Coronavirus DK: More infections, restrictions and testing

 Like many other European countries, Denmark has seen Covid-19 infections rise (DK) and has resumed restrictions on social and business activity. In the past week, new daily infections have risen above 500, which is higher than the peak of the first wave. They have subsided somewhat in the past week. As before, the number of hospitalizations and deaths remain low. In the past two weeks, daily hospitalizations have risen to double digits and there have been 13 deaths. The reproduction number has fallen slightly to 1.3.

Restaurant sign showing reduced capacity and hours. Photo: Lisbeth Janniche.

Partial lockdown
The restrictions (DK) that were implemented in Greater Copenhagen now apply to the entire country until October 4:

• Restaurants, bars and cafes must close by 10 pm.
• Gatherings are limited to 50 people. Attendance at sporting and cultural events are limited to 500 people.
• Masks must be worn by people over the age of 12 on public transportation, including taxis; by employees and visitors at hospitals, nursing homes and doctors’ offices; and by employees and customers at restaurants and cafes when they are not sitting at tables (not yet at stores and businesses, although health authorities say they will be covered too if the infection rate rises further).
• Alcohol is banned on buses (including so-called “party buses).
• Strict rules apply to visits to hospitals and nursing homes.

Additional recommendations.

• Avoid public transportation at rush hour; ride a bicycle or walk instead.
• Both public and private employees who are able to work at home are urged to do so.
• People are advised to limit their social contacts as much as possible.
• While daycare centers, schools and universities remain open, social arrangements at them are discouraged.

Low mortality rate
Some good news: the mortality rate for patients at Danish hospitals (DK) is relatively low. During the first wave, that is, in the period ending May 19, some 63 percent of ICU patients recovered. In many other countries, including the US, the UK and Italy, the rate was around 50 percent. The average age of the patients was 68. Around 30 percent had no preexisting illness. 

The breakdown by sex in total mortality rate of 37 percent was 42 percent men and 29 percent women. The breakdown by age in the total mortality rate was 5 percent for the 50-64 age group and 64 percent for patients over 80. 

More testing and longer waiting
The administration has promised that testing would be increased significantly for months, and lately the number of test centers and the number of tests administered have increased. Around six weeks ago, the number of daily tests reached 30,000 per day, and in the past week, it has exceeded 40,000 and 50,000. The goal was that 80 percent of requests for tests should be granted within 24 hours and the subjects should receive the results within 24 hours. 

Nevertheless, there are long waiting periods at many test centers (DK). On September 23, it was possible to be tested within 24 hours at only three of the 48 test centers across the country. In a few places, the delays were up to seven days, and sometimes when people appear for test they must wait in line up to six hours before they are tested. The Opposition parties are criticizing the administration for not fulfilling the agreement that was made as a condition for phase 4 of the reopening plan, and Prime Minister Mette Frederiksen reiterated the government’s commitment to the 24-hour framework.

Self-testing for antibodies
The government also has an ambitious plan to test 2 million people for antibodies (DK) during the autumn and in the beginning of the new year. That would be 35 percent of the population. Test kits will be sent to people’s homes, and they will administer the tests themselves by pricking a finger and letting a drop of blood on a testing strip. The result will appear in 15 minutes. 

Coronavirus DK: Infections up and restrictions back

Denmark has seen a steady rise in infections (DK) in the past month, although the number of hospitalizations and deaths remain low. For three months, from the beginning of May to the beginning of August, the number of daily infections was below 100. Since the beginning of September, it has been above 200, rising to 300 this past week. Hospitalizations number 47, 4 in ICUs, and deaths total 631. The reproduction number has fluctuated between 1.0 and 1.5 since mid-July, and it is back at 1.5. Testing has also increased significantly.

The number of deaths per million is now 109. In comparison, the figure is 588 in Italy, 589 in the US, and 616 in the UK. The other Nordic countries: 49 in Norway, 582 in Sweden, and 61 in Finland. 

