“What’s up with Iceland?” - this graph has caught the attention of several of my friends abroad and there are probably things others can learn from the Covid response here in Iceland. Let me elaborate (chart: https://ourworldindata.org/coronavirus#testing-for-covid-19) 1/

First of all, I’m not an expert on this topic. I’ll try to stay factual, providing refs along the way. This is not an attempt to give a “this is the only way to do it” rant, but rather look at which actions worked in a nation that’s like a microcosm of many bigger nations. 2/

The first question is “can Iceland really be representative?” I believe it can. It’s tiny (~360k) island, but it's a well connected hub btwn Europe and America with a surprising amount of thru traffic from all over the world. This does not make the Covid response job easier. 3/

Let’s start with the current data. You can see it all at https://www.covid.is/data  and this is the most important one: the number of active infections is going down, and has been for several days now. Crossing fingers it will continue to do so. 4/

How did we get there? The overall timeline can be found at https://www.covid.is/categories/icelands-response and I won't repeat it all here, but just a few things to highlight based on my own experience going through this. 5/

The government very early on decided to put people who might have been in contact with infected people into quarantine, and as the cases started mounting up more than half of cases diagnosed were from people who were already in quarantine. 6/

This shows that the quarantines were an effective tool, and made contact tracing and mitigation efforts easier than otherwise. We also did aggressive contact tracing, and have been able to successfully trace 93% of all cases diagnosed. 7/

All responses have been fairly measured, and folks have reacted with stoic attitude. Eg we didn't close the country fully to begin with, but instead focused on mitigating efforts (mostly mandatory quarantines) for ppl coming from high-risk areas (eg N-Italy very early on). 8/

Similarly, a public gathering ban went into effect when the first case couldn't be traced, so there was usually a logical connection between things that were going on and the actions. 9/

A local biotech company, DeCode Genetics, offered to do public sampling for research purposes, and this has been a major boon to our testing abilities, resulting in far more tests per capita than other countries (as per the initial graph) and almost 10% of the population. 10/

The results from the public sampling has been pretty startling, initially hovering around <1% and now only around 1-3 per thousand (they only test non-quarantined asympt. people in the public sampling, sympt. cases are handled by the National University Hospital of Iceland) 11/

I believe this is one of few places where the data can give a good picture of what is actually happening nationwide wrt infection rates, age distribution etc. Critical in terms of being able to understand how this disease behaves and eventually hopefully how to treat it. 12/

Speaking of age distro, it used to be that most cases were in the 40-49 year olds, but now the 18-29 year olds are the biggest one - I don't know the reasons why, but it's interesting in light of the whole discussion about who are most likely to contract this disease. 13/

At this point, we are taking social distancing measures (>2m) and gatherings are limited to 20 people. However, most stores are still open and a lot of restaurants as well. Elementary schools are open on a limited schedule. High schools and universities are teaching remotely. 14/

Take-out and delivery has picked up like elsewhere but people still go to restaurants, being careful (sanitizing hands, eating areas etc). Stores are also ensuring distancing, cleaning self-checkout registers between every customer etc. This will last until at least May 4 15/

The government has built a contact tracing app which uses double opt-in for the information (ie the data is stored locally on your device, if there's contact suspicion, you can opt to offer 14 days of location data but not required to) - it just launched so effects remain tbd 16/

We also do follow-up on all diagnosed cases, with nurses calling everyone who’s at home in isolation to check up on symptoms. This has proven very important to track on-going cases, but only scales to a certain degree. 17/

I am involved with a company called Sidekick Health to offer an app to enable self-reporting of symptoms 2/day. This allows us to follow up on more cases, get better data and free up critical healthcare workers to attend the ones who need care. 18/ https://www.ft.com/content/b5f70a96-6f47-11ea-89df-41bea055720b

This is already proving beneficial, with some worsening cases being detected earlier than before, resulting in faster and better treatment, potentially saving lives. It’s still anecdotal, but looks promising. 19/

Related, we have a team of data scientists working on training a model using this data to help hopefully identify those who need treatment or hospitalization. Still work in progress, but yet another effort to mitigate the situation and ease the burden on our health system. 20/

So far I’ve only touched on health care. On the economic front, the government has announced a stimulus package similar to most western nations, a mixture of worker protection and business loans through the local banks to try to see healthy businesses through this time. 21/

I think we (not just Iceland, but the whole world) are just at the very beginning of the economic effects, and it's hard to tell how and when it will recover. The world will change, this won't be easy. 22/ https://twitter.com/gummihaf/status/1242464261617659906

Overall I think our Covid response has been largely working and few draconian actions from the government. It's not over by any means, but hopefully other affected areas can learn something from this. If you’re curious about any specific parts, feel free to DM me. 23/fin