The Netherlands is one of the wealthiest and most favored countries when it comes to dealing with nature. If it weren’t for our continuous watchful eye on nature this country would - in the most literal sense of the word - simply not exist. A very large part of our land area was won back from the sea over the centuries, and without continous maintenance the sea would reclaim it within a generation.
Within that context, I have to say I’m fairly disappointed in how such a technocratic society has been apparently blindsided by the Coronavirus crisis. This did not need to happen and I’m sad to see us very close to the top of the charts when it comes to the number of dead per capita, realizing full well that this is only just beginning and that many more will be added to that long long list of names of the deceased before we can say that this crisis is under control.
Contrary to other countries that are in bad shape we had plenty of warning. China, Italy and to some extent Spain had already gone before us and we have some of the world’s best institutes when it comes to virology right here in the country (at the University of Utrecht and the Erasmus in Rotterdam). So we were not exactly lacking in knowledge.
What happened when the first cases of spread within Europe were reported still angers me, we slow walked our countermeasures which took a serious toll on our healthcare system and caused a lot of unnecessary deaths. It also ensured that the peak demand on our healthcare system is much higher than it need have been.
Several key mistakes were made:
- For some reason we felt that this virus would pass us by completely The authorities stated in this article of the 24th of January that the chances of the virus landing here are small. By then the virus already had a foothold in Europe and as closely connected as we are even the most skeptical people assumed it would also spread here. What magic would protect us from the virus has never been disclosed. This false sense of security effectively sleepwalked us right into the present day nightmare.
- Initial government communiquees regarding the crisis underplayed its seriousness Our prime minister was making jokes about it, made people believe that washing your hands would be enough to keep the virus at bay, and we were told that the Italians have worse hygiene than the Dutch which is why they are more at risk (the opposite is true, but never mind) and so on. This set the stage for people not taking the matter serious enough.
- Advisories rather than concrete directives were issued These were then interpreted in the most lax way possible by the population leading to very little actual change. Companies used the leeway given irresponsibly and insisted that non-essential personnel still report on-site even though there was no actual need. In crisis communications you have to use specific words: “must” rather than “should”. So, beaches were full, everybody was treating the directive to stay at home as one to have parties, go out into nature and start working on all those projects around the house leading to crowds at building markets.
- Carnival was not cancelled In deference to either religion or the income of the hospitality sector carnival was allowed to go through. In a miss of epic proportions it was said that carnival is celebrated mostly in small private circles. The reality, however, is that carnival is a massive festival which brings tens of thousands of people that would not normally meet in close contact in various cafes and restaurants as well as closely packed parades. This has led to the epicenter of the epidemic being located around the towns of Breda, Tilburg and ’S Hertogenbosch, all of them very much in the middle of the area where carnival is celebrated extensively, the province of Noord Brabant. A similar thing took place a bit further South in Limburg, fortunately not as bad.
- Schools were kept open way too long The government in one of its communiques managed to relegate teachers to child minders when they said that because children themselves (below 10, that is) are not at risk and our essential emergency services rely on parents being able to go to work the schools should stay open. This reasoning does not hold up to scrutiny: an exception could have been made to keep the schools open for those children that have both parents working in healthcare or other critical services (firemen, police, EMS), only a very low number of parents ended up having to use that exception once the schools were closed (for instance, in the schools of my children with 100’s of pupils < 20 made use of this), and finally, during pickup in normal times 100’s of parents congregate in the school yard for approximately 30 minutes which is of course an excellent spot to exchange pathogens. After pressure from health care professionals the schools were eventually closed. All this also totally ignored the fact that even though children may not get all that ill themselves they can still be asymptomatic carriers of the virus and given close contact between family members this is an excellent way to spread it around.
- When the ‘smart’ lock-down was finally announced several municipalities contradicted government guidance
For instance, in Amsterdam the Mayor announced publicly that they were going to enforce the government rules ‘reluctantly’, which undermined the connection between civilians and their government and which made it much harder for law enforcement to actually act upon that guidance if so required. When your ‘first citizen’ breaks your policies it really doesn’t help. This only topped a few weeks later by Amsterdam complaining that it is harder hit than other cities because of its reliance on the hospitality industry. Amsterdam has done everything it could to make itself as attractive to tourists as possible over the last couple of years, this has resulted in it being overly dependent on that one industry, which is not something it should complain about. - On multiple occassions the authorities have spoken in ways that are not solidly supported by the facts and needlessly optimistic
For instance, two days of a few cases less than before are immediately jumped on to crow that we are seeing a ‘flattening of the curve’, whereas every statistician knowns that when you deal with noisy data you need to have much more of it before you can make such claims. The effect on morale with such claims is devastating, hope is given and then just as quickly yanked away again. Given the fact that we are undertesting, that plenty of people die and are ill at home and that there is a tremendous lag between reporting and interpretation a much longer period of better stats is required before such positive sounds should be given to the public. Good news followed by bad news is worse than no news at all.
