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.
Some persons who have recovered from COVID-19 are testing positive (DK) for the coronavirus. In a study at Aarhus University, around 20 percent of 200 persons tested still had the coronavirus four weeks after they had recovered from the illness. Martin Tolstrup, Lecturer in Infectious Diseases, made the study in order to determine whether the patients had antibodies against the illness and also tested them for the virus. “We are very surprised at the high number who are still positive,” he said. The patients no longer had symptoms, but the researchers do not know whether they are infectious or how to interpret the persistence of the positive results.
“I have reached out to several other researchers, but no one knows,” continues Tolstrup. “There are reports from abroad about a reactivation of the virus.” In South Korea, some recovered patients tested negative and later tested positive. Some of the patients in Tolstrup’s study had both antibodies and the virus. Tolstrup has not seen any indication that these patients are infectious, but others are conducting contact-tracing to see whether they have infected anyone recently.
But are they infectious?
Jens Lundgren, Professor of Infectious Disease Medicine at Rigshospital in Copenhagen, is not surprised by these results. “It can take up to four to six weeks before the PCR test [for the virus] tests negative. We do not expect that it is an infectious virus.” Lars Østergaard, Professor of Infectious Disease Medicine at Aarhus University, agrees but notes that it is not certain that recovered patients cannot infect others. “If they prove to be infectious, that of course raises new questions about how we contain the virus.”
Potential superspreader event
More people who attended the Black Lives Matter demonstration (DK) on June 7 have been found to be infected. At least three additional cases have been identified. Attendees had been warned of the risk of infection before the demonstration, in which 15,000 people participated, many standing very close together and chanting. After the demonstration, they were urged to undergo a test, but it is unknown how many have done so. BLM held smaller protest demonstrations in other Danish cities as well. Political demonstrations are exempt from the limit on the number of people who may gather together.
First Danish pet with coronavirus
Several days after reports of coronavirus infections at a mink farm in northern Jutland, the virus has been identified in a dog (DK) at the same farm. It is the first time a pet in Denmark is known to have been infected. The dog’s owner was instructed to treat the dog according to the same guidelines as the people on the farm. It must “avoid contact with other animals and people outside the household,” said Mogens Jensen, Minister of Environment and Food. The Ministry does not believe that the dog will spread the infection, “but we must keep it away from sick people in the family,” said Peter K. Embarek, an expert in food-borne illness outbreaks.
I wrote recently about two separate reports of outbreaks of the coronavirus in Hjørring in northern Jutland, one at a nursing home and another at a mink farm. Officials have now determined that it is the same mutation of the virus (DK) that occurred in both locations. “We have used our brand-new genetic tool on tests from the mink from the farm in Sindal, the mink breeders who are sick, and the residents of the nearby Vendelbocenter [nursing home],” said Anders Fomsgaard, a virus researcher at SSI, the agency for preparedness against infectious diseases. “And we can see that it’s the same virus. They have infected one another.”
Who infected whom, mink or man human?
Well, at least one of them infected the other, but Fomsgaard cannot yet say who had the virus first. All the mink on the farm, more than 10,000, were slaughtered. At the nursing home, 12 residents and 29 staff were found to be infected. The Hjørring municipality has also found infections among pupils at three schools. The pupils had connections to the other infection sites. Another mink farm in the municipality is being investigated.
Officials are trying to determine how the outbreak originated. The mutation appears to be unique to these locations. “It does not appear in the virus in other places in Denmark or Europe, so this apparently has not been a foreign infection,” said Fomsgaard. Several coronavirus outbreaks have occurred at mink farms in the Netherlands, and more than 500,000 mink have been slaughtered.
The app is finally ready
Last week the Health Authority launched an app (DK) intended to help people avoid the coronavirus and break chains of infection. The app, which is called Smittestop (Infection Stop), works by bluetooth monitoring. Persons who are infected register the infection in the app, and when they are within one meter of another person for 15 minutes, the other person receives a warning in the app. The notification does not identify the infected person by name.
