3. Providing health services effectively
The section on PROVIDING HEALTH SERVICES EFFECTIVELY describes approaches for service delivery planning and patient pathways for suspected COVID-19 cases. It also considers efforts by countries to maintain other essential services during periods of excessive demand for health services.
3.1 Planning services
22 May: Due to the still decreasing number of hospitalized COVID-19 cases, hospitals with special COVID-19 hospital wards and only very few COVID-19 patients are closing COVID-19-wards (https://politiken.dk/forbrugogliv/sundhedogmotion/art7792101/Slagelse-Sygehus-sl%C3%B8jfer-coronaafdeling-%E2%80%93-det-er-spild-af-ressourcer).
On November 3, the Danish Health Authority has made recommendations for the organization and professional efforts in the event of late sequelae of COVID-19. Recommendations describe how and where in the health system late sequelae should be investigated and treated (https://www.sst.dk/da/Nyheder/2020/Nye-klinikker-til-patienter-med-svaere-senfoelger-efter-COVID-19).
Since December 14 the Danish Health Authority publishes a weekly status on the bed capacity for patients with COVID-19 (https://www.sst.dk/da/Udgivelser/2021/Sygehuskapacitet-COVID-19).
On December 16 the Capital Region reported that due to the increasing number of patients hospitalized with COVID-19 elective surgery in the next three weeks would be postponed, except for patients with life-threatening conditions (https://www.regionh.dk/presse-og-nyt/pressemeddelelser-og-nyheder/Sider/Region-Hovedstaden-udskyder-alle-planlagte-behandlinger.aspx).
On December 23 the Danish Health Authority announced that due to an increasing incidence of COVID-19, the authority has asked the five regions to increase their bed capacity in internal medicine by 1,300 beds or 50 %. The Capital Region and Region Zealand face a higher need for bed capacity than the other three regions. The capacity for intensity care will remain at the current level – 300 beds (https://www.sst.dk/da/Nyheder/2020/Presset-paa-sygehusene-er-stigende-og-derfor-oeges-kapaciteten).
VACCINE SERVICES AND DELIVERY
November 19: the Danish Medicines Agency stated that it has entered into a fourth provisional agreement with a company, which develops a vaccine. So far, the government, as part of an EU initiative, has reserved access to vaccine doses for the vaccination of 11.8 million citizens from the following vaccines (pending to be approved):
o Astra Zeneca: approx. 2.6 million citizens
o Sanofi-GSK: approx. 2 million citizens
o Johnson & Johnson: approx. 5.2 million citizens
o BioNTech/Pfizer: approx. 2 million citizens.
On November 26, the government presented a plan for distribution of COVID-19 vaccines in the population. The plan consists of 4 sub-phases. In Phase 1A, vaccines will be offered to persons with high risk of severe COVID-19 complications (e.g. chronic heart patients) and frontline personnel in the health, elderly and social care sectors. In Phase 1B, vaccines will be offered to all other persons with risk of severe COVID-19 implications and all remaining frontline personnel, potentially also including other critical public sector areas. Phase 2A is a continued roll-out based on segmentation e.g. according to age. In phase 2B, when vaccines become widely available, they will be provided on demand to the rest of the population.
Vaccinations will be free, and it will be voluntary to accept the offer. Vaccinations will initially take place within the testing stations that have been established during the pandemic. The government will provide a Danish vaccination “passport” that can be used by travelers (https://sum.dk/Aktuelt/Nyheder/Coronavirus/2020/November/Regeringen-praesenterer-Danmarks-vaccinationsplan-mod-COVID-19.aspx).
December 21: the Danish Health Authority reported that the EU Commission had authorized the first vaccine against COVID-19 – from BioNTech/Pfizer (https://www.sst.dk/da/Nyheder/2020/Den-foerste-vaccine-mod-COVID-19-er-godkendt-og-klar-til-brug-i-Danmark).
December 22, 2020: The recommendations from the Danish National Health Authority regarding the prioritization and distribution of vaccines are based on the following principles:
• Regional population figures: The vaccines are distributed between the regions according to population figures
• Risk: Assessed risk for serious illness with COVID-19 for the individual target groups, including minimization of death and serious illness due to COVID-19, epidemic control and minimization of infection spread and securing socially critical key functions
• Conditions concerning distribution and logistics: Assessment of vaccine quantities, vaccine availability, vaccine characteristics, capacity and availability of regional vaccination sites, as well as logistical conditions of significant importance to the supply and distribution chain.
The prioritized groups are:
1) Persons living in nursing homes, etc.
