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At the beginning of February, Denmark became the first major country to lift the last of its COVID-19 restrictions and effectively declare its part in the pandemic over.
Around the world, and especially in the United States, Denmark’s “liberation” from indoor mask mandates, vaccine passports and nightclub closures was heralded as a watershed moment — the shape of things to come. Democratic governors across the U.S. started rescinding their own mask rules a few days later.
“This marks the transition to a new era for all of us, because Denmark will once again be an open society, completely open,” said Prime Minister Mette Frederiksen. “We dare to believe that we are now through the critical phase."
Since then, however, Denmark has continued to record more COVID-19 cases per capita than nearly anywhere else in the world, and both COVID hospitalizations and deaths have shot up by about a third.
“Not looking good in Denmark,” Dr. Eric Topol, founder and director of the Scripps Translational Institute, tweeted Sunday, sharing several charts that terminated in near-vertical upward lines. “Deaths are now 67% of peak, with a steep ascent.”
“The world is looking to Denmark as a guide to removing all restrictions,” Topol added in a subsequent tweet, “and it seems that we've seen this movie before.” He then attached a screenshot of a news story headlined “Denmark lifts all coronavirus restrictions and celebrates ‘a whole new era’” — from Sept. 10, 2021.
Topol’s argument was clear: By ending mitigation measures prematurely, Denmark has brought a resurgence of infection, hospitalization and death upon itself — and anyone who follows in the country’s footsteps risks doing the same.
But is that the right way to read the numbers? In response to Topol’s tweet — and others like it — Danish experts took to Twitter to object.
“Those data do not capture the epidemic situation in Denmark adequately,” tweeted political scientist Michael Bang Petersen, who advises the Danish government and leads the country’s largest study of pandemic behavior.
“Hospital burden in regards to COVID-19 is still low compared to former waves, and mortality is low,” Søren Neermark, an official at the Danish Health Authority, went on to explain.
“Test-positive admitted in Denmark” — that is, the number of people who are hospitalized with COVID but not necessarily because of it — “reflects high incidence in society, but is not the best current indicator for the burden of COVID-19.”
At first, this might sound like an academic debate about Scandinavian statistics. But it’s actually something much deeper and more significant. Like Denmark before it, the United States is also hurtling toward its own post-Omicron tipping point — the moment that U.S. society, broadly speaking, decides that COVID risks have become more tolerable than COVID rules.
Such a pivot wouldn’t mean that the pandemic is over; the virus will spread regardless of how we label it, particularly in poorer, less vaccinated countries and communities. Instead, it would mean we have, in effect, given up trying to protect each other from the pandemic collectively, at least as a matter of government edict, leaving individuals to protect themselves as they see fit.
The question then becomes: How much risk — how many hospitalizations and deaths — is a society ultimately willing to tolerate in exchange for no more rules?
“Endemicity” — the less disruptive coexistence with a virus that comes after a pandemic — “just identifies a pathogen that’s fixed itself in our population so stubbornly that we cease to be seriously perturbed by it,” the Atlantic’s Katherine Wu has written. “We tolerate it. Even catastrophically prevalent and deadly diseases can be endemic, as long as the crisis they cause feels constant and acceptable to whoever’s thinking to ask.”
The current situation in Denmark offers an early glimpse of how that kind of “endemic” future could unfold. In late January, COVID cases there appeared to crest. But driven by BA.2, a more transmissible subvariant of Omicron, they began to rise again immediately after mitigation measures were lifted, reaching a new all-time high average of 7,970 cases per million residents on Feb. 13 — 13 times the country’s previous peak, recorded in December 2020.
That’s an astronomical amount of virus. In comparison, the U.S. and the U.K. both topped out at around 2,500 cases per million residents at the height of their recent Omicron waves.
At the same time, Danish COVID hospitalizations began to climb as well, surpassing the U.K. rate on Feb. 6 and the U.S. rate one week later. About one and a half times more Danes are currently hospitalized with COVID than ever before. COVID deaths are a similar story; if they keep increasing at their current rate, Denmark will set a new record within the next few days.
On paper, that looks bleak. But Danish experts such as Petersen and Neermark argue that it is, in fact, tolerable. For one thing, they say, Denmark tests at nearly twice the U.K. rate — and more than six times the U.S. rate. That means, of course, that more COVID cases will be detected.
