“If bird flu becomes transmissible from person to person, there is not much we can do”

She doesn’t look like she’s been in the middle of the hurricane of the pandemic for three years. Even Danish epidemiologist Lone Simonsen showed no sign of frustration. She appeared relaxed and unperturbed at the Swiss National Science Foundation’s Corona research conference in Thun. Simonsen says she has received a lot of positive feedback from the public.

While no epidemiologist or scientific adviser lasted long in Switzerland, she apparently managed to keep the balance: She says she always made diplomatic statements, even if she sometimes disagreed with government decisions, such as the border closures. Denmark has replaced Sweden as a model for pandemic management. We wanted to know how it happened.

Nice that you are going to Switzerland! How long have you been traveling again?
Lone Simonsen: I started again a year ago, not only for research meetings but also to visit my daughter in the US. But I still like to have some conferences online. Now I have seen my colleague Marcel Salathé again here in Thun. The last time I saw him, we had a glass of wine together in Paris. That was just before the pandemic

And since when have you stopped wearing a mask?
For a long time we Danes did everything we could to control the spread of the virus, but with the milder omicron variant in January 2022 and because most of them had been vaccinated, we dropped all measures. This also included lifting the face mask obligation

I thought “Freedom Day” when all measures were lifted was September 2021 in Denmark?
Yes, the Danish government tried it at an early stage, as more than 80 percent of the population had been vaccinated by then. But then came the deadlier Delta variant and we had to take measures again to prevent hospitals from becoming overloaded. When Omikron appeared at the end of 2021, we came to the conclusion that we can finally open. In January and February 2022, about 70 percent of all Danes became infected with the virus.

Does the decision require courage?
It was always clear to me that we cannot contain this virus forever. And what better time than when everyone has been boosted?

The omicron wave in Denmark hardly appears in the statistics on excess mortality, while in Switzerland the excess mortality was always very high until the end of 2022. Is that only because of the 12 percent higher vaccination rate in Denmark?
Yes, this difference is relevant because vaccination is a very effective measure. If, like us, 96 percent of all people over 50 are vaccinated and in Switzerland only 84 percent of this age group are most at risk, then this difference makes a big difference. Then we had mass testing. A very expensive but effective measure. Every Dane was tested every third day. Together with face masks and other measures, only 10 percent of all Danes became infected in the first two waves of vaccination.

What did Denmark do better in terms of communication so that more people got vaccinated?
That’s the million dollar question. The Nordic countries have more confidence in their governments and also in the healthcare system.

Where does this confidence come from?
You should ask a sociologist. In any case, we had a very charismatic and qualified head of health, Søren Brostrøm, who was said that when he told you to jump, the Danes would only ask: how high?

Could it be because Denmark has reacted very decisively to new results? Not only did the government open immediately when it seemed responsible, it was also your country that was the first to phase out the Astrazeneca vaccine when it became known that there was a slightly increased risk of venous thrombosis in young women.
Yes, that was important to me. That was a terrible side effect, even though it only occurred in about 1 in 50,000 people who were vaccinated. We did without it, even though we then had to wait for the mRNA vaccination. This is how the Danes realized: if there is a problem, they will tell us and solve the problem.

Now a new threat is looming, with bird flu. What must be done?
After the outbreak of bird flu on a Spanish mink farm, all minks must be tested. You must act now because minks are sometimes kept outside and visited by birds. The risk of zoonosis is increasing.

I hope it doesn’t come to that. But if so: what have we learned from the corona pandemic that can now be improved?
If this flu virus really spread from person to person, then there’s not much we can do, I’m afraid. It would go around the world in a few months and infect most people, because its incubation period is initially shorter than that of Sars-CoV-2. We also have models showing that flu is harder to stop than a super-spreading virus like Sars-CoV-2.

You have to explain that. Why is a pandemic easier to control when it happens through super-spreaders?
Because then it is very effective in preventing mass contamination. Apart from these events, there were too few transmissions of Sars-CoV-2. But all people spread the flu equally well. She is more democratic.

So how does the flu spread?
Even without a superspreader, a person with flu infects an average of two to three others. Hard lockdowns would be necessary and I fear that the vaccine will not be available in time either, even though we already have avian flu vaccine candidates. After all, masks would prevent transmission more efficiently, because the virus is not transmitted via aerosols, but in larger droplets.

