A coronavirus test for anyone? In Iceland, it's happening

As other countries limit tests, Iceland has undertaken an ambitious model to test anyone who is willing.|

In coronavirus hot spots around the globe, hospitals are so overwhelmed with sick patients that they're running out of lifesaving supplies. And in many places, testing for the virus has been reserved for people who meet specific medical and travel-related criteria.

But one of the challenges that has made the pandemic so difficult to control is that research increasingly suggests a large number of people infected with the virus may show no symptoms - as many as 25%, according to U.S. officials. That means that in places with limited testing, doctors and scientists know they are missing people who are infected with the virus - and may be spreading it to others.

So what if anyone could be tested?

That's what scientists in Iceland are now trying to make happen - and they hope their approach could yield important insights that will not only help the country handle its own outbreak more efficiently, but also help researchers elsewhere.

In late February, Iceland confirmed its first case of the virus: a patient who had recently returned home after a trip to Italy. Over the next several weeks, as the pandemic seeped into communities around the world, other cases began to pop up across the island, home to about 364,000 people.

Icelandic officials quickly embarked on an ambitious contact-tracing initiative that helped identify and isolate individuals who had come into contact with people diagnosed with the virus - and urged them into isolation.

Meanwhile, the Reykjavik-based deCODE Genetics, a subsidiary of U.S.-based biotechnology company Amgen, teamed up with the country's public health officials to rapidly expand the country's testing capacity.

Now, anyone in Iceland who wants to be tested for coronavirus can be. They do not need to have recently traveled abroad or have come into contact with anyone diagnosed with the virus. They don't even need to show any symptoms.

The initiative has drawn thousands of people from the general population in for testing. Between swabs carried out free by deCODE and those conducted at Icelandic hospitals for those showing symptoms, about 19,500 people - more than 5% of the country's total population - had been tested for the virus as of Wednesday. More than 1,200 cases had been confirmed, and two people had died. More than 7,800 others were in quarantine, and more than half of those who had been diagnosed with the virus were already in quarantine at the time of their diagnosis, according to official government data.

As a point of comparison, the United States had conducted more than 1.1 million tests as of Wednesday, according to the COVID Tracking Project, which would amount to testing roughly 0.34% of the total population. (My Washington Post colleagues wrote last week that the United States has ramped up its testing in recent weeks but still lags behind many other countries in tests per capita.)

"It looks to us now that we have this relatively under control in Iceland," Kari Stefansson, chief executive of deCODE Genetics, told this column. "We are clearly optimistic and we will continue to screen. We are increasing the effort."

The deCODE testing in Iceland is free, but Stefansson said the data collection isn't considered completely random, because individuals still opt in to the swab and "those who respond are most likely to be those who are more concerned than the rest of the population."

Still, the results have provided some interesting data. Of those who tested positive, Stefansson said, about half were asymptomatic at the time of their testing, though they could have developed symptoms later on. The tests have also revealed genetic information that researchers can use to trace the virus's geographic spread.

Kristjana Asbjornsdottir, an acting assistant professor of epidemiology at the University of Washington, said that the widespread testing in Iceland means "the numbers [Iceland has] are probably quite reflective of the true epidemic."

That has allowed Iceland to make informed decisions about what a proportional response to the outbreak looks like, she said, a response that has been aided by Icelandic government officials who have "taken their cue from public health authorities instead of the other way around."

Some businesses have closed, but Iceland's schools were only partially closed in response the pandemic. While social distancing has been encouraged, small groups can still meet.

The country's small population has strong social networks that make navigating society at a time of crisis less complicated than in larger countries, noted Thor Aspelund, a professor of biostatistics at the University of Iceland who is providing modeling and forecasting assistance to the country's response team. And because of Iceland's small size, data is centralized, not spread out over 50 states as it is in the United States.

Iceland's latest prediction model suggests that 1,700 people will be diagnosed with covid-19 in the country but that the number could reach as high as 2,800 in a much worse scenario, and that hospitals will probably be most burdened in mid-April.

In the meantime, scientists and medical professionals in Iceland plan to keep testing, isolating and keeping track of cases, which they can now more easily identify.

Curious to know if he has already been exposed to the virus, Aspelund, who hasn't felt sick, signed up for an appointment to be tested through deCODE on Friday.

"I'm going to be a data point," he said, "in a hopefully negative test finding."

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