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“Even at its worst, I don’t expect a situation like in Italy”

“Even at its worst, I don’t expect a situation like in Italy”


Appie Derks

Already 210 corona deaths in Limburg

The peak in the number of those infected and fatalities will most likely come in April, or possibly in May. Because of the corona measures taken, the epidemic is not growing exponentially, but it is growing, says professor Christian Hoebe, member of the Outbreak Management Team (OMT) that has been advising the government. That is why the measures have been extended until 28 April.

Limburg is one of the provinces that has been hit hardest, with 210 deaths, 180 of which have been proven and 30 most likely caused by the corona virus. These were the local health authority’s figures on the afternoon of Tuesday 31 March. “It is almost as bad here as it is in the province of Noord-Brabant,” says Christian Hoebe, one of the experts monitoring the crisis under the leadership of RIVM director Jaap van Dissel. “The number of those infected is comparable. We didn’t quite have the first patient, but it could have been possible.”

Hoebe is head of infectious diseases control for the local health authority, GGD Zuid Limburg, and UM professor of Social Medicine, but ‘not right now’. He is dealing with the corona crisis 24/7, although he did manage to send off a thesis to the reading committee last week.

It was mainly people celebrating carnival in the border region of Heinsberg – near Sittard across the border in Germany – who spread the virus in Limburg. “The local health authority was quick to acknowledge this, but it still spread more quickly underground than we expected at that time.”

Saliently, we held a three-day exercise six months ago, focussing on What to do in case of an outbreak of a deadly infectious disease? Hospitals, nursing homes, the GGD, GPs, ambulances, everything and everybody was involved. It concerned a new virus from Asia.

And what appeared during the exercise: we soon had a shortage of protective materials and IC beds. This observation did not get any follow-up, according to Hoebe, because who should have paid for it? “It is always difficult to get money for something that might happen in the future. Still, we did benefit from that so-called BioWare exercise. Co-operation between the care parties in Limburg is running well.” 

Belgium chose to shut its borders with the Netherlands. The story was that we were consciously making our own people ill. Should the two countries not have stood strong together?

“That would absolutely have been my ideal. Despite the Belgians’ emotional reactions, the Netherlands and Belgium, aside from specific points, have pursued practically the same policy. In addition, closing the borders was of little value because the traffic across the border hardly caused any spreading of the virus. Anyone travelling to Belgium for petrol, drives there, pays by card and returns home. The same applies to cross-border workers commuting to and from work.

Belgium chose a semi-lockdown, the Netherlands didn’t.

“What we are doing is just as effective as a lockdown. Firstly, because with a lockdown people don’t stay at home anyway. Mobile phone tests show that there are still plenty of people on the streets in Italy and Spain. We say: stay at home – together with the people you live with – if it is really necessary, so if you are actually displaying symptoms of the disease. That will include the odd person with flu, but the great advantage is that others can still go outside, to carry out economic activities or just for a breath of fresh air.”

According to Hoebe, each phase requires appropriate measures, and that is not always understood very well. “People think: do I suddenly have to stay at home just because I have a cough, while that wasn’t the case yesterday. Yes, that is the way it works, we take measures based on the development of the epidemic. And those measures are effective immediately. The time delay is difficult, you only see the effect two weeks later, but until now it works as was predicted. I think that that is rather impressive. Also because it concerns a new virus and you have to act for 100 per cent with only 50 per cent of the knowledge.”

Hoebe is less impressed with how politicians are communicating. “That really needs to improve. I am thinking in particular of the penultimate press conference, in which four ministers took to the stage to announce stricter measures. All four said that we need to intensify our efforts, but exactly what that entailed, remained unclear. Including the starting date and the end date. Yesterday it was much better.”

What about the IC capacity in Zuid-Limburg?

“I don’t have detailed information about that. I know that the capacity in the MUMC and Zuyderland has doubled. It will be touch-and-go: code-black scenario or not? Having to refuse patients, or not, in the intensive care unit? Everyone immediately thinks of the situation in Italy when they think of a code-black scenario, but there are important differences. Italy was completely surprised by the virus. They also have a different IC policy. In principle, everyone goes to the IC unit there. We don’t do that; we make an estimation of a patient’s chances of survival in IC beforehand. If that is low, the patient is not admitted. That is also the reason why the survival rate in IC units in the Netherlands is very high compared to the rest of Europe. Anyway, if we get to code black, IC doctors will have to make choices.”

What lessons should we learn from this crisis?

“For one, that we should have more IC capacity, but there are many more lessons to be learned. Just look at how dependent we have become on other countries for face masks and medication. It has its advantages to get these products from low-wage countries such as India and China, but maybe we need to make agreements in the Netherlands or in Europe about our own production. At the same time, we shouldn’t go too far and put all kinds of precautionary measures in place. The fact remains that every disaster has its own dynamics.”

Temporary hospital and corona hotel

At this very moment, a temporary hospital is being set up in the MECC with more than 250 beds. This emergency measure is meant for patients who are infected with the corona virus but who do not need intensive care. The first patients will be admitted at the end of this week. In Urmond, a Van der Valk hotel has been transformed into a temporary shelter, where 240 patients can be cared for. This also concerns patients who find themselves falling between two stools, not sick enough to be hospitalised but too sick to stay at home. Nursing students from Zuyd Hogeschool will step in as volunteers.



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