International Journal of Circumpolar Health ISSN: (Print) (Online) Journal homepage: www.tandfonline.com/journals/zich20 Public health restrictions, directives, and measures in Arctic countries in the first year of the COVID-19 pandemic Malory Peterson, Gwen Healey Akearok, Katie Cueva, Josée G. Lavoie, Christina VL Larsen, Lára Jóhannsdóttir, David Cook, Lena Maria Nilsson, Arja Rautio, Ulla Timlin, Miguel San Sebastián, Elena Gladun, Elizabeth Rink, Ann Ragnhild Broderstadt, Inger Dagsvold, Susanna Siri, Charlotte Brandstrup Ottendahl, Ingelise Olesen, Larisa Zatseva, Rebecca Ipiaqruk Young, Ay’aqulluk Jim Chaliak, Emily Ophus & Jon Petter A. Stoor To cite this article: Malory Peterson, Gwen Healey Akearok, Katie Cueva, Josée G. Lavoie, Christina VL Larsen, Lára Jóhannsdóttir, David Cook, Lena Maria Nilsson, Arja Rautio, Ulla Timlin, Miguel San Sebastián, Elena Gladun, Elizabeth Rink, Ann Ragnhild Broderstadt, Inger Dagsvold, Susanna Siri, Charlotte Brandstrup Ottendahl, Ingelise Olesen, Larisa Zatseva, Rebecca Ipiaqruk Young, Ay’aqulluk Jim Chaliak, Emily Ophus & Jon Petter A. Stoor (2023) Public health restrictions, directives, and measures in Arctic countries in the first year of the COVID-19 pandemic, International Journal of Circumpolar Health, 82:1, 2271211, DOI: 10.1080/22423982.2023.2271211 To link to this article: https://doi.org/10.1080/22423982.2023.2271211 © 2023 The Author(s). Published by Informa Published online: 29 Oct 2023. UK Limited, trading as Taylor & Francis Group. Submit your article to this journal Article views: 683 View related articles View Crossmark data Citing articles: 1 View citing articles Full Terms & Conditions of access and use can be found at https://www.tandfonline.com/action/journalInformation?journalCode=zich20 INTERNATIONAL JOURNAL OF CIRCUMPOLAR HEALTH 2023, VOL. 82, 2271211 https://doi.org/10.1080/22423982.2023.2271211 ARCTIC COMMUNITY PERSPECTIVES ON COVID-19 Public health restrictions, directives, and measures in Arctic countries in the first year of the COVID-19 pandemic Malory Peterson a, Gwen Healey Akearok b, Katie Cueva c, Josée G. Lavoie d, Christina VL Larsen e,f, Lára Jóhannsdóttir g, David Cook g, Lena Maria Nilsson h, Arja Rautio i, Ulla Timlin i, Miguel San Sebastián h, Elena Gladun j, Elizabeth Rink a, Ann Ragnhild Broderstadt k, Inger Dagsvoldk, Susanna Siri k, Charlotte Brandstrup Ottendahl e, Ingelise Olesene,f, Larisa Zatsevaj, Rebecca Ipiaqruk Young l, Ay’aqulluk Jim Chaliak m, Emily Ophusb and Jon Petter A. Stoor h,k aDepartment of Human Development and Community Health, Montana State University, Helena, USA; bQaujigiartiit Health Research Centre, Nunavut, Canada; cInstitute of Social and Economic Research (ISER), University of Alaska, Anchorage, AK, USA; dOngomiizwin Research, University of Manitoba, Winnipeg, MB, Canada; eNational Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark; fInstitute of Health and Nature, University of Greenland, Nuuk, Greenland; gEnvironment and Natural Resources Programme, University of Iceland, Reykjavík, Iceland; hDepartment of Epidemiology and Global Health, Lávvuo-Research and Education for Sámi Health, Umeå University, Umeå, Sweden; iFaculty of Medicine, University of Oulu, Oulu, Finland; jInstitute of State and Law, University of Tyumen, Tyumen, Russia; kCentre for Sámi Health Research, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway; lDepartment of Psychology, University of Alaska, Anchorage, AK, USA; mKuskokwim Campus, University of Alaska Fairbanks, Bethel, AK, USA ABSTRACT ARTICLE HISTORY Beginning January of 2020, COVID-19 cases detected in Arctic countries triggered government Received 16 August 2023 policy responses to stop transmission and limit caseloads beneath levels that would overwhelm Accepted 28 September existing healthcare systems. This review details the various restrictions, health mandates, and 2023 transmission mitigation strategies imposed by governments in eight Arctic countries (the United KEYWORDS States, Canada, Greenland, Norway, Finland, Sweden, Iceland, and Russia) during the first year of Epidemic; Inuit; first nations; the COVID-19 pandemic, through 31 January 2021s31 January 2021. We highlight formal proto- health policy; Indigenous; cols and informal initiatives adopted by local communities in each country, beyond what was infectious diseases; remote mandated by regional or national governments. This review documents travel restrictions, com- health services, community munications, testing strategies, and use of health technology to track and monitor COVID-19 cases. We provide geographical and sociocultural background and draw on local media and communications to contextualise the impact of COVID-19 emergence and prevention measures in Indigenous communities in the Arctic. Countries saw varied case rates associated with local protocols, governance, and population. Still, almost all regions maintained low COVID-19 case rates until November of 2020. This review was produced as part of an international collaboration to identify community-driven, evidence-based promising practices and recommendations to inform pan-Arctic collaboration and decision making in public health during global emergencies. Introduction an international research collaboration was initiated to The first positive case of COVID-19 (SARS-CoV-2) in the document the range of public health restrictions, directives, Arctic region was detected in January of 2020 in Saariselkä and measures that were implemented in Arctic countries Outdoor Resort in Finland, precipitating responses across all during the first year of the COVID-19 pandemic. Led by Arctic countries and from the Arctic Council to prevent the a team of Fulbright Arctic Initiative Alumni, the long term spread of COVID-19 and control the pandemic [1,2]. At goal of this project is to identify community-driven models national and local government levels and across private and evidence-based practices and recommendations to and public sectors, all Arctic countries implemented strate- inform circumpolar collaboration and decision-making in gies to attempt to limit COVID-19 incidence beneath case- public health during times of global emergencies. loads that would overwhelm existing healthcare systems. The purpose of this article is to summarise and To assess the positive and negative societal outcomes asso- compare the various regulations, restrictions, health ciated with the COVID-19 pandemic in Arctic communities, mandates, and transmission mitigation strategies CONTACT Malory Peterson malorykpeterson@gmail.com Department of Human Development and Community Health, Bozeman, Montana State University, 217 Herrick Hall Montana State University, MT 59715, USA © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent. 2 M. PETERSON ET AL. imposed by governments in eight Arctic countries, United States federal guidance and state of Alaska including the United States (US), Canada, Greenland, guidance on COVID-19 Norway, Finland, Sweden, Iceland, and Russia between Former President Donald Trump declared a State of January of 2020 and 31 January 2021. We use reports Emergency due to the COVID-19 pandemic on from national governments as well as media from local 13 March 2020, which allowed for increased executive communities within each country to contextualise the power to direct emergency relief, economic aid, and conditions of initial emergence of COVID-19, and the policy oversight [7]. Federal efforts to mitigate COVID- immediate government responses. Countries saw 19 transmission were impeded by misinformation and greatly varied case rates based on local protocols, politicisation, rendering an absence of federal guidance governance, and population, although almost all during the first year of the COVID-19 pandemic [8–12]. regions maintained low COVID-19 case rates until Consequently, states and local communities developed the second wave spiked in October through and implemented public health protections, contribut- December of 2020 [3]. While each country varied in ing to disparate within-country transmission mitigation their timeline of response and the types of protocols strategies [13,14]. implemented, we have organised this article to focus The first case of COVID-19 in Alaska was confirmed on on common themes across all regions: travel restric- 12 March 2020 from a foreign national aboard a cargo tions, communications, lockdowns and closures, test- flight, and the State of Alaska began issuing public ing strategies, and use of health technology. Because health orders in late March of 2020 [15,16]. Initial state circumpolar Indigenous populations experience health mandates limited visitation to public facilities, closed all inequities relative to other national groups, we provide in-person public schooling, and imposed social distan- key background information and highlight localised cing protocols. The State of Alaska enacted travel restric- experiences of COVID-19 health policies and mandates tions for within-state, non-essential travel and gave throughout Indigenous communities across the permissions for local communities to enact travel bans Arctic [4]. [15]. COVID-19 regulations and requirements issued by the State of Alaska were impacted by politicisation and a priority to protect commerce, creating inconsistencies Arctic countries and overall strategy during the between municipalities. For example, some boroughs first year of the COVID-19 pandemic and communities in Alaska issued mask mandates despite no state-mandated requirement [6,17]. Alaska The following section introduces relevant governance experienced high rates of COVID-19 relative to other of each Arctic country and summarises the overall strat- Arctic regions during the first year of the pandemic, egy and case emergence between January 2020 and particularly during November and December of 2020 31 January 2021. An overview and comparison of gen- [3]. From 2020 through 2021, Native Hawaiian and eral COVID-19 prevention strategies across all Arctic other Pacific Islander persons and Alaska Native persons countries during the first year of the pandemic is listed experienced the highest rates of COVID-19 cases and in Table 1. hospitalisations among all racial