Coronavirus DK: Confusion over testing policies at the border

Several political parties are criticizing the government for not following stricter policies for travelers (DK) arriving in Denmark. They say that all people from countries with a high infection rate should present a recent negative test for the coronavirus or be tested on arrival. The current practice is inconsistent and insufficient, they maintain. Some arrivals from so-called “quarantine countries” with a “worthy purpose,” such as a job interview, must present a negative test. In other cases, people attending a funeral or a business meeting, for example, can enter freely. It is optional whether they submit to a test on arrival.

Are the testing facilities even being used?

Testing facilities were set up at Kastrup Airport in Copenhagen on June 15. Since then, some 25,000 people have entered Denmark there, but the number who have presented tests or have been tested is unknown. “We have said that Danes must comply with guidelines,” says Peter Skaarup of the Danish People’s Party. “And then we see, for example, a flight from Islamabad that brought a large number of infected people to Denmark.” Arrivals from high-risk countries should also be quarantined, added Skaarup.

Other parties agree that the current policy is not effective. Although testing is available at the airport, the facility is not prominent. All arrivals should be met by a test team that offers them a test, says Kirsten Normann Andersen, health care spokesperson for the Socialist People’s Party. They should be isolated until we know they aren’t infected, continues Normann Andersen, and that includes all travelers from other EU countries.

One test is not enough

But according to virologist Allan Randrup Thomsen, a negative test is no guarantee that one is free of infection. Tests may not be reliable in the country of origin, and one can become infected after testing negative. “To be certain, people should actually be tested twice at a few days’ interval,” says Randrup Thomsen. “And during that time they should be isolated, if this system is to function optimally.” Randrup Thomsen doesn’t think it is worthwhile to test travelers from all EU countries, however. If the infection rate is below the limit of 20 per 10,000, then the testing would involve much work and identify very few cases. The tests also produce some false positives.

Rasmus Horn Langhoff, health care spokesperson for the governing Social Democratic Party, agrees “with the intention to ensure that we protect Denmark from the coronavirus as well as possible. . . . I’m sure that we can do it better than we do today. And we very much want to look into this.”

Swedes sail to Denmark in vain

The confusion was no more evident than regarding the new regulations for arrivals from neighboring Sweden (DK). The country, which has followed a singularly laissez-faire policy regarding the coronavirus, has about the highest infection rate in the EU. It is one of the EU six countries that Danes are not allowed to travel to. There is an exception, however, for three regions in southern Sweden close to Denmark. Even residents of these quarantine regions are subject to certain requirements, however. If they do not have a valid purpose, such as work or family in Denmark, they must present a negative coronavirus test taken within the previous 72 hours. 

The Swedish media and a ferry company announced incorrectly that a negative test was not required, and the Danish police that manage border control at the ferry terminal in Helsingør had also received incorrect information at first. This led to chaos at the border as many Swedes on the ferry were turned away (DK) and had to sail back to Sweden. The ferry company, Sundbusserne, which had waited three months during the lockdown before opening the route, announced that it was canceling the route again.

Coronavirus DK: It’s not over yet, Part 2

After praising citizens for their careful behavior on Pentecost weekend, the police needed to declare an area in Copenhagen off-limits (DK) because too many people were gathering there. The temperature in Denmark has risen to the highest level of the year, all of 75 degrees, and many went to popular spots at the beaches and harbors. One of the hotspots was the Sandkai and Goteborg Plads waterfront area in Nordhavn, which lies along the Sound in the northern district of Copenhagen. 

The place was full of sunbathers lying beside one another and not observing the guidelines on social distancing and limiting gatherings to ten persons. “Citizens did not follow our directions to go to places where there are not so many people,” wrote the police in a press release. People may still pass through the zone and swim from the quay, but they must leave immediately after swimming or else face the possibility of a fine of up to DKK 2,500 ($350). The ban applies until Thursday evening. The ban on gatherings expires on June 8, when the government has said that it will consider raising the limit from ten to 30 to 50 persons if the spread of infections remains under control.

