While the administration is holding discussions about which parts of the economy to open next, some people are acting as though the risk of the infection spreading is over.
The weather has improved this past week, with the highest temperatures of the year. Danes are always eager to come out in the sunshine after the long, dark winter. But too many of them are forgetting to follow the guidelines (DK) for social distancing, say the police. “I am very upset and extremely disappointed,” tweeted Claus Oxfeldt, chairman of the Danish Police Union, about the crowds in certain areas of Copenhagen. He pointed specifically at the Islands Brygge neighborhood in Copenhagen, which has several large lawns along the harbor front, where 300-400 people were gathering, mostly in small groups of under 10 persons each but too close to one another. The police have issued warnings rather instead of giving fines immediately, and people disperse. But when the police return, they find that the same people have returned to the spot or others have gathered there. They are surprised that people care more about getting sun than their health and say they will begin to issue fines more quickly. The fine for violating the limit of a 10-person group is about DKK 1,500 ($215).
Crowded supermarkets and full busses
Employees in supermarkets have noticed similar behavior (DK): more people are no longer complying with the recommendations on social distancing. According to Per Tønnesen, section chairman for the retail trade union, the organization receives 15-20 reports per day that customers come too close together in certain areas, such as the produce and refrigerated sections, and they are not using sanitizer and disposable gloves. People are also shopping in groups, both young people and families. The problems are worst at the large supermarkets, where there is more room for customers to keep their distance from one another. Smaller grocery stores are better at limiting the number of customers on the premises at a time. One large supermarket chain, Coop, however, says that it has not received such complaints from employees and that customers appear to be adhering to the guidelines. That may be because employees are reluctant to take problems to their employers, comments Tønnesen. Jens Juul Nielsen, Coop’s information director, responds that union representatives should feel free to speak to their managers because they company wants to maintain the safest conditions possible in the stores.
A few days ago, TV2 News published photos of a bus full of passengers (DK) traveling across the country from Aalborg to Copenhagen. The sight angered Benny Engelbrecht, the Minister of Transportation, who asked the Minister of Health to issue an executive order that long-distance buses may not be more than half-full. At the time of the photo, the situation on the bus was not a clear violation of the law but went against the general recommendations that passengers in collective traffic maintain a distance from one another. If the bus company in question, Flixbus, does not comply with the rules, said Engelbrecht in a press release, its operating license will be withdrawn. The company apologized to any passengers who felt insecure about riding on a full bus.
Too early for zoos and cafes
Although the trend in infections and deaths is still on the right track, epidemiologists say that we shouldn’t become complacent because the reopening has begun. Allan Randrup Thomsen, Professor of Virology at University of Copenhagen and Jens Lundgren, Professor of Infectious Disease Medicine are both skeptical about proposals (DK) for opening additional parts of the economy. They warn that people must be careful to continue social distancing, and more testing is needed. Recently the police gave permission for zoos to reopen, but the government asked them to reconsider and the reopening was postponed. Others have proposed opening certain regions of the country on a staggered schedule, but the experts warn that the country is so small that such a policy could prompt people to travel to restaurants and cafes in the open areas. They stress the need for an overall plan for reopening gradually.
Five patients and 35 employees have been infected at Nykøbing Falster Hospital in southern Denmark. This is the second large outbreak inside a hospital (DK). The hospital believes that the outbreak began with an elderly patient who was admitted to the ward for treatment of liver disease in March without Covid-19 symptoms. Two weeks later, the patient and two other patients showed Covid-19 symptoms. The ward was also used for cardiology patients and staff. The infected patients were serviced by several nurses, doctors, physical therapists and others who began to show symptoms and tested positive. As soon as the symptoms were discovered in the patients, they were moved to a separate ward. Five of the 10 patients in the ward were infected, and it was closed afterward. The hospital had followed all the rules in effect at the time that the patients in question were admitted, when there was no policy on testing all new admissions. The Healthcare authority introduced such a policy only this week.