and ethnic groups in the State of Alaska, consistent with COVID-19-related racial disparities throughout the US [18,19]. The United States: Alaska Governance structure and health policy Initial Alaska Native community responses to administration in Alaska COVID-19 The State of Alaska is the homeland of diverse Alaska To understand the initial pandemic response in Native people, including 229 federally recognised Indigenous communities in Alaska, we investigated tribes, 13 Alaska Native regional corporations, and COVID-19 related policies of Nuniitnek Yupiit tribal com- over 200 tribal village corporations [5]. These unique munities in the Yukon Kuskokwim region of Southwest tribal entities administer federal and state health, hous- Alaska. A common theme of focus groups among ing, and education services in their respective regions Nuniitnek Yupiit tribal communities was a prioritisation [6]. In Alaska, COVID-19 mandates differed between of collective wellness and a holistic approach to protec- federal, state, and local/borough issued orders. The tion and treatment of households impacted by COVID-19. State of Alaska and regional tribal health corporations Communities in the region initiated lockdowns and travel functioned as centralised entities issuing state-wide and restrictions to mitigate the introduction of COVID-19 [20]. regional guidelines. Some community members used traditional medicines to INTERNATIONAL JOURNAL OF CIRCUMPOLAR HEALTH 3 Table 1. Overview of general health protocols, restrictions, and mandates across Arctic countries during the first year of the COVID-19 pandemic. Canada US Nunavut NWT Yukon Alaska Iceland Greenland Norway Sweden Finland Russia Declaration of state of emergency ✔ ✔ ✔ ✔ ✔ ✔ ✔ Physical distancing ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ (1–2 metres) (1–2 metres) (2 metres) Ban on large gatherings ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ (5 people) (10 people) (10 people) (1,000 people) (5 people) (8 people) (6 people) Widespread testing ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ Travel ban ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ Proof of negative COVID-19 test for travel ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ Internal border closures ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ Contact tracing ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ Mask or face covering mandate ✔ ✔ ✔ Regional ✔ ✔ ✔ ✔ mandates Mandatory quarantine of symptomatic individuals ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ Mandatory quarantine period for travellers ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ Strict lockdown ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ Education institution closures (kindergarten to higher education) ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ Business closures (restaurants, bars, pubs, and clubs) ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ Postponement of elective health procedures ✔ ✔ ✔ ✔ ✔ ✔ Recreational closures (fitness centres, swimming pools) ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ Business closures (hairdressers, tattoo and piercing shops, massage studios, spas) ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ Closure of public transport ✔ Work from home orders ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ No visitation of elders/nursing care centres ✔ ✔ ✔ ✔ ✔ ✔ ✔ ✔ “✔” denotes implementation at some point in the first year of the COVID-19 pandemic to reduce transmission. Abbreviations: NWT=Northwest Territories. US=United States. 4 M. PETERSON ET AL. prevent and treat people infected with the virus, and Iceland blended Indigenous and western medical paradigms to Governance structure and health policy establish transmission mitigation strategies [6,20]. administration in Iceland Iceland has two administrative governance levels, including the national/central government and local Canada: Northwest territories, Yukon, Nunavut authorities (i.e. municipalities). Local authority responsi- Governance structure and health policy bilities are the same across all municipalities, regardless administration in Arctic regions of Canada of population size [25]. The Iceland Ministry of Health is Arctic regions of Canada include Yukon, Nunavut, and responsible for administration of health policy in Northwest Territories, each governed by their respec- Iceland, including public health, health insurance, hos- tive territorial government. Territorial governments pital operation, health centres, pharmaceutical centres, have authority over social services, health, education, and health technology [26]. In the first year of the justice, and the administration of territorial laws. Each COVID-19 pandemic, the total population of Iceland territory has a public-health act and a chief public was around 369,000 inhabitants, and 63% of the popu- health officer who guided the initial COVID-19 lation lived in the Greater Reykjavík area. The munici- responses in each region. The first case of COVID-19 in palities range in size from 42 inhabitants to 133,000 Arctic regions of Canada was confirmed on inhabitants in Reykjavík [27]. 21 March 2020 in Northwest Territories from a Canadian citizen who had travelled domestically [21]. Initial public health policy response to the pandemic in Iceland Initial public health policy response to the pandemic The goals of the Icelandic authorities and measures in Arctic regions of Canada employed to manage COVID-19 transmission were uni- During the first year of the pandemic response, restric- fied and constructive from the onset of the pandemic. tions across Canada followed federal guidance but were Beginning January 2020, the focus in Iceland was on individually mandated by territorial governments. ensuring that the infrastructure of the country, particu- Guidance generally included limits to public gatherings, larly the healthcare system, could accommodate the closure of public facilities, travel restrictions, and strict anticipated caseload [28]. The first case of COVID-19 in quarantine guidelines. Non-essential travel restrictions Iceland was confirmed on 28 February 2020 from an were imposed in all regions and between the United Icelandic citizen who had travelled to States and Canadian border. In Nunavut, a travel ban Italy, with subsequent quarantine of the affected and mandatory isolation hubs were implemented in person and declaration of alert by The National airport cities, including Ottawa and Winnipeg, to keep Commission of the Icelandic Police [29–31]. Iceland the virus out of the territory. In Manitoba, the provincial employed testing strategies, physical distancing recom- government implemented a Provincial Indigenous mendations, mask requirements, and travel restrictions. COVID-19 Collaboration, with representatives from the As a major international tourism destination, travel federal, Nunavut and provincial health care system as safety and organisation was significant for resident pro- well as Indigenous organisations to address emergent tections. Iceland was one of the first countries to imple- issues (the unmet needs of new mothers expected to ment mass testing, beginning within 6 weeks of COVID- self-isolate in a hotel for 14 days prior to returning to 19 presence in the country [32]. Planes arriving to the Nunavut, for example) [22]. The territorial governments country from areas with known COVID-19 events were issued public-health orders based on current COVID-19 screened and passengers were immediately placed into case counts in each respective territory. There was varia- quarantine until they were cleared with a negative tion in the level of governance that dictated COVID-19 COVID-19 test [33]. Travellers arriving from COVID-19 transmission mitigation strategies. For example, school risk areas were required to quarantine for 14 days upon closures were issued at the territory level in Northwest arrival to Iceland, later shortened to seven days with Territories and Yukon, though in Nunavut each individual a negative COVID-19 test [28]. During mid-March 2020, school district had authority to determine if schools secondary schools and universities were closed and dis- remained open or closed. Ultimately schools in all three tance learning was implemented. An initial ban on public territories were closed for at least three weeks [23,24]. gatherings of more than 100 people was issued, with Canada did not adopt a countrywide mask mandate specific restrictions targeting certain businesses, pubs, during the first year of the pandemic, though they and clubs that were associated with transmission events were strongly advised in most municipalities [23]. [29]. Iceland notably varied allowable gathering sizes INTERNATIONAL JOURNAL OF CIRCUMPOLAR HEALTH 5 between 10 and 500 people throughout 2020 based on three other members, two of whom are appointed by active caseload in the country. Relative to other coun- the government and one who is a regional tries in the Arctic, Iceland had more relaxed standards for representative. gatherings. For example, in a given period, cultural and Greenland experienced very few COVID-19 cases art events were permitted with a total of 30 people throughout 2020. Public awareness of the pandemic allowed on stage, while 50 adult and 100 children audi- emerged gradually and largely in reaction to devel- ence members were permitted in attendance if they opments in Denmark. Greenland’s major strategy to wore face masks [34,35]. Official vaccinations began in prevent the introduction of COVID-19 was to impose Iceland on 29 December 2020 [29]. border closures and travel limitations from all coun- tries. Because movement between communities necessitates air or boat travel, Greenlandic commu- Greenland nities were able to monitor within-country travel. By Governance structure and health policy June of 2020, Greenlandic borders opened to visitors administration in Greenland from neighbouring countries with proof of a negative Greenland (Kalaallit Nunaat, land of the Greenlandic COVID-19 test, as a condition to be allowed to board people) has a population of 56,650 people, of whom any flight to Greenland and a retest upon five days 90% are ethnic