Monday Morning News & Notes

Denmark clarifies travel rules ahead of most restrictions being removed

Jan 31, 2022

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Danish healthcare authorities are providing more clarity on entry rules as the strict testing requirements end as of midnight tonight, along with virtually all other COVID restrictions.

As of February 1:

All travelers can enter Denmark with proof of vaccination or recovery from a recent coronavirus infection without having to face entry restrictions, with some exceptions.
Unvaccinated travelers arriving in Denmark from a country deemed to be a COVID high-risk will face testing and quarantine requirements. Travelers coming from a country classified as a COVID risk country (currently 13 countries outside the EU) will be required to either have a negative COVID test in hand on arrival (PCR test no older than 72 hours or rapid test no older than 48 hours) or take a coronavirus test within 24 hours of entry. Children younger than 15 and people with permanent residency in a country bordering Denmark are exempt.

Denmark has also expanded its list of approved vaccines and will recognize travelers who have at least two doses of Covishield, Covaxin, Sinovac and Sinopharm as being fully vaccinated. These are in addition to vaccines already approved for use in the European Union Moderna, Pfizer/BioNTech, Johnson & Johnson, AstraZeneca, and Novavax.

All previous rules around proof of vaccinations, EU residency, and a defined list of accepted vaccination certificates have been repealed. As of February 1, proof of fully vaccination with one of the nine accepted vaccines will suffice.

Lastly, all restrictions on cruise ship passengers are abolished and they will fall under the same requirements for all other travelers as described above.

You can find more information (in Danish) on the new rules HERE.

Danish Health Minister Magnus Heunicke has signed the executive order officially removing the designation that COVID is a ‘socially critical disease.’ The designation provides the legal basis for leveling restrictions. When the designation is lifted at midnight, virtually all restrictions will vanish along with it.

When COVID restrictions vanish at midnight, it will mean some things will change for students and teachers in schools, and some things won’t.

According to Denmark’s Ministry of Education, this is what changes as of midnight:

Parents and visitors to daycares, primary schools, and youth and adult education sites will no longer be required to wear a mask or visor.
Students and staff in youth and adult education are no longer required to wear a mask or visor when moving around the school or in common areas.
Masks and visors are no longer required for visitors to hands-on learning and activity centers.
Primary school students can mix and socialize across classes again.
Coronapas requirements are lifted for entry to youth and adult education and adult continuing education facilities, as well as learning and activity centers.

Recommendations still valid after January 31:

Schools and educational institutions will still be encouraged to follow general guidelines including social distancing between staff, good ventilation indoors, hand-washing, and extra cleaning.
The recommendation for two weekly COVID tests remains in place for daycare staff, students and staff in primary schools, students and staff in youth and adult education. Free self-testing kits will continue to be supplied to all.
School staff in daycares, primary schools, and youth and adult education facilities can still wear a mask or visor when moving around the school, but not while teaching or interacting with students.

The Danish Agency for Patient Safety retains the authority to order classes and schools to close in the event of a major outbreak.

The big windstorm that swept across Denmark over the weekend is going to have an impact on daily COVID numbers. Region Hovedstaden (Metro Copenhagen) closed its PCR testing centers on Saturday and reopened them Sunday afternoon due to weather conditions.

Region H wasn’t alone as testing sites were shuttered across the country due to weather-related safety concerns. This will create a reporting lag across the board and will probably be followed by a rush on testing sites and numbers ‘catching up’ with the lag over the next few days.

Denmark added 77,279 COVID infections and another 38 coronavirus deaths over the weekend. It reported 41,083 infections on Saturday followed by another 36,196 on Sunday.

There were 266,963 corona tests conducted on Saturday, of which 162,422 were PCR tests equaling a positivity percentage of a sky high 22.28%.

Region Sjælland is cutting back its daily COVID rapid testing capacity from 65,000 to 26,000. Hand in hand with reducing rapid testing capacity, as of today the region is closing 25 rapid testing sites. PCR testing sites are not impacted.

Testing Manager Anne Hjortshøj says the bottom has fallen out of demand for rapid tests, especially after self-testing kits were distributed by the thousands to healthcare staff and students.

“There will continue to be test sites in all municipalities and sufficient capacity for all citizens who want it to be tested. For some, this means that it will be a little longer for a test site, but with 40 test sites, there is still good coverage.”

The region says rapid testing will be maintained on all the islands.

In the last seven days there have been 115,250 COVID infections among children and young people 19 years old and younger. Of those, 39,051 were among children aged 6 to 11 years old, followed by 32,826 for kids 12 to 15 years old. Among infants there were 6,442 positive tests resulting in 148 hospitalizations, the highest of any of the age groups under the age of 20.

