WIRED : MAR 3, 2022

ICELAND lifted all restrictions against Covid—no quarantining for the infected, no testing at the border, and no size limits on gatherings. The same day, the country broke its single-day record for the highest number of cases, with over 4,300 reported.

On that day, too, Landspítali, the country’s largest hospital, declared it was at emergency levels, with 55 Covid patients admitted and three of them in the ICU. Hildur Helgadóttir, project manager of the hospital’s epidemic committee, told the national broadcaster RUV that the government had not consulted with the hospital before dropping restrictions and that the move was too abrupt. The epidemic could be severe in the coming weeks, she said.
But what shocked the country even more was the words of Iceland’s chief epidemiologist, Thorolfur Gudnason. In his memo to the Minister of Health laying out the rationale for dropping restrictions, Gudnason said the main way out of the epidemic is natural herd immunity, or when enough people are immune to the virus that its transmission ceases. In order to achieve this, Gudnason wrote, “as many people as possible need to be infected with the virus” because vaccines alone are not enough. (Almost 80 percent of Iceland’s population has been fully vaccinated.) According to Kristjana Ásbjörnsdóttir, an epidemiologist at the University of Iceland, his argument is that if the health care system isn’t overwhelmed, and the Omicron wave indeed ends in a few weeks as he is projecting, it may be worth a short-term spike in infections to “get this over with.”

When asked for the rationale behind dropping the restrictions, a spokesperson for the Directorate of Health, where Gudnason works, said that although nobody knows the level at which herd immunity will be obtained, “it is quite evident to us that the only way to get out of this pandemic is by obtaining herd immunity via natural infections.” Given that Iceland has high vaccine coverage, and that the restrictions required to control the spread of Omicron would cause “considerable and unforeseen consequences on the society as a whole,” the spokesperson wrote that their office believes “reaching herd immunity via the natural process of infection in a highly vaccinated population is justifiable.”

Gudnason’s approach deeply concerns Ásbjörnsdóttir. “Unfortunately, after doing a truly excellent job for the majority of the pandemic, we’re now falling into the trap of [only] thinking about the average person,” she says—and forgetting about the clinically vulnerable and immunocompromised. “We need to have deeper conversations about what minor modifications we can live with longer-term that will allow most things to return to pre-pandemic operations without endangering our most vulnerable.”

Indeed, Gudnason’s statement was met with fear and anger by some members of Iceland’s clinically vulnerable community. Some immunocompromised people do not mount a good—if any—response to vaccines. For them, Omicron might not just cause a sniffly nose; it presents a real danger. Dropping mask mandates and vaccination requirements can mean that the world outside their homes will become a no-go zone. “The complete lifting of all measures, including masks and testing, feels like an unspoken death sentence,” says Hans Jónsson, who is disabled and lives in Ólafsfjörður, a town in northeast Iceland. “I feel like they’ve decided that I simply don’t deserve to live.”

Thordis Björg, who lives in Reykjavík, the capital where more than 60 percent of the population lives, has an autoimmune disorder that puts her at risk from Covid. She calls Willum Thór Thórsson, the Minister of Health who enacted the decision to drop the restrictions, “the Minister of No-Health.” “He does not really talk about the trade-off of infecting everyone. He’s just looking at the hopeful side of it,” Björg says.
Iceland has had a relatively mild pandemic experience, recording just 62 deaths and around 133,000 cases in total. In the first few months of 2020, its strategy of quashing any outbreaks using painstaking genomic surveillance, testing, and contact tracing was declared a success and a scientific marvel: The country had “beat the coronavirus,” “hammered COVID with science,” or—put more elegantly—“Scienced the Crap Outta COVID.” At the end of June 2021, the government triumphantly announced it was lifting all restrictions. But the supposed return to normal didn’t last long. By the end of the month, numbers began to shoot up. Restrictions were reintroduced in late July, just a month later. They were dropped again at the end of August and stayed that way until, on December 1, Iceland declared its first case of Omicron. By December 21, tighter restrictions were introduced, and those only began to loosen at the beginning of 2022.

