Health logics in and beyond the laboratory: Medicine, public health, and pandemic governance in Denmark

The COVID-19 pandemic spread rapidly across the globe after its emergence in 2020. Various strategies were used to prevent the spread of infection, including lockdowns, testing, and social distancing. However, accepting or rejecting certain measures had implications for individuals, populations, or both, and the pandemic foregrounded the relation between medicine and public health, including their different objectives, ethical principles, and risk perceptions. Drawing on ethnographic fieldwork in two COVID-19 testing laboratories in Denmark, this study reveals the co-existence of two distinct health logics in the national pandemic testing strategy: a logic of medicine, centering on individual diagnostics and treatment, and a logic of public health, oriented towards screening and collective responsibility. We show that these logics were embedded in distinct workflows and shaped how laboratory workers understood their tasks, navigated dilemmas, and processed tests. By exploring institutional logics in the organization of COVID-19 testing laboratory work, the study highlights the implications of distinct health logics in pandemic testing and raises important questions about the balance between individual rights and collective responsibility during public health emergencies in the welfare state. We argue that the COVID-19 pandemic catalyzed a reframing of risk, as risk was reframed from being an individual concern to a collective issue that citizens had to manage. While no logic was inherently superior, the decision to prioritize the logic of medicine or the logic of public health reflected a shift in societal values and the relationship between individual and society in the Danish welfare state.