Denmark: The ‘new normal’ pioneer with lower vaccination coverage than Spain

A trip to Copenhagen is like journeying into the future – or back into the past – to a time when a respiratory coronavirus was not shaping people’s lives. It is not that Covid-19 has been eradicated in Denmark. It’s still spreading, with an incidence rate that more or less mirrors that of Spain. But, since September 10, the virus is no longer officially “a critical threat to society.”

It is a statement that can only be taken as provisional given that it has been issued in the midst of a quickly changing pandemic in which the developing world has almost no access to vaccines.

It is the vaccines that have, in part, made it possible for Denmark to lift all restrictions. Many western countries are now moving towards this reality at different speeds 18 months into a pandemic that changed many facets of life. When exactly each country will reach the so-called “new normal” will depend on local fluctuations. But if Denmark is anything to go by, whenever it comes, the “new normal” will be almost indistinguishable from the old one.

What Denmark is doing is finding a way to live with Covid-19, which is the future, whether we like it or not

Søren Riis Paludan, from the Department of Biomedicine at Aarhus University

When it comes to living with the virus, Denmark has become a pioneer in the European Union, blazing the trail for something that sooner or later, the rest of the world will have to do. Once Danish prime minister, Mette Frederiksen, considered the pandemic “under control” in Denmark, the view has been that it is time to treat Covid-19 as just another disease, although the Danish authorities insist that they are prepared to reintroduce restrictions if transmission spirals back out of control.

Denmark has staked its strategy on the success of its Covid-19 vaccination drive. Approximately 74.55% of its population is fully vaccinated, a figure that is slightly below that of Spain (77.03%, according to Oxford University’s Our World in Data website). The probability of becoming seriously ill has plummeted and SARS-CoV-2 is considered unlikely to challenge the Danish healthcare system again, as long as a new variant does not emerge that changes the rules of the game.

But no one is under any illusion that the virus is about to disappear. Spanish epidemiologist and director of the Health Ministry’s Coordination Center for Health Alerts and Emergencies, Fernando Simón, said at a congress of epidemiologists earlier this month that we must begin to “normalize the disease.” At some point, the pandemic will be what experts call endemic, similar to the flu, although not everyone is as clear as the Danes that this point has been reached. This is due, among other things, to the fact that few countries in the world – even the developed world – have such high vaccination rates. In Germany, where 62% of the population is fully vaccinated, virologist Christian Drosten, a government advisor and one of the most respected voices in his field, said earlier this month that living with the virus, Danish-style, would not be a reality this fall. “The loss of life would be too high,” he explained. Italy, France and the United Kingdom have vaccination rates below 65% that are closer to Germany’s than those of Denmark and Spain. Meanwhile, in the United States and Japan, rates languish at around 53%.

To reach endemic status, Drosten not only believes that more people need to be vaccinated, but that the immunity from the shots should be combined with immunity acquired through contact with the disease. The idea is to protect the most vulnerable with the vaccine doses shown to be necessary, so that the death rate decreases, while the disease itself continues to circulate with immune systems adapting to coexist with it. Undoubtedly, other coronaviruses that do not cause major problems today, such as the one which causes the common cold, once took the shape of an aggressive pandemic in an era when there were no vaccines to cushion the blow.

On the surface, evidence that a pandemic has swept through Copenhagen is confined to the ubiquitous hydroalcoholic gels and the signs in some stores and on public transport explaining preventive measures that no longer apply. Besides the Church of Scientology’s headquarters, Copenhagen airport is the only place where it is still mandatory to wear a mask, for passengers at least. Most airport staff do not wear them. On landing, controls are also maintained. However, they are far from stringent, being limited to asking travelers, as they walk to collect their baggage, if they are vaccinated, without obliging them to show a vaccine certificate. If the answer is no, an antigen test is carried out on the premises.

