Coronavirus in Denmark: Beware the asymptomatic

The number of coronavirus patients hospitalized, in ICU and on respirators has been declining steadily since April 1. The number of deaths has been falling also, not every day but by half since April 1. Yesterday, Prime Minister Mette Frederiksen (DK) held a press conference to remind people one last time before Easter Sunday to keep their distance from one another and to stay home because it is the only way to stop the outbreak. Police Chief Thorkild Fogde made a separate announcement urging the same and warning that the police would be out and would give fines to people who didn’t adhere to the restrictions on social distancing and gatherings.

On Friday, Steen Bostrøm of the Danish Health Authority revised the Authority’s guidelines (DK) on the risk of infection from persons who are asymptomatic. Previously the risk was described as “unconfirmed” and “very small.” On the basis of international studies and the recommendation of Danish researchers, the risk level has been changed to “significant.”

Mixed opinions on reopening the schools

Schools and day-care centers are preparing to reopen on Wednesday. They expect to hold more classes outside, and some schools have asked to borrow large tents (DK) used for parties so that the classes can also be held outside if it’s raining. Teachers emphasize that children will need to understand they must keep their distance from others and not hug one another. Many parents look forward to a resumption of school and have confidence in the schools’ ability to operate under these extraordinary conditions.

Other reports are not so sanguine. The English-language daily The Local reports that many expat parents think that the schools are reopening too soon and have decided to keep their children home for a while longer. Some feel that all the social distancing that people have followed so far will be wasted and that infections will begin to increase again. Other express fears that the policy is a dangerous experiment in which parents and teachers as well as children risk being infected.

Two parents’ associations issued a protest (DK) have lodged a protest against the Health Authority’s guidelines on school attendance. The guidelines give permission to go to school to children who live in homes where someone has Covid-19 if the patient remains isolated. The two organization, Schools and Parents and the National Parents’ Association, warn that it is very difficult to ensure that children have no contact with an infected person and believe that children from such families should be kept home. Allan Randrup Thomsen, Professor of Virology and University of Copenhagen, concurs, citing the change in the Health Authority’s warning about the risk of infection from asymptomatic carriers.  Nevertheless, the Health Authority maintained its position that the risk of infection is minimal. If patients are unable to isolate themselves, they should speak with their doctor and get help from the municipality. The parents’ associations ask how it’s possible for a family member to isolate herself in a small apartment if she uses the same bathroom as others, for example. The Health Authority responds that patients must make sure to use sanitizer whenever necessary. The parents’ associations are not satisfied with that position. The Minister of Children and Education, Pernille Rosenkrantz-Theil did not respond to requests for an interview.

Quest for a “Danish” vaccine

TV2 News, citing a report in the daily Jyllands-Posten, reports that experts have criticized the administration (DK) for not giving more money to research to discover a “national vaccine.” They say there is a great potential that is not being utilized in a collaboration between pharma companies, hospitals and universities. Representatives of several parties agree and are willing to allocate more money to such projects. At least one collaborative project to find a vaccine is under way, and researchers complain that they need more funding. It seems odd that the report refers to a “Danish vaccine,” as though each country must develop its own vaccine and its citizens would not get vaccinated until a vaccine is produced locally. It would make more sense for researchers to collaborate across borders with their counterparts in larger countries and at larger organizations that have already allocated much greater resources to the project.

The Minister of Finance Nicolai Wammen says that the second quarter of 2020 will be the worst period in Danish financial history (DK). The administration expects GDP for the full year to fall 3 to 6 percent. The outlook is very uncertain, however, and depends to a great degree on developments in the countries that Denmark trades with. This forecast is more favorable than the estimates of a group of leading economists reported earlier in the week, which called for a decline in GDP in the range of 11-16 percent in the second quarter and 4-12 percent for the full year.

