Coronavirus DK: The facemask debate continues

The number of infections in Denmark has been rising steadily for three or four weeks, and more and more governments around the world are requiring that people wear masks in public. Denmark still doesn’t require them except in special situations where people might have been exposed, but some politicians and researchers are beginning to speak of a general requirement. Michael Bang Petersen, Professor of Political Science at Aarhus University, says that masks could be the next step in the management of the pandemic. 

A matter of time
Bang Petersen has studied Danes' behavior, opinions and feelings during the coronavirus crisis and believes the authorities should prepare people for wearing masks (DK). “There is now a relatively broad consensus in other places that masks work,” says Bang Petersen. “I would therefore expect that there would be strong political pressure to recommend masks as a first layer of protection if there is a second wave.”

Masks are required on roller coasters. Photo: Mads Claus Rasmussen © Scanpix.

The EU has recently recommended that people wear masks on trains and in railway stations. Denmark’s Red-Green Party proposed that masks be required on public transport (DK). “There is a group of citizens who are actually excluded from using public transportation [because of the risk of infection],” says Peter Hvelplund, the party’s health spokesperson, “and therefore the Health Minister and Minister of Transport must find a solution.”

Not a second wave
Most of the parties are in favor of a recommendation to wear masks but do not believe it is necessary to make them mandatory while the infection rate remains low. “Masks are an option, but there is of course a tradeoff with the inconvenience of wearing them all the time,” says Stinus Lindgreen of the Social Liberal Party. 

Søren Brostrøm, the head of the Health Authority, says that at present there is no value in requiring masks (DK) in order to reduce infections. “We are following the figures closely across the country and locally in order to see whether we should use the tools we have in our toolbox,” says Brostrøm. “We don’t have anything against masks in principle. . . . We are ready if the situation requires it.” But he describes the latest rise in cases as a “flare-up” rather than the beginning of a second wave. 

Use the app
More than 820,000 people have now downloaded the contact-tracing app, Smittestop. But only 207 have registered having the infection. That is far from enough (DK), says Thomas Benfield, Professor of Infectious Disease Medicine at Hvidovre Hospital. “We should register four or five times as many before it becomes optimal.” The app did not become available until after the number of cases had already been reduced greatly. The delay in the rollout occurred because of concerns about privacy.

Coronavirus DK: Reversals in both Lockdown-gate and EU deal

On Saturday another piece of news came out about Prime Minister Mette Frederiksen’s decision to implement a strict lockdown (DK). As explained yesterday, Frederiksen said that the policy had been determined on the basis of “recommendation of the authorities.” But a recently discovered email from her closest healthcare advisor, Søren Brostrøm, had actually advised against closing the schools and day care centers. Frederiksen faces renewed criticism and questions about the specifics of these “recommendations.”

Kåre Mølbak at a coronavirus press conference. Photo: Niels Christian Vilmann, Ritzau Scanpix.

Now Kåre Mølbak, the director of Statens Serum Institut (SSI), the agency responsible for preparedness against infectious diseases, says in an email to the daily Politiken (DK, paywall) that he supported the administration’s decision. Mølbak was also one of the administration’s closest advisors during the worst period of the epidemic and appeared with Frederiksen and Brostrøm in several press conferences.

An “authority” comes forth
“For me it was essential that the government was prepared to maintain the comprehensive effort that was presented to me on March 11 until after Easter,” wrote Mølbak. “According to SSI’s assessment, this long-term perspective was necessary in order to bring the epidemic under control.”

In his March 11 email, Brostrøm had stated that he had “discussed” his conclusion with Mølbak, but Mølbak now says that at the time he did not share Brostrøm’s concerns about a lockdown. So it appears that Frederiksen has acquired at least one “authority” for her policy and may therefore escape the insinuations of dishonesty and deceit from the opposition parties that became more pointed after the disclosure of Brostrøm’s email.

Don’t celebrate yet, prime ministers
The historic agreement that European Union leaders recently reached on the next seven-year budget and emergency pandemic aid for southern Europe is now in doubt. The deal must be approved by the European Parliament, and at present, a large majority of the Parliament is against it. They voted 465-150 for a provisional resolution to reject the budget (DK).

They have several reservations. According to Manfred Weber, the chair of the Christian Conservative group, the Parliament’s largest bloc, more money in the budget should be directed toward research, healthcare and the EU’s outer borders. Along with other factions, Weber also insists that the disbursements to member states be contingent on adherence to the “European spirit,” that is, to democratic principles. 