The Health Authority is finally making good on its intention to test more people for infection. Yesterday, nearly 8,000 people were tested (DK), an increase of 3,000 over the previous record. This week, the testing policy was changed to include people with mild symptoms. At the end of April, people without symptoms will also be able to be tested. This will cover people who have been in contact with an infected person or who work at a location where someone was infected. They will be tested at the new TestCenter that was set up in tents in Fælledparken in Copenhagen.
Update on the spread
The tests discovered 217 new infections, bringing the total of confirmed cases to 7,912 out of a total of 108,465 people tested. The number of deaths per day has fallen to the single digits this week, and total deaths now stand at 384. These figures may seem very small in relation to those in the US. For comparison, the number of deaths from Covid-19 per million inhabitants is 67 in Denmark versus 142 in the US. That is, even though the social distancing policy in Denmark appears to be working well and the Danish economy is reopening, the overall fatality rate for the US population is only little over twice as high. By this measure, the situation is much worse in other European countries, with 465 deaths per million in Spain, 414 in Italy, and 269 in the UK. Infections and deaths per day have begun declining in Europe, however, and they have not in the US.
Healthcare employees who become infected with Covid-19 can register their illness as a work injury (DK) and receive compensation for it. That policy was confirmed by Employment Minister Peter Hummelgaard in a press conference yesterday. According to the normal rules, an employee must document the specific situation in which she became infected and must test positive. The Employment Ministry has made an exception and will now honor claims if employees have worked in an ICU and have had contact with Covid-19 patients.
Debating herd immunity
Danish researchers dispute statements by Kåre Mølbak of the Statens Serum Institut (SSI) on the possibility of herd immunity (DK). Herd immunity requires that 60 percent of a population has recovered from infection and become resistant to it. According to Astrid Iversen, Professor of Virology and Immunology at Oxford University, that can take up to five years and immunity may last only one or two years. That has been the case with previous outbreaks of corona virus, the first SARS virus in 2003 and the MERS in 2012. There is much uncertainty about whether Covid-19 antibodies give protection against reinfection and about the effectiveness of herd immunity, and researchers believe that SSI has not explained this clearly.
In a question session yesterday, Prime Minister Mette Frederiksen said that it was unwise and untenable that Denmark did not have a secure source of personal protection equipment (PPE) (DK) and testing equipment for an epidemic. Until a few years ago, Statens Serum Institut, the agency responsible for preparing for infectious diseases, had a unit that produced vaccine. It was sold to a Saudi Arabian firm for DKK 15 million ($2.2 million). When asked whether that was not a mistake, Frederiksen answered simply that Denmark should not be in such a vulnerable position regarding supplies again. It was not clear that it was economical for the Danish state to produce all the necessary equipment, she said. She favored shared production with other, like-minded European countries, and she would raise the subject at a meeting of EU this week.
Beware cheap PPE
The Danish Safety Technology Authority issued a warning about sales of protective equipment (DK) that does not satisfy security standards and named specific companies. The firm Hifling Labels, for example, was ordered to stop the sale of “corona masks” to nursing homes in Copenhagen. It must also inform customers that purchased the masks that there was no documentation that masks complied with the relevant standards or provided any protection against the Covid-19 virus. The agency is investigating 11 other companies that sell equipment. The demand for masks and other PPE has increased now that small businesses such as dentists and hairdressers have reopened. Sisse Marie Welling, Deputy Mayor for Health, said it was reprehensible that private companies try to earn money by putting vulnerable elderly persons at risk. In any case, individual nursing homes are not supposed to purchase equipment themselves. Such equipment is purchased centrally by the municipality, which ensures that it fulfills the security requirements.