Greenlanders [36]. The population after entry. The COVID-19 pandemic has highlighted lives in 80 isolated settlements along the western, the need to close infrastructure gaps and prioritise southern, and southeastern coast of the country. the protection of vulnerable Indigenous communities Communities are accessible by boat and ship in the in Greenland. summer, and by airplane and helicopter the remain- der of the year [37]. Greenland’s physical geography Sweden and settlement pattern necessitates unique logistical strategies to ensure access to health services. Governance structure and health policy Greenland was under Danish colonial rule until 1953 administration in Sweden and has been in a political and social decolonisation The Swedish government system includes a national process, including through the Home Rule Act of governing body and self-determining elected bodies 1979 and the establishment of self-government in at the municipal level and regional levels. At the regio- 2009. As part of the Danish Kingdom, Greenland nal level, Sweden is divided into 21 counties which are remains connected to Danish authority in financial responsible for political issues within the region, includ- and diplomacy sectors but has an autonomous ing the universal healthcare systems. The local munici- Government of Greenland (Naalakkersuisut). During pality level is responsible for social programmes, the first year of the COVID-19 pandemic there was including schools and elder care, and there is no hier- a high degree of cooperation and communication archical relationship between the two (i.e. municipali- between health authorities in Denmark and health ties are not accountable to the regions). The Swedish authorities in Greenland. constitution prohibits ministerial control of national The Greenlandic response to COVID-19 was charac- government authorities and guarantees the indepen- terised by a small and uniform group of leaders guiding dence of the state administration. In practice, this restrictions. The Chief Medical Officer is the highest means that the Swedish government acts collectively medical authority in Greenland and had a central role and oversees national agencies with limits to national in planning, evaluating, and providing professional power, including in times of crisis or war. medical advice to the Greenlandic government and other authorities concerning the spread and contain- Initial public health policy response to the pandemic ment of COVID-19 [38]. The Chief Medical Officer in Sweden reports directly to the Naalakkersuisoq of Health (the The first cases of COVID-19 in Sweden were confirmed on Minister of Health) and is responsible for monitoring 9 March 2020, from five adults who had travelled to Italy infectious disease and advising government and health- [40]. Many aspects of the Swedish COVID-19 transmission care authorities on response and prevention [37]. mitigation strategy closely resembled that of other coun- Restrictions to prevent or contain infectious disease in tries, including the focus on increasing test capacity, con- Greenland were ordered by the Epidemic Commission tact tracing, and reducing unnecessary travel between [39]. The Epidemic Commission consists of the Chief countries. However, health authorities in Sweden did not Medical Officer, the chief of police, the chief veterinary immediately enforce strict measures to halt the spread of officer, the director of the governing body of taxes, and COVID-19 throughout the country [41]. Rather, an 6 M. PETERSON ET AL. alternative approach was adopted focusing on protecting COVID-19, self-report surveys were used to assess the capacity of the healthcare system and mitigating COVID-19 outcomes among Sámi peoples [48]. The COVID-19 impact through voluntary behaviours. For Sámi Health on Equal Terms (SamiHET) survey and the example, recommendations for social distancing and Health on Equal Terms (HET) survey included questions remote work were communicated to the public, but stay- about COVID-19 in four Sámi languages [48]. at-home orders and mask mandates were not imposed Preliminary survey results showed that in comparison [42]. Schools for older students transitioned to distance with the general Swedish population (8.4%) a larger education, while kindergarten and schools for younger proportion of Sámi people (11.5%) reported that they students remained open. Some restrictions were placed had tested positive for COVID-19 [48,49]. on public gatherings and restaurants, but public spaces, stores, and services remained accessible [42]. This was Norway a notably different strategy relative to other Nordic coun- tries [43]. Like many countries, Sweden experienced Governance structure and health policy severe COVID-19 outbreaks among older adults in nursing administration in Norway homes in the early months of the pandemic, resulting in Norway has a presiding central/national government and stringent policies to protect adults aged 70 years or older a two-tier system of local government, the municipalities [44]. To mitigate COVID-19 transmission risk, the Swedish and the county authorities, which have the same admin- government issued an ordinance prohibiting all external istrative status [50]. The central government of Norway visits to nursing homes for older people [44,45]. Vaccines owns four Regional Health Authorities that employ for COVID-19 became available in Sweden in late numerous hospital trusts to provide clinical health ser- December of 2020. The Swedish government developed vices [50]. Regional Health Authorities were responsible an operational plan to distribute COVID-19 vaccines first for epidemic preparedness and management in the hos- to older individuals and healthcare workers, followed by pitals and secondary care services in their respective geo- people in high-risk categories, and then to the general graphical areas. The Norwegian Institute of Public Health public [46]. (NIPH) is responsible for infectious disease control, and nationally coordinated pandemic response was headed Initial Sámi community responses to COVID-19 in by the Directorate of Health [51]. Municipalities are Sweden responsible for detecting, reporting, and monitoring the The geographic boundaries of the Sámi homelands in local spread of infectious disease [52]. Sweden span more than half of Sweden’s northern land Norway is divided into 11 counties, each with an mass and include grazing lands for reindeer herding, elected administrative council. The Sámi people live in though formal boundaries are not defined. Most Sámi all counties of Northern Norway, and in the southern live in the northernmost Arctic county, Norrbotten, with parts of the country in Trøndelag and Femundsmarka in the Sámi population declining gradually south and Hedmark [53]. To understand local context and impact towards the Gulf of Bothnia. Sweden recognises specific on Arctic Indigenous communities, we reviewed public- Sámi administrative areas in which Sámi are entitled to health restrictions in 119 of the most northern munici- expanded rights, such as communicating with govern- palities in Norway. ment authorities in their own language. Through 31 January 2021 the Sámi Parliament reported that no Initial public health policy response to the pandemic Sámi representatives had been invited to participate in in Norway decision-making processes on COVID-19 measures The first case of COVID-19 in Norway was identified in affecting the Sámi. The Sámi people were not consulted a traveller who had returned from China on on the impacts of the national response or on needs for 26 February 2020 [54]. COVID-19 restrictions were issued measures and programmes to address the situation and at the national level beginning 12 March 2020 which were impacts from a Sámi perspective [47]. The Sámi notably the strongest and most sweeping measures Parliament reported that the most impactful COVID-19 Norway has seen in peacetime [55]. Under a state of crisis, restriction for the Sámi population in the first year of the Directorate of Health was tasked with risk communi- the pandemic were closed borders and travel restric- cation, infection control measures, and supporting activ- tions. The border closure between Norway, Sweden, ities of other public bodies to prevent negative and Finland had severe negative consequences for the consequences of COVID-19 [51]. National restrictions Sámi people, particularly related to reindeer herding. included physical distancing recommendations, closure Because Sámi people are not consistently included as of public facilities, quarantine and isolation rules, and an ethnic category in epidemiological data related to strict travel restrictions [56]. Border restrictions initially INTERNATIONAL JOURNAL OF CIRCUMPOLAR HEALTH 7 required any foreign citizens who had arrived in Norway aid to support municipalities in the COVID-19 pandemic on 17 March 2020 or earlier to quarantine in Norway, management [1]. National policies and municipal poli- prompting public response as many travellers and work- cies in Finland included travel restrictions, ers were suddenly unable to return to their homes in Sweden or Finland [56]. By 15 June 2020 national borders Initial Sámi community responses to COVID-19 in were re-opened to allow travel between other Nordic Finland countries, though strict travel bans were re-instated as Lapland (Lappi) is the northernmost of the 21 Finnish the second COVID-19 wave hit in August 2020. The NIPH regions. North Sámi, Skolt Sámi, and Aanaar Sámi are established COVID-19 testing facilities, initially in hospitals Indigenous to the region. As in Sweden, border closures and later through special testing sites that delivered sam- in the initial stages of the pandemic challenged the ples to hospital laboratories for analysis [56]. In addition to movement of Sámi reindeer herders. Moreover, closed national restrictions, municipalities issued restrictions as borders impacted on the life of Sámi people living in local COVID-19 cases increased [56]. Norway´s application these border communities, challenging the everyday of strict mandates and public health recommendations life, business, culture and communication between peo- resulted in low COVID-19 