European Countries That Do More Tests To Detect Variants Are Betting On Very Cautious De-escalation

Slow and cautious de-escalation, conditioned on the data and with monitoring of worrisome variants of the coronavirus. These are the plans of Denmark and the United Kingdom, two countries that have stood out for their efforts in recent months when it comes to tracking down new mutations of the virus. Both have also ordered tough restrictions to quell transmission, with which they have managed to lower the number of cases within their borders, while continuing to advance rapidly in vaccination.

This Wednesday, Denmark, which in December decreed the closure of economic activity, said that it will begin to ease some of the measures in the coming weeks, starting with some of the shops and schools in certain areas. Also this week, the UK announced a four-phase roadmap, which will begin with the return of children to school on 8 March and will not allow the reopening of non-essential shops or outdoor catering until, at least mid-April.


“The absolute numbers of cases remain relatively high (…). We must all remain vigilant, especially in the face of the threat of new variants, but a safe exit from confinement can be initiated,” warns the British Government. For her part, Danish Prime Minister Mette Frederiksen had already announced on Monday that the restrictions were not yet to be fully lifted. “Now, with the lower infections, the unanimous opinion of the experts is that it is not possible to reopen completely,” he wrote in a Facebook post. In it, he said that with variant B.1.1.7, first detected in Kent, England, “it takes less for the infection to explode and therefore runs the risk of spiraling out of control.”

What scientists predicted, the variant B.1.1.7, more transmissible, is already the one that predominates in Denmark, as in the United Kingdom. Both are, together with Iceland, the European countries that, in proportion to their cases of COVID-19, share the most genomic sequences of the virus via Gisaid, a data base on-line to share viral genomes.

According the latest report from the European Center for Disease Prevention and Control (ECDC) focused on variants, sequencing capacity varies greatly across the European Union, but only Denmark (along with Iceland, which is not a member of the EU) exceeded the level recommended by the Commission, which asks countries to preferably sequence 10% of positive coronavirus samples.

Also, in general, it is estimated that between 5 and 10% of all COVID-19 cases they are regularly sequenced in the UK. In contrast, many European countries continue to sequence at very low levels, recalls the ECDC, so the low capacity to do so or the lack of notification of variants does not mean that there are no variants circulating in a country.

In Spain, for example, the Ministry of Health has established the objective that the autonomous communities sequence between 1 and 2% of their weekly diagnosed cases.

“The British mutation is really a big challenge, and I will emphasize why we should organize the continued reopening of Denmark with care and wisdom,” Frederiksen said earlier in the week. The Danish Government has detailed this Wednesday what the “gradual and responsible elimination of the restrictions” will consist of.

Starting March 1, retail stores of less than 5,000 square meters will be able to reopen their doors. Sports and associative activities of up to 25 people will be authorized, but only outdoors. Outdoor cultural entities such as zoos will also be allowed to reopen, but visitors have to submit a negative COVID-19 test that is no older than 72 hours.

In general, the maximum number of people that can meet is still five people. And the rest of the restrictions in force since December they will last until April 5, which affects gyms, hair salons, swimming pools, theaters, cinemas, restaurants and nightlife, which will remain closed. Furthermore, citizens are still being asked to work from home. The schools reopened at the beginning of the month for the youngest students, but will remain closed for the rest. However, in regions with a lower incidence, face-to-face teaching will be allowed, forcing two weekly tests to be taken. Current travel restrictions will also remain in effect, but the entry ban for UK travelers has been lifted.

The plan, says the government, is based on the experts’ recommendations. “The prevalence of variant B.1.1.7 is increasing in Denmark. The working group, including the health authorities, concludes that there is a considerable risk that the number of infections due to this virus variable will increase,” he argues, to justify why the measures are extended until April. The authorities speak of “calculated risk”.

“More activity will also mean more infected and, therefore, also more hospitalizations”, said the Minister of Health, Magnus Heunicke, in a press conference. He estimates that hospital admissions could reach a peak of about 880 in mid-April, more than triple the current 247, according to Reuters. Camilla Holten Møller, one of the experts at the Institute of Serology, the reference body for epidemics in Denmark, explains in a statement

that, according to their models, in the scenario of less openness, “the development of variant B.1.1.7 leads to slightly increasing infection rates and new admissions in mid-April.”

After December restrictions in the attempt to stop the new variant, Denmark has managed to control the curve and has experienced a precipitous decline in the number of cases. At the moment, however, infections are rising slightly, according to Johns Hopkins data analyzed by Denmark maintains relatively low infection rates in Europe, when compared to countries such as Spain, France or Italy.

Vaccination is progressing in Denmark, where about six million people live, at a higher rate than in other European countries. The country plans to end the campaign on June 27. At this time, it has administered the complete vaccine to 3.05% of the population, one of the most together with Malta, Romania and Iceland. The United Kingdom, however, is the European nation that has given the most doses per 100,000 inhabitants so far, a total of 27.34.

In the UK, Prime Minister Boris Johnson has been optimistic that the country will have emerged from the national confinement imposed in January at the end of June, but has asked citizens for “prudence” and to respect the planned phases of de-escalation. The progress of the gradual de-escalation of the restrictions will depend on each step of the vaccination program, but also on the evaluation of the variants. Johnson also did not rule out that local restrictions may be imposed to curb the expansion of possible new variants.

It is, they say, to open “with caution.” The British Government has insisted that when implementing the plan, it will be guided “by the data, not the dates, so that we do not run the risk of an increase in infections that would put unsustainable pressure on the health system” . There will therefore be a minimum of five weeks between each phase: four weeks for the scientific data to reflect the changes in the restrictions and to be analyzed. One of the requirements is that the risk assessment is not modified by new worrisome variants of the virus.

The objective of the plan is to protect the population and the health system through effective long-term contingency plans. “The Government will ensure that it has the necessary tools to manage local outbreaks, as well as the necessary means to quickly and effectively combat the new dangerous variants, both at the national level and at the border, in close collaboration with the administrations local “, reads the document.

The first step of the plan will take place on March 8, when it is expected to begin to reopen English schools and allow some contact with loved ones. The stay-at-home requirement will continue, but people can go outside for outdoor fun, such as a coffee or picnic with friends, the so-called “support bubble,” or with someone outside their home. Non-essential shops, gyms, open-air hospitality, as well as some outdoor cultural activities will not be allowed to resume until at least April 12.

The rules on social contact are not going to be relaxed until at least May 17. It is expected that, on that date, outdoor shows such as theaters or cinemas will resume. Indoors, however, contact will be restricted. It will also be the turn of the interior of bars and restaurants, and sporting events. The desired horizon is that on June 21 all legal limits to social contact can be eliminated, nightclubs reopened and large events allowed.

In its plan, the Government implicitly recognizes that, despite concern about the new, more communicable variants, containment measures have been successful in reducing cases, hospitalizations and deaths.

The B.1.1.7 variant, they recall, began to spread very rapidly in the UK at the end of last year and has grown rapidly to become the dominant variant throughout the country, so the Government ordered a new lockdown a few weeks after finish the earlier one of the fall. At its peak, UK healthcare system hospitals cared for more than 34,000 COVID-19 patients in England, roughly 80% more than at the peak of the first wave a year ago.

Cases, hospitalizations and deaths have decreased since the confinement began, the government explains in the plan. Between February 6 and 12, 1 in 115 people have tested positive for COVID-19 in England, compared to the peak reached between January 3 and 9, when 1 in 50 tested positive. As of mid-February, 20,177 people were hospitalized for COVID-19, down from the peak of 39,244 on January 18, and the average number of reported daily deaths has dropped from a high of 1,248 to 494.



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