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Too many Dutch people are ending up in intensive care: can the system cope?

Intensive care (IC) units around the country are now dealing with 761 coronavirus patients, according to the latest figures from the Dutch Association for Intensive Care (NVIC).

That means only a low number of IC beds are now available. The NVIC says that the number of people ending up in IC is “going too fast,” with 117 people joining yesterday.

There are normally 1150 beds in the Netherlands. With 761 taken up by coronavirus patients, and an unreported number in use by other patients, hospitals are reaching full capacity.

Some relief on the way

However, Health Minister Hugo de Jonge announced yesterday that the Netherlands is working on expanding the number of beds to around 1600. This could happen as early as next week. Around two-thirds of these beds will be used to cope with the increasing number of seriously ill corona patients.

Part of the difficulty is the length of time that each coronavirus patient must use the bed for. While diagnoses continue to soar, each patient admitted to the IC spends around two to three weeks attached to a respirator, according to the NVIC.

Rutte’s response

Prime Minister Rutte said they are working hard to continue to build capacity for the incoming hospital admissions. “From there, people will also go to IC,” he said. “I fear that there will also be bad news about people who die in the coming days. Additionally, there will be increasing numbers in the infections. That is really the expectation,” he said.

“What we have to prevent is to draw conclusions based on daily figures. You have to look at trends when it comes to hospital capacity.”

What are the trends?

The trends Rutte may be referring could be the news that the growth of infections in the Netherlands is reducing. While it’s early days for the numbers, authorities remain “cautiously optimistic” that containment measures are beginning to create a flattening of the curve.

In the meantime, Rutte is expecting all hospitals to do their part over the coming days. “Hospitals in Brabant or in other places where it becomes too much, ask other hospitals: jump in.”

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Initiative to move King’s Day to August 31 in light of coronavirus measures

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A group of entrepreneurs have started an initiative to push King’s Day celebrations to August 31, according to AT5. King’s Day has been cancelled due to restrictive measures in place to prevent the novel coronavirus. 

A Facebook group was set up by the page ‘Red Koningsdag’ to recruit people to help instigate change. King’s Day originally took place on August 31, marking the birthday of Queen Wilhelmina, who reigned 1890-1948.

Something to look forward to

The organisers of the event write, “In these difficult times, let’s have something we can look forward to. Let’s not cancel everything, but simply move it forward . . . Think of it as a victory over the virus and the beginning of another great time for us as a country.”

The plan is to go to the municipality of Amsterdam, showing the amount of support and trying to convince them to move the celebrations to August 31 instead of cancelling them completely.

Are you on board with this idea? Check out the full Facebook event.

Restrictions due to coronavirus

In the Netherlands, the government has urged to remain indoors as much as possible. After an alert was sent out to all residing in the Netherlands and that was apparently ignored by many, the government has decided to tighten its grip on regulations.

These restrictions include the cancellation of all big events till June 1, and a rule banning people from walking in groups of more than three people.

In light of measures taken to combat the spread of coronavirus, it’s good to have something to possibly look forward to after all this is over.

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Why fighting a global pandemic could mean trading off human rights

Measures are being taken to limit the spread of the coronavirus. These measures have human rights implications — but at the same time, they are needed. How can we strike a balance?

Just over a month ago, I was returning to the Netherlands from a two-week-long holiday in India. The coronavirus outbreak in China was discussed in the news, but I didn’t pay much attention to it. “It won’t affect me,” I thought.

Two weeks later, my parents rang me up from our home in Poland as I was on my way out, heading over to see some friends. “Come home,” they ordered. “I’m fine,” I responded. “It isn’t that bad in the Netherlands.”

That day, I unknowingly went to work at the DutchReview office for the last time. When we released our coronavirus video, we had no idea how much things would change here in the Netherlands.

At the time, my friends (who are still at university) were taking their mid-term exams. All of the sudden university classes in the Netherlands were suspended, exams were postponed and students at the university were told that if they wanted to go home for the remaining half of the semester, they could. The university campus, once busy and bustling with energy and life is now empty.

Suddenly, life in the Netherlands had changed.

The descent to dystopia

In the span of four weeks, coronavirus measures went from advice and recommendations by the government to businesses closing, educational institutions closing, birthdays, dinners, parties, and all social events being cancelled or postponed.