Disperse and regroup

After the ban went into effect, there were reports that many people simply moved to Marmorbyen (DK), a nearby area on the other side of the water, and crowds were congregating there. The sunbathers understood why the police took action, but some were not concerned about the risk of infection. “Honestly, I see better and better news that the infection rate is low and fewer than ever are hospitalized and few deaths,” said one of them. “So in my mind, the worst is over.”

A month ago the Social Liberal Party proposed that the city of Copenhagen expand the number of bathing zones in order to spread out the sunbathers, and it appears that the city is now taking steps to set up new areas near the city center.

The lure of forbidden Sweden

On Monday there was a report that five high school students who had been on a trip to Sweden on Ascension Day weekend had tested positive after they returned to school (DK) and the principal had cancelled classes for a week for all first-year students at the school, Roskilde Cathedral School. A total of 12 students had been together on the trip, which had not been organized or authorized by the school. 

It is not certain that the students became infected in Sweden, but the trip violated the government’s restrictions on unnecessary travel abroad. Sweden has not implemented a strict lockdown and has a much higher rate of infection than Denmark. It is not one of the three neighboring countries in the region covered by the plan to reopen the borders to tourists on June 15. Sweden does not prohibit Danes from entering, however. Many Danes have summer houses in southern Sweden and visit them often. “You wonder why the pupils didn’t think more carefully [about the trip],” said Claus Niller Nielsen, the principal. “You wonder why there wasn’t an adult somewhere who put their foot down about the trip.”

Mixed reactions

The incident prompted a representative of the Foreign Ministry to reiterate the government’s warning (DK) against traveling abroad and reminder that travelers returning from other countries should be quarantined for 14 days. While a representative of the students’ organization was annoyed that the entire class had to miss out on classroom teaching again soon after they had returned to school, the mayor of Roskilde, Tomas Breddam, a Social Democrat, took a more indulgent view: "I think we can all remember what it was like to be a first-year high school student at the start of summer. I don’t think we should scold [them], I think we should try to help.”

Coronavirus DK: Winners and losers from the new border policy

On Friday Prime Minister Mette Frederiksen announced that on June 15, Denmark would allow tourists from Germany, Norway and Iceland to visit Denmark as long as they stayed at least six nights outside of Copenhagen. Danes likewise could travel to these three countries and were advised to avoid large cities. The plan drew criticism from the opposition parliamentary parties and the Copenhagen tourism industry. The reactions continued yesterday.

Summerhouse rental agencies in Jutland (DK) were suddenly overwhelmed with bookings from both Germans and Danes. Meanwhile, tourism officials in Copenhagen tried to tote up the damage to the capital because of the ban on overnight stays. Mikkel Aarø-Hansen, the managing director of Wonderful Copenhagen, estimates that it will cost the city DKK 1.3 billion in revenue ($185 million) and will affect 1,400 jobs. That comes on top of a loss of DKK 4.25 billion ($600 million) already in the three months since the lockdown began.

Some healthcare researchers approve

“If you want to avoid people crowding together in the evening – since that is the situation we have seen in superspreader events,” says Jens Lundgren, Professor of Infectious Disease Medicine, “there is a good argument on healthcare grounds (DK) for not allowing tourists to stay overnight in the city.” Allan Randrup Thomsen, Professor of Virology, agrees: On a nice day, you see many people out at Nyhavn and Strøget (the main pedestrian street). You have to add tourists to them. Copenhagen has been the hotspot, and you don’t want to make it a larger one.

Danes must stick to the countryside

Danes also began to make vacation plans according to the restrictions (DK) on their travel to the three countries. Those who visit a city with more than 750,000 inhabitants must self-isolate for 14 days after returning. That limitation is irrelevant for Norway and Iceland, where there are no cities of that size, but it affects five cities in Germany, including Berlin and Munich. This is a travel advisory, not an absolute prohibition, says Erik Brøgger Rasmussen of the Ministry of Foreign Affairs. “There will be no control of where people have been by the police at the airport. . . . But we expect that Danes will listen to the advice and guidelines as they have done throughout the coronavirus crisis.”

