Policy responses for Denmark - HSRM


Policy responses for Denmark

1.5 Testing

The parliament’s agreement on April 17 on extending the previously announced Phase 1 of the re-opening of society (see Exit Strategy: Measures in other sectors) partly builds on an understanding that the Statens Serum Institut (SSI) will prepare an integrated test-strategy, including health care personnel and vulnerable groups to improve information on the incidence and prevalence of COVID-19.

April 22: The regions have established temporary test facilities away from hospitals (including in public parks), and the Danish Health Authority published new indications for testing:
Patients with symptoms (immediate implementation)
- Patients with mild respiratory symptoms will be referred directly to test for SARS-CoV-2 after evaluation by phone by the patient’s GP or acute out-of-hours-service
- Health care personnel (including long-term care and home care) with mild respiratory symptoms. Self-referral directly to test for SARS-CoV-2 after discussion with the employee’s manager
- Patients with moderate-serious respiratory symptoms for evaluation and test (after evaluation by phone by the patient’s GP or acute out-of-hours service)
Estimated test activity: Approx. 6,000 patients/weekday. Presumably a smaller test activity on weekends and on public holidays. *

Persons without symptoms to be tested to reduce the risk of further spread of the disease (fully implemented by April 27 2020)
- Asymptomatic inhabitants of nursing care homes (and other institutions) as well as front line nursing home personnel in case of infection among inhabitants or colleagues
- Patients expected to be hospitalized for 24 hours or more, independently of the patient’s condition (referral by the hospital)
- Patients – independently on the patient’s condition – who are going to attend certain procedures at a specialist, a dentist or an out-patient clinic at a hospital (referral by a specialist, a dentist or a hospital)
Estimated test activity: Approx. 6,000 patients/weekdays on weekdays. Presumably a smaller test activity on weekends and on public holidays*.

Asymptomatic persons tested to prevent further spread of the disease (to be implemented as soon as possible)
- Close contacts of a person with confirmed COVID-19 on day 4, 6 or 8 after contact
Estimated test activity: Approx. 15,000 patients/weekday. Presumably a smaller test activity on weekends and on public holidays.*

Possible new indications for test
- Systematic, standardized test of asymptomatic employees in the health care sector, including nursing homes, other social institutions, the probation services’ half way houses, etc., who work with people in increased risk, including patients in ongoing immunosuppressive treatment (cancer, chronic inflammatory diseases, organ transplantation, etc.), innate or acquired compromised immune system (premature newborns, certain hematological diseases, severely uncontrolled diabetes), immobile persons (secure institutions, people with handicaps, elderly people, etc.) and other certain groups in increased risk (especially elderly people > 80 years).
Estimated test activity: Approx. 15,000 patients/weekday (a highly uncertain estimate). *

*: Estimates in need of regular revision.

The Danish Health Authority has emphasized the need to prevent outbreaks of COVID-19 in nursing homes

April 28: The Danish Health Authority has published new guidelines for testing women giving birth in hospital. They will now all be tested independent of the duration of their hospital stay (https://www.sst.dk/da/Nyheder/2020/Retningslinje-for-graviditet-og-foedsel-er-revideret).

April 29: The Danish Health Minister has announced plans to be implemented over the next couple of weeks for a new strategy on testing in order to limit new infections. All individuals who are tested positive for COVID-19 infection will be asked to track down recent contacts with other persons that they may have infected and these will then be offered testing 4, 6 and 8 days after the day of the contact (https://www.dr.dk/nyheder/indland/coronasmittede-skal-selv-opspore-kontakter-vi-skal-undgaa-skjulte-smittekaeder).

