Policy responses for Netherlands - HSRM


Policy responses for Netherlands

1.5 Testing

Since 25 March, the following testing protocol is used:

• Patients admitted into hospitals with (severe) acute respiratory infections are tested to ensure proper treatment and to protect hospital personnel and other patients.
• Patients presenting at GP practices and patients that receive home care are in principle not tested, with the exception of patients with intensive care demands, requiring many care related contact moments (potentially with different care professionals) per day. They can be tested when they present themselves with symptoms. GPs that would like to have a patient tested have to organize this themselves.
• Nursing homes and homes for disabled: one or two patients per department or location may be tested when they become symptomatic to assess a possible outbreak in order to protect those living and working in these facilities and to optimize individual patient care.
• Practices of the Nivel Primary Care Database: these are GP practices (40) where all patients with influenza-like illnesses and symptoms are tested for surveillance purposes. Since early February, the collected swabs are also tested for COVID-19.
• Healthcare personnel are not tested. Symptomatic personnel with a fever >38⁰C should stay at home until 24 hours symptom free. In all other cases, when there has been unprotected contact with a confirmed patient and the healthcare worker has symptoms, he/she should either stay at home up to 24 hours symptom free or be tested.

As of 11 May, tests will also be available for primary school teachers, child day care workers, and those with professions that require physical contact. (https://www.rivm.nl/coronavirus-covid-19/testen). Testing will be done after triage by a physician.

As of 18 May, tests will also be available for informal carers and paid carers that are hired by a patient living at home (https://www.rijksoverheid.nl/binaries/rijksoverheid/documenten/richtlijnen/2020/05/12/richtlijn-testbeleid-mantelzorgers-vrijwilligers-palliatieve-zorg-en-pgb-gefinancierde-zorgverleners/Richtijnen+mantelzorgers+PGB+en+vrijwilligers.pdf).

Testing is not available upon request for individual citizens, and is only done after triage by a physician up to 1 June.

As of June, testing is available for all citizens that have symptoms. Following a positive test, the regional Public Health Services will perform a comprehensive contact tracing (https://www.rijksoverheid.nl/onderwerpen/coronavirus-covid-19/nederlandse-maatregelen-tegen-het-coronavirus). There is some discussion about whether the regional Public Health Services have sufficient capacity to perform such comprehensive contact tracing and a national protocol on how to do this is not (yet) available (https://nos.nl/nieuwsuur/artikel/2331268-grootschalig-contactonderzoek-nodig-maar-wie-moet-dat-gaan-doen.html). In some regions, citizens are asked to inform their contacts by themselves. In addition, informed contacts are asked to proactively report to the Public Health Service whether they have symptoms; the organisation will not perform active contact tracing (https://nos.nl/nieuwsuur/artikel/2333281-protocol-voor-contactonderzoek-kent-twee-grote-zwakke-plekken.html).

There are about 34 laboratories that can perform COVID-19 testing. Together they can handle about 10,000 tests per day. However, a problem for testing is the limited availability of supplies that are needed for these tests. Among these 34 labs, there are two reference labs (RIVM and Erasmus Medical Centre), and 13 are (relatively) large laboratories that have scaled up to be able to perform at least 100 tests per day, 24 hours per day. To confirm COVID-19, two tests are performed independently. (see https://lci.rivm.nl/covid-19/bijlage/aanvullend). It takes one to several hours before the test results are available.

As of 31 March, the actual testing capacity is about 4000 tests per day. By the middle of April, this should increase to 17,500 per day and later on to 29,000 per day. As a result, from 6 April onwards, the testing protocol will be adjusted so that personnel in nursing homes, home care, youth care and mental care can also be tested for COVID-19 (https://nos.nl/l/2328996).

The Dutch government announced on 15 April that they had successfully purchased extra testing materials, so that an additional 14,000 tests are available per day (https://nos.nl/artikel/2330578-nederland-krijgt-toezegging-voor-2-7-miljoen-testen-maar-is-het-genoeg.html).

The Netherlands is still facing an impending shortage of testing material, especially concerning cotton swabs and virus transport medium (https://lci.rivm.nl/covid-19/bijlage/aanvullend).

As of 1 June, all Dutch citizens that have COVID-19 related symptoms can be tested, and can make an appointment without seeing a physician using a dedicated phone number. However, people are asked to go only when they have symptoms.

The numbers of people who test themselves has fluctuated. At peak moments, the Public Health Services had to scale up testing facilities. The norm of getting tested within 24 hours and receiving the result within 48 hours was not always realized.

The capacity of the Public Health Service is a problem, particularly in big cities with high numbers of tests and positive cases. The Public Health Service of the cities of Amsterdam and Rotterdam have restricted the tracing of contacts of positive cases to high risk contacts due to lack of capacity. The government has suggested that the Public Health Service can use military personnel for tracing.

An evaluation by the Algemene Rekenkamer (National Auditing Agency) of the testing policy of the Dutch government revealed that the government did not have a clear view on the testing capacity of the Dutch testing labs and the supplies necessary for testing. The landscape of labs is fragmented and labs use a multitude of testing systems which have varying and different problems with acquiring sufficient supplies. As a result, the number of performed tests has lagged behind the available capacity (https://www.rekenkamer.nl/publicaties/rapporten/2020/09/23/testen-op-corona).

At the end of September, the testing capacity lagged by an average of 10,000 requests for tests per day (the total capacity is 28,000 tests per day). The reasons include lack of testing capacity at the labs and that persons without health complaints also requested tests (for instance, those coming back from holidays from areas with high infection rates). As a result, the government started buying test capacity in Germany and Abu Dhabi, although the Data Protection Authority (Autoriteit Persoonsgegevens) has objected against the latter, because data protection outside the EU should be studied carefully. (https://nos.nl/artikel/2349563-privacywaakhond-wil-uitleg-over-abu-dhabi-deal.html; https://nos.nl/artikel/2349521-lab-in-abu-dhabi-gaat-nederlandse-coronatests-analyseren.html)

To prevent schools from closing and healthcare providers from having insufficient staff due to the long waiting times for testing, as of 21 September, a temporary special phone number is available to request priority testing as long as testing capacity is insufficient.