Coronavirus in Denmark: Preparing for reopening

Today is the beginning of the Easter holidays, when families gather from across the country for parties and people travel to their summer houses. Yesterday, the two main officials in the government’s crisis management team gave brief interviews in which they urged people to stick to the program.

Prime Minister Mette Frederiksen (DK) said that is the next phase will be just as difficult as the past month. It is important that the reopening takes place in stages so that the authorities can follow the development of infections and cautiously so that  the country does not risk wasting the progress made in the lockdown. 

 Director General of the Danish Health Authority Søren Brostrøm (DK) was asked whether he could promise that the infections will not get out of control after schools and day-care centers reopen next week. He warned that they could if everyone does not continue to follow the government and Health Authority’s recommendations on social distancing, washing hands, etc. Reiterating the PM’s exhortation, he said that people must demonstrate over the Easter weekend that they can maintain their discipline because it is our collective responsibility to make the controlled reopening a success.

Not so fast

Meanwhile, there are several other developments as the country moves toward the next stage of the epidemic. 

Most of the country’s 20 largest municipalities report that they are not ready to reopen (DK) their schools fully on April 15. The schools and day-care centers need to make new arrangements in order keep the children at distance from one another, to clean the facilities more frequently than usual, and so on. Fourteen of them say if they reopen on the target date they will need to do it gradually because they cannot manage the usual number of children.

A few days ago, there was a report on the percentage of blood donors who were found to have coronavirus antibodies, and it was used to make an estimate of the actual number of infections above the official figures. Since then there has been a boom in blood donations (DK) because people want to find out whether they have been infected and developed immunity. Officials explain that, while testing for antibodies gives a rough indication of the spread of the virus in the general population, it is not intended to determine whether individuals have antibodies and the individual tests are not reliable. The first results from testing on Monday were presented yesterday. They showed that 22 of 1,487 tested positive for antibodies. That would correspond to 127,000 infected persons in the country, as opposed to the 5,386 confirmed cases.

New monitoring tool

I wrote a few days ago that a group of IT people had launched a volunteer initiative to develop a self-reporting tool to monitor people’s symptoms (DK). Yesterday, the Ministry of Health unveiled its own solution for the same purpose, Covidmeter. As many people as possible are urged to report once a week on their health status, their contacts and whether they have been tested. The information will give the authorities a better idea of whether the level of infections is being kept at a manageable level. You can access the reporting app with a secure logon at sundhed.dk (DK), and the information is anonymized.

Hospitals may not be able to care for all of their patients because of extra cases of Covid-19. General practitioners have offered to take on patients and complete their treatment if they need to leave the hospital early. According to an agreement between the Danish Medical Association (PLO) of Zealand  and the Zealand Region, they will charge double their normal fees (DK). This has been criticized for being greedy and unsympathetic by spokespersons of the parliamentary parties across the political spectrum. A PLO representative defended the agreement as fair because of the degree of responsibility entailed and added that GPs have seen their income decline about 40 percent during the crisis.

European solidarity

On April 1, Italy sent a request to Denmark for help in managing the Covid-19 outbreak. Yesterday, the administration announced that it would send Italy aid (DK) in the form of a number of respirators, an unstaffed field hospital and EUR 1 million to be used for protective equipment and ambulance operations.

(Note: During the coronavirus crisis, this blog has become daily digest of news from Denmark. Since the situation has stabilized, it will probably also take an Easter break for the next couple of days unless there is something urgent to report.)

Coronavirus in Denmark: The reopening controversy

Prime Minister Mette Frederiksen has received criticism about the plan to begin ending the lockdown – from several quarters. It seems almost like a tradition. When a crisis occurs, there is unusual unanimity among the various political parties, and at the first sign that the crisis may be ending, they all come forth with criticism and alternative plans (DK). 

