The island nation of Iceland reported its first COVID-19 case in late February. By mid-March, confirmed cases were increasing at a rate of 60 to 100 per day – an infection rate higher than in the U.S., adjusted by population. Iceland became the worst-hit country in Scandinavia. But fast forward to today, and the situation is completely different.
The country reversed the rate of infection without ever imposing a full lockdown, and as countries around the world struggled with persistent caseloads and climbing death tolls, Iceland saw few deaths. This success was no fluke, it came about because of previous experience with crisis, learning from setbacks, careful planning and persistent collaboration. It came about, too, because of the “Trinity” – Iceland’s chief epidemiologist, the Director of Health, and the superintendent of police – who worked in harmony to contain the spread of the virus when it threatened most. The Trinity implemented the “pandemic plan” – a framework that stipulated effective, honest communication and flexible, autonomous decision-making. It was a crisis strategy that never lost sight of the main goal: work together to save lives. In episode two of Teamistry’s second season, host Gabriela Cowperthwaite brings us a story of optimism to cut through the gloom. We hear directly from The Trinity, the voices of the country’s heroes: Alma Moller, Iceland’s Director of Health, Þórólfur Guðnason, Chief Epidemiologist, and Víðir Reynisson, Chief Superintendent of the Office of the National Commissioner of the Police. We also learn how Kári Stefánsson, the CEO of deCODE Genetics, and his team of scientists assisted government health officials by examining the virus and increasing Iceland’s testing capacity. And Alexander Elliott, an Icelandic journalist, explains how the country’s pandemic fight unfolded and how teamwork saved lives.
Teamistry is an original podcast from Atlassian.
Transcript
The first Icelander infected with COVID-19 returned home from a ski holiday in the Italian Alps in late February. Six weeks later, the tiny island nation becomes the worst-hit country in Scandinavia. It’s April 5th, and they’ve recorded their highest-ever number of active cases. Health authorities are bracing for the worst.
Easter is just a week away. It’s a special holiday in Iceland, full of cozy festivities and large family gatherings. And that could mean disaster. Health authorities know that people need to stay home to avoid spreading the virus. But how are they going to get the message across to the entire nation?
Would you believe… through song?
A group of Icelandic musicians record a jaunty new version of a popular song called “Góða ferð,” or “Bon Voyage,” with lyrics changed to a decidedly 2020 theme. The track is called “Let’s Travel Indoors,” and it extols the virtues of self-quarantine, including bubble baths, cuddling on the couch, and the very Icelandic tradition of the home spa.
But it’s not the pop stars who get the public’s attention. It’s a trio of bureaucrats who, until a couple months before, had worked at their jobs in relative anonymity. Þórólfur Guðnason, Iceland’s chief epidemiologist, Alma Moller, the country’s Director of Health, and Vidir Reynisson, superintendent of police, each pop up to sing a couple of lines. Here they are now.
The three are known to the public as the Trinity, and since the crisis broke, they’ve worked together to manage the country’s response.
While the world reeled from a new and unknown threat, Icelanders were able to follow a detailed roles and responsibilities framework drawn up years in advance. It guided their plans but also allowed them the freedom to improvise, which let them respond to the crisis with amazing effectiveness. An incredible story of how teamwork can save lives and avert disaster.
I’m Gabriela Cowperthwaite and this is Teamistry — an original podcast from Atlassian. This show is all about the chemistry of teams – proving that when teams work together, and teams of teams work together, they can achieve more than they ever thought possible.
The story of Iceland’s response to COVID begins in January, 2020, with reports of a new respiratory disease coming from China’s Wuhan province.
In February, cases start to pop up in Europe. And it becomes clear that sooner or later, it will make it to Iceland. This disease spreads fast and it spreads far.
For anyone watching, especially with a medical background, it’s evident that it’s not a matter of “if,” but “when.”
Alma Möller:
We have been waiting for the first case for some days.
Here’s Alma Möller, Iceland’s Director of Health and member of the “Trinity.”
Alma Möller:
I remember very well that we got information on the first case as quarter past one on Friday the 28th of February.
Iceland’s first COVID patient has just spent his holiday skiing in northern Italy, the European epicentre of the outbreak. He returns home, but isn’t diagnosed for days. In that time, he manages to go to work, to meet with colleagues and run errands.
