Netherlands

Netherlands Delay Treatment for Cancer and Heart Patients to Free up Space for Covid Patients

Preparing for another Covid wave, the Netherlands has begun to delay treatment and vital operations for cancer and heart patients to ensure that there is more space in intensive care units for incoming Covid patients. Reuters has the story.

Dutch healthcare officials said on Friday they have begun delaying operations for some cancer and heart patients to free up space in intensive care units during a record wave of Covid infections.

“These are cancer patients that should actually be operated on within six weeks of diagnosis, and that won’t be met in all cases. It’s also heart patients,” said a spokesperson for LCPS, the national organisation that allocates hospital resources.

“It’s horrible, of course, for the patients.”

The National Institute for Health (RIVM) reported a record of more than 23,000 new cases in the previous 24 hours on Thursday, compared with the previous daily high of around 13,000 reached in December 2020.

With 85% of the adult population vaccinated, both hospital and intensive care unit (ICU) admission rates have so far remained lower than they were at the height of the initial wave in April 2020, although there is a delay between the date of infection and the date of admission to hospital.

With fewer than 200 beds remaining in Dutch ICU as of Thursday, hospitals are scrambling to add more capacity.

Worth reading in full.

Dutch Cost-Benefit Analysis Done During Lockdown Concluded, “The Costs Are Disproportionately High”

In a post written back in August, I said the following: “To my knowledge, no Western government has published a cost-benefit analysis of lockdown (presumably due to what it might show).”

While this may have been technically correct – since I said “published” – it appears that at least one Western country did carry out a cost-benefit analysis (though that analysis was never published).

According to Dutch newspaper Het Parool, documents obtained via freedom of information request show that the Ministry of Economic Affairs carried out a cost-benefit analysis in March/April of 2020. (Hat tip to Michael Senger for bringing the Dutch newspaper article to my attention.)

The FOI request was apparently made by a 66 year old lockdown sceptic by the name of Jan van der Zanden, who just assumed the Ministry of Economic Affairs would have tried to gauge the costs and benefits.

What did the Ministry conclude? In short, that the costs of lockdown far outweighed the benefits.

They assumed that one year of lockdown would prevent the loss of about 100,000 QALYs (quality-adjusted life years). And they attached a value of €80,000 to each QALY, which is the typical upper limit applied in analyses of this kind. Hence the expected benefits of lockdown were €8 billion.

As to costs, they projected an economic contraction of €40 billion, a loss of €25 billion due to the cessation of regular healthcare, plus a loss of €5 billion due to the “psychological consequences” of lockdown. Total expected costs were therefore €70 billion – almost nine times greater than the benefits.

The authors concluded that the “costs are disproportionately high”. They also said that “a one sided focus on mortality should be avoided” and the “health of the elderly should not be given an indisputable priority”.

The authors even proposed an alternative to lockdown, which involved expanding care and testing capacity to “get society going again”. Widespread testing would mean that infectious people could be isolated “in a targeted manner” and those who had “built up immunity” could return to work.

In the end, of course, the analysis by the Ministry of Economic Affairs was ignored. To date, the Dutch have endured 144 days of curfews and stay-at-home orders, along with assorted other restrictions. And the country has just entered another “partial lockdown” in response to rising infections.  

Het Parool contacted Eric Wiebes, who served as Dutch finance minister through January 2021. However, he “declined to respond to questions” about the cost-benefit analysis. This suggests the original probably conclusion probably hasn’t been overturned.

Professor Neil Ferguson Says Netherlands-Style Lockdown Unlikely in Britain

Professor Neil Ferguson has declared that Britain’s Covid cases and hospitalisations may be “petering out”, adding that the country is unlikely to need a Netherlands-style lockdown because antibody levels are higher in the U.K. population due to higher case numbers earlier in the year. MailOnline has more.

The Professor at Imperial College London told BBC Radio 4’s Today programme: “We’ve had two or three weeks of declining cases and admission to hospitals, that may be petering out, it is too early to say.

“There is a hint of an uptick in the last few days.

“But we are in quite a different situation from those European countries you are talking about (the Netherlands, Germany).

“We’ve had very high case numbers, between 30,000 and 50,000 a day, really for the last four months, since the beginning of July.

“That has obviously had some downsides. It has also paradoxically had an upside of boosting the immunity of the population compared with countries like Germany, the Netherlands and France, which have had much lower case numbers and are only now seeing an uptick.”

The Epidemiologist, whose modelling helped instigate the first lockdown last year, said he hopes the U.K. can “avoid” returning to social distancing restrictions this winter.

He said: “I think it is unlikely we will get anything close to what we had last year, that catastrophic winter wave.

“We might see slow increases as we did in October, for instance, but not anything as rapid as we saw last year.

“We can’t be complacent, but at the moment I don’t think we’ll be in a situation the Netherlands is coming into where they really do need to get on top of rising case numbers using social distancing.

“I very much hope we can avoid that in this country.”

The expert also said modelling from the London School of Hygiene & Tropical Medicine has indicated that rolling out booster vaccinations to the “younger age groups” once the most vulnerable have been jabbed could help “drive down transmission to low levels” in Britain.

Worth reading in full.

Stop Press: When lockdown sceptics have suggested that natural immunity can provide you with protection that’s at least as robust as the Covid vaccines – with all the attendant implications for vaccine passports, ‘No Jab, No Job’, etc. – they’ve been branded “anti-vaxxers”. Does this mean Professor Lockdown is now an anti-vaxxer?