The right-wing parties complain about not being consulted about the decision to reopen Denmark for business. In an unusual move, former Liberal Prime Minister Lars Løkke Rasmussen (DK), in a column in the daily B.T., warned that the strategy could cause an economic crisis because many small businesses would go under if they were kept closed until May 10. Allan Randrup Thomsen (DK), a virologist at University of Copenhagen, thinks the plan to let young children return to school and day-care centers is a risky experiment because data on how many children are infected but asymptomatic are lacking. If the new policy causes problems, it may be mean that the complete lockdown needs to be implemented again and the full reopening is delayed. Some parents are reluctant (DK) to let their children return to school, some teachers think it will be difficult to manage them and expect to become infected themselves, principals and other leaders begin to plan all of the special preparations for minimizing contact and risk.

Statens Serum Institut estimates (DK) that the actual number of infected people is 30 to 80 times higher than the official figure. The estimate comes from tests of blood donors and studies in Germany and Iceland. SSI also expects that reopening schools and day-care centers will raise the R0 factor – the number of people that the average infect person infects – from 1.00 to 1.23 and will result in around twice as many patients in ICU.

An ultraconservative strategy?

The administration had been presented with three scenarios (DK) for ending the lockdown by SSI, documents show, and it chose to follow a policy that was even more limited than the most conservative option. The first scenario allowed for all higher educational institutions to open, for example, and it would cause the epidemic to peak in mid-May. The second option would have allowed restaurants and other businesses to open. This would have raised R0 to 1.36 and would have caused a peak in ICU patients in early June. The third would have returned Denmark almost to normal conditions, raising the limit on gatherings from ten to 50, and would have caused maximum pressure on ICUs in mid-June. All three scenarios assume that the population continues to practice social distancing.

To parents who are worried about sending their kids back to school and day-care, Pernille Rosenkrantz-Theil (DK), Minister of Education, says that school activities can be conducted in a safe, responsible way. She warns that if children are kept home, it will be counted as an official absence, except in cases where the household includes people in a high-risk group, such as the elderly. The administration’s plans take into account how children’s behavior differs from adults’, Rosenkrantz-Theil continues, and guidelines have been set forth: For example, they should play with as few others as possible (one or two) for as short a period of time as possible; play with the same ones, not new ones every day. Is that realistic?

Where is the wisdom of the crowd when we need it?

It is hard to identify patterns in the reactions to the plan on Twitter and Facebook: Some say it’s Russian roulette, how do you change a diaper from two meters away? there should be more testing; other say it’s too cautious, older children should be sent out first, they should be allowed to take exams, businesses should be allowed to open, etc. Some praise Mette Frederiksen, some criticize all politicians, some say that no one knows the best strategy, and many comments are of course criticisms of other commenters. I would guess that most approve that something is happening if only to end the uncertainty. See #coronavirusdk, #covid19dk, #genåbning (reopening), and on Facebook “Mette Frederiksen som statsminister.”

The administration announced that churches may hold services on Easter (DK) on the condition that they are conducted safely. No details were given. In this case the reaction on Twitter (DK) seems predominately negative. Many felt that the decision was the result of pressure from Marie Krarup of the Danish People’s Party and was irresponsible. 

Yesterday Norway announced (DK) that it would also begin reopening certain institutions one week after Easter. The rate of infection in Norway has been similar to Denmark’s, and its plan for reopening is also similar. 

Coronavirus in Denmark: Kindergartners appointed the avant garde

Mette pulls the trigger, or rolls the dice, or whatever metaphor you like – Denmark looks to become, along with Austria, one of the first Western countries to emerge from the lockdown. Gradually, as promised.

On Monday evening, Prime Minister Mette Frederiksen announced a plan to reopen (DK) the country for normal activities. The announcement came a full week before the end of the current lockdown period, which extends until after Easter. 

The first phase will be limited and will take place only on the condition that “everyone, everyone!” – said Frederiksen for emphasis – continues to follow the authorities’ recommendations on social distancing and other restrictions. The plan calls for a reopening of nurseries, day-care centers and schools up to the fifth grade on April 15 in order to allow parents to resume working. The schools will follow strict rules on cleaning and hygiene, the kids will be outside as much as possible, and adults will keep a greater than normal distance to them. The upper grades and other educational institutions will remain closed. Elementary school graduation exams for ninth graders are canceled.

