The Corona crisis has hit the whole world hard. One of the more interesting cases is The Netherlands, where the Government has had a relatively relaxed attitude towards the pandemic from January. This relaxed approach has led to a relatively high death rate. But it is also associated with a large number of decisions, opinions, events and outcomes that in an ideal world, and certainly in many other countries, would cause outrage that amounts to a scandal. Still, most people seem to accept the Dutch response as rational and reasonable. For the response to become rational and reasonable, that must change.
First published on July 7th, 2020 by Michael Blok with input from Jaap Stronks, Jorrit Posthuma de Boer, Arnold Niessen, @BarkingDog2020 and many others.
As a resource for our Platform Containment Now! and the investigative journalists and upstanding citizens of the world, we now present a list of these errors and (potential) scandals. Or at least, what should probably be scandals. We do not offer a full investigation of these scandals, nor do we analyze (fully) why they happened. We do invite curious investigators to speak with us about collaboration to expose the full extent of this complicated and comprehensive disappointment of a Corona response.
This is not a fixed page, as time and insight develops we will be refining this list and adding to it, where appropriate. The list is not organized chronologically per se. The items are not investigations, they are invitations to investigate. Upon investigation, it may turn out that in some scandals only few and forgivable mistakes were made, but first we need to investigate to be able to say. The Main actors are Prof. Jaap van Dissel of the RIVM (Dutch CDC), the Outbreak Management Team (OMT), the GGD-GHOR public health federation under Sjaak de Gouw and the regional GGDs (public health units). Please note there is no national Public Health Authority in the Netherlands, and that hospitals and health insurance companies are private and independent. The Health Ministry has a coordinating and regulatory role and tops up the insurance premiums paid by the (lower earning) public.
Scandal No. 1: No serious attempt at containment
While the Dutch authorities downplayed the incoming virus threat in January and February ("it's like the flu", "there are no direct flights from Wuhan", "human-to-human transmission is unlikely" and "it will be only a few cases") we were also assured by Public Health Federation Director Sjaak de Gouw that we were very well prepared and could ramp up to thousands of contact tracers pretty quickly. But when the virus actually hit the province of North Brabant in late February, it seems there were only a few contact tracers active. No evidence is available that anyone was isolated. Between March 6th and March 12th, containment measures were largely abandoned.
Even if the Government had been asleep at the wheel until about March 1st, it could have ramped up testing, tracing and isolate within days. It could also have locked down a few towns or the entire South (easy due to the limited amount of Meuse and Rhine river crossings, which is the same problem the Romans encountered a long time ago). Carnival could have been canceled, limited or at least its revellers could have been warned about risks. No such containment effort happened. If it had, the Dutch outbreak might have stayed at Danish/Norwegian/German levels, countries in which (partial) containment control was never really lost. Iceland is an example of a country which wasn't really looking for Containment, it just did a lot of testing and thus managed to never lose track of the spread of the virus.
A very revealing account comes from Animal Rights Party MP Eva van Esch. As people started coming back from the late February winter sports vacations, the GGDs refused to test people who clearly had strong Covid systems, because "it was not necessary according to RIVM guidelines". People were asked to stay home but likely infectees were not contacted. At least this person the MP talks about was told not to tell other people about being infected. Of course, none of this makes any sense as part of a serious containment effort. Was the little that was done merely theater?
Scandal No. 2: No return to containment when possible
After containment was given up in early March the Dutch outbreak spun out of control quite badly. Care homes lost many occupants, in some cases more than half. Much evidence exists that hospitals would not have been able to handle the inflow of Covid patients if older and frail patients would not have been turned away even more than usual from early April. Based on excess mortality, the Netherlands is one of the worst-hit countries in Europe.
Given such disastrous results, one would expect a return to containment and low infection levels to seem quite attractive. But despite dozens of countries having contained the virus to low or zero levels without too much difficulty, even after having lost control for a while, the Dutch authorities have not chosen to take that route. Why? The dominance of the Flu Playbook, arrogance, Cost Utility Analysis thinking, uncritical media, and a morally and intellectually weak Prime Minister all play a role.
Scandal No. 3: Questionable information about the Science
The Covid pandemic has been one long list of remarkable statements on the Science from the RIVM, the Dutch CDC. All of these statements were unusual, controversial or just plain wrong when they were uttered.
