COVID-19 pandemic in Denmark


The COVID-19 pandemic in Denmark is part of the ongoing worldwide pandemic of coronavirus disease 2019 caused by severe acute respiratory syndrome coronavirus 2. The virus was first confirmed to have spread to Denmark on 27 February 2020. As of 21 July 2020, there have been 13,302 confirmed cases. Among these, 611 people have died, 12,261 have recovered, and 18 are in hospital, including 4 in intensive care.
Denmark was among the first European countries to introduce lockdown measures, starting on 13 March. Following a period of consistent increase in hospitalisations, the number of people in hospital with COVID-19 has been falling since late March, with the number of cases in need of intensive care and ventilator being well below available resources. Starting on 15 April, a very slow and gradual reopening has been initiated, but if there are indications that the number of infections increases too fast, it will be reversed.
In an attempt to reduce the economic impact of the pandemic, the government has introduced large economic packages with the support of all parties in Parliament. Nevertheless, it has been estimated that there will be a decrease in Gross Domestic Product of 3–10% in 2020.

Background

On 12 January 2020, the World Health Organization confirmed that a novel coronavirus was the cause of a respiratory illness in a cluster of people in Wuhan City, Hubei Province, China, which was reported to the WHO on 31 December 2019.
The case fatality ratio for COVID-19 has been much lower than SARS of 2003, but the transmission has been significantly greater, with a significant total death toll.

Timeline

From late January to early February, several groups of Danish citizens were evacuated from China. All were placed in quarantine and tested; none were infected.

February 2020

;27 February
On 27 February 2020, Denmark confirmed its first case when a man named Jakob Tage Ramlyng from Roskilde tested positive for COVID-19 at Zealand University Hospital, Roskilde. He was an editor from TV 2 who had been skiing in Lombardy in Italy and returned to Denmark on 24 February. He had mild symptoms and was placed in home quarantine.
;28 February
On 28 February, a man who had returned home from a ski holiday in Northern Italy on 15 February tested positive at Rigshospitalet in Copenhagen and was placed in home quarantine. The case was considered problematic because of the relatively long time that had passed from the person returning to Denmark to him contacting the authorities, increasing the period where he might have infected others and potentially making it more complex for the authorities to locate everybody that had been in close contact with him.
;29 February
On 29 February, a man who had returned home from a conference in Munich, Germany, tested positive at Aarhus University Hospital. Another attendee at the conference in Germany, an Italian man later found to have COVID-19, is the presumed origin of the Danish man's infection. The Dane was an employee of the Department of Dermatology at Aarhus University Hospital. He had mild symptoms and was placed in home quarantine.

