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How Denmark got its children back to school so soon after lockdown

Denmark was the first country in Europe to reopen day care and primary schools after the strict coronavirus lockdown. Emma Firth takes a look at how Denmark did it and what lessons there are for other countries.

How Denmark got its children back to school so soon after lockdown
Children wave Danish flags as Danish Prime Minister Mette Frederiksen visits Stolpedal school in Aalborg, eastern Denmark on May 18, 2020. AFP

‘Tak for i dag’, says the nursery teacher (pædagog) as I collect my two and four year old daughters from day care. This is a well-used phrase in Denmark to say thanks for the day and you’ll often hear it echoing around schools and nurseries, as parents pick up their children. But it’s quieter now.

I stand at the side door of the kindergarten (børnehave) and wait for my daughter to be brought out to me. I can’t step inside the building. Another parent waits behind me, at a marked distance.

Collecting my two year-old is slightly different, as parents can go inside the nursery (vuggestue), but not inside the room the children play in. At kindergarten, my four year-old can’t hug or hold hands with her friends but adults can comfort them with cuddles whenever needed.

With our hands thoroughly washed, I put both girls in the cargo bike and cycle home. As the spring sun shines down on Copenhagen, I cycle past bustling cafes and shops; bike traffic is the same as usual; mask sightings are rare. Life almost feels back to normal. Except it’s not.

As soon as we arrive home, I change my daughters out of their clothes. We wash our hands, again. It’s a familiar routine for many parents across Denmark, since the reopening of schools and day care institutions six weeks ago. And it’s a routine that’s being watched across the world.

Danish Prime Minister Mette Frederiksen (R) speaks with pupils as she participates in the reopening of Lykkebo School in Valby in Copenhagen on April 15, 2020. AFP

On April 15th, Denmark became the first country in Europe to reopen primary schools, nurseries and kindergartens after five weeks of lockdown caused by the coronavirus pandemic.

Unlike in other countries like France it was compulsory in Denmark for parents to send their children back unless they had a doctors note or a sympathetic school leader.

The quick, decisive and extensive lockdown announced by Prime Minister Mette Frederiksen on March 11th, before any deaths from the coronavirus had occurred, garnered huge support.

In fact Mette Frederiksen said it was the first time in her political career that she had witnessed such unanimous agreement in parliament. It meant new laws were passed at lightning speed.

The country followed the rules of ‘væsk hænder, nys i ærmet og hold afstand’ -‘ wash hands, sneeze into your sleeve and keep a distance.’ Within a month, the infection rate flattened so much, that reopening plans had begun.

The speed of it all took the country by surprise. With advice from Denmark’s infectious diseases agency Statens Serum Institute, the government announced that the youngest children would re-enter society first.

SSI’s scientific model showed that children were the least susceptible to the coronavirus and the government wanted parents to work more effectively from home. The infection rate was at 0.6 with 433 coronavirus patients in Danish hospitals.

The united political front seen during lockdown began to crack as politicians, teachers, parents and business owners all had differing views. A parent group formed on Facebook, called 'Mit barn skal ikke være forsøgskanin for Covid19'- 'My child will not be a Covid19 guinea pig' and within days it had over 40 thousand members. Denmark’s world-renowned trust in authorities was being tested.

With just a week’s notice, teachers scrambled to implement the new health authority guidelines, in order to welcome pupils safely back. Extra funding was promised to each municipality, as part of on-going negotiations about what schools would need.

Stef Fleet, a primary school principal at the International School of Hellerup, says it was a challenging time.

“We built a hand wash station outside, installed extra sinks, converted taps from manual lift ones to automatic sensory ones, reallocated toilets so each class had their own bathroom facility and hired more cleaners to regularly wipe down all contact points like door handles,” he says.

New hygiene guidelines stated that children should wash their hands at least every two hours. Surfaces also needed to be cleaned twice a day.

Inside the school, classrooms were divided so that desks could be at the recommended two-metre distance. Teaching timetables were changed, to keep to small groups and a lot of focus was put on outside play and learning. The playground was marked into sections, to keep pupils in the same, small groups. Toys were put away, if they couldn’t be easily cleaned.

