have tested positive to the virus.

However, conspicuously absent from many of those theories – which are the subject of a debunking article by Reuters Fact Check – are references to the severity of symptoms caused by the current wave of cases.
According to the country’s Director General of the Ministry of Health Ásthildur Knútsdóttir, around 97% percent of those current infections include mild or no symptoms at all.
As previously covered by newsGP, the level of ‘breakthrough infections’ among those vaccinated is expected to rise as vaccination coverage increases. Around 77% of Iceland’s local cases are now among vaccinated individuals, Ms Knútsdóttir told Reuters.
But despite the rise in cases, there are currently only 18 hospitalised COVID cases nationwide. Demands may have increased on the country’s healthcare staff since the country opened up but the figures do not suggest the system is being overwhelmed.
Of the 30 COVID-related deaths in the country, only one person has died in Iceland this year so far – back in May before this current wave.

The statistics as they stand largely seem to support the work published by Doherty Institute, which has provided modelling to the Government considering the transmissibility of new variants such as Delta.
‘That work demonstrated that even at very high levels of vaccine uptake [80% or above], suppression of epidemic growth below the critical reproduction number of one required to attain “herd immunity” was unlikely for such a strain,’ the recent Doherty Institute report said.
‘However, substantive reductions in transmission potential could be achieved which, together with intermittent application of social measures, would constrain the rate and extent of epidemic growth.
‘In addition, the decrease in disease severity in vaccinated individuals would lead to lower rates of hospitalisation, intensive care utilisation and death.’
In Iceland, there have been four vaccines used, with Pfizer the most widely administered. The one-dose Johnson & Johnson vaccine has also been widespread, as has the AstraZeneca vaccine.
Moderna is now also online and has predominantly been used in people aged 60 and under.
The example of Iceland has also raised the question of vaccinating children: only those deemed at risk under the age of 16 were immunised when restrictions were lifted in country, and the level of vaccination in that age group remains low.
The Doherty Institute modelling also does not suggest prioritising the widescale vaccination of children within its recommendation to Australia’s Government.
‘It is anticipated that inclusion of 12–15-year-olds in the vaccine rollout as an early priority group would not materially change the expected overall health outcomes at each key vaccination threshold,’ the Doherty Modelling Report for National Cabinet on 30 July states.
‘For a given level of vaccination, the total number of Australians who experience severe illness from COVID-19 will be similar regardless of whether the vaccination rate has been achieved across the 12+ or 16+ population.’

However, for Alexandra Martiniuk, a Professor of Epidemiology at the University of Sydney, the gap is a concern – as other disease experts have also said.
‘For some time, this will mean that children are at high risk of catching COVID until they too can be vaccinated,’ Professor Martiniuk told newsGP.
With Northern Hemisphere countries like Iceland on summer holidays, Professor Martiniuk said she expects schools and day-care centres to become sites of increasing transmission.
‘The good news is that the majority of vaccines being used globally, certainly Pfizer and AstraZeneca in Australia, protect very well against hospitalisation and death,’ Professor Martiniuk said.
‘The bad news is that the younger age groups have not yet had the opportunity to be vaccinated in Australia.
‘We know that preschool and school is important for children and their working parents, but without this age group being vaccinated, it is difficult to imagine schools re-opening.’
She said that while previous variants of COVID suggested children were much less likely to get severely ill, there is still a lack of clarity about the impact of the recent strain on younger people.
‘Australia will need to vaccinate children at some point as it appears that COVID is here to stay,’ Professor Martiniuk stated.
‘They will either get COVID or they will get a COVID vaccine, and given the risk of severe disease and long COVID, the vaccine is likely the preferred option.
‘Schools will be an unsafe place for the unvaccinated pool of children and teachers – and we must take this into account.’
In the meantime, Professor Martiniuk said preventive health measures such as mask wearing, social distancing and isolating will be needed until mid-2022 when vaccine supplies are expected to cover the whole population, including children.
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