Policy responses for Netherlands - HSRM


Policy responses for Netherlands

1.2 Physical distancing

As infection rates in some regions in the Netherlands have increased to a worrisome height in the beginning of August, regional measures have been taken in the two large cities of Amsterdam and Rotterdam. Face masks were obligatory in busy areas. The experiment lasted from 5 August and 31 August. During this time period, people who did not wear a face mask were provided one, could get fined or were asked to leave the area. (https://www.nu.nl/coronavirus/6067700/mondkapje-vanaf-5-augustus-verplicht-in-delen-van-amsterdam-en-rotterdam.html). Scientific research revealed that the measure did not lead to fewer visitors, more people wore masks (from 55% to 75% of visitors), most masks were worn correctly (67%) and most people do not obey the 1.5 meter rule as a result of the hustle and bustle in the streets (https://nscr.nl/app/uploads/2020/09/NSCRMondkapjesonderzoek.pdf). The Mayor of Amsterdam announced that the measure was no longer necessary after 31 August because the changing weather already made the streets less crowded (https://www.volkskrant.nl/nieuws-achtergrond/mondkapjes-hoeven-niet-meer-op-in-centrum-amsterdam-en-rotterdam).

In a press conference on 1 September, the Prime Minister announced the following measures:
• Music venues and night clubs remain closed
• Shouting and singing in groups (e.g. in soccer stadiums or at demonstrations) continues to be forbidden
• A campaign will be initiated to better prepare staff in nursing homes for infections. They will learn how to recognize symptoms, respond to an outbreak and use personal protection materials.
• If an infection is detected in a nursing home, both staff and residents will be tested once a week.
• People returning from countries with high infection rates should stay in self quarantine for 10 days. Their children up to the age of 12 are allowed to go to school, child day-care and sports.

As of 21 September, children up to the age of 12 with running noses and mild complaints are allowed to go to primary school.

As infection rates are still going up and also hospital admissions start to increase, new measures were announced on 28 September for a period of three weeks:
• Work from home as much as possible
• It is urgently recommended to limit the number of guests at home to a maximum of three (children under the age of 12 not included)
• Outside of the home, the maximum group size is four persons (for instance in a cinema or restaurant)
• In a space inside (not being a home), a maximum of 30 people is allowed (including children). Exemptions for this rule are, amongst others, funerals, schools, religious services and demonstrations
• Cafes and restaurants close at 22.00, new customers can enter up to 21.00. Leaving contact details is compulsory
• Canteens of sport organizations are closed
• A reservation is compulsory when visiting a museum or a library
• Supermarkets will have special hours for the elderly and vulnerable people.
• People with a profession requiring physical contact, such as hairdressers, should take the contact information from their customers.
• Sports games will be played without an audience.
• In the open air, the maximum number of people in one place is 40 (including children), and walking around is not allowed. Exemptions are similar to the inside limitations. (https://www.rijksoverheid.nl/onderwerpen/coronavirus-covid-19/nederlandse-maatregelen-tegen-het-coronavirus/openbaar-en-dagelijks-leven).
• Businesses that do not comply with the rules can be closed for two weeks.

As the number of people admitted to the hospital is slowly showing a flattening curve, the Netherlands has begun to anticipate an exit strategy for the coronavirus measures. The Outbreak Management Team, which advises the government on measures to be taken, formulated five conditions that should be met before measures can be gradually eased:
1. The number of newly infected persons by each infected person (R0) should be below one for a longer period of time;
2. The healthcare system, including ICUs, should be no longer working at or above its capacity and should have had time to recover;
3. There should be sufficient testing capacity;
4. There should be sufficient capacity for contact tracing, including the capacity to analyse large numbers of data;
5. There should be measurement systems available to evaluate the effect of the strategy.
The largest difference with the current measures is that people with an infection should be traced and tested and his/her contacts should be isolated. Using mobile phone apps is one of the options for contact tracing of infected persons, and the government is currently investigating the options for introducing such apps. This has given rise to discussions about the appropriate balance between privacy and health (https://nos.nl/l/2329716; https://nos.nl/l/2329737).
On 20 April, the Prime Minister announced that there will be a gradual relaxation of the measures, since the number of hospital admissions and ICU admissions in particular are showing a flattening curve. The measures that will be relaxed are based on the interpretation of data and current research on how the infection affects and is transmitted by children. Preliminary results indicate that children very rarely have severe symptoms and do not easily infect other persons. On 11 May, after the May school holidays, primary schools will start up again, however with only half of the pupils in the classroom. Schools are free to organize this in a way that suits them best (for instance half of the children at one day and the other half at the next day, or half of the children in the morning and half in the afternoon). Teachers that are in the at-risk groups themselves are still allowed to work from home and attending school is temporarily not compulsory for children. After-school and pre-school care facilities are also allowed to open their doors again. These measures should release the burden for parents working from home.