Substitutes for hugging
The prime minister was also asked how long people will have to practice social distancing. She responded that the authorities don’t know yet, but she didn’t think that anyone could stand not being able to hug their grandfather in a year, for example. This prompted a journalist to ask a brain researcher what people can do if they have withdrawal symptoms from lack of hugging (DK). Professor Troels Kjær of Zealand University Hospital and the University of Copenhagen, explained about the benefits of oxytocin, the famous “hugging hormone,” and gave a few suggestions. 1) Take a warm shower. It activates the sensors in the skin for touch and heat, widens the blood vessels, and triggers a release of oxytocin. 2) Lie under a heavy comforter or wear tight clothing. The steady pressure on the skin also releases oxytocin. 3) Lay a vibrating phone against your body. It stimulates cells sensitive to touch in a way similar to a shower. 4) Self-massage. Sex of course releases large dose of oxytocin. But if that or a massage from a quarantine partner isn’t an option, you can always give yourself what Kjær calls a “self-hug.” But none of these substitutes can beat a good hug, he concludes, because of all the positive feelings and associations you get from your relation to other person.
Still aiming for more testing
Yesterday, the Danish Regions offered some more information about those tents that were set up in Fælledparken (DK) in Copenhagen. They are called TestCenter Danmark, and they are intended to enable authorities to test more people than before for both coronavirus infection and antibodies. The objective is test everyone with mild symptoms, everyone who is hospitalized, and personnel in healthcare facilities and nursing homes. Testing will take place on two tracks. The healthcare system will manage one of them, and the Test Center will manage the “society track.” The TestCenter will allow testing of an additional 20,000 per day. Thus far fewer than 6,000 people have been tested in a single day.
Danes are not following the authorities’ recommendations (DK) on hygiene and social distancing as strictly as they were before, according to a new study. A research project called “HOPE – How Democracies Cope with Covid-19” has found that as the number of infections and deaths decline and society begins to reopen, Danes are easing up on the practices that led to an improvement of the situation. Michael Bang Petersen, Professor at the Institute for Political Science at Aarhus University, says the tendency has been consistent and is cause for concern. Most people continue to comply with the guidelines, but it becomes harder to do so over time. People get a sense of security because the infection figures are falling and they are tired of following a strict regime, says Petersen.
The survey covered three parameters: hand hygiene – whether people washed their hands several times a day; social distancing – whether they avoid gatherings of more than 10 people; and whether they had changed their behavior generally during the lockdown. The figures for all three parameters show that people’s compliance with the recommendations peaked around March 23-25 and has been declining steadily since. The problem with using such information in an epidemic, says Petersen, is that the effects of changed behavior may not show up in symptoms until 14 days later, when it is too late to avoid infection. He urges people to maintain their discipline, especially now, when businesses are reopening and people are coming into closer contact, because not doing so could lead to a second wave of infections. In that case, the country would lose the progress it has made.
Debating the criteria for reopening
A child psychologist has criticized the conditions (DK) in which the youngest children are returning to day-care centers and has advised parents to keep them home. In an interview on Sunday, Margrethe Brun Hansen argued that children under the age of three should be introduced to nurseries gradually, with their parents in the room until they feel secure. Minister for Children and Education Pernille Rosenkrantz-Theil said that she could understand why some parents might be concerned, but she has a young child herself and is not worried. She said that we have well-educated employees who evaluate the children when they arrive. The key factor for her was that the staff comply with the Health Authorities’ guidelines before they open a day-care center.
The Sports Confederation of Denmark has announced that it has received new guidelines from the Health Authority and it is removing its ban on activities for sports (DK) that take place outdoors without physical contact. This applies to sports that involve only small groups and that can be conducted according to the general guidelines for the pandemic. For example, people must dress and shower at home and not share equipment. The Health Authority’s ban on sports had applied specifically to indoor sports, but the Sports Confederation itself extended it to cover outdoor sports as well as a precautionary measure. The sports that can reopen include golf, tennis and kayaking, in which few people participate together. Team sports such as soccer that involve physical contact, are still not allowed.