But since Omicron tends to trigger less severe disease, they continue, and since so many Danes are vaccinated — 82 percent overall (including 95 percent of those over 50, 90 percent of whom have also been boosted) — relatively few of these cases are worth worrying about.
To back up this claim, Petersen and others note that while the number of “incidental” COVID-positive hospitalizations, ICU admissions and deaths has increased in tandem with the ongoing surge, the number of hospitalizations, ICU admissions and deaths due to COVID itself has remained flat, according to government analyses. This suggests that vulnerable Danes remain well protected through vaccination and/or prior infection and that the costs of trying to control Omicron and BA.2 would not have been proportionate to the current threat.
In contrast to last winter, when Denmark saw “a significant increase in all-cause mortality … due to COVID-19,” according to Neermark, “overall mortality in Denmark in all age categories has now fallen into the normal spectrum as Omicron has become fully dominant.”
“So we essentially let the Omicron epidemic roll,” Dr. Jens Lundgren, a professor of infectious diseases at the University of Copenhagen, told the New York Times.
It is not hard to imagine the U.S. fully embracing a similar “Let ’er rip!” attitude in the months ahead. In truth, many Americans — including nearly all Republican politicians and most red-state residents, as well as a substantial minority of left-leaning Americans — have been living that way for some time now.
Bars and restaurants are packed even in supposedly “restrictive” places like Los Angeles and New York City; patrons are unmasked even as COVID rates surpass previous peaks. Regardless of policy, behavior has largely reverted back to the norms of 2019, signaling widespread public impatience with the economic and social trade-offs of mitigation measures.
Once states such as California repeal their indoor mask mandates, in schools and elsewhere — and once the last few federal rules about masking for interstate air travel are lifted — the United States, like Denmark, will officially “once again be an open society,” to quote the Danish prime minister. As Omicron numbers now plummet across the country, this spring could mark “the transition to a new era” for the U.S. as well.
But then what? Will U.S. leaders acknowledge that new variants — variants such as BA.2, but perhaps even more transmissible, and possibly more virulent — could emerge? Will they recognize that immunity tends to wane over time, and that even now, 35 percent of U.S. seniors remain unboosted (and that nearly as many 40- to 65-year-olds aren’t fully vaccinated) — and do whatever it takes to increase those numbers?
Will they stockpile the tests and high-quality masks that were in such short supply during the last surge? Will they improve access to antiviral pills? Will they fully invest in a new universal coronavirus vaccine that’s already effective against future variants?
And, to pose a more politically perilous question, will they be able to reinstate indoor mask requirements if conditions deteriorate?
Or will Americans just live with whatever comes their way? And if so, what price will they pay?
Earlier this week, Scripps immunologist Kristian Andersen spoke to former Biden administration COVID adviser Andy Slavitt about precisely this issue. A Danish expatriate himself, Andersen has been observing his home country closely in recent weeks — and he is worried about the message it’s sending, particularly to places like the U.S. that are far less protected and far more divided than Denmark.
“Saying, ‘Look, we’re going to lower all these remaining restrictions, because it’s not reasonable to put them on people and we want people to make their own decisions’ — I get that,” Andersen said on Slavitt’s podcast.
However, Andersen said, “we have to be realistic. If we say we’re not going to have restrictions, it’s up to you to get your boosters and wear a face mask if you can — if we say that’s your decision entirely — we should probably expect that for the next few years to come that most people will get infected a couple of times a year. And we should expect 200,000 to 250,000 deaths [a year] in this country alone.”
If officials make that clear up front, Andersen continued, “then that is the decision we make, and we can agree or disagree on whether we think that’s acceptable. But that’s a very, very different conversation [from] what they’re doing in Denmark.”
The alternative, Andersen said, is fairly straightforward — a middle path that allows restrictions to toggle on and off in response to changing conditions, and that places greater emphasis on innovation.
“It’s saying, ‘We’re going to lower these restrictions, but we’re going to innovate the heck out of this,’” he explained. “We can get better home testing, better masks, better vaccines, better antivirals. … That is where I would like to see us go, because that gets us to a place faster where the virus is going to be much less of a concern.”
“But it also requires that we realize [COVID] is going to be a problem we’re going to continue to deal with during the next five to 10 years,” Andersen concluded. “If we say it’s all over, my concern is that the innovation stops. Because then it’s like, ‘Well, what’s the point?’”