Is the Netherlands sleepwalking into catastrophe?
Visiting a Dutch city during a deadly pandemic can be a bizarre experience. Cautiously travelling to a few different places for work this week, I found the shops busy and the streets bustling. Squares and canalside terraces were filled with people drinking beer in the sunshine. Museums were open, and in some places people were queuing to get inside tables at restaurants. Face masks were about as common as mountains. Walking through Amsterdam and the Hague, I found myself thinking that if a Dutch person now woke from a six-month coma and went out for a walk, they probably wouldn’t notice much different from an ordinary summer. Even the Dutch love of foreign travel doesn’t seem much diminished. “It was nice and sunny”, I heard one older woman tell a friend about the holiday she’d just had in Italy, “but there were just too many Dutch people everywhere”.
All this is surprising not just because of the state of the coronavirus pandemic worldwide – 20 million confirmed infections, 750,000 deaths, increasing evidence of airborne transmission – but because of the state of the pandemic in the Netherlands. A few months ago, the situation here was terrible: in early April, at least one hundred and fifty people were recorded as dying from the virus every day, with the true death toll certainly much higher. But then, despite a lockdown which was relatively light compared to those in places like Britain and France, the numbers began to fall. By late April, the daily death toll had fallen to more like fifty per day, and two months after that had hit nearly zero. On June 24th, Prime Minister Mark Rutte announced that the “crisis atmosphere” was over and the country had entered “a new normal”. Now, though, the figures are going up again, sharply. In the last week, close to five thousand people have tested positive for the virus, including over six hundred people yesterday (12th August) alone. This was the fifth week in a row that infections have risen, and epidemiological graphs now look not mountain-shaped, but N-shaped. The Netherlands has had roughly as many coronavirus cases in the last fortnight as Greece has had since the pandemic began.
This turnaround in fortunes isn’t unique to the Netherlands, course. With lockdowns being eased across Europe, many other countries have followed similar ski-jump pattern of rapid decline followed by renewed steady rise. Even some countries which were recently being lauded for their COVID-fighting performance (such as Germany) are now battling to contain localized outbreaks, while others (such as Australia) are already experiencing second waves which appear worse than the first. What is more unique, however, is how the Dutch government has responded. Last Thursday, as newspapers began filling with worrisome stories about spiking infections, and parts of England were going back under lockdown, Mark Rutte and health minister Hugo de Jonge gave a press conference at which many expected them to announce new restrictions in at least some parts of the country. However, their response amounted to little more than a stern lecture telling young people not to get sick and then visit their grandparents, and an announcement that people who visit bars and restaurants should leave their contact details behind to assist with contact tracing – something which the British and Germans have already been doing for weeks. “Planning to grab a cocktail on a terrace, spend an afternoon shopping or visit family or friends? Everything is possible!” one local council tweeted a few days later.
Unfortunately, this isn’t the first time the Dutch response to the virus has seemed underpowered. In early April, for example, de Jonge and Rutte announced an app would be developed to help trace the contacts of people who tested positive and prevent infection spreading. For months, the government insisted this app would form as a critical part of the solution to the pandemic. However, a contest to actually develop the app fizzled out embarrassingly, and four months after the original announcement, a version of the app is only being trialled by a small number of people in Twente. Germany’s app, meanwhile, already has roughly as many users as the Netherlands has people. Similarly, efforts to step up more low-tech means of test and tracing have not gone particularly smoothly. While the number of coronavirus tests completed has risen quickly, and some patients have reported excellent service, there have been worrying delays in some regions, and continued problems with contact tracing. Official data shows that a few weeks ago, about 98% of people who tested positive for the virus went on to complete a full contact-tracing process, but that’s now fallen to around 76% – meaning one in four patients don’t have their contacts traced at all. Last week, the health board in Amsterdam announced it would be forced to cut back on contact tracing because it had run out of capacity; reportedly partly because the authorities had wrongly estimated it would take five hours per case to complete the tracing, even though the WHO warned it would take twelve. Several people have told me that upon falling ill and requesting a test, they were told to travel to other cities to obtain one, which seems a bit like advising someone to put out a flaming match by taking it to a bucket of petrol.
