Policy responses for Belgium - HSRM


Policy responses for Belgium

3.3 Maintaining essential services


From March 14th all hospitals (general and university, psychiatric and rehabilitation settings) were required to cancel all non-urgent consultations, investigations and elective interventions (with special focus on those potentially impacting intensive care capacities). Urgent consultations, investigations and interventions could be maintained as well as necessary treatments (chemotherapy, dialysis, etc.) and rehabilitation.

After a few weeks, it was observed that other patients (those not affected by COVID) were no longer presenting to the emergency room (for heart attacks, strokes, etc.). Several calls were made through the media to reassure people and confirm that all medical emergencies were being taken care of safely. It remain to be seen whether there will be excess mortality due to other causes of death (see Transition measures).

Primary care professionals

Primary care professionals (general practitioners (GPs), home care nurses, physiotherapists, etc.) were advised to prioritise their care and to assess whether the care is essential or can be postponed. They were asked to devise replacement solutions (colleagues, family of the patient taking over some care) in case they would be infected and need to self-isolate. Specific guidelines for each professions are available on the Sciensano website and relayed on other professional and federated entities’ websites. More precisions have been added in an update on April 17th: the following activities are considered essential and must be maintained: the treatment of chronic illnesses whose suspension would lead to an irreversible or unacceptable deterioration; the treatment of urgent mental illnesses; essential preventive acts, in particular vaccination (mainly in children under 15 months) and neonatal screening. Homecare nurses were also advised to organise care in cohorts: within a homecare organisation, a permanent team is exclusively responsible for the care and support of persons infected with COVID-19 or considered to be potentially infected. Caregivers and nurses who are not part of this COVID-19 team take care of the clients who are not infected.

Mental health care sector

The mental health care sector was asked to ensure the continuity of care as much as possible, while taking all necessary precautions. Psychiatric hospitals were urged not to refer patients to general hospitals except for emergencies and life-threatening situations. Day care settings for older patients are temporarily closed and alternative solutions had to be found to continue providing the necessary psychological care. Day hospitalisation for other patients could continue, provided all precautions were taken. The work of mobile teams has not stopped, with home care currently being the most appropriate care under these circumstances. Individual consultations are maintained, but teleconsultation is encouraged.

To support the mental health of the population, the reimbursement of psychological care has been extended (see 4.2).

Worries also currently concern the mental health of the young population (16-25 years old). In order to help them, it has been decided to reduce restrictions for them in the near future, such as allowing them to partially return to school (for secondary or higher education) from around mid-April 2021. Indeed, since November 2th 2020, for students in the second and third levels of secondary schools (14-18 years old), half of their education must be done remotely and for higher education levels (university, etc.), education must be provided remotely (except for students in the first year for who a part time was allowed).

Residential facilities for older people

Residential facilities for older people or people with a handicap received detailed guidelines and tutorials about how to manage infected residents and/or staff members. Nevertheless, many of them complained of a lack of personal protection material. In some institutions, staff shortages have posed real problems, to the extent that it was decided on March 8th to send the army in to some institutions as reinforcement (for logistical support only).

Other residential facilities

Prisons, shelters for asylum seekers and the homeless, and equivalent residential facilities received general hygiene and prevention advice from their respective supervisory authorities and were asked, whenever possible, to increase their capacity and to develop collaborative arrangements with health care facilities and alternative care sites where people with respiratory illnesses could receive appropriate care. In prisons, all visits were forbidden from March 14th.

Marginal populations

Many humanitarian volunteer initiatives (from NGOs like Médecins sans Frontières, Médecins du Monde, Croix Rouge, etc.) were set up for marginal populations (homeless people, foreign populations and migrants, etc.). In Brussels, a telephone line was set up by the GPs’ organisation to direct sick people to the local GP circles where a doctor will answer the call.

General public

For the general public, phone or video consultations are allowed, remunerated and totally reimbursed by the National Institute for Health and Disability insurance (NIHDI) for the following health care professionals: physicians (from March 16th), psychologists, dentists, speech therapists, physiotherapists, midwives, dieticians, occupational therapists and diabetes educators (from April 1st). Telephone lines were opened for psychological support in some regions.

For blood donors, additional precautionary measures were imposed (on March 13th): postponement of donor candidates until at least 28 days after a possible exposure, or after complete disappearance of symptoms and the end of treatment, or after their return from a country with high transmission rates.

• FPS Public Health (2020). Coronavirus Covid-19. Brussels: Federal Public Service Health, Food chain safety and Environment (www.info-coronavirus.be, Accessed April 2020);
• Sciensano (2020). Coronavirus. Brussels: Sciensano (https://epidemio.wiv-isp.be/ID/Pages/default.aspx, Accessed April 2020);
• Flemish Agency for Care and Health (2020). Uitbraak coronavirus COVID-19. Brussels: Flemish Agency for Care and Health – Agentschap Zorg en Gezondheid (https://www.zorg-en-gezondheid.be/covid-19, Accessed April 2020);
• AVIQ (2020). Coronavirus 2019. Charleroi : Agency for a Quality Life-Agence pour une vie de Qualité (https://www.aviq.be/coronavirus.html, Accessed April 2020) ;
• Iriscare (2020). COVID-19. Brussels: Iriscare (http://www.iriscare.brussels/fr/professionnels/, Accessed April 2020);
• Ostbelgienlive (2020). Coronavirus: Fragen und Antworten. Eupen: Ostbelgienlive (http://www.ostbelgienlive.be/desktopdefault.aspx/tabid-6711/, Accessed April 2020);
• Personal communication with AVIQ: Belpaire Joëlle.

Primary care - On May 4th primary care professionals started to see the patients whose care had been discontinued during the acute phase, starting with the most urgent ones.

Hospitals - On April 4th the Belgian Group of specialised physicians (GBS-VBS) warned that care for non-COVID-19 patients has deteriorated critically since the closing of all non-urgent care. They proposed a phased recovery plan for specialist medicine and pleaded for a progressive re-opening of operating theatres from May 4th. On April 16th, the federal authorities announced that a consultation with health professions would be organised in order to examine how regular activities could be restored and restarted once the restrictions measures have been lifted.

On May 4th, hospitals started inviting patients whose consultations had been cancelled during the acute phase, starting with the most urgent ones.  A new plan was established to ensure patients with COVID-19 are distributed and treated in the most optimal way while ensuring that other care is provided as much as possible (see section 2.1).

During the second wave (around November 2020), all essential services were maintained (including medical ones).