Guidelines for day care institutions were similar; even babies had to be seated two metres apart when at a table. The recommended floor space per child was also doubled, which meant many institutions could only accept half the children back, while they tried to find other buildings and outdoor space. Some schools even used tents as temporary classrooms in parks and playgrounds.

When the day of reopening came on April 15th, a mixture of excited and anxious parents turned up at the school, nursery and kindergarten gates. They waved their Danish flags (Dannebrog) and hugged their children goodbye for the first time in two months.

“I really wasn’t keen on sending my children back at first but three days before reopening, we got a big document from our school, explaining all the new guidelines and I thought, let’s try it,” mother of two, Virginie says.

“The kids don’t talk about it. They just take the good and positive from it – seeing their friends, playing, they’re just happy to have a routine and we’re happy as well,” she says.

Claire Astley is a teacher at a school in Vester Skernige, on Fyn. She thinks the new school set up has had a positive impact on pupils.

“The shorter school day, which is from 0800-1300, the emphasis on outside projects and smaller class groups has actually improved behaviour.

“The morning is spent doing maths or science, where we include children who are still at home, via Zoom. Then we’ll go outside and do activities like digging in the school garden, getting tadpoles from the lake or going on bike tours to the forest or beach. We don’t tell the children off if they get too close to each other. We let them be kids,” Claire says.

As parents started to see the new set up working, and the infection rate remain stable, attendance levels increased. Some parents were initially confused about the Danish Health Authority’s guidelines for school attendance. The authority later clarified that for parents to be able to keep children at home, they needed a doctor’s note and to get permission from their school leader.

Figures from the Department of Children and Education (Børne og Undervisningsministeriet) show that for the first week of April 15th, which included three days of reopening, 50.7% of pupils returned to primary school and 26% returned to day care. By the third week, 90.1% of pupils attended primary school and 66% attended day care.

It's a contrast to France, where two weeks after schools reopened on May 11th the number of pupils attending was around 25 percent, with many parents reluctant to send their children back.

On May 18th, pupils in Denmark aged 12-16 returned to secondary school. The guidelines were updated but were not as definitive, leaving a lot to school interpretation. School leaders were however encouraged to call the Ministry of Education helpline for advice.

Pupils of the Norrebro Park primary school dance to warm up outside in a nearby park in Copenhagen, Denmark on April 29, 2020. AFP

“There are so many new rules, from hand washing, to the children’s different breaks times, where we should be with the class. It’s quite hard to figure out what we should do,” one teacher in Copenhagen says.

Her principal receives texts and emails every evening about new procedures to update, which she says is very stressful.

The main difference in the guidelines is that social distancing has been reduced from two metres to one metre. This means there is space for all pupils to return to both school and daycare, although some schools are offering split days and a mix of online teaching to avoid overcrowding.

This has caused further concern for some parents. Pernille from Aarhus sent her 13 year-old son back to school last week because she wanted him to socialise again.

“I am still very worried by the one-metre distancing and there isn’t enough hand sanitiser. I am at risk so it also means I can’t hug my son anymore,” she says.

When 15-year old Latharna returned to her school in Stenstrup, the excitement of seeing friends was met with the reality of the new situation.

“All the new rules are quite overwhelming and my hands are really dry from the hand washing,” she says.

“It’s weird not hugging friends. And if you do, it’s quite risky. One boy in my class has a mother who is quite sick and we’ve been told we really have to keep a special distance from him because the risk is too high. If his mother gets ill we’ll all feel so guilty,” she says.

Latharna’s new shorter school day involves a morning walk, outside activities, before a small amount of academic work inside.

The emphasis on children’s social needs is mirrored in other schools. “There is an increased focus on well being. We’re not putting the academic needs second but we’re thinking differently about it,” says primary school principal Stef Fleet.

At the International School of Hellerup, a well-being unit has been developed so all classes can focus on an activity related to this. The school is also monitoring the use of the school psychologist and counsellor. So far there hasn’t been a noticeable increase, although this could occur later, especially as older pupils are now returning.