March 2020

;1 March
On 1 March, a person who was already in home quarantine was tested positive. The person had been in contact with the man tested positive on 28 February.
;3 March
On 3 March, five people that had visited northern Italy and one person that had visited Iran were tested positive for COVID-19. All six were placed in home quarantine.
;4 March
On 4 March, there were four more cases confirmed in Denmark and the first confirmed case was reported from the Faroe Islands, bringing the total number of confirmed cases to fifteen. All the new cases were placed in home quarantine. The case in the Faroe Islands was a man with mild symptoms that had returned home from a conference in Paris, France.
;5 March
On 5 March, there were five new confirmed cases. One of the cases was former Danish national football player Thomas Kahlenberg, who had been infected at a birthday party in Amsterdam, the Netherlands. This forced the Danish clubs Brøndby and Lyngby, and the Dutch club Ajax to place some of their players and coaches, who had recently met with Kahlenberg, into quarantine. Kahlenberg described his symptoms as similar to a flu, and he was placed in home quarantine. On the same date, the first Dane that had been confirmed infected on 27 February also became the first Dane to be declared fully recovered.
;6 March
On 6 March, there were three new confirmed cases, including one in the Faroe Islands.
;7 March
On 7 March, there were six new confirmed cases. Most Danes confirmed to be infected with SARS-CoV-2 had contracted it abroad, and they had infected a few people in Denmark.
;8 March
On 8 March, there were eight new confirmed cases, including a patient first admitted to North Zealand Hospital Hillerød with symptoms resembling pneumonia. Another mild case where the patient was placed in home quarantine was the first person confirmed to have COVID-19 in the North Jutland Region, meaning that all five regions of Denmark now had cases.
;9 March
On 9 March, there were 53 new confirmed cases, bringing the total in Denmark to 90. Among all those infected, six were in hospital, but none of them required intensive care.
;10 March
On 10 March, there were 172 new cases, bringing the total in Denmark to 262. Among the new cases was one patient admitted to hospital, bringing the total to seven.
;11 March
On 11 March, there were 252 new cases, bringing the total in Denmark to 514. One of the cases, who likely had become infected at a meeting where another attendee was infected, caused particular concern because the person worked in a nursing home. As a result, the elderly at the nursing home were isolated in their own rooms, they were closely monitored, and tests were being performed. Among all the infected people in Denmark, ten patients were in hospital, including two in intensive care.
;12 March
On 12 March, there were 160 new confirmed cases, bringing the total in Denmark to 674. Among these were two at the nursing home where the elderly had been isolated and closely monitored since the day before because an employee was tested positive. On the same date, former footballer Thomas Kahlenberg announced that he had been declared fully recovered, making him the second publicly known recovery in the country. Whereas many early cases were related to people returning from ski holiday in northern Italy, many cases discovered later were related to people returning from ski holiday in Tyrol in Austria.
An 80-year-old man with a history of heart disease tested positive after having a heart attack and dying in the North Jutland Region. Although unclear whether the virus had played a role in it, the authorities counted it as the first fatality related to COVID-19 in Denmark.
;13 March
On 13 March, there were 127 new confirmed cases, bringing the total in Denmark to 801. In addition, the Faroe Islands had their third confirmed case. Among all the infected people in Denmark, 23 were in hospital, including 4 in intensive care.
;14 March
On 14 March, there were 26 new confirmed cases in Denmark, bringing the total to 827. Another 6 were confirmed in the Faroe Islands, bringing the total to 9 in this archipelago. The second person died from COVID-19 in Denmark, in the Capital Region. It was an 81-year-old that was already weakened due to other serious diseases.

April 2020

;6 April
On 6 April, Prime Minister Mette Frederiksen announced what she called the "first phase" of the reopening of Denmark: she announced that nurseries and kindergartens would be opened again on 15 April and that folkeskole would be reopened for pupils in years 1–6 ; furthermore, the final exams for pupils in year 10, the last year of the folkeskole, were cancelled. Restaurants, cafés and hairdressers are to remain closed until 10 May, and larger gatherings will be prohibited until September.
;10 April
The Danish Health Authority changed its guideline to say that asymptomatic people can transmit the disease, from saying that the risk was "unconfirmed" or "very small" to "significant". As documented by Berlingske, there has long been consensus among experts that this was indeed the case, and the health authority was unable or unwilling to defend their previous claim. It had previously been strongly criticized that workers in a retirement home were asked to continue working after having had contact with sick persons, again against all expert advice, and apparently because of Danish Health Authority guidelines.

May 2020

;12 May
On 12 May, Prime Minister Mette Frederiksen announced a new offensive testing strategy, which aims to "strengthen the contact tracing". The national testing strategy is based on three essential elements: testing, tracing and isolation. The new testing strategy takes a more aggressive approach with broader testing of both symptomatic and asymptomatic individuals. The new testing strategy also charge the local municipalities with providing holiday centres, hotels or the like, as a voluntary offer of self-isolation.
As a part of new offensive testing strategy, the Prime Minister presented a new government agency. The agency will be organized under the Ministry of Justice. The Ministry of Justice said, that experience in dealing with COVID-19 in Denmark shows that there is a need for a consistent and transverse coordination and support of government efforts, for example to ensure the supply of socially critical infrastructure. The implementation of the new offensive test strategy, the detection of infection and better possibilities for self-isolation require a massive support from, among other things, the use of the test-system, security of supply and practical operation. At the same time, there is a need for health authorities in such a situation to focus on the core tasks of health care. In order to strengthen more permanently the overall regulatory effort, this new government agency was established. The agency is expected to be fully operational in August 2020.