New Lancet Study From Sweden Shows Vaccine Effectiveness Against Infection Dropping to Zero and Sharp Decline Against Severe Disease As Well

To judge from recent scientific and media output, there appear to be two parallel realities currently existing side-by-side in Covid world. In one, the vaccines are highly effective at preventing infection and transmission, and any data that suggests otherwise is being misrepresented or is biased or contains some kind of basic error. In the other – the one that bears a much closer resemblance to the one we actually live in – vaccine effectiveness against infection has been declining significantly and after six months is basically zero. At some point, one of these realities is going to have to give way because they can’t both be true. I know which one my money’s on.

An example of the first appeared in New Scientist this week, headlined: “How much less likely are you to spread COVID-19 if you’re vaccinated?” The answer: at least 63%, according to a new population-based pre-print study from the Netherlands.

A recent study found that vaccinated people infected with the Delta variant are 63% less likely to infect people who are unvaccinated.

This is only slightly lower than with the Alpha variant, says Brechje de Gier at the National Institute for Public Health and the Environment in the Netherlands, who led the study. Her team had previously found that vaccinated people infected with Alpha were 73% less likely to infect unvaccinated people.

What is important to realise, de Gier says, is that the full effect of vaccines on reducing transmission is even higher than 63%, because most vaccinated people don’t become infected in the first place.

De Gier and her team used data from the Netherlands’ contact tracing system to work out the so-called secondary attack rate – the proportion of contacts infected by positive cases. They then worked out how much this was reduced by vaccination, adjusting for factors such as age.

The data comes from August and September 2021, when Delta was dominant in the Netherlands. The key table, breaking the figures down by whether the index case and contacts were vaccinated, is below.

Dutch Protest Against Vaccine Passports

Demonstrations against vaccine passports have been taking place across the world over the weekend, including in the Netherlands, where people protested against the “medical apartheid” barring those who haven’t been vaccinated or tested for Covid from bars, restaurants and theatres. The Guardian has the story.

Hours after the requirement to show the pass or a recent negative coronavirus test took effect, the Government of caretaker Prime Minister Mark Rutte sacked a cabinet minister who had publicly questioned the measure.

Rutte’s office said Deputy Economic Affairs Minister Mona Keijzer had been dismissed because her comments went against cabinet policy on an issue “of such importance and weight”.

In an interview with the Telegraaf newspaper, Keijzer questioned whether the requirement was justified. “If we end up in a society where we have to be afraid of each other unless we can show proof, then you really have to scratch your head and ask yourself: is this the direction we want to go?” she was quoted as saying. …

Several hundred protesters gathered in The Hague, the seat of the Dutch Government, to march through the city centre.

Most Dutch people support the introduction of the admission pass, but it has drawn criticism from the hospitality sector.

More than 40% of bar and restaurant owners do not plan to ask clients for the vaccination certificate, said Koninklijke Horeca Nederland, the country’s hospitality industry association, citing a survey of its members.

It said many businesses saw the requirement as a “political tool” aimed at boosting vaccination take-up.

“It is not only impossible to enforce, but will financially damage a sector that is just starting to recover,” the association added in a statement.

Worth reading in full.

What’s Behind the Covid Surge in the Netherlands?

The Netherlands has been in the news this week after Prime Minister Mark Rutte apologised for reopening nightclubs at the end of June following a surge in infections that came in the following two weeks. Rutte has now closed them again for a month amid allegations that he made a “criminal choice” and “put people in danger”.

The rise in positive tests certainly looks alarming – though note the past four days has seen a slowdown.

However, the rise needs to take into account that when night clubs and other venues reopened there was a requirement that guests presented a negative COVID-19 test (or proof of vaccination, but few in the relevant age group are vaccinated) within 40 hours prior to entry. This means lots of asymptomatic or mild infections in young adults are now being picked up that were previously going under the radar.

Most Of the AstraZeneca Vaccines Ordered By the Netherlands Will Go Unused

Most of the 11 million doses of the AstraZeneca Covid vaccine ordered by the Dutch Government will go unused because so many other vaccines will soon be available in the country, according to the director of its vaccination programme. The Netherlands recently limited the use of the AZ vaccine to people aged over 60 following cases of blood clots which are also believed to have damaged public confidence in the vaccine. Dutch News has the story.

The head of the vaccination department at [the Dutch National Institute for Public Health and the Environment has told] the AD [newspaper] in an interview that the millions of doses of the AstraZeneca vaccine due to reach the Netherlands in the coming weeks will largely remain unused.

So many vaccines will be delivered that the AstraZeneca vaccine, currently only given to people aged 60 to 64, will not be needed, Jaap van Delden told the paper.

The Netherlands has ordered 11 million doses of the vaccine and some 1.5 million doses have been given to date. Most of the order is due to be delivered in mid-May.

The chaotic introduction of the AstraZeneca vaccine – first halted, then allowed, then halted for the under-60s – because of concerns about very rare blood clots, has led to a low take-up rate in some doctors’ practices.

But the national family doctors association [the National General Practitioners Association] LHV has reacted to the comments, saying that the AstraZeneca vaccine is extremely important and that the interview with Van Delden has only confused the issue more.

“The policy changes surrounding this vaccine are making it more difficult for doctors to ensure high turnout [for the vaccination]”, the organisation said.

“This is absolutely not helping… As far as we are concerned it is clear: if the choice is AstraZeneca now or possibly another vaccine later, then the choice should absolutely be for AstraZeneca now.”

In the interview with AD, Jaap van Delden said the leftover vaccines are likely to be distributed among poorer countries.

The Dutch News report is worth reading in full.