- It's just like the flu (January)
- When it comes, it will stay small (January)
- Not contagious from human to human (January)
- Carnival is celebrated in small groups and not dangerous (February)
- Transmission is all or mostly by people with complaints (February-today)
- Children suffer hardly or any ill effects from the virus (March-today)
- Children do not transmit the virus (March-today)
- Masks are not useful and offer a false sense of security (March-today)
- Transmission is through droplets, not also airborne (until today)
It is hard to believe that so many unwelcome statements would be mistakes or just a different view. The easier explanation is that most served to rationalize the mitigation/herd immunity policy, either within the brain of decision makers or between them and the public.
Scandal No. 4: Misleading information about policy and measures
We can leave most of the explaining to this article, a breezy read about the massive disinformation campaign of and by the authorities.
On July 11th, a former RIVM Director claimed that the contagiousness of asymptomatic infectees is hidden by the authorities: "You can also transmit if you have no symptoms. Somehow that is more or less kept secret or denied".
Fatal Error No. 5: Debilitating Public Health Budget Cuts
The Netherlands had a reputation for being well-prepared for this pandemic. This has turned out to be at best a partial truth. There has been a lack of urgency, a casual attitude in general to disease, and there's also the spread-out responsibility of the health care system (which is basically a regulated private system rather than the public system of most other European countries).
All of this led to the regional Public Health units (GGDs) having had their pandemic response capabilities reduced greatly by budget cuts. Few doctors and other specialists remained who know how to organize large emergency projects, carry out contact and source tracing or isolate people remained within the GGDs when the pandemic hit.
But the arrow also points the other way: the very elaborate and professional Dutch Respiratory Disease Playbook seems to have taken on a role of itself, determining and leading the Corona response without being an actual human. This has made course changes more unlikely, spread out responsibility and perhaps made it more difficult for a leader to say "we're not doing this crazy stuff". In any case, there is a suspicious correlation with high scores in this GHS index and bad Corona performance.
Fatal Error No. 6: Lack of strategic supplies and local production
Given the lack of a real top-down integrated health care system, the Netherlands did not have a pandemic unit standing by in early 2020. There were no strategic supplies of PPE or medicines. Little or no local European production had been provided for in terms of key medicines (antibiotics, antivirals, immune suppressants) and materials (masks, gloves, ventilators). Vaccine production was privatized in 2010 and even as the Corona pandemic unfolded in March and April the Government was still working to privatize vaccine research. After this caused an uproar, the plan was shelved.
Fatal Error No. 7: Lack of testing materials
As the need to do lots of testing became apparent in the second half of February, the Netherlands seems to have failed to place orders for various testing components. Whether this was due to outmaneuvering by other governments, or because a mitigation/herd immunity strategy doesn't require much testing, is not clear. There is talk of the 16 February ECDC meeting, in which almost all governments downplayed the risks from Covid-19, having been a bit of theater for some Governments which had already made contingency plans to order testing materials quickly.
Whether the Dutch Government was then more (Herd Immunity) or in fact less (lazy ordering) cynical than our European friends is not clear. It is also not clear to what degree a lack of tests informed the Herd Immunity policy. What is clear is that even to this day, the Dutch Government is testing little, even as testing capacity is now much higher than in March.
Scandal No. 8: Treating the media and population like mushrooms
In March, the WOB (Public Record Transparency Law) was suspended with respect to the pandemic, making it very difficult for media and the public to extract information about decision making, including the much-desired minority opinions on the Outbreak Management Team. Keep 'em in the dark and feed 'em sh*t, just like mushrooms.
An article about us was published online by the AD newspaper, but removed a few hours later from the website. It later turned out the RIVM had given the AD a call.
On July 6th, a state TV news service summarized an interview with Aura Timen, the number 2 of the Outbreak Management Team, as "the RIVM underestimated the epidemic in late February". Within 14 minutes, this became "Europe underestimated the epidemic". It is no longer conspiracy thinking to assume a call was made.
Multiple accounts have reached our action group that pro-suppression scientists were not invited to, or disinvited from, TV shows after government pressure. We have also been told that our action group was denied attention after a TV show called the RIVM and were told our position of containment was scientifically impossible.
Scandal No. 9: Loyal and uncritical media
The before scandal was compounded by our discovery that the editor of the Volkskrant newspaper said on radio on March 19th he would not be publishing critiques of the Government's policy. There was some discussion in the media and Parliament in February about the best approach to deal with the pandemic. But around the time containment was officially shut down around March 10th, all such discussion stopped. Our platform's collaborators have offered many op-ed articles (good ones) to major newspapers, but were never published there.
In June, the editor of the Telegraaf newspaper confirmed having received a request from the Government to keep criticism of the policy to a minimum. Now, a bit of alignment of policy in a giant crisis is OK, but not if the policy is different from what other European countries are doing. In that case, criticism is warranted and necessary. As they say, journalism that doesn't challenge power is just propaganda.
