Coronavirus DK: Making Christmas safe for grandparents

Yesterday the Danish government held a press conference to announce new restrictions (DK) because of the persistently high level of infections in the Greater Copenhagen region. The pandemic is not accelerating significantly, and the hospitals are not filling. But in past the month infections have remained much higher than in the spring, and they hit a record number yesterday (DK), at 1,468.

Minister of Health Magnus Heunicke, along with several other officials, presented the new measures, which take effect on December 7. The restrictions apply to 17 municipalities, which on average have a higher incidence of infection and higher positive test rate than the rest of the country. Heunicke explained that the restrictions are necessary because the pandemic is expected to spread more easily during the winter months and people are also more likely to gather during the holidays. He acknowledged that people are tired of pandemic and the restrictions but urged everyone to comply during the coming month because of the prospect of vaccine becoming available early in next year.

Invitation to all-inclusive staycation © Grafik: Mads Peter Ogstrup Nielsen

Talking about you, young people
Heunicke focused on measures to contain the spread of the virus among students and young adults. The most striking trend in infection statistics in the past few weeks has been a disproportionate number of cases in the 10-19 and 20-29 age groups. This reflects the facts that young people circulate more widely and may be less concerned about the virus than older people because they experience milder symptoms and recover more easily. But Heunicke cautioned that even if they are not threatened as seriously, they still pose a risk to others, particularly during the holidays when families gather across generations. He issued what amounted to a plea to this group to moderate their behavior until the vaccine can be dispensed.

The main initiative in the new measures is therefore a campaign, beginning today, to test everyone from 15 to 25 in the metropolitan region before Christmas. That is around 200,000 young people. There will be mobile units visiting schools and universities as well as additional testing capacity at existing test centers. The tracing staff will be increased, and there will be better conditions at isolation facilities, including meals free of charge. Other measures include limitations on contact for schoolchildren in classrooms and a maximum of 10 in sports and other after-school activities.

Work at home, shop alone, party next year
Workplaces and higher educational institutions are urged to conduct activities online. Large retail outlets and shopping centers are to monitor customer traffic and allow more space per customer, and people are urged to do their Christmas shopping alone. There are selective restrictions and bans on visiting nursing homes that have seen outbreaks. People are urged generally to see as few others as possible, with a maximum of 10 at both private and public gatherings. 

Heunicke and the other officials noted that the situation in Denmark is not as dire and the new measures are not as strict as in several other European countries, but the country has recently had to deal with outbreaks at mink farms and in the western suburbs and it must remain vigilant. The main purpose of effort is to avert a surge of infections that could take place after people travel and gather for holiday shopping and gatherings.

Coronavirus DK: Resilience and its perils

Denmark was one of 30 countries that participated in a survey on mental health (DK) designed by the WHO, and the results are in. The study was conducted by Aarhus University. A questionnaire was sent to 2,000 people in two rounds. The first took place in late March, when the coronavirus was at its peak in Denmark - the reproduction rate and the number of deaths per day were at their highest. The second round took place one month later, when the number of infections and deaths were subsiding and the economy was reopening.

The subjects were asked how they felt when they got up in the morning, whether they were optimistic, and whether they felt rested and energetic. The findings from the first round were lower than historical levels. They showed more depression and anxiety. People were worried about both their health and their finances. The results from the second round were significantly higher. The subjects' psychological well-being had already begun to recover.

An adaptive species

While the higher second reading might not seem so surprising to a layperson, the amount and speed of the improvement impressed researchers. It made sense that people recovered their spirits, says Anders Korsgaard, a professor who works at Rigshospital’s Crisis Clinic: “We have an incredible ability to adjust and overcome violent events, crises and accidents. We also know that many people can have a good quality of life even with a chronic affliction such as a serious diagnosis."

Too much of a good thing

But in Denmark you rarely see good news without someone coming afterward with skepticism or dissent. TV2 News ran the headline “Danish coronavirus success can be the cause of a second wave (DK), says researcher.” The researcher is Allan Randrup Thomsen, who has been cited many times during the crisis. After seeing reports this week of crowds gathering at the resort town of Skagen at the northern tip of Jutland, he warned that the positive trend in Denmark may make people think the danger has passed and forget the precautions that have contained the virus thus far.