For the moment, the threat to public health is minimal and it would be disproportionate to maintain restrictions, which are also very negative for society

Jens Lundgren, infectious disease specialist at Copenhagen University Hospital

Outside the airport, the coronavirus seems like little more than a distant memory. You can spend an entire day wandering around the city without seeing a single mask: mask-wearing is almost unthinkable outdoors and extremely unusual inside, even in packed restaurants. There are macro-concerts and festivals that bring together thousands of people as if it were 2019; bars and nightclubs have reopened with no restrictions on opening hours or capacity and no request for a coronavirus passport, a document certifying that the bearer has been vaccinated or undergone a recent test that was widely used in Denmark in the months running up to September 10. “We can now live a normal life, and that includes going out partying,” says Erik, 18, who has slipped out for a cigarette from The Drunken Flamingo, a cocktail bar in the center of the capital. “Nobody cares much about the coronavirus anymore.”

There is consensus in Danish society that it was time to take the plunge. “They are very disciplined here,” says Marta Pastur, a 25-year-old Spaniard who came back to Asturias on vacation in August and found herself to be in “another world” because of the difference in restrictions. “When the government introduced a measure, everyone complied with it, and now the public trusts that if the authorities say you can live a normal life, it is because there is no risk.”

With a slightly lower percentage of the population fully vaccinated than in Spain and a very similar cumulative incidence, according to the Our World in Data website, it is tempting to think that Denmark can serve as a testing ground and that, if all goes well there, it may soon be possible to follow in its footsteps. But comparisons between countries in order to measure the need for restrictions to contain the virus have always proved tricky. In the United Kingdom, where there is a slightly lower rate of vaccination (65%) than in Spain and Denmark and very few restrictions, the virus is circulating far more intensely and the 14-day cumulative number of cases per 100,000 inhabitants is more than 700 – seven times the figure in Spain and Denmark. In Israel, which was once a vaccination frontrunner but now has just 63% of the population fully vaccinated, the 14-day incidence rate has been above 1,000 for weeks, according to Our World in Data.

Beyond cases and vaccination rates, there are many differences between Denmark and other countries such as Spain, including its size; Denmark has a population of 5.8 million, which is smaller than the population of the Madrid region. The density of Denmark’s cities should also be taken into consideration; the capital has the same population as Zaragoza in Aragón. And then there is the culture; when the mandatory two-meter safety distance was eliminated, the joke, especially among the immigrant community in Denmark, was: “At last, they can go back to the usual five meters.”

The pressure on the healthcare system has also been different. The latest wave has been much milder than in Spain, perhaps because of Denmark’s decision to vaccinate young people straight after the vulnerable. On September 17, only 116 people remained in hospital, 18 of whom were in intensive care. Taking the population of both countries into account, these hospital figures are about a fifth of Spain’s.

Denmark has done more than 82 million tests, more than 20 million more than Spain despite the fact its population is eight times smaller

Moreover, the Danish response to the pandemic has been very different from that of Spain, and so has its impact. Its most aggressive wave struck last winter. In response, the government introduced a hard lockdown that helped curb the spread of the virus. With intermittent restrictions on activities depending on the rates of transmission, there has never been a lockdown so strict that people couldn’t go outdoors, and the use of masks has never been mandatory outside and only in certain scenarios indoors. The last place people were required to wear masks was public transportation, a measure that was lifted on August 22, 2021. “But only if you were standing up; sitting down you didn’t have to wear it either, so for practical purposes, many people didn’t wear it,” says Pastur, whose Spanish academy for children in Copenhagen is operating “completely normally” as is the school where she teaches.

Søren Riis Paludan, from the Department of Biomedicine at Aarhus University, explains that masks have never been a key element in Denmark’s strategy. “They have an effect, but not a big one,” he says. “More than 80% of transmissions occur between close contacts. We have not seen a major impact, neither when they were introduced, nor when their use was dispensed with, so the Danes are happy not to have to wear them. What Denmark is doing is finding a way to live with Covid-19, which is the future, whether we like it or not.”