Scandal No. 10: Testing, or lack of it
The Netherlands lead Europe in not having done much testing. This has been bothering many people and MPs, who would like some control over the virus. There were some motions in Parliament about doing more testing, some public pressure, and some media attention. The government responded throughout April and May by promising more testing capacity. In fact, the increased testing was not happening. It serves no purpose in a Mitigation strategy of allowing the virus to spread, but not too fast.
Only on June 1 did an increased testing regime start off. But even in July, testing is in the range of 10,000 per day (17m population). Basically no proactive testing is happening, very little research is done. And only people with symptoms are allowed to be tested, children are discouraged from being tested.
Scandal No. 11: Schools and children
The Government never intended for the schools to close. By March 12th, parents were starting to keep their kids home and your servant helped turn the government's "we have to keep them open as child care for essential workers" around into "that means there's no more mandatory schooling". Schools didn't open again on Monday the 15th. By mid-April, the Government was very eager to reopen schools, and used the arguments that kids don't suffer much from a Corona infection (probably mostly true) and that they are not significantly contagious (no way of knowing, but the default is that they are as much as bigger humans).
Despite protestations and a Parliamentary motion followed by government promises, schools closed for the Summer in July without a proactive testing regime in place. Schools are not closed in the case of infection of teachers or pupils. Classes were halved in mid-May but by mid-June primary schooling was pretty much back to normal. By early July, child care facilities were told to allow children with Covid symptoms to continue to attend. August will bring secondary schools back without any real restrictions.
All of this comes down to a giant medical experiment on a part of the population. It is not certain that children suffer little when infected. The virus may linger in the brain, there's Kawasaki syndrome, and a host of other afflictions that kids with Covid seem to suffer from. What if it's not one in a thousand but 1% or even 10% that suffer real consequences to their health? And what about their teachers and parents? Kids are certainly infectious, probably significantly so.
On July 16th, reports came in that one third of children tested in Florida came up positive. How much infection has been building up among Dutch children? How much health damage will that cause, and how much infection in other age groups? Check out our Dossier Safe Schools and Kids.
Scandal No. 12: Masks
Masks are very important in controlling the epidemic. All countries that do well, use them in public (indoor) spaces. The RIVM pioneered research in this field. Masks are a cheap intervention, too. But masks have been discouraged in the Netherlands since March. There was the argument of lack of efficacy, then of "a false sense of security" (masks actually make people more careful), then they were supposedly not available in world markets. But home-made masks, tea towels even, can be a big help. When the public transportation sector forced the Government to adopt a mask mandate in trains and buses, the Dutch population found themselves in a situation where masks are both discouraged, mandatory, and forbidden (because of the face covering laws against Muslim women).
How did the RIVM decide their own research about mask effectiveness is bunk? Or why did they say it is? Is it as simple as the fact that masks are too effective if you want the virus to spread?
Scandal No. 13: Inactive municipalities
The Dutch WPG (Public Health Law) makes the GGDs responsible for outbreak management in their territories. Contact tracing is mandatory and the law gives broad powers to control outbreaks of dangerous pathogens. But except for the North of the country, all GGDs have been following RIVM guidelines (advice, not commands) punctually. Only in three municpalities were questions even raised about allowing the virus to spread. Only in Amsterdam was a motion filed by the left-wing BIJ1 party in the City Council to scale up testing, tracing and isolation and try to suppress the virus. The other parties would not hear of it.
The Public Health Minister does have the right to take some centralizing measures in a major pandemic, but his command to stop reporting confirmed cases to local GGDs in mid-March was not an official ministerial decision, so appears to lack a legal foundation. Municipalities should have done what they needed to do, although in their defense they do not have much disposable cash after many budget cuts and centralizations in recent years.
Mayors of larger cities caucus in a kind of "super mayor conference" which has quite a lot of influence over corona policy, since it effectively creates local ordinances on social distancing and the police. Not once has any dissent been heard from this commission. Not even about regionalization, which fits the model and would have perhaps mostly stopped Covid from coming to the main Randstad conurbation at all (by closing off the South for a while and keeping up contact tracing, testing and isolation).
Scandal No. 14: Bad crisis management
The Government not only got its preparation and strategy wrong, but also the execution. When it became clear in April that the GGDs would need to do a lot more testing, tracing and isolation from May, the GGDs were left in the dark for weeks about what was expected of them, the how, the protocols, the who, where the money would come from etc. The government spent its energy on a Corona Tracking App which could never have achieved results on its own and which was a doomed project in such a time frame and without collaborating with projects in other countries (or just taking their functioning app).
