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Europe Versus Coronavirus - Putting the Danish Model to the Test

BLOG - 12 May 2020
Key Points
1

On February 27, Denmark confirmed its first case of COVID-19in a man who had recently returned from a holiday in Italy. Lockdown measures came into effect on March 16; around April 3, the country reached the peak of the epidemic with 466 new cases in 24 hours. According to the Danish health authorities, there were just over 500 hospitalizations, including approximately 150 patients in intensive care and 20 deaths. 
 

2

Relatively spared from the COVID-19 pandemic, Denmark began easing restrictions gradually and carefully on April 15. This was one month after implementing lockdown measures to contain the spread of the virus in the country. Many of its European neighbors have been keeping a close eye on Denmark, especially its approach to education: it was the first country to re-open some of its schools. 
 

3

The Scandinavian response to COVID-19 has revealed two differing approaches. Denmark and Norway decided to take preventive measures at a very early stage to stop the virus from spreading in their countries. Sweden, on the other hand, took a much less restrictive approach and neither imposed widespread lockdown measures on the population nor closed shops and public places.
 

A Timeline of Denmark's COVID-19 crisis

  • February 27: Denmark confirms its first case of coronavirus in a man returning from a ski trip to Italy. 
  • March 11: Denmark reports its first death from COVID-19.
  • March 13: The Danish Parliament enacts an emergency law extending the powers of public health authorities and law enforcement. This law allows, among other things, measures restricting access to public institutions and public transport.
  • March 14: Danish borders close to all non-resident foreigners and foreigners not working in Denmark.
  • March 16: Lockdown comes into force following a March 11 speech by Mette Frederiksen, Prime Minister and Leader of the Social Democrat government, which announced the implementation of restrictive measures. Schools, administrative establishments and public places (non-essential stores, places of worship, cinemas, theaters, performance venues, etc.) are closed. Outings are not under any restrictions. 
  • March 30: Mette Frederiksen announces that the Danish government would be able to ease restrictions in the country in a controlled and gradual manner, provided that the population continued to follow the general recommendations on appropriate conduct and that the number of people hospitalized remained stable. The government also announces the upcoming implementation of a widespread testing strategy launched by the Statens Serum Institut, a Danish research institute. 
  • April 1: Denmark reports its highest death toll in 24 hours, with 22 deaths.
  • April 3: The country reaches the peak of the epidemic, with 466 new cases in 24 hours and just over 500 hospitalizations, including approximately 150 patients in intensive care (source: Danish health authorities).
  • April 6: The Prime Minister announces that restrictions will be eased in a gradual and controlled manner. This includes the reopening of some schools, professional practices, small stores and small businesses (e.g., hairdressers, fitness centers, etc.). During her speech, the Prime Minister said, "This will probably be a bit like walking a tightrope. If we stand still along the way, we could fall and if we go too fast, it can go wrong. Therefore, we must take one cautious step at a time."
  • April 15: Denmark is the first country to reopen some of its schools, with pre-schools and elementary schools welcoming back young Danish children. A decree, in effect until May 10, prohibits gatherings of more than 10 people. 
  • April 20: 
    • Small stores and small businesses reopen to the public.
    • The Danish government decides to ban companies registered in tax havens from accessing financial aid implemented as a result of the coronavirus crisis. 
    • A campaign of comprehensive testing begins, with Health Minister Magnus Heunicke declaring that it is "the most effective way that we can stop the spread of the infection." Previously, only at-risk people or those with severe symptoms were tested because there were not enough tests for the entire population.
  • April 21: Gatherings of more than 500 people are prohibited until September 1.
  • April 30:  Mette Frederiksen tells Parliament that "the infection is under control and the Danish strategy has succeeded in its first, difficult phase." 
  • May 1: Zoos and amusement parks reopen.
  • May 10: The scheduled reopening of middle schools, high schools, restaurants and bars begins.

Analysis

Governed by a left-wing coalition since the June 2019 election, Denmark has been branded a "test case" country, along with Austria, in its response to the COVID-19 crisis. Its swift response earned it this status, having implemented a widespread lockdown and closed its borders early in the crisis. As these measures quickly paid off, Denmark was one of the first European states to announce the gradual and controlled easing of restrictions. 

The spread of the virus in Denmark

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.

After Denmark's first confirmed case of COVID-19 was announced on February 27, the growth rate increased rapidly, reaching 256 new cases on March 10. The Danish government closed its borders on March 13, a few days before France and other European countries, and then implemented its lockdown measures on March 16. Although the growth rate decreased with 37 new cases on March 14, it rose again and reached a peak two weeks later on April 3. The reopening of Danish schools on April 15 led to a slight initial increase in the number of new infections. On April 24, the curve began its decline once again, going down to 39 new cases on April 29. However, it was too early to talk about a second wave of the pandemic at this phase in the country's lifting of restrictions.

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. 
 

Some Danish scientists questioned this stance. In the Danish daily Jyllands Posten, Professor Allan Randrup Thomsen from the University of Copenhagen stated that "the fewer people who get infected, the longer it takes before the epidemic has infected enough people that there is broad immunity in the population." These different approaches pit the issues of society’s economic continuity and public health against one another. The price of achieving collective immunity can be seen in the statistics. According to Johns Hopkins University, which is actively monitoring COVID-19 data from around the world, more than two-thirds of deaths in the Nordic countries have been in Sweden (as of April 30: 2,586 deaths in Sweden, compared to 452 in Denmark and 209 in Norway).

On April 6, Danish Prime Minister Mette Frederiksen confirmed that her government did not wish to achieve collective immunity and preferred to contain the pandemic until a vaccine was developed.

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. 

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. 

Primary care physicians, whose numbers per capita are higher than in many European countries, have also been instrumental in mapping COVID-19 cases. Many practices have set up an active surveillance approach that includes "sentinel testing." The aim is to regularly test not only patients with moderate respiratory symptoms, but also patients with no respiratory symptoms. This is a method used in monitoring influenza epidemics. On March 16, the government also announced that funds would be allocated to COVID-19 research projects. Offered to private and public research institutes, this aid was increased on March 30, reaching a sum of almost EUR 20 million.

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

Studies differ on the extent of the economic difficulties that Denmark will face as it emerges from the crisis. But everyone agrees that, as the Danish daily newspaper Berlingske points out, 2020 is likely to be the most painful year for Denmark’s economy since the Second World War. Nicolai Wammen, Denmark's Finance Minister, has predicted that GDP will fall by between 3 and 6% and that the second quarter of 2020 was "set to become one of the darkest chapters in Danish economic history."  According to the IMF, Denmark's real GDP could fall by - 6.5% in 2020. 

In total, the Danish authorities will eventually release EUR 60 billion for businesses, amounting to 2.6% of GDP. 
 

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.

86.3% of respondents believed "the government has done the right thing" in the way it has handled the pandemic. 

In terms of decision-making, the Danish government, like its European neighbors, introduced emergency measures to deal with the pandemic. Some countries have the legal tools to deal with crises. Unlike France, for example, Copenhagen does not have specific legislation on states of emergency but rather relies on "ordinary" bills presented to Parliament in such situations.
 

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

 

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