It is not clear, however, when everyone will get there. The World Health Organization has set a target of 40% vaccination coverage in all countries by the end of the year. So far, all the forecasts in this regard have been overly optimistic. While some rich countries do not know how to increase their vaccination rates and are even resorting to mandatory vaccination – all workers in Italy must show proof of vaccination, a negative test or recovery from the virus, and for health workers in France – barely 2% of the population in low-income countries has received as at least one dose. Other countries, such as Israel and the United Kingdom, are already offering third doses to those over 50, even though it is not yet clear whether this is an effective strategy.

For the moment, the threat to public health is minimal and it would be disproportionate to maintain restrictions, which are also very negative for society

Jens Lundgren, a professor and an infectious disease specialist at Copenhagen University Hospital

And there is always the dreaded possibility that the virus mutates and vaccines lose effectiveness, which, while not taking us back to square one, would force us to return to more stringent restrictions. Most of the experts consulted do not see this as highly likely, but say it should not be ruled out.

This kind of flexibility is something the Danes are clear on. If social life has to be restricted again, it will be. But the social consensus on lifting restrictions is a consensus that also exists in the scientific field. “We have managed to deploy vaccines very effectively and protect the most vulnerable,” says Jens Lundgren, a professor and an infectious disease specialist at Copenhagen University Hospital. “For the moment, the threat to public health is minimal and it would be disproportionate to maintain restrictions, which are also very negative for society. This does not mean that we will never have to implement measures again, should they be necessary.”

To compensate for measures that are seemingly less strict than those in Spain, Denmark has focused its strategy on testing. In practically every neighborhood, there is a test center with tests that are free of charge. This made it possible to introduce the coronavirus passport, which people had to show to entertainment venues, until this measure was lifted on September 10. The country has done more than 82 million tests, more than 20 million more than Spain despite the fact its population is eight times smaller. If every Spaniard has had an average of just over one test since the beginning of the pandemic, in Denmark the average is 14 per citizen. “If you are going to meet people at the weekend, you get tested, and in some companies, they even screened everyone in order to bring the situation under control,” says Sheree, who works in a souvenir store in Strøget, Copenhagen’s main shopping area.

A less-visible legacy of the pandemic is the extensive teleworking in Denmark, says Einar, an employee of a multinational company that closed its offices and has not reopened them. “There has always been a lot of flexibility with that here, but now there are many of us who don’t go to the office anymore. It’s a bit lonelier, but it also has many advantages.”

When will the new normal come to Spain?

Although September 10 was the day on which all restrictions were lifted in Denmark, it was not a sudden release as happened on England’s so-called Freedom Day on July 19, 2021, when practically all measures were lifted at once. In Denmark, the measures were gradually eased: up until September 10, only a few remained, such as asking for the coronavirus passport. “To all intents and purposes, I don’t notice any change in my daily life between now and a month ago,” says Martin, a waiter in a bar.

In Spain, coronavirus measures are also being lifted gradually. José Martínez Olmos, professor at the Andalusian School of Public Health, believes that there should not be a race to reach normality. “As long as there is transmission, there are still risks,” he says.

Spain’s regions – which are in charge of their healthcare systems, vaccination drives and coronavirus restrictions – have already lifted most of their restrictions and will continue to do so as the number of cases continues to fall. Meanwhile, the Inter-Territorial Council of the National Health System (CISNS), which brings together health chiefs from the central and regional governments, is working on a new traffic light scheme for restrictions that takes into account the new circumstances: three out of four Spaniards are already fully vaccinated. This system is expected to be more flexible than the previous one, which, although it was not mandatory, served as a reference for establishing measures. Under the current parameters, the 14-day cumulative number of cases per 100,000 inhabitants must be below 25 for Spain to enter the new normality. As of Tuesday, this figure was 79, according to the latest figures from the Spanish Health Ministry. A total of 3,450 people were in hospital with Covid-19, while 10.21% of all intensive care unit (ICU) beds were occupied by Covid-19 patients.

In Spain, the last measure to be removed will most likely be the use of face masks in indoor spaces. It is the only non-pharmacological measure affecting Spaniards’ daily lives that is regulated by national law. The day the law is repealed will, symbolically, hail the end of the pandemic in Spain, provided, of course, that the virus does not have more surprises in store.

English version by Heather Galloway.