Highly vaccinated nations thought that they had survived the worst. Denmark claims that the worst month of the pandemic is only beginning.

And scientists say the surge is just beginning.

As omicron drives a new phase of the pandemic, many are looking to Denmark — and particularly the government institute devoted to testing, surveillance and modeling — for warnings about what to expect.

The emerging answer — even in this highly vaccinated, wealthy northern European country — is dire. The virus has outsprinted all of the protections that have been put in place over the past year. Scientists here are expecting a similar trend to occur around the globe.

“The next month will be the hardest period of the pandemic,” said Tyra Grove Krause, the chief epidemiologist at Denmark’s State Serum Institute, a campus of brick buildings along a canal.

Ever since the omicron variant emerged in November, the best hope has been that it might cause less severe sickness than the delta version it is competing with, which in turn might make this wave more manageable and help the transition of covid-19 into an endemic disease. However, Denmark’s projections indicate that the tsunami is so large it will overwhelm the entire country.

Scientists caution that the knowledge of omicron remains imprecise. The virus models in Denmark have many possibilities. Even in the middle of the road scenario, Danish hospitals could soon see a greater number of patients than they have previously.

“This will overwhelm hospitals,” Grove Krause said. “I don’t have any doubt about it.”

In her office building, where she works with a six-person modeling team, she tried to explain why omicron amounts to such a setback in the fight against the pandemic. The virus was likened to a flood and she described the role of vaccines under previous variants as two barriers protecting the system. The vaccines’ ability reduce infection rates, keeping the spread of the virus low is one barrier. Another barrier was the decreased likelihood of serious illness and death. Although both barriers were not perfect, together they made sure that floodwaters did not rise too much.

But now, she said, the first barrier has been largely removed. According to data from Denmark, people who have received two doses of omicron are just as susceptible to the infection as those not vaccinated. The data shows that those who have received boosters are more protected — which is a sign there’s hope. However, the vast majority of Danes still have not been given a third dose of vaccine, leaving them vulnerable.

That dynamic, coupled with a variant far more transmissible than the one from last winter, means any Danish person is now dramatically more likely to come in contact with the virus — including the old and the frail, as Denmark’s demographics skew older, like much of the West. Water will flow now through the holes in second wall.

At least four dozen countries and 39 U.S. states have reported cases of the omicron variant. Hannah Jewell, a national video reporter, explains the facts. (Casey Silvestri/The Washington Post)

On her double-monitor computer, Grove Krause pulled up the institute’s latest projections, which scientists were still tweaking before releasing them to the public on Saturday. There are many possibilities, however, the best one — which she believes is very unlikely — would show daily hospitalizations that match the highs of the previous year. The numbers rise into the stratosphere in most other scenarios.

Denmark’s hospitals have never had more than 1,000 covid 19 patients at any given time, last winter’s peak. But by early January, in a moderate scenario, hospitals could be seeing 500 new covid patients arriving every day. If omicron’s transmissibility winds up on the higher end, and it proves just as severe as the delta variant, with a strong ability to evade vaccines, daily admissions could reach 800.

And then there is the matter of infections. Before this wave, Denmark had never seen more than 5,000 cases in a day. On Friday, it logged more than 11,000 new cases. Within a week, in a moderate scenario, case numbers could hit 27,000. What about January? Further off the Yaxis, estimates by the institute rise.

With the surge coming into view, Denmark this month cut the opening hours for bars and restaurants, urged people to work from home, and closed schools seven days earlier than planned for Christmas break. Grove Krause warned that projections don’t account for the additional moves by the government on Friday which included the closing of theaters and cinemas. But even a full lockdown, she said, “won’t stop this from getting out of control.”

Denmark’s projections are taken seriously around the world, because they are informed by an all-encompassing coronavirus surveillance system designed specifically for moments like this — when the nature of the virus is quickly shifting.

The system starts with testing: Denmark swabs more people than almost any other country — at a per capita pace seven times that of the United States. Both citizens and tourists can take the tests for free at the State Serum Institute as well as a sister facility located on the opposite side of the country. Lab technicians identify the positives within 24 hours. They know the variant responsible in each case by the next day.

A portion of the positives are then fully genetically sequenced, delivering an extra layer of insight — allowing researchers not only to see mutations, but also to potentially understand who infected whom.

“We’re seeing things pretty much in real time,” said Arieh Cohen, head of development at the lab that processes test results and conducts the initial variant analysis.