case rates compared to other ple and families. Later, border crossing restrictions were Arctic countries up through 31 January 2021. lifted for occupations working with livestock, which ameliorated challenges to Sámi communities and her- ders. During the first year of the pandemic Finland Finland experienced lower COVID-19 case rates than other Governance structure and health policy countries in the Arctic. administration in Finland Finland is divided into 21 regions, each governed by Russia a regional council which serves as forum of cooperation for the municipalities of a region. The main tasks of the Geographic distribution and governance of regions are regional planning and development of Indigenous peoples in Arctic regions of Russia enterprise and education. The organisation of social Russia is a federative state divided into 85 regions. welfare and healthcare services is the responsibility of There are three tiers of governance in the Russian municipalities. The system consists of 20 hospital dis- Federation: federal, regional (federative “subjects”), tricts and 5 university hospitals. In 2021, 8 out of the 20 and local (municipalities). Russia is a multi-ethnic state districts had social and healthcare under a regional joint with a population of 244,000 Indigenous peoples in the authority [57]. north, Siberia, and the far east. Arctic Indigenous peo- The first case of COVID-19 reported in Finland was ples include the Aleuts, Koryak, Siberian Yupik, Chukchi, from a Chinese tourist on 29 January 2020, though no Evenks, Yakuts, Yukagirs, Dolgan, Selkup, Nanai, Khanty, domestic cases were identified until 26 February 2020 Mansi, Nenets, Sámi, and others [58]. Administratively, [1]. From March 2020, the Finnish government Indigenous groups are encompassed in more than 20 announced a state of emergency due to the COVID-19 federative regions [59]. Each region is divided into outbreak and employed a hybrid strategy to issue municipalities empowered to decide local issues like restrictions. The hybrid strategy aimed to gradually public health services, schools, and social services. transition from restrictive measures to enhanced man- Federal and regional authorities began issuing reg- agement of the pandemic through COVID-19 testing, ulating documents (orders, mandates, directives) begin- contact tracing, isolation, and treatment. Governmental ning in late March of 2020. Regional governments were and national policies were implemented and revised as responsible for decisions about mask requirements, conditions changed in order prevent the spread of social isolation, testing and monitoring, and travelling. COVID-19, especially at the beginning of the pandemic. Decisions were discussed and coordinated through These actions were mainly based on the Communicable operational headquarters and regular meetings with Diseases Act of 2016 and influenced municipal pan- public representatives [60]. demic management strategies [1]. All hospital districts and municipalities were responsible for pandemic pre- Federal public health policy response in Russia paredness and management in their respective geogra- By January of 2021, the Russian federal government phical areas. Municipalities were responsible for mobilised to develop testing, build COVID-19 specific funding any measures implemented in the public health centres, and initiate physical distancing and health system due to the pandemic. Beginning in quarantine efforts to reduce transmission risk. Russia March 2020, the national government released financial established national operational headquarters under 8 M. PETERSON ET AL. the leadership of the Deputy Prime Minister and Travel restrictions released a national plan to prevent the spread of All Arctic countries and nearly all regions imposed some COVID-19 [61]. On 11 April 2020, the Russian Health type of travel restriction by March of 2020. Minister indicated that the Russian population did not A comparison of travel restrictions in each country is understand the risks and threats of COVID-19 and pub- listed in Table 2. The imposition and monitoring of lic authorities needed to encourage citizen compliance border closures and travel bans reflected transportation with anti-transmission measures [62]. In April of 2020 patterns and geographical characteristics within each COVID-19 infections were recorded in all regions of country. Island countries, including Iceland and Russia and by May of 2020, Russia had the third highest Greenland, had increased levels of control over entry COVID-19 caseload in the world [63,64]. relative to regions sharing national borders, including Nordic countries and both inter-territorial and interna- Public health restrictions and outreach among tional border crossings in Canada [35,47,67–70]. For Indigenous communities of the Yamal region many countries national borders were never fully To understand initial pandemic response in Indigenous closed, but temporary and differing controls were communities in Russia, we investigated COVID-19 related adopted at the internal borders depending on the sta- policies in the Yamalo-Nenets Autonomous Region tus of caseloads throughout the first year of the pan- (Yamal). Indigenous tribes in Russia experienced conflict demic [1,28,29,71]. with regional governments due to restrictions that affected their ability to hunt, fish, and herd reindeer. In the Yamal region, basic necessities were provided for the International cooperation to permit country-specific Indigenous population isolated on the tundra including travel food, essential supplies and goods, and gasoline. The Travel allowances and restrictions reflected interna- support was distributed through trading houses (factorii) tional cooperation, accounting for factors such as inter- available for the tundra reindeer herders. Special hospi- national commuters and relative risk by each country’s tals were assigned for patients with COVID-19 infections. epidemiological profile. For example, border closures If reindeer herders were infected on the tundra, they between Sweden, Finland, and Norway initially caused were provided all necessary healthcare and delivered to severe challenges for community members and the nearest hospital by air ambulance [65]. Indigenous reindeer herders who regularly crossed Representatives of regional public authorities visited dis- international borders, but by 2021 were modified to tant settlements and nomadic camps to communicate allow commuter crossing [56]. Beginning in May of with Indigenous families explaining the situation, mea- 2020, Iceland lifted travel restrictions on passengers sures, and calming their fears and uncertainties. In the arriving from Greenland and the Faroe Islands, which Yamal region, a working group of specialists from the were considered low risk [29]. For all other countries, Governmental Department for Indigenous Peoples took travellers to Iceland were required to observe a 14-day special support measures for the Indigenous population. quarantine upon arrival. This restriction was further During 2020 and winter of 2021, medical specialists loosened from 16 July 2020 when travellers from visited reindeer herders’ camps and visited families living Denmark, Norway, Finland, and Germany were added on the tundra to inform local communities about COVID- to the allowable travel list along with the Faroe Islands 19 and measures taken in the region to prevent the and Greenland, and were exempted from COVID-19 spread of the infection [66]. testing and quarantine requirements [28]. In Greenland, borders were completely closed and internal Overview of specific restrictions, mandates, travel was discouraged from March through June of and prevention strategies across the Arctic 2020. With zero cases of COVID-19 in the country, Greenland began accepting travellers from the Faroe Though response timelines and details of each inter- Islands and Iceland without a negative test until August vention varied depending on local conditions, colla- of 2020. After COVID-19 cases spiked in November of borative review of restrictions and protocols in each 2020, the airspace over Greenland was reclosed, and respective Arctic country demonstrated commonalities only travellers from the Copenhagen Airport were per- across the following arenas: Travel restrictions, commu- mitted to fly to Greenland [94]. nications, testing strategies, and use of health technol- Some regions of the Arctic adopted travel restric- ogy to track and monitor COVID-19 cases. The following tions to protect remote communities with low access section details and compares COVID-19 prevention and to healthcare centres relative to urban communities. response strategies across all Arctic countries. In Canada, border control was enforced at the US INTERNATIONAL JOURNAL OF CIRCUMPOLAR HEALTH 9 Table 2. Travel restrictions and regulations across Arctic countries during the first year of the COVID-19 pandemic. Canada United States Nunavut Northwest Territories Yukon Alaska Russia Travel ban for March 24, 2020. Travel March 18, 2020. All travel March 20, 2020. Driving March 25, 2020. Alaska January 30, 2020 Russia foreign ban maintained by land, air, and porty through Yukon to/from implemented a 2-week closes border to nationals/ through all of 2020. banned for non- Alaska permissible if intrastate travel ban. China. March 30, nonresidents Travel allowed residents. completed within 24 Alaskans permitted 24 2020, borders between NWT, hours and no hours to drive through completely closed to Nunavut, and passengers are Yukon. all foreign citizens. All Manitoba June to symptomatic. international flights November 2020 grounded. Limit to travel in March 24, 2020. No formal restrictions to March 20, 2020. March 28, 2020. Small March 2020. Limited remote Individual remote areas. Travel Requested by First communities charter planes to communities communities restricted exemptions for Nations communities. permitted by the State citizen homes. access to all travel at Aboriginal peoples to issue additional Remote communities their discretion. with a treaty right to travel restrictions. encouraged to harvest. distance. Enforced denial March 24, 2020. Only March 18, 2020. April 17, 2020. March 