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07 April 2020

Coronavirus in Denmark: Kindergartners appointed the avant garde

Mette pulls the trigger, or rolls the dice, or whatever metaphor you like – Denmark looks to become, along with Austria, one of the first Western countries to emerge from the lockdown. Gradually, as promised.

On Monday evening, Prime Minister Mette Frederiksen announced a plan to reopen (DK) the country for normal activities. The announcement came a full week before the end of the current lockdown period, which extends until after Easter. 

The first phase will be limited and will take place only on the condition that “everyone, everyone!” – said Frederiksen for emphasis – continues to follow the authorities’ recommendations on social distancing and other restrictions. The plan calls for a reopening of nurseries, day-care centers and schools up to the fifth grade on April 15 in order to allow parents to resume working. The schools will follow strict rules on cleaning and hygiene, the kids will be outside as much as possible, and adults will keep a greater than normal distance to them. The upper grades and other educational institutions will remain closed. Elementary school graduation exams for ninth graders are canceled.

The second important change is that employees in the private sector may begin returning to work. This will take place according to agreements with employees’ and employers’ associations and will also require upon more stringent health conditions than normal. People are still encouraged to remain home if they can. Public employees in non-essential functions will remain home.


Roskilde Festival canceled

The other restrictions remain in place, and the periods in which they apply have been extended. Large gatherings, such as music festivals, are banned through the month of August. The other closures are extended until May 10: public institutions, shopping centers, theaters, the national borders and gatherings of more than 10 people. If this first phase can proceed successfully, the administration will afterward consider opening restaurants and small businesses such as hairdressers. 

Frederiksen stressed that it was not administration’s strategy to pursue herd immunity. There had been some speculation that a reopening implied an attempt to build up herd immunity, but Kåre Mølbak, the head of Statens Serum Institut, clarified the issue by explaining that the objective is to control and delay the spread (DK) of the virus so that the healthcare system is not overwhelmed.


Day-care staff in hazmat suits?

Not surprisingly, this announcement caused some concern among teachers (DK) and day-care staff. They note that small children have trouble remembering to wipe their noses and sneeze into their sleeve, aside from keeping a distance to others. Staff want to get clear guidelines about how many kids can be close to one another, for example, and what symptoms will dictate whether they need to be sent home. Kåre Mølbak said he was not worried about the risk to children, since only around 1.8 percent of them test positive. The task of preparing for the reopening is up to the local institutions, and the chairman of the association of municipalities believes that the plan is feasible. 

Frederiksen received some criticism from the other political parties (DK). They were informed of the plan a few hours before the press conference but were not consulted about the specifics, as Jakob Ellemann-Jensen, the leader of the Liberal Party, believes they should have been. Kristian Thulesen Dahl of the Danish People’s Party thinks it might have been more viable for the older students, who are better able to keep a distance from one another, to take their exams. Jens Veirum, a head pediatrician at Aarhus University Hospital, defended the decision by saying that parents of young children are usually young and healthy and can withstand being infected.


What happened to Europe’s precautionary principle?

I find the announcement, which occurred around  the same time as a report that British Prime Minister Boris Johnson has been placed in intensive care, surprising and probably premature. I had understood the administration’s preceding announcement to mean that after April 13, it would consider options for reopening the country, not necessarily begin them immediately afterward. The plan for reopening will be encouraging for some people, but the situation changes so rapidly, with new findings about protection and possible treatments coming daily, that IMHO, it wouldn’t have hurt to wait a little longer at least before making this kind of announcement.

The main factor that argues for reopening is that the country has vacant capacity in ICUs and expects to maintain a buffer according to the trend in declining infections. But the greatest failing in its policies thus far is that it has not tested extensively. It therefore does not have a complete picture of the actual spread of the virus, and it has not traced the contacts of those with mild symptoms who have been told to self-quarantine. Healthcare officials have said recently that they intend to begin testing cases with mild symptoms as well as healthcare staff and people with severe symptoms, as advised by the WHO, but they have not begun testing more than 5,000 persons per day. I know one person who has had persistent cold symptoms for two weeks and has not been able to get a test.


Stealth infections

One issue that I don’t understand well enough to have an opinion on but that seems critical is whether children who don’t become sick can become carriers. Children have greater resistance to the coronavirus than adults, but is it a greater resistance to developing Covid-19 from an infection or a resistance to the infection itself? If they become asymptomatic carriers, they will probably infect their teachers and day-care staff and will certainly infect their parents. And if some of these parents are returning to their workplaces, they are likely to infect others before their symptoms appear. If children are not sent home until they develop symptoms, then at least the youngest will almost certainly have already infected others. This strategy does seem to be inviting infections, and the decisive factor will be how many of them will require intensive care. 

It will be interesting to see the reaction to the announcement on Twitter and Facebook.

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