Randrup Thomsen cautions about the situation in Melbourne, Australia, which has had to implement a lockdown again after its initial success. He notes that crowds can be hotspots in Denmark as well as abroad, and people who are exposed to them should have themselves tested afterward; “In reality it is up to the people themselves what direction the epidemic will take in Denmark. The authorities can’t do much more.”

Mobile test center at a resort in northern Jutland. Photo: Henning Bagger © Scanpix.

1 million tested

Actually, Denmark’s testing program is going well. It has just passed the milestone of 1 million people tested (DK), about 20 percent of the population). Health officials are pleased with the progress: “We are well on our way to finding out how many infections we have in the country and we can find the new infections,” says  Jan Pravsgaard Christensen, Professor of Infection Immunology at University of Copenhagen.

Some 1.3 percent of those tested have been positive for the virus. The number of tests is actually around 1.3 million, since some people have been tested more than once. The number of new infections has been averaging around 22 per day, a manageable level, says Prasgaard Christensen; “We don’t need to worry unless we get several days with 50 to 75 cases.”

Coronavirus DK: Evaluating the lockdown, testing and PPE

Danish researchers are calling attention to a recent study showing the importance of strict lockdown (DK) measures in preventing coronavirus infections and saving lives. That might seem obvious, but this is the first time that researchers have put specific figures on the effects of the policy. They estimate that lockdowns from April to June saved 285 million people in China from being infected, 49 million in Italy, and 60 million in the USA.

“I don’t think that any human intervention has ever saved so many lives in such a short time,” said the leader of the study, Solimon Hsiang, Professor at the Geopolitics department at University of California. The study, which compares the lockdown periods with the trend in infections in individual countries, indicates that the countries that maintained lockdown conditions until the infection rate declined to a low level succeeded in controlling the virus.

Vindication for Mette

The study provides a justification for the Danish policy of maintaining a relatively strict policy even while the infection numbers were declining steadily. A comparison of a few charts shows that countries such as Denmark and Germany, which waited until the infection rate was low before relaxing restrictions, have flattened the curve, while others that did not introduce restrictions or that lifted them quickly, such as Sweden and the United States, have not yet stopped the spread of the virus.

Attracting test subjects

The government recently decided to suspend testing a representative sample (DK) of the population, and the decision drew criticism from researchers and one of the government’s supporting parties. The testing program began in April, when the government started reopening the economy. The number of people who responded to the invitation to be tested fell steadily in step with the decline in infections, and the sample became so small that researchers decided the program was not worthwhile. Of the most recent group invited to testing, only 12.9 percent reported to the country’s Test Centers.

“It is the cornerstone of the entire testing strategy,” says Peder Hvelplund of the Red-Green Party, “and it is an especially unfortunate time to stop the representative monitoring of the spread of infections.” Jens Lundgren, Professor at Rigshospitalet, agrees: “In the beginning of the epidemic, the problem was that we didn’t discover the spread until it was too late. So it’s a bad idea to relax the practice because the situation is peaceful now.”

The government has now responded that it will resume representative testing (DK) with a modification of the approach. Beginning in August, it will test the same control group as before for both coronavirus and antibodies. “We will thus inconvenience fewer people and kill two birds with one stone,” says Rasmus Horn Langhoff, healthcare spokesperson for the Social Democratic Party. Horn Langhoff believes that more people will respond to the invitation again because it includes an antibody test. “Perhaps we should use mobile units that drive out to people,” says Peder Hvelplund, who criticized the suspension of testing project, “or GPs can be part of the solution.”

Who decided whom to protect first

Meanwhile, the Ministry of Health and Health Minister Magnus Heunicke have come under criticism (DK) for a decision in early March to give priority for protective equipment to the Danish Regions over the municipalities. The Regions administer the public hospitals, and the municipalities administer the nursing homes. The equipment was intended for both the staffs and patients of the institutions.

Jane Heitmann, spokesperson for the elderly of the Liberal Party, says that it was very irresponsible to overlook the most vulnerable segment of the population in the nursing homes. Heitmann wants to know whether it was Heunicke himself who made the decision or officials lower down in the Ministry: “There may be good reasons for the decision. But I think that the elderly and the staffs out in the nursing homes need to know who made the decision and why.”