Danish tourists are also advised to follow the local guidelines on precautions when they travel. For example, in Germany people must cover their mouths and noses with masks or scarves when they enter shops and use public transportation, but in Norway there is no requirement on wearing a mask. The rules and recommendations may also vary from locality to locality within the countries, for example the limit on gatherings.

Swedish annoyance

In Sweden, the reaction (DK) to the country’s exclusion from the border policy met disappointment, as expected. Niels Paarup Petersen, a Danish-born member of the Swedish parliament, called it “a little hypocritical” that Denmark cannot tolerate its neighbors from Skåne (the southern region of Sweden), which has not been hurt badly by the pandemic. “Many Danes are running around in Skåne, and it is apparently not dangerous. But if some people from Skåne come to Denmark, it is dangerous.”

By far the greatest number of infections in Sweden, which has not ordered a strict lockdown, have occurred in Stockholm. The infection rate is actually lower in Skåne than in Zealand, the island where Copenhagen is located, says Mikael Damberg, Swedish Minister for the Interior. The Swedish Foreign Minister, Ann Linde, says that the country had hoped for a joint Nordic solution and is continuing its dialogue with the other countries in the region.

At the same time, the Swedish Minister for Social Affairs, Lena Hallengren, acknowledged that the country is still in the midst of the crisis (DK). The number of deaths rose to 4,395, in contrast to 571 in Denmark. Anders Tegnell, the state epidemiologist who designed the laissez faire policy, admitted that it was a mistake not to test skiers who returned from Ischghl, the Austrian hotspot.

Coronavirus DK: Is there a verdict on Sweden?

Is it possible to judge Sweden’s singular coronavirus policy yet? Denmark’s neighbor has diverged from the rest of the world in refraining from locking down large sectors of social and business activity. It has kept restaurants and schools open and has not issued social distancing rules. Like its Scandinavian neighbors, it citizens exhibit a high degree of social trust in one another and in the government, and it has relied on people to behave sensibly of their own accord. For a while it seemed to be working well. The number of infections and deaths in the country were not significantly higher than in similar countires. It was praised by critics of lockdown policies in other countries for showing the strict regulations that harm the economy are unnecessary. So what is the status of the experiment?

It has now reached almost 4,000 deaths (DK), in comparison with 562 in Denmark. Its population is around twice as large. It has 398 deaths per million persons in comparison with 98 in Denmark, 44 in Norway, and 55 in Finland. I have thought that the spread of the infection has been higher in Denmark than in Norway because the first cases involved superspreaders who returned from hotspot ski resorts in Austria and northern Italy, and Norwegians do not need to travel south to go skiing. So if Sweden’s most comparable neighbors are Norway and Finland, its fatality rate is about eight times higher.

Elusive herd immunity

The person behind the strategy, Anders Tegnell, the head state epidemologist, has defended the policy all along, contending that is too early to judge the results. If the objective was too reach “herd immunity” by allowing most of the population to become infected and afterward immune, then there would inevitably be more infections and deaths in the beginning stages. In countries that conduct extensive lockdowns, when people who have isolated themselves begin to emerge, many of them will become infected and the country will see additional waves of infection, goes the rationale.

On several days last week, the fatality rate in Sweden (DK) was the highest in the world. On day 60 of the epidemic, the rate was even higher than Italy’s at the same stage, and ten times as high as Denmark’s. And the country is still far from herd immunity. There were earlier predictions that around half of Stockholm’s population would reach immunity in June, but a recent count of persons who have developed antibodies to the disease was only 7.3 percent, and that is much higher than in the rest of the country. There is much uncertainty in identifying immunity, and the WHO had warned Sweden in April that not everyone who is infected develops immunity.