COVID hospitalizations (948) bounced back up (+26) after seeing a Saturday decline. While the number of severely infected patients in an ICU (31) continued its downward march (-4) and of those the number on a ventilator (15) also kept dropping (-4). The number of corona admissions to a psychiatric ward (216) continues to rise (+3).

Region Midtjylland has seen vaccination demand fall and with a lack of “customers” it is now scaling back its inoculation capacity. In the third week of January, despite a weekly capacity for 80,000 vaccinations, sites across the region saw just 44,860 people show up to get their shots.

Beginning this week, the region will cut weekly vaccination capacity back to 40,000 booking times. As of today, it will also end a collaboration with private companies to help in the vaccination effort.

So far, 1,123,806 people (83.7%) in the region have at least one dose, 1,100,713 (82%)have two doses, and 826,366 (61.6%) have a booster shot. 198 people in high risk groups who are immunocompromised have had a fourth vaccine dose out of a group of 22,400 who qualify for a 2nd booster dose.

Since joining the vaccination effort on January 11, pharmacies in the region have inoculated 1,553 people. Family doctors covered off another 90,167.

On the vaccination front, there were just 6,988 total inoculations on Saturday. The massive windstorm that battered the country probably had a hand in keeping the numbers down.

To date, 82.5% of the total population have one vaccine dose, 80.7% have two, and 60.6% have a booster shot.

Danish pharmacies are looking to build on the successes they have had in helping out with the national vaccination effort. Since mid-December, when they joined the vaccination campaign pharmacies have administered around 100,000 inoculations.

Danish Pharmacy Association Chair Jesper Gulev spoke to DR:

“I think we can go ahead and get a permanent adult vaccination program and expand it to other vaccines, as you see in other countries.”

Other treatments pharmacies are eyeing to pry away from doctors are for the treatment of chlamydia, eye inflammations, and childhood worms.

The Department of Clinical Microbiology at the University Hospital of Sjælland has passed a pandemic response milestone. The department usually spends its time analyzing about 680,000 bacteriological and virus samples sent in from local hospitals and family doctors in the region. When the pandemic struck two years ago, it shifted gears and took on the role of analyzing PCR tests from across the region.

At the end of last week, the department passed the 1,000,000 mark in analyzing PCR tests so far in the pandemic.

The program’s Pia Krohn Hansen:

“Analyzing one-million COVID PCR tests in two years is like going from 0 to 100 km/h in five seconds. It has gone well. We received up to 6,000 COVID samples daily. Now we are down to half with approximately 3,000 COVID samples every day, we are still busy analyzing.”

In order to adjust to the added responsibility, they had to hire bioanalysts, laboratory technicians, molecular biologists, bioinformatics, secretaries, hygiene nurses, and doctors. Not to mention adding new technology and expanding the physical space to meet the demand.

The Winter Olympics in Beijing, China aren’t due to start until February 4 but already the coronavirus is making its presence felt. Among the athletes testing positive on arrival are two Danish ice hockey players, Lilli Friis-Hansen and Kristine Melberg, according to the Danish Sports Federation. The two players can leave quarantine as soon as they can post two negative COVID tests taken 24 hours apart. The Danish women’s team flew into Beijing with a contingent of Norwegian and Swedish athletes, of whom several have also had positive test results.

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Sweden only updates its COVID numbers four times a week and it won’t issue its next report until Tuesday.

Sweden is running out of a monoclonal antibody drug used to treat severe coronavirus infections. According to a report by Swedish Radio supplies of the drug sotrovimab are about to run out. The treatment supplies left are now being prioritized for patients who need it most and have a higher chance of benefiting from treatment. Sweden generally uses the drug to treat severely infected people who have weakened immune systems who don’t benefit from the full protection offered by vaccines. The next shipment of the drug is sometime in February.

Region Skåne has passed a vaccination milestone with one-million people in Southern Sweden now having at least one vaccine dose. But health officials in the region are still urging people to get vaccinated especially for those that have two doses but have not yet had a booster.

Vaccine Coordinator Per Hagstam:

“Many who need a third dose have recently been ill with COVID. When you have recovered from an infection, you have some immunity. But it is unclear how long this will last. Therefore, take the third dose provided that you have recovered. With a third dose, you get enhanced protection and reduce the risk of an Omicron infection because that variant has been shown to more easily get past both natural immunity and vaccination with just two doses.”

The other group the region is focusing on getting the vaccination message out to is pregnant women.

“Pregnant women have a higher risk of a severe COVID infection compared to others of the same age, and there is also an increased risk of blood clots and other complications if you become infected during pregnancy. Pregnant women are therefore strongly recommended to get vaccinated.”

Studies have shown severe coronavirus infections in the later stages of pregnancy increase the risk of premature birth.

New infections in Region Skåne are headed up. Keep in mind the low testing in Sweden and the opportunity for a lot of escape detections. So, the numbers are likely higher than they appear.