Coronavirus DK: Confusion over testing policies at the border

Several political parties are criticizing the government for not following stricter policies for travelers (DK) arriving in Denmark. They say that all people from countries with a high infection rate should present a recent negative test for the coronavirus or be tested on arrival. The current practice is inconsistent and insufficient, they maintain. Some arrivals from so-called “quarantine countries” with a “worthy purpose,” such as a job interview, must present a negative test. In other cases, people attending a funeral or a business meeting, for example, can enter freely. It is optional whether they submit to a test on arrival.

Are the testing facilities even being used?

Testing facilities were set up at Kastrup Airport in Copenhagen on June 15. Since then, some 25,000 people have entered Denmark there, but the number who have presented tests or have been tested is unknown. “We have said that Danes must comply with guidelines,” says Peter Skaarup of the Danish People’s Party. “And then we see, for example, a flight from Islamabad that brought a large number of infected people to Denmark.” Arrivals from high-risk countries should also be quarantined, added Skaarup.

Other parties agree that the current policy is not effective. Although testing is available at the airport, the facility is not prominent. All arrivals should be met by a test team that offers them a test, says Kirsten Normann Andersen, health care spokesperson for the Socialist People’s Party. They should be isolated until we know they aren’t infected, continues Normann Andersen, and that includes all travelers from other EU countries.

One test is not enough

But according to virologist Allan Randrup Thomsen, a negative test is no guarantee that one is free of infection. Tests may not be reliable in the country of origin, and one can become infected after testing negative. “To be certain, people should actually be tested twice at a few days’ interval,” says Randrup Thomsen. “And during that time they should be isolated, if this system is to function optimally.” Randrup Thomsen doesn’t think it is worthwhile to test travelers from all EU countries, however. If the infection rate is below the limit of 20 per 10,000, then the testing would involve much work and identify very few cases. The tests also produce some false positives.

Rasmus Horn Langhoff, health care spokesperson for the governing Social Democratic Party, agrees “with the intention to ensure that we protect Denmark from the coronavirus as well as possible. . . . I’m sure that we can do it better than we do today. And we very much want to look into this.”

Swedes sail to Denmark in vain

The confusion was no more evident than regarding the new regulations for arrivals from neighboring Sweden (DK). The country, which has followed a singularly laissez-faire policy regarding the coronavirus, has about the highest infection rate in the EU. It is one of the EU six countries that Danes are not allowed to travel to. There is an exception, however, for three regions in southern Sweden close to Denmark. Even residents of these quarantine regions are subject to certain requirements, however. If they do not have a valid purpose, such as work or family in Denmark, they must present a negative coronavirus test taken within the previous 72 hours. 

The Swedish media and a ferry company announced incorrectly that a negative test was not required, and the Danish police that manage border control at the ferry terminal in Helsingør had also received incorrect information at first. This led to chaos at the border as many Swedes on the ferry were turned away (DK) and had to sail back to Sweden. The ferry company, Sundbusserne, which had waited three months during the lockdown before opening the route, announced that it was canceling the route again.

Coronavirus DK: Summer traffic, youth programs, test milestone

Saturday was the start of the summer vacation period in Denmark. Schools had just closed for the summer, and the government approved travel to most EU countries. It was also skiftedag (changing-day) at summer house resort regions, the day of the week when  rentals start – last week’s renters leave and the new week’s arrive.

There was traffic advisory for the highways (DK) because many people have chosen to spend their vacation in Denmark and others are heading to Germany, one of the original three countries approved for summer travel. They’re driving because the destinations are close and there’s less risk of infection in comparison with sitting on a plane and passing through crowded airports. So they encountered lines on the main roads out of Copenhagen and at the German border.

Here you can read the official rules and guidelines for travelers entering Denmark (in English).

More soldiers and students

The Danish military services (DK) have increased the number of recruits they will take this year and next in order to give opportunities to young people who are not able to pursue other plans. After high school, many young Danes take a gap year to travel or study abroad, and this year they aren’t able to. Youth unemployment always rises in times of crisis, and it is important to help young people get a good start in life, said Defense Minister Trine Bramsen: “Training in the Defense Forces opens doors in life, and therefore I think we should contribute to the current challenge.” 

The number of additional spots is only about 150; it is limited by the availability of training facilities and instructors. Last year there was a total of about 5,000 recruits in the Defense Forces and the Emergency Management Agency. Earlier, Danish universities announced that they were adding 5,000 spots in technical and health care programs in order to accommodate young people who have trouble finding work during the recession.