The virus is officially in the country, and there’s no telling how far it’s already spread.
By March, confirmed cases are increasing at a rate of 60 to 100 per day. That’s much faster, per capita, than cases in either the United States or the United Kingdom are growing at the time, and more than any other Scandinavian country at that point.
Þórólfur Guðnason:
We was pretty worried when we had this big rise in the newly diagnosed cases in the beginning of March, actually.
This is Þórólfur Guðnason, the second member of our Trinity. He’s Iceland’s chief epidemiologist, in charge of tracking the spread of the disease and figuring out how to stop it.
Þórólfur Guðnason:
We had about 30 people admitted to ICU and that was quite a strain to our hospital. So I think the capacity of our hospital was not reached, but was close, very close to be reached. And we had 18 people on ventilators, and that was almost up to the maximum at one point. And we had 10 deaths. So when this was happening, we thought that this was quite a strain.
This strain makes it very clear, very quickly that an effective response is absolutely necessary if the situation isn’t going to spiral completely out of control.
Iceland is a small country of around 360,000 people. That means they might be able to contain the situation—but if they don’t, there’s no telling how much damage could be done.
Back in the 15th century, the plague wiped out more than half the isolated island’s population. This new, fast-moving virus could be equally devastating.
Luckily, the country has a response plan in its back pocket, an understanding of how they would mobilize if ever a health crisis arose.
Iceland has had its share of national emergencies. In 2010, for instance, the country’s Eyjafjallajökull volcano erupted, spewing so much ash into the atmosphere that air travel had to be grounded for a week and disrupting daily life.
COVID is different. As we all know, it’s an emergency on an unprecedented scale. But for years, Iceland’s government has been planning for something just like it.
Iceland wasn’t affected by the first SARS epidemic in the early 2000s. But after watching it play out across the world, the country put together what they called their “Pandemic Plan” in 2006. It’s a decision-making framework meant to go into effect in case of just such an emergency. It lists the organizations and institutions needed to mount an effective response, and details what their responsibilities are. Here’s chief epidemiologist Þórólfur Guðnason again.
Þórólfur Guðnason:
This backup plan that we use makes all these institutions that have their place and role in this plan, they have to make their own plans, which are compatible with this big plan. So whenever there is a crisis like this, all these organizations are asked, "Now, you should open your plans and you should update them. You should read them through again. You should see what is your responsibility, how you should be doing in case if 50% of your staff get sick and so forth and so forth." And this plan also enlists the responsibility of the healthcare system, what they should be doing, how they should be contacting the chief epidemiologist and the civil protection. This is a structure that you know what you should be doing.
Lack of an effective plan can be disastrous when it comes to handling an outbreak, especially when so much is still unknown about the disease. Teams might not understand their own responsibilities, or how they’re meant to work with other players in the larger scheme. The existence of a clear framework for decision-making, one that anticipates ambiguity from new scenarios, is crucial to managing a new pandemic. The key is in understanding how to create frameworks that don’t just rigidly tell people what they’re supposed to do, but help them make difficult decisions as circumstances evolve.
Iceland also has a law, passed in the late ‘90s, that delineates exactly who should be in charge of the response, and what their powers are. It’s called “The Act on Communicable Diseases,” and it’s how the Trinity came into being.
Þórólfur Guðnason:
We have a certain legislation in Iceland which underlines and stresses how sort of crisis like this should be dealt with, who is responsible. And the legislation says that really the two main players responsible for obtaining data and risk analysis and response is, first of all, the chief epidemiologist which I am running. But then the director of health, Alma Möller, she is responsible for preparing and the response of the healthcare system, making sure that everything works there. So this had been done in the past with all health crises, so it was quite natural for us to play our roles in that sense.
So, at this point we have Alma Möller, Director of Health, and Þórólfur Guðnason, the chief epidemiologist, in charge of the COVID response. The Act on Communicable Diseases makes it very clear that they are responsible for running the country’s pandemic effort, and it lays out their individual roles clearly.
Þórólfur Guðnason’s role is to track the disease throughout the country. You can’t control an outbreak if you don’t know where it’s spreading. Alma Möller’s job is to oversee the health system itself—the hospitals, the health care workers, and the country’s active response to the pandemic. But there’s one more player needed to make this team a Trinity.