The second important change is that employees in the private sector may begin returning to work. This will take place according to agreements with employees’ and employers’ associations and will also require upon more stringent health conditions than normal. People are still encouraged to remain home if they can. Public employees in non-essential functions will remain home.

Roskilde Festival canceled

The other restrictions remain in place, and the periods in which they apply have been extended. Large gatherings, such as music festivals, are banned through the month of August. The other closures are extended until May 10: public institutions, shopping centers, theaters, the national borders and gatherings of more than 10 people. If this first phase can proceed successfully, the administration will afterward consider opening restaurants and small businesses such as hairdressers. 

Frederiksen stressed that it was not administration’s strategy to pursue herd immunity. There had been some speculation that a reopening implied an attempt to build up herd immunity, but Kåre Mølbak, the head of Statens Serum Institut, clarified the issue by explaining that the objective is to control and delay the spread (DK) of the virus so that the healthcare system is not overwhelmed.

Day-care staff in hazmat suits?

Not surprisingly, this announcement caused some concern among teachers (DK) and day-care staff. They note that small children have trouble remembering to wipe their noses and sneeze into their sleeve, aside from keeping a distance to others. Staff want to get clear guidelines about how many kids can be close to one another, for example, and what symptoms will dictate whether they need to be sent home. Kåre Mølbak said he was not worried about the risk to children, since only around 1.8 percent of them test positive. The task of preparing for the reopening is up to the local institutions, and the chairman of the association of municipalities believes that the plan is feasible. 

Frederiksen received some criticism from the other political parties (DK). They were informed of the plan a few hours before the press conference but were not consulted about the specifics, as Jakob Ellemann-Jensen, the leader of the Liberal Party, believes they should have been. Kristian Thulesen Dahl of the Danish People’s Party thinks it might have been more viable for the older students, who are better able to keep a distance from one another, to take their exams. Jens Veirum, a head pediatrician at Aarhus University Hospital, defended the decision by saying that parents of young children are usually young and healthy and can withstand being infected.

What happened to Europe’s precautionary principle?

I find the announcement, which occurred around  the same time as a report that British Prime Minister Boris Johnson has been placed in intensive care, surprising and probably premature. I had understood the administration’s preceding announcement to mean that after April 13, it would consider options for reopening the country, not necessarily begin them immediately afterward. The plan for reopening will be encouraging for some people, but the situation changes so rapidly, with new findings about protection and possible treatments coming daily, that IMHO, it wouldn’t have hurt to wait a little longer at least before making this kind of announcement.

The main factor that argues for reopening is that the country has vacant capacity in ICUs and expects to maintain a buffer according to the trend in declining infections. But the greatest failing in its policies thus far is that it has not tested extensively. It therefore does not have a complete picture of the actual spread of the virus, and it has not traced the contacts of those with mild symptoms who have been told to self-quarantine. Healthcare officials have said recently that they intend to begin testing cases with mild symptoms as well as healthcare staff and people with severe symptoms, as advised by the WHO, but they have not begun testing more than 5,000 persons per day. I know one person who has had persistent cold symptoms for two weeks and has not been able to get a test.

Stealth infections

One issue that I don’t understand well enough to have an opinion on but that seems critical is whether children who don’t become sick can become carriers. Children have greater resistance to the coronavirus than adults, but is it a greater resistance to developing Covid-19 from an infection or a resistance to the infection itself? If they become asymptomatic carriers, they will probably infect their teachers and day-care staff and will certainly infect their parents. And if some of these parents are returning to their workplaces, they are likely to infect others before their symptoms appear. If children are not sent home until they develop symptoms, then at least the youngest will almost certainly have already infected others. This strategy does seem to be inviting infections, and the decisive factor will be how many of them will require intensive care. 