In the media and in parliament, the debate has focused mainly on the issue of face masks. It’s fair to say that the evidence on whether masks can prevent infection among the public has always been somewhat mixed. It is, among other things, possible that people may act more carelessly when wearing them, may wear them incorrectly or may be more likely to touch their faces when wearing a mask, thereby increasing the risks of contamination. However, as time has passed, these fears largely have been discounted. The WHO, for instance, shifted from recommending that masks don’t need to be worn by healthy people in March to recommending widespread use of masks in high-risk locations in April, before recommending masks in most public places in June. The European Centre for Disease Prevention and Control has similarly moved from scepticism to outright endorsement. In response to this shift, many countries have adjusted their own policies: masks are now effectively compulsory when shopping in much of the UK, Belgium, France, Germany and the USA. Yet following the advice of their own scientific advisers, the Dutch government remains adamant that masks aren’t just pointless, but perhaps actively harmful. In contrast with other world leaders, Mark Rutte has largely avoided being seen wearing one, and come close to actively telling people not to wear them. Amazingly, Donald Trump is now more pro-mask than the Dutch Prime Minister is.
The government has been quick to emphasise that they’re simply following the lead of scientific advisers, and that city mayors have the power to enforce stricter rules if they want to. However, the official explanations have sometimes seemed disingenuous – the website of the RIVM health advisory agency says “it is not necessary to wear a face mask [and] in these measures, the Netherlands is following the recommendations of the WHO” – but then links to WHO guidance which explicitly says non-medical masks should be used by the “general population in public settings, such as grocery stores, at work [and in] social gatherings”. The decision to devolve authority to the local level also means rules have varied widely from place to place. In Gouda, near where I live, you’re about as likely to encounter a mask-wearer on the street as you are to bump into an escaped lion, but in both Amsterdam and Rotterdam, the mayors have made masks compulsory in certain places. For members of the public, the contradicting policies are sometimes hard to navigate: if the mayor of your city says masks are essential but the Prime Minister says they’re useless, who should you listen to? And is it really essential for public safety that you wear a mask if you visit (say) the H&M store in Amsterdam, but not if you visit the H&M in the Hague or Utrecht? When I visited a hospital a couple of weeks ago I wore a mask, as it seemed the sensible thing to do. I was amazed to find that of the dozens of other patients, doctors, nurses and visitors on site, almost no-one else was wearing one. “Why are you wearing that?!” the receptionist asked when I arrived, as if I’d walked in wearing a fluffy panda suit.
When discussing all this, the most common response one hears is that masks are unnecessary because is distancing what matters. As the RIVM puts it on their website, “it is not necessary to wear a face mask” in the Netherlands because “we are avoiding crowded areas as much as possible, and we are staying 1.5 meters apart”. The problem is, though, that if you spend much time in any Dutch town or city, you may well conclude both these things are untrue: people very often don’t avoid crowded areas, and don’t stay 1.5 metres apart. A couple of weeks ago, an RIVM survey found that only 28 percent of Dutch people said they always or mostly obey distancing rules, compared with 63 percent a few months ago. Most alarmingly, asked how they behaved if they had coronavirus symptoms such as a bad cough, 89 percent said they went shopping, 63 percent said they visited friends or family and 47 percent said they still went to work. Things which some other Europeans accept as routine these days – social “bubbles”, strict curfews, quarantines, no visitors at home – are almost completely unfamiliar to the Dutch these days. “Many people who have symptoms are still not getting tested”, the RIVM has warned. In that context, it’s hardly surprising that infections are rising.
Why, though, has the government been reluctant to clamp down harder? As mentioned above, it’s partly down to an insistence on following expert advice, which is in principle an admirable thing to do, and in keeping with the Dutch tradition of consultative decision-making. Cultural factors also probably play a role: as I’ve written elsewhere, trust in public institutions in this country is high, and there’s a long tradition of assuming the state will intervene to protect you from existential natural threats, albeit usually of the watery variety. The laissez-faire instinct is also quite strong here – Rutte has repeatedly emphasised that he’s “not a dictator” and that people shouldn’t be treated “like children” and told what to do. Perhaps the best example of this libertarian impulse came when the city of Groningen announced a very Dutch form of curfew – no new customers in bars after 1.30 am – and some locals reacted with outrage at the gross infringement of their civil liberties. Dutch people seem laid-back, but don’t like being told what to do. More troubling is the air of triumphalism which emanates from certain members of the commentariat and political class, who point proudly at declining infections while ignoring the horrendous overall death toll; like airline pilots who’ve lost passengers in a terrible crash but are boasting that they’ve lived to fly another day. One wonders how many of those who lament the terrible handling of the pandemic in other countries are aware that by some measures, their own country hasn’t done that much better. In terms of excess mortality, about 27% more Dutch people have died this year than in a usual year, compared with 31% more in France, 45% in the UK and 40% in Belgium, but only 6% in Denmark and 5% in Germany. Rutte’s decision to label his policy the “intelligent lockdown” was clearly a genius piece of branding, even if the main thing which distinguishes it from its foreign rivals is that it’s hard to detect at all. “Invisible lockdown” might be more appropriate.
