Jacques Scheres

The authorities’ first responses were the classification of COVID-19 as Group A-disease in the sense of the Law on Public Health, scaling up of regular crisis control structures, installation of an Outbreak Management Team OMT and a “National Operational Team-Corona”. COVID-surveillance is done by the RIVM (National Public Health Institute), and is based on data from Municipal Public Health Services (GGDs) supplemented with additional (inter)national sources. The OMT is the main advisory body regarding preventive measures and includes experts from relevant medical specialisms. Organisations of medical professionals gave separate advices. Sanctions to preventive measures can be fines and closure of accommodations. Initially, 80% of the population trusted the government’s messages and “intelligent lockdown” strategy. The Prime Minister’s addresses to the people were highly appreciated. However, at slow-down of the outbreak (May-June) society’s trust crumbled (“quarantine-fatigue”). The initial testing policy was very restricted and contrary to WHO’s adagium “Test, test, test!”. In June the Minister of Health announced that a capacity of 30.000 tests per day was achieved, to be scaled up to 70.000. The crises management’s primary concern was to increase the (ICU-)bed capacity and was achieved by transforming regular wards into COVID-care, setting-up external “Corona-wards” in hotels, and regional, interregional and crossborder spreading of COVID-patients. This focus on ICU-bed capacity was criticized, as half of the death cases and extreme equipment shortages occurred in other sectors (nursing homes, homecare, homes for the elderly, psychiatry, mental handicaps). Transformation of hospital wards also led to waiting lists for non-COVID care. End of June the government presented a step-by-step easing of the lockdown in which a fine-tuned epidemiological surveillance dashboard and the continuation of economical support for the economic sector are the backbones.

In a previous report we answered a number of questions by the editors about the Dutch strategic policy in the first half year of the SARS-CoV2 crisis. In the present paper we reply to a number of additional questions of the editors about the steps put by the Dutch policy during the second half of 2020, when the SARS-CoV2 and COVID-19 pandemic developed its second wave. Especially, the awareness of an upcoming second and third epidemic waves, the specific preventive actions and measures taken by the government and the changing compliance and trust of the public in the government’s strategy are described. Actions such as the Dutch test strategy, the division of regional vs national competences, partial and complete lockdowns, and cooperation with other member states and the (or their lack) are also briefly treated. Specific temporary and structural adjustments in the public health and health care system are mentioned.

No hard conclusions or qualifications about the adequacy of the Dutch public health and health care policy are drawn. Nevertheless, in retrospect it is clear that a straightforward, focussed and highly effective strategy in this unprecedented crisis by a new and dangerous and rapidly mutating virus is a great challenge for every country. Many things go well, but many more could or should have be done better. We have to learn, also from each other.

The paper presents lists of Ten Threats to Global Health published by the World Health Organization in 2018 and 2019. The lists give health problems and emergencies which seriously menace the health and well-being of billions of people on earth. The threats and health challenges are commented in the text. The interested reader is referred to the concise and easily legible original documents which give core data about the threats, actions and responses.