1. Preventing transmission
The section on PREVENTING TRANSMISSION includes information on key public health measures that aim to prevent the further spread of the disease. It details how countries are advising the general public and people who (might) have the disease to prevent further spread, as well as measures in place to test and identify cases, trace contacts, and monitor the scale of the outbreak.
1.1 Health communication
Since some of the measures will be relaxed in May and others could follow in June, the discussion on the use of masks in public spaces is getting renewed attention, especially in those spaces where physical distancing is difficult, such as public transportation. Since scientific evidence appears to be inconclusive, proponents of face masks in public spaces argue that you can better be safe than sorry, whereas opponents argue that they contribute to a false sense of security.
Since the number of hospital and ICU admissions is decreasing, the government formulated an exit strategy that it announced publicly in a press conference on 6 May. The information provided to the public focused on what is expected to be possible in the near future rather than on restrictions, using a more positive approach to motivate the population to adhere to the guidelines. Starting on May 11, the following “intelligent lock down” relaxation measures were announced:
• Primary schools will partially open
• Outdoor sports activities are allowed with the exception of matches and people should change clothes and shower at home
• Professions that require physical contact, such as hairdressers, are allowed again. If possible, people should follow the 1.5-meter distance rule and use these services by appointment only. Clients will be asked about their health beforehand.
• As of 1 June, public transportation will resume the normal timetables. The available space will be reduced to 40% of normal capacity to enable people to keep distance. However, since keeping distance is difficult in public transportation, face masks will become compulsory, despite the discussion on the effectiveness of wearing face masks (for more information, please see Section 1.2 – Physical distancing).
Since the number of hospital admissions is still decreasing and ICU bed occupancy is again below the regular capacity in the Netherlands, from 1 June onwards the following relaxations of the measures have been announced:
• Secondary schools re-open on 2 June as long as pupils will be able to keep the 1.5 meter distance. This implies that not all pupils will be able to go to school at the same time. Schools will have to take measures to assure the 1.5 meter distance and pupils should avoid travelling with public transportation. Schools are required to organize transportation for pupils that are unable to come by bicycle due to distance and for whom parents are not able to bring them.
• As of 8 June, primary schools will be fully open. All children can go to school as usual.
• As of 15 June, those living in nursing homes are allowed to receive more than one fixed visitor (As of 18 March visitors in nursing homes were no longer allowed, as of 25 May one fixed visitor was allowed per resident) (https://nos.nl/artikel/2336093-verpleeghuisbewoners-mogen-vanaf-15-juni-weer-meer-dan-een-bezoeker-ontvangen.html).
• The catering sector opens up as of 1 June, with a maximum of 30 visitors inside. Visitors outside on terraces should be sitting at tables.
On 24 June, the Prime Minister announced extensive relaxation measures as infections continued to be very low, including some that were introduced earlier than expected:
• The main rule of keeping 1.5 meters physical distance from each other remains. This rule applies to adults and excludes children under the age of 18 and people belonging to the same household.
• Face masks remain compulsory in public transportation (including taxis), although all seats in public transportation can be used again.
• The maximum number people for inside gatherings is 100 persons. If more people come, this is allowed as long as a reservation system is in place
• The maximum number people for open air gatherings is 250 persons. More persons are allowed as long as there are fixed seats available (only nightclubs and disco’s remain closed until 1 September).
An action group (Virus Madness, Viruswaanzin) that was against the measures taken to prevent the coronavirus from spreading went to court to stop the measures. The judge did not agree with their case and ruled that the Dutch government did make valid choices despite working with a lot of uncertainties.
Official advice on hand hygiene, respiratory etiquette and physical distancing is issued regularly by several channels, varying from messages by the Prime Minister to messages in the press. A special web page dedicated to all issues related to the coronavirus and health is provided by the National Institute for Public Health and the Environment (Rijksinstituut voor Volksgezondheid en Milieu, RIVM) (https://www.rivm.nl/). Most health-related communications refer to this website as the official information channel in relation to guidelines for the COVID-19 crisis.
On 9 March, the Prime Minister announced that shaking hands was no longer desirable. In the newspapers and on news websites, coronavirus-related news is widely available. Special coronavirus television and radio programs and a weblog of the Dutch public broadcast system (NOS) have been produced to inform the public on facts and fiction and to answer questions (27 February and 13 March). Several patient organisations organize webinars to inform their patients on disease-specific risks and prevention. The Dutch GP Association created a special page on their website with information for patients (https://www.thuisarts.nl/nieuw-coronavirus). The Cabinet and the Prime Minister have conducted several press conferences on the COVID-19 situation and the measures to prevent the spread of the virus (9, 13, 15, 23 March and 21 April). Since 13 March, press conferences of the Cabinet and the Prime Minister are translated live by a sign language interpreter after receiving criticism concerning the absence in the first press conference.
The public is informed that washing hands regularly, using paper tissues and sneezing and coughing in your elbow will prevent spreading. Several videos on how to wash your hands properly show up in the media. Using face masks is not promoted. Face masks are considered useful only in certain situations, for example health care personnel working with confirmed or suspected cases. In addition, confirmed or suspected cases who need to visit health care facilities for medical assistance are recommended to wear face masks in order to prevent infection of healthcare personnel.
At the beginning of June, the government launched a coronavirus dashboard (https://coronadashboard.rijksoverheid.nl/) providing figures on the spread of the virus and the health impact, presented in a graphical way. The dashboard shows the current situation and flags the numbers (signal values) that may indicate the start of a second wave. The dashboard is updated daily. The dashboard includes information about testing, hospital admissions, ICU admissions, GP data on infections and wastewater analysis. The dashboard is in development, and new features are expected to be added in the future, such as the results of contact tracing and behaviour of people (such as compliance with measures, self-reported data on infections) and spreading patterns of the virus. As of 1 September, the dashboard displays the figures per municipality in addition to the national figures.