He’s not a disease specialist or a scientist. But his expertise proves invaluable in keeping the outbreak under control.
Vidir Reynisson:
My name is Vidir Reynisson. I'm chief superintendent of the National Commission of Police, and my role is the overall command and coordinating of Iceland in response to major disasters.
Part of that response is a key role in contact tracing. Now, we’ve heard a lot about that this year. The idea is, to manage an outbreak, you have to know exactly who has the disease, so that they can quarantine themselves and not spread the infection further. This is especially important in the case of COVID-19, where a significant number of the infected are asymptomatic and have no idea they’re sick—or contagious.
But under Vidir Reynisson and members of the Trinity he worked closely with, Iceland turned contact tracing into practically an art form, bringing together police investigators and health workers to track the disease’s spread and inform potential victims.
When someone tests positive, they get a phone call from a health worker.
Vidir Reynisson:
The nurse was discovering information through our checklist about where they have been, who they have met, and that they stayed within two meters for more than 15 minutes with someone. Then, we said, "We'll call you back in one hour. We want you to write down everywhere where you have been and everyone that you have met" And then, came the police and starts to talk to the person and systematically gathering information based on, I will not use the word interrogation but it's the same method.
It's proven tremendously effective. In Iceland, 57% of all patients diagnosed with COVID were already in self-quarantine, which is an astonishing number. And that never would have happened if the authorities weren’t able to work together seamlessly and inform people that they might be infected before it was too late.
In the early days of the pandemic, each member of the Trinity works remotely from one another. But as the infection rate keeps inching up, they realize that while some of their communications work fine remotely, some of their teams require constant live communication.
So, while the rest of the country is busy turning their homes into offices, they decide to do the opposite, and bring the task force together under one roof.
Alma Moller and Þórólfur Guðnason move into Vidir Reynisson’s office complex. Since nobody is eating in the cafeteria, they set up their offices there. Here’s Vidir Reynisson again:
Vidir Reynisson:
That was kind of a key thing that instead of meetings three times a day, four times a day or something like that, my office is now about 10 steps from Þórólfur's office. If I need something, I'll just walk over to his office and we talk together, coordinate things and take decisions.
Also in the building are representatives from other governmental agencies. That way the pandemic task force can stay in constant communication - in-person and remotely - with the entire governmental apparatus, giving round-the-clock updates and, importantly, flagging problems before they snowball out of control.
For example, there’s a moment when Reynisson gets a sense that the country’s social care system isn’t quite onboard with the pandemic action plan.
Vidir Reynisson:
I had a meeting with our Department Secretary of the Ministry of Social Care, and we had a meeting with the Minister himself, and we got the feeling that there was kind of a mismatch in information-sharing to all the different agencies that was both on the state level but also, most of it is run by the local governments.
Bad communication in this area in particular could be disastrous. Social housing, which the department oversaw, has been known to see severe outbreaks around the world because of the often-tight living conditions. Reynisson is able to act quickly, hiring a social housing expert and taking quick steps to make sure all the different teams are on the same page.
By trusting designated leads to make calls on their areas of expertise, each team is able to be flexible, to make decisions quickly and get out ahead of potential problems. This would be helpful in any team situation, but in a rapidly evolving pandemic, it’s absolutely essential to spend as little time making decisions in large groups as possible.
And it has other benefits as well. There’s one more stakeholder in this entire process whose buy-in and participation in managing the disease is crucial.
That’s the public.
As we all know by now, public participation in social isolation and self-quarantining is critical to stem COVID’s spread. But the message needs to get across.
The Trinity of Alma Moller, Þórólfur Guðnason and Vidir Reynisson becomes the face of COVID control in the country. Every day at 2pm, people diligently tune into their televised briefings—what they know about the virus, what they don’t know, and most importantly, what they want Icelanders to do in order to fight it.
Alexander Eliott:
They had set up two temporary units almost like shipping containers, but sort of temporary classroom things outside in the carpark of the civil protection response center because journalists obviously were not allowed inside the building. It was a top priority exclusion zone.
This is Alex Eliott. He works at RÚV, Iceland’s national broadcasting company.