Questions about effectiveness and privacy
The app, which was developed by Netcompany, was originally described as being “free” (DK). Later, its cost was estimated at DKK 10 million, and now it is up to DKK 20 million ($3 million) for use only during the last six months of this year. Its development was delayed because of a security feature on iPhones that blocked its functioning. Data from contacts is saved only on people’s phones and not in a large database.
Concerns about privacy have been paramount. Nevertheless, some people are skeptical about the app (DK), sometimes for contradictory reasons: It won’t work; it comes too late; people won’t use it; it’s the start of an authoritarian surveillance society. Why delay notification for 15 minutes when you might already have become infected?
1.6 million users and zero results
Several countries have had problems with contact-tracing apps. A similar app in Norway was discontinued because officials decided they should not gather a large amount of personal data when the number of infections was very low. More than 1.6 million Norwegians downloaded the app, and it has not led to a single positive coronavirus identification. But that’s not necessarily bad news; it’s an indication of how safe Norway is.
The good news couldn’t keep going forever. The infections and deaths have been declining steadily for six weeks; the country just saw its first day without a single death; the relaxation of restrictions is proceeding on schedule. But the virus has not been eradicated. The new policy of systematic contact tracing may be responsible for the latest discovery. Yesterday, the urology surgery ward at Lillebælt Hospital in the provincial town of Vejle had to close after a large outbreak (DK).
Last week two patients in the ward tested positive, and tracing showed that a total of seven patients and 14 employees in the ward were also positive. The hospital tested 120 patients who had been in contact with the ward in the preceding week, and five tested positive. Most of the infected persons have only mild symptoms. Thirteen of the infected employees have been sent home for self-quarantine and one has been hospitalized.
The bug beats the tests
The patients had tested negative before they were admitted, as had the many of the employees on their first test, said Mads Koch Hansen, the medical director of the hospital, who maintains that hospital had followed all of the relevant guidelines: “We can say who was the first to show symptoms and how early we identified the infection, but we cannot confirm it [the beginning of the infection]. . . . This shows how tricky an illness we’re dealing with when people can be infected without testing positive.”
Hospitals in the Southern Denmark Region had begun to return to ordinary operations because of the low number of covid-19 cases. After this episode, they will reconsider their procedures. The ward in Lillebælt Hospital will reopen tomorrow after it finishes conducting a thorough cleaning.
No second wave here
People had otherwise become optimistic about reopening businesses and resuming other activities. The day before, Prime Minister Mette Frederiksen had said in an interview (DK) that she did not expect that Denmark would need to conduct another lockdown in the autumn, when some researchers are predicting a second wave of the illness. The country had now developed an infrastructure that enables it to react quickly to new outbreaks, she said. Frederiksen has also become open to the possibility of differentiating the restrictions and reopening by region because of the large geographic differences in the spread of the virus, which has been concentrated primarily in Greater Copenhagen.
Entitled to binge
Some people say Danish teenagers are spoiled. There is a tradition here that just after their graduation ceremony, gymnasium (high school) students are drawn around town in a large open trailer, cheering and honking, stopping at their homes for snacks, and drinking and partying long into the night. There has been some concern that this year’s graduates may not be able to enjoy the custom because of the epidemic and the increased risk of its spreading under those conditions.
At the political debate on Thursday, several of the party leaders expressed a wish that this graduating class not miss out on this rich tradition (DK), even if it was borderline unadvisable because of the difficulty of following hygienic guidelines when drunk. One of them, Josephine Fock of the small Alternative Party, made the heretical suggestion that the rides could be held without drinking. After the debate, however, Fock clarified in a tweet (DK) that she had meant it only as an alternative if the rides would otherwise be disallowed and that she also preferred that they take place “WITH alcohol.”
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.
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.)
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.
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.
