Europe Versus Coronavirus - Putting the Danish Model to the Test

From suppression strategy to mitigation strategy

Denmark's response to the spread of the virus was to first adopt a "suppression" strategy that included social distancing, lockdown for the entire population and screening of at-risk individuals. The aim was to curb the expansion of the virus and avoid overburdening hospitals. 

By gradually easing societal restrictions, Copenhagen has been moving towards what health authorities call a "mitigation strategy" aimed at reducing the effects of the COVID-19 outbreak. As a study by the French research institute INRAE points out, the purpose of this strategy is to limit the spread of the virus through controlling it. Danish health authorities have stressed that this strategy "aims to ensure that we will get through this epidemic without jeopardizing the Danish welfare state." 

This easing of restrictions has been implemented alongside a widespread testing campaign that was announced by the Danish Ministry of Health on April 20. It aims to obtain a "representative sample" that will provide a clearer picture of the rate of infection in Denmark. On April 26, the country already had five testing tents and eleven more due to be set up. 

Scandinavia, a firm yet flexible approach 

The Scandinavian response to the COVID-19 crisis has offered up two different approaches. Denmark and Norway chose to take restrictive measures early on. At the same time, Sweden adopted a strategy closer to that of "collective immunity", a term not officially used by Stockholm in its communications. By encouraging civic responsibility and respect for health measures, an appeal to common sense was used instead of an enforced lockdown. Moreover, shops and cafes remained open, while only middle schools, high schools and universities closed their doors. 
 

Denmark's health care system: the backbone of a successful response to the crisis?

When the Danish health care system was hit with the COVID-19 crisis, its response was to adapt quickly. This is a relatively positive result in a country with universal access to health care and where, according to the Health Consumer the Danish state funds 85% of costs, compared to 78% in France, for example. 

In hospitals, dedicated units were set up in each facility and additional resuscitation beds were provided. Medical students helped support the teams already in place and retired doctors were called in to help.

The numbers hospitalized went from slightly over 500 during the peak on April 3 to 249 on May 1, which included 61 patients in intensive care. While successfully containing the spread of the virus, Danish hospital services did not become overburdened, which might otherwise have been a concern given the relatively low number of hospital beds. For example, a 2018 OECD study showed that Denmark had 2.5 beds per 1,000 inhabitants, compared to 6 per 1,000 in France. According to the scientific publishing house Springer Nature, the number of intensive care beds is 6.7 per 100,000 inhabitants compared to a European average of 11.5. 

These figures can be explained by the specific way in which the Danish hospital system functions. Following administrative reforms in 2007, the system is now highly centralized. Small hospitals were closed and a university hospital - with specialized emergency units and state-of-the-art digital equipment - was established in each of the five Danish regions. The goal was to reduce the time spent in hospitals by providing more effective diagnosis and treatment. Primary care physicians also play a pivotal role in the Danish hospital system. They are the ones who send patients to the hospital, as Danes only go to the emergency room when they get a referral. 

A test for social and economic models

The COVID-19 crisis has put all existing economic and social models to the test, and the welfare state is no exception. This governance model, characterized by active state participation in the social and economic spheres, has made it possible to quickly provide various forms of assistance to the Danish public, such as state aid for businesses and universal access to health services almost entirely covered by the state. However, this kind of social protection comes at a price. Denmark has one of the highest tax rates among the OECD countries. In 2018, it came second after France, with a tax-to-GDP ratio of 44.9% compared to an OECD average of 34.3%. 

Regarding employment, Denmark took quick action to utilize remote working before the lockdown came into force. It has been common practice in the country for many years. For example, government employees were invited to work from home, with full pay. This represents a large proportion of the population: according to the latest OECD figures, there are 142 public officials per 1,000 inhabitants in Denmark, compared to 89 in France, for example.

On April 18, the Danish government approved a new financial aid package of approximately EUR 13 billion to support companies that faced a decline in their revenues because of the lockdown measures. This assistance was intended to help prevent job losses and cover fixed expenses. Self-employed individuals and freelancers were also offered a compensation scheme. It also allowed companies to claim back some of the VAT payments made last year, in the form of an interest-free loan. The state is expected to finance these measures by issuing government bonds. In total, the Danish authorities will eventually release EUR 60 billion for businesses, amounting to 2.6% of GDP. 
 