Alexander Eliott:
So the journalists were allowed into these containers. So that's where they set up the three pedestals or four actually side-by-side, two meters apart of course. People were tuning into their press conferences every day taking what they were saying seriously and following their advice for the most part.
Key to this effective communication was defining the Trinity’s separation of powers. Each member would be responsible for covering a different area of expertise. That way, there would never be any confusion or conflicting statements.
Þórólfur Guðnason:
Well, we decided before we met on the television, the daily briefing meetings that we had, that we would do it in a way that I would talk about the epidemiology of the pandemic. I would talk about the number of cases. I would talk about the actions that we were undertaking and the actions that we were going to undertake. Alma Möller's responsibility was to talk about the healthcare system, the hospital, the protective equipment, if there was any shortage of personnel. And Víðir Reynisson's responsibility was to talk about the actions in the society, asking people to stick to our recommendations of the mass gathering, staying home, how they should behave when they got out.
Like the Pandemic Plan, the communication strategy for the briefings was meant to provide a clear framework that would inform key decisions. When you’ve got a team of teams managing a crisis situation, and especially in cases where communication is literally life or death, this type of preparation can do more than smooth the decision-making process: it can save lives.
The Trinity makes another key decision. No matter what, they’d be transparent and honest. They’d share what they’d know—and what they didn’t know. That way they’d build trust with their most important partner: the public they served.
Þórólfur Guðnason:
We decided that we would not keep anything away from the press. We would not keep anything away from the public or from our ministers. So we said that some things were doubtful. We talked about things we didn't know. We talked about things that were maybe unexpected. We talked about what might happen. What might not happen. What could happen. So we were very open with all our thoughts.
One example of that is when, in early March, the country records its first infection among its frontline medical care providers. It’s the kind of news that could provoke a panic. But the Trinity doesn’t hold back from telling the truth. Here’s Director of Health Alma Moller again.
Alma Möller:
It was, of course, not easy to go public with this, but we decided, when there was bad news, to try to be before the press and to be honest.
In a situation where the public’s trust and cooperation are so very important, they quickly find that their transparency pays dividends.
Alma Möller
I think the most important things in crisis communication is to show humility, to acknowledge skepticism, and listen to criticism, and to act on what causes people concern. But, honesty is the most important thing. We discovered very early on that it's not at all difficult to say that we don't have all the answers, but we tried to acquire them. And I think that trust and to work with the public was the most important things that we did.
The people of Iceland not only tune in, they take what the Trinity says seriously and follow their directives.
Alexander Eliott:
What there was was a great deal of solidarity, a great deal of people watching the daily press conferences and taking note of what was being said and following it for the large part. And I mean, some of the biggest problems we had, to put it into perspective, was perhaps groups of teenagers that were still going into shops to buy non-essential items like candy. I wouldn't say it was a scandal, but people were like, should not be doing that. And that was kind of almost the extent of it. People were very much behind the response to it, which I think helped enormously.
The Trinity is not only in charge of the government’s response to the pandemic: the entire country is following their lead.
But even as the health care workers and police work diligently to trace the contacts of COVID patients and ask them to self-isolate, they’re still just treating the symptoms. It’s early March and not only is the rest of the world beginning to wake up to the seriousness of the pandemic, the virus is spreading like wildfire in Iceland. If the Trinity has any hope of getting this under control, they’ve got to go deeper. And that’s where a company called deCODE Genetics enters the picture.
deCODE is an Icelandic biotech firm founded in the 1990s by a neurologist named Kari Stefansson. He’s a well-known personality in the country, outspoken, opinionated and willing to publicly call out the government when he doesn’t agree with their decisions.
For years, deCODE has studied Icelanders’ DNA to try and find the genetic basis for diseases ranging from Alzheimer’s to schizophrenia to diabetes. It’s called “population scale genetics,” and over 2/3rds of the country’s adult population have contributed their DNA to the company’s studies.
COVID is an entirely new disease, only months old, with very little known about it. But just days into the outbreak in Iceland, in the first week of March, Kari Stefansson decides to tackle it head on and reaches out to the Trinity himself.