It will be interesting to see the reaction to the announcement on Twitter and Facebook.

Coronavirus in Denmark: Don't get careless

As the situation in Denmark continues to improve, people have the luxury of speculating about what will come next. 

Three of Denmark’s Regions, which manage the public hospitals, report that if the number of Covid-19 patients follow the original forecast from March 13, they wouldn’t have enough nurses in the intensive care units (DK). According to that forecast, the number of cases would peak in the two weeks after Easter. The trend has improved since that forecast, but the Regions have issued a warning that if it rises again, they will lack some 1,300 nurses and will need to train other nurses to work in ICUs. They have begun giving nurses a two-day course in case they are needed. Joachim Hoffmann-Petersen, chairman of the Danish Association for Anesthesiology and Intensive Medicine, says that it is too early to think of opening the country up for normal activities as early as next week, a possibility that Prime Minister Mette Frederiksen announced last week. It takes four weeks for a patient to go through a recovery cycle – one week from infection to showing symptoms, another week before becoming critically ill, and two weeks on a respirator until the patient is no longer infectious. 

With Denmark’s success in flattening the curve of cases, people have begun to debate how the process of reopening (DK) the country is to take place. The main strategy is control the number of infected persons so that the hospital system can treat them. If the ultimate objective is herd immunity, with more than 60 percent of the population infected and recovered and presumably immune, that is a long process. It will require exposing many people to the virus, and an estimated 2 percent will die. The WHO advises against pursuing herd immunity, instead recommending mass testing and isolation of those testing positive. And there is not yet evidence that those who recover will remain immune, says Astrid IIversen, Professor of Virology and Immunology at Oxford University and an advocate of WHO’S recommendation. If they are not immune, there is nothing to gain from seeking herd immunity.

Bad times make leaders popular

Mette Frederiksen’s approval rating has shot up (DK) during the crisis, almost doubling. In the beginning of March it was 39 percent, and a month later, it is at 79 percent. Voters on both sides of the political spectrum approve of the way she has handled the crisis. Her approval rating among voters from the left-wing parties is at 93 percent and from right-wing voters, 66 percent, while 9 percent of the latter think she is doing a bad job. Observers note that the plan to manage the crisis was agreed upon by all the parliamentary parties and that the increase may be temporary. The bounce is a typical polling phenomenon during a crisis, as can be seen even in countries where the leadership has done a terrible job addressing it. 

On Sunday evening Frederiksen gave an interview (DK) on DR, the country’s public broadcasting corporation. She reiterated the tentative plan to consider reopening the country next week but warned that it was necessary to continue following a strict policy of social distancing in order to be able to do so. She also stressed that the process would be very gradual and that the world after the crisis wouldn’t resemble the one before it. People would not be crowding together at concerts, for example, and schools and businesses might operate with staggered schedules so that fewer people were gathered together.

Minister for Health Magnus Heunicke made a post on Facebook (DK) urging people to stick to the program. Sunday was a warm, sunny day, and many people were out. Heunicke noted that some people have begun to slack off on the restrictions but it will not be possible to phase them out unless everyone cooperates.

Treating the virus like heartburn

Hospitals in Aarhus will begin testing a Japanese medication, camostat mesylate (DK), on Covid-19 patients. A study in Germany showed that it may slow the process of infection in cells, but this will be the first time it is used on a large number of patients. The doctors expect to be able to see whether it has favorable results after three months. It had some effect against SARS in 2003, Danish researchers at Aarhus University Hospital found. Its original purpose was to treat heartburn.

Coronavirus in Denmark: The next steps

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

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

Tests, masks and antibodies

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

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

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

EU collaboration problems revisited

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

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

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

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

Coronavirus in Denmark: Bending the curve

There have not been any dramatic developments in the epidemic in Denmark in the past few days, certainly nothing like the crises in Italy, Spain and New York. 

