Diet Herd Immunity

The Netherlands attempts a UK-style reopening – without the UK’s low level of infections

In his press conference in early May, Mark Rutte sounded cautiously upbeat. “We have achieved something together” and “got the spread of the virus under control”, the Dutch Prime Minister said, with “the figures… developing in a favourable direction for a few weeks now”. Although hospitals were still badly strained, the authorities were, Rutte said, willing to take the calculated risk of letting restaurants and cafes reopen mostly as normal, as long as they respected distancing rules. Museums, gyms and brothels would probably also be able to reopen soon, as part of a sequence of “steps to slowly but surely open up the economy and society again… [under] the absolute precondition… that the figures for hospital admissions and intensive care beds remain under control”. The country was heading, he said, “towards a new normal, in which we can lead