In the context of the COVID-19 pandemic and in order to respond to a possible shortage of health care professionals, the government has in first instance issued recommendations regarding the involvement of nursing students, medical students and physicians in training. These recommendations were sent to the deans of the faculties of medicine, the chief physicians and general directors of hospitals as well as to the Federated entities responsible for the recognition of health care professionals. These recommendations addressed the strict supervision of these students, clear protocols, measures to avoid risks of infection, and the obligation to have a civil liability and occupational accident insurance (1).
In addition to these recommendations, the government has decided to take exceptional measures to guarantee the provision of the required care during this period of crisis. These measures are aimed at increasing the number of health care professionals who can help in the management of this health crisis and supporting doctors and nurses in caring for patients during the pandemic.
A first measure concerned the temporary authorisation of performing nursing activities by health care professionals other than those already authorised to do so in normal times. This authorisation would nevertheless be restricted to activities that are necessary to cope with the consequences of COVID-19. A second measure concerned the requisition of all health care professionals licensed to practice under three conditions: (i) when a facility in which health care is provided (such as nursing homes, homes for older people, hospitals or individual practices) is faced with a shortage of health care professionals that no longer allows it to function properly; (ii) this shortage can no longer be addressed by increasing capacity in accordance with crisis plans or on a voluntary basis; and (iii) requisitioned health care professionals will be assigned exclusively to managing the consequences of the coronavirus. Nevertheless, because of the reactions of trade unions, these measures were dropped (but were re-discussed during the second wave, see below).
At the level of federated entities, list of reserves are also organised to provide assistance in the health services under their competencies (such as nursing homes and homes for older people) in cases where additional support would be required. The call is particularly aimed at volunteers with medical experience, such as medical or nursing students, as well as retired doctors who can still help out. People can register via the respective platforms created by Iriscare (Brussels), the Flemish Agency for Care and Health (Z&G), the Walloon Agency for a quality life (AViQ, also for non-medical volunteers), and the German Community (2-5). Insurance may be provided by the Federated entities to cover for the work of volunteers during the crisis (6-8). Online platforms were also created to help GPs monitoring COVID-19 patients remotely (9) as well as specific mobile teams to improve care for COVID-19 patients at home (10).
Psychosocial support is also being coordinated, with the federated entities, through Psychosocial coordination committees. The areas they work on are (1, 10-11):
• Support for citizens
• Support for health care professionals
• Support for crisis management teams
The federated entities have, for example, created platforms or free call numbers to support the mental wellbeing of all professionals working in the health care or welfare sector (12, 13). There is also platforms or free call numbers for the population in need of psychosocial support (14-16). Initiatives to combat domestic and intra-family violence have also been put in place (e.g. call centres and audio visual campaigns) (17).
Additionally, even though schools were closed from 16th March 2020, cover is provided for children of people who are working in the health care sector or other essential sectors. This cover was continued during the Easter holiday period.
Measures are also taken by the National Institute for Health and Disability Insurance (NIHDI) such as the development of a global mechanism allowing teleconsultations (see sections 3.1 and 4.2). Since March 23rd, a flexible financial and administrative framework was also put in place to support "triage centres" for COVID-19 patients (https://www.inami.fgov.be/fr/covid19/Pages/medecins.aspx).
Many volunteers also help out. In order to relieve the emergency services, Red Cross volunteers have, for example, set up medical orientation posts at 20 hospital sites (18). Measures are also taken by other non-governmental organizations (NGOs) such as ‘Médecins sans frontière’ (19) or ‘Médecins du monde’ (20) as well as the army (see section 3.3).
On April 15th, the Interministerial Public Health Conference (gathering all federal and federated levels of power) approved a framework for possible support from the hospital sector to the older care sector (namely the nursing homes, see section 3.3).
Measures during the second wave
On October 23th, it was decided that the Belgian army would provide the following support: (i) provision of medical and paramedical personnel where needed; (ii) intervention in medical transports (i.e. provision of military ambulances, C130 planes, helicopters, etc.); (iii) increase in the treatment of major burns by military hospitals to relieve pressure on other hospitals (i.e. possibility to transfer patients with major burns in order to open up more beds for COVID patients); and (iv) the management of prisoners affected by the virus, where the capacity for isolation within prisons has been exceeded.
Additionally, a new law was passed authorising persons who were in principle not legally qualified to perform nursing acts in the context of the COVID-19 pandemic are now allowed to do so (under strict conditions) as of November 6th. These acts must be carried out under the supervision of a coordinating nurse but do not necessarily require his/her physical presence.
However, the acts cannot involve the use, handling or monitoring of extracorporeal circulation and counterpulsion devices; of invasive techniques where blood vessels are manipulated; of blood and blood components; and of dialysis, perfusion and apheresis equipment.
Some opposition nevertheless remains and an appeal of the law is with the Constitutional Court.