No money for autocrats
“It is completely clear for us socialists,” said Iratxe Garcia Perez of the Social Democratic group, “that not a single euro should go to the governments that do not fully respect the rule of law and the fundamental values of the Union.” These are allusions to the infringement of freedom of the press and judicial independence in Hungary and similar tendencies in Poland. Those two countries succeeded avoiding immediate sanctions that affect their receipt of EU funds.

The resolution isn’t binding. The final vote is not scheduled to take place until the end of September.

Editorial note
You may have noticed that the news about the epidemic in Denmark has become less dramatic in recent weeks as the spread of infections remains under control despite the gradual relaxation of lockdown restrictions. There is no longer much need for these updates on a daily basis, so from now on, they will appear less frequently and may treat other topics besides the coronavirus. If there is a second wave that causes great disruption again, as is happening now in some locales, they can resume. Stay tuned, and thanks for reading.

Coronavirus DK: Justification for lockdown questioned again

The tabloid B.T. has discovered an email message that throws further doubt (DK) upon Prime Minister Mette Frederiksen’s justification for locking down Denmark in mid-March. The email, which was sent from Søren Brostrøm, head of the Health Authority, only seven hours before Frederiksen’s historic announcement of the lockdown, recommends not closing schools and day care centers. It states that “children are not expected to cause a significant spread of the virus” and the negative effects of the closure would outweigh the positive ones.

Prime Minister Mette Frederiksen. Photo: Niels Christian Vilmann © Scanpix.

At the press conference, Frederiksen said that she was ordering the lockdown “on the recommendation of the authorities.” She has been questioned about the decision earlier. At a meeting requested by the opposition parties held on June 9, she reiterated that it was based on the recommendations of a “broad group of authorities” without specifying who or what she was referring to. The issue is important, says Sten Brønsing, Professor of Constitutional Law at Aalborg University, because ministers may not justify political decisions (DK) on the basis of recommendations of government officials if such recommendations have not been made.

Come clean, Mette
Now three opposition parties are demanding a clear explanation (DK): “We hope that she will realize on her own that it is reasonable to explain to the Danes why she said something that is not true,” says Peter Skaarup, leader of the Danish People’s Party parliamentary group. The effect of Frederiksen’s press conference was to “deceive the Danes,” continues Skaarup. “It cannot be interpreted otherwise.”

(Commentators have noted that both the administration and opposition parties have begun referring to the population as “the Danes” rather than “citizens” or “people.” Some have attributed populist, even subtly racist intentions to this usage, which might imply that a certain segment consists of real, ethnic Danes.)

Ratcheting up the rhetoric to “not honest”
The Liberal Party is demanding a written report (DK) from the prime minister and threatening to call for another investigatory meeting. “It is wrong that the prime minister in the beginning was not honest and did not say that this was a political decision,” says Karen Ellemann, the acting political spokesperson for the Party. “We have asked several times who had recommended [the lockdown].” The Conservative Party is also criticizing Frederiksen for not being forthcoming.

In none of these accusations did the opposition say that the lockdown was wrong or was a bad decision. They did not contain any evaluation of the administration’s lockdown policy itself or its consequences in comparison with results in countries that did not implement similar restrictions. The opposition pressured the government to relax restrictions earlier than it had planned, but Frederiksen has had a high approval rating in opinion surveys throughout the crisis.

She is away on vacation at present. Her office refers inquiries to the explanation given at the June 9 meeting. Parliament has appointed a commission that will evaluate the entire management of the coronavirus crisis. 

Coronavirus DK: Rise in infections may delay phase 4 reopening

The number of infections in Denmark has been rising (DK) in the past month, and some are becoming concerned. The level had been rather low for a long time, and although the rise has not been drastic, it has been steady in the period since the borders were opened. In week 27, which began on Monday, June 29, there was an average of 18 confirmed cases per day. In week 28, the number rose to 24, and last week it hit 34. So far this week, the level is 43.

On Thursday, Minister of Health Magnus Heunicke commented on the increase (DK) in a Facebook post. He wrote that the situation is still under control but urged people to observe the Health Authority’s guidelines. There have been no large outbreaks, added Heunicke, and the Patient Safety Authority, which is responsible for contact tracing, reports that the rise in cases is not owing to increased testing. 

Nevertheless, Heunicke notes that new lockdowns have become necessary in several places, such as Spain, Australia and the US, and urges Danes to be more cautious: “Maybe we have succeeded so well that people have begun to slack off a little on the good habits that keep the virus down. That must not happen. We must not put everything in jeopardy at any price.”