New restrictions but no return to a general lockdown
Tighter restrictions (DK) went into effect last week. In 18 municipalities, almost all of them in Greater Copenhagen, the limit on gatherings was reduced from 100 to 50 and bars had to close by midnight instead of 2 a.m. The limit on spectators at major sports events was reduced to 500. Face masks have been required on public transportation for two weeks now. 

The number of infections per 100,000 inhabitants has risen above 20 in 39 municipalities, and the mayors of several of them are asking that similar restrictions be implemented there. Many of them have placed limits on visits to nursing homes. But virologist Allan Randrup Thomsen (DK) does not think it is necessary in every case. The absolute number of infections is what matters most, and in some municipalities with a small number of inhabitants, the infections have come from individual incidents.

For example, if an infection is discovered in a school, it may be sufficient to close the school or class temporarily without setting restrictions on the entire community. Future restrictions will probably be implemented locally. One of the next likely measures is requiring face masks in supermarkets and shopping centers. 

Copenhagen Sunday evening. Photo: Ólafur Steinar Rye Gestsson / Ritzau Scanpix.

Young people can’t stop partying
One of the main reasons for the rise in infections, besides the loosening of earlier restrictions, is that young people are holding parties and frequenting bars and parks without observing social distancing measures. Persons from 20 to 30 account for large portion of new infections. At a press conference on Saturday (DK), Police Chief Thorkild Fogde issued a warning that if young people do not become more careful, the police will need to reinvoke tighter restrictions.

It has already made two parks in the Nørrebro district of Copenhagen off-limits, and a violation of the ban is subject to a fine of DKK 2,500 (about $400). Patrols have broken up so-called “pirate parties” at several locations on the weekends. The further restrictions could be requiring masks at bars, closing bars earlier in the evening, and banning gatherings in other areas. Several universities have suspended social activities involving more than 50 attendees. 

Economy is relatively sound
Prime Minister Mette Frederiksen (DK) issued a statement on September 11, exactly six months after the government announced lockdown restrictions. She emphasized that the Danish economy has recovered much faster than it did after the financial crisis. The number of unemployed has fallen from a peak of 45,000 to 25,000. Housing prices have risen since March, particularly for vacation homes. Consumer spending has recovered. Certain industries, such as hospitality and travel, have suffered long-lasting damage, but others, such as the DIY segment, have thrived during the epidemic.

As in the rest of the world, the stock market has rebounded from the initial selloff. Exports have not recovered yet because they are dependent on the economies of other countries. The recovery has been owing to the government’s relief package, and it is difficult to predict its long-term effects. Economist Michael Svarer expects the recovery to continue. He does not expect a deep second drop, as a in W-shaped pattern, but rather something resembling Nike’s swoosh logo.

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: Masks catching on and also causing complaints

Since the Health Authority recommended the use of face masks in certain situations a few days ago, sales of masks have shot up (DK). They had begun to rise at the beginning of the summer vacation period, and after the announcement they took a further jump, from about 6,000 a week earlier to 41,000 last week. Retailers are restocking. They advise customers to look for the CE label, the certification mark that indicates conformity with safety standards in the European Economic Area, and to follow the instructions on proper use. Masks have been mandatory at the airports since June 15. 

Holdout on recommendation
Denmark is one of the few remaining countries – only 19 in the world – that does not recommend or require that people wear masks in public places The WHO changed its position on the subject recently as studies indicate that asymptomatic or presymptomatic people can spread the virus and masks offer some protection against it. The Danish Health Authority maintains its position (DK) that masks should be worn in situations where you are at risk of having the infection or being exposed to it, for example when traveling home from a high-risk country. 

The Health Authority holds that in other situations masks are a useful supplement if you cannot follow the general recommendations on social distancing and hand hygiene but that they can also increase the risk of infection if not used correctly. Because of the danger posed by incorrect use, it discourages the use of masks on young children (DK) and people with impaired motor skills, cognitive abilities or chronic obstructive pulmonary disease.

Families on the Demon at Tivoli Gardens. Photo: Mads Claus Rasmussen / Ritzau Scanpix.