More tests

More than 1 million tests (DK) for the coronavirus have now been performed in Denmark. In the beginning of the outbreak, people with symptoms were encouraged simply to self-quarantine, but after pressure from the WHO and others, the Health Authority stepped up its testing program significantly. It set up temporary tents in several cities and offered tests to anyone who suspected they had been exposed to the virus in an effort to gain a more complete idea of the extent of the infection.

The 1-million figure doesn’t mean that 1 million people have been tested, though, because some have been tested more than once. Around 800,000 people have been tested out of the population of 5.8 million. The testing has identified 12,675 cases, and the number of hospitalized patients has fallen to a mere 31.

More protest infections

One of the recent findings of the testing program is the infections stemming from the Black Lives Matter (DK) demonstration on June 7. The event caused concern because it was attended by some 15,000 people, many of them standing close together and chanting and few of them wearing masks. The number of new infections identified from the demonstration has remained low, however. It has now risen to 10 or 12, although it is unknown how many who attended have been tested. 

Coronavirus DK: Second wave or paranoid gossip?

There have been several local outbreaks of the coronavirus in the past couple of weeks since restrictions have been relaxed. More than 40 people at the Vendelbocentret nursing home in northern Jutland were infected. Entire school classes and their teachers have been quarantined, and half of the people who attended a large party at a restaurant in northern Zealand have tested positive. Is this the start of the second wave?

Most researchers and officials say no (DK). The number of new cases per day has been in the double digits for six weeks, usually below 50. That’s far below the peak of 473 on April 3. “As long as the virus isn’t eradicated, we must get used to these small outbreaks,” says Jan Pravsgaard Christensen, Professor of Immunology at University of Copenhagen. “Apart from the concentrated outbreaks, there are only minor instances.”

Mantra: Test, trace and isolate

“The problem with such infections is that if you don’t do anything, they have exponential growth,” says Claus Thorn Ekstrøm, Professor of Biostatistics at University of Copenhagen. The key is to trace contacts and break the chain of infection. Danes have behaved well, but we must not let ourselves be lulled to sleep before the “last, difficult mile,” says Thea Kølsen Fischer, head of research at North Zealand Hospital, who notes that a second wave arose in South Korea at a nightclub one weekend in May.

Known unknowns and unknown unknowns

The researchers warn that the summer season brings unknown factors that can increase infections: the heat, more socializing and drinking, tourists from abroad. “A superspreader may be someone who sheds a large volume of the virus or someone who speaks with many people,” continues Christensen. “No one knows for certain yet.”

Pandemic rumors

The researchers’ optimism may not give much comfort to some of the employees of Vendelbocentret, who have been subject to behavior "bordering on  harassment" (DK). One was told to leave a supermarket, and the husband of another was sent home from work. “We are both angry and disappointed that our employees are getting such bad treatment,” says Arne Boelt, Mayor of Hjørring Municipality, who notes that the staff are working under difficult conditions and taking many precautions. 

When people are insecure, they begin to seek information, says Michael Bang Petersen, Professor of Infection Psychology at Aarhus University, “and we know that they also have a tendency to get carried away with rumors.” The best protection against corona gossip, Bang Petersen advises, is for the authorities to give out as much information as possible.

Local suppression strategy

Since the outbreak, the municipality, which has also identified outbreaks at schools and mink farms, has taken intensive measures to contain the virus (DK). Nursing home employees work in heavy protective outfits. Some 20 medical students have been trained to conduct tests and have been sent to visit 3,000 elderly people who live at home. The municipality wants to test as many as possible twice, so the project will take two or three weeks to complete.

Coronavirus DK: Stopping infections at protests and mink farms

Minister of Health Magnus Heunicke says that the health authorities will issue guidelines for large political demonstrations (DK) in order to avoid the spread of the coronavirus. At least one person who attended the Black Lives Matter demonstration on June 7, along with 15,000 others, has tested positive, and other people who were part of the closely packed crowd are urged to be tested. 