For three or four days, the number of new cases, hospitalizations and deaths in Denmark have been leveling off (DK) and have even begun to decline slightly. There have been instances of outbreaks with multiple infections (DK) at nursing homes and homes for people with developmental disabilities, but the curve is indeed flattening. In his latest press conference (DK), Søren Bostrøm, the Director General of the Danish Health Authority, called the situation reassuring but still serious. He stressed that the positive trend was the result of people adhering to the restrictions and that it was necessary to continue them if the country is to begin resuming normal activities after Easter.

Officials for organizations of healthcare personnel are concerned about not having sufficient supplies of PPE (DK) and being overly exposed to patients. The Danish Regions, which operate hospitals, and other authorities say they are working to improve the situation. Private companies are now producing equipment, and in another initiative, all patients who visit doctors are now to wear masks.

Data collection from Techværnet

A group of Danish IT startup founders, developers, programmers and others is creating a self-reporting tool to track the spread of coronavirus symptoms in the population beyond the official figures for infections. The organization is called Techværnet (The Tech Protection), and it consists of volunteers led by Martin Permin, CEO of Pelion. The tool is intended to give healthcare authorities better knowledge of the extent of the epidemic so that they can anticipate the demands on hospitals. A brief questionnaire will be sent to participants in a text message every day. Everyone, including people who are healthy, is encouraged to register on the website https://c19.dk/. Data are not being collected yet, but the Danish Ministry of Health has expressed interest in using the reporting tool. It can be used in other countries as well, and a few have already shown an interest. The code is open source, and it can be found on GitHub. More than 28,000 people have registered so far. 

Danish Lutheran churches (DK) are supposed to be suspending services, but some people still want to hold them on Easter. Although the bishops are in favor of finding solutions other than physical services, such as videoconferencing, the Danish People’s Party’s spokesperson for church affairs, Marie Krarup, believes that is not sufficient, especially at this time when people are anxious. The Liberal Party has suggested holding outdoor services. The debate continues.

Who’s right?

Health authorities in Denmark disagree with the WHO (DK) about some of its recommendations. This has caused some confusion, but it is not clear that the differences have great practical consequences at the moment. The WHO has wanted to test as many as possible. Denmark first tested only those with moderate or severe symptoms. Earlier there was some uncertainty about whether the WHO’s position applied to all countries or only those that had not tested extensively by mid-March. The Danish Health Authority now plans to increase the number tested daily after Easter. The WHO recommends total isolation for infected patients. In Denmark, some patients have been advised to self-quarantine at home. The WHO advises against a strategy of herd immunity because too many will be sick and will put pressure on hospitals. The director of Statens Serum Institute says that it will be necessary to achieve herd immunity, with up to 60 percent of the population gradually infected and afterwards immune. 

Coronavirus in Denmark: First do no harm

Let’s look at a different aspect of the situation today. Denmark has done fairly well in managing the coronavirus epidemic. I don’t want to give the impression that everything is going perfectly smoothly, though. It has also made some mistakes in the choice and timing of its emergency measures. But part of its relative success may be attributable to avoiding certain mistakes, for things it has not done.

It could be instructive to consider some things that are not happening in Denmark:

• Bureaucratic delays in starting testing.

• Doctors prohibited from complaining about lack of protective equipment.

• Workers fired for complaining about lack of soap.

• Spring breakers holding coronavirus parties where 20 or 40 get infected.

• Churches holding services in defiance of stay-at-home orders.

• Crowding in subway systems.

• People crowding together to watch the arrival of a hospital ship to treat people who don’t observe social distancing.

• A governor who says that senior citizens can be sacrificed so that businesses can reopen.

• A ban on KN95 masks from China despite shortages.

• States banning abortions during the crisis.

• A boom in gun sales and the prepping and home bunker business.

• A popular news outlet claiming that the virus – no more harmful than the flu – is being used “to score cheap political points.”