Few new hospitalizations
The most significant aspect of the situation, according to Henrik Nielsen, head doctor at Aalborg University hospital, is that the number of hospitalized and ICU patients has not followed the trend in infections. There is usually a lag of about two weeks between a rise in infections and increased hospitalizations, but the latter have held steady at a low level. Yesterday the total rose from 16 to 19, but it has been below 20 for two weeks. 

Phase 4 of the reopening is scheduled to begin on August 4, with the reopening of nightclubs, concert halls, and other venues where people congregate at close quarters. “We can’t see from the figures whether that will lead to a new wave,” says Nielsen.

The virus loves to party
The trend has led to a division between the two sides of the political spectrum (DK). The left wing wants to reconsider the planned phase 4 reopening. “It is very worrying,” says Peder Hvelplund, the healthcare spokesperson for the Red-Green Party. “It is crucial that we intervene early.”

Giving "disco fever" a new meaning. Photo: Mogens Flindt, Scanpix Danmark.

“Nightclubs could be something that I think it isn’t certain that it is wise [to reopen],” says Kirsten Normann Andersen of the Red-Green Party. She notes that it is especially difficult to trace contacts when you are close together with a crowd of strangers.

Typical political schism
Not all the parties are alarmed, however. “An increase was expected because we are opening further and people are traveling both in and outside the country,” says Stinus Lindgreen of the Social Liberals. “We have seen before that there is a rise and then it falls again.” Karen Ellemann of the Liberal Party agrees: “With these figures I don’t see a cause for concern because there is nothing to indicate that they are out of control.”

The Ministry of Health offered no further comments except to say that the government would discuss the phase 4 reopening with the other parties after the summer vacation. But the Foreign Ministry has just updated its travel advisory and now discourages unnecessary travel to Bulgaria (DK), where young people flock to beach resorts.

Coronavirus DK: Border skirmish - the next front

Yesterday, the EU Commission presented a tourism package (DK) that is intended to rescue the summer tourist season in Europe. Germany had just announced that it will open its borders tomorrow, and Margrethe Vestager, the European Commissioner for Competition and Danish Social Liberal politician, urged other member states to follow suit. The Danish government has said that it will not consider reopening the borders until after June 1. When asked whether that was too late, Vestager responded, “Both service and production businesses need to move across borders to a greater extent,” adding that all the necessary precautions must be taken.

The package is set of recommendations and guidelines for the member states. For example, people should not travel if they are sick; passengers should check in online and avoid lines at the airport; airlines should not serve food on board; they should take fewer passengers; unrelated passengers should not sit close together; hotels and camping grounds should follow strict hygiene policies. In the first phase, the EU recommends that countries with similar levels of infection (DK) open their borders to each other, for example Denmark and Greece, where the epidemic is under control. The entire Schengen region should not open until later.

Digital travel solutions

The Commission will also develop an interactive map that shows the status of the epidemic in various regions and will present guidelines that will allow the “corona apps” from each country to function in the other member states. The EU has no authority to determine the policies of member states, however. Tourism represents 10 percent of the EU’s economy, and 27 million jobs, directly or indirectly, depend on it, mostly in southern Europe. It represents 8 percent of the Danish economy.

The pandemic has of course been a disaster for countries with a large tourism industry (DK). The Cannes Film Festival should be taking place at the moment, for example, but the many hotels in the region are empty. Italy only last week relaxed restrictions for its own citizens, who must present documentation if they want to travel between regions. Spain, which is also heavily dependent on tourism, is still in the early stages of reopening. Airlines, whose business has plummeted during the crisis, have canceled many flights and passengers are demanding refunds. The airlines have asked for permission to issue credits toward future flights instead, but the Commission has rejected the request.

Pressure from the right

A majority of the Danish parliamentary parties is reportedly in favor of at least a partial opening (DK), for example for German and Norwegian tourists or for people who rent summer houses. At Parliament’s latest question session, representatives of three right-wing opposition parties pressed the government (DK) to follow Germany’s initiative. Danish Justice Minister Nick Hækkerup, however, maintained that Denmark is not ready to put the positive developments in controlling the coronavirus at risk, noting that the epidemic entered the country with skiers returning from Austria and Italy in February. It costs Denmark DKK 107 million ($15 million) for every day that the borders are closed, said Ulla Tørnæs from the Liberal Party. 

Hækkerup answered that the losses could be even greater if the borders are opened too soon and the epidemic flares up again. He was open to the possibility of allowing foreigners who already have a rental contract to enter the country, but the session was frustrating for parties on both sides of the debate. “I must confess that I have not become much wiser from this answer,” said Tørnæs after another testy exchange. Not all parties are in favor of an immediate relaxation of border restrictions. The Red-Green Party, for example, warns that the country shouldn’t drop its precautions simply because of the positive trend in limiting infections. 