But the biggest mistakes of all were that we wasted a lot of time and that we asked a scientist to run our crisis response, rather than a general. See, an epidemic is not a science problem. The science of epidemics has been studied for many years and is well understood. There is absolutely no reason to see this as an opportunity to do some interesting research. This is a CRISIS, and a crisis is a logistics problem, not a science problem. And for that you need a general and someone who preferably looks ahead rather than at today. I don’t blame mr. van Dissel for this. He was named as the pandemic response team leader and as head of the RIVM infectious disease response team it must have made good sense. He stepped up to the plate and has been operating under immense pressure from politicians who do not always have our best interests at heart but simply want to score points for their electorate (I’d like to single out messrs. Baudet and Wilders here for special attention) and their lack of understanding of the base material doesn’t help. Then there are the media and annoying bloggers like myself. So far he’s done quite well in staying his course, unlike for instance our poor minister for healthcare who - quite literally - collapsed under the load and had to resign. Van Dissel has done his best to keep everybody informed. I don’t always agree with his choice of language, he continues to speak like a scientist and the press and the politicians have a hard time digesting that and making it actionable. There is too much room for interpretation and caveats and nuance tend to get lost. Speaking more directly and clearly would get people to realise the gravity of what he is saying in a better way, and this would help when making policy.
The logistics situation is simply terrible. Even though we knew by the middle of February that absent countermeasures and plentiful tests we might need lots more ICU beds and ventilator setups this part was neglected. Again, I can see how it happened. A lot of the slow-walking decision making was geared towards avoiding a panic and a nationwide shut-down, to try to protect the various markets that NL operates in and to try to keep the economy alive. That has backfired spectacularly, and - see intro to this piece - leaves me disappointed. Nothing would have stopped the authorities from trying to avoid panic while at the same time increasing their preparation levels, which was postponed until it was effectively too late. We really could have done a lot better here. But that would have required someone speaking bluntly, rather than carefully and nuanced. Every three days delay causes the peak load on our healthcare system to be twice as high, and will result in 100’s, possibly 1000’s more dead. That’s blunt language. But it does the job. Even now we could do better.
Finally, and this is the reason why I’m writing all this: If the RIVM, and mr. Van Dissel in particular want to be taken seriously by the citizens of the Netherlands then they should always aim to speak truthfully and consistently. This is not a time to lose the trust of your constituents, and that is why I am sorely disappointed to catch the RIVM in an outright lie. This should never happen again and it is angers me in a way that is hard to describe that this has happened. Such behavior in a minister of one of our departments would likely lead to someone stepping down. Now, there are some extenuating circumstances: van Dissel and the RIVM are under high pressure and it could have easily been a slip up, though, I honestly do not believe this to be the case.
In particular this centers around the on the claim by Van Dissel on April 1st that the RIVM did not have the data required to model the required ICU capacity prior to March 19th. The problem I have with that statement is that acquiring new data was not necessary in the first place. Van Dissel acknowledges [1] that the RIVM has relied on WHO estimates (and the RIVM has clearly stated from the very beginning that it follows the WHO; van Dissel himself has been following the situation ever since December [2]), then they were already aware that the WHO had already communicated as early as Feb. 28 [3] that recovery for severe/critical cases takes more than just two weeks [4].
Besides that, even the RIVM tweeted as early as Feb. 6 [5] that for patients requiring to be hospitalized the recovery can take even several weeks.
This is absolutely inexcusable and should never happen again during this crisis. Van Dissel should explain exactly why this happened, what reasons the RIVM had to ignore available evidence and should take responsibility for this and should do his utmost best to convince us all that this will never happen again. I’ll take a pinky promise that it was an honest mistake and that it is absolutely not the intention to mislead our politicians or to harm our healthcare systems, and that from now on all available data, including data supplied from abroad will be used to inform our response to this pandemic. ICU capacity is a critical component, as is the availability of personal protection gear (PPE) and tests. Germany, our next door neighbour has been doing much better in this sense, the RKI (Robert Koch Institute) had exactly the same data to work with, had its first confirmed Coronavirus patient a full month before the Netherlands did and yet has managed to keep things under control in a much better way, we could have done better than Germany, doing much worse on a per-capita basis is not acceptable.
[1] April 1st, 2020: “Van Dissel gaat nader in op de ic-capaciteit. Die dreigt eerder dan verwacht vol te lopen. Dat heeft ermee te maken dat het RIVM eerder uitging van een kortere opnameduur waardoor er sneller bedden zouden vrijkomen. Nu blijkt dat coronapatiënten gemiddeld drie weken op de ic liggen. Van Dissel wijst erop dat het RIVM geen data had om de eerste prognose te maken en zich beriep op schattingen van de Wereldgezondheidsorganisatie. Sinds 19 maart zijn er Nederlandse gegevens over de opnameduur. De modellen zijn daarna aangepast.” https://www.nu.nl/coronavirus/6036016/rivm-baas-volhouden-van-maatregelen-is-cruciaal.html?redirect=1
[2] Mar. 22, 2020: “Sinds de uitbraak in december in het Chinese Wuhan liggen er stapels gegevens over corona op zijn bureau.” https://www.parool.nl/nederland/op-dit-schaduwkabinet-van-deskundigen-vaart-premier-rutte~b054de45
[3] Feb. 28 is when the “Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19)” was published. https://www.who.int/publications-detail/report-of-the-who-china-joint-mission-on-coronavirus-disease-2019-(covid-19)
[4] Feb. 16-24, 2020 - WHO: “Using available preliminary data, the median time from onset to clinical recovery for mild cases is approximately 2 weeks and is 3-6 weeks for patients with severe or critical disease. Preliminary data suggests that the time period from onset to the development of severe disease, including hypoxia, is 1 week. Among patients who have died, the time from symptom onset to outcome ranges from 2-8 weeks.” https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf
[5] Feb. 6, 2020 - RIVM: “Hoe snel kun je genezen van het nieuwe coronavirus? Iemand met milde klachten kan al na een paar dagen genezen. Als je bent opgenomen in het ziekenhuis met ernstige klachten, duurt dit vaak langer, soms zelfs enkele weken” https://twitter.com/rivm/status/1225367076602351616