Just last week a new rule was announced where people in groups larger than three could not have gatherings. New measures, in a pre-coronavirus world thought to be unthinkable, are being brought into place day-by-day.

Public and private life has been put on halt as a result of the novel coronavirus, and elsewhere, borders have been shut. The last time these ‘big-brother’ style measures were imposed in the Netherlands was during WWII, according to the NRC. We still haven’t reached a total lockdown — but it could be on the horizon.

The situation is even worse in other countries: The Chinese government imposed a draconian-style lockdown. In India, imprisonment is possible for those that violate social distancing measures.

Restrictions and Rights

The outbreak has caused several fundamental human rights to be suspended. Fundamental rights are those that are enshrined by documents such as the Universal Declaration of Human Rights, and are bestowed upon all human beings regardless of “race, colour, sex, language, religion, political or other opinion, national or social origin, property, birth or other status.”

Included in the scope of fundamental rights are civil and political rights. These are mostly negative obligations on part of the government, meaning that the government must, for example, refrain from torture, or refrain from interfering in elections.

Social and economic rights are also included. These are positive obligations, meaning that the government must, for example, guarantee adequate welfare to the unemployed, or provide education and healthcare.

How have rights in the Netherlands been affected?

In the Netherlands, a western, democratic country that has ratified various human rights instruments, rights violations are pretty uncommon. In fact, it has a pretty high ranking  on the Freedom barometer (as well as various other indices).

But coronavirus measures have resulted in the suspension of several rights, including the right to private and public life (like banning gatherings that exceed more than three people at a time indoors), the right to liberty (via quarantine and isolation), freedom to conduct business (many have been shut), the right to education (schools and universities have either closed or switched to online classes) — this is key for students that do not have access to online education platforms.

But other countries have it far worse

These rights violations become even more problematic in poverty-stricken countries where social welfare is inadequate, and fundamental rights guarantees are already at the bare minimum. Not being able to work in these instances translates to no food on the table.

Other rights violations include freedom of movement and even the right to adequate healthcare in countries that are inundated with COVID-19 patients such as Italy. These countries need to make choices on who can receive care in ICUs. So far the Netherlands has not had to deal with the latter but this might be something on the horizon if current measures fail.

There may also be implications on other groups, like refugees. Refugees are a vulnerable group in society — and the virus may spread more rapidly in refugee camps due to close living conditions.

Additionally, the government’s priorities have now shifted to tackling the global pandemic, which may put certain asylum proceedings on halt. Also at risk is the right to a fair trial, since many court trials have been put on halt to limit the spread of the virus.

State of Emergency

In terms of human rights, enshrined in the constitutions of many countries are certain rights that citizens and residents are entitled to. In law there are derogable rights, or rights that can be suspended temporarily, and non-derogable rights, which cannot be deviated from at all regardless of the circumstance. However, many of these rights are derogable when a country is in a state of national emergency. 

Essentially, this means that the government is allowed to impose certain measures or engage in certain actions that it would not usually be permitted in everyday life, only in exceptional circumstances.

For instance, Article 15(1) of the European Convention on Human Rights (ECHR) states:

“In time of war or other public emergency threatening the life of the nation any High Contracting Party may take measures derogating from its obligations under this Convention to the extent strictly required by the exigencies of the situation, provided that such measures are not inconsistent with its other obligations under international law.”

*note that although this is a Council of Europe instrument (and not created by the EU), all EU countries are party to it.

This means that in cases of public emergency, a state can take the necessary measures to alleviate the situation. UN Conventions have similar provisions listed.

So as a result, a lot of human rights have been limited, and these are justified limitations by provisions such as the latter. Are there consequences of limiting these rights? Yes, of course. But a more important priority is the right to life — and this is at risk.

The right to life is a jus cogens norm, meaning that in international law, it to be guaranteed at all times (as much as possible except perhaps in situations like war) — even in times of national emergency. And many are at risk for this one as a result of the impending virus.

To lock or to not (completely) lock?

So countries need to make a trade-off. They must balance extreme measures that are unwelcome in democratic societies, with guaranteeing public safety, and with securing the right to life. So far during the coronavirus pandemic, two methods have been used:

Complete lockdown

A complete lockdown is the most restrictive of all the measures that could be taken in terms of rights restrictions. This tactic is aimed to eradicate the virus. Since China’s lockdown, the country has seen a decline of its coronavirus cases (on Thursday, March 19, no new cases were reported). But for how long is this sustainable? And if a second wave follows (like experts predict), then how effective is a complete lockdown?