28, 2020. State March 30, 2020. of non- enforced by air travel. Transport officers Enforcement officers and local law essential initiate roadside checks deny entry to non- enforcement and travel at the of vehicles at the essential travel. federal border control border. border. officers enforce non- essential travel. Required 14-day March 24, 2020. Air March 15, 2020. All Initiated March 13, 2020. Recommended March 28, All tourists banned quarantine passengers required to travellers required to Citizens of 2020, requirement beginning upon entry to quarantine in Ottawa, self-isolate for 14 days. neighbouring varied between March 2020; 14-day the country Winnipeg, Edmonton, territories exempt communities. quarantine instated or Yellowknife. beginning July 1, 2020; Recommendation for travellers reinstated reduced to 5 days beginning late November 2020. October 15, 2020. July 2020. Travel March 24, 2020. Only March 18, 2020, travel March 2020. Critical care March 28, 2020. Shipping, March 30, 2020. exemptions critical care workers exemptions for health workers permitted to oil production, and Exemptions for for essential permitted to enter and other professions. work but must self- commercial fishing freight trucks and professions territory. isolate for 14 days considered essential. Russian diplomats. when not working. Negative March 24, 2020. After 14- Beginning March 18, No test requirement to March 25, 2020. State August 1, 2020, COVID-19 test day quarantine 2020, returning travel implemented in required travel negative PCR test and or letter of residents must submit residents must submit 2020. Temperatures declaration of travel. travel registration authorisation a signed letter from a plan for a 14-day taken at all airports September 8, 2020, required for travellers. for travel CPHO to return home, quarantine in and symptomatic proof of negative test including medical Yellowknife, Inuvik, travellers instructed to via Alaska Safe Travels. travel. Hay River, or Fort self-isolate. Smith. Iceland Greenland Norway Sweden Finland Travel ban for March 20, 2020 through March 13, 2020. All flights March 12, 2020. All travel March 19, 2020 March 16, 2020. foreign July 1, 2020, cancelled. Exemption banned. May 7, 2020 temporary travel Restrictions to travel nationals/ participated in travel for Faroe Islands and national borders restrictions enacted initiated, EU citizens nonresidents restrictions with other Iceland. From reopen to commuter with exemption for EU permitted to travel Schengen states. November 9, 2020, quarantine-free travel citizens with work/ home through May 15, 2020, airspace over of Sweden and residence permit. Finland. Helsinki total Greenland and Faroe Greenland closed, only Finland. June 15, 2020 July 4, 2020 entry travel ban March 28 Islands permitted. travellers from Nordic countries reopened to EU to April 15, 2020. July 15, 2020 Denmark, Copenhagen airport permitted entry, citizens and residents Reopened to EU Norway, Finland, and were permitted. excluding Sweden. of specified countries. countries beginning Germany permitted. January 2021, limit to August 2020 ban on all July 13, 2020. July 30, 2020 all number of travellers travel re-instated. tourists. permitted entry. Limit to travel in No formal restrictions to March 19, 2020, March 12, 2020. No formal restrictions to No formal restrictions to remote remote areas. lockdown for residents Prohibition against remote areas. remote areas. communities of Nuuk. April 22, 2020 staying at cabins/ travel permitted to 12 leisure properties. towns. Enforced denial March 20, 2020. Airlines March 13, 2020. Airlines March 12, 2020. Border Border entry enforced by March 22, 2020. Borders of non- controlled, cruises controlled, cruises control between Swedish Police enforcement unless essential cancelled throughout cancelled. Enforced by Schengen countries. consistent with travelling for travel at the 2020. Air Greenland and temporary restrictions. employment border. Greenlandic police. between, Finland and Sweden or Norway. Required 14-day Required March 2020. March 13, 2020. Within- March 12, 2020. Recommended 14-day March 22, 2020. 14-day quarantine August 19, 2020, country travellers Beginning 2021 quarantine for required upon entry. upon entry to tourists may quarantine 14 days or travellers must travellers. the country quarantine 5 days with 5 days with negative quarantine 10 days. two negative tests. test. (Continued ) 10 M. PETERSON ET AL. Table 2. (Continued). Canada United States Nunavut Northwest Territories Yukon Alaska Russia Travel National borders never November 9, 2020. Only March 12, 2020. March 19, 2020. Allowed for livestock exemptions fully closed, emergency flights Healthcare Exemptions for movement and for essential permissible travel for allowed to land in professionals travellers with work certain professions professions critical infrastructure. Greenland. prohibited from permit. between Finland, travelling. Sweden, Norway. Negative Requirements varied. Requirements varied. Beginning November 7, June 2020, citizens over Beginning COVID-19 test July 30, 2020 tourists June 2020, travellers 2020 negative COVID- age 18 of certain September 11, 2020 or letter of from risk areas must must have negative 19 test required within countries permitted negative COVID-19 authorisation test twice. January 15, test within 5 days of 72 hours of arrival. By entry with proof of test within 72 hours for travel 2021, all entering arrival. September 8, 2021, travellers may negative COVID-19 test of arrival required for Iceland must have 2 2020, travellers re- quarantine for 10 days within 24 hours. entry, as well as negative tests with tested 5 days after or 7 days with PCR quarantine. 5-day quarantine in- arrival. January 2021, test. Quarantine reduced between, or application needed. with 2nd negative vaccination. test. Abbreviations: NWT=Northwest Territories. CPHO=Chief Public Health Officer. EU=European Union. See References: 21, 29, 38, 57, 71, 75, 80 [72–76], [77–92]; [93]. border between Yukon and Alaska beginning in March Testing strategies of 2020 [95]. Regions of Alaska and Canada adopted All countries in the Arctic initiated testing strategies by restrictions on travel in remote communities to protect April of 2020 to identify COVID-19 cases in people with vulnerable populations with low access to health ser- flu-like symptoms, travellers from high risk areas, or vices. The Government of Yukon also limited nonessen- contacts to confirmed or suspected COVID-19 cases. tial travel into Yukon’s more remote communities [96]. By the end of the 2020, most Arctic countries allowed By the end of March of 2020, at least 17 Alaska Native testing for all individuals, regardless of criteria such as villages in the Yukon-Kuskokwim Delta had suspended flu-like symptoms, recent travel, or exposure to all non-resident travel to protect elders and over- a confirmed COVID-19 case. Early in the pandemic, crowded homes [97]. By contrast, the State of Alaska Nunavut and Iceland stood out in their broad criteria never imposed interstate border closures, though driv- to allow testing, making COVID-19 testing available to ing from Alaska to lower states necessitated admission people who were asymptomatic and did not have through highly restricted Canadian border cross- a known contact to a COVID-19 case [33,103]. Iceland ings [98]. was one of the first countries to begin mass-testing of Norway had some of the most strict internal travel residents returning from abroad. Planes arriving to the restrictions of all Arctic countries. In an extraordinary country from high-risk areas were screened and passen- ministerial meeting on 15 March 2020, the government gers were immediately placed into quarantine until adopted regulations regarding quarantine, isolation, they were cleared with a negative COVID-19 test [25]. and a legal basis for a ban on holiday property stays. DeCODE genetics, a biopharmaceutical company based This meeting introduced a quarantine obligation for in Reykjavík, Iceland, carried out sequence analysis of all everyone who arrived in Norway between positive cases of the virus to identify mutations of the 27 February 2020, meaning travellers or workers from virus, which was described as having a low mutation Sweden and Finland who came to Norway before rate relative to the scale of its spread. In 2020, Iceland 17 March 2020 would be held in 14-day quarantine in was the only country in the world in which every posi- Norway [99]. The border was closed to any foreign tive case was analysed in this manner [27]. Nunavut’s nationals without a Norwegian residence permit, and early testing criteria included contacts to COVID-19 travellers found in violation of the required quarantine cases as well as asymptomatic individuals and indivi- were subject to a fine of 20,000 Norwegian kroner duals with mild symptoms, so the territory could imme- ($2,000 USD) [56,99,100]. diately identify the possibility of COVID-19 [26]. The By the winter of 2020, the governments of Iceland, Swedish testing strategy was to ensure large-scale test- Sweden, Norway, Finland, and Greenland had adopted ing for COVID-19 throughout the country, as directed a scaled-back system of international travel with proof by the regions, county administrative boards, other of a negative COVID-19 test (taken within 72 hours), authorities, and private actors throughout Sweden proof of vaccination, or proof of a COVID-19 diagnosis [28]. However, through 31 January 2021, only sympto- [1,28,38,72,101,102]. matic or contact screening was advised in Sweden. INTERNATIONAL JOURNAL OF CIRCUMPOLAR HEALTH 11 Definitions of qualifying timelines for contact tracing Director of Health, and the Chief Constable of the Civil and testing of contacts to a suspected or confirmed Protection Department of the National Commissioner of COVID-19 case varied between regions. For example, the Icelandic Police [28,106]. Iceland’s first wave of in Greenland the Chief Medical Officer defined COVID-19 infections subsided in May of 2020 and con- a contact as an infected person with symptoms, from ferences were held less frequently but were essential 48 hours before the person’s symptoms started and for public