• A head of state denying that the virus is a threat and claiming it will disappear “like a miracle”; falsely claiming that anyone who wants a test can get one and that a vaccine will be ready “relatively soon”; defending using an ethnic epithet for the virus despite warnings that it encourages hate crimes; etc. etc. etc. etc.

• Death threats being made against an expert who finally persuaded the head of state that the virus isn’t a hoax.

• And this incident, reported on April 2, not on April Fools Day: An engineer derailed a train and drove it toward US Navel Ship Mercy, a hospital ship that had docked in Los Angeles. He said he thought the ship had “an alternate purpose … related to a government takeover…. People don't know what's going on here. Now they will.”

The head of state’s predecessor got a lot of criticism for his pithy foreign policy slogan – “Don’t do stupid shit.” Maybe it’s not such a bad operating principle in a crisis. 

Coronavirus in Denmark: Day 21 of the shutdown

On Wednesday, Søren Brostrøm, Director General of the Danish Health Authority, held a press conference. He reported that 224 healthcare employees (DK) in the Greater Copenhagen and Zealand Regions have now been infected with the coronavirus. They represent 10 percent of all the infected. This is becoming a critical factor in several countries. First, doctors, nurses and others on the front lines should be able to go to work without risking their lives. Second, patients should be treated by healthcare personnel who aren’t a threat themselves. Third, if many of the staff become sick and cannot work, the system may not be able to care for all the sick patients. Fourth, the staff should be tested regularly and frequently. And finally, the need for employees to take cautious measures can put pressure on the supply of personal protective equipment available. Brostrøm expressed concern about all of these things. The vice chair of the Regions reported that the supplies of PPE were not in abundance but were sufficient.

Brostrøm also reported that it will be easier for people with mild symptoms to be tested. They can be referred to testing directly (DK) from the GPs instead of being evaluated first by a hospital. People who live with a person in a high-risk group, such as those over 80, and people who live in close proximity to others, such as those in a nursing home, can also be tested. The objective is now to test 5,000 per day, but it has not been possible to process that number yet because of a shortage of tests. Brostrøm acknowledged that Denmark previously had not been testing as extensively as the WHO recommended and said that they were working hard to increase capacity.

Coronavirus in Europe

Neighboring Sweden has followed looser policy (DK) than the other Scandinavian countries. It has not required or advised people to stay at home and isolate themselves. This has caused concern in Denmark because many Swedes commute to work in Denmark over the Øresund Bridge and the ferry from southern Sweden. The coronavirus seems to have arrived in the country slightly later than in Denmark, and the figures on infection and deaths had been roughly comparable, until this past week. Yesterday, it saw 59 deaths, while 14 occurred in Denmark; Sweden’s population is about twice as large as Denmark’s. Sweden has now implemented tighter restrictions and made recommendations on social distancing. According to Søren Riis Paludan, Professor of Virology and Immunology at Aarhus Universitet, however, one cannot simply conclude that Sweden’s strategy was wrong. It may result in a steeper infection curve, achieve herd immunity sooner, and return to normal activity sooner. But it may also put greater pressure on the healthcare system.

Southern European countries that are suffering the most from the pandemic have been asking the other EU member states for help. This has become a sore point in the EU again, with some of the northern countries in particular rejecting calls for the issuance of EU “Corona bonds,” for example. Several Danish political parties are now discussing ways in which Denmark could aid Italy (DK), the hardest hit, either by sharing equipment, by sending healthcare workers, or by taking patients. This will probably be sensitive issue throughout Europe for some time to come as each country needs to ensure that it has sufficient capacity to manage the epidemic within its borders.

Postponing amusement but keeping the news channels open

Parliament passed a bill to give 180 million kroner ($26 million) to the media industry as partial compensation for a drastic drop in advertising revenue (DK).