The measures that were introduced and the behavior expected of the populace were usually difficult to grasp, and even lawyers could not figure out the forest for the trees. Something as simple as "when indoors, wear a mask, keep a meter distance and clean your hands" was never introduced.
Scandal No. 15: Little responsibility or accountability
The key player in the Dutch Corona saga is RIVM Infectious Disease Unit head Jaap van Dissel. He is:
- Main advisor to the Government
- Constituted the Outbreak Management Team when the pandemic arrived
- Heads the Outbreak Management Team
- Sets guidelines for the GGDs (which are treated as commands)
- Defends Government policy in Parliament and in the media
- Is the key figure in framing masks as "false security" and therefore undesirable
Van Dissel largely makes the policy, presents it, defends it, monitors it and details it for the lower ranks of Government. He is good friends with Sjaak de Gouw who heads the GGD-GHOR, the federation of GGDs (Regional Public Health Units). When the Herd Immunity strategy which Van Dissel and De Gouw are vehement fans of became less of a thing in April, these two men were the chain of command between the Government and the GGDs which were supposed to work hard on at least partial containment. It is no surprise that what came out was the world's first attempt at TTI that was not designed to contain, but mitigate the outbreak at a sort of stable level.
When the Outbreak Management Team expressed its desire on June 23rd to aim to move towards zero infections, the architects of the ruinous Herd Immunity strategy and lacklustre containment measures (Van Dissel and De Gouw) were left in place. This signals that if they fall, they all fall. And so the guys who broke it get to fix it, with not guarantee they'll try hard.
Atonement for all the mistakes? We haven't heard much more than "we underestimated, as Europe, the virus in February". You cannot (no seriously, you cannot) change such a clear Herd Immunity strategy into something much more contained without even acknowledging the change of policy. This is a matter of democratic principle. But the best the authorities can do is claim that "containment" was always part of the "maximum control" strategy which was supposed to be about controlled spread and herd immunity.
Another point of note is that the GGDs (G=municipality) are no longer run by their City Councils, but have merged into regional Public Health Units which are commanded by the mayor of the largest city in that region. How this is supposed to ensure democratic control is unclear, because the Super Mayor isn't even very answerable to his/her own council about police, public order and public health decisions, let alone to the other municipalities in the region.
Scandal No. 16: Concentration and abuse of power
Apart from the fuzzy responsibilities and lack of accountability of the previous scandal, it appears the Van Dissel/De Gouw tandem (RIVM and GGD-GHOR, CDC and Public Health Unit Federation) have concentrated power in their own hands. Testing was concentrated in the hands of the academic hospital laboratories whose directors form an influential part of the Outbreak Management Team.
Despite the urgency of ramping up TTI in April and May, the choice was made to not work with outside experts such as Arnold Bosman, who had a team of thousands of tracers ready. For contact tracing, an outside call center was used from June 1st. Regional GGDs were not expected to come up with their own locally-adapted policies and approaches, even though the Law makes them responsible for doing exactly that. The Public Health machine was run from RIVM with guidelines which had the effect of commands.
On June 25th, two testing laboratories sued the government for abuse of power. A Dutch and a German laboratory claim they were falsely kept out of the Corona testing system.
The Outbreak Management Team was apparently selected by Van Dissel and contained only doctors, mostly microbiology.
Scandal No. 17: Conflicts of interest
The OMT is composed largely of microbiologists who do research in their hospitals on Covid and similar diseases. Such research depends on having infected people to study, as was explained multiple times by OMT member Marc Bonten of Utrecht University MC on radio and TV. This gives these people, who effectively decide on Dutch Corona policy, an incentive to choose a policy that allows infection to persist. Such interests were never declared.
Another interesting situation revolves around the Sanquin organization. This is the non-profit national blood bank, tasked with collecting blood from recovered Covid patients from which antibodies can be extracted which, in turn, may serve as a medicine for "new" Covid patients. So far, so good. But Sanquin has a for-profit subsidiary SPP which sells that product. In 2019, this company lost half of its revenues after Takeda pulled its business, putting the whole Sanquin organization at risk, and therefore the blood supply hospitals depend on. That same Takeda is now in the market for antibodies.
As infections tended down in May and June, the government offered a 10 million euro subsidy to Sanquin to try to convince more ex-Covid patients to donate blood, and signals arrived there was a race against the clock before infections run out. Mixing profit-seeking with government roles and an incentive to maintain infections which was not declared or talked about: not the best way to organize things, perhaps.