Iceland is one of a growing list of European countries rapidly abandoning almost all their Covid restrictions. At the beginning of February, Denmark became the first country in the European Union to drop all restrictions, with officials saying they no longer considered Covid “a socially critical disease.” On February 9, Sweden followed suit, though symptomatic people are still advised to stay at home. In Switzerland and Austria, almost all Covid restrictions have been scrapped (apart from mask mandates in certain situations and, in Switzerland, the requirement to self-isolate for five days after a positive test). Europe might be nearing a “plausible endgame for the pandemic,” Hans Kluge, the World Health Organization’s director in Europe, said at a news conference in early February.

In other parts of the world, nations that enjoyed low case counts throughout the first two years of the pandemic took the opposite approach as Omicron surged regionally. The fragile health care systems of Pacific Island nations like Kiribati, Palau, and Tonga meant that the virus’s arrival necessitated a rush to vaccinate their populations, introduce mask mandates, close schools, or institute lockdowns. China, which remains vulnerable to Omicron due to the use of less-effective inactivated-virus vaccines, is still pursuing a “dynamic zero-Covid” policy that aims to contain outbreaks through strict lockdowns and tracing apps.

Most bizarrely, for the lion’s share of these European countries, including Iceland, the decision to roll back restrictions came amid soaring Omicron waves. Denmark had the second-highest infection rate in the world at the time. But, as Jens Lundgren, a professor of infectious diseases at the University of Copenhagen, says, the virus was no longer considered “a socially critical disease” by the government, meaning it wasn’t threatening critical infrastructure—hospitals, in particular. That being the case, he says, “it would be impossible to continue to argue that it was still necessary to maintain restrictions.”

These near-overnight returns to a semblance of pre-pandemic life have triggered serious questions from experts. Natural herd immunity, or the total halt of transmission, is an elusive and often-misunderstood concept, says David Heymann, a professor of infectious disease epidemiology at the London School of Hygiene and Tropical Medicine. Achieving herd immunity against Covid is a pipe dream, he says, because neither vaccines nor infections offer lifelong immunity or entirely stop transmission. The idea that herd immunity is a viable way out of the pandemic has been widely criticized; the World Health Organization deemed it “unethical” to allow the spread of a dangerous virus that we don’t fully understand.

Rather, Heymann says, we should be aiming for population immunity—where a certain percentage of people have antibodies against the virus, either from infection, being vaccinated, or both, so that an infection or reinfection doesn’t lead to severe illness. In this scenario, the virus still circulates, but it is able to do less damage. Achieving population immunity through vaccination is the much safer route, Heymann says, as it diminishes the likelihood of long Covid in those who get infected.

Others have echoed Ásbjörnsdóttir’s concerns, saying that waiting until cases go down to open the country up might be the safer route. Tedros Adhanom Ghebreyesus, the WHO director-general, warned on February 1 that countries were wrong to assume that because Omicron is so transmissible and vaccination increasingly widespread, preventing transmission is “no longer possible, and no longer necessary.” “It’s premature for any country either to surrender or to declare victory,” he said.

Omicron’s relative mildness—at least among vaccinated populations—might offer a temporary moment of respite, but experts warn that these countries must remain vigilant for other, potentially more pernicious variants that could arise and which may warrant clamping down once again. Lundgren acknowledges this: “The virus has a big say in what will happen, and I, for one, would never lose my guard.” He is sympathetic to the concerns of the most vulnerable but says the situation has changed. “We also need to appreciate that we are not defenseless,” he says, pointing to the treatments for Covid that now exist.

To Heymann, it comes down to each nation’s risk calculus. “Countries have to make their own decisions. And that’s what they’re doing,” says Heymann. “Governments have to determine what risk they’re willing to take.”