Secondary schools reopen on 2 June and have to prepare for a 1.5-meter distance solution. Minors are allowed to participate in group sports as of 29 April, as long as there are no matches, children shower at home and there are no spectators. Professional athletes are allowed to train again in the designated sports facilities. For large-scale events, the measures are extended to 1 September. The advice to not visit elderly non-institutionalized persons is relaxed; those over 70 years of age may now receive one or two regular visitors. All other measures will continue until 20 May, when the government will provide a new update (https://nos.nl/artikel/2331272-dit-zijn-de-nieuwe-coronamaatregelen-op-een-rij.html).
As of 1 June, face masks are compulsory in public transportation. Any type of mask is permitted except for medical masks, since these are still reserved for those working in healthcare. This measure has been introduced despite the debate in the Netherlands concerning the effectiveness of (self-made) face masks. The Prime Minister gave the rationale that in public transportation, keeping a 1.5-meter distance is not feasible and thus the measure is necessary. However, the National Institute for Public Health and the Environment stated from the beginning that face masks are not very effective in preventing infections and that they can lead to a misperception of safety, resulting in less physical distancing than necessary. In an overview published on 9 May, they repeat this view but add that in situations where physical distancing is difficult to maintain, it might protect the spreading of the virus to some extent, provided that the mask is used correctly (https://www.rivm.nl/sites/default/files/2020-05/Toepassing%20van%20niet-medische%20mondneusmaskers%20in%20openbare%20ruimten.pdf).

As of 1 July, all seats in public transportation are again available (and face masks are obligatory). Children under the age of 18 no longer have to obey the 1.5 meter physical distance rule.

Secondary schools will resume normal classes after the summer holidays. Pupils will have to keep 1.5- meter distance from their teachers.

There is a fierce discussion in The Netherlands about the value of wearing face masks. The government is against an obligation to wear face masks, as the research does not clearly show effectiveness  and some policymakers fear that wearing a mask will give people the impression that physical distancing is no longer necessary. Several mayors of larger cities, however, would like to introduce face masks in areas with a high concentration of people. The national government has granted mayors the discretion to decide on the obligation to wear a mask in their cities. In the cities of Rotterdam and Amsterdam, since the beginning of August, it is now compulsory to wear face masks in designated areas (mainly busy shopping and tourist areas).

On 6 March, residents of the Noord-Brabant province, where the first case in the Netherlands was identified on 27 February and where most of the identified cases live, were advised to stay at home and limit social contacts when they have symptoms of a cold, coughing or fever. Employers were asked to facilitate working at home for their employees living in Noord-Brabant.

Since 10 March, all public events involving more than 1,000 persons in the province of Noord-Brabant have been prohibited.

Because of the increase in the number of people that have become infected and the broader spread of the virus, measures were scaled up to the national level on 12 March. People with symptoms of a cold or other mild health complaints were advised to stay at home and avoid social contact until symptom free again. Furthermore, all events involving more than 100 people were cancelled in the whole country. This includes sports, museums, concerts, lectures and other gatherings.

Since 15 March, all schools, pre-school childcare facilities, cafés and restaurants have been closed. Only children of parents with essential professions (such as medical personnel, grocery store employees and several others) can still go to school or child care facilities in order for their parents to continue to work. In addition, sports facilities, saunas, sex shops and coffee shops were closed. Take-away services are still allowed, as long as people do not stay close to each other when waiting for their order and the meal is consumed at home. Furthermore, everyone should keep a distance of 1.5 meters from each other, also during shopping.

Since 24 March, all public events have been prohibited. This measure will be reconsidered on 1 June. Exemptions are in place for funerals and religious gatherings, where 30 people are allowed to attend.

Since 24 March, the following additional measures have come into force:
• Professions that have inherent bodily contact (such as beauty salons and hair dressers) have to close their business
• Shops, markets, holiday resorts, nature reserves and beaches can be closed if the rule of 1.5 meter distance is not observed and hygiene measures are not followed
• Forming groups of three and more persons (except family members) who do not keep 1.5 meter distance are prohibited, with a maximum fine of EUR 400 (EUR 4000 for businesses).

All measures will be reconsidered on 6 April (except the measure on public events, which is valid up to 1 June).

Some hospitals have limitations on the number of visitors allowed to visit admitted patients (https://www.etz.nl/Over-ETZ/Nieuws/Uitgelicht/Laatste-informatie-Coronavirus) and some have a complete ban on visitors (https://www.bernhoven.nl/actueel/nieuwsarchief/nieuwsupdates-corona/bezoekersstop-in-bernhoven/; https://www.jeroenboschziekenhuis.nl/bezoekregeling-jbz-aangepast-geen-bezoek-bij-opgenomen-patienten).

To prevent the spread of the virus in long-term care facilities, visitors are no longer allowed to these premises.

On 31 March, the government announced that all measures will be extended to 28 April (https://nos.nl/l/2328969). The Prime Minister warned that after 28 April, the situation will not be completely normal again. People are advised not to make plans for the national school holidays in the beginning of May. On 21 April, the government will reconsider the measures again.