Unrealistic expectations

Now criticism is growing (DK) both inside and outside the country. For example, former state epidemologist Annike Lind said that if the country had closed down early it could have done more to protect the most vulnerable people. Tegnell had said that they would protect the elderly, she said, but it “had little relation to reality.” A large share of the deaths have come in nursing homes. 

Tegnell denies (DK) that Sweden could have done anything differently to protect the elderly, arguing that the poor quality of Swedish nursing homes made them vulnerable. He also says that the objective has never been herd immunity, which is not possible until there is a vaccine. But he maintains that if people don’t change their behavior they will continue to see a decline in the number of infections.

Playing with statistics

Another Swedish researcher recently defended the strategy (DK). Matti Sällberg, a professor at the Karolinska Institute, argues that if you do not measure the epidemic by the fatality rate but rather by the number of deaths in relation to the number of infections, then there is little difference between Sweden and Denmark. With an infection rate of 6 percent in Sweden, the fatality rate is about 0.6 percent. In Denmark, the infection rate is about 1.0 percent and the fatality rate 0.8 percent. That is not necessarily the most significant statistic, says Søren Riis Paludan, Professor of Biomedicine at Aarhus University. It indicates that Sweden has been as good as Denmark in treating people who have become infected, but not whether not it has been successful in containing the epidemic.

Tegnell has maintained that it will be years before one can judge what strategy is best, and he thinks there may be not be large differences between the results in various countries. Does he have a serious case of confirmation bias or will he prove correct?

(No post tomorrow. Back on Thursday.)

Coronavirus DK: Milestone: Holding death at bay

Yesterday was the first day in two months when there were zero deaths from covid-19 (DK) registered. The disease statistics have been falling since around April 1. The number of patients hospitalized declined by ten in the past 24 hours, and the new cases of infection have been below 100 for the past five days. Here are the latest totals:

• Hospitalized: 137
• ICU patients: 32
• On respirators: 26
• Deaths: 537 (93 per million)
• Infected: 10,791
• Recovered:8,959
• Tested: 368,889 persons (400,000+ total)

The results indicate that Denmark’s strategy of beginning the relaxation of restrictions with young children (DK) was effective, says Virologist Allan Randrup Thomsen, Professor of Virology. The staff at schools and day-care centers succeeded in dividing children into groups and maintaining a distance between them. Thomsen cautions, however, that the number of fatalities is not the most important parameter because they can come after a long period of hospitalization. The number of new hospitalizations is more important, and that has also fallen steadily.

Intra-Nordic discrimination?

It’s a little curious that this announcement comes on the same day as a hypothetical complaint from Sweden (DK) about Denmark’s possibly opening its border with Germany but not the border with its closest Scandinavian neighbor. In the political debate on Thursday, some party leaders proposed opening the Danish borders to German and Norwegian tourists. This led Sweden’s Minister for Nordic Collaboration, Anna Halberg, to declare that such a move would be “unfair discrimination.” Halberg argues that one should not compare the spread of the infection in Copenhagen and Stockholm, where it is highest in Sweden, but rather the spread in Greater Copenhagen and the neighboring Skåne region in Sweden, where the spread is less extensive. 

Jakob Ellemann-Jensen of the Danish Liberal Party had said that Denmark should “not wait to open the border with Germany until it is defensible from a healthcare perspective to open the border with Sweden.” Prime Minister Mette Frederiksen reiterated that the government will wait until June 1 to open any of the borders. Italy, one of the countries hardest hit by covid-19, has just announced that it will allow foreign travel next month (DK).

The long, hard trek to herd immunity

Sweden has been following a more open policy on the pandemic than Denmark and the rest of the world. It has not ordered a strict lockdown and has not closed restaurants but has rather relied on the population to practice social distancing voluntarily. Its disease statistics are much higher than those in the rest of Scandinavia. There has been some uncertainty about whether its official policy is to pursue “herd immunity,” but in any case, the earlier admirers of its controversial laissez-faire approach from other countries have begun to change their minds about its advisability. It has registered 3,646 deaths (363 per million), almost four times as many per million as in Denmark and Germany and eight times as many as in Norway.