May 12: The Danish Health Authority published an updated strategy for testing and contact tracing. In contrast to previous plans on this regard, it will now be the responsibility of public authorities to assist in tracking and contacting close contacts to persons tested positive for COVID-19. Close contacts will be offered to be tested on day 4 and day 6 of the initial contact. Close contacts will be urged to enter into self-isolation until they have received a negative result of the testing. The government will provide capacity for those that are unable to self-isolate at home, e.g. in hotels (https://www.sum.dk/Aktuelt/Nyheder/Coronavirus/2020/Maj/Offensiv-national-teststrategi-sikrer-trygt-genaabning-af-Danmark.aspx).

Besides, the government announced on May 12 a new agency for coordination of capacity in testing and provision of personal protective equipment. The agency will be operational from August.

The government published more details about the new test strategy. The strategy now contains two "tracks" for testing:
-Track 1 (“the health care track”): testing of referred citizens with COVID-19 symptoms, citizens in hospitals and health care personnel (this track is organized by the five regions)
-Track 2: ("the societal track"): testing of asymptomatic "close contacts", citizens selected for random sample testing, social care personnel, etc. This track is organized by national authorities and takes place in temporary COVID-19 test facilities in 16 locations throughout the country.

The "health care track" precedes “the societal track” in case of resource limitations.

May 15: A majority of the parliament agreed to develop an app in a public-private partnership. The app will track citizens who voluntarily decide to use the app, and if a citizen using the app is diagnosed with COVID-19, all citizens who have been close to the patient will be informed that they may have been exposed to COVID-19, but the identity of the patient will not be revealed to them. The app was implemented on June 18. (https://www.sum.dk/Aktuelt/Nyheder/Coronavirus/2020/Maj/Politisk-aftale-om-frivillig-smittesporingsapp-for-covid-19.aspx). By June 28, the app has been downloaded 563,000 times. In total, 85 persons have registered themselves as infected with COVID-19 using the app (https://www.dr.dk/nyheder/indland/85-personer-har-meldt-sig-smittet-i-corona-app-efter-godt-en-uge). By October 7, the app has been downloaded 1,607,875 times. In total, 4,457 persons have registered themselves as infected with COVID-19 using the app. This increase in numbers partly reflects that more people have downloaded the app and partly because the app has currently been rectified to be more sensitive to inform about risks of infection.

May 18: In order to increase testing of the population, all citizens may get tested (in “the societal track”) without a referral – a citizen who wants to get tested for COVID-19 may make a reservation on a website: https://www.coronaprover.dk/Account/NemIdLogin?RequestPath=%2F  
This has been fully implemented by May 25 based on a daily testing capacity up to 50,000 tests. Citizens with symptoms must still call their GP to be referred to a test at a hospital (“the health care track”) (http://sum.dk/Aktuelt/Nyheder/Coronavirus/2020/Maj/Alle-borgere-faar-mulighed-for-at-blive-testet-for-COVID-19.aspx).

May 20: The Danish Health Authority revised its guidelines on testing at nursing homes: more citizens who have been in close contact with infected persons at nursing homes must be tested, and if a test of a person is negative, the test must be repeated one week later to establish, whether the outbreak is under control.

May 26: Blood banks discontinue temporarily Covid-19 antibody testing among blood donors due to the low precision of the newly delivered test equipment
30 May:  If requested by the authorities, corona-infected citizens must declare with whom they have had contact in order to contribute to the containment of the infection. Resistance to do so will result in a fine. The rule applies to anyone who has been found infected from May 20. The rule is set to expire on October 31, 2020 (https://www.retsinformation.dk/eli/lta/2020/746).

June 10: A minor adjustment to the strategy for tracking COVID-19 infected persons was announced on June 10. - Henceforth the Danish Patient Safety Authority will contact all infected persons with an offer to assist in tracing and contacting close contacts. - https://stps.dk/da/nyheder/2020/nu-intensiveres-kontaktopsporingen-af-naere-kontakter-til-covid-19-positive/ - (This is an example of a behavioral public policy initiative whereby infected persons are "nudged" to engage in tracing and contacting through a change in the decision architecture).

