Categories
CoronaVirus COVID-19 COVID-19NL

Never let a pandemic go to waste

Summary: Never let a pandemic go to waste – Recommendations for the Netherlands. What could the Dutch have done better in response to the coronavirus pandemic?

Safe Zone

Never let a pandemic go to waste 

Recommendations for the Netherlands

Imagine your country is under attack by a foreign military force. The invaders have breached the borders, the enemy is spreading and getting closer, the number of casualties is rising. What is the best way to handle the situation?

In medieval times when a city fortress was under siege, the women, children, the old and the weak will be hiding in the innermost and safest part of the fortress, while those who can fight would defend the city walls.

During world war II, when sirens go off as a warning to an imminent air-raid, people would stop whatever they were doing and make for a shelter, except for those operating antiaircraft weapons and pilots climbing into warplanes to counterattack the enemy in the air.

More recently, in the TV series Games of Thrones, during the battle at Winterfell, those who were not warriors hid underground in the crypts of the castle as the carnage took place above.

The idea is that those who cannot fight are kept in a safe place, where they would not get in the way of those fighting the enemy.

Before we look at what could have been done better to cope with the coronavirus pandemic, let’s look at what some of the world’s leaders have said at the onset of the COVID-19 pandemic.

 

Global leaders have used the war metaphor in describing the COVID-19 pandemic, as reported in “Can we compare the COVID-19 pandemic to a world war?”:

  • In March, Chinese President Xi Jinping, after visiting the virus-stricken city of Wuhan, declared that China would have won the “people’s war” against the coronavirus.
  • “We are at war,” President Emmanuel Macron told the French people in a televised speech announcing the lockdown measures that would have kept the country at home for more than two months. “We’re not up against another army or another nation. But the enemy is right there: invisible, elusive, but it is making progress.”
  • British Prime Minister Boris Johnson declared on 17 March that his government would have acted “like any other wartime governments” to support the British economy and take “steps that are unprecedented since World War II,” calling the virus an “enemy that can be deadly.”
  • In the same week, U.S. President Donald Trump referred to himself as a “wartime president,” and the week after, New York Governor Andrew Cuomo reportedly said that “ventilators are to this war what bombs were to World War II.”
  • A day after lockdown was imposed in Germany, its chancellor, Angela Merkel, appealed for national unity in the name of a challenge that she described as the greatest faced by the country since World War II – words that have been repeated, in a global context, by UN Secretary General Antonio Guterres, and many others across Europe.
  • The UN Secretary General’s remarks at the G-20 virtual summit on the COVID-19 pandemic, on 26 March: “This war needs a war-time plan to fight it”.

Dutch prime minister Rutte said in a televised speech on 16 March: “The Dutch government is going for a managed spread of the virus… at the same time protecting those most at risk. Complete isolation and lockdown is not practical if not impossible. There is no easy and quick solution, without a vaccine.” See my Facebook post about this.

 

Has the government leader’s rhetoric been followed by matching actions?

While promising to “protect those most at risk”, many of the reported COVID-19 deaths in the Netherlands (and Belgium) occurred in nursing and aged care homes, and many suspected COVID-19 deaths have remained unreported. See my post about death numbers in the Netherlands during the first wave. It became clear that care homes are not safe places as at least some of the victims were infected by asymptomatic care workers. The government was not very successful in protecting those most at risk.

If we were under attack by a foreign invasion force, it would make sense to send the old and the weak (young children and those who cannot fight) to safe places (bunkers and shelters) to keep them away from harm. Having them out of the way will allow our troops (and others who can fight) to focus on fighting the enemy and not accidentally shoot on our own people. We cannot deal with the problem effectively when the old and weak are bogging us down and with children running around.

 



What comparable measures should have been taken in a pandemic?

We learned from the first wave of attack in early 2020 that the coronavirus could be transmitted by a seemingly healthy person without any symptoms to other more vulnerable people. Therefore, the weak should not just be taken to a temporary bunker or shelter, but instead be segregated from the strong (and from the young, who seem to be less affected by the virus) for longer periods of time. This means moving the most vulnerable people to a separate living area, a “safe zone” where they are well protected from the virus.

 

What exactly could the government have done?