Scandal No. 18: Bad decision making frameworks
The RIVM used SEIR models for their pandemic response modeling. These are outdated and biased away from containment with TTI and towards assuming Herd Immunity caused the Wuhan outbreak to die down. Our excellent article provides the details.
The OMT is dominated by medical doctors and hospital directors, who effectively decide policy for the Government and thus for society: health care bosses determining societal response, or to put it differently, a health care system putting the focus on defending itself (stop hospitals overflowing) and thinking using its own narrow treatment cost effectiveness frameworks without adequate regard for the economy, civil rights and health damages outside of hospitals.
Scandal No. 19 : Inaction by the Inspectorate IGJ
The IGJ (Inspectorate for Health Care and Youth Care) is responsible for regulating the quality of, among others, epidemic response efforts by GGDs. Despite many calls from activists, the IGJ has been invisible in the public sphere since the outbreak started. Only in late June did the IGJ seem to be working on something as it started to invite public input into its inspection and regulation framework. Since a great many things went wrong in and around the GGDs and TTI, an active IGJ would have been very welcome. Was it active? Then why did it not let us know? If is was inactive, why did it decide not to act?
On July 16th, IGJ finally published a regulatory framework for test-trace-isolate.
Scandal No. 20: Ignoring health damage outside of hospitals
if you don't look, and if not looking gives you a sense of control, then you won't find. The Dutch authorities define non-hospitalized survivors of Covid-19 as "mild cases". This is part of the "Maximum Control" strategy which puts the brakes on the outbreak if ICUs start to be at risk of overflowing: if you don't need hospital admission (given that it's a "pretty harmless virus"), the Government doesn't count you as a societal cost.
But Covid is a dangerous virus. We don't know yet what percentage of infectees develop serious symptoms, but estimates are of between 10% and 95% of survivors suffering months, years of damage or even permanent damage. Lung scarring, nervous system damage, loss of smell, ME, arterial and heart damage have all been named. If such complications were one in a million, then life is hard, but that doesn't seem to be the case.
We need more research into long term damage and we need to apply the precautionary principle until we know that damage is very low in almost all cases that don't die from Covid-19. If not, we run the risk (with short-lived immunity and controlled spread) that we are essentially wearing down the population, which may get re-infected multiple times and suffer more damage every time.
Scandal No. 21: The care homes
How care homes went unmonitored and unprotected, how its inhabitants were rarely taken to hospital and deprived of oxygen as they lay dying of asphyxiation, in at least some cases.
Scandal No. 22: The vulnerable
How can a policy effectively lead to the years-long isolation of perhaps as much as a million people in risk groups (over 75s, diabetics, people with cancer, etc.)? Depending on infection levels in the community at a given time, groups of at-risk people will need to quarantine themselves completely, avoid indoor spaces, wear a respirator mask, or simply decide to accept a certain risk of infection. The average infection fatality ratio is about 0.7%, but if you're an overweight, 74-year old cancer survivor, the risk of dying or ending up in a wheelchair can be well over 10%, 20% or even higher.
Humans prefer to stay alive, but perhaps not at the cost of giving up their social lives, which are of course key to our well-being. Is it reasonable to make a million or more people restrict their movements for years if containment of the outbreak is feasible and not overly expensive? Would this be accepted if the same risk applied to our most productive citizens, forcing them to stay away from others?
Fatal error No. 23: Meat industry
How were unsafe conditions in the meat industry ignored, despite being reported to the relevant authorities?How are foreign and poorly paid workers protected against working in enclosed, cold, busy spaces with a lot of suspended aerosols, under strong pressure to go to work even with Covid sympoms? How much of an impact does that have on community transmission of the virus?
Scandal No. 24: Herd Immunity
How on Earth did Herd Immunity through controlled exposure as a policy goal come into being? Who came up with the yoyo-lockdown concept and why? Why was such this key goal later denied by all? What is the link with the Brits, Swedes and Fins who also went down this road, using the same arguments and speaking the same language?
Scandal No. 25: Legality
Allowing controlled exposure of a dangerous virus is not in accordance with the WPG public health law or with international treaties. Allowing 60-80% of the population to be infected amounts to claiming ownership of their bodies for a policy goal. The policy also ruins the economy through permanent fear of the virus. This presumably goes against the rights to Life, Safety, Bodily Integrity and Work. It also appears the Medical Experimentation Law WME has been disrespected, as the subjects of this giant medical experiment have not been notified or given the option of not participating.
