Danes can now get a COVID-19 passport (DK) if they have tested negative for the coronavirus in the past seven days. They can use it to travel to countries that require such documentation. As soon as the lab has processed your test and released the results, you can go to sundhed.dk (DK), the website where everyone’s health information is stored, and download the passport, which has a document validation number and can be printed.
Not all countries will recognize this document, however. Some have special requirements, for example that you use their own official form for test results and have it signed by a doctor. You should find out the regulations in force in any country that you are traveling to or through. You can see them on the Danish embassy’s website for the country in question. You can order a test for the coronavirus at coronaprover.dk (DK), which has an English version.
Masks as passport to fun
But if you want to ride a roller coaster at Djursland Sommerland, an amusement park in mid-Jutland, a COVID-19 passport won’t be enough. You will also need a face mask (DK). Face masks have not been mandatory in Denmark and are seen very rarely outside of hospitals and perhaps nursing homes. Since it opened one month ago, Djursland Sommerland has been able to load its roller coasters only to one-quarter of their capacity. It has now received permission from the government and the Patient Safety Authority to make this experiment and fill up the Dragon King with screaming riders.
“There is no doubt that it is more fun to stand in line for a ride for only ten minutes instead of an hour,” says Henrik B. Nielsen, the director of the amusement park. All the amusement parks in the country are eligible to take part in the experiment. The masks cost an extra DKK 5 ($1), and they can be used only for one ride. “We don’t earn anything from selling these masks,” says Nielsen. “And the policy has actually been very well received by our guests.”
Him again
Danish media have noticed that the word “Denmark” has popped up in a tweet from a country where face masks are becoming the occasion of a civil war, more precisely, from the White House. Along with Germany, Norway and Sweden, the country was cited because “SCHOOLS ARE OPEN WITH NO PROBLEMS.” Trump threatened to withhold funding for school districts that don’t hold ordinary classes when the school year resumes.
This comes at a time when the US is setting records for new COVID-19 cases and a couple of days after the Orwellian president claimed that the US death rate was “just about THE LOWEST IN THE WORLD!” He may have been too busy playing golf these days to notice that no one has been envying the epidemic conditions in Sweden for some time.
(This is the second part of a two-part post.)
The position of the European Centre for Disease Prevention and Control is similarly nuanced. It recommends masks for healthcare personnel and persons with symptoms, and it says a mask also “may help reduce the spread of infection . . . from infected individuals . . . before they develop any symptoms.” On the other hand,
There is conflicting evidence on the protective effect for the wearer. . . . Based on the lack of evidence, it has so far not been recommended that people who are not ill or who are not providing care to a patient should wear a mask. . . . There is no evidence that non-medical face masks or other face covers are an effective means of respiratory protection for the wearer of the mask. . . . In one study, cotton surgical masks were associated with a higher risk of penetration of microorganisms and ILI compared to no masks.
According to this view, the only strong reason for the general public to wear a mask is not to protect yourself but rather to protect others from the small risk that you have contracted the virus without showing symptoms – if you have not just tested negative for the virus or positive for the antibodies.
Social trust
One advantage in dispensing with masks that Denmark and the other Nordic countries have is strong social trust among citizens and trust in the authorities – things that in the US are at about their lowest ebb in at least 50 years. They have small, relatively homogeneous and relatively well-educated populations with a high standard of living as well as a tendency toward conformism. Most Danes who could not work from home were excused from work with compensation for lost wages. With fewer people forced to work, there were fewer to avoid on the street and in workplaces.
In Denmark now, you see very few people wearing masks on the streets or in stores, less than 5 percent and most of them elderly. People stand in supermarket lines at two-meter markers on the floor. If you meet someone in an aisle or on a stairway, you move as far apart as you can and perhaps turn your head aside briefly as you pass. There is little controversy about it. A small lockdown protest group gathers before city hall occasionally, but nobody has bothered to interview them more than once. The cityscape is looking almost normal again. People are back on the streets, and shopping centers are crowded. Maybe a society doesn’t need masks if people respect one another’s space. It is ironic that Americans need masks because they don’t trust one another and the masks only exacerbate the polarization and increase their distrust.
Consulting big data
On June 1, The Lancet published a large metastudy on social distancing and face masks that concluded that masks do indeed have a protective effect for the wearer. The effect of N95 respirators was greater than with surgical masks or cloth masks, but the effect of the latter was significant, although the certainty of the conclusion was rated as “low”: “For the general public, evidence shows that . . . face masks are associated with protection, even in non-health-care settings, with either disposable surgical masks or reusable 12–16-layer cotton ones.”