Tivoli, the world’s oldest amusement park, which is located in central Copenhagen, was supposed to open today. It has postponed the opening (DK) until May 1. Did it really wait until now to make that decision? Will we be ready to share a roller coaster seat with others by May Day?

Deaths per day in the period March 23-31: 6, 6, 6, 10, 12, 9, 8, 10, 12.

The pattern of confirmed infections is similar: the curve is indeed flattening, but it has not yet flattened out. In all their announcements, Søren Brostrøm, spokespersons for police and other officials remind people not to relax the social distancing practices that are showing that they work.

Coronavirus in Denmark: The New Abnormal

Denmark is hunkering down for the long haul and waiting for the infections to start declining.

On Monday, Prime Minister Mette Frederiksen announced that after April 13 the government could begin consider opening up society and the economy. Statens Serum Institut recommended that the reopening take place in stages lasting at least one month so that the effects on the spread of infections can be measured. On Tuesday, the other parties responded (DK) to the announcement. They all endorsed the plan for a slow, gradual resumption of activities, some citing the needs of businesses and schools businesses and others emphasizing welfare services, according to their usual priorities.

On Tuesday, March 31, the Danish Parliament passed a bill (DK) allowing it to prohibit public gatherings of more than two people. It has not put this prohibition into effect yet but has simply given itself the option of doing so. The current limit for public gatherings is ten people, and the police have issued fines for violations. The two-person limit is in effect in neighboring Germany. The limit in Denmark would not apply to immediate family members but, as Minister for Health Magnus Heunicke explained, it would mean that grandparents could be prohibited from being with their grandchildren. The new law was adopted unanimously by the 96 MPs present. Only about half of the MPs, in proportional representation, attend proceedings at any given time in order to avoid proximity to one another.

Easter visits rescued

After questioning from opposition parties, one of the most extreme measures in the emergency plan has been moderated (DK). The police had been given authority to enter private homes if they had reason to believe that a gathering with non-family guests posed a threat of spreading the infection. The right-wing parties objected on the grounds that it went too far in violation of civil liberties. Such interventions by the police will now require a warrant. This has been settled just in time for the traditional Easter parties in which people travel across the country to be together with their extended families. 

The Greater Copenhagen Region reported that 114 healthcare employees have been infected (DK) with the coronavirus. Apparently none is seriously ill, and the situation has not caused great alarm. A spokesperson for the Region says that it is not unexpected and not considered serious and that there is sufficient staffing to maintain normal operations. Others are more concerned about the absence of qualified staff but add that preventive measures have improved since the outbreak began.

Managing the fallout

People who do not understand Danish are not getting enough information (DK) about the emergency measures, say the chairpersons of the residents associations at two of the largest housing complexes with many immigrant families. Posters have been set up in Arabic and Turkish, but that is not sufficient. Many of the residents do not follow Danmarks Radio, the state television network. Volunteers have translated some of the news, including the prime minister’s latest press conference, and made it available on WhatsApp. Representatives of the Ministry of Immigration and Integration say that it will work to improve the communications. There are an estimated 20,000 to 100,000 foreigners living in Denmark who have difficulty reading and understanding Danish.

Beer consumption (DK) in Denmark has fallen 40 percent during the lockdown, says the beer industry association. People are not drinking in bars and restaurants, at concerts and at sporting events; they are not entertaining at home. Some breweries depend on bars and restaurants for most of their sales, and they are close to going bankrupt. It is possible in some cases to adapt their equipment to produce hand sanitizer, but it does not have a significant effect on their revenues. This situation contradicts somewhat a report (DK) that I cited earlier of a very large increase in calls to the Alcohol Hotline during the crisis. The wine and liquor industry reports a much smaller decline in sales, so perhaps a partial explanation is that people are switching to the harder stuff.

Finally, Danish cultural institutions are getting killed (DK) because people cannot attend theaters and visit museums, and it’s the administration's fault, says a prominent spokesperson from one of the administration's supporting parties.