Scandal No. 26: The parliamentary deal
There is strong reason to believe that the Government made an explicit deal with the entire opposition (or at least the non-governing democratic parties) to not criticize the Corona strategy in at least March and April. What seems to have happened is that around March 6th, discussions started between the government and MPs. There was room for input, but the condition was that the chosen strategy would not be challenged. And indeed, the criticism that was regularly heard in Parliament in February of the relaxed attitude to the incoming pandemic died down completely in in mid-March. Not even Prime Minister Rutte's highly disappointing National Address on Herd Immunity on March 16th led to criticism. Only in May did some gentle criticism become visible in Parliament, as the left-wing opposition started mumbling about containment and complaining about propaganda.
Now, we don't mind a government lying and making shady deals in such a giant crisis. We might not even mind the media falling in line by accommodating propaganda and marginalizing opposing voices. But those responsible have a lot to answer for if it's in the service of a crazy herd immunity strategy that kills a lot of people and jobs.
Scandal No. 27: Code Black in Hospitals, which did overflow bigly
Contrary to what the media reported, Dutch hospitals DID overflow in April. The scenes that were seen in Italy of hospital wards overflowing with patients would have been much worse in the Netherlands, if not for a few useful customs and interventions.
Look at this graph showing true IC requirements (Daadwerkelijke IC-behoefte) which grows in tandem with actual hospital admissions (Aantal ziekenhuisopnames). But then in early April the number of people actually in ICU wards stabilizes suddenly, and suspiciously close to actual "surge" capacity of about 1,400 Covid beds. Please note that already in March hospitals were keeping patients away from ICUs to some extent to make room for Covid patients. From April hospitals were effectively closed for non-urgent care, which also had a "masking" effect that made hospital load numbers look better.
Now look at the following chart, based on an analysis by Chemical Engineer Jorrit Posthuma de Boer, part of our team. The data points are week numbers. Suddenly after week 13 (early April), the probability of ending up in hospital for a given number of infections falls dramatically, by a factor of 4 (four).
If all patients had made it to hospital who would under "peacetime" have made it to hospital, then significant overflow would have happened. And these "peacetime" policies already restrict the access of (older/frail) patients to hospitals. So the real overflow was even greater, if measured by the standards of most health care systems.
Another interesting article published in the Trouw newspaper shows that the age distribution of ICE admittees feel significantly in the first half of April. In plan English: the old were no longer getting in as before to make way for the young. The article also mentions the surprising peak of ICU load on April 9th, where a further inrease had been forecast to as much as 2,500 ICU beds. We can only assume the "convince the old that it's no use to go to hospital" missive that went out to GPs on March 27th worked better than planned, as perhaps did compliance with social distancing measures beyond what the government had assumed.
The third image shows how suddenly in early April the number (Aantal) of new positives stayed high, but hospital admissions (opgenomen in ziekenhuis) fell. A lot.
The early April change in hospital admission probability also coincided with the NVIC (national association of IC doctors) stopping with daily ICU covid numbers publication on their website. The NICE foundation website was referred to from then on, but they had considerably smaller numbers. Extrapolating the NVIC numbers, we would have seen a large overflow of hospitals. Were the hospitals more full than we were told? It certainly seems so.
The analysis points to a clear conclusion: as hospitals started to overflow, GPs were asked to reduce the inflow. They did this by discouraging the elderly and "frail" from making the trip to hospital. And they did this very effectively. In addtion, a lot of anecdotal evidence suggests care homes and ambulances were not taking old people with Covid symptoms to hospitals. There is no reason to believe hospitals stopped existing Covid inpatients from going to the ICU; it sufficed to stop hospital inflow.
Scandal No. 28: The role of hospitals, GPs and other doctors
In astounding news for the whole planet, Dutch hospitals have a no-mask policy. Only personnel in Covid wards wear PPE. Other wards and departments are free of masks. The reasoning behind this is very revealing, and revealed by an Amsterdam UMC explanatory video: "We can stay 1.5m away from each other, even when we treat you. We test our people when they get sick". This fits with key observations about the Dutch medical establishment, true before the pandemic but even more so now:
- The virus is not seen as very dangerous: not too many people die, and sickness outside of hospitals is largely ignored
- The ability to pass the virus to others when you don't even know you're sick is denied (or shared as a convenient mitigation-enabling lie)
- The risk of getting infected in small rooms with stagnant or recycled air is (aerosols) is denied
- Doctors see the pandemic as a health care issue (keeping or making one person healthy), denying the enormous external effects of other people getting sick, and for the economy. They don't know or accept that society needs to suppress the virus, and that hospitals are prime vectors for transmission, instead focusing on "it's a low risk you will get it, and when you do it's not so bad"
(Some) GPs seem to be discouraging their patients from getting tested, which does not take into account Public Health considerations and interests.