In the interests of balance, it’s fair to point out that the Netherlands’ response to the virus hasn’t been unusually terrible so far, and things could still turn out relatively well, if one overlooks the minor matter of ten thousand dead. This country is inherently more vulnerable to the virus than somewhere like New Zealand is, and the country’s leaders were, like everyone else, flying blind at the beginning. The government has responded decisively at times and approached the pandemic in an admirably pragmatic and bipartisan way. Many other nations would think themselves lucky to have such moderate and sensible leaders. At the practical level, testing has been scaled up and hundreds of extra intensive care beds have been created, meaning the country is better prepared to handle a spike in infections than it was a few months ago. Quarantine rules for travellers are about to be tightened. By some measures the rules aren’t that lax already – Oxford University’s government response tracker, which also takes into account things like school closures and travel advice, actually rates the Dutch policy as stricter than Britain’s. Politically, Rutte’s strategy also appears wise: a poll this week by I&O found that three quarters of voters support the general approach of the government, while only 29 percent think the authorities are losing and control. Many shops and businesses have adapted their facilities well, and the activities which many people are now doing – meeting friends outside, going to the park, sitting on a terrace – are not particularly dangerous, yet provide a huge boost to both mental health and the economy. The early signs are that the export-dependent Dutch economy has been hit hard, but not quite as badly as some other countries: the IMF currently forecasts Dutch GDP will shrink by nearly 8% this year, compared to about 10% in Britain and nearly 13% in France. A rise in infections is probably inevitable at some point, but another lockdown now, or even the adoption of masks, could damage the economy further and make it harder to enforce stricter rules in the winter. The death toll has been distressingly high, but in the two countries which are arguably most similar to the Netherlands in culture, geography and economy – Britain and Belgium – the toll seems might higher. It’s also important to note that although the number of infections here is rising sharply, the number of new hospital admissions and deaths remains, at the moment, low: in the last few days, more people have drowned swimming at Dutch beaches than have died from coronavirus.
A few months ago, I wrote that it was possible that the pandemic response would prove to the be the Dutch Polder Model’s finest hour, and I think that could turn out to be the case. It’s entirely possible that in the future, we’ll look back and conclude that the Netherlands achieved roughly similar outcomes to comparable countries in terms of lives lost, but at less cost to the economy, society and mental health. It could well be that I and others are – as I’m told on social media daily – fretting over minor problems which will soon fizzle out like a firework in the rain. However, as one looks at the juxtaposition between the increasingly dire infection data and increasingly blasé attitudes to infection control, there are serious reasons to be concerned. Deaths and hospital admissions usually lag a few weeks behind people getting sick, and many infections currently are among the under-40s, who are less likely to get seriously ill. However, if (when) the virus starts spreading to more vulnerable people again, we could easily end up back where we were a few months ago. Unfortunately, Thierry Baudet’s confident prediction that the virus would disappear when warm weather came has not proved correct. In late May, the basic reproductive number in the Netherlands (R0, or the average number of other people which an infected person infects) was 0.52; now it’s 1.3. Whatever one’s view of masks or lockdowns, it’s undeniable that the Netherlands is something of an outlier in northern Europe with respect to its current policy. It’s also clear that there have been genuine problems with testing and tracing, and that social distancing guidelines are being only loosely adhered to. And it seems undeniable that despite the breezy atmosphere, things are quickly getting worse. The French Prime Minister, Jean Castex, said this Tuesday that his country was going “the wrong way” on the pandemic and announced stricter guidance on masks and on public gatherings, after France saw nearly 1,400 new infections in a single day. That same day, the Netherlands – a country with a population roughly one-quarter that of France’s – reported 779 new infections, yet life here goes on unchanged. A scolding from the Prime Minister feels necessary, but insufficient. With terrible irony, a country which is essentially one big disaster prevention scheme might be sleepwalking into a catastrophe.