Testing, treatment and preventive measures

In Denmark, Aalborg University Hospital, Aarhus University Hospital, Hvidovre Hospital, Odense University Hospital, Rigshospitalet and Zealand University Hospital Roskilde have sections prepared for serious cases of COVID-19 that require treatment, as well as patients that are elderly or have pre-existing conditions and therefore are particularly vulnerable to the disease. Other hospitals were required by the regions to prepare lists of non-essential operations that can be postponed. This would allow the manpower, space and equipment to rapidly be allocated towards an outbreak of coronavirus. On 11 March 2020, the first hospitals began postponing non-essential operations as a preparation for future cases of COVID-19, and on 17 March this was done in all hospitals nationwide. Initially, all testing of samples for SARS-CoV-2 was performed at the Statens Serum Institut, but on 25 February this was expanded to all the hospitals that also had sections that were ready for treating serious cases of COVID-19. In early March, other hospitals started to perform the tests. On 6 March, Aarhus University Hospital made a "drive-through" test facility where a person can be tested without having to leave his/her vehicle, but people using it still have to phone their personal doctor or the doctor-on-call for instructions first. On 10–11 March, Aalborg University Hospital, Regionshospital North Jutland Hjørring and Zealand University Hospital Roskilde introduced "drive-through" test facilities.
On 11 March, the Danish Health Authority announced a change of strategy, which means that only people hospitalised with severe signs of respiratory illness or shortness of breath, will be examined for COVID-19 infection. As a consequence, it is suspected that COVID-19 cases in the country are underreported, and health officials expect the actual number to be significantly higher than the current amount of confirmed cases.
According to the guidelines by the Danish Health Authority, all infected people that have no or mild symptoms and are not considered particularly vulnerable are placed in home quarantine with daily contact from health professionals. Anybody that has been in close contact with someone known to be infected with SARS-CoV-2 is also placed in home quarantine. As of 2 March 122 people were in home quarantine in Denmark because they had been in contact with an infected person in Denmark or abroad; by 12 March this had increased to 1366 in Denmark and 31 in the Faroe Islands. It is expected to further increase as a result of new cases of COVID-19. Should it become necessary, each region has its own facilities for quarantining at least one thousand people, and if containment of SARS-CoV-2 through normal isolation fails, more drastic measures can be implemented using the Epidemic Law.
Initially, the authorities strongly recommended that all events with more than one thousand people be cancelled or postponed, but on 11 March the limit was lowered to one hundred people; this recommendation covers March, but can be extended if necessary. Among others, football and handball matches were without spectators or entirely cancelled, the Dansk Melodi Grand Prix did not have an audience, concerts and conferences were cancelled or postponed, and the Euroschoolsport tournament at Esbjerg High School, where students and teachers from much of Europe were supposed to meet, was cancelled. The Folketing cancelled some of its regular meetings and hearings, and when voting a clearing system will be used to avoid having more than 95 members in the main chamber at any one time.
On 10 March, the authorities recommended that people using public transport attempt to reduce their travel in peak hours, additionally encouraged them to walk or cycle shorter distances instead if possible, and advised any persons feeling sick in any way or suspecting that they might have been infected against using public transport. In an attempt to increase the space between people using public transport, more buses and trains were added to the schedules, and there were stricter limits on the number of passengers allowed in each. From 12 March, all intercity train rides were restricted to people with seat reservations.

Lockdown

Starting on 13 March 2020, all people working in non-essential functions in the public sector were ordered to stay home for two weeks. In the private sector, employers are urged by the authorities to allow their employees to stay home in the same period and work from there if possible, although this should not affect functions that are essential to the society. On that same date, all secondary education, universities, libraries, indoor cultural institutions and similar places were closed, initially for two weeks. Starting on 16 March, all primary schools, daycare and similar places were also closed for two weeks. Virtual schooling was used to some degree. The municipalities are establishing limited daycare for children where the parents could not stay home and take care of them. Because of the vulnerability of elderly to COVID-19, it was strongly recommended that grandparents should not take care of their grandchildren.
Starting on 18 March at 10:00 AM, a number of further restrictions were activated: it became illegal to assemble more than ten people in public, all shopping centres and stores with close contact such as hairdressers and nightclubs must be closed, restaurants can only serve take-away, and other businesses must ensure that there is enough space between customers.
Unlike previous restrictions on the number of people allowed to assemble, the new restrictions are not merely a recommendation, and breaking the new restrictions is associated with fines of DKK1500. On 23 March, it was announced that the above lockdown measures would be extended for a further 2 weeks, and be in place until 13 April.
In late March, authorities acknowledged that the strategy of mitigation had partially worked, but had been less successful than the mass testing in China and South Korea. Efforts were increased for immediate testing, mass testing and local rapid testing for individuals.