June 16: The Danish Health Authority published revised guidelines on testing of close contacts (https://www.sst.dk/da/Nyheder/2020/Retningslinjen-for-smitteopsporing-af-naere-kontakter-er-opdaterede). 

June 17: The app agreed upon on May 15 (see above) was presented: “Smitte|stop” (Infection|stop’). If a citizen downloads the app on his/her mobile phone, the app registers which phones the citizen is in close contact with, and if the citizen is diagnosed with COVID-19 and registers this finding in the app, the other users of the app, who have been close to the citizen, will receive a warning that they may have been exposed to COVID-19 (specifically: if a device has been closer than one meter to the device belonging to the citizen diagnosed with COVID-19 for more than 15 minutes less than two weeks before the diagnosis, the owner of the device will receive a warning). The other citizens will not be informed which person was infected, and the information that a citizen was infected will be automatically validated by the national patient registry, before the other citizens receive the warning. Due to privacy and data protection concerns, there is no centralized storage of data from the app.

June 30: As part of the surveillance of the epidemic and the protection of the most vulnerable citizens at risk of being seriously ill from COVID-19, the government, the Danish Regions and Local Government Denmark (KL) have agreed on a systematic testing of nursing staff working at nursing homes or in home care) in all the municipalities. The frequency of the tests will be adjusted according to how widespread the infection is in each municipality. The new test system will be implemented in addition to the open test offer that nursing staff already have access to, and it will be done with a new setup, which will make it much easier to be tested at the workplace. In those municipalities that exceed a certain level of infected population, the testing program will be immediately implemented. For the other municipalities, the system will be ready by the end of August (https://sum.dk/Aktuelt/Nyheder/Coronavirus/2020/Juni/~/media/Filer%20-%20dokumenter/2020/Aftale-mellem-regeringen-KL-og-DR-om-model-for-test-af-personale-paa-plejehjem-og-i-hjemmeplejen.pdf).

On July 2, the Government decided to pause the representative study of the development of the corona infection in the population (part of “the societal track”) since the purpose of the study was not achieved due to very low participation rates (https://files.ssi.dk/PCR-undersoegelsen_24_6_2020_2).

From August, it is planned that a representative sample of the population will be asked to be tested for both actual COVID-19 infection and COVID-19 antibodies (https://www.dr.dk/nyheder/politik/ny-model-coronatest-skal-fa-flere-borgere-til-melde-sig), on the assumption that it will be possible to achieve a higher participation rate.

On July 9 the Danish Health Authority published three revised leaflets to citizens with symptoms of COVID-19, citizens who had tested positive, and close contacts

July 30: The Ministry of Health reported that the app Smitte|stop has been downloaded 824,000 times, and that 209 citizens have registered in the app that they are infected with COVID-19 virus (whereupon the app notified other users of the app who have been in close contact with the infected users). According to a survey by the SSI of citizens who booked a test for COVID-19 from July 7 to July 28 (response rate: 56%), at least forty-eight citizens booked a test because they had been notified by the app that they had been in close contact with a person who had tested positive for COVID-19. Forty-six of the 48 citizens had not been in touch with the Danish Patient Safety Authority’s contact tracing unit –indicating that the app identifies citizens in increased risk of COVID 19-infection, who would not have been identified as early by other means

August 25: The health authorities have updated their guidelines for testing and sending home teachers and pupils in in case of infections in schools. The recommendations suggest different measures according to the physical distancing in the actual school (more or less than one meter). In the first case, close contacts should be identified, sent home and tested according to the general rules for close contacts and the whole class/group just tested once, whereas in the latter case, all pupils and staff in the class/group are considered close contacts and should be tested and sent home according to the general rules for close contacts to infected persons

By August 26, a new technical solution made it possible for parents to access their children’s test results electronically through sundhed.dk without calling their GP
By September 9, in order to be tested at the Copenhagen Airport test center, which is one of the few places where you can be tested without having booked an appointment in advance, because it is designed so travelers can be tested directly on arrival in Denmark, persons will have to show airline tickets. This is a consequence of a survey among 1,500 persons showing that two-thirds of those who have been tested at the airport have not been travelers (https://www.dr.dk/nyheder/indland/slut-med-springe-testkoeen-over-nu-skal-der-vises-flybilletter-blive-testet-i).

