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: Why aren’t face masks necessary? (cont’d)

(This is the second part of a two-part post.)

The position of the European Centre for Disease Prevention and Control is similarly nuanced. It recommends masks for healthcare personnel and persons with symptoms, and it says a mask also “may help reduce the spread of infection . . . from infected individuals . . . before they develop any symptoms.” On the other hand, 

There is conflicting evidence on the protective effect for the wearer. . . . Based on the lack of evidence, it has so far not been recommended that people who are not ill or who are not providing care to a patient should wear a mask. . . . There is no evidence that non-medical face masks or other face covers are an effective means of respiratory protection for the wearer of the mask. . . . In one study, cotton surgical masks were associated with a higher risk of penetration of microorganisms and ILI compared to no masks.

According to this view, the only strong reason for the general public to wear a mask is not to protect yourself but rather to protect others from the small risk that you have contracted the virus without showing symptoms – if you have not just tested negative for the virus or positive for the antibodies.

Social trust

One advantage in dispensing with masks that Denmark and the other Nordic countries have is strong social trust among citizens and trust in the authorities – things that in the US are at about their lowest ebb in at least 50 years. They have small, relatively homogeneous and relatively well-educated populations with a high standard of living as well as a tendency toward conformism. Most Danes who could not work from home were excused from work with compensation for lost wages. With fewer people forced to work, there were fewer to avoid on the street and in workplaces.

In Denmark now, you see very few people wearing masks on the streets or in stores, less than 5 percent and most of them elderly. People stand in supermarket lines at two-meter markers on the floor. If you meet someone in an aisle or on a stairway, you move as far apart as you can and perhaps turn your head aside briefly as you pass. There is little controversy about it. A small lockdown protest group gathers before city hall occasionally, but nobody has bothered to interview them more than once. The cityscape is looking almost normal again. People are back on the streets, and shopping centers are crowded. Maybe a society doesn’t need masks if people respect one another’s space. It is ironic that Americans need masks because they don’t trust one another and the masks only exacerbate the polarization and increase their distrust.

Consulting big data

On June 1, The Lancet published a large metastudy on social distancing and face masks that concluded that masks do indeed have a protective effect for the wearer. The effect of N95 respirators was greater than with surgical masks or cloth masks, but the effect of the latter was significant, although the certainty of the conclusion was rated as “low”: “For the general public, evidence shows that . . . face masks are associated with protection, even in non-health-care settings, with either disposable surgical masks or reusable 12–16-layer cotton ones.”

A few days later, the WHO recommended that face masks should be worn (DK) in public when social distancing is not possible, for example on public transportation and in shops. Previously, the organization had said there was not enough evidence to require the general public to wear masks. Its recommendation is that people wear a fabric mask, not a medical mask, and one with “at least three layers of different material.” At the same time, it recommended that people over the age of 60 with underlying health conditions should wear medical masks and also cautioned that masks alone are not sufficient protection. People must continue to practice good hygiene and social distancing.

Not about to start now

Danish researchers responded to the announcement (DK) by saying that masks are not necessary in ordinary situations and the evidence for their value is slight. They add that masks are appropriate in situations where it is difficult to maintain social distancing, such as airplanes and public transport, but they doubted that the Danish government and Health Authority would change their recommendations now, after the infections have been declining steadily without the use of masks. So let’s hope the reopening of sporting events and gyms this week doesn’t lead to a new outbreak.