Trouble in vacationland
Also as noted earlier, some amusement parks began requiring that their patrons wear masks when they ride on roller coasters. That is prompting dissatisfaction and complaints (DK) in certain quarters. Five amusement parks in the country are participating in this trial program. Two offer the masks to riders free of charge, and the others charge an extra DKK 5 ($1) for a mask. Since the masks can be used only a single time, the expense can be significant. 

One woman, for example, tweets on behalf of her family of four with a season pass: “We find out that we MUST all ride with masks on the best roller coasters . . . okay, fair enough, we can live with that . . . but fuck no to your taking 5 kroner per mask . . . and then we find out that they can’t even be used again.” Then she proceeds to do the math: 10 rides a day for the family comes to DKK 200 ($30) and nothing left for ice cream, food and drinks. “That’s fucking bullshit.”

Cheaters and scientific skeptics
The price isn’t the only problem with the policy. Some guests notice others using questionable homemade masks such as scarves or re-using them despite the amusement parks’ policy that masks must be an approved type and thrown out after use. Søren Kragelund, the chair of the Danish Amusement Parks Association, is not pleased with the policy either. He is glad that the masks allow patrons to avoid long lines because they can sit close together on the rides. But he doesn’t understand why masks should be necessary when people are on the roller coasters for only a couple of minutes instead of the 15 minutes required when registering exposure to the infection in the recently introduced contact-tracing app.

He can also cite researchers, such as Christine Stabell Benn, an epidemologist at Southern Denmark University, who says there is no evidence that masks work or that they need to be thrown out after one use. Kragelund continues to follow the policy but hopes that the Patient Safety Authority will ease up on the strict rule.

Coronavirus DK: Denmark finally recommends masks

The Danish Health Authority is now recommending the use of face masks (DK) for the first time, but only in selected situations. The agency updated its guidelines on Thursday with this announcement: “People can use face masks for short periods in special situations in order to protect others from the coronavirus.” It is thus not recommending that everyone wear masks, that people wear them in all situations, or that people wear them in order to protect themselves. The announcement cites the change in the WHO’s guidelines last month to recommend the use of masks in certain situations on the basis of new knowledge about the spread of the infection.

The Authority advises that masks be used in situations where you cannot follow the general recommendations, on social distancing for example. They are most important for people who are infected, who have symptoms, or who have been exposed to someone who might be infected.

Photo: Coronavirus.dk.

These are the situations:

• You are infected or have symptoms and must leave isolation in order to travel to or from a hospital.
• You are returning home from traveling to a high-risk country and must undergo self-isolation.
• You are in close contact with someone who is infected and must break self-isolation in order to transport you to a test.
• You are related to a person with elevated risk and cannot maintain physical distance, for example because you must care for the person.

The Authority stresses that it is crucial to wear masks correctly, to follow good hand hygiene when putting them on, to change them after every use, and to have a good supply if you need to wear them.

“Masks must be seen as an extra tool in the workbox,” the announcement concludes. “There are other, more effective tools, for example self-isolation if you are sick, keeping 1 meter’s distance, and adhering to good hygiene.” The Authority has produced a folder and a poster (DK) on the correct use of masks.

Tracing app is spreading

On June 18, the Ministry of Health released the Smittestop app, which is intended to monitor the spread of coronavirus and warn people who come into proximity of it. It has now been downloaded 745,000 times (DK), and people have registered their infection 112 times. The Ministry did not disclose the number of notifications.

According to researchers, the number of downloads is satisfactory and the number of infections registered is not so low considering Denmark’s low reproduction rate, but they hope to see more downloads. They are preparing models based on the spread of the virus that the government can use to determine what to keep open and closed in society and the economy. “If there is a new outbreak, we can make fewer interventions if the app is in widespread use,” says Jacob Stoustrup, Professor at the Institute for Electronic Systems at Aalborg University. 

As described in an earlier post, when you are in close proximity for 15 minutes with someone who is registered as positive for the virus, the app sends you a notification. The notification does not include the name of the infected person, and the data are encrypted, anonymous and stored only on individual phones. Researchers would prefer having more data available but acknowledge the need for privacy.