communications. In addition, information until 72 hours after the person’s symptoms stopped about the pandemic were available in various lan- [104]. In Yukon, contacts to confirmed or suspected guages through a dedicated website, www.covid.is [29]. cases of COVID-19 were informed of exposure and asked to monitor symptoms for 14 days, and the con- Communications for Indigenous communities tact-tracing window was defined as 48 hours prior to In Nunavut, Northwest Territories, Yukon, Alaska, and any onset of symptoms consistent with COVID-19 [28]. Greenland, health messaging and advisories were trans- lated into multiple languages and included local Indigenous dialects. The Public Health Agency of Communications Sweden provided general COVID-19 information online Communications about COVID-19 information, risk fac- in three Sámi languages: Northern-, Lule- and tors, restrictions, case rates, travel bans, and associated Southsámi. Some Swedish municipalities also dissemi- services differed depending on local, regional, and nated localised information in Sámi languages on their national conditions. In most Arctic countries a national- websites due to a national legal obligation to commu- level taskforce of multi-disciplinary health and govern- nicate in the five recognised minority languages (in mental leadership was initiated to advise on pandemic which Sámi languages are included). The public Sámi response and communications to the general public. In broadcaster (Sameradion) provided news in the Sámi Nunavut, Yukon, and Northwest Territories, information languages in Sweden. In both Finland and Norway, was communicated directly from territorial govern- local regions and municipalities translate information ments, following recommendations of national guide- on COVID-19 into the Sámi languages. lines and adapted to local conditions. In Greenland, the Chief Medical Officer and Epidemic Commission were Multi-level risk advisories and restrictions responsible for issuing advisories, which were commu- In some areas, like the US, a formal state of emergency nicated to the public through press conferences [39]. In declaration allowed access to federal funding to sup- Alaska, lack of federal and state guidance in many port pandemic prevention efforts. In March of 2020 arenas of COVID-19 protections encouraged a more Finland, the US/Alaska, Nunavut, Yukon, Northwest robust local reaction to communicate information. Territories, and regions of Russia formally declared Local city and tribal governments reported on indivi- a state of emergency in response to COVID-19. Several dual community protocols, as advised by regional countries adopted multi-level risk advisories to reflect healthcare providers. The Norwegian government held changing national epidemiological conditions. Iceland press conferences three times a week through did not issue a formal state of emergency declaration 15 June 2020, and for the remainder of 2020 they until October of 2020, but the Civil Protection were held once a week and on an as needed basis Department employed a national risk alert system that [102]. Norwegian municipalities communicated using alerted uncertainty (January 2020), danger daily web-based press releases, local newspapers, (February 2020), and emergency (March to May 2020) radio, and Twitter [102]. Health authorities in all coun- alert status, but a colour-level system was implemented tries used social media (Facebook, Twitter) at the in December 2020 [28,29]. Finland initiated a hybrid national and local levels to communicate COVID-19 strategy that classified risk level based on the incidence health messaging such as handwashing, recommenda- of COVID-19 infections. The Finnish government action tions against public gatherings, and symptoms. Many plan divided the epidemiological situation into three countries, including Sweden, communicated informa- general stages: base level, accelerating stage (greater tion through government websites. than 10–25 COVID-19 cases per 100,000 persons over For example, the State of Alaska communicated all a period of 14 days), and spreading stage (greater than advisories and infection rates through a COVID-19 18–50 COVID-19 cases per 100,000 persons over 14 Summary Dashboard via the Alaska Department of days) [1]. Norway qualified municipality-specified Health [105]. In Iceland daily press conferences were restrictions and recommendations, such as the closing streamed through all main media outlets. These confer- of public institutions, via a colour-level system, with red, ences were headed by the Chief Epidemiologist, the yellow, and green levels declared depending on the 12 M. PETERSON ET AL. infection rate within a municipality [107]. For example, arenas such as theatres. In Iceland and Russia arts and in January of 2021 Rana municipality notified residents cultural events remained allowable with attendance that care homes were at red level and unnecessary restrictions and precautions throughout 2020. In visitation to care home residents was prohibited [107]. Sweden, events remained permissible though age The Federal Service for Supervision of Consumer Rights restrictions were imposed in December of 2020. Protection Russia employed a similar three-tiered sta- Cultural and sporting events reopened in June of 2020 ging system to determine restrictive measures against in Finland. COVID-19, though decisions on the stages, prevention, and monitoring were transferred to regional govern- School closures ments [108]. In Sweden, the Pandemic Act was estab- All countries and regions initiated school closures and lished in January 2021, to allow governmental distance learning. However, in Sweden this only applied authorities to interfere to a higher extent in societal for upper secondary school and above, while other areas previously governed locally, such as lock-down schools remained open throughout the pandemic. In of local public facilities [109]. March of 2020, distance learning became mandatory across Russia and the northern regions were most suc- cessful with implementation, partially because families Lockdowns and closures were already adapted to remote education during severe Most countries/regions initiated a period of strict lock- frosts [133]. Indigenous families in the Yamal region were down to attempt to curb the spread of COVID-19 in the happy to have children back on the tundra. So-called first 6 weeks of the COVID-19 pandemic, beginning “school helicopters” cancelled their flights at the end of March of 2020. Sweden, Iceland, Finland, and May of 2020 [134]. This measure reduced the risk of rein- Greenland did not initiate a country-wide lockdown, deer herders becoming infected. School closures in the though they implemented restrictions on gatherings Yukon Kuskokwim region of Alaska were challenging for and other measures to reduce transmission risk. families with working parents, as well as in households Characteristics of COVID-19 lockdown and closures in without reliable internet access. In Iceland schools and each country are listed in Table 3. Closure of non- universities were closed as a first response, but childcare essential businesses, schools, and services were advised and primary schools were permitted to remain open with in most countries, and all regions encouraged or limitations. In NWT, Yukon, and Nunavut schools were required limitations to gatherings throughout the closed for the remaining 2019–2020 academic year, as first year of the pandemic. In many regions, changes initiated by territorial governments and local school dis- to the number of allowable people gathered reflected tricts. In Finland, local closures were recommended based the temporal threat of COVID-10 caseloads. For exam- on the pandemic level (base, accelerating, or spreading). ple, in Iceland gatherings were initially limited to 100 However, in March 2020, all schools were closed nation- people and then reduced to 20 people as a COVID-19 ally for three weeks, excluding younger children (grades 1. wave hit the country in April of 2020 [29]. However, by to 3.) and children with a parent in a working position that June of 2020 the COVID-19 caseload declined and gath- was crucial in handling the pandemic. During the Finnish ering limitations were increased to 500 people. Like national lockdown children and youth studied remotely other countries, when the second wave of COVID-19 and adults worked remotely. After this period of national cases affected Iceland in November of 2020, gatherings school closure, local decisions for closures took prece- were reduced to 10 people. dence in Finland [135]. In Iceland, Sweden, Yukon, and parts of Alaska, bars and restaurants primarily remained open with restric- Funeral exceptions tions, such as limits to the number of patrons, mask Conditions around COVID-19 safety and allowable gath- requirements, and seating requirements. However, bars ering numbers for funerals generated varying responses and restaurants were connected to COVID-19 transmis- between countries. In Norway all events were postponed sion. Provision of food services varied, for example, if gathering people from several municipalities, with the restaurants in Nunavut were closed for in-person dining exception of funerals [102]. In Sweden, from and open for takeout only since end of March 2020, 23 November 2020 a maximum of eight people were though food-providing centres (such as food banks) allowed to gather for public and private events in pre- could remain open [132]. mises outside one’s own home, except for funerals In many regions, strict restrictions on gatherings where 20 persons were allowed to participate [136]. In necessitated the cancellation of arts and cultural events, Iceland the gathering restriction limits rules also affected sporting events, and closure of public entertainment the number of people who were allowed to attend INTERNATIONAL JOURNAL OF CIRCUMPOLAR HEALTH 13 funerals at any given time [29]. The Yupiit tribes in Alaska we outline some specific characteristics of COVID-19 restric- have protocols and follow traditional and religious rituals tions and directives in Arctic Indigenous communities dur- when loved ones die. The COVID-19 pandemic interfered ing the