Kári Stefánsson:
I proposed that we should screen for the virus and I phoned The Directorate of Health and I asked them whether they wouldn’t support the idea. And indeed they did.
By March 13, tests are underway. By screening as many people as possible, not just the visibly ill, they’re able to get out way ahead of the asymptomatic transmission now believed to be an important vector in the spread of the virus.
And while deCODE Genetics is a private company, they’re able to work hand-in-hand with the government response without worrying about jurisdiction or stepping on each others’ toes.
Kári Stefánsson:
I never had the feeling that it was any line of distinction between the law enforcement agents and the employees of The Directorate of Health. This was just a team of people working together. There were no problems in communications. There were no problems in interaction. This went wonderfully.
deCODE’s contribution is an unprecedented example of a successful private-public partnership. By clearly delineating their role in the process and giving them the freedom to do what they do best, the government was able to tap into a powerful resource that helped them overcome the virus at its peak. Here’s Director of Health Alma Moller again.
Alma Möller:
There is no doubt in my mind that this helped us to get a grip on the virus. And, you know, everyone was put into isolation, then we did the contact tracing and quarantine, and this was very, very important for our response. And very early on we had tested more than most, and in the last weeks, other nations are doing that as well, testing, testing, testing. But, we were very early on that.
The infection rate peaked in early April, just before Easter. Whether it’s due to that charming music video, deCODE’s testing, or a combination of factors, that Easter surge never happens. The fear that drove the authorities to work so hard, never materializes. Since then, the virus has been on a downward slope in Iceland. There have been smaller outbreaks, but they’ve been largely managed.
It does make you ask—what about Iceland’s response is so special?
If you ask deCODE Genetics CEO Kari Stefansson, it’s bigger than just the Trinity or his company.
Kári Stefánsson
I actually think that the teamwork that really matters, and the team that really brought us under control was not the Trinity, it was not deCODE, it was not the healthcare system. It was basically the nation as a whole because the measures used to contain the infection, was wholly dependent on the voluntary isolation and on voluntary quarantine.
According to superintendent of police Vidir Reynisson, successful teamwork is all about communication and trust.
Vidir Reynisson:
if you have a task ahead of you that you know that will take months, probably no one will be able to take a day off, they will work long hours, they will be very tired, they will be frustrated from time to time. But if you look at those keywords “openness, honesty, trust, information sharing and a high level of commitment,” I think they are something that you need have not only in the back of your head, but you have to have in front of you.
And for Þórólfur Guðnason, it all comes back to a plan that’s flexible enough for situations that do not yet exist, anticipating crises before they happen.
Þórólfur Guðnason:
Planning, planning, planning. You have to do it. And to me, you have to have sort of all hazard plan. It seems to me that many countries have different plans for different healthcare crises or health crises. So you have a lot of players and different setups. In my mind, the country should have all hazard plans with same approach, same players and in all kinds of hazards.
The key to creating frameworks that don’t rigidly tell people what to do, is aligning on what might happen if things don't go according to plan. In other words, as circumstances evolve, how should decision-making protocol evolve?
Þórólfur Guðnason:
I always said, even though you prepare and you write it down, what you're going to do, you're probably going to do something different. But it's the time that you spent on the preparedness that pays off, not necessarily the end product, not necessarily the book that you write on your preparedness plan or the plan, how you write it. It's the mentality that you gain and obtain by writing your preparedness and exercising it.
Iceland’s COVID journey hasn’t been without its bumps. From that first vacationer returning from northern Italy to suffering Scandinavia’s highest per-capita case load, it’s been a very real crisis.
But overall, it’s been a remarkably effective success story. While other countries struggle with staggering caseloads and truly heartbreaking death tolls, Iceland’s rate of infection remains remarkably low, with very few deaths attributable to the virus.
And it’s not because Iceland is isolated, or because there’s anything special about its population’s genetic makeup. It’s because its health authorities had a plan—a framework that guided them through what could have been a devastating crisis.
Through effective communication, coordination, and yes, just a little bit of song, Iceland’s well-loved Trinity proved that committing to thoughtful plans made ahead of a crisis can help us fight the most pressing of global problems.
We can’t predict the next global emergency, but we can plan for the unexpected. Knowing that a team is ready to face future challenges might be enough to give us hope in these scary times.