On Thursday evening, the Danish administration negotiated an agreement (DK) with all of the other parliamentary parties to reopen additional sectors of the economy besides the schools and day-care centers. The agreement to expand the first phase of the reopening was based on a memorandum issued by Statens Serum Institut (SSI), the agency under the Ministry of Health responsible for handling infectious diseases. The memorandum presented scenarios of the risk of further infection under the relaxation of various restrictions. The other parties, which were not consulted about the original reopening plan, were generally satisfied with the agreement, although some had hoped that even more restrictions would be lifted. The announcement was made in press release (DK) and in a post on Prime Minister’s Mette Frederiksen’s Facebook page, which includes what appears to be an automatic translation into English (for example, a very happy emoji is rendered as “I’m sorry”).
Time for that overdue haircut
The revised guidelines take effect on Monday, April 20. The main economic segment that can resume activities is professional services and certain small service businesses such as hairdressers and driver education. Courts and research laboratories can also open on April 20. The agreement allows for initiatives to resume visits to the elderly and provide support for distressed children and families. The agreement also calls for the establishment of “sector partnerships” under which other industry associations and organizations can negotiate with the authorities on the timing and degree of reopening. The SSI recommended against opening restaurants and boarding schools.
As an adjunct to the relaxation of restrictions, SSI set forth a strategy for testing frontline staff, vulnerable groups, relatives of patients, and representative sample of the population in order to monitor the spread of the infection. Negotiations on phase two of the reopening will begin next week.
Both the administration and the SSI stress the importance of continuing social distancing. Some observers, for example Allan Randrup Thomsen, Professor of Experimental Virology at the University of Copenhagen, warn that there is a danger that people will interpret the expanded reopening plan to mean that the danger has passed and that they can resume their old habits. SSI’s memorandum (DK) showed estimates of the number of hospitalizations if the population continued to practice social distancing, if only half practiced it, and if none did. Even under the second scenario, with half the population adhering to the guidelines, the number of hospitalizations and ICU patients would continue to decline. According to the SSI’s model, if professional services resume normal activities, the chances that in three months hospitalizations would be above the current level was less than 20 percent.
Nurseries without teddy bears
On Wednesday, many schools and day-care centers across Denmark reopened. About half of the municipalities requested additional time before opening. Children were described as being happy to see their friends again but sometimes disappointed that they couldn’t hug. Teachers and day-care staff were adjusting to the new guidelines, for example that desks are two meters apart and pupils could not gather in groups of more than two inside and five outside.
The kindergartens and nurseries were struggling with the extensive rules on limiting contact. For example, parents could not enter the facilities, and children could not bring extra clothing or their own teddy bears and toys. They had to sit two meters apart and were allowed to play only with plastic toys that could be washed frequently. Staff meetings have to be held outside or by telephone. Denmark is the first country in Europe to reopen its schools. Austria, which allowed the resumption of small businesses this week, will not reopen the schools until next month.
On April 15, an antibody test (DK) was offered to 40,000 hospital staff in Greater Copenhagen with contact to patients. The test will clarify whether the staff who previously stayed home with mild cold symptoms actually had the virus. It will also show which hospital departments are the riskiest and allow staff to take additional precautions. Later it will be offered to hospital staff in the rest of the country. The test has been used on blood donors to get an estimate of how many have been infected beyond the confirmed cases. Thus far, the level is about 2.1 percent. The measure is an indication of herd immunity that can help the authorities decide when to relax restrictions on commercial activity and gatherings. The test is a simple blood test that shows the result in 15 minutes. Although researchers believe that people with antibodies are immune to the virus, those with positive results are advised not to change their behavior and to continue to practice social distancing.
Earlier there had been problems acquiring reliable tests (DK). A large delivery of tests from China was delayed, and another test produced 23 percent false negatives.
Quest for a treatment
Researchers are preparing to begin treating Covid-19 patients with plasma (DK). Martin Tolstrup from the Institute for Clinical Medicine at Aarhus University says that they are now testing the plasma to see whether it stops the virus. The plasma is expected to be given to patients in one or two weeks, and the results will be available in a few months. Researchers around the world are working on similar projects. The method is promising because it can be implemented quickly on a large scale.