Event arrangers “will get a very concrete evaluation from the Danish Patient Safety Authority on how they should conduct the demonstration purely from a healthcare perspective,” said Heunicke. He stressed that this measure will not abridge people’s constitutional right to stage political demonstrations, which are the only exceptions allowed to the restrictions on the number of people who may attend gatherings. On June 8 the limit on gatherings was raised from ten to 50.

More requests for tests

Since Heunicke urged demonstration participants to be tested, the number of referrals for tests has risen (DK). The day after, there were 400 more bookings than usual. “I thought it was an opportunity to take responsibility for what I did and to see whether or not I have been infected,” said one person at the Test Center, who had worn a face mask and tried to keep a distance from other demonstrators. Despite the rise in bookings for the tests in the capital region, the testing is still below capacity.

Flashmob with precautions

BLM was to hold another demonstration (DK) on Thursday, and the spokesperson for the organization, Bwalya Sørensen, says that it would use special measures to prevent the spread of the virus. It bought 250 face masks, it had lots of sanitizer, and it would divide participants up into groups of 50 or fewer. “We have chosen a flashmob instead of a demonstration,” said Sørensen. “We have done it simply to keep the number of participants down.” More than 100 people have signed up for the event. 

After the demonstration on June 7, Sørensen received criticism for issuing restrictions on the behavior of white people at the event. The Ritzau news agency wanted to ask her whether the guidelines would also apply at the new demonstration, but she hung up the phone.

Virus infiltrates key export product

A coronavirus outbreak has been identified in a new location, a mink farm in northern Jutland (DK). The Danish Veterinary and Food Administration has tested 34 mink and placed restrictions on the farm. The herd in question will be slaughtered, and the farm will be quarantined. Mink breeding is an important industry in Denmark, which is the largest mink breeder in the world, with almost 1,400 mink farms.

This is the first time the coronavirus has been discovered at one of them. The infection probably came from an employee or the owner the farm, say the authorities.There were coronavirus outbreaks at two mink farms in the Netherlands in April. 

“We will be completely certain that we do all that we can to limit the infection,” said Mogens Jensen, Minister of Environment and Food, “also among mink.” The ministry is investigating how the infection arose and preparing a testing strategy for other mink farms in the region, among other measures. Healthcare researchers are not worried (DK) that the infection will spread from mink to people and say that pet owners shouldn’t be afraid that their dogs and cats will make them sick.

Coronavirus DK: Testing for all while social distances shrink

Now anyone can be tested (DK) for COVID-19. Previously, only people with symptoms could request a test and they had to do it through their GP. On Monday, the Health Ministry announced that people who have only a slight suspicion that they have been exposed to the coronavirus can order a test on the coronaprover.dk website. The purpose is to track down as many infections as possible before they infect others, said Health Minister Magnus Heunicke. The new policy is possible because the country’s testing capacity has been expanded substantially in the past month. Up to 42,000 persons can be tested per day.

Wait your turn, boomer

In the first stage, young adults from the ages of 18 to 25 are eligible to make an appointment at one of the 16 Test Centers set up in large white tents located across the country. Later in the week, the system will be open for the rest of the population. People who are identified by contact tracers as having been exposed to an infected person will be referred for a test automatically. Heunicke cautions that people with a negative test result must still observe careful hygiene and social distancing because the result does not guarantee that someone is not infected.

Some 4,500 persons succeeded in booking a test (DK) on Monday. Many more people tried, even though they weren’t all in the right age group. By the afternoon, 25,000 people were waiting in line on the website. The Health Ministry has not announced when other age groups will become eligible.

Quarantine fatigue?

The expanded testing policy comes at a time when more people than ever are disregarding the government’s guidelines (DK) on social distancing. A new survey from Epinion and Aarhus University shows the largest drop in the number of people who avoid gatherings of more than ten people, the current limit, since the lockdown was imposed on March 13. The percentage who observed the limit declined from 85 percent on May 8 to 71 percent on May 15. The level had been stable in the range of 81-89 percent since March 20. More than 17,000 persons took part in the survey.

Unlocked and optimistic

One can also notice a difference on the streets and in shops, say observers such as retail salespeople. People are less careful to maintain social distancing and they are coming into contact with others they haven’t been exposed to before. The trend does not necessarily mean that people have become indifferent to the guidelines, however, according to Professor Michael Bang Petersen, who worked on the survey. More than half of those surveyed still wash their hands more than ten times a day. The main factor, says Bang Petersen, could be that the sphere of their daily routines has expanded with the lifting of lockdown restrictions and more people are back at their workplaces, for example. Others warn that hand-washing alone shouldn’t be considered an adequate precaution.