High school pupils, aged 16-19 returned on Wednesday May 27th. Those in their last year of school will take their final exams, but fewer of them. For everyone else, exams are cancelled and end of year grades will be decided on teacher assessments.

“Longer-term it’s still unknown what happens next year with grades, exams and reading levels and how much has been lost. That’s something we’ll start planning for soon,” principal Stef Fleet says.

Teacher Marie Kaas-Larsen speaks with her pupils of the Norrebro Park primary school outside in a nearby park in Copenhagen, Denmark on April 29, 2020.AFP

Six weeks on from the first reopening of schools, Denmark’s coronavirus infection rate stands at 0.7. Many sectors of society, including cafes, restaurants, shops and museums have also reopened, although the country's borders remain restricted.

There are currently 112 patients in hospitals across Denmark with coronavirus – a figure that has dropped from 380 when primary schools and daycare reopened. 563 people have died so far with coronavirus in Denmark; a country with a population of around 5.6 million.

Christian Wejse, an epidemiologist at Aarhus University believes the school reopening “has proven to be very safe”.

“Children are not important drivers of this epidemic,” he says. “They are less infectious, do not have a lot of symptoms and are very rarely hospitalised.

“We’re not risking lives I think by opening up schools. We may risk some increased transmissions in the children’s families and teachers but really we’ve seen that very little in Denmark. We are now down to a very low number of infectious individuals in the country, I think it will just continue going downwards and die out completely.”

Many have credited Denmark’s societal trust and propensity to follow rules, for the success of reopening and reducing the spread of infection.

“In Denmark we were able to have some mutual understanding between teachers, employers and authorities that everyone needed to feel safe in opening the schools in a situation like this. There was respect for all the people involved,” says Dorte Lange, vice president of the Danish Association of Teachers.

She recognises that there is still a lot to do. There are parents who haven’t sent their children back to school and day care yet because of infection fears.

“Some students are lagging behind now so there needs to be a big effort to help them. It depends on what chances teachers will get to do this catching up. But we’ve learnt that pupils thrive better in smaller groups with more teacher contact and shorter days, so we hope we can continue some of this.”

Dorte Lange commends the teachers for their flexibility and recognises it has been tough for them. “They are looking forward to their summer holiday,” she says.

When teachers return for a new school year in August, the repair work will begin. The long-term effects of this unprecedented change to children’s lives, is still yet to be seen.

Confronting Coronavirus: This article is part of a new series of articles in which The Local's journalists across Europe are taking an in-depth look at the responses to different parts of the crisis in different countries; what's worked, what hasn't, and why.
 
This article has been supported by the Solutions Journalism Network, a nonprofit organisation dedicated to rigorous and compelling reporting about responses to social problems.
 
The SJN has given The Local a grant to explore how different countries are confronting the various affects of the coronavirus crisis and the successes and failures of each approach.
 
How Denmark got its children back to school so soon after lockdown by Emma Firth is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Based on a work at https://www.thelocal.dk/20200528/how-denmark-got-its-children-back-to-school.

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CONFRONTING CORONAVIRUS

‘Nip the virus in the bud’: How Germany showed Europe the way on coronavirus testing

It’s taken other countries in Europe months to develop an adequate coronavirus testing regime needed to combat the pandemic. Rachel Stern examines how Germany managed it much sooner and how the country continues to lead the way.

'Nip the virus in the bud': How Germany showed Europe the way on coronavirus testing
A woman receives a coronavirus test in the courtyard of a doctor's practice in Berlin in April. Photo: DPA

On a sunny Friday afternoon in mid-June, Berliners enjoyed picnics in public parks, gathered at outdoor street markets and filled the outdoor terraces of restaurants.

But Hannah, a 21-year-old trainee nurse in the German capital, kicked off the weekend by starting a two-week quarantine in her flat, having just discovered she had been infected with Covid-19 after coming into contact with an acquaintance confirmed to have the disease.

“I had no symptoms, but I still tested positive,” Hannah told The Local. 

When a friend told her she was infected, Hannah quickly arranged for a test at the hospital where she works and received the results the same day.