September 9, The Minister of Health has proclaimed an increase of test facilities: the test capacity at Copenhagen Airport will be increased, and new test centers will be set up around Copenhagen this weekend as a results of long waiting times for corona tests (https://www.dr.dk/nyheder/indland/lang-koe-til-coronatest-der-er-ikke-kapacitet-til-alle-lader-sig-teste-foer-hver).

On September 17, The Danish Health Authority published a slightly revised version of the guidelines for handling cases of infections in schools and other educational institutions. The publication now more clearly emphasizes that in a situation with just one case in a class, it is not required to send the whole class home, but only those who have been in close contact with the case. The same rule should be followed when one member of the staff is infected (https://www.sst.dk/da/Nyheder/2020/Opdaterede-retningslinjer-tydeliggoer-hvad-man-goer-ved-enkelttilfaelde-af-smitte-hos-boern-og-elever).

On October 7, The Health Ministry updated the test strategy of May 12: during the autumn, the test capacity will be further increased, so that 70-80,000 people can be tested daily. In times of special peak loads, it will be possible to test up to 100,000 people a day. It is the government's goal that 80% will be able to be tested within 24 hours.
The following groups of citizens referred to or requesting a test will be prioritized:
- Citizens with symptoms necessitating evaluation by a clinician
- Close contacts of patients with confirmed COVID-19
- Patients who will be hospitalized for more than 24 hours
- Citizens related to localized outbreaks
- Regular tests of personnel at nursing homes and home care – and personnel employed by the regions with face to face contact with patients
- Citizens arriving in Denmark from abroad
Like before surplus capacity will be available to other citizens

On October 8, the Danish Regions began publishing a daily survey of waiting times at different testing sites to enable citizens to choose the testing site with the shortest possible waiting time

On October 15, the waiting time at all of the 36 test sites was zero days for citizens booking a test through the home page www.coronaproever.dk 

On October 21, the Health Authorities updated the test strategy implying that citizens with symptoms suspicious for COVID-19, but not feeling a need for talking to a medical doctor, do not need to contact their general practitioner for a referral, but  can now book time for a test themselves. Everyone can also still book a test for any other reason.
You are advised to contact your general practitioner: if you feel so ill that you would like to talk to a doctor; if you are worried or in doubt; if it involves a child less than 2 years.
If the general practitioner thinks that there is a need for immediate examination, the patient will be offered a visit the same day in a local, newly established COVID-19 assessment clinic for testing and examination. If the general practitioner thinks that it is not that urgent, the patient is offered testing the day after at the general test centers

On October 30, the Ministry for Health reported that the capacity to trace citizens who may be infected will be increased to trace contacts for 3,000 patients every day. The tracing unit under the Danish Patient Safety Authority is staffed by the Authority, the police, the defense forces, the Home Guard, and the Danish Emergency Management Agency. Within 24 hours of a positive test, the patient should be called by staff from the tracing unit who will then start tracing and calling the patient’s close contacts

From November 2, as a supplement to the public testing strategy (and in light of current increasing infection rates and waiting times of at least two days to a public test), Falck (a private rescue group) offers COVID-19 tests to individuals without an appointment or a referral from a doctor for DKK 299 (around 40 euros) per test. Thus, Falck joins the ranks of several private providers of corona test, offering no waiting times and a response to the test in a short period (https://www.falck.dk/foerstehjaelp/saadan-goer-du/fokus-paa-covid-19/coronatest_privat/).

From November 4, to have sufficient test capacity in the region in Northern Jutland affected by the new strand of COVID-19 which has evolved in mink, test capacity from the other Danish regions will be transferred to the region in Northern Jutland.