Dutch GPs do not regularly keep track of Covid patients when they're home. In Germany the GPs do actively monitor and treat Covid patients.
The GPs were also instrumental in restricting the inflow into hospitals in April, by responding to a centralized request to discuss with their older and frail patients the pros and cons of going to hospital if Covid arose.
Scandal No. 29: Abuse of trust of a medical professional
On July 10th. in an interview with the major Volkskrant paper, national ICU capacity coordinator Diederik Gommers recounted the days in April when hospital capacity ran out. He claims to have been put under pressure to write health minister Hugo de Jonge a Whatsapp message confirming there would be 1,600 ICU beds available by Sunday. Gommers did not know whether this was the case, and he had no influence on the amount of beds, but he sent the message which was used minutes later by De Jonge in Parliament to claim adequate ICU capacity was available. "I was being taken for a ride. I stood perplexed", claims Gommers.
This event is part of the gap between the official history (we just managed to save the hospitals) and reality (the hospitals continued to admit younger patients, but were effectively closed to the elderly and frail who were encouraged to believe it was better to die than suffer after perhaps surviving ICU care).
Scandal No. 30: A non-independent independent commission
After much political wrangling, Parliament approved a motion to ask the government to instigate an independent in-action review on the Corona response in the Netherlands. This will require an independent commission, expert and/or consultant. However, on July 12th the government announced that Marije van Schaik would become the "quartermaster" for the commission, with the role of selecting members and setting goals and procedures. However, Ms Van Schaik is a "spin doctor" for the CDA political party of the Health Minister Hugo de Jonge. She even supported him in July's CDA leadership election.
Not a very auspicious start for an independent review. A sub-scandal is how this parliamentary motion came to be, allowing a government that made so many mistakes to organize a very light and managed review of its performance.
Scandal No. 31: Protection of (health) care workers
Health Care workers are essential in a pandemic, and deserve to work safely. On July 16th, the Nieuwsuur show on Dutch public TV reported in a very revealing long item on how health care workers came to work with so little protection. Many became infected, some died. The lack of PPE was initially claimed to be a problem of scarcity, which begged the question why people weren't allowed to reuse masks, why hospitals did get masks and respirators, and why other countries did manage to secure supplies.
On July 16th it was revealed that the rules, which emanated from RIVM, were in fact written up by its Infectious Disease Unit director Jaap van Dissel based on his "experience". The entire sector had assumed the rules had been developed based on sound Science and much deep thinking of a broad range of experts. In any case, they didn't work.
On July 17th, the Nieuwsuur show revealed that scarcity of materials (within the health care sector) did play a role in allocation of PPE (causing people to work without adequate protection). The ministry claimed that played no role. Interestingly, there is no proof that there was a shortage on the market, so this is about internal processes within the sector. Jos de Blok, head of a care home organization, claims the actions by the government increased scarcity and that common-sense ways ot increasing the supply of PPE were ignored.
So either it's a scandal that the materials were not provided because of artifical scarcity, or because (as the government claims) there really was no necessity in their opinion, or both.
Another sub-scandal is how the "ICU-managed" mitigation strategy came down to health care workers indirectly causing death. The more ICU beds and doctors/nurses are available, the more infection the government would allow, and thus also the more death. This is especially true since in the Netherlands most Covid-deaths are outside of hospital. So even if a doctor saves one life, multiple other lives are indirectly lost. Doctors did not become doctors to play such a perverted role in a Herd Immunity strategy.
Another sub-scandal is that the doctors and nurses are put at great risk in a mitigation scenario. They never chose to sustain such risks. And since the risks are avoidable with a containment strategy, and considering also the previous point, a crude way of putting it is that doctors were selected to operate "meat grinders" at considerable personal risk.
Scandal No. 32: The game of responsibility musical chairs
(Health) care workers had not been protected enough during their work in care homes and the homes of their patients/clients, causing much disease and death (Scandal 31). The entire health care sector had been following the "Richtlijnen" of the RIVM (Dutch CDC) on when, where and how to use PPE. Now, "richtlijn" can mean "guideline" (advice) as well "protocol"/"command". The richtlijnen were treated as commands, and had been intended that way, as the minister himself admitted. But when it turned out the guidelines were inadequate, the government said the richtlijnen were merely advice.
We await how the GGDs and the minister will respond when it turns out the GGDs theoretically also had the power to contain the virus in their respective regions, and that many unfortunate choices were made.
