Last year, outbreaks of influenza (the flu), RS-virus, and Group A Streptococcus (GAS) coincided with a rise in COVID-19 cases, leading to heightened morbidity in children and the elderly, and straining healthcare services. This fall/winter, we can anticipate outbreaks of influenza and RSV, possibly alongside an increase in COVID-19. Additionally, other viruses like enteroviruses, adenoviruses, and rhinoviruses will also be in circulation, as is typical for this time of year.

It's important to remember that while COVID-19 may appear mild for most, it's more contagious than the flu and can lead to more severe illness than the flu or the common cold in certain groups. COVID-19 can also result in chronic symptoms for some individuals.

Booster vaccinations for COVID-19 are set to begin in Iceland in October, coinciding with the availability of the influenza vaccine. The Pfizer XBB.1.5 vaccine, developed in line with recommendations from the European Medicines Agency (EMA), the European Centre for Disease Prevention and Control (ECDC), and the World Health Organization (WHO), will be used for COVID-19 booster vaccinations. The SARS-CoV-2 XBB.1.5 variant, which has been in circulation for several months, is closely related to various other variants currently in circulation.

Vaccinations will be prioritized for high-risk groups, including individuals aged 60 and above without contraindications. Detailed instructions on autumn vaccinations will be provided by the Chief Epidemiologist soon.

Individuals experiencing symptoms of infection are urged to stay at home, exercise caution when interacting with high-risk groups, practice hand hygiene, and consider using a face mask under certain circumstances.

The current situation in Iceland
Recent data published by the Chief Epidemiologist on August 14 shows a slight increase in COVID-19 cases over the previous weeks, though the overall number of diagnoses remains low. PCR diagnoses from laboratories are at around 40 per week, with an additional 15–20 clinical diagnoses by doctors per week. While diagnoses are more prevalent in older age groups, the total number of cases in 2023 is significantly lower than in the previous three years.

Fewer diagnoses are partly due to the increased use of home tests and decreased public testing. Most COVID-19 diagnoses are now made in hospitals, the Primary Health Care Information Centre, and the Primary Care On-Call Service (Laeknavaktin).

Serious Illness and Death
In the past week, there were ten individuals in isolation at Landspítali due to COVID-19, none of whom required intensive care. In 2023, up until July 2023, a total of 23 people in Iceland have sadly lost their lives due to COVID-19, with 14 of these fatalities occurring in January. These figures are based on death certificates where COVID-19 is deemed either the primary or underlying cause. For further details, you can refer to the Directorate of Health´s dashboard.

To understand COVID-19-related deaths in relation to vaccination status, analysis was carried out by considering whether the deceased were fully vaccinated at the time of their passing. Full vaccination was defined as having received two or more vaccinations in 2021 and three or more in 2022 and 2023. Person-years were calculated by calendar year up to May 2023. For 2021 and 2023 alone, the data set is too small for robust statistical processing. However, for 2022, there is ample data to conclude that full vaccination provides significant protection. The mortality ratio stands at 0.55 (95% confidence interval 0.44–0.68, p<0.0001)*, indicating that being fully vaccinated reduces the chance of dying from COVID-19 by almost half compared to being unvaccinated.

When considering the three-year period 2021–2023 (up to and including May 2023) in its entirety, significant protection is also evident for the fully vaccinated against COVID-19-related mortality, with a mortality rate of 0.59 (95% confidence interval 0.46–0.74, p<0.0001).*

*Please note that when interpreting these numbers, it's crucial to consider population demographics and vaccination rates at different times. The methodology used involved Poisson regression analysis, factoring in the number of deaths per person-years, adjusted for age and calendar year.

The Situation in Europe
Europe has also experienced an uptick in COVID-19 cases, albeit with a low frequency, and no notable increase in severe illness. So far during the pandemic, there has been an increase in cases every 2-3 months, characterized by a trend of lower peaks and a general decline in hospitalizations and fatalities. However, the latest data are limited, especially concerning severe cases. Hence, cautious conclusions should be drawn about the current situation.

All the currently circulating variants of the SARS-CoV-2 virus belong to the omicron lineage. In EU/EEA countries, the most common variants are XBB.1.5+F456L (including EG.5, FL.1.5.1, XBB.1.16.6, FE.1), and these variants have also been identified in Iceland through sequencing. Another variant, BA.2.86, has attracted attention due to its increased number of mutations compared to other omicron variants. So far, nine unrelated cases have been identified in five countries (Israel, Denmark, UK, USA, and South Africa). This strain has also been detected in sewage in the United States, Switzerland, and Thailand. However, there is still a high level of uncertainty regarding this variant due to the small number of diagnosed cases. To date, this variant has not been identified in Iceland. There is no evidence suggesting increased morbidity or reduced vaccine efficacy for these variants compared to other current variants. For more information, refer to the ECDC website.

The Chief Epidemiologist