From November 4, throughout the country positive test results will be examined for presence of the new strand of COVID-19 (https://sum.dk/Aktuelt/Nyheder/Coronavirus/2020/November/~/media/Filer%20-%20dokumenter/01-corona/Faktaark-om-restriktioner-i-NJ.pdf).

On November 13, the Danish Health Authority recommended that citizens with symptoms on COVID-19 and close contacts to COVID-19-patients do not use rapid antigen tests instead of PCR-tests, because of the rapid antigen tests’ low sensitivity (https://www.sst.dk/da/Nyheder/2020/Antigentest-boer-ikke-bruges-hvis-du-har-symptomer-paa-COVID-19-eller-er-naer-kontakt).

December 1: Due to the rising number of infections in the Copenhagen area, testing efforts in the Greater Copenhagen area have been further increased and will be intensified in the coming weeks. Additional mobile test units will be deployed locally to ensure access to tests for as many people as possible. Based on the development of infection rates and ongoing dialogue with the affected municipalities, the mobile test units will be located where the need is greatest. Especially the 15-25-year-olds are encouraged to get tested as they often only develop very mild or no symptoms. The authorities will intensify infection detection with stronger outreach efforts for effective detection and isolation (https://sum.dk/Aktuelt/Nyheder/Coronavirus/2020/December/Nye-Covid-19-tiltag-i-Hovedstadsomraadet.aspx).

December 9: The Danish Health Authority announced that rapid antigen tests will now be offered to people who are not close contacts or tested because of symptoms (these are still offered the more precise PCT-tests). In order to increase test capacity private laboratories will now also be included in the test program.

On January 20 the Minister of Justice invited all the Danish mayors to a meeting on January 21, where the minister strongly advised them to take advantage of the increased test capacity by setting up mobile test units in the municipalities (https://www.justitsministeriet.dk/pressemeddelelse/justitsminister-med-kraftig-opfordring-til-kommunerne-faa-bestilt-mobile-testenheder-med-det-samme/).

February 3:  The municipalities announced that they will now start planning quick testing of school staff to be in place in connection with the re-opening of schools by February 8. Staff is also encouraged to get a PCR-test before the opening (https://www.kl.dk/forsidenyheder/2021/februar/personalet-paa-skolerne-kviktestes-2-gange-ugentligt/).

February 13: In order to secure sufficient facilities the Government has invited private providers to tender based on specific requirements regarding quality, compenteces of staff etc (https://sum.dk/nyheder/2021/februar/regeringen-og-regionerne-vil-sikre-mulighed-for-over-400000-daglige-vaccinestik).

February 15: Due to high incidence numbers in the municipality of Ishøj – a suburb to Copenhagen – it has been decided to: a) send a national level task force to the municipality, b) recommend that all citizens in Ishøj are tested in week 7, schools from grade 0-4 must return to virtual teaching from 15th to 28th of February, c) stronger communication and enforcement efforts are applied (https://sum.dk/nyheder/2021/februar/skaerpede-tiltag-i-ishoej-kommune).

February 18: the Minister of Health presented the plans for a new, expanded test strategy as a precondition for further reopening of society. The plan includes the expansion of rapid test centers by private providers from presently 55 centers to several hundred, offering free testing to healthy citizens without referral or booking. PCR testing will still be offered at special testing tents for close contacts to people infected (booking required) and at hospitals for people with symptoms indicating possible COVID-19 infection illness – this, however, requires referral from medical doctors. Children, students and teachers in schools and other institutions will be offered rapid testing twice a week through mobile units organized by local authorities and involving private providers. Mobile test units will also offer rapid testing in areas with special needs – whereas routine testing in nursing homes and institutions will no longer take place. The government has purchased 10 mio new rapid tests using a more gentle testing procedure in the nose than the present test kit (https://politiken.dk/forbrugogliv/sundhedogmotion/art8105835/Minister-om-regeringens-nye-teststrategi-%C2%BBDet-er-en-af-de-vigtigste-n%C3%B8glebrikker-i-forhold-til-at-kunne-%C3%A5bne-samfundet-igen%C2%AB).