2) Persons aged 65+ who receive both personal care and practical help
3) Persons aged 85+
4) Personnel in the health sector, elderly care sector, and selected parts of the social sector who are at particular risk of infection or who perform a critical function
5) Selected persons with conditions or diseases which entail a particularly increased risk of a serious course of COVID-19 and selected relatives
6) Selected relatives of persons with a particularly increased risk of a serious course or relatives who are an indispensable caregiver
7) People aged 80-84 years
8) People aged 75-79 years
9) People aged 65-74 years
10) Persons under the age of 65 who have conditions or diseases that increase the risk of a serious course of COVID-19
11) Personnel who perform other socially critical functions
12) Other population groups, e.g. segmented by age
(Source: Sundhedsstyrelsen, Organisering af vaccinationsindsatsen mod COVID-19 – første udrulning https://www.sst.dk/da/Udgivelser/2020/Organisering-af-vaccinationsindsatsen-mod-COVID-19-foerste-udrulning).
On December 22 the Danish Health Authority stated, that the authority had sent guidelines to the regions, municipalities and GPS on who should be vaccinated, by whom and how (https://www.sst.dk/da/Nyheder/2020/Den-foerste-sending-godkendte-vacciner-lander-om-faa-dage-planerne-for-vaccinationsindsatsen-er).
All adult residents received an information letter on the upcoming vaccination offer from the Danish National Health Authority (https://www.sst.dk/da/Udgivelser/2020/Information-fra-Sundhedsstyrelsen-om-kommende-tilbud-om-vaccination-mod-COVID-19).
December 27: The first citizens were vaccinated at hospitals and nursing homes in each of the five regions (https://www.sst.dk/da/Nyheder/2020/Saa-er-vi-i-gang---i-dag-bliver-de-foerste-vaccineret-mod-COVID-19).
January 5, 2021: Vaccination centers have now been opened in all the Regions and the first invitations to special risk groups have been distributed through the e-box system by the health authorities – however slightly delayed due to data problems
January 7, 2021: 82,544 persons have received the first shot of COVID-19 vaccine corresponding to 1.41% of the population (https://files.ssi.dk/covid19/vaccinationstilslutning/vaccinationstilslutning-07012021-sol8).
On January 13, the Danish Health Authority published the status for the vaccination campaign emphasizing that 113,000 citizens had received the first dose of the vaccine, that two vaccines had been approved so far, that every Danish citizen will be offered vaccination in 2021, and that the Danish authorities have assisted the authorities in Greenland and the Faroes with their vaccination campaigns (https://www.sst.dk/da/Nyheder/2021/Vaccinationsindsatsen-er-kommet-godt-fra-start).
Since January 13, the Danish Health Authority publishes a weekly status on the vaccination campaign
The roll-out of vaccination program continues with additional vaccination sites in local communities/municipalities in the Capital Region and Region North Jutland. The first citizen was inoculated with the Moderna vaccine on January 14th.
On January 19 the Danish Health Authority informed the regions that, due to delays by BioNTech-Pfizer, the regions will only receive half of the amount of the vaccines that had been promised by the companies in the present week (https://www.sst.dk/da/Nyheder/2021/Vi-faar-faerre-vacciner-end-lovet-i-denne-uge).
On January 21 the Danish Health Authority published a revised plan for vaccination of different groups of the Danish population, due to delays in BioNTech-Pfizer’s provision of vaccine doses to Denmark (https://www.sst.dk/da/Nyheder/2021/Sundhedsstyrelsen-har-opdateret-vaccinationskalenderen). The revised plan is available here: https://www.sst.dk/da/Udgivelser/2021/Vaccinationskalender
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.
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).
March 2: The regions will contact those citizens in vaccination groups 2 and 3 (elderly and vulnerable) who have not yet been vaccinated to ensure that it is not practical problems that prevent vaccination (https://www.sst.dk/da/Nyheder/2021/Aeldre-borgere-faar-mere-hjaelp-til-at-blive-vaccineret).
From March 5: Vulnerable citizens can be vaccinated in their own homes, where health teams provide the vaccination to these vulnerable citizens. The municipalities are responsible for assessing which citizens need this offer and for contacting these citizens. The municipalities, regions and general practices will jointly be responsible for organizing the new scheme. GPs will assist in the home vaccination (https://www.sst.dk/da/Nyheder/2021/Saarbare-borgere-kan-fremover-blive-vaccineret-i-eget-hjem).
On March 11, the health authorities announced that the Covid-19 vaccine from AstraZeneca is paused for 2 weeks following reports from AstraZeneca of severe cases of blood clots in people who have been vaccinated with this vaccine (https://www.dr.dk/nyheder/indland/danmark-saetter-astrazeneca-vaccine-paa-pause-mistanke-om-bivirkninger-med).
March 18: The vaccination plan is changed, and age is now the decisive criteria (as opposed to other health conditions) (https://www.dr.dk/nyheder/indland/danmarks-vaccineplan-aendres-igen-nu-bliver-din-alder-helt-afgoerende).
March 19: Denmark extends the pause in vaccinations with the AstraZeneca vaccine until March 26, to allow for more detailed investigations of the potential risk of serious adverse side-effects.