(1) Personal communication with the FPS Public Health: Van der Auwera Marcel, Ashton Nicholas, Somer Aurelie, and Van Renterghem Tom;
(2) Flemish Agency for Care and Health (2020). Aanmelding medische reserve COVID-19. Brussels: Flemish Agency for Care and Health – Agentschap Zorg en Gezondheid (https://www.zorg-en-gezondheid.be/aanmelding-medische-reserve-covid-19, Accessed April 2020);
(3) AVIQ (2020). Plateforme solidaire wallonne. Charleroi : Agency for a Quality Life-Agence pour une vie de Qualité (https://solidaire.aviq.be/, Accessed April 2020) ;
(4) Iriscare (2020). Coronavirus : appel en vue de la constitution d’une réserve de volontaires. Brussels: Iriscare (http://www.iriscare.brussels/fr/2020/03/19/coronavirus-appel-en-vue-de-la-constitution-dune-reserve-de-volontaires/, Accessed March 2020);
(5) Ostbelgienlive (2020). Unterstützen Sie Ihre Kolleginnen und Kollegen im Gesundheitsbereich!. Eupen: Ostbelgienlive (http://www.ostbelgienlive.be/desktopdefault.aspx/tabid-71/211_read-59699/, Accessed April 2020);
(6) Ostbelgienlive (2020). Versicherungsschutz für Coronahelfer ausgeweitet. Eupen: Ostbelgienlive (http://www.ostbelgienlive.be/desktopdefault.aspx/tabid-71/211_read-59758/, Accessed April 2020);
(7) AVIQ (2020). Coronavirus 2019 : Extension gratuite et sans aucune formalité des couvertures d’assurance RC et/ou accidents corporels pour les MR/MRS et les centres d’hébergement pour personnes handicapées ou fragilisées qui reçoivent l'aide de bénévoles. Charleroi : Agency for a Quality Life-Agence pour une vie de Qualité (https://www.aviq.be/coronavirus.html, Accessed April 2020) ;
(8) Vlaanderen (2020). Vrijwilligerswerk in kader van coronacrisis. Vlaanderen (https://overheid.vlaanderen.be/personeel/maatregelen-coronavirus/vrijwilligerswerk-in-kader-van-coronacrisis, Accessed April 2020);
(9) E-santé Wallonie (2020). COVID-19 SafeLink. E-santé Wallonie (https://e-santewallonie.be/covid-19-appli/, Accessed April 2020);
(10) Personal communication with the German Community: Lena Pankert;
(11) AVIQ (2020). Coronavirus 2019 : Un soutien et une écoute gratuite à l’attention des professionnels de l’aide et du soin des services agréés et reconnus par l’AVIQ. Charleroi : Agency for a Quality Life-Agence pour une vie de Qualité (https://www.aviq.be/coronavirus.html, Accessed April 2020) ;
(12) Walloon Government (2020). Covid-19 Ligne d'écoute gratuite pour les professionnels de l’aide et de la santé. Walloon Government (https://www.wallonie.be/fr/actualites/covid-19-ligne-decoute-gratuite-pour-les-professionnels-de-laide-et-de-la-sante, Accessed April 2020);
(13) De ZorgSamen (2020). Veerkracht voor zorgverleners en welzijnswerkers. De ZorgSamen (https://www.dezorgsamen.be/, Accessed April 2020).
(14) Zorgen Voor Morgen (2020). Actie plan voor mentaal welzijn. Zorgen Voor Morgen (https://www.zorgenvoormorgen.be/, Accessed April 2020).
(15) CBCS (2020). Un numéro vert pour les urgences sociales. Bruxelles : Conseil bruxellois de coordination sociopolitique (https://www.cbcs.be/Un-numero-vert-pour-les-urgences-sociales, Accessed April 2020).
(16) Ostbelgienlive (2020). Fragen zum Coronavirus? Ministerium bietet ab sofort eine Hotline auf Deutsch. Eupen: Ostbelgienlive (https://www.ostbelgienlive.be/desktopdefault.aspx/tabid-6736/10885_read-59467/, Accessed April 2020);
(17) Walloon Government (2020). Covid-19 Campagne « Rien ne justifie la violence conjugale ». Walloon Government (https://www.wallonie.be/fr/actualites/covid-19-campagne-rien-ne-justifie-la-violence-conjugale, Accessed April 2020);
(18) Red Cross (2020). Nos actions. Brussels: Red Cross-Croix Rouge (https://www.croix-rouge.be/coronavirus-nos-actions/, Accessed April 2020);
(19) MSF-AZG (2020). Coronavirus en Belgique : MSF se mobilise pour les personnes les plus vulnérables. Bruxelles : Médecins Sans Frontières (https://www.msf-azg.be/fr/news/coronavirus-en-belgique-msf-se-mobilise-pour-les-personnes-les-plus-vulnérables, Accessed April 2020);
(20) Médecins du Monde (2020). Covid-19: Quel confinement lorsqu’on n'a pas de toit ? Bruxelles: Médecin du Monde (https://medecinsdumonde.be/actualites-publications/actualites/covid-19-quel-confinement-lorsquon-na-pas-de-toit, Accessed April 2020).