  1. Bring the most vulnerable people to safe places. This group would constitute mostly of (but not limited to) elderly people above the age of 70 and younger people with medical conditions that may be at risk.
  2. The safe places would be in a “safe zone” at least the size of a small town where residents, caregivers and others live and work, with limited access by outsiders. The safe zone should be self-sufficient: there will be shops, medical facilities and supporting services, as well as places for meetings and entertainment.
  3. Declare the safe zone as being outside the Schengen area. The safe zone should be like an independent country with strict border controls, which is the only way to guarantee that the safe zone remains virus-free.
  4. Visits to the safe zone by family and friends would be allowed but have to meet strict testing and quarantine requirements, that would also apply to anyone planning to work or live in the safe zone.
  5. Retail shops and other businesses could apply to operate inside the safe zone if they comply with safe working and operating conditions. Workers employed by these businesses would have to live inside the safe zone. Commuting daily from outside the safe zone would not be allowed.
  6. Develop rules for safe transfer of food and supplies to the safe zone.
  7. Building a safe zone from scratch would be the preferred option, to allow everything to be planned properly. It would also create many new economic activities.
  8. To enable this project the Netherlands may have to declare “martial law” or a state of emergency to speed-up decision making at all levels. The Dutch consensus-seeking way of decision-making (a.k.a. “polderen”) doesn’t work in a large-scale emergency.

 

What are the advantages of having a safe zone that separates those most at risk from those who are less likely to be affected by the coronavirus?

  1. Those living inside the safe zone can continue their lifestyle in almost the same way as before the pandemic without the worry of getting infected.
  2. Businesses inside the safe zone can operate normally like before the pandemic.
  3. Performers, entertainers and other workers that are willing to undergo a test and a quarantine period can work inside the safe zone for short or extended periods.
  4. People moving into the safe zone will vacate their former home and this will reduce the housing shortage in other parts of the country. There is an estimated shortage of 300,000 to 400,000 homes in the Netherlands.
  5. Building new homes in the safe zone, when using prefabricated modules, can be done at a significantly lower cost and in shorter time than building the same number of (non-standard) homes outside the safe zone.
  6. Having a safe zone that protects against the current coronavirus will also protect the inhabitants from other and future airborne diseases.
  7. A project to relocate 100,000 people (in the first stage) will give the community at large a sense of purpose. It shows that a major effort is in the works that will benefit many. This will give people the much-needed perspective, which is lacking today.
  8. In a pandemic that hits different age groups in opposite ways, segregation by age group is the best if not the only way out. Evidence of infection rate and mortality rate by age group in the Netherlands and other countries show that mixing the elderly with lower age groups, wherein the coronavirus is more prevalent, could have fatal results for the elderly. See my recent post on COVID-19 Cases and Deaths by Age Groups in Belgium, Denmark, the Netherlands, Sweden and the UK.
  9. Availability of COVID-19 vaccines does not make a safe zone obsolete. It may take up to a full year if not longer to vaccinate everyone in a country. The safe zone is not a temporary fix but a permanent solution to protect those most at risk from known and future airborne diseases. It would also be the perfect place to have a research institute for aged health care.
  10. The safe zone will continue to exist and improve after the pandemic.

 



Where should the safe zone be located? 

For reasons to do with population and the Dutch economy, Zeeland would be a good contender. For readers unfamiliar with the Netherlands, that’s not New Zealand, but the Dutch province of Zeeland that gave New Zealand its name.  Maybe we can name the safe zone “Old Zealand” to avoid confusion, and it would be appropriate as many of the inhabitants will be older people.

Let’s look at the numbers. For the sake of simplicity, assume that all vulnerable people that would like to move to the safe zone are 70 years or older. In reality, some people under 70 would also want to move to the safe zone, and on the other hand, not all people over 70 would want to move away from where they currently live.

According to CBS (the Dutch Bureau of Statistics), there are around 2.3 million people aged above 70 in the Netherlands.  If only 5% of these are willing to move, we’ll have about 115,000 people who would need around 100,000 new homes. The province with the lowest number of inhabitants (~385,000) in the Netherlands is Zeeland. The population density is 215 people/km2 which is the 3rd lowest province after Drenthe and Friesland. With a new total population of 500,000, Zeeland will surpass Groningen and have the 4th lowest population density with 280 people/km2.  Even if 50% of people over 70 are willing to move to the safe zone in Zeeland, the new population total of 1,535,000 will still be less than the 4 largest provinces (in terms of population) and the new population density of about 860/km2 in Zeeland will still be less than Noord Holland (1080/km2), Zuid Holland (1370/km2) and Utrecht (910/km2).