A few days later, the WHO recommended that face masks should be worn (DK) in public when social distancing is not possible, for example on public transportation and in shops. Previously, the organization had said there was not enough evidence to require the general public to wear masks. Its recommendation is that people wear a fabric mask, not a medical mask, and one with “at least three layers of different material.” At the same time, it recommended that people over the age of 60 with underlying health conditions should wear medical masks and also cautioned that masks alone are not sufficient protection. People must continue to practice good hygiene and social distancing.
Not about to start now
Danish researchers responded to the announcement (DK) by saying that masks are not necessary in ordinary situations and the evidence for their value is slight. They add that masks are appropriate in situations where it is difficult to maintain social distancing, such as airplanes and public transport, but they doubted that the Danish government and Health Authority would change their recommendations now, after the infections have been declining steadily without the use of masks. So let’s hope the reopening of sporting events and gyms this week doesn’t lead to a new outbreak.
(This is the first part of a two-part post.)
During the COVID-19 pandemic, face masks have become a flashpoint of contention in America between those who favor precautions and lockdown and those who rebel against them in the name of personal freedom or because of skepticism about the disease. Masks have become the new symbol of the culture wars in the United States between the Right and Left. The CDC recommends them, and many states and cities require people to wear them on public transport, in stores and elsewhere. According to a new Wall Street Journal/NBC News poll, “Roughly two-thirds of Americans said they always wear a mask when they leave the house.” Yet the country has the highest number of deaths from COVID-19 in the world, and although the epidemic might be plateauing, it is not yet under control.
Worse than nothing?
In contrast, Denmark, where coronavirus infections continue to subside during the reopening of the economy, has never required masks. The government has followed the precautionary principle with a stricter lockdown than the Danish Health Authority recommended even while it drew criticism from the private sector and the right-wing opposition. Danes are much more acculturated to acting in the collective interest than Americans, yet masks have been considered unnecessary. In fact, the government and the Health Authority have always advised healthy people not to wear them because they can do more harm than good. None of the other Scandinavian countries has required masks either, and except for Sweden, which has followed a laissez faire policy, they have had an even lower infection rate than Denmark.
So what is the reality? Do masks work at all in nonmedical settings, and if so, do the benefits outweigh the costs? Is it possible that the masks and all the strife they have occasioned in the United States have been unnecessary and even counterproductive?
False security
Masks clearly have value a protective value when health professionals wear them while treating infected patients, and there appears to be strong evidence that they reduce the spread of the virus from infected persons. Whether they have much protective value for the wearers is not as well established. What is the downside the Danish Health Authority alludes to? This is the government’s position, explained on the English FAQ page of its coronavirus website, under the heading “Other questions”: “The Danish Health Authority does not encourage healthy individuals who go about their daily business to wear mouth or face masks as is [sic] uncertain that they have any effect on virus transmission.”
The Health Authority does not deny that masks might be beneficial or reject their use altogether. They are recommended in certain situations, “such as prolonged or frequent close face-to-face contacts with customers/clients.” They are also advisable for persons in high-risk groups in “situations where you get very close to others, for example if you have to take public transport during rush hour.”
But these are the reasons against general use: First, the infection rate in Denmark is low; people are generally conscientious about following advice on hygiene and social distancing; and in ordinary situations they are not at much risk of infection. Masks can be a liability if you don’t use them correctly, so that they cover the mouth and nose fully, and do not dispose of them correctly. If you adjust them often, your hands can become contaminated. If you wear a paper mask for too long, it may become wet and ineffective. You should not try to make your own fabric mask because it protects less well than a surgical mask. Masks can lull people into a false sense of security and make them less careful in following the guidelines on hand-washing and social distancing. They may also make people with symptoms believe they need not isolate themselves.
Practical disadvantages
The Authority argues rather that, in situations where people observe hygienic guidelines, the additional value of masks is slight and does not outweigh the risks that masks themselves entail and the disadvantages of using them. You must find them, buy them in a large supply, and replace them or wash them regularly. If everyone is wearing masks, you cannot see people’s faces and might not be able to understand their speech as easily. Some people might experience difficulty breathing. This is aside from another negative effect that is more relevant to America: the advantage it gives thieves by turning their disguise into ordinary apparel. They don’t look suspicious when they enter a store to rob it, and on the way out they don’t need to remove their masks at just the right moment between the security camera and the street.
(To be continued.)