Private test providers as well as public testing facilities all report testing results to a central public data base (Den Danske Mikrobiologidatabase (MiBa)) that provides all national data on COVID-19 surveillance (https://www.ssi.dk/aktuelt/nyheder/2021/ssi-faar-tal-fra-de-private-testudbydere).

Information about positive cases is communicated by Statens Serum Institut to Styrelsen for Patientsikkerhed that is responsible for contact tracing (https://stps.dk/da/sundhedsfare-og-beredskab/coronaopsporing/om-coronaopsporing/).

Genetic sequencing is performed based on large samples of positive test material by Statens Serum Institut and the Danish Covid-19 Genome Consortium (DCGC) through the coordinated effort of Aalborg University, Statens Serum Institute, Hvidovre Hospital, and Aalborg University Hospital. The Consortium has established additional local sequencing nodes at Aalborg University Hospital, Aarhus University Hospital, Slagelse Hospital, Rigshospitalet, Sygehus Lillebælt, and Odense University Hospital (https://www.covid19genomics.dk/home).

Regarding the number of people and the share of the population vaccinated against COVID-19, the Statens Serum Institut publishes a daily report on the number and share of vaccinated people: by January 28,

February 13: The government announced a public tender to scale up vaccination capacity. The aim is to enable up to 400,000 persons to be inoculated against COVID19 (https://sum.dk/nyheder/2021/februar/regeringen-og-regionerne-vil-sikre-mulighed-for-over-400000-daglige-vaccinestik).

February 19: The Danish Health Authority announced that the plan for vaccination will be revised once a week (https://www.sst.dk/da/Nyheder/2021/I-naeste-uge-fortsaetter-vi-med-at-vaccinere-de-alleraeldste).

On February 26, 375,794 citizens (6.4% of the population) had initiated vaccinations, and among these 181,084 (3.1% of the population) had completed their vaccination

Since March 1, a new and more gentle quick test has been introduced (where the cotton swab should only be 2-3 cm up into the nostril) to get more people to be tested (https://www.dr.dk/nyheder/indland/det-kilder-lidt-mere-ny-skaansom-naesetest-skal-faa-flere-til-testcentret).

Since March 1, Delta-2 PCR test has been used in the screening of all positive covid samples. The so-called Delta-2 can detect B.1.1.7 directly and at the same time it can detect the South African variant B.1.351 and the Brazilian P1 variant (https://www.ssi.dk/aktuelt/nyheder/2021/delta-2-pcr-test-tages-i-brug).

On March 25 the Minister for Health presented a revision of the testing strategy: since March 1, the test capacity has been 400,000 persons a day or more. To facilitate the gradual re-opening of society, from April 6 the test capacity will be increased to 700,000 persons a day in May (500,000 antigen tests and 200,000 PCR-tests).
The strategy includes:
Three legs:
o A large, decentralized, stationary test capacity for all citizens. There is at least one test center in each municipality
o Local test capacity at large educational institutions, etc.
o Small, mobile test units for use in areas with local outbreaks
Three phases:
o Spring 2021: massive testing to facilitate the re-opening of society
o Summer 2021: a reduced capacity as more and more people are getting vaccinated, and the weather reduces the incidence. The remaining capacity will be aimed at geographical areas with increased incidence and unvaccinated demographic groups
o From the autumn 2021, testing will focus on early warning of new epidemics and new mutations – probably based on randomized samples of citizens and analyses of sewage

By April 21 the test capacity reached 570,000 tests/day of which 400,000 antigen tests and 170,000 PCR-tests (https://sfos.dk/nyheder/2021/april/570000-test-om-dagen-skal-bidrage-til-genaabning/).

