02 Iceland Contact Tracing

For halting COVID-19’s spread—and demonstrating an alternative to lockdown for the rest of the world

In the early stages of the COVID-19 crisis, things were looking grim in Iceland. The country of about 365,000 residents had one of the highest infection rates in Europe: 513 cases per 100,000 people. New cases were rising fast, increasing by up to 99 a day by early April. That’s when Iceland’s director of health teamed up with homegrown biotech firm DeCode Genetics to launch a project that helped the small Nordic nation virtually eliminate coronavirus infection within its borders by June.

Through a combination of widespread testing, contact tracing and viral sequencing, the team set out to determine how the virus entered the country, how it mutated and how it spread. Funding for the project came from U.S. pharmaceutical company Amgen, which had bought DeCode in 2012.

Taking cues from contact tracing apps in South Korea and Singapore, DeCode joined forces with government agencies and other private companies to build a smartphone app called Rakning C-19 to identify those who had been in close proximity of anyone who was infected. The app featured strict privacy protocols, and DeCode set out precise rules for how data would be used.

For instance, information would be stored for only 14 days, and the app would be shut down after the pandemic. The public was reassured: Within a month of the app launching in April, 38 percent of the population had downloaded it.

The project also included a 52-member tracing team to track down by phone anyone who had come in contact with an infected individual. The exposed were urged to self-quarantine for two weeks, even if they showed no signs of infection.

“People knew they had been in contact with someone who had been infected, so it was not difficult to persuade them to abide by the restrictions,” says DeCode founder Kari Stefansson.

Comprehensive testing augmented the contact tracing efforts, assessing even people with mild or no symptoms. That caught cases that otherwise would have been overlooked. “It allowed our society to have full transparency around the spread of the virus, so we weren’t poking around in the dark,” Stefansson says.

By 21 April, DeCode and Iceland had tested more than 12 percent of the population, some 43,000-plus people. By 17 May, that figure was up to 15.5 percent (by comparison, the United States at that point had tested 3.4 percent). Iceland’s volume of new cases fell quickly, and by June the country’s death rate from COVID-19 was one of the lowest in the world: just 10 people.

By using a scientific scalpel instead of a sledgehammer, the project team’s efforts enabled Iceland to avoid the disruption of a lockdown. While the government did impose social-distancing measures (ordering people to stay 2 meters, or 6.5 feet, apart) and banned gatherings of more than 20 people (also closing some businesses such as nightclubs and hair salons), overall activities continued as usual. Primary schools and child care centers, for instance, always stayed open.

In the process, Iceland and DeCode demonstrated a model from which other nations—even the big ones—could learn. “Screening and contact tracing can be done in any corner of the world that uses modern technology like smartphone apps,” Stefansson says. “Anyone can do this.”