Coronavirus DK: New plan for testing, tracing and isolation

Yesterday the government held a press conference to present the next steps (DK) in the management of the coronavirus in Denmark. They involve several initiatives: a new board dedicated to addressing the pandemic, a revised testing strategy, the implementation of systematic contact tracing, new options for isolating infected persons, and the use of the temporary test centers. The board, which will operate under the Ministry of Justice, will coordinate all these activities. For example, it will manage the availability of protective equipment throughout the country, access to the test and isolation facilities, communications and international collaboration. 

The number of tests will increase gradually to include testing for antibodies (DK) in randomly selected citizens. The tests will give an indication of how many people have been infected without showing symptoms. They will be conducted by medical students recruited for the task at the temporary Testcenters set up across the country. There are now 16 Testcenters, and they have the capacity to conduct 10,000 PCR tests (for the virus) and 5,000 tests for antibodies per day.

Hotels and vacation centers

Persons who test positive will undergo self-isolation. If isolation at home is not convenient, they will be offered the opportunity to use an isolation facility. This is indicated in cases where they are not able to isolate themselves from their family adequately or if they live with someone in a high-risk group such as a person with a chronic illness. The municipalities will be responsible for making facilities available in a hotels, vacation centers or other commercial lodging facilities. This option is available only for people who do not require medical supervision in a hospital. Hotels and youth hostels have already offered to make their facilities available.

Quarantining contacts

An infection tracing unit will be set up from the resources in the current coronavirus hotline. It will work with infected people to contact everyone the person has been in contact with – family, coworkers, friends, etc. Infected people will get instructions from their doctors about how to pursue the tracing. Contacts exposed to infected persons will be offered two tests, one four days after exposure and another six days after, and they will be encouraged to self-isolate until the results of the first test are available. Tracing will begin this week, and the testing of contacts will take place at the temporary Testcenters. An app is being developed to supplement the tracing process.

The purpose of these measures is not only to manage the current stage of the epidemic but to be prepared in case of a second wave of infections, although Kåre Mølbak, the head of SSI, the agency responsible for preparedness against infectious diseases, says he believes a second wave is unlikely (DK) because the healthcare sector has learned much in the past two months about how to manage the disease in hospitals and society.

Forced isolation and masks

At the press conference, Health Minister Magnus Heunicke was asked what will happen if an infected person refuses to isolate himself or herself. He said that the law governing the epidemic allows the possibility of forced isolation but it will be used only very rarely, for example with psychiatric patients, if necessary, in order to avert the risk of superspreading. 

Prime Minister Mette Frederiksen was asked about the criticism the government has received (DK) about reducing the physical distance guideline from two meters to one meter without warning. She responded that the other political parties had known the Health Authority was working on the requirement and that she had not known any more about it than the other parties at their latest meeting last Thursday.

When Søren Bostrøm, head of the Health Authority, was asked why there is no requirement to wear masks in Denmark, he replied that the Authority had considered the recommendations and concluded that there was no strong documentation supporting a policy that everyone must wear a mask.

Coronavirus DK: Always something to complain about

Yesterday, SSI, the agency responsible for preparedness for infectious diseases, reported that the reproduction rate, R0, had fallen in the month of April (DK) from 0.9 to 0.7. The figure represents the average number of persons who are infected by a single infected person. If the level is below 1.0, the spread of the infection is declining. The drop has thus occurred since the first phase of the reopening began, with the return to school of children in the lowest classes and the opening of service and professional businesses. That shows that people have been conscientious about following the Health Authority’s guidelines, says Tyra Grove Krause of SSI.

Grove Krause cautions that the figure is an estimate that is more useful as an indication of the direction of the spread of the infection than a precise measure. The choice of criteria used affect the result. The SSI’s figure is based on the number of hospitalizations, not the number of persons who test positive for the coronavirus, and it assumes that it takes an average of 4.7 days for one person to infect another. The favorable results presumably influenced the Health Authority’s recommendations on lowering the recommended physical distancing from two meters to one and the reopening additional businesses and other organizations.

Is one meter enough?

On the day after the Health Authority announced the reduction of the guideline on physical distancing, spokespersons from virtually all of the political parties in Parliament were raising questions about it. Some were surprised that this key recommendation was changed suddenly and without consultation with the other parties after several of them had inquired about it earlier and received no clear answer. Some questioned whether it was safe. Most of them, like Liselotte Blixt of the Danish People’s Party, asked whether the decision was based on healthcare considerations (DK) or practical exigencies, implying that the latter might have weighed too heavily. If it wasn’t necessary to keep two meters’ distance from one another for the past three months, they asked, then why did we do it? Supermarkets have placed tape on the floor to show customers where to stand in line, and hairdressers have moved their chairs apart. Other party leaders criticized the way the decision was made (DK) without their input. 