At least around 100,000 new housing units will need to be built for the first wave of newcomers (residents and caregivers). What are the costs?  International figures show that good quality senior and aged care housing can be built for €100,000 per unit (single room ensuites, excluding land costs).  A June 2019 McKinsey report titled “Modular construction: From projects to products” claims that modular construction can cut schedule by 20-50 percent and costs by 20 percent. As time is of the essence and with the relative high costs and shortage of skilled workers, prefabricated construction will be the way to go. This new construction method will also create jobs for lower-skilled workers.

Van Wijnen, a Dutch construction company that builds prefabricated building modules, has recently started construction of a new factory in Friesland, which will use robotics to increase their production capacity tenfold.

It would make sense to also build a hospital in the safe zone and housing facilities for staff members. Ideally, workers and caregivers would live within walking distance to their place of work and to the residential buildings, to minimise travel time and costs.

Other than the low population density, another good reason for locating the (first) safe zone in Zeeland is to compensate the province for the central government’s cancellation of the new Dutch Marines base that was originally planned to be built in Zeeland.

Marines base? Yes, a Marines Base. Since 2012, the Dutch government had been planning to move the Dutch Marines base from the province of Utrecht to Zeeland. There was even a written contract for this between the central and the provincial government. The plan involved moving 1800 marines and their families to Zeeland, giving the Zeeland economy a bit of a boost. However, many of the marines and their families did not agree with the move, causing some even to quit their service. Facing the prospect that a large number of marines would leave the service if they were forced to move to Zeeland, the central government decided in early 2020 to renege on their promise (and contract) and cancelled the move. There was a lot of unhappiness about this decision in Zeeland, but as a compensation, the central government has promised to build a jail (!?) and a new courthouse in Zeeland.

 

Where else in the Netherlands can a safe zone be located?

More than one safe zone could be established at the same time, the second closely following the first as experience is gained and lessons are learned. In anticipation of the future rise of sea levels, it might be a good idea to build a safe zone on the water, possibly somewhere on the calmer waters of the Ijsselmeer lake.

 

Will people (such as those most at risk) be forced to move to the safe zone?

Moving to the safe zone will be on a voluntary basis. There will be a priority list in case the number of interested people exceed the initial capacity.

 

Will the safe zone cause elderly residents to be separated from the rest of society and lose ties with their past?

The safe zone would not be only for the elderly. People of any age would be welcome, although in the early stages it may not be suitable for people with school-aged children if no schools are available. The new residents, together with caregivers, health workers and other people working and living in the safe zone, will establish a new community that in many ways will resemble the society outside. Life would continue as before except in a much safer environment. Family and friends from outside the safe zone who meet health and safety requirements would be allowed to visit.

At a later stage when the safe zone grows larger, schools and other facilities may be added if required. When another pandemic hits the country and lockdowns or restrictions are imposed, the facilities and businesses inside the safe zones would normally stay open and continue to operate safely, while those outside may have to be closed.

 



What has the government done so far as a response to the pandemic?

Other than providing a lot of funds to prop up businesses (e.g. KLM) and to prevent mass layoffs, the government’s response has been characterised by:

  • Inertia
  • All talk and little action
  • Paralysis by analysis
  • “Not everything is known yet”
  • “Not invented here” syndrome (not adopting measures taken by other countries that were more successful in keeping the number of cases and deaths down).
  • Overcomplicating things
  • Not being practical
  • Policy and measures based on wishful thinking (“we hope the numbers will go down”).
  • Half-baked solutions (Covid testing facilities at Schiphol airport were not compulsory for incoming travellers and closed at 5pm while international flights were still arriving later than 5pm).
  • Incomprehensibly low levels of testing throughout the first wave and for months thereafter (see my blog post on 2 June 2020).
  • Trying to be too clever (intelligent lockdown).
  • Lying to the public about the rate of COVID-19 deaths in comparison with other European countries (RIVM presentations to members of parliament on 16 April, 22 April and 7 May 2020; see my blog posts dated 28 May and 1 June 2020).
  • Misinforming the public about face masks (telling people that face masks are not necessary out of fear that telling the truth about the face masks retail shortage would result in shortages for hospitals).
  • Patronising (“people don’t know how to wear face masks properly”; and assuming that “people wearing face masks will not follow social/physical distancing rules”)
  • No clear leadership actions

 

The “experts” (virologists, micro-biologists) were not of much help either:

  • “We don’t know enough”
  • “Not supported by literature”
  • “No studies show that this or that claim is true or false”
  • “We don’t even know everything about the influenza”

 

What’s behind the government’s indecisive behaviour?