So not much time savings?
Well, then we would have the testing capabilities ready much faster and the helpers would be better protected with hygiene equipment. An mRNA vaccine against bird flu could possibly be developed even faster than the Corona vaccine, and more people would want to get vaccinated because a flu pandemic would be more deadly than Covid-19.

They draw a horror scenario.
What really worries me is that the H5N1 avian flu virus is more likely to affect younger people, those born after 1968. In 2009, during the swine flu, mainly younger people died – the elderly were still protected against an older flu virus (H1N1). But after 1957, that virus was replaced by a new flu virus (H2N2). Now, the few cases where people have been infected by birds show that younger people are also affected. It matters which type of flu we came into contact with in childhood!

Are we at least better prepared now that we have faced the reality of a serious pandemic?
That’s true. The swine flu of 2009 hardly caught our attention and we lost respect for pandemics because of it. We haven’t even seen the full scope of what could have happened with Sars-CoV-2. If we hadn’t gotten the vaccine, we would have had 30,000 deaths in Denmark and not the 8,000 we are suffering now. 0.6% of the population would have died – and even more during the delta wave.

As happened in Bulgaria, where only 30 percent were vaccinated?
Yes, Bulgaria is a sad worst case scenario: 1 percent of the entire population died! That’s the same excess mortality that many countries had during the Spanish flu in 1918.

The health system in Bulgaria is also probably worse.
You have to take that into account. But the better health systems of Denmark and Switzerland would also have collapsed with such low vaccination rates: not only did the vaccination save lives, it also ensured that there was still enough oxygen, staff and beds in the hospitals for anyone who did get sick goods. If this is no longer the case, mortality will increase even more – as in Bergamo at the beginning of the pandemic.

Sweden was initially praised for its relaxed pandemic regulations, but the bottom line is that Denmark is doing much better now: its total excess mortality after three years is half that of Sweden.
Yes, the Swedes had twice as much excess mortality, mainly due to a bad wave in 2020. After that, Sweden also introduced measures: no mass events, more social distancing. If you look at the mobility index, you will not see any major differences for us from 2021. But Sweden, despite the initially different strategy, performed well compared to almost every other country in the world. Sweden certainly had to spend less money on the measures and perhaps people were happier. And something else was better.

What then?
They were probably right in keeping the schools open all the time. Even though the open schools had their price: higher infection rates and therefore more excess mortality, especially before the vaccination came.

A Swiss study states that the elderly would not have been better protected if schools had been closed for longer.
Well, the children bring the virus into the family, for example at Christmas. I don’t know the study, but I think the school closures were a big sacrifice, especially for the parents, who then had to take care of the children and work at the same time. I would like to have enough time to see which of all the pandemic measures were most effective – apart from vaccination. Then next time we can do without everyone.

What do you think of the ban on visits to nursing homes?
The seniors have been very lonely in this pandemic. I myself had a friend who had to die alone in a retirement home. That was very sad, but it was just as sad when the virus swept through a retirement home. Before vaccination, the death rate with Covid-19 in retirement homes was up to 30 percent! After the vaccination it was important to allow visitors again.

The Danish health authority’s website now recommends that everyone over the age of 50 should be vaccinated. But Denmark has vaccinated from the age of 18 from the very beginning. Was that a mistake?
No, because that’s not how young adults spread the virus at the start of the pandemic. Also because 80 percent of the entire population in Denmark has been vaccinated, we have never had any lockdowns, never any curfews. This freedom was very important to us. But with Omikron, when vaccination no longer protected against infection but only against serious illness, the signs changed: solidarity vaccination made less sense.

What about the restaurants where you could only enter with a vaccine? was that ok
Before we had the high vaccination rate, we introduced the Corona passport to control the pandemic. It was not fun, but the Danes patiently allowed themselves to be tested in order to visit restaurants. With Omikron, when the vaccine, as I said, barely protected against infection, it no longer made sense to keep unvaccinated people out of restaurants. It’s crazy what we’ve been through. But it was worth it to avoid a major disaster. (aargauerzeitung.ch)