Not everyone can download the app. It requires a phone with Android 6.0 or iOS 13.5. 

Coronavirus in Denmark: The next steps

The numbers continue to fall (DK) for the third consecutive day in Denmark. They have been almost flat for about a week. It seems almost callous to quote them because they are tiny in comparison with what is happening elsewhere, particularly in the US, where the infections are still accelerating. The most telling figures are the number of hospitalized and ICU patients, says Thea Kølsen Fischer, Head of Research at North Zealand Hospital, because the number of infections and deaths may be influenced by other factors, such as the extent of testing and preexisting conditions. But the figures reported across all these parameters are consistent, and they indicate that the strategy of social distancing and quarantine is working. So that is something that other countries can learn from if they still have doubts.

With this main issue more or less settled, attention is turning to other questions: Do masks protect people from being infected? How many carriers are asymptomatic? Is herd immunity feasible? Will there be a second wave? Can people who recover be reinfected?

Tests, masks and antibodies

In Denmark, the tests appear to be very accurate (DK): the percentage of false negatives is small, around 1 percent. The sample in the test must be taken from the right location, says one researcher. If the virus has moved from the throat to the lungs, a sample from the throat may be negative. If the swab isn’t applied correctly, it may miss an infection. Rigshospital, a large, specialized hospital in Copenhagen, has made a video on how to do it correctly, and the WHO is translating it for use in other countries. 

Researchers are undertaking an experiment to investigate whether masks help (DK) protect against infection. Four researchers from the Greater Copenhagen Region, in cooperation with the Salling Group, which owns several supermarket chains, are giving surgical masks to Salling Group employees. They have recruited 6,000 employees. Half of them will wear the masks when they are outside their homes for thirty days, and the other half is the control group. They will test themselves regularly, and the tests will be analyzed after the thirty-day period. Masks have been found to prevent people who are already infected from spreading the virus, but there is much debate about how effective they are in protecting people who have never been infected.

Blood donors are being tested for antibodies (DK) in order to get an indication of whether the population is developing herd immunity. The estimate of effective herd immunity is around 60 percent, and only a few of those tested had antibodies.

EU collaboration problems revisited

Denmark’s Social Democratic representatives to the EU Parliament point out that, per capita, the largest amount of coronavirus aid is going to Hungary (DK), where the epidemic is rather limited. Italy and Spain, which are suffering the most, receive very little, the fifteenth and sixteenth most. This is because the money was redirected from a source, structural and investment funds, whose the distribution was based on the general standard of living. The funds had also already been distributed. This is a little embarrassing, particularly because the drastic steps that Hungary has recently taken in declaring a state of emergency have virtually suspended the democratic rule of law and drawn criticism from other EU nations. It also says something about the lack of flexibility in the EU. The solution, just as in the US and from all the central banks, will almost certainly be another rescue package. 

Simon Kollerup, Minister of Industry, Business and Finance, has criticized Danish banks (DK) for not giving enough loans to small businesses. He accuses them of not showing social responsibility and solidarity toward more vulnerable businesses. Some have had loan applications rejected, and others have been offered overdraft facilities with an interest rate as high as 18.75 percent. The banking industry organization, Finans Danmark, answered that 90 percent of applications are approved and that it would be irresponsible to grant loans to businesses that are unlikely to survive after a return to normal conditions. 

These are some of the main elements of the Danish aid package, which totals DKK 286 billion ($41 billion, or the equivalent of $2.25 trillion in the US):

• Extension of the deadline for withholding tax and VAT (DKK 165 billion)
• Guarantees for loans to SME and large businesses (DKK 60 billion)
• Temporary compensation for loss of salary
• Temporary compensation for self-employed and freelancers
• Temporary compensation for companies’ fixed expenses
• Unemployment and illness benefits
• Refund to companies for unemployment benefit contributions
• Compensation for cancellation of large events
• Guarantees for SAS
• Increased loan options for students