Partial lockdown

The second option, a partial lockdown (minimal restrictions), which allows the coronavirus curve to flatten slightly, spreading the virus out so that people can grow immune. But the cost of this is obviously that more people are infected and more lives are put at risk. And in the Netherlands, numbers are still growing — and fast.

Until a widely-accessible vaccine or effective treatment is developed, there appears to be no perfect solution, because each one has implications. So we can choose to adhere to democratic values, but at what cost? Or we can impose a hard lockdown, but at what cost?

For now, things are changing each day — this unprecedented phenomenon that is the coronavirus is something the world has never experienced, and governments around the world are navigating unchartered territory.

Do you support an increase in restrictive measures, or do you believe that these measures should be kept to an absolute minimum to protect fundamental rights? Let us know your thoughts in the comments below.

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New measures for going out: groups of three or more are no longer allowed

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Even if you are not in a risk group, it is very important that you do what is necessary to not spread the virus. 

Not all people seemed to have gotten the memo. Some people are still out there playing football and risking fines. Others simply do not respect the necessary 1.5 metres distance needed to prevent spreading the virus.

Given these circumstances, the Dutch Government has implemented even harsher measures, reports RTL Nieuws.

Fines for all groups of three or more people

At the beginning of the week, the law was that you risk getting a fine if you are out on the streets in a group of 3 or more people and you do not respect the distance of 1.5 metres.

The law caused a certain degree of ambiguity, as it was not clear if people can assemble in larger groups as long as they keep the needed distance. Well, to remove any ambiguity or any sort of prominent social life, all groups of three or more people will no longer be allowed, no matter the distance between them.

While this measure might seem harsh, it is a necessary step to contain the virus, keep it from spreading, so that we might return back to our day-to-day lives sooner rather than later.

Exceptions for families with kids

Families with kids under 12 get a pass on this new law, but it’s still important that they keep the distance.

What about private gatherings? Technically, the new rules only apply to outdoor gatherings. While you may be legally allowed to have an indoor get-together with your closest friends, why risk infection? Meet through the magic of the internet instead and continue to #SelfIsolate.

But if you really must gather because you miss that sweet face-to-face contact, do so at your own risk.

If you are having a huge party, however, with lots of noise and loud music, don’t be surprised if the police show up on your doorstep to enforce the rules. As of now, it’s not completely clear how the enforcement will work. Chances are that the police will initially be more lenient, but nevertheless, you should be respecting the new regulations.

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Over 1000 new coronavirus infections diagnosed in 24 hours, 78 deaths

The coronavirus count for the Netherlands has climbed to 7431 after 1019 patients tested positive since the last update. 78 people have died in the same period of time. 

It brings the total death count for the infectious disease in the Netherlands to 434. A further 315 people were admitted to hospital, with 2151 beds occupied, or previously used.

However, the National Institute for Public Health and the Environment (RIVM) says the number of patients admitted to hospital and the death rate is increasing slower than without containment measures in place. That means self-isolation and quarantine tactics could be having the desired effect. We’ll know more later this week. 

RIVM also says that Noord-Brabant remains the epicentre of the virus in the Netherlands, with 2161 infections. South Holland has 1042, and North Holland has 1029. If you’re living in Friesland or Drenthe you can breathe a sigh of relief — only 71 and 72 people respectively have tested positive in these areas.

RIVM is also cautioning people not to overreact to the daily statistics. Sometimes death reporting is delayed by several days, so daily figures can be misleading.

What else has been going on today?

Testing delays

We started off the day with the news that Roche, a major pharmaceutical company in the Netherlands, was slowing progress on mass testing for coronavirus. Due to a vendor lock-in, Dutch laboratories using Roche machinery also have to use Roche materials: which includes some which are crucial for the test. But because Roche has a shortage of these materials and won’t share the prescription with other laboratories, mass testing is off the cards for the moment.

Ventilators in high demand

Hospitals will likely need to use one ventilator for multiple patients, according to The Dutch Association of Intensive Care (NVIC). Ventilators are crucial in keeping patients who are severly affected by coronavirus alive, but there will probably be a shortage of them when the illness reaches its peak. Luckily, modern ventilators have more power than is needed for one person, though they were not designed to be shared.