Meanwhile, researchers at two Copenhagen hospitals are conducting an experiment with an arthritis medicine (DK). They hope that the drug will prevent or reduce lung infections and thereby shorten the time that patients need treatment. That will increase the capacity of the entire healthcare system because patients who require oxygen that put pressure on hospital facilities, says Lars Erik Vølund Kristensen, head of research at the Parker Institute at Bispebjerg and Frederiksberg Hospital. The results of the experiment will not be ready for six months, and the amount of time required depends on how many patients can be recruited for the study. Ironically, Denmark’s success in holding the number of infections down has limited researchers’ ability to conduct experiments on possible treatments. But researchers and doctors in several larger countries are interested in seeing the data from the experiment.
Shortages of patients and customers
Danish hospitals have had high unused capacity (DK) during the crisis because there have been fewer infections than were first forecast when the administration ordered the lockdown on March 13. For example, four wards were prepared for Covid-19 patients at Aarhus University Hospital and only one has been used. Hospitals took fewer patients for other treatments and procedures, and staff were trained for treating Covid-19 patients. It is unfortunate that some other patients have had their treatments postponed, says Kurt Espersen, head of the South Denmark Region, but it is of course positive that the number of serious coronavirus infections is lower than had been expected. This was the right decision, maintains Espersen, because the priority was to avoid the kind of pressure on the hospital system that was occurring in Italy and Spain at that time.
When shops reopen, they are expected to hold large clearance sales. Since the lockdown began on March 13, sales of clothing have fallen (DK) 50 percent and sales of shoes have fallen a full 90 percent. Retail businesses have set discounts on goods on their webshops, but they have not made a dent in their inventory, which peaks in the spring months. They have ordered new collections that will arrive before the current ones are sold. A significant amount of their sales normally go to tourists, and there is no outlook for tourists in Denmark yet. Retailers fear that they may need to hold clearance sales for the entire summer.
The monarchy endures
Today is Queen Margrethe II's 80th birthday. The customary gathering at Amalienborg Palace Square to wave at her on the balcony has been been canceled, but she will hold a brief interview on TV. In the evening her sons and their wives will visit her, keeping a safe distance, while her grandchildren will send their greetings on social media.
Prime Minister Mette Frederiksen and others held a press conference on Tuesday (DK), the day before the reopening of schools and day-care centers. She reported that the number of hospitalizations and ICU patients are declining more quickly than expected and that the country can open up slightly more in next phase than it had planned. She did not specify what restrictions would be relaxed but said that the administration’s focus was on workplaces and the economy. Frederiksen seemed relieved, more relaxed and confident – even happy – as she announced the change in the administration’s outlook. She defended its conservative policy, praised people for their cooperation in observing the social distancing guidelines during the Easter holidays, and reiterated the necessity of continuing the practice.
R0 shrinking to a safe level
Statens Serum Institut released a report yesterday afternoon on the status of the infection with an estimate of the R0 rate (DK), that is, the rate of infection from an individual Covid-19 patient. The rate had fallen from 2.6 persons on March 12 to 1.4 persons on March 24, to 0.9 on April 7, when Frederiksen presented the reopening plan, and further to 0.6. A level below 1.0 means that the virus is not spreading. At the press conference, Kåre Mølbak, from the Institute, said that the positive trend was owing in particular to the behavior of people in the 70-80-year-old age group (DK), who followed the administration’s guidelines and avoided infection. He added that the infection rate would rise to about 0.8 after the first stage of lifting restrictions but would remain under control.
Frederiksen invited representatives of the other political parties to a meeting immediately after the press conference to discuss how to expand the reopening. She had previously been criticized for not including other parties in the decision on the extent of the first phase of reopening, and yesterday, as the figures on infections and deaths continued to decline, she came under pressure to ease up (DK) further on the restrictions. The administration had chosen to follow the most cautious of the three policies that the Ministry Health set forth for the first phase of the reopening, which is scheduled to run until May 10.