Sex is good
Another physical activity that usually involves few people has also gotten a green light. At a press conference on Monday, Søren Brostrøm, the head of the Danish Health Authority, assured people that there is no ban on sex (DK): “Sex is good. Sex is healthy. We are sexual creatures.” Singles can also have sex, he continued, referring people to the practical guidelines on safe sex on the Health Authority’s web site. The website indeed has an enormous amount of information on all aspects of behavior and social relations during the epidemic. On its FAQ page (DK), it says that the corona virus is not transmitted by semen and blood and that you should protect yourself by “washing your hands (and any sex toys) with soap and water before and after sex and masturbation.” The advisability of wearing masks for singles who are dating is not addressed.
Today the next phase of the lockdown exit process begins. Professional services and small service businesses can reopen. In many of them, such as hairdressers and physical therapists, it is impossible to avoid physical contact. Yesterday the Minister of Industry, Business and Financial Affairs held a press conference to present the guidelines it has set forth, along with the Health Authority, for minimizing the risk of infection (DK). These are the main principles: 1) Customers must be able to maintain two meters’ distance from one another in the lobby or waiting room. 2) Businesses must post guidelines on good hygiene and a warning that people with Covid-19 symptoms must remain home and they must make hand sanitizer readily available. 3) Employees should be scheduled in such a way that they do not work close to one another, by following staggered schedules or extending business hours. 4) Employees must observe strict rules of hygiene, washing their hands after contact with each customer, sanitizing points of contact on the premises, such as doorknobs, and washing fabrics at 80 degrees Celsius. 5) Employees should avoid sustained face-to-face contact with customers, for example by holding a preliminary conversation at two meters’ distance or by wearing a mask or visor.
Faulty protective equipment
One of the big issues for healthcare staff around the world is getting access to adequate personal protective equipment (PPE). While there is a great demand for products, prices are rising. But at the same time the quality of the PPE is unreliable (DK). The Danish Safety Technology Authority tests the products and has found that many of them must be discarded. For example, of the 20 million masks acquired, 5 million had to be thrown out. Some of the masks and visors fall apart, some do not cover the face correctly, and some don’t have the proper certification or otherwise do not protect against infection. According to Birgitte Nellemann, Purchasing Manager at the Mid-Jutland Region, one problem may be that the manufacturers in China have speeded up production and have not conducted thorough quality assurance.
Anders Kühnau, Chairperson of Mid-Jutland Region, says that Denmark may have higher standards than some other countries, which might want to use the discarded equipment. When asked whether he cold guarantee that the Region would get a refund for the defective equipment, he said, “It is difficult to guarantee anything at all.” The private company Force Technology works with the Safety Technology Authority to test the equipment. It reports that some of the masks do not screen out enough particles and some make it difficult to breathe. The equipment has sometimes been made by firms that have not produced PPE before.
The Region has begun to ask for a sample of the products before an entire order arrives. Sometimes it finds that if a product is not acceptable at the desired level, it can be used for other purposes. For example, FFP3 masks are supposed to screen out 99 percent of particles, and FFP2 (aka KN95) are supposed to screen out 94 percent. If a shipment of FFP3 masks is not fully effective, it may be possible to use the masks for functions that normally require only FF2 masks.
Doctors are also open for business
People are making appointments with their GPs again (DK) after the prime minister and the head of the Danish Health Authority encouraged them to do so. Doctors had seen a sharp drop in appointments since the lockdown began. Some people with mild illnesses or chronic illnesses had been staying away either because they thought that the doctors were especially busy with Covid-19 patients or they wanted to avoid the risk of infection at doctors’ offices. Doctors’ offices must still follow strict rules for visiting patients, for example patients are screened by telephone and fewer of them can sit in a waiting room. Doctors expect that there may be an increase in the number of patients with Covid-19 symptoms now that segments of the economy are reopening.