Not everyone agrees that such caution is necessary, however. Søren Riis Paludan, Professor of Virology and Immunology at Aarhus University, says it doesn’t matter whether tourists to Jutland come from Germany or Copenhagen, which also has a higher infection rate than Jutland. He does not even think that the wider spread of the disease in Sweden is significant. While the number of deaths in Denmark fell to zero yesterday, there were 117 new deaths and 625 new infections in Sweden.

Coronavirus in Denmark: Day 21 of the shutdown

On Wednesday, Søren Brostrøm, Director General of the Danish Health Authority, held a press conference. He reported that 224 healthcare employees (DK) in the Greater Copenhagen and Zealand Regions have now been infected with the coronavirus. They represent 10 percent of all the infected. This is becoming a critical factor in several countries. First, doctors, nurses and others on the front lines should be able to go to work without risking their lives. Second, patients should be treated by healthcare personnel who aren’t a threat themselves. Third, if many of the staff become sick and cannot work, the system may not be able to care for all the sick patients. Fourth, the staff should be tested regularly and frequently. And finally, the need for employees to take cautious measures can put pressure on the supply of personal protective equipment available. Brostrøm expressed concern about all of these things. The vice chair of the Regions reported that the supplies of PPE were not in abundance but were sufficient.

Brostrøm also reported that it will be easier for people with mild symptoms to be tested. They can be referred to testing directly (DK) from the GPs instead of being evaluated first by a hospital. People who live with a person in a high-risk group, such as those over 80, and people who live in close proximity to others, such as those in a nursing home, can also be tested. The objective is now to test 5,000 per day, but it has not been possible to process that number yet because of a shortage of tests. Brostrøm acknowledged that Denmark previously had not been testing as extensively as the WHO recommended and said that they were working hard to increase capacity.

Coronavirus in Europe

Neighboring Sweden has followed looser policy (DK) than the other Scandinavian countries. It has not required or advised people to stay at home and isolate themselves. This has caused concern in Denmark because many Swedes commute to work in Denmark over the Øresund Bridge and the ferry from southern Sweden. The coronavirus seems to have arrived in the country slightly later than in Denmark, and the figures on infection and deaths had been roughly comparable, until this past week. Yesterday, it saw 59 deaths, while 14 occurred in Denmark; Sweden’s population is about twice as large as Denmark’s. Sweden has now implemented tighter restrictions and made recommendations on social distancing. According to Søren Riis Paludan, Professor of Virology and Immunology at Aarhus Universitet, however, one cannot simply conclude that Sweden’s strategy was wrong. It may result in a steeper infection curve, achieve herd immunity sooner, and return to normal activity sooner. But it may also put greater pressure on the healthcare system.

Southern European countries that are suffering the most from the pandemic have been asking the other EU member states for help. This has become a sore point in the EU again, with some of the northern countries in particular rejecting calls for the issuance of EU “Corona bonds,” for example. Several Danish political parties are now discussing ways in which Denmark could aid Italy (DK), the hardest hit, either by sharing equipment, by sending healthcare workers, or by taking patients. This will probably be sensitive issue throughout Europe for some time to come as each country needs to ensure that it has sufficient capacity to manage the epidemic within its borders.

Postponing amusement but keeping the news channels open

Parliament passed a bill to give 180 million kroner ($26 million) to the media industry as partial compensation for a drastic drop in advertising revenue (DK).

Tivoli, the world’s oldest amusement park, which is located in central Copenhagen, was supposed to open today. It has postponed the opening (DK) until May 1. Did it really wait until now to make that decision? Will we be ready to share a roller coaster seat with others by May Day?

Deaths per day in the period March 23-31: 6, 6, 6, 10, 12, 9, 8, 10, 12.

The pattern of confirmed infections is similar: the curve is indeed flattening, but it has not yet flattened out. In all their announcements, Søren Brostrøm, spokespersons for police and other officials remind people not to relax the social distancing practices that are showing that they work.