I don’t know the background of Dutch political leaders, but I wouldn’t be surprised if a significant percentage are legally trained or economists. These two groups can deal well with most worldly problems – the lawyers will find what’s legally possible and the economists will find the most economical solution. However, these leaders have shown they are at a loss in handling a virus that doesn’t adhere to the law and doesn’t follow economic principles.

With limited knowledge about the virus, the best people to deal with incomplete information would be the military. They are trained to act and make decisions based on limited information, at least that’s what we assume. Other than that, a movie screenwriter might have come up with a better plan than the people currently in charge.

 



What should be the best response to the pandemic?

Embrace the pandemic. Embrace neither means that one agrees with nor surrenders to the pandemic. It means that one accepts reality and take actions that produce positive results, regardless of how the pandemic will play out.

 

Examples of positive actions in response to the pandemic:

  1. Create one or more safe zones, as outlined above, that protect those most at risk from the virus and other airborne diseases, while at the same time reducing the housing shortage problem as well as create opportunities for a new modular construction industry to build homes faster and at lower costs.
  2. The Dutch are masters in water management. Why not become masters of air management as well? New types of air handling units need to be developed that produce clean air for schools, hospitals, care homes and in fact all spaces and buildings where people come together: commercial, residential, industrial and other types of buildings.
  3. Architects and builders need to review and renew building designs to have air circulate naturally and prevent stagnant air.
  4. KLM and the transportation sector should use some of the government assistance funds to retrain staff and become experts in moving people safely, including people infected by the virus.
  5. Schiphol airport should invest in becoming the airport of choice for safe travel: rapid testing and health screening facilities for departing and arriving passengers 24/7, safe transit areas and touchless facilities. Brussels airport has 30,000 square meters of temperature-controlled pharmaceutical warehouses, the most of any European airport. With close proximity to the Flanders pharma cluster, it is fast becoming Europe’s largest pharmaceutical hub. Schiphol airport, having a higher number of international connections (Schiphol 332 vs Brussels’ 248), could cooperate with Brussels airport to share the workload of transporting coronavirus vaccines worldwide.
  6. To never again face a shortage of Personal Protective Equipment (PPE) when another pandemic strikes, PPE production facilities must be established locally. The same for medical supplies.
    During the first wave of the pandemic some medical lab equipment could not be used for lack of spare parts. The sole manufacturer of the spare parts in Northern Italy was closed when that region was hit hard by the pandemic. Lesson learned: even a production facility in a nearby European country could not always be relied on.
  7. In a more general sense, bring back industries and jobs that have been lost due to relentless globalisation. The idea that rich western countries should focus on high-value manufacturing and service jobs and leave the production of low-cost items to poor and less developed countries is a fallacy. The closing of borders during the pandemic has taught us that each country must be self-sufficient in providing the bare minimum of food, health care and basic necessities.
  8. Instead of just handing out money for doing nothing to people and businesses, the government should mobilise the know-how and energy of the nation to build new and improved structures and systems. It will give people something to focus on and stop the whining and self-pity.
  9. Update 5 Feb 2021:
    To prevent misuse of personal data in case of a data breach*, the Netherlands and other countries that use a single national unique identification number (UIN) (in the Netherlands: BSN) to identify individuals for health services as well as for other public and private sector services, should solve the problem at its root by using a different unique health identifier (UHI) for health purposes. They can follow the example of Slovenia that assigns a national UHI to each individual for health care, in addition to having a national UIN. The two numbers are linked by the central population register (CPR). To further protect the privacy of individuals, countries can follow the example of Australia, where people who are vulnerable or at risk can request a pseudonym UHI under a different name and a different date of birth (within six months of the real date of birth). This allows an individual to access health services using a pseudonym.

    * See recent media reports about stolen personal data, of thousands of people who had taken COVID-19 tests, being offered for sale on underground criminal networks, at dutchnews.nl , zdnet.com and at nos.nl (in Dutch). Two of the five suspects who are still in detention worked for the callcentre of GGD, the Dutch Municipal Health Service.

 

Taking actions such as the above will result in increased economic activity and a higher GDP rather than a shrinking economy as experienced by most countries, except China and some emerging Asian countries. The positive actions will help to better withstand future attacks by contagious diseases.

 



Leave a Reply