Policy responses for Netherlands - HSRM


Policy responses for Netherlands

1.2 Physical distancing

The physical distancing measure (1.5 meter distance for everyone over 18 years) remains valid along with all previously introduced measures. From 14 October 2020, the maximum group size inside and outside of a non-family group is limited to four persons. Inside, only one visit per day is recommended. Face masks become compulsory from the age of 13 and over, although at present there is not yet an act available by which this can be enforced.

As of 4 November 2020, all public venues have closed, except for shops and some sports facilities. Funerals are restricted to 30 persons and weddings to 20. The maximum group size inside and outside is limited to two persons. It is recommended to have as few as possible visits and if a visit is necessary, it is recommended to limit this to a maximum of one visit per day. More details about the restrictions can be found in Section 1.1 Health Communication.

As described in Section 1.1, since 15 December 2020 a lockdown has been imposed in the Netherlands, with the closure of non-essential shops, schools and sports and cultural activities.

As of 20 January 2021, the measures were supplemented with a strong recommendation to receive only one visitor per day, a limitation of the number of funeral attendees to a maximum of 50 (as of 25 January). From 23 January a curfew was installed from 21.00 hours to 04.30 hours. Exemptions apply to the following groups:
• Those who need to be on the road because of their work (such as policemen, healthcare personnel and those delivering meals at home). These persons need to bring a signed employer’s declaration. Falsification of such a declaration is considered a criminal offense.
• Those supporting medical assistance to a human or animal
• Those who provide informal care
• People walking their dogs (you should walk your dog alone)
• People who urgently need to go abroad, for instance for urgent family matters
• Those who are on their way to attend a funeral
• Those who are on their way because of an exam related to vocational or higher education
• People who are invited for a live television program
When you have to go out during the curfew, you need to bring a personal declaration, which is provided by the government on its website, except in cases of emergency, when walking the dog or when arriving from abroad (when you can prove that, by means of travel tickets for instance).

The curfew is currently installed until 10 February 2021 04.30 hours. The fine for breaking the curfew is 95 euro.

The start of the curfew coincided with some fierce riots at a several places in the Netherlands. In one location, a testing facility was set on fire during the riot.

As young children appear to have little impact on the spread of the new virus variants and because of the negative impact on children to stay at home for such a long time, the government decided that primary schools and day-care for pre-school children can reopen as of 8 February 2021. Schools have to ensure that up to the age of 10 (grades 1-6) children work together in small groups of 5 children. The last two years (age 10-12, grades 7-8) should work in groups of 2 persons. When a child tests positive, the whole class should quarantine for at least 5 days. After a negative test, children may return to school. In the Netherlands, some parents object to having their child tested. As testing is not compulsory, the quarantine period for these children is increased to 10 days. Classes should start at varying times and have varying times for breaks. Parents are not allowed to accompany their children into the school building and should wear face masks when bringing their children to school. Childcare for after-school hours will stay closed, since these forms of childcare often combine children from different schools, which would increase the number of children having contact with each other. Children from the oldest two grades (age 10-12) are advised to wear masks when outside of the classroom. Some schools announced to stay closed as they thought that they cannot adhere to the required measures at this short notice, but finally all schools managed to find a workaround and opened up. Rapid testing is available for teachers via a dedicated phone number.

Non-essential shops can now (10 February 2021) accept orders from clients and clients may pick up their order at the shop, provided that they will receive their order outside. There should be at least four hours between the order and the picking up and the order should be picked up by one person only, in order to prevent browsing and too many people in the shopping areas. Also, clients are not allowed to enter the shop.

A new roadmap for measures for different levels of severity of the crisis was presented at the press conference of 2 February 2021, revealing the conditions to both making measures more stringent and releasing them again (https://www.rijksoverheid.nl/onderwerpen/coronavirus-covid-19/documenten/publicaties/2021/02/02/routekaart-coronamaatregelen).

Nursing homes and rules on visitors of residents

As of 20 March 2020, nursing home residents could no longer receive visitors, in order to protect them from getting infected with the coronavirus. After a pilot of allowing visitors in 26 nursing homes starting on 11 May 2020, it was decided that as of 25 May 2020, one dedicated visitor per resident was allowed.  (https://www.rijksoverheid.nl/actueel/nieuws/2020/03/19/bezoek-aan-verpleeghuizen-niet-langer-mogelijk-vanwege-corona; https://www.verenso.nl/nieuws/archief/2020/verlenging-bezoekstop-verpleeghuizen-en-kleinschalige-woonvormen; https://www.venvn.nl/nieuws/vanaf-25-mei-versoepeling-bezoekregeling-verpleeghuiszorg/)

As of 15 June 2020, residents were allowed to receive more than one visitor, provided that the nursing home was free of infections (https://www.zorgvoorbeter.nl/nieuws/test-bezoek-verpleeghuizen-corona).

As of September 2020, the number of visitors allowed in a nursing home resident is subject to the local situation, that may vary between “alert”, “worrisome”, and “severe”.  The nursing home sector developed guidelines on how to act in each of these situations.

As of February 2021, as a result of the more contagious variant of the virus, the government advises nursing homes to limit the number of different visitors for each resident to 2 or 3 (the visitors bubble), of which one person can visit in one day (https://www.vilans.nl/artikelen/aanvullend-advies-bezoekregeling-verpleeghuizen-engelse-variant-corona)

As of 8 March 2021, fully vaccinated residents of nursing homes are allowed to receive two visitors instead of one at the same time and these can be different persons over the week. Nursing homes have to make a plan for receiving visitors and all common rules should be obeyed (such as 1.5 meter distance, washing hands, using a face mask) (https://www.vilans.nl/artikelen/lichte-versoepeling-bezoekregeling-verpleeghuizen).

The Netherlands has monitored the number of nursing home locations with any infections over the whole pandemic. This number is decreasing since the start of the vaccination of nursing home residents.

As infection rates in some regions in the Netherlands have increased to a worrisome height in the beginning of August 2020, 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 2020 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 2020, 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 2020, 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 2020 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 in spring 2020 slowly showed 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 2020, 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 2020 and have to prepare for a 1.5-meter distance solution. Minors are allowed to participate in group sports as of 29 April 2020, 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 2020. 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 2020, 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 2020, 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 2020, 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 2020, 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 2020 (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 2020 (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.