A multitude of scenarios for the future of Denmark's economy

Health economists are now examining the lockdown measures, which are regarded by some as excessive. CEPOS, an independent Danish think tank promoting conservative and classical liberal ideas, has pointed out that treatment costs for COVID-19, where the mortality rate is relatively low, are far higher than for other commonly treated conditions. This skepticism was shared by Lars Lokke Rasmussen, former Prime Minister and leader of the Danish Liberal Party until 2019, in an op-ed for the Danish tabloid B.T. Referring to a tweet from the American President, Rasmussen wrote, "This rarely happens, but I agree with Donald Trump: the cure must not be worse than the problem!" While restrictions are being eased in phases, some political parties, and in particular the Liberal Party, believe that the process should be sped up to revive sectors vital to the economy, including reopening shopping malls and restaurants.

The Danish public affairs institute De Økonomiske Råd believes that the country faces two possible scenarios. The first scenario takes an optimistic view of how COVID-19 will impact the economy: fairly rapid stabilization with a 3.5% decline in GDP. With the second, more pessimistic scenario, a 5.5% decline in GDP is predicted. By comparison, in the fall of 2019, it was predicted that Denmark's GDP would increase by 1.9% in 2020. As a solution, De Økonomiske Råd has suggested reducing the tax on electricity and increasing taxes on CO2 in order to stimulate the economy and drive environmental change.

In Sweden, the anti-lockdown strategy has certainly resulted in fewer short-term consequences for the economy. It has, however, resulted in behavioral changes: shops and restaurants are still open but are frequented less and less. International trade has also been slowing down. But it is unclear whether Sweden will fare better economically in the long run than its Danish neighbor.

The closure of large sections of society has undoubtedly cost the Danish economy dearly. Nevertheless, the root of the issue is also the faith that Danish society places in its institutions and decision-making bodies. 

Reaffirmed trust in institutions 

According to a Voxmeter opinion poll for the Danish news agency Ritzau published on April 3, support for the ruling Social Democratic Party had increased by 2.5%, placing them 8% above their results of the last parliamentary elections in June 2019, when the center-left party regained its majority after four years in opposition. 

The same poll indicated that 86.3% of respondents believed "the government has done the right thing" in the way it has handled the pandemic, with 80% saying that they trust the government's decisions. Compared to other countries, Denmark has a traditionally high confidence rate when it comes to institutions. For example, a 2019 study by Eurofound estimated this confidence rate at 65% among Danes, compared with 47% for the French. The Danish Prime Minister, on the other hand, was not so popular before the crisis: her polling approval rate went up from 39% on March 4 to 79% on April 2.

On March 12, the Danish Parliament unanimously passed an emergency law giving health authorities the power to compel certain citizens to undergo testing, treatment or quarantine. Jens Elo Rytter, a law professor at the University of Copenhagen, told the Jyllands Posten that the measure was "certainly the most extreme since the Second World War."  Indeed, the country has a strong culture of following the rule of law. However, as the German NGO Democracy Reporting International points out, the fact that the constitution does not provide for a special regime for such an exceptional situation is not ideal. 

The tricky question of going back to school

In all European countries, the reopening of schools is a potentially divisive and challenging issue. As such, the measures taken by Denmark, the first country to reopen some of its schools, have been closely observed by other European states.

Pre-schools and elementary schools reopened on April 15. Middle schools, high schools and universities were set to open their doors again on May 10. These measures are subject to certain conditions, such as the requirements of smaller class sizes and a regulated distance of two meters (a little over six feet) between desks. The reopening of elementary schools has given rise to logistical obstacles that may be repeated in other European countries. Some municipalities cannot accommodate class sizes of 15 from May 10, the return date for middle school and high school students. This is because the premises are already being used by the recently reopened elementary schools. In addition, some parents have been reluctant to send their children back to school. In Copenhagen, only half of students returned in mid-April.

The issue of reopening schools has been controversial, and opinions are still divided among both Danish and European researchers. The reopening of schools clearly goes hand in hand with a desire for economic recovery but opening up too quickly potentially increases the risk of a second wave of the epidemic. In Denmark, although the rate of spread of infection has gone up since schools and kindergartens were reopened, the number of people infected has continued to fall.

Copyright : Philip Davali / Ritzau Scanpix / AFP