When asked about the change, Søren Brostrøm, the head of the Health Authority, said that it was sound from a healthcare perspective and that the Authority also considered the practical ramifications because the guidelines must be sustainable. He said it consulted other countries’ policies and experience. The WHO recommends a distance of one meter, which is the policy in Norway, where there has been a very small number of infections; Germany and the Netherlands require 1.5 meters’ distance. Prime Minister Mette Frederiksen had previously said that the government deferred to the Health Authority on such decisions and that the guidelines could change.

Democracy in action

What all the spokespersons’ comments had in common was that none of them disagreed with the decision itself. Indeed, most of the parties had been arguing strongly for a further relaxation of restrictions. This discussion seems characteristic of the Danish style of political debate. The dissenters are well aware that the pandemic is under control and that Frederiksen’s and Bostrøm’s handling of the crisis has been viewed favorably by the public. The hospitals are not overwhelmed; there are no mass graves, massive job layoffs, long lines for food banks, or dangerous recommendations to drink disinfectants. Yet they feel an obligation to put in their two cents in order to show their constituencies that they still exist and are keeping an eye on developments.

Coronavirus DK: New meaning to the phrase “spitting distance”

Today shopping centers in Denmark can reopen and people can begin to participate in outdoor sports and other activities. In preparation for phase 2 of the relaxation of pandemic restrictions, the Health Authority yesterday announced an adjustment in its recommendations on hygiene. The most important change is that it will be sufficient for people to keep a distance of one meter (DK) from one another instead of two meters. In reducing the distance, it is falling in line with the guidelines from the WHO and neighboring countries. It still recommends two meters’ distance in situations such as group singing in churches, where there is a heightened risk of infection, and from people in a high-risk group, such as the elderly. The Health Authority is maintaining almost all of its previous guidelines.

Søren Bostrøm (DK), head of the agency, stresses that good hygiene, such as washing hands, using sanitizer and cleaning frequently touched surfaces, is more important than distancing. The other change mentioned in the press release is the lifting of objection to buffets, which apparently applied mainly to schools, since restaurants will not reopen until May 18. Bostrøm says the agency wants to implement sustainable solutions that balance effectiveness and convenience, and that certain measures, such as the availability of santizer in public places, will be with us for a long time. The recommendations will be adjusted gradually as various segments of society and the economy resume activities.

A “dangerous experiment”

Some doctors and researchers are in favor of the change and do not believe that it will result in many additional infections. But of course not all. Allan Randrup Thomsen, Professor of Virology at University of Copenhagen, who is one of the most frequently consulted observers of the pandemic management, calls the change “a dangerous experiment” (DK). In ordinary speech, says Randrup Thomsen, most droplets from the breath fall to the earth within one meter’s distance, but in louder speech they go further. He would maintain a distance of at least 1.5 meters. 

The difference between one and meters is not trivial when it comes to determining how many pupils can be together in a classroom and how many customers a restaurant can serve. The change will mean that additional children will be able to attend school for a full day and cafes will have a better chance of turning a profit. The issue of buffets is similar. The food served in buffets is not dangerous, says Jan Pravsgaard Christensen, Professor at the University of Copenhagen’s Institute for Immunology and Mikrobiology. What matters is that people do not crowd together in lines and follow the other recommendations on hygiene.

No carrot without a stick

As I mentioned yesterday, upon the further relaxation of restrictions, the government will also issue a formal prohibition against reopening and large gatherings for organizations that are not allowed to resume activities until phase 3 or 4. The ban, which applies to zoos, museums, fitness centers and boarding schools, was announced yesterday by Justice Minister Nick Hækkerup. If an organization with more than 50 people violates the ban, it will be subject to fines (DK) ranging from DKK 40,000 ($5,700) in the first instance to DKK 150,000 ($21,500) in the third. The police will also have the option of closing the business or organization. 

The Copenhagen Zoo and the ARoS art museum in Aarhus had mentioned the possibility of opening despite the general guidelines against it. Erlend Høyersten, the director of ARoS, called the decision “absurd and illogical” (DK). Museums do not pose a higher risk of infection than shopping centers, says Høyersten, and culture should not be assigned a lower priority than commerce in some kind of politics of symbolism. Justice Minister Hækkerup denies that there is any politics of symbolism at play and emphasizes that various institutions needed to be reopened gradually and middle schools, for example, were considered more important than museums by all the parliamentary parties.