In Sweden’s capital region the COVID crunch continues across Stockholm’s hospitals as the number of available care beds continues to dwindle. As of Sunday afternoon, there were 610 coronavirus patients and of those, 40 were in intensive care. The region has just 77 available care beds, 58 less than they had the day before.

Chief Physician Johan Bratt:

“The infection spread is still at a very high level and the number of COVID patients who are admitted to our hospitals is still increasing. The health service continues to report very high sick leave rates among employees. All in all, the situation is strained across the entire health care system and we are seeing longer waiting times than usual.”

But, Bratt notes, as seen elsewhere, while overall hospitalizations soar the number of those needing intensive care is easing.

“This is probably largely due to the fact that the vaccination rate is high and vaccinated people have a significantly lower risk of serious illness and that the now dominant Omicron variant does not cause as severe a disease as previous variants. At the same time, healthcare employees have become better at treating the disease.”

The region continues to see soaring COVID numbers according to Infection Control Doctor Maria Rotzén-Östlund:

“In the last two weeks, almost 120,000 people in Region Stockholm have had a confirmed COVID infection. And the actual number of infections is even higher because not everyone is getting tested now. This means that the risk of being infected in Stockholm has never been higher, which means that it is now particularly important to follow all advice and recommendations.”

Confidence in Sweden’s healthcare system is taking a big hit due to its approach to the pandemic. In an Ipsos survey conducted for Dagens Nyheter just 49% of respondents said they had a high level of confidence in the Swedish healthcare system. That is down 15 points since the last polling was down just six months previous. 23% say they have very little confidence in the system’s ability to handle another COVID wave.

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Norway has added 33,025 infections and had no new corona deaths since Friday’s update.

COVID hospitalizations (230) dropped (-33) while the number of severely infected people in an ICU (53) crept upward (+1) and of those the number on a ventilator (32) remains unchanged.

To date, 80% of Norwegians 12 years old and older have one vaccine dose, 74% have two, and 49.2% have a booster dose.

The latest modeling from the Norwegian Institute for Public Health anticipates the Omicron/BA.2 infection wave could infect three to four million people. Of those, there could be up to 13,000 hospitalizations.

Director Camilla Stoltenberg:

“The health service and other agencies with important functions in society must have plans to handle more patients and higher-number of staff who will be off sick.”

The projections anticipate scenarios where the infection wave could see a significant peak by late February or early March, with between 40,000 to 125,000 infections per day and between 25 to 300 new hospitalizations.

The agency notes the pandemic is much more complex now, with a huge number of new infections causing significant strain on hospitals, a soaring number of corona-related staffing absences, and that in turn is putting pressure across many businesses, especially those with critical functions.

The institute highlights one other major pandemic concern. It notes the international situation is still “unstable” with low vaccination coverage in many countries, which “makes the emergence of new varieties likely.”

Another potentially exacerbating factor it is keeping an eye on is the seasonal flu. The agency notes that it is unusual to be this far into January without seeing an influenza spike, and that the “epidemic may still come.”

Norway will take shipments of the Novavax COVID vaccine, which was recently approved for use in Europe, but the Scandinavian country expects to give most of the doses away. The Norwegian Institute for Public Health says there may be a small segment of the population who prefer a more traditional vaccine than an mRNA one, and Novavax may fit the bill. But it anticipates demand to be very low. It says a significant number of Novavax doses will be donated to other countries with a greater need.

Novavax is a protein-based vaccine using fragments of the coronavirus protein to provoke an immune response from the body. It learns to recognize coronavirus and ‘remembers’ how to make antibodies to fight it should the actual virus show up.

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Finland doesn’t update its COVID numbers on weekends. It will table three days worth of coronavirus data later today.

Finnish health authorities have fine-tuned their COVID wastewater surveillance program to include advanced sequencing techniques to identify coronavirus variants. Since December, when the first Omicron infection in Finland was confirmed, the new wastewater testing technique has been deployed and proved successful. However, the Finnish Institute for Health says the turnaround time to get variant results is still very slow, taking about a month for results.

Finland has been using wastewater testing as an early warning system for COVID activity. It tests wastewater from around the country weekly and reports the results online every Friday. The latest results from sampling done between January 16 and 17 show that COVID RNA in wastewater around the country is continuing to increase.

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The European Centre for Disease Control says it is now likely that coronavirus is here to stay and that a future “new normal” will involve regularly dealing with COVID. The agency says it is now imperative that there be multi-layered COVID surveillance, especially for monitoring for new variants. Along with a virus surveillance system there needs to be beefed-up preparedness and response strategies to deal with coronavirus outbreaks. The ECDC says while extensive restrictions have reduced pandemic deaths and lessened the strain on hospitals, they have exacted heavy economic and societal costs.