first year of the pandemic. with cultural responses to grief and loss and required loved ones to take on mortician duties, (i.e. body pre- Safety disagreements between state and tribal paration for burial) because the typical caretakers could governance in Alaska not risk exposure to the infection [137]. The COVID-19 pandemic underscored a variety of pre- existing vulnerabilities of the healthcare system for resi- Use of health technology for monitoring/tracking dents in remote parts of Alaska, such as provider shortages, Most countries developed new health technology via web- limited material resources, and dependence on air travel sites and phone apps to aid in contact tracing and symp- [144]. During the first year of the COVID-19 pandemic, state tom assessment. Nunavut, Yukon, and Northwest and tribal governance in Alaska experienced incidences of Territories created a self assessment online tool for citizens conflict. For example, in April of 2020 the State of Alaska to identify symptoms of COVID-19 [138]. Iceland released announced it would allow commercial fishing to continue, the Rakning C-19 tracking app to improve contact tracing acknowledging fishermen as critical infrastructure to the [26]. In August of 2020, Iceland implemented a COVID-19 state’s economy despite the expressed opposition of online chat on www.covid.is, to improve the provision of coastal tribal communities [145,146]. Tribal members and public information [28]. Greenland used the Danish app other residents expressed concern that an influx of thou- smitte|stop, a Bluetooth-based contact tracing tool sands of non-resident fishery workers from out-of-state and designed to track and notify phone users detected within country could overwhelm the low-capacity healthcare sys- range of confirmed COVID-19 cases [139]. In Norway, tem in the region [6]. Cultural attitudes about individual smitte|stop app was initially used to help trace COVID-19, right-to-privacy versus group protection contributed to but was suspended by the Norwegian Institute of Public disputes about COVID-19 transmission tracking Health in June of 2020 due to data privacy concerns related approaches for some tribal communities in Alaska. to sharing individual’s locations [140]. In Finland, Individual rights to healthcare privacy are protected by Koronavilkku was launched in August of 2020 as a private the US federal government, meaning individuals who contact-tracing app produced by the Finnish Institute for tested positive for COVID-19 did not have their status Health and Welfare [141]. If a user tested positive for disclosed in their place of residence [147]. This approach COVID-19, they could use the app to anonymously notify created an ethical conflict for some Nuniitnek Yupiit tribal close contacts and prompt them to seek testing [141]. The members who emphasised the need for transparency of Finnish symptom checker website Omaolo offered advice individual COVID-19 cases in order to track and prevent the on when to seek professional medical care [142]. In Sweden spread of cases into small communities. the COVID-19 Symptom Tracker app helped map the spread of infection and share knowledge of the virus. The goal of COVID-19 exposed healthcare infrastructure gaps the app was to assess regional and behavioural factors for Kalaallit communities in Greenland associated with risk of infection, and how quickly the virus was spreading in different parts of Sweden [143]. The Greenlandic health system is based on a Danish framework and the governance structure in Context of Indigenous communities and Greenland is not adapted to include local Inuit com- prevention strategies in the first year of munity in decisions. The Inuit Circumpolar Conference COVID-19 (ICC) has urged the government to acknowledge the challenges that Inuit communities face [52]. The ICC During the first year of the COVID-19 pandemic Arctic warned that rural, remote communities of Greenland Indigenous communities had varying levels of inclusion were at higher risk of severe consequences related to and control over COVID-19 restrictions and protocols epidemics due to the chronic lack of basic infrastruc- depending on their level of governance, health infrastruc- ture, including lack of sewer and running water in ture, and inclusion in national level health decisions. Tribal many communities [52]. The ICC called on govern- governance in Alaska Native communities allowed for loca- ments to close the infrastructure gaps throughout lised control and leadership to establish COVID-19 safety Kalaallit Nunaat through major investments in com- directives. By comparison, Sámi Parliament of Sweden munities, prioritising basic infrastructure such as experienced exclusion from important decisions on housing, water, and sewer. This is identified as part COVID-19 that affected Sámi communities. In this section, of the path forward to create social and economic 14 M. PETERSON ET AL. Table 3. Lockdowns, closures, and limits to gatherings regulations in Arctic countries in the first year of the COVID-19 pandemic. Canada United States Nunavut NWT Yukon Alaska Russia Observed initial March 17, 2020, initial Territory-wide lockdown Territory-wide lockdown March 28, 2020, shelter-in March 30, 2020, lockdown territory-wide not initiated. not initiated. -place order issued. nationwide stay-at- lockdown through Individual communities home order for 6 June 2002. Second extend lockdown at weeks. To protect lockdown their discretion. All economy, no federal November 18, 2020. State of Alaska restrictions issued mandates lifted during second wave May 19, 2020. in Fall 2020. Regional restrictions varied throughout 2020. Work from March 14, 2020, March 17, 2020 municipal March 18, 2020, March 28, 2020, shelter-in March 30, 2020, Federal home government programs close and government issue work -place and work from government enforces advisory employees sent home. work from home from home directive. home initiated. State of non-work days for 6 November 18, 2020 advisory issued. Alaska employees weeks. businesses instructed return to work May 22, employees work from 2020. home. School closures March 17 & 18, 2020 Mach 16, 2020, CPHO April 7, 2020 in-person March 13, 2020. Public March 2, 2020 schools schools, daycares, and orders closure of classes cancelled until schools close. Certain closed, reopened college classes close schools. August 2020. communities maintain July 13, 2020. for 3 weeks. April 17 & closures through 2020 24, 2020 all schools and into 2021. and college classes suspended until Fall 2020. June 1, 2020 daycares reopen. Closures of March 17, 2020, bars and March 22, 2020. Tours, March 22, 2020 all March 18, 2020, food and March 28, 2020, services restaurants takeout bottle depots, gyms, services close. bar services restricted restaurants and non- (restaurants, only. Lines cannot bars, restaurants, March 29, 2020 to take out and essential services to bars, exceed 10 people. salons, etc. closed. restaurants can reopen delivery. Gyms and close through theatres, Food banks and soup with submission of entertainment venues June 2020. salons, etc.) kitchens remain open. a health plan. July 1, close. May 19, 2020 2020 restaurants and state allows all bars open to 50% businesses to operate capacity. at full capacity. Individual communities maintain restrictions. Limits to March 17, 2020, public March 22, 2020 all public March 18, 2020, March 18, 2020, limited March 19, 2020, regional gatherings events cancelled and events and gatherings gatherings limited to to 10 people. State of authorities limit and public gathering discouraged. cancelled. April 10, 10 people. Healthcare Alaska mandate lifted gatherings from 50 to events November 18, 2020 2020 all private and workers, essential May 19, 2020. 1,000 people at their gatherings limited to 5 public gatherings services, and people Individual communities discretion. people. between different over 65 are not to maintain limits to households banned. gather. August 26, gatherings. Maximum 10 people 2020 10 people from a household indoors or 50 people permitted to gather. outdoors permitted. Visits to elderly April 2020, restrictions to March 17, 2020, March 25, 2020, seniors March 18, 2020, April 6, 2020, Federal care homes visits. June 15, 2020, all visitations to long-term to stay home and all visitations to hospitals, guidance issued to and Elder’s homes closed to care homes and older nursing home visits nursing homes, skilled limit outside visitors hospitals visitation for remainder programs restricted. prohibited. nursing facilities, and to nursing facilities. of 2020. Acute-care limited to 1 residential care visitor. prohibited. Special funeral No special permissions for No special permissions for August 26, 2020, 50–100 Funeral and mortuary April 20, 2020, regional permissions funerals. funerals. people permitted for services suspended in variations on funeral outdoors celebration of some Alaska Native size limit. Special life. communities. Families regulations for funeral provided materials to service operators and conduct burial. Church for Muslim burials. services suspended. Arts, cultural, March 17, 2020, all events March 22, 2020, theatres March 18, 2020, events March 2020, festivals, Limits to events, sporting cancelled. October 26, and museums close. cancelled. August 26, fairs, theatre, and museums, theatres, events 2020 sports, recreation, 2020 contact sport cultural events concerts, but were gyms, fitness centres guidelines released for cancelled. Numerous not completely reopened with ice, field, and court cultural and dancing closed. August 1, restrictions. Harvest sports. events performed via 2020 cinemas and and outdoor activities online streaming concerts reopen. permitted. platforms. Gyms and recreations centres reopen June 23, 2020. (Continued ) INTERNATIONAL JOURNAL OF CIRCUMPOLAR HEALTH 15 Table 3. (Continued). Canada United States Nunavut NWT Yukon Alaska Russia Iceland Greenland Norway Sweden Finland Observed initial Country-wide lockdown Country-wide lockdown March 12, 2020, Country-wide lockdown March 16, 2020, no lockdown not initiated. not initiated. Nuuk lockdown announced not initiated. formal lockdown residents lockdown for for two