The exhortations by Prime Minister Mette Frederiksen and healthcare officials have always stressed that the lockdown exit process depended on the continuation of social distancing. The survey also shows that people are less worried and more optimistic about the country’s condition. 

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: Testing as a way of life

The debate over testing will never end. In a detailed opinion piece, Kenneth Jensen, head doctor specializing in anesthesiology and intensive therapy at Næstved Hospital, questions whether the Health Authority has the capacity to carry out its planned testing strategy (DK). A key problem for testing, he says, is that the number of asymptomatic infected people is three to ten times larger than the number who become ill and they are not being tested. Of those tested recently, only 5-7 percent have been found positive, so number of tests has relatively little value. In addition, the treatment of those who test positive is the same as for anyone else with mild symptoms – self-quarantine at home. The Health Authority’s new policy is that people who test positive must trace their recent contacts, who must all be tested.

Double the testing

Jensen calculates the number of tests required to implement the policy and points out a number of problems, for example the difficulty of identifying all relevant contacts and a seven-day wait for results. He estimates that at least 25,000 must be tested daily, whereas the maximum level thus far has been around 13,000. Jensen also says that spot checks must be made in order to find asymptomatic carriers, that healthcare staff must be tested regularly, and that results must be available within 48 hours. He concludes that because the number of infected persons is now low, more aggressive testing and tracing could reduce the spread of the virus while lockdown restrictions are further relaxed, but the window of opportunity will not be open for long.

No, 30x the testing

That advice is similar to recommendations that the Ministry of Health recently received from an unexpected quarter. On May 1, the Danish Broadcasting Corporation’s Detektor program interviewed Paul Romer, Professor of Economics at New York University and Nobel Prize winner. Romer has been advocating an even more aggressive test-trace-and-isolate policy in the United States in order to allow the economy to reopen quickly. His proposal is that 7 percent of the population should be tested per day until a vaccine is developed; that is, everyone should be tested every two weeks. That will give people the confidence to return to work without much danger of getting infected. In Denmark, this plan would require some 400,000 tests per day. Romer’s argument is that the cost of such extensive testing is much lower than the cost of idling the economy and the concomitant rescue packages, only about DKK 1,800 ($250) per person for a year.

Betting on free-market incentives

When questioned about the feasibility of the plan, Romer goes as far as to propose a bet to Minister of Health Magnus Heunicke: If Denmark offers a prize of, say, DKK 1.4 billion, to the first lab that can produce 1 million tests per day, he believes a lab will achieve this within six months. When asked whether such mass testing is really necessary, he cautions that there was an earlier, milder version of the corona virus and there may be an even more dangerous version in the future. So every country should invest heavily in testing capacity in order to be ready for the next pandemic.

Danish researchers do not think such a drastic suppression policy and extensive testing are necessary in order to continue the lockdown exit since the number of infections remains low and people have been able to adapt to social distancing and stricter hygienic habits. Heunicke didn’t respond to the wager. Instead, the Health Ministry made a referral to its press release about increasing the testing capacity as quickly as possible.

Not so bad after all

On Monday, the government released a chart showing that Denmark ranked second among selected countries in the number of tests it has conducted per million inhabitants. At 42,262, it was 3,500 behind Israel and nearly 8,000 ahead of the third-highest country, Ireland. The chart included the major European countries as well as some countries that have been most successful in stopping the virus – South Korea, Hong Kong, Singapore and New Zealand.

(NB: Coronavirus DK will take tomorrow off and return on Friday.)

Coronavirus DK: The "Covid bloc's" sickly dissent

On Wednesday Prime Minister Mette Frederiksen spoke (DK) during the question session in Parliament. She noted that Denmark’s strategy for controlling Covid-19 was working. The number of persons hospitalized has been cut in half in the month of April and now stands at 267. She said the government planned to announce next week a long-term plan for reopening so that citizens, businesses and other organizations know what to expect. It is negotiating the next phase of the reopening, which will begin on May 10, with the other political parties.