March 25: the Danish Health Authority extended the pause for vaccination with AstraZeneca’s vaccine until April 18, because the Authority’s analyses are not finished yet (https://www.sst.dk/da/English/news/2021/The-decision-to-put-vaccination-with-the-COVID-19-vaccine-from-AstraZeneca-on-hold-is-extended).
March 31: the Danish Health Authority recommends that persons who have completed the vaccination can be close to family members and friends who are not in an increased risk. In public space, everyone is still to keep 2-meter distance. Vaccinated persons can also use public transportation and do shopping without limiting it to out of rush hours (https://www.sst.dk/da/corona/Vaccination-mod-COVID-19/Vaccinerede-personer).
April 14: The National Health Agency announced the decision to remove the AstraZeneca vaccine from the Danish vaccination program. Those individuals who have received the first shot of the vaccine will be offered another vaccine for the second inoculation.
On April 2,1 the Danish Health Authority, citing reports from the EMA about the Johnson and Johnson vaccine, forecasted that the Authority next week will decide on whether the vaccine will be used in Denmark (https://www.sst.dk/da/Nyheder/2021/COVID-19-vaccinen-fra-Janssen-kan-muligvis-give-sjaeldne_-men-alvorlige-bivirkninger).
By April 29, a total of 1,307,569 persons had been vaccinated (22.4% of the population). Some 631,260 persons (10.8%) had received all necessary vaccines (https://covid19.ssi.dk/overvagningsdata/vaccinationstilslutning).
May 3: The Danish Health Authority has concluded that the benefits of using the COVID-19 vaccine from Johnson & Johnson do not outweigh the risk of causing the possible adverse effect, VITT, in those who receive the vaccine. Therefore, the Danish Health Authority will continue the Danish mass vaccination programme against COVID-19 without the COVID-19 vaccine from Johnson & Johnson (https://www.sst.dk/en/English/news/2021/The-Danish-COVID-19-vaccine-rollout-continues-without-the-COVID-19-vaccine-from-Johnson-Johnson).
A vast majority of the Parliament agreed that citizens can in future opt for vaccination with Covid-19 vaccines outside the vaccine program. This is a decision in principle, and further work must now be done to establish the specific model for the optional scheme (https://sum.dk/nyheder/2021/maj/tilvalgsordning-for-covid-19-vacciner-uden-for-program).
May 5: The National Board of Health has given the green light for people on small islands to deviate from the order that otherwise applies to all other Danes. Now all inhabitants of smaller islands can -regardless of age- be vaccinated if decided by the Regional Health Authorities. The reason for deviating from the age criterion is resources in relation to staff, time, transport and logistics (https://www.dr.dk/nyheder/indland/flere-danske-oeer-faar-nu-lov-til-droppe-raekkefoelge-paa-vaccination).
By May 7, a total of 1,415,117 persons had been vaccinated (24.2% of the population). Some 740,184 persons (12.7%) had received all necessary vaccines (https://covid19.ssi.dk/overvagningsdata/vaccinationstilslutning).
All non-critical elective operations have been postponed. This has enabled hospitals in the public sector to divert capacity to corona-related services and to include private sector ventilators in the calculation of overall response capacity.
There is a designation of departments and sections, but no hospitals are dealing exclusively with COVID-19 patients yet (March 25). Hvidovre Hospital in Copenhagen has converted a large section to deal with COVID-19 patients. Rigshospitalet (The National Hospital) has a designated department for severe COVID-19 cases.
Regarding the role for primary care providers in detecting and treating COVID-19 cases, patients experiencing symptoms may call the emergency phone service or their primary care physician. They are not allowed to visit the primary care providers or hospitals directly. The phone consultation determines whether the patients should be referred to quarantine at home or testing and potential further treatment in hospitals.
Video, telephone or other alternative consultations for health services were already in place, but have been scaled up during the epidemic. The regions and the GPs’ organization have agreed on a fee for consultations by telephone with patients with COVID-19 symptoms by telephone to encourage GPs to handle these cases by phone (https://www.laeger.dk/covid-19-i-almen-praksis-ny-aftale-om-telefonkonsultationer-og-aarskontrol). The Danish Health Authority has also established a telephone hotline for general questions about corona to ease the burden on the regular emergency phone service (https://www.dr.dk/nyheder/indland/politiet-til-corona-bekymrede-ring-til-hotline-ikke-vagtlaegen).
On March 27, the Danish Health Authority published guidelines on how to achieve continuity in care when discharging a patient with a positive test result or with symptoms of COVID-19 from a region's hospital to home care provided by a municipality (https://www.sst.dk/da/Nyheder/2020/Hvordan-sikrer-man-udskrivelse-af-personer-med-smitte-med-COVID-19-til-kommunal-pleje).