In other countries governments have been heavily criticised for not providing rapid testing for healthcare workers or indeed the general population, even those with symptoms – a factor scientists believe exacerbated the spread of the disease.

But since the first outbreak of coronavirus Germany has made testing a priority, and now as lockdowns ease and public life reopens testing has become a crucial weapon in the fight against any resurgence of the virus.

The country’s continual effort to test its residents for the coronavirus is considered one of the key factors which has led to its low per capita case numbers and low death rate, and spared its medical system from a crippling overload experienced in other European countries.

It continues to be one of the few countries in Europe with an “open public testing” policy meaning even asymptomatic people can have access to tests. In contrast countries like France and the UK are only testing those with symptoms or those who have come into contact with anyone infected.

READ ALSO: Germany to expand coronavirus testing for people without symptoms

By mid-June it had carried out over five million tests out of its population of 83 million people, according to the Robert Koch Institute. 

As of Friday June 26th, Germany has had over 196,000 confirmed coronavirus cases, over 176,760 which are reported to have recovered, according to data from Johns Hopkins University. There have also been 8,940 deaths, well below the numbers seen in France, Italy, Spain and the UK.

Testing for the novel coronavirus in a lab. Photo: DPA

Taking action from the beginning

Germany’s success with getting its testing system up and running was down to several factors.

Firstly it acted quickly when the first cluster emerged in the country back in January.

Germany’s first coronavirus case was detected on January 27th at a car parts manufacturer just outside of Munich, also marking the first incident of human to human transmission of the virus in Europe.

The case was traced back to an employee who had recently visited her parents in Shanghai and brought back the virus. 

After confirming the virus, local health officials also ordered tests for 40 people who had been in contact with the infected employees, including colleagues and family members. Importantly the company, Wabasco, paid for 139 Covid-19 tests. 

This quick-fire testing to isolate the cluster at such an early stage of the outbreak was considered crucial by experts to prevent the kind of outbreak and knock-on effects on the health service seen in other countries.

“If this cluster of infections in Bavaria hadn’t been discovered, then Germany could have had a situation like that in Italy,” Professor Jonas Schmidt-Chanasit, the chair of virology at the Bernhard Nocht Institute for Tropical Medicine, told The Local. 

The example set in Bavaria was copied throughout Germany as infections spread to all 16 states.

“Infections were quickly registered and their contacts quickly reached,” so that they could be tested, said Schmidt-Chanasit.

It was exactly the kind of procedure recommended by the WHO, which other European countries struggled to put in place and only began to roll out once lockdowns were eased in May and June. The test was developed domestically by coronavirus expert Dr. Christian Drosten of Berlin’s renowned Charité university clinic.

At the peak of the epidemic in Germany, the week beginning March 30th – Germany carried out 408,000 tests a week, according to data from the Robert Koch Institute.

From the beginning of the outbreak Germany has relied on “PCR tests”, which detect viral RNA even before antibodies form or symptoms – which can take up to 14 days to show – are present. 

READ ALSO: '200,000 tests a day': Germany pushes to expand coronavirus testing

Following the outbreak of SARS-CoV-2, as the virus is scientifically known, in Wuhan, China in December 2019, Drosten and his team of researchers got to work. 

As soon as their Chinese colleagues made the genome sequence available, they were able to roll out the test which would not only be available for use by the end of January in Germany, but also worldwide. 

Although not everything went smoothly in the early days of the epidemic in Germany.

Initially public health insurance companies would only pay for a test if someone showed systems of the virus.

Part of the rationale was that it was in the middle of flu season and, as such, a lot of German residents exhibited typical respiratory symptoms. 

Some also reported challenges acquiring a test at the beginning. 

Ali, a 34-year-old digital marketing executive who suspected he had Covid-19, was initially refused a test in a Berlin clinic because he didn’t show enough symptoms, but was able to eventually get one after “legal pressure” from his employer.

“The costs were by no means covered by the health insurance company, so my employer paid around €270,” Ali told The Local.

Things have changed since then with the German government realising it paid in the long run to invest in testing notably by covering costs that might have dissuaded members of the public from taking a test.