Schools, amusement parks and many other types of organizations also treat the RIVM "richtlijnen" as law. But when a restaurant gets sued over wrongul death, we can be sure the RIVM will not be held criminally responsible. Such a blurring of advice and command, advice and policy, and advice and management, is of course not best practice governance.
Scandal No. 33: Allowing people to die without oxygen
Scandal No. 27 is that many were effectively banned from going to hospital, usually choosing to stay home under light or strong pressure. Multiple anecdotal stories have emerged that people spent their last hours and days without supplemental oxygen, meaning they died lonely and short of breath, in many cases gasping for breath as care workers watched helplessly. Some might argue that morphine can alleviate the anguish of shortness of breath, but no-one can claim that oxygen can't make people feel better. When Swedish family doctor Jon Tallinger found out many patients died away from hospitals without oxygen, he became an advocate for a more humane Covid policy in Sweden. So at least one doctor finds this practice barbaric.
It is now clear that those staying home while terminally ill were denied oxygen in many cases as a matter of policy in the Netherlands as well. A small group of home patients is allowed to get supplemental oxygen, but only if there is a chance of recovery. Now, medical professionals tell us that giving oxygen is not always helpful in a terminal situation, but when oxygen saturation is low, it is. And low oxygen saturation is a very common symptom of Covid-19. This means we can safely assume that many if not most of the 10,000-odd Covid deaths in the Netherlands died while being short of oxygen, or at least feeling as if they do.
The text above comes from the website of the NHG Dutch Association of GPs. It's still current at the time of writing (July 19th), so this is still going on as deaths still happen daily in the Netherlands.
Scandal No. 34: depriving people of care because of their age
In July we uncovered documentation that proved people 70 and over were denied care, simply because of their age. The government said this never happened.
Scandal No. 35: Failing to Act in July when the second uptick was upon us
Almost immediately after the last control measures (apart from 1.5m distancing) were relaxed on July 1, infections started doubling again every week. Calls to make masks mandatory were met with Government and media claims of masks being "unproven", offering a "false sense of security" and, if mandatory, "illegal". No other control measured were instituted. The situation was declared "under control" on multiple occasions in late July, despite the fact that Prime Minister Rutte spoke about the "first wave" being "over" only weeks before.
By early August it was clear that things were out of control, with 400 infections being reported every day (multiply that by 10-15x for the actual figure in a country that restricts testing). The parliamentary opposition asked for an emergency debate in the week of August 4th, which was refused by the governing coalition. No-one in Parliament or Government even spoke of how schools can open from August 17th with so much virus circulating.
In the following days, the Government and its friendly Scientists and Health Care managers showed up daily on TV and in newspapers, saying there is no problem as there is still lots of room in hospitals (Herd Immunity = Mitigation speaking). Well, "we're staring into the abyss" but things are under control".
Meanwhile, the RIVM/CDC said it's better to not visit Rotterdam, the main Corona hotspot, but then said it's OK to go, even though the city has much more infections than the German lockdown threshold.
Fishy move No. 36: Moving the goalposts
The Dutch Government maintains a Covid Dashboard. It confirms the strategy is ICU-based Mitigation (Herd Immunity) because its Control Measure Trigger Values ("Signaalwaarden") focus on hospital admissions, not infections. Such a Trigger Value was promised in June for release by July 31st, but it never came.
But that's not the scandal.
The number of infectious people ("Aantal besmettelijke mensen") per 100,000 inhabitants was on a 0-50 scale during July. As the estimated number of infectious people grew and shot past the 50, the scale was adjusted to 80, without any comment or explanation.
And, you saw it coming, on August 4th, as infections rose again, the scale was changed again to 100. Watch this space!
Fatal Error No. 37: A Public Health Secretary with a math problem
On August 12th 2020, during the plenary parliamentary debate on the Corona crisis, Public Health Minister Hugo de Jonge said "there was no exponential growth in recent weeks. Is has been more of a linear growth these past weeks". This is not true. Not as a matter of theory (only when the Reproduction Factor is exactly 1 for a sustained period of time can the growth be linear) but also as a matter of observation. Twitter researcher Innouveau listed the reported cases and shows that growth was, of course, exponential in Amsterdam, Rotterdam and nationwide.
It is of course possible that Mr de Jonge is bad at math. Or maybe, as a former school director, he is perfectly up to date and was merely telling porkies to the public in a bid to avoid panic. You be the judge. In any case, Public Health Authority (GGD) Head Sjaak de Gouw also seems to have a lot of trouble understanding exponential growth. Interesting that is, since the GGDs were founded to combat epidemics which behave exponentially.