2. Ensuring sufficient physical infrastructure and workforce capacity
ENSURING SUFFICIENT PHYSICAL INFRASTRUCTURE AND WORKFORCE CAPACITY is crucial for dealing with the COVID-19 outbreak, as there may be both a surge in demand and a decreased availability of health workers. The section considers the physical infrastructure available in a country and where there are shortages, it describes any measures being implemented or planned to address them. It also considers the health workforce, including what countries are doing to maintain or enhance capacity, the responsibilities and skill-mix of the workforce, and any initiatives to train or otherwise support health workers.
2.1 Physical infrastructure
Once a week, Danish Regions publishes statistics on the stocks of desinfectants, gloves, coats and face masks (https://www.regioner.dk/sundhed/coronaviruscovid-19/vaernemidler).
The Danish hospital structure has been centralized over the past few decades. This means that microbiology labs exist in major hospitals in all five regions. Lab capacity is perceived to be sufficient, while there is a shortage of test kits and materials for PCR machines. A number of private and university lab facilities are available, in addition to hospital laboratories.
The Danish Health Authority is chairing a “COVID-19 Intensive Task Force”, with representatives from national authorities and the Danish regions. The task force is responsible for coordinating the regional capacity of ICU capacity and staff. The Danish Health Authority has published a status document with assessment of the need for ICU and ventilator capacity (https://www.sst.dk/-/media/Nyheder/2020/ITA_COVID_19_220320.ashx?la=da&hash=633349284353F4D8559B231CDA64169D327F1227). The document shows a capacity of 925 ventilators in the public sector. It outlines two scenarios based on data from China and Italy. If developments follow the pattern from Italy, there will be sufficient capacity of both ICU beds and ventilators.
Additional capacity may be included from the military and from private hospitals. The Danish regions have also ordered 67 additional ventilators to be delivered in the coming months. Finally, there is an opportunity to use veterinary ventilators. In total, it is estimated that the military, private hospitals, universities and other sources can deliver 116 additional ventilators (https://www.sst.dk/-/media/Nyheder/2020/ITA_COVID_19_220320.ashx?la=da&hash=633349284353F4D8559B231CDA64169D327F1227).
There are shortages of protective equipment (masks, hand sanitizer, etc.) and test kits. ICU capacity and number of ventilators is expected to be sufficient, but this will depend on the development in the number of cases in March/April/May. In March, the Danish authorities decided that regions should be prioritized (over municipalities) in terms of protective equipment (https://www.dr.dk/nyheder/politik/toppen-i-heunickes-ministerie-satte-plejehjem-bagerst-i-koeen-til-vitale). The pandemic is supposed to peak in the middle of April in Denmark but it may peak earlier, if the initiatives to reduce the epidemic turn out to be successful.
Regarding measures implemented or planned to mitigate shortages, the General Health Law in Denmark (article 210, 3) states that private hospitals and clinics must be part of the general capacity in an emergency situation. The Danish Health Authority has therefore included the private sector capacity and ventilators in their assessments of total capacity. It has not yet been necessary to use this resource. As of April 17, the number of COVID-19 cases is decreasing but expected to peak by the end of April (about two weeks after the reopening of schools, high schools (only the third and final year) and child care facilities. Additional ventilators may be acquired from the military and universities (see above).
In addition, new legislation mandates that private firms, regions and municipalities must provide information to the Danish Medicines Agency about stocks of pharmaceuticals and medical equipment, so that these resources may be redistributed to other parts of the health care system (https://laegemiddelstyrelsen.dk/da/nyheder/2020/laegemiddelstyrelsen-faar-flere-befoejelser-til-at-modvirke-forsyningsproblemer/).
An Internet platform where private firms can contribute with all types of medical equipment has been established by the Danish Medicines Agency (https://laegemiddelstyrelsen.dk/da/udstyr/danmark-hjaelper-danmark/#). Many Danish firms have offered to contribute.
Once a week, Danish Regions publishes statistics on the stocks of masks, disinfectants and gloves (https://www.regioner.dk/sundhed/coronaviruscovid-19). The latest statistics were published on June 16. On May 20, the Danish Regions concluded that stores of surface disinfections and protective overalls, etc., are ‘stable’, and that more is under way. The more recent reports do not estimate how many weeks stores will suffice like in previous reports:
Cases with fake certificates issued by an approved European testing institute on protective equipment have been reported and warnings have been issued by the Danish Safety Technology Authority (https://www.sik.dk/erhverv/produkter/personlige-vaernemidler/vejledninger-forbindelse-corona-covid-19/nyheder/advarsel-virksomheder-disse-ansigtsmasker-ikke-lovlige-danmark#).