A woman receives a test in the coronavirus 'hotspot' of Heinsberg. Photo: DPA

Health Minister Jens Spahn of Chancellor Angela Merkel’s centre-right Christian Democrats said in June “It is much more expensive to test too little than to test too much.”

Spahn was speaking after the German the Health Ministry announced that the country’s public health insurance would cover the roughly €50 test for anyone who suspected they might have coronavirus, even if they didn’t show symptoms

The cost of all tests since May 15th would be covered, the ministry announced, for both the publicly and privately insured in Germany, and for any official testing centre or location.

READ ALSO: Germany plans to test everyone admitted to hospitals and nursing homes

Germany’s pharmaceutical industry played its part

Not everything came down to policy.

One of the reasons Germany was able to dramatically up its testing regime was that it could rely on its pharmaceutical industry. 

While the coronavirus plunged Germany into its worst recession since World War II, its medical diagnostics industry – the largest in Europe – boomed due to an increased demand for testing. 

A full 65 out of the 100 members of the Association of German Diagnostics Industry (VDGH) offer “corona tests and associated products”, a large number of them centering on standard PCR-Tests. Others often so-called Schnelltests (rapid tests), which give an immediate result but questions remain about their accuracy.

“The German government decided for an early, comprehensive and goal-oriented testing strategy,” said the VDGH during a presentation entitled ‘Why Germany is at the top of testing’ on June 12th

READ ALSO: Germany ramps up coronavirus testing to 500,000 a week

Following the large coronavirus outbreak in February, Philipp Freese’s first thought was how to improve testing for the coronavirus. 

His company PharmGenomics had focused on screenings for colon cancer, but it quickly shifted gears, developing an at-home PCR test (CoronaScreen) from genetic information which had already been published, and testing its 17 employees.

“It was pretty apparent that the pandemic would rapidly spread,” said Freese, whose wife comes from the district of Heinsberg, one of Germany’s original coronavirus hotspots.

“We decided that we have to help fight the pandemic and focus on this topic,” said Freese, who is raising the funds to finance the tests through a crowdfunding campaign dubbed #CrowdBeatsCorona. “We would lose our scarce time if we did not follow the trend.”

A blended approach’

According to the World Health Organisation (WHO), testing is a crucial tool in stemming the spread of the coronavirus, but must be part of a comprehensive approach which also includes quarantining confirmed and suspected cases for two weeks, ensuring sufficient capacity in the health care system such as beds and ventilators, and enforcing social distancing measures. 

“Germany has been organized, they continued to test at high rates, they continued with tracking and tracing despite challenges,” a WHO spokesperson told The Local.

“They have activated the public health and social measures and implemented the comprehensive and blended approach as recommended by WHO,” the spokesperson added.

That comprehensive approach meant the battle against the epidemic wasn’t all about the testing strategy in Germany.

For a start the strict lockdown imposed across the country is credited with saving many lives and the government also moved to bolster its health system.

By mid-March, when the country counted slightly more than 11,000 confirmed cases and 27 deaths, it announced a plan to double its 25,000 hospital beds with respiratory care capacity.

They set aside enough space to not only accept severely ill patients from Germany, but also coronavirus patients from neighbouring EU countries when their own hospitals lacked capacity and supplies. 

Ana, a nurse who works in intensive care at a hospital near Cologne, told The Local that while protective medical equipment (PPE) ran low, it never ran out and Germany had far more ventilators available to the worst-off Covid-19 patients that other countries.

'Nip the virus in the bud'

Widespread testing has so far helped Germany avoid a second wave of new infections as it transitions from a strict lockdown by crucially helping to identify and isolate new clusters such as the one that emerged at a meat-packing plant in North Rhine-Westphalia.

Out of 6,140 employees tested at the plant, 1,553 are confirmed to have been infected with coronavirus. The plant was immediately closed and a new local lockdown imposed on the whole district.

Tönnies, the slaughterhouse where a corona outbreak occurred in June. Photo: DPA

Further widespread testing in the area will continue, especially in care homes. In addition, everyone in the district is allowed to voluntarily undergo testing free of charge if they want to. If the numbers “remain low”, the lockdown will be lifted.