Inconsistent policy on reopening

The right-wing parties have been pressing for an earlier opening of businesses and other institutions. Jakob Ellemann-Jensen, the chairman of the Liberal Party, noted that people with medical conditions unrelated to Covid-19 were not able to get treatment because of a prejudice toward private hospitals on the part of the government. He said that the reopening has not been “controlled” as it was supposed to be. It has rather been arbitrary, with shifting policies, and businesses must guess the cabinet ministers’ mood if they do not want to be shamed for reopening even under legal conditions – an allusion to the controversy over IKEA’s reopening on Monday. Søren Pape Poulsen, the chairman of the Conservative Party, said that the testing policy has been confusing because it appeared that it was determined by a shortage of equipment rather than principle. 

When asked whether businesses would suffer if the relaxation of restrictions went too slowly, Frederiksen reasserted the government’s position that the process must be done gradually and carefully. She underscored the five main elements of the regimen: more extensive and aggressive testing and tracing; continued use of protective equipment, for example when people visit older relatives; frequent, thorough cleaning; routine social distancing in workplaces and schools; and prevention of “superspreading” in large gatherings such as concerts.

Illness close to home

In the middle of the session, Frederiksen suddenly left Parliament (DK) because she had gotten a message that a family member had fallen ill, and she was driven directly to Herlev Hospital. Later she posted a message on Facebook saying the situation was not serious and she looked forward to continuing negotiations the next day. She didn’t say whether the illness was related to Covid-19.

The “Covid” opposition

On Thursday, political commentator Lars Trier Mogensen, the editor of the newsletter dkpol, wrote that the current parliamentary opposition was the weakest (DK) in this century. He called it the “Covid bloc.” Danish parties are identified by single letters on voting ballots, and the right-wing parties’ abbreviations, beginning with C for the Conservative Party, by an odd coincidence happen to spell “Covid.” 

In his trenchant analysis, Mogensen wrote that it might seem as though the bloc had been bewitched and paralyzed by the corona virus because since the crisis Prime Minister Mette Frederiksen’s Social Democrats have become more popular than ever in recent times and their own standing in opinion polls has fallen sharply. But he hastens to add that the right wing’s decline had been underway before the corona virus came to Denmark, for several reasons. For example, the Social Democrats have moved to the right and preempted much of their traditional platform, leaving them with no distinctive positions on either cultural values or economic reform – in “psychic quarantine.” In any case, despite its complaints about the details and pace of the process, the bloc is unable to offer any meaningful counterpoint to the government’s handling of the pandemic.

Coronavirus DK: Self-tracing and self-regulating commerce

The Danish Health Authority is planning to change its corona virus testing policy (DK) so that infected individuals become responsible for informing people they have been in contact with about their condition. Søren Brostrøm, the head of the agency, explained that the Patient Safety Authority does not have the capacity to trace contacts because it is testing more people than before. He described the change as a “paradigm shift.” Contact is defined as sharing the same home or being close together for at least 15 minutes. This means that many more people, including those without symptoms, will be tested. According to Lone Simonsen, Professor at Roskilde University, this policy will allow the economy to reopen sooner and make it safer for people who have not been infected to move about in society. 

Others are more skeptical about the plan. Allan Randrup Thomsen, Professor of Virology at University of Copenhagen, is not certain that all infected people will be up to the task. He thinks that active tracing and increased testing will get rid of the virus sooner and allow additional businesses to open, but he also believes that every infected person should have a professional healthcare contact who follows up on the tracing. Martin Geertsen, the healthcare spokesperson for the Liberal Party, says that if the Health Authority wants to change its testing strategy yet again, it should make sure that the public understands its expectations because it has not succeeded in carrying out its earlier plans to test a much higher number of people. In the past week it has increased tests from around 5,000 to more than 10,000, it has said that, with the new Test Centers set up in tents at four locations in the country, it has the capacity to test up to 42,000.

Backdoor fashionistas

Three stores at a shopping center have discovered a trick that has allowed them to open (DK) up again. According to Peter Møller, who owns Herrehuset, a men’s clothing shop, if a store has a back door, it is allowed to open. The front entrance of the shop is closed and displays a sign directing customers to the back. Customers are happy that they can return, says Møller, and the shop has plenty of room so that people do not need to come close to one another. Theresa Berg Andersen, the business spokesperson for the Socialist People’s Party, thinks that the rules need to be clarified. Shopping centers are not allowed to open yet, but it is unclear whether the rule applies to individual shops. Simon Kollerup, the Minister for Business, Industry and Financial Affairs, did not want to comment on the case.