“Since many EU/EEA countries currently have or are approaching high levels of population immunity (through vaccination and/or through natural infection), now may be the time to consider adapting the broad strategy for addressing the pandemic, from one focused on managing transmission of SARS-CoV-2 to one that aims to manage outcomes of COVID-19. For this, countries will need to balance what, on the one hand, they consider to be an acceptable level of COVID-19 hospitalizations and mortality, against what, on the other hand, is an acceptable level of restrictions, given their societal impact.”

The ECDC stresses that to successfully transition to what it calls the “post acute phase of the pandemic” getting everyone vaccinated is key, as is finding ways to sustainably protect vulnerable and high-risk populations.

Europe is still in the throes of an Omicron-fueled infection wave, causing infection numbers to increase rapidly, according to the latest assessment from the European Centre for Disease Prevention and Control. The ECDC notes COVID numbers have been rising quickly for five straight weeks and it expects that trend to continue for at least the next two weeks. It also cautions that due to testing systems either being inadequate in some countries or being overrun in others, the number of reported cases is likely an underestimation.

The agency says infection numbers are highest among those under the age of 50 but adds it is also now seeing coronavirus numbers rising in older age groups as well “albeit at a slower rate.” It expects infection numbers and fatalities to keep rising.

The COVID incidence rate per 100,000 people continues to rocket up across Europe for a fifth straight week going from 2,722 to 3,111 from one week to the next. On hospitalizations, the ECDC says of the 28 countries reporting admissions and intensive care data, 13 reported increasing numbers.

Omicron is king across Europe, accounting for 83.3% of all sequenced positive test results, while the Delta variant accounted for 14.3%. The Omicron variant is now dominant in 17 of the 22 EU/EEA countries the ECDC assesses as having adequate testing and sequencing capabilities.

With the pandemic situation classified as being of high or very high concern across 27 European nations, the ECDC says Omicron waves are in different stages from one end of Europe to the other. It assesses nine as being of very high COVID concern. They are Bulgaria, Croatia, Estonia, France, Latvia, Portugal, Romania, Slovakia, and Slovenia. 18 countries including Denmark, Germany, Iceland, the Netherlands, Norway, and Sweden are deemed to be of high concern. While three, Cyprus, Finland, and Spain are classified as moderate concerns.

The cumulative uptake for having two doses of the vaccine across Europe as of the third week of January was 70% of the total population. Booster dose uptake was 42.6%.

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Canada’s National Advisory Committee on Immunization (NACI) has updated its guidelines and now strongly recommends children 5 to 11 years old get two doses of the Pfizer/BioNTech COVID vaccine. They should be taken at least eight weeks apart. NACI also advises children in the age group who are immunocompromised to get a booster dose.

The Public Health Agency of Canada (PHAC) says the Omicron wave continues to challenge or in some areas overwhelm COVID testing capacity. This has resulted in case numbers being underreported. That said, the agency states that “multiple factors” suggest the Omicron wave has peaked, at least at the national level.

From January 21 to 27 there were an average of 18,497 new infections daily across Canada, a 28% decrease compared to the week prior. The positivity percentage for the same week was 19% “indicating widespread community transmission.” PHAC warns this is putting significant pressure on the healthcare system, both due to a high number of admissions but also because of so many staff being off-sick. It says there was an average of 10,766 infected people being treated in hospital each day over the same week, a 7% increase from the week before, which is the highest of any week in the pandemic to date. Intensive care numbers also increased, rising 6% higher week to week.

PHAC stresses vaccination is key and as of January 22, 88% of the population over the age of 12 had at least one dose. Among children 5 to 11 years old 53% have had their first dose. On the booster dose front, 77% of seniors 70 years old and older and 64% of those 50 to 69 years old have had their booster shot.

Of the provinces that reported over the weekend:

Ontario saw hospitalizations (3,019) drop (-516) while ICU numbers (587) were down (-20). Not all hospitals report on the weekends, so take the numbers with a grain of salt. The province lost another 58 lives to coronavirus. It has a positivity percentage of 13.5%

Quebec has a positivity percentage of 10.73%. Hospitalizations (2,895) were down (-196) while ICU numbers (233) rose slightly (+5). The province lost another 11 lives to the pandemic.

In Newfoundland and Labrador, hospitalizations (23) have hit a new record high (+3) but Sunday’s update didn’t provide ICU numbers. The province has a positivity percentage of 16.8%.

Nova Scotia hospitalizations (92) crept up (+4) and ICU numbers (15) were unchanged. The province has a positivity percentage of 14.2%.

In New Brunswick there are 164 people in hospital (+23) with 13 in an ICU (+4). The province also saw five more deaths.

Saskatchewan saw hospitalizations (349) rise (+21) as it approaches a record high. The province had one more pandemic death. Its positivity percentage is 40.6%.

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