May 4: TestCenter Denmark is now using a new Delta PCR test for screening of all positive covid samples. The new Delta-3 PCR test can detect the much talked about E484K mutation. It has been found on both the South African variant B.1.351 and the British variant B.1.1.7

People with relevant severe symptoms are referred to testing. This ”conservative” testing strategy is gradually being replaced by a more “aggressive” strategy. As of March 2, the criteria for testing were changed to include the following (guidelines from the Danish Health Authority):
• Citizens in specific risk groups – elderly citizens and chronic care patients can be referred to testing when presenting mild symptoms.
• Pregnant women and infants with mild symptoms may also be tested
• Employees in health care, elderly care and social care can also be tested even with mild to moderate symptoms.

Further guidelines were issued on 24 March: testing can be requested/approved by the patient’s own doctor. Emergency services (by phone) can refer patients to hospitals and test. Hospital doctors can also refer admitted patients to test. COVID-19 testing occurs in specialist settings in tents outside hospitals and there are also some drive-through test facilities. The test is done using PCR machines. Laboratory capacity is sufficient, but there is a shortage of some of the supplies needed for the test machines (plastic trays, chemical substances, pipettes). The Danish strategy has therefore been relatively restrictive in terms of the number of tests performed.

A total of 912 persons were tested from 27 Jan to 7 March. Since 8 March, the daily number of people tested has been below 1,000 except for a peak of 1,800 on 19 March  and close to 1,200 on 18 and 19 March. From 30 March the aim is 5,000 tests per day (https://www.dr.dk/nyheder/indland/danske-virksomheder-har-tilbudt-corona-hjaelp-i-en-uge-nu-raekker-myndighederne). The Danish Health Authority has signaled that it expects the daily number of tests to increase to 5,000-10,000 with the recent strategy change, depending on the availability of test kits, etc.

New guidelines for COVID-19 testing are available since April 1 (https://www.sst.dk/da/Udgivelser/2020/Retningslinjer-for-haandtering-af-COVID-19). After criticism from experts and media for not providing a sufficient number of COVID-19 tests, health authorities have decided to increase the numbers dramatically by offering testing to a larger group of persons after referral from the general practitioners. The following groups with mild symptoms are now considered suitable for testing:
• persons who are in close contact with special risk groups
• persons with chronic diseases
• persons who due to social or behavioral problems or their housing situation are not easily able to follow recommendations for isolation
• persons who have been in close contact with confirmed COVID-19 infected individuals
• persons with key functions in society.
Health professions and staff involved in social care for vulnerable groups may attend testing facilities directly without GP referral.

From April 20, testing is offered to anyone who has symptoms of COVID-19 (https://www.dr.dk/nyheder/indland/heunicke-med-ny-strategi-nu-skal-alle-med-symptomer-testes). This is initiated since Denmark has sufficient (and vacant) testing capacity, and since the Danish Health Authority has declared that testing is essential to stop the chains of infection.

On April 21, the Danish Health Authority published new guidelines for testing, in order to achieve a much better overview of the prevalence of COVID-19; from April 21, persons in these groups may be referred to test:
- Citizens with mild symptoms of COVID-19
- Citizens in close contact with a confirmed diagnosis of COVID-19
- Patients who presumably will be hospitalized for 24 hours or more
- Out-patients who presumably will undergo one or more procedures which constitute a serious risk of exposure to COVID-19
- Inhabitants and personnel in institutions where one or more inhabitants or employees have a conformed diagnosis of COVID-19

From May 4, guidelines for testing in hospitals, nursing homes and other assisted living facilities have been updated. Staff and citizens with a negative test are henceforth to be retested after 7 days (https://www.sst.dk/da/Nyheder/2020/Opdaterede-retningslinjer-for-sundhedsvaesenet

By April 29 2021, 27,284,633 PCR-tests and 9,913,606 antigen tests have been performed (from March 10 including both public and private test providers), and 4,743,283 persons have been PCR-tested (https://www.sst.dk/da/corona/status-for-epidemien/tal-og-overvaagning).