weeks. initiated, though 3 weeks beginning Finnish government March 18, 2020. releases emergency measures for daily activities. Work from Companies and March 13, 2020, work March 2020, advisory to March 2020, advisory to May 5, 2020, work from home institutions responsible from home advisory work from home if work from home if home encouraged in advisory for following gathering issued. possible. possible. public and private restrictions. Remote sector if possible. work encouraged. School closures March 13, 2020, March 13, 2020, all March 12, 2020, daycares, March 18, 2020, primary May 5, 2020, schools Universities close, schools close. Schools primary schools, upper and secondary schools and other learning nursery and primary outside of Nuuk education and and universities closed. facilities advised to programs have limited reopen April 14, 2020. universities closed. Online learning close according to the openings. May 4, 2020 Exceptions for children extended through pandemic level (base, primary schools in daycare with parents remainder of 2020. acceleration, reopen. August 4, 2020 who perform critical spreading level). secondary schools duties. reopen with restrictions. Closures of May 25, 2020 pubs, clubs, March 18, 2020, March 12, 2020, Restaurants and bars March 28, 2020, services and gaming allowed to restaurants and pubs restaurants, bars, pubs, remain open through restaurants and bars (restaurants, open until 11:00 pm closed. Reopened and social 2020 with restrictions only open for bars, with capacity April 8, 2020. establishments closed on capacity, operable takeaway. June 22, theatres, restrictions. with exception for hours, and alcohol 2020 restrictions salons, etc.) September 18, 2020 places that can sales. eased. October 8, pubs in urban areas maintain 1 metre 2020 restrictions to close, reopened with distance between hours of operation seating restrictions patrons, such as and alcohol sales. September 27, 2020. canteens. Iceland Greenland Norway Sweden Finland Limits to March 13, 2020, March 13, 2020, March 12, 2020, limit to March 11, 2020, events March 16, 2020, public gatherings gatherings restricted to gatherings limited to 10 people indoors or limited to 300 people. gatherings limited to and public 100 people. March 22, 1,000 people. 20 people outdoors. March 27, 2020 private 10 people. June 1, events 2020 reduced to 20 Maximum allowable gatherings restricted to relaxed to 50 people. people. April 21, 2020 gatherings of 100 50 people. Permitted gatherings increased to 50 people. people indoors with November 23, 2020, shifted based on During low infection fixed seating gatherings limited to 8 pandemic level. period May/June up to arrangements, or 3 × people. 500 people permitted 200attendants at to gather. Some outdoor public events communities reduce with fixed seating. gathering limits to 5. Visits to elderly August 14, 2020, nursing No specific restrictions. March 12, 2020, April 1, 2020, elder care March 16, 2020, visits to care homes homes, and healthcare Can anybody in visitations to nursing homes encouraged to elderly homes and centres may determine Greenland confirm care facilities restricted. determine their own prohibited. hospitals their visitation this? visitation restrictions. June 2020, facilities restrictions. advised to determine Restrictions vary visitation restrictions. throughout 2020. Special funeral December 10, 2020, No special restrictions on Events gathering people November 23, 2020, No special permissions permissions Funerals allowed up to funerals, attendance from multiple funerals permitted 20 for funerals. 50 attendants. permitted in municipalities attendants. accordance with 1,000- cancelled with the person gathering exception of funerals. restriction. Arts, cultural, April 21, 2020, sporting Sporting and cultural March 12, 2020, Cultural Sporting events March 16, 2020, sporting events permitted events permitted events and organised permitted with certain museums, theatres, events without restrictions. throughout 2020 based sporting activities, both restrictions for athlete cultural venues, Arts and cultural on low COVID-19 case indoors and outdoors, contact, outdoor pools, sports clubs, events allowed with load. were prohibited. competitions and other centres precautions and limits mandated, and events closed. June 1, 2020 to number of people postponed. sports and cultural performing and in December 2020, activities begin to audience. October 31, participation reopen with 2020 sports and arts restrictions for children restrictions. events cancelled. born after 2001. Abbreviations: NWT=Northwest Territories. CPHO=Chief Public Health Officer. Abbreviations: NWT=Northwest Territories. See References: 29, 57, 58, 81, 94 [110–114], [115–131]. 16 M. PETERSON ET AL. equity, support population health, and reduce vulner- cumulative economic effect of COVID-19 aggravated ability to virus and disease. When designing local, the conditions for reindeer herding, as pasture lands regional, and national responses and preparedness are already under pressure due to competing land use to the coronavirus and other infectious diseases, gov- (natural resource exploitation, wind power, infrastruc- ernments must acknowledge the challenges faced by ture) and impacts of climate change [47]. Inuit communities [52,148]. Compromise between state and tribal (regional) Sámi communities of Sweden and consultation in governance in Russia national COVID-19 prevention strategy In the Arctic territories of Russia, local communities high- In June of 2020 the Sámi Parliament in Sweden released lighted the importance of responsible behaviour during a report on the impact of COVID-19 on Indigenous peo- the pandemic. Communication with the federal repre- ples that stated no Sámi representatives had been sentatives and public opinion helped to implement pre- invited to participate in decision-making processes on ventive measures. Public authorities in Indigenous- COVID-measures affecting the Sámi [47]. The Sámi peo- populated regions made compromises with Indigenous ple had not been consulted on the impacts of the peoples to allow fishing, hunting, and reindeer herding Swedish national response or on needs for measures during the pandemic conditions. Reindeer herders were and programmes to address COVID-19 from a Sámi per- allowed to hunt and to herd reindeer if they stayed on spective [47]. Within the first 6 months of 2020, Sámi the tundra, away from the villages [134]. The restrictions Parliament in Sweden was not able to identify any initia- had little impact on the Indigenous peoples of the tives by hospitals and healthcare or test facilities collect- remote Arctic settlements of the Russian regions. In ing and analysing information/data on COVID-19 health spring 2020, almost all reindeer herders moved their impacts on Sámi individuals [47]. Furthermore, no infor- herds to summer pastures, far from densely populated mation-sharing or awareness-raising initiatives were areas to reduce the risk of COVID-19 outbreaks. Regional directed at Sámi society or communities [47]. authorities understood that reindeer need constant care, and herders couldn’t be isolated completely; these Reindeer herding and national border closures in requirements were more easily complied with. Sápmi The Sámi Parliament of Sweden assessed that one of the Conclusions most impactful COVID-19 restrictions for the Sámi popula- tion was the initial closing of the borders between Norway, Each Arctic country detailed in this article conducted Sweden, and Finland and travel restrictions between March case studies in their respective region to investigate and June 2020. Sámi homelands cross the nation state positive and negative societal outcomes related to the borders, and border closures did not account for the move- COVID-19 pandemic, with a special interest in the ment of the Sámi in pursuit of traditional livelihoods. experiences of rural communities and Arctic Reindeer herding necessitates free-range movement Indigenous communities. In subsequent publications, between grazing lands in Norway, Sweden, and Finland. we describe each of the seven country case studies Family members within a Sámi family often reside in differ- (Greenland, Iceland, Finland, Norway, Sweden, Canada, ent countries depending on the seasons following the and US/Alaska) and the evidence-based health policy cycles of the reindeer. Restrictions on border crossings recommendations that each case study elicited. into Finnish Lapland included limited operational hours of Arctic countries and communities implemented certain border crossing points on the western and eastern a diverse array of measures at multiple levels to pro- borders in Lapland. The objective of the Finnish health tect their populations from the spread of COVID-19. authorities was to guide all people crossing the Finnish The most common measures included travel restric- border to a COVID-19 test [149]. In June 2020, restrictions tions, quarantine/isolation protocols, lockdowns/clo- were lifted for essential occupations, including the care of sures, and testing. At times regional, national, and livestock between Sweden, Norway, and Finland [150]. municipal decision-makers either clashed or worked The Sámi Parliament of Sweden conducted a survey together, most often the latter. Special allowances on the financial impacts on Sámi business with a focus were made for Indigenous community harvesters and on reindeer herding. The survey found a decrease in herders to continue their practice when a more demand for reindeer meat (mainly from the restaurant detailed picture of COVID-19 began to emerge sector), which was expected to result in lower sales through the spring of 2020. Furthermore, Indigenous volumes and lowered prices next year [151]. The communities demonstrated a strong desire to keep INTERNATIONAL JOURNAL OF CIRCUMPOLAR HEALTH 17 the virus out to protect Elders and vulnerable mem- [3] Petrov AN, Welford M, Golosov N, et al. The “second bers of communities and took precautions to prevent wave” of the COVID-19 pandemic in the Arctic: regional transmission. Ultimately, the Arctic did not see the and temporal dynamics. 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