The vulnerable areas of the new package of measures

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Why intervention was necessary and stricter corona rules apply, is indisputably clear from the latest weekly figures from the RIVM. A record number of nearly 20,000 positive tests, significantly more hospital admissions and nearly three times as many deaths as a week earlier, the institute reported Tuesday. “An awful lot has happened in a week”, RIVM director of infectious disease control Jaap van Dissel noted in the Lower House on Tuesday.

While Prime Minister Mark Rutte (VVD) said on Friday that he would prefer targeted local measures, the cabinet had no choice but to present a package of heavy national tightening up on Monday. The virus is spreading all over the country, so the catering industry has to close earlier from Tuesday evening, the group size at meetings is again strongly reduced and the cabinet is calling on everyone to work from home again, unless there is really no other option.

The effect of the new measures will only become visible in a week or two – after all, it will take a while for those who are infected, actually get complaints and eventually end up in hospital. Despite the measures, the number of IC admissions will rise to perhaps seven hundred. But is the package of measures strong enough to reduce the virus afterwards? Four caveats.

1. The cabinet is not adopting all recommendations

Prime Minister Rutte called the recommendations of the Outbreak Management Team (OMT) “sacred” at the beginning of the crisis, but they no longer appear to be. The cabinet did not adopt all recommended measures. For example, the OMT wanted to limit the maximum group size in indoor spaces to twenty people, the cabinet turned this into thirty. Furthermore, contrary to the advice, changing rooms at sports clubs will not be closed. While source and contact research shows that the number of infections during sports is also increasing, especially among young people.

These may seem like minor differences, but they can make a big difference. The package that the OMT advocated should be precise enough to bring the reproduction number a little below 1, to 0.9. That is to say, a hundred infected persons light ninety others. The epidemic then slowly shrinks.

However, since the margin from 0.9 to 1 is not large, small changes in the recommended measures are of great importance. One measure less can keep the R just above 1 – which means that the epidemic is still growing.

2. OMT suggested, as a precaution, do something extra

The OMT provided the cabinet with additional measures to further reduce the reproduction number. An R of 0.9 is an ‘upper limit’, the OMT writes in the advice to the cabinet. It is “wise to aim for a lower R”. This can be done, for example, by setting a curfew, so that people are no longer allowed to go out on the street late at night after the catering industry has closed.

Professor of infection prevention and OMT member Andreas Voss would have liked such a curfew. “That way people cannot continue to party at home and it would also make it clear that something is really going on.” He supports the current set of measures, but also calls it ‘a minimum package’.

OMT chairman Van Dissel called a curfew on Tuesday useful “in areas where the infection pressure is high”. Minister Hugo de Jonge (Public Health, CDA) wrote in a letter to Parliament on Tuesday that he wants to keep the curfew “on hand” “to possibly apply it at a later stage”.

watch here the Dutch hot spots

3. Behavior is difficult to predict

The fact that the package of measures recommended by the OMT is pushing the R back to 0.9 is not based on guesswork: RIVM calculated the effect of all measures. But that calculation is not perfect, people’s behavior is difficult to model.

The cabinet has focused on its own responsibility, in which the discipline of the citizen plays an essential role. Many measures are ‘urgent advice’ and therefore cannot be enforced. For example, there are no fines for working in the office or receiving more than three people at home. This is difficult, because these are major sources of infection, according to figures from the RIVM. Of the infections from which a possible source has been traced, 10 percent happened in a ‘work situation’. More than 15 percent started at a party or drink or at gatherings with family or friends.

Voss, he is “concerned” about compliance with the rules. He cites as an example that the mayor of Groningen is considering investigating an exception for the catering industry in his city. “If you get that kind of discussion, it is counterproductive for compliance.” According to Voss, the fact that there will be a different facial mask policy regionally does not help either. “Face masks are not a panacea, but I think it helps if there is one national policy.”

Also read this analysis: Now that the infections are on the rise again, things are getting exciting for the economy

4. Seasonal influences are not included

Another flaw of the RIVM calculation: the seasonal influences have not been included. The measures could push the R to 0.9 under the same circumstances. But the circumstances don’t stay the same: autumn is coming, the weather is getting worse and we are going more indoors, where we are more likely to infect each other.

In short: the package of measures starts at the beginning of the flu season, which roughly runs from October to March. Many virologists assumed that the corona virus would also revive in the flu season. But, says RIVM modeller Jacco Wallinga, we do not know how great the influence of the seasons is. It is therefore not included in the calculation of the effect of the measures.

The question therefore remains whether this package of measures in combination with the flu season will be able to slow down the corona outbreak sufficiently.





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