Economy on a slippery slope

Even after coronavirus stops being a fatal threat to individuals, it is likely to decimate the economy with a recession. The Dutch economy is expected to shrink by 7.7% this year. Unemployment is already a problem, and likely to get worse, but the government is trying to mitigate the damage.

Retirees return to work

20,000 retired healthcare workers have decided to return to work in the Netherlands to help with the coronavirus outbreak. This is possible thanks to a relaxed law instituted by Minister Bruins, which allows those who retired after 2017 to return to work.

And finally, here’s what we know about the statistics surrounding coronavirus deaths in the Netherlands.

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Here’s what we know about coronavirus patients and deaths in the Netherlands so far

New information about Dutch patients with coronavirus has been revealed. The statistics show that two-thirds of hospital admissions are 65-years old or more. One quarter is over 80-years-old. 

The majority of patients who are hospitalised or who die have underlying conditions, in particular diabetes, heart conditions, or lung problems, according to the data.

However, we also know that children and young people are not necessarily safe from developing serious symptoms. Of the 1230 hospitalisations of coronavirus to date, 11 were children under the age of 10.

When it comes to deaths, 276 people have died from the virus so far. The youngest was 55-years-old, and 60% of deaths accounted for persons over the age of 80.

Let’s see the data

In the graph below, the yellow bar represents how many people in each age group have been hospitalised. The orange bar represents how many of the same age group have died from coronavirus.

Does gender have an impact?

We still don’t know whether coronavirus has a higher impact on men or women. The newest data could show that men die more often, with almost two-thirds of the admitted and deceased patients were men.

However, men could also just be more prone to infection. The ratio of men and women testing positive is approximately the same. But, this could be skewed by more healthcare workers, who are predominantly women, being tested. At this stage, it is too early to come to a conclusion on a gender divide for coronavirus.

How many had underlying conditions?

RIVM has detailed information on 164 of the 276 deaths. Of these 164, 90% had an underlying condition. 15 of the 276 patients had no previous issues.

The same goes for patients who were hospitalised. Of the 1041 known cases, 784 were known to have a condition that may have contributed. For 454 persons it is unknown.

What are your thoughts on the new data? Does it reassure you, or make you more anxious? Tell us your thoughts in the comments below. 

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Solidarity in times of crisis: 20,000 retired healthcare workers sign up to help

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Every crisis situation is also an opportunity for people to lend a helping hand, demonstrate solidarity and be supportive of one other.

Here in the Netherlands, 20,000 ex-healthcare workers have signed up to help with the coronavirus outbreak, reports NU. This number includes both, those who are retired from the field and also those who have had a career change.

Relaxed laws allow former healthcare workers to return

Last week, the former Health Minister Bruins, who has since stepped down, relaxed laws around healthcare workers, allowing them to return to work more easily. Normally, there’s a register for healthcare workers that expires after a period of time. The new law allows those whose register expired after 2017 to return to work if they wish so.

The Ministry of Health, Welfare and Sport will also provide and pay for additional training if need be.

New corona tests are being researched

The new Minister of Health, De Jonge, has sent a letter to the House of Representatives urging that the country increases its testing capacity. He has also stated that production will begin on ventilation systems for patients.

In the meantime, the RIVM has started research about potential options for corona tests, including fast tests, and a committee will be created in order to look at how to improve the development and production of testing kits in the Netherlands.

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Coronavirus likely to cause recession in the Netherlands

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The consequence of the coronavirus outbreak throughout the world is likely to result in financial strain across the globe — including in the Netherlands.

Coronavirus has essentially put the world on a time-out. People are quarantined to their homes, shops have shut their doors, and restaurants are no longer open for business. And we don’t know exactly how long this will last. Naturally, there are consequences.

The world wasn’t “built to be shut down”

In the US, much to the chagrin of health experts, President Donald Trump stated in a press interview that “our country wasn’t built to be shut down. This is not a country that was built for this.” He has suggested that the situation would only last in the US for a few weeks. In reality, experts say it will likely be much longer.

But what Trump says resonates with the rest of the world as well. This world was not built to take a break, let alone one without a firm end. A recession now appears to be looming in the future, and not just for the US. The Netherlands and most other countries will feel it too.

