COVID-19 Good News — from Iceland

COVID-19 may not be nearly as deadly as some believe

From a Government Press Conference. Daily press conferences have been held since the end of February.

Two of the major problems we have with COVID-19 is lack of medical capacity and lack of testing. Both are areas that we should absolutely bolster, and quickly! Better testing would tell us where the virus is, how it spreads, and provide us better data on its true risk.

Iceland is in a unique position to be able to test its entire population for COVID-19. Their initial efforts are giving a wealth of information not available elsewhere and early results are extremely encouraging.

I will summarize the facts below (source)

• Iceland has tested a sample size of ~9800 people (2.7% of the population)
• They have published results for ~5500 people (1.5% of the population)
• The results show that around 0.9% of their population currently has COVID-19 (likely more had it previously which is even better news)
• Of 473 positive cases, there’s been one death, which would be a fatality rate of 0.2%. One person is in ICU (0.2%)
• Iceland’s first known case was Feb 28th and it already spread to nearly 1% of the population in two weeks by March 13th.

The above are facts. Below is speculation, though very positive.

• Given the virus’ highly contagious traits, it would not be inconceivable that other countries, including the US, already have a similar infection rate as Iceland of around 1% of the population (a claim some health organizations have already made). There are arguments on why it could be more (such much higher international travel through the US) and why it could be less (such as Iceland’s population being more densely concentrated).
• If we take for a moment the assumption that the US has a 1% infection rate similar to Iceland, it means we would have around 3.3M positive cases of COVID-19 now. Since the vast majority of people with the virus show no symptoms, this is not inconceivable. Combined with ~500 known deaths, that would imply a fatality rate as low as 0.015%, though this number could go up with people who are infected and haven’t developed severe cases yet, among other reasons (see footnote).
• Such a rate would equate to 50,000 deaths out of the entire US population, or about the same number as we see every year from the regular flu.

I know that it is not popular right now to go against the doomsday narrative, but nothing is so sacred that it cannot be questioned, especially when it comes to the welfare of hundreds of millions if not billions of people who are and will soon be suffering from the economic fallout. In addition to protecting individual lives, we must also protect human dignity and our global community.

What we can learn from the 2009 Swine Flu scare

The 2009 swine flu scare was based on an H1N1 variant believed to be similar to the 1918 Spanish Flu, and many of the world’s leading medical organizations were giving us dire warnings. This led to the United States declaring a National Emergency due to the “H1N1 Pandemic.”

By the end of 2009 though, it was shown that the virus only had a death rate of 0.026%, which is only slightly worse than the regular flu. It was completely overblown by the same organizations who are warning us now. I can understand this because as a health organization, you would much rather be wrong about over warning people than by being too relaxed and under warning. Those are logical incentives, but it’s also why we have leaders who must take in data from many sources and make the final decisions affecting our health, economy, and society.

The Open Question

Is it possible that we should consider — or at least that we have yet to see data which rules out — the possibility that COVID-19 will ultimately prove with sufficient testing to not be more lethal than the regular flu, or if does, than no more than 2–3x deadlier. This is only a question and not intended to be any sort of definitive statement by any means. We must continue to make every possible effort to ramp up hospital capacity, produce protective equipment to protect our medical personnel, protect those at risk, and increase testing capacity. However, we have to also at least acknowledge that our current estimated fatality rates may be 10–20x too high since the vast majority of people with this virus will never show any symptoms, and that the economic destruction that we are embarking on may be largely driven by hysteria and fear. It is possible that the most impactful disease that is currently spreading is not COVID-19, but hysteria.

We need more medical capacity to prepare for the worst and more testing to make better decisions. We’ll see where the data will take us from here.

I also want to thank the medical community for their efforts, especially those on the front lines who are bearing the difficult brunt of all this.

Footnote: Reasons to be cautious before jumping to conclusions

• The initial data sample of 1.5% may not be representative and it could over represent the positive cases
• The positive cases may have numerous false positives
• Some of the people currently infected may have not yet had time to come down with severe cases
• ~1/3rd of the entire Icelander population lives in one city and ~47% live in two cities. ~6% of the entire U.S. lives in our largest city. Iceland is a small community that lives very closely together
• Winter is cold and people stay indoors together in small confined spaces
• Icelanders have a relatively narrow genetic pool, and it’s possible that something in their genetics makes them less susceptible to COVID-19
• Icelanders may be healthier than most populations

Fortunately continued testing and monitoring will help answer most of the above questions. Personally, I am cautiously optimistic of the early results.