Coming to the furniture giant's defense

Yesterday I wrote about IKEA’s reopening and Simon Kollerup’s disapproval. Various right-wing politicians have now criticized Kollerup for interfering with IKEA’s business (DK). Alex Vanopslagh, from the Liberal Alliance Party, says that when IKEA has a legal right to open it is inappropriate for Kollerup to pronounce his personal opinion about the issue. Lars Løkke Rasmussen, former prime minister, also asks, in a tweet, whether citizens and businesses are supposed to follow the country’s laws or a minister’s intuitions. The right-wing parties demand that the government explain more precisely what rules apply to shops and other businesses. Commentators have questioned Løkke’s own intervention in the lockdown exit strategy debate as undermining the authority of the current Liberal Party leader, Jacob Ellemann-Jensen.

IKEA maintains that it was not subject to any specific order to close. It closed down voluntarily on March 18 and has now implemented precautions to prevent the spread of the corona virus. It has stationed staff throughout the buildings to ensure that customers keep a distance from one another. The police have also been on hand to monitor (DK) the long lines of customers waiting to enter the stores, and they report that people seem to understand the seriousness of the risk and are complying with the guidelines. 

Coronavirus DK: Don’t get careless, people

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.

Coronavirus DK: Healthcare staff still at risk

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.

Coronavirus DK: Gearing up for the long haul

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. 

Coronavirus DK: Taking precautions as business resumes

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. 

Coronavirus in Denmark: Testing, testing

Testing facilities are being set up (DK) in Fælledparken, Copenhagen’s largest park. They consist of a large complex of tents with three stations for testing people on foot and one drive-in station. There had been no announcement of this measure before police began erecting the tents, installing electrical cables and water pipes, setting up signs and rerouting traffic. The initiative was ordered by NOST, Denmark’s agency for coordinating activities during crises. It is part of the administration’s new testing policy. The facilities in Fælledparken are a prototype that will be copied afterward in other parts of the country.

Scaling up the data 

On Friday, the administration announced a new, comprehensive testing strategy (DK). As I wrote yesterday, the policy on testing has changed a few times and officials from the Health Authority and the Danish Regions have expressed a desire to test significantly more people than were being tested, at least twice as many. The WHO has urged Denmark to increase its testing. The testing will now include a representative sample of the population. Thus far it has been done mainly on people with severe symptoms. With the new policy, it will also be done on people without symptoms.

According to Allan Randrup Thomsen, Professor of Experimental Virology at University of Copenhagen, this will show the breakdown into people who are sick and hospitalized, people who are sick but not hospitalized, people who have been infected but are not sick, and people who have not been infected. That information will be important for the administration’s decisions on reopening parts of society and the economy. It would have been useful to have that information now, when businesses are resuming activities, as a baseline, said Thomsen.

Virtual solidarity 

Fælledparken is also the place where the largest of the International Workers’ Day gatherings take places on May 1. The Danish Trade Union Confederation recently announced that it was canceling this year’s event because of the danger of infection with the corona virus. The Confederation has now announced that the event will be held after all, by livestream on Facebook (DK). Lizette Risgaard, the chairperson of the Confederation, said that these times make it clear that we should be more attentive to those who have the least and must make greater demands on politicians. The event will last one hour. A number of well-known musicians will perform, and Prime Minister Mette Frederiksen has been invited to hold a speech. This will be the 130th year that the gathering has been held in Denmark. The tradition has been broken only once, in 1940, when Germany began the Occupation.

The tents for testing are reminiscent of those that are set up in Fælledparken every year for the DHL Relay Race, which draws thousands of participants. Today, Sunday, April 19, a “virtual race” called “Denmark Runs” (DK) will be held. It is a race that complies with social distancing rules. Participants will not run on the same route. They will each choose their own route, but they will run at the same time, 11:00 a.m. They can register online to run or walk either 5 km, 10 km or 21.1 km (a half-marathon). They are urged to wear the Danish colors, red and white, along with a number tags they can download and pin on their shirts. The event will be livestreamed, so the runners can follow along with others on their phones – as long as they remember to keep one eye on the traffic.