Unemployment on the rise

According to the NOS, despite all the measures taken by the Dutch government (i.e. facilitating social assistance for people to work from home easier), greater unemployment rates are a likely possibility.

The Central Planning Bureau (CPB) reports that three months of restrictions (as of now some will be in place till June 1) will result in a shrinkage of the Dutch economy by 1.2% and an increase in 4% of unemployment rates. However, next year it will improve.

If restrictions last for six months or longer, statistics rise: The economy will shrink by 7.7% this year with an increase of 8% in the unemployment rate. And if the restrictions continue for a full year, a 10% decline in the economy will occur with an unemployment rate of over 9%.

To put this into perspective, during the 2009 recession the economy shrunk by 3.7%. In short, the longer the restrictions, the greater the economic damage.

The unemployment rate in the Netherlands is currently at 2.9%, with 274,000 unemployed. In the worst case, this number will more than triple, amounting to 850,000 unemployed by 2021. These numbers are worse than the outcomes of the last recession, where in February 2014, unemployment was at 699,000.

Although public finances will deteriorate, national debt will not enter the danger zone according to the CPB. In the worst-case scenario, it will reach 73.6% by the end of next year.

Trying to mitigate the damage

Of course, governments around the world are aware of this, and are trying to keep the economy afloat as much as possible (i.e. by keeping businesses open). But at the end of the day, the spread of coronavirus is a matter of public health — and this must be prioritised.

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Hospitals to use one ventilator for several patients

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The coronavirus outbreak brings several challenges to hospitals, the medical staff and the available resources.

Be it the number of beds in intensive care, the number of protective masks or ventilators, hospitals either need to order in advance what they anticipate they might need, or get creative with what they already have.

One ventilator for several patients

The Dutch Association of Intensive Care (NVIC) suggests, in case of an emergency situation, to use one ventilator (made for aiding patients in breathing in severe cases of coronavirus) for several patients, reports RTL Nieuws.

The suggestion comes after concerns that the number of available beds in intensive care units is quite small. Numbers published by the NVIC show that last night 644 patients were admitted in intensive care, 98 more than the day before.

As mentioned above, patients who are strongly affected by coronavirus develop breathing problems, which when left unchecked, can severely damage the lungs. Ventilators are used to help the patient breathe, and this process can take up to several weeks.

Manual made by the NVIC

The NVIC developed an instruction manual if the need comes to connect several patients to one ventilator.  Overall, the measure is temporary, and the best-case scenario is that all patients have their own individual ventilators, as the ventilators were not designed to take in several patients. Thankfully, modern ventilators have a stronger output than just one patient requires, which is why the NVIC has recommended using one for several patients.

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Roche pharmaceuticals: why large scale testing for coronavirus isn’t happening in the Netherlands

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Roche pharmaceuticals is a large part of the reason there is not yet widespread testing for coronavirus. The company does not have enough test materials to supply Dutch laboratories, but they are also standing in the way of workaround solutions, de Telegraaf reports. 

Vendor lock-in is preventing the production of coronavirus tests

Roche is a market leader in the Netherlands, and has used this privilege to create what is called a vendor lock-in, according to research by Follow the Money. That means that laboratories which use Roche machinery to make medicines or do experiments also have to use Roche materials to do so. Because Roche is experiencing a shortage of the materials necessary for coronavirus tests, Dutch laboratories haven’t been able to allow for the widespread testing that was so effective in halting the spread of coronavirus in other countries like South Korea.

Roche could share the prescription with Dutch laboratories

You might feel some form of sympathy for Roche if they were just underprepared for the scale of coronavirus: almost everyone was. But the problem is that there is a solution to this shortage, but Roche is refusing to take it presently because of its impact on their profits. Roche could share the prescription for one of the elements of the testing materials, called a lysis buffer, with Dutch laboratories. It would be very easy for the laboratories to make this once they had the prescription, and that could in turn ease the shortage of tests.

So far, they are refusing to do so

Roche has been getting lots of media attention over the past couple of days. In an interview with de Volkskrant, Dutch microbiologist Dr Ann Vossen was hoping that Roche would share the prescription for the lysis buffer. When asked by Follow the Money whether they would provide this information in this time of crisis, Roche declined to respond. It seems like the shortage will continue for a while to come, even though there is no need for it, nor the suffering it will cause.

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