Testing has also slowed smaller outbreaks that could have otherwise spiralled outside of control. At a residential complex in Berlin’s trendy Friedrichshain district, 44 people were confirmed to be infected with the virus on Wednesday June 24th. 

The local health department arranged for testing – even for asymptomatic residents  – after a contact person was identified.

“Among the people tested positive for Covid-19 by the health department, there are also children attending schools and day care centres…They affected facilities were informed immediately,” said the health department authorities, pointing out that immediate testing would occur at these locations.

“We want to nip the virus in the bud,” said Health Minister Spahn.

Germany now has the capacity in its labs to carry out up to one million tests a week, Susanne Glasmacher, a spokesperson for the Robert Koch Institute, told The Local. 

Of the tests which have been conducted, one percent have come back positive, “a very good result in international comparison,” said Glasmacher. 

READ ALSO: Coronavirus outbreak in Germany is 'under control' says health minister

The test capacity in Germany has progressively grown larger since the start of the outbreak. By March 9th, there were 28 laboratories in Germany processing results, with a total of 7,115 tests carried out per week. 

By June 15th, Germany counted 138 such labs, and had the capacity to carry out 166,445 tests per day, meaning capacity was nearly twice the number of actual tests being carried out.

But testing only works with tracing and Germany has 400 coronavirus call centres where operators field calls from people worried they might have contracted the virus after coming into contact with a person who tested positive. 

They not only put them in touch with medical personnel to arrange for a test themselves, but – working with 21,000 tracers throughout the country – aim to track down every person the positive person has come into contact with and alert them.

Germany is also armed with a new voluntary coronavirus warning app, which can measure whether smartphone users have come closer than about two meters to an infected person for over 15 minutes. 

They can then quickly seek out a test.

The success of testing also relies on those people who are positive going into a two-week quarantine, even if they have no symptoms. 

Quarantine rules

Germany has strict punishments for those who flout the rules.

Violation of quarantine could in extreme cases result in a maximum prison sentence of up to two years or a steep fine. The health authorities check the quarantine by calling the affected person's home to talk to the patient and check how they are doing.

But not everything is perfect with Germany’s testing strategy.

Despite all of its resources, hotlines and testing centres for the coronavirus often remain closed on weekends, or after hours. 

While large metropolitan centres are equipped with several makeshift centres and drive-in testing centres – which can accept patients after they are referred by local health authorities – more rural areas have less resources. 

Amr Aswad, a virology researcher at Berlin's Free University, told The Local that the system for testing in Germany was working “very well” but that Germany could make an even greater push to test more asymptomatic people.

“There is a case to be made for testing more asymptomatic people, particularly in situations where a large number of people are gathered, even if they are observing social distancing,” said Aswad.

“It's hard to say for sure but I think this could help stop the chain of transmission in its tracks early on.”

Testing is 'building block'

The pandemic – and concerns about it – are still far from over in Germany as the recent outbreaks detailed above show. 

As of Sunday June 21st, the so-called R-Wert or reproductive value, had shot up from 1.79 to 2.88 following the recent outbreaks.

What’s clear is that Germany, thanks to its well-established testing strategy set up right from the outset, appears well-placed to be able to prevent a second wave.

“Testing is a big building block,” said Schmidt-Chanasit. “It's very important as Germany goes from general blanket measures to specific ones. Testing plays a very important role in ensuring success.”

Schmidt-Chanasit said that such a comprehensive testing strategy of identifying contacts of an infected person – whether co-workers, schoolmates or acquaintances – is the way forward.

“As soon as a contact person arises, there must be a lot of testing,” said Schmidt-Chanasit.

“Now and in the future.”

Confronting Coronavirus: This article is part of a new series of articles in which The Local's journalists across Europe are taking an in-depth look at the responses to different parts of the crisis in different countries; what's worked, what hasn't, and why.
 
This article has been supported by the Solutions Journalism Network, a nonprofit organisation dedicated to rigorous and compelling reporting about responses to social problems.
 
The SJN has given The Local a grant to explore how different countries are confronting the various affects of the coronavirus crisis and the successes and failures of each approach.
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