Policy responses for Denmark - HSRM


Policy responses for Denmark

1.4 Monitoring and surveillance

Several minor outbreaks with locally rising numbers of COVID-19 cases have taken place over the summer. This has led to local (municipality level) measures by the state, such as the early introduction of face masks in public transportation and shops, restrictions in access to old people care facilities, temporary closing of schools and childcare facilities in Hjoerring, Silkeborg, Aarhus and Ringsted. At the same time, there have been efforts to increase testing capacity in these areas. All of these measures are part of a flexible strategy to enable rapid reaction to local outbreaks. This strategy appears to have been successful in containing the number of cases, and the special restrictions have (August 27) now been lifted in all of the affected municipalities. It is, most likely, that similar local outbreaks will be managed in the same way, except that the use of face masks in public transport is now mandatory.

On August 25, the Danish Patient Safety Authority published a catalogue of initiatives that municipalities may introduce to tackle local outbreaks of COVID-19 (https://stps.dk/da/nyheder/2020/covid-19-inspirationskatalog-skal-hjaelpe-kommunerne-til-at-haandtere-lokale-smitteudbrud/).

By September 2, an outbreak at a college of education in the city of Odense led to a lockdown of the college (https://www.tv2fyn.dk/odense/flere-laererstuderende-smittede-paa-ucl-i-odense).

On September 15, the Danish Health Authority announced that it has established a special committee responsible for developing national guidelines to health services and health professionals regarding the handling of long-term COVID-19 complications (https://admin.sst.dk/da/Nyheder/2020/Staerkt-fagligt-fokus-paa-senfoelger-efter-COVID-19).

On September 28, the Danish Health Authority offered health care personnel who gets in touch with patients in increased risk of COVID-19 free immunization for influenza to reduce the risk of a combined infection with COVID-19 and influenza (https://www.sst.dk/da/Nyheder/2020/Influenzasaesonen-staar-for-doeren-Det-er-ekstra-vigtigt-at-huske-vaccinationen-i-aar).

October 1: The Danish Health Authority announced plans to establish fast track clinics, ‘cough clinics’, for citizens suspected of COVID-19, to alleviate the pressure on pediatric and emergency departments. Currently, the regions are setting up the clinics, and the Danish Health Authority expects to publish indications for attending the clinics and where in two weeks’ time (https://www.sst.dk/da/Nyheder/2020/Nye-klinikker-skal-fremover-vurdere-patienter-med-COVID19).

October 30: The Danish contact tracing app “Smittestop” will be updated to increase sensitivity and to allow communication with similar apps in Germany and Italy. Henceforth the app will register a close contact in 10 minutes as opposed to 15 minutes.

On November 24, the Danish Health Authority redefined "close contacts", thereby extending the indication for test. From now on, the following groups will also be asked to undergo a test:
• Persons who have been closer than two (not one) meter to a COVID-19-patient for more than 15 minutes in a situation with singing, shouting or loud talk
• Persons who have been closer than two (not one) meter to a COVID-19-patient for more than 15 minutes in a badly ventilated room
• Persons who have shared an office, a meeting room etc. with a COVID-19-patient, even though the person is not a 'close contact' according to the current indication

On January 14, the national government and Local Government Denmark (the Danish municipalities’ organization) agreed that the municipalities will take on a larger role in tracing close contacts – a task which so far has been the responsibility of the Danish Patient Safety Authority (https://sum.dk/nyheder/2021/januar/1401-kommunerne-vil-spille-en-stoerre-rolle-i-smitteopsporingen).

On January 19, the Danish Health Authority published new guidelines to reduce the risk of spread of cluster B.1.1.7: close contacts (people who have been closer than two meters to a person diagnosed with COVID-19 for more than 15 minutes) should stay isolated until the sixth (not the fourth) day, even if the test on the fourth day is negative, and close contacts of patients with cluster B.1.1.7 should stay in isolation for 14 days, even if they have a negative test result. The new recommendations are valid until February 7th (https://www.sst.dk/da/Nyheder/2021/Retningslinjer-for-naere-kontakter-skaerpes-for-at-oge-epidemikontrollen).

By January 18, the Danish contact tracing app “Smittestop” had been downloaded 2,129,206 times, while 52,156 persons have reported themselves as infected in the app (https://smittestop.dk/status/).

On March 24, the Danish Patient Safety Authority published a report with quantitative data on its effort to trace infections and thereby stop outbreaks (https://stps.dk/da/nyheder/2021/covid-19-noegletal-for-smitteopsporingen-for-januar-og-februar-2021/~/media/22C69CC53FD84EFD9CA197DA55E9E743.ashx).

(Update 14 May) Monitoring and local interventions: Every day, the Statens Serum Institut publishes data on the incidence in each municipality and parish, indicating whether a municipality or parish is close to or exceeds the limit of 250 per 100,000 inhabitants (diagnosed by PCR tests only), which means that the municipality will go into lock-down until the incidence has been less than 250 for at least one week (the criteria for parishes are more complicated). The incidence data are available from this homepage:

All people with symptoms are considered to be potential cases and subject to medical assessment to determine the need for testing and treatment. Contacts of confirmed cases are traced and asked to pay particular attention to possible symptoms (until March 15, citizens who had been in contact with patients with COVID-19 were told on an individual basis by the Danish Patient Safety Authority to self-quarantine for two weeks).

When COVID-19 is confirmed, the responsible health care practitioner must ensure that the patient or other health care practitioners inform the people who have been in close contact with the patient from the onset of symptoms until 48 hours after the end of symptoms. Close contacts are defined as: members of the same household as the patient with COVID- 19,  people who have been in direct physical contact with the patient, people who have been in contact with body fluids from the patient, people who have been in close face-to-face contact within 2 meters for more than 15 minutes, people have been in a closed environment e.g. classroom or meeting room with the patient in more than 15 minutes and within two meters, health care personnel and others that have participated in treating the patient, and have not had access to protective equipment.

Close contacts are informed to be aware of symptoms that could be related to COVID-19 until 14 days after close contact.
Systems used for surveillance of COVID-19 include national-level tracking of tests, hospital admissions, patients needing ventilator assistance for breathing, and deaths; a website with voluntary self reporting of symptoms where voluntary citizens report influenza-like symptoms (Influmeter, – 19,000 participants, https://influmeter.dk); a panel testing surveillance system is initiated by the Statens Serum Institut (SSI) based on a sample of GPs and a sample of their patients who are tested on a weekly basis.

To assist health authories in gaining an overview of how many among the Danish population have been infected with coronavirus and have developed antibodies and thus immunity, the blood banks in all the regions have started testing blood for coronavirus from their blood donors (April 6). As approximately 5% of the Danish population regularly donate blood, these numbers will contribute to a more robust estimate of the spread of the coronavisus in the population (https://www.dr.dk/nyheder/indland/blodbanker-tester-om-donorer-har-haft-coronavirus).

May 7: The health authorities have initiated a monitoring of the development of COVID-19 infections in the population based on the testing of random samples of the total population. A random sample of 2,600 individuals are invited through the national digital platform “e-boks” to visit one of the Regional test centers for a test for COVID-19 infection and antibodies indicating previous infection. This will be repeated regularly (https://www.dr.dk/nyheder/politik/tjek-din-e-boks-tilfaeldige-danskere-skal-testes-corona).