ILA/Covid-19 in the Faroe Islands

The ISA-Virus and Covid-19 in the Faroe IslandsIn their travelogue about the yacht Maria's voyage to the Faroe Islands in 1854, Samuel Rathbone and E. H. Greig recount the story about their arrival in the islands. They sailed close by Nólsoy, with a hoisted signal flag indicating that they needed harbour pilots. A large boat with 12 rowers was launched from the village of Nólsoy, cautiously approaching the yacht. The first question the Faroese fishermen asked when they came within earshot of the crew on the yacht was: "Are there any sick people on board?"

Only when the crew of the yacht had assured the Faroese that there was no illness on board, the rowing boat approached and touched the yacht side. Two men came on board and navigated the yacht to port in Tórshavn.
The Faroese had ample reason to be very careful when approaching a foreign ship. For centuries, right from the beginning of The Black Death, the plague pandemic which devastated Europe in the 14th century, the isolated population of the Faroe Islands had been very vulnerable to plague, smallpox or other epidemic diseases brought to the islands by ships from around the world.
In 1846, just a few years before the yacht Maria visited the Faroes, the island population was hit with a violent measles epidemic. Almost no one was immune to the disease, and out of a population of 7782, approx. 6,000 people were infected. About 150 died of the disease.

An infamous influenza epidemic called the Spanish flu, which ravaged the world in the years 1918-1920, also reached the Faroe Islands. More than 1100 people contracted this disease and 13 died. On a worldwide basis, it is estimated that approx. 50 million people lost their lives due to the Spanish flu.

From around the turn of the last century and well into the 20th century, the Faroe Islands were also badly plagued by tuberculosis. An extensive testing of the population began in the mid-thirties, and later seamen were required to undergo TB examination in order to be able to sign on as crewmembers on Faroese fishing ships. This happened in conjunction with the mandatory tuberculosis vaccination, which began in 1946. In 1950, medication had been developed for tuberculosis patients, which in time led to the eradication of tuberculosis as a public disease in the Faroe Islands.

Covid-19 occurs

December 2019 brought the disturbing news that a new infectious type of the dreaded Coronavirus had been detected in Wuhan, China. The new virus which received the taxonomic classification SARS-CoV-2 caused the severe disease Covid-19, a severe and even fatal flu-like sickness that could lead to pneumonia and attack the lower respiratory tract causing acute lung illness, especially in people with weakened immune systems.

Alarm bells are ringing

Covid-19 spread rapidly and in January 2020, it was detected in several countries in the Far East as well as in the United States. On January 30, the World Health Organization, WHO, declared Covid-19 an international health crisis. By February, it had spread to 28 countries, including several in Europe - and it was clear that the whole world was facing a severe pandemic.
Many alarm bells started ringing in those days - also in the Faroe Islands. The Faroese Health Service began preparing procedures in January in case the disease should reach the Faroe Islands. One of those who heard the alarm most clearly was Dr. Debes H. Christiansen, head of the pathology department in "Heilsufrøðiliga Starvsstovan", the Faroese Food and Veterinary Authority - FFVA.

It became clear early on that the most important approach in the fight against Covid-19 would be to test people, isolate the infected and trace the sources of infection. Failure to reduce outbreaks could lead to the congestion and collapse of hospital capacity in the Faroe Islands.
Already in January 2020, Debes Christiansen began to inspect and analyse the composition of the coronavirus. He came up with a rather untraditional solution to the problem of getting the Faroese population tested for the virus.
From salmon to humansIn 2001, the Faroese salmon industry was hit by a disaster. In most fish farms, the salmon had been infected by the influenza virus ISA - infectious salmon anaemia. In a very short time, the salmon farmers lost approx. 90% of farmed salmon and the industry collapsed.

As a result of this large loss in one of the Faroe Islands' most important export sectors, the authorities decided that farmed salmon must be regularly examined for viruses and the FFVA purchased and set up an advanced laboratory for analysis of samples from the breeding stations.

When the H1N1 influenza, commonly known as swine flu, raged in 2009, Debes Christiansen had investigated whether an adjustment of the test tools and methods for salmon testing could be used to test humans. This conjecture proved to fit Covid-19 quite nicely.

Debes Christiansen contacted Dr. Shain Gahini, a specialist in infectious diseases at the "Landssjúkrahúsið", the Faroese National Hospital, and it was agreed to invest in the test capacities available at Heilsufrøðiliga Starvsstovan. The laboratory was expanded and at the end of February the first Faroese were subjected to the new test.

Strategy

Using this new test method, the health authorities could now focus on preventing the spread of the infection. Mandatory testing was set up for everyone arriving in the Faroe Islands by plane or ship - and testing could be implemented on a large scale when Covid-19 was finally found in the islands. While the outside world was still struggling to get the test capacity ready, the Faroe Islands were already working on an efficient and much cheaper test programs. Testing, tracing sources of infection, isolating the infected, 6-day quarantine for all arriving from abroad, as well as restrictions on the right of assembly, became the main strategy points in the fight against Covid-19 - combined with the usual calls for hand hygiene, keeping appropriate distance and using a mask in public transport.

It came as no surprise when Debes H. Christiansen, quite deservedly, was named the Faroese Man of the Year 2020.

First wave

On March 4, 2020, the dreaded virus was detected for the first time on Faroese soil. In the coming days, the number of infections increased sharply and peaked on March 23, when the health authorities confirmed 102 active cases. This first wave was met with extensive testing, detection and quarantine of the infected and their friends and relatives. On May 11 2020, there were no active cases in the Faroes.

Second wave

From May 11, these excellent results lasted until the end of July. Shortly before the Faroese national holiday Ólavsøka (July 28-29), the infection was confirmed anew and in the following days, the number of cases increased sharply. On August 15, the second wave peaked with 147 infected persons. Once again, health authorities managed to beat down the infection with large-scale testing, detecting and tracing sources of infection and quarantining the sick and their friends and relatives.

A small third wave

However, the period just after the second wave was not quite as tranquil as the one that succeeded the first. No cases were detected in late August but then the curve started rising again slowly in September and peaked with 43 cases around October 1, subsequently sliding down again to 3-5 patients in early December. It should be noted, however, that some of the Covid-19 cases found in the Faroe Islands originated from foreign fishing vessels seeking port with diseased people on board.

Fourth wave

In December, there were again fears of a sharp increase in the cases of infection as Faroese residing and studying abroad traditionally arrive in the Faroe Islands to celebrate Christmas with their families. Later in December the number of infected also began to rise slightly, but did not reach the same levels as in March and August. The experiences from Ólavsøka had probably given many people a fright and made them more cautious. The wave peaked around the New Year with 66 cases of Covid-19 – subsequently falling again until mid-January after which it slowly ebbed out completely.
At the time of writing (March 30, 2021) there have been 661 cases of Covid-19 in the Faroe Islands, of which 660 have recovered. 241,082 tests have been made on a population of 52,920 individuals - the highest number of tests in the world in terms of population.

What the future will bring is hard to predict. Vaccination of the whole population has started. On March 28, 2021, 5,853 people received the first injection (approx. 11% of the population) while 4,106 have received both injections (7.7% of the population).
Anker Eli Petersen