What that data has shown, so far, is that the hospitalization rate is slightly lower for omicron than it is for delta — though because hospitalizations lag behind infections, and because omicron infections hit only recently, scientists say the results will be more meaningful in a couple of weeks.

Scientists have also identified how omicron was seeded throughout the country, first from travelers inbound from Africa, and then through several superspreader events. A just-published paper from the institute and other researchers described a Christmas party attended by about 150 people. All were fully vaccinated. And yet 71 tested positive for omicron.

Initial omicron cases in Denmark have been concentrated disproportionately among people in their 20s — an age group that normally has mild symptoms, and whose infections might be missed by countries that test less. The institute believes Denmark is experiencing a wave that’s a week ahead of the rest. Others believe that many other countries may be already experiencing this pattern. The young, who tend to travel the most and interact with others — could help jumpstart community growth.

“There’s a chance that Denmark is capturing the spread that other countries are missing,” said Marc Stegger, whose team analyzes genomic data.

The government hasn’t implemented a comprehensive lockdown this time. However, it tried to respond to emerging science. The spread of omicron has not slowed down. Denmark attempted to quarantine contacts and close friends of those with early cases. However, the plan was not feasible after just nine days.

At the State Serum Institute, many scientists talk wearily about the pre-omicron days as if reflecting on another era, back when the pandemic was manageable and understandable. In the past several weeks alone, the testing lab has hired 100 new people. It bought 20 new PCR machines. The institute began to dip into its plastic laboratory parts reserve and compete with other countries for supply. Last week’s planned Christmas party at the institute was cancelled.

Scientists say they feel trepidation — and also a bit of awe — about what they are seeing: an incredibly fit virus, winning a turf war against delta. As of Monday — the most recent day with complete, publicly released data — omicron accounted for 26.8 percent of cases. Omicron had 4.9 percent share a week prior.

“It’s moving so fast,” Cohen said, as more swabs arrived at the lab below his second-floor office. Cohen stated that his main concern was keeping things moving. He described himself as a lab guy and stated that he was not interested in the larger picture. But he ventured: “I can’t help but have a fatalistic opinion: that we’re all going to get this.”

For the moment, the full consequences of the omicron variant are still on the horizon — weeks away, on a computer screen, or part of government warnings. In Britain, the only country that can match Denmark’s variant surveillance, Prime Minister Boris Johnson has talked about a “tidal wave” of incoming cases. It is already dominant in London and Europe’s centre for disease control predicts it will be dominant across the continent in January or February. America is also bracing itself for an enormous wave that could swamp hospitals and cause havoc in the coming months.

But the models project only a few weeks into the future, and what lies beyond — after the omicron wave crests and dissipates — is left to the scientific imagination.

Public health officials took to the airwaves on Dec. 5 to outline the dangers posed by the omicron coronavirus variant as cases were reported across the U.S. (Zach Purser Brown/The Washington Post)

At the State Serum Institute, the man with the imagination is Anders Fomsgaard, one of Denmark’s best-known virologists. His curly locks make him a passionate saxophone player. He is referred to by his colleagues as an “idea man”. He works in a yellow squat building, where researchers grow omicron culture.

He greeted a visitor at the entrance, under neon lights shaped like geometrical fragments, which he explained represent HIV.

“Another epidemic,” he said. “Still going on, by the way.”

Perhaps, he said, omicron’s origins are connected to HIV, as the virus could have come from an immunocompromised person whose body couldn’t kill off the virus, which was able to grow and change. He said that there were people in Danish hospitals who had been suffering from the coronavirus for at least seven to eight months. The changes in Denmark are monitored, but they’re not being observed at all elsewhere.

“This could be one of the ways you create this resistant virus,” he said.

His goal, he said, is to help humanity finally get ahead of the coronavirus. He’s conducting all kinds of experiments to achieve that goal. One of these is the research into a vaccine targeting T cells. Although it wouldn’t prevent infection, such a vaccine would stop illness. It would target parts of coronavirus which don’t appear to be mutating. This is an advantage.

“We are all the time responding,” he said. “We’re behind. We are five steps behind.”

He thinks the next month will be brutal, but after that? It is difficult to know. It’s difficult to say. He also stated that the virus was impossible to eliminate completely. It could spread to rodents. It could then jump into rodents and be reformed. The coronavirus is a master mutator, and vaccinations are clearly driving it into a corner where it can weaken or alter.

“It could come out on the other end even weaker,” Fomsgaard said. It could hit another jackpot mutation. It might hit another jackpot mutation.”

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