Professional services and small businesses could be next
At the subsequent meeting, the parties had many and various recommendations for relaxing (DK) the restrictions. The Liberal Alliance Party favored opening professional services as well as restaurants that can adhere to precautionary principles. The Danish People’s Party emphasized the need for contact among older people who have been isolated and sometimes become lonely and depressed. The Socialist People’s Party and the Social Liberals recommended opening adult education, the courts and small businesses such as hairdressers and dentists. Other parties urged opening of outdoor clubs, afterschool workshops and other educational institutions. The New Right had a detailed plan for accelerating the reopening schedule to cover almost everything by May 20. No conclusions were reached at the meeting.
This good news came after reports yesterday that the four largest municipalities in the country, including Copenhagen, would not follow the Health Authority’s recommendation that children from households with infected people should attend school. After many parents and several political parties expressed concerns about the policy, Minister of Health Magnus Heunicke announced that it was changing the guidelines to allow such children to stay home. Teachers and day-care staff with sick family members in their homes were still expected to work, however, because they should be able to maintain good hygiene.
On Monday, Minister of Health Magnus Heunicke announced that the healthcare system would begin resuming normal operations (DK) this week. Ordinary activities have been suspended since the outbreak of the epidemic, but now the epidemic is considered to be under control and the system has the capacity to treat other health issues as well. Patients normally have a right to be treated within 30 days. A backlog of cases needing treatment by both GPs and specialists has accumulated during the crisis, including thousands of elective surgery procedures.
The administration reached an agreement with organizations representing the Regions, the Municipalities and the Danish Medical Association but not with the other political parties. Last week, the opposition parties called for concrete measures to reestablish patient rights. Heunicke stated that he wished that the administration could have reached a broad agreement on reopening the system with the other parties, but the “political will” was lacking. The Ministry of Health has not set a date for formally reinstating the treatment guarantee. The chairman of the Danish Medical Association, Anders Rudkjøbing, stated that it would be irresponsible to reinstate the guarantee (DK) now because the system cannot yet operate at full normal capacity.
Are recovered patients immune?
The health authorities are working hard on an antibody test (DK) that will show whether recovered Covid-19 patients have acquired immunity to the disease. According to Martin Tolstrup from the Institute for Clinical Medicine at Aarhus University, who heads the project, most people who are infected develop antibodies, but it is not yet certain that they have developed immunity. His group is applying antibodies to live viruses in petri dishes to see whether the antibodies kill the viruses. This is an important issue, not only because the results will determine whether recovered patients, including healthcare personnel, can return to work. Plasma from patients with strong antibodies could also be used as a treatment for new Covid-19 patients. But that part of the project could take up to a year, says Tolstrup, around the same amount of time for a vaccine to be developed and approved.
Margrethe Vestager, the European Minister for Competition, has recommended that EU member states be prepared to take stakes in private companies because there is a risk that China will attempt to take over companies that are in a distressed financial condition because of the epidemic. Vestager, who is the former chair of the Danish Social Liberal Party, was speaking generally and not in reference to Denmark in particular. But DR’s business correspondent Jakob Ussing says that the warning applies to Denmark (DK) as well as to the larger European countries. China has had an interest in acquiring infrastructure and technology companies. After the financial crisis, a Chinese company bought Greece’s largest harbor, in Piræus, for example. China is interested in green energy, one of the fields in which Denmark excels, and a Chinese company has already acquired a tower plant from Vestas, Denmark’s leading wind energy firm.
Man’s Humans’ best friend in a crisis
International business competition is not the only area where a watchdog is needed. The Dansk Kennel Club reports a large rise – around 40 percent – in demand for dogs (DK) since the lockdown. Other dog breeders have seen similar interest, and animal shelters have fewer occupants than usual because of adoptions. According to breeders, the reasons that people want dogs now are that they have more time for pets at home under quarantine and they are not making plans for summer travel. A spokesman for Animal Protection Denmark, Jens Jokumsen, however, warns that a pet should not be an impulse purchase. People must also be prepared to care for it after the epidemic ends. They should also take time to consider what is the best breed for their family.
