If a country sees daily averages of new Covid cases eight times higher than it recorded two months ago and has triple the number of people hospitalized with the disease, what should be done?
Many experiences around the world would say that the correct booklet would include the reintroduction of restrictive measures, such as mandatory vaccination passports and the use of masks. Not in Denmark.
With a scenario like the one described above, the Nordic country decided to abolish all restrictions. National health authorities are still considering ending the national vaccination campaign in the coming months and no longer see the need to offer booster doses to those under 18, according to a statement issued this Friday (11).
There were three key factors that weighed on the decision of the Danish health authorities: 1) a large part of the national population has already received the booster dose; 2) the number of people with Covid hospitalized in ICUs has decreased; 3) the country’s overall mortality rate has been falling since the beginning of this year.
The proliferation of Covid cases leveraged by the omicron variant​ caused the just over 5.8 million inhabitants of Denmark to witness record numbers. After almost two years of recording a moving average of daily cases that rarely exceeded 3,500, the nation has recorded averages of more than 40,000 for more than two weeks.
And the numbers could be even higher. Even if the country tests the population massively — the average daily test is 26 per 1,000 inhabitants, compared to 0.3 in Brazil — the number of adult Danes infected in recent months could be double the official count, according to preliminary research conducted by the Statens Serum Institute, the main one in the country, and released on Thursday (10).​
As a direct consequence of the explosion of infections, hospitals have also seen the number of patients increase. There were 1,354 people hospitalized with Covid on Thursday, according to Our World in Data. The previous peak was 964 hospitalized in mid-January last year. But here, there is another important indicator: most of those hospitalized did not develop severe cases of the disease.
Denmark has about 33 coronavirus patients hospitalized in ICUs, a third of the number seen at other times of the pandemic. For specialists, this is a clear indication that the advance of vaccination, for now, has managed to create a cushion of immunity capable of mitigating the greatest impacts of the omicron — the strain is responsible for practically 100% of hospitalizations.
Almost 82% of the population has completed the first vaccination schedule, and the application of the booster dose has already reached 62% of Danes — in Brazil, 25% received it. Immunization is advancing even among children: 37% of children aged between 5 and 11 are on both doses; among adolescents aged 12 to 15, the rate is 78%.
The high vaccination coverage of these groups was one of the arguments presented this Friday to justify the possibility of ending the immunization campaign soon and not applying the third dose in children under 18 years of age. “This age group already has high immunity and little risk of developing severe cases,” reads the statement from the Danish Health Authority.
If in some countries it is the effects on the economy or the anti-vaccination movement that pressure governments to lift restrictions, in Denmark the greatest pressure came from the education system. That’s what it says to leaf Flemming Konradsen, professor and director of the School of Global Health at the University of Copenhagen. “They are seriously concerned about an entire generation missing out on education opportunities.”
The high vaccination coverage did not prevent the death curve from growing, but the main health institutes, such as Statens Serum, urge caution in analyzing the numbers. Over the last week, the average number of deaths from Covid was the same for Denmark and Brazil – considering, of course, the proportionality in relation to the two populations.
Local experts, however, have stopped looking only at the number of victims of the coronavirus to prioritize another analysis: that of total deaths in Denmark, whether from Covid or from other causes. And that figure has been falling steadily since the beginning of the year.
They claim that the vast majority of deaths from Covid occur in people with some pre-existing comorbidity and, in these cases, the disease caused by the coronavirus can even have a decisive impact on the cause of death, but its relative importance is difficult to measure. Thus, the statistics could overestimate the number of deaths.
The calculation is based on a system that analyzes historical data on deaths in the country to understand what the expected level of deaths is — this average sets the zero line. When the index reaches 1, for example, the reading is that there is a slight excess of deaths, but at a level that is not worrying. Above 2, excess deaths are configured. In the first week of 2021, Denmark recorded 7.13 on this scale. At the end of the month, it was 1.7.
For Professor Konradsen, analyzes of national data allow us to assess that 75% of deaths recorded by Covid in the country are of people who actually died as a result of the disease. The other 25% would be individuals who were with Covid when they died, but the cause of death may have been another.
With this equation, the expert says that an epidemiological scenario was created that allows the suspension of restrictions. Denmark would thus be prioritizing learning how to live with a virus that is here to stay.
“We need to monitor new variants, invest in protecting the most vulnerable, expand our healthcare system and improve vaccines. We have to understand that this virus will be with us forever,” says Konradsen. “And the price to pay for not learning to live with the virus is very high, especially for the youngest, who couldn’t go to school, and the mental health consequences.”
He makes the reservation, however, that what was observed in Denmark does not dictate a formula to be adopted in other countries. “It is not a pandemic, but more than 200 separate epidemics. In each country the scenario is very different. And the Danish experience cannot be replicated in a country where vaccination coverage is low, for example – in this case, the price would be too high in terms of mortality.”​