International travel, quarantine after return and foreign visitors

The Danish Foreign Ministry has changed its travel guidelines several times during the coronavirus outbreak. During the peak of the outbreak on the Chinese mainland, Iran, the regions of Aosta Valley, Emilia-Romagna, Lombardy, Marche, Piedmont and Veneto in Italy, Ischgl in Tyrol of Austria, and San Marino, all travel to these places was advised against, and during the peak in the rest of Italy, the rest of Tyrol in Austria, Madrid, Basque Country and La Rioja in Spain, parts of Germany, parts of France, parts of Switzerland, and Daegu City and North Gyeongsang Province in South Korea, all non-essential travel to these places was advised against. On 13 March, all non-essential travel to the rest of the world was advised against because of the spread of the outbreak, restrictions introduced on foreign visitors, their healthcare system's ability to handle a major outbreak or other reasons indirectly related to the coronavirus pandemic. On 13 March, the authorities recommended that all Danes that were abroad return to Denmark as soon as possible. From 14 March to 13 April, all Danish borders were closed, with exceptions made solely for the transport of goods, people with an important reason for visiting, foreigners leaving Denmark, and Danes and people with a residence permit returning to Denmark.
On 3 March, the Danish government required all healthcare workers who had travelled to a high-risk region to self-quarantine themselves for 14 days after returning to Denmark; this was done to reduce the risk of vulnerable people getting infected. As of 9 March, the list of high-risk regions included mainland China, part of South Korea, Iran, Italy and the Austrian state of Tyrol. Other people who had visited these high-risk areas were advised against visiting hospitals or nursing homes for 14 days after returning to Denmark, and it was recommended—but not required—that they also stay home from work for 14 days. This recommendation was supported by the employers' organisations in the country, such as the Confederation of Danish Industry and the Danish Chamber of Commerce. Kommunernes Landsforening, which represents the municipalities in Denmark, made similar recommendations for all children that had visited a high-risk region; it recommended that they stay home from school, kindergarten, daycare and similar places for 14 days after returning to Denmark. Foreigners that arrive in Denmark from a high-risk region were urged—but not required—by the authorities to follow the same guidelines as Danes, and localities for quarantining were made available for people that did not already have a suitable locality.
Starting on 9 March, passengers on flights that originated in a high-risk region were not given access to Danish airport buildings, but instead were picked up directly from the plane and transported by special buses that could drive them to their home or other locality of quarantine. From 11 March onwards, all flights from high-risk regions were cancelled.
The postal service suspended international mail outside the European Union to all but 17 countries due to lack of transportation, and suspended gathering of signatures on delivery.

Statistics

As of 24 April, Denmark has a per-capita rate of 1,782 positive coronavirus cases per million people. The definition of being 'recovered' means the number of patients no need of emergency service 14 days after being diagnosed. Patients with mild symptoms are not being diagnosed.
In the daily report published by Statens Serum Institut that covered all 785 confirmed cases in Denmark as of the morning of 13 March, it was reported that 67.8% were male and 32.2% female. In terms of age, 10 were 0–9 years old, 30 were 10–19 years old, 134 were 20–29 years old, 135 were 30–39 years old, 253 were 40–49 years old, 159 were 50–59 years old, 50 were 60–69 years old, 5 were 70–79 years old, 7 were 80–89 years old, and 2 were 90+ years old. In terms of origin, 265 had been infected in Austria, 60 in Italy, 2 in Germany, 1 each in Iran, the Netherlands, Spain and the United States, and 158 had been infected within Denmark, while data was pending for the remaining. In terms of residency, 324 live in the Capital Region, 103 in Region Zealand, 130 in the Region of Southern Denmark, 175 in the Central Denmark Region and 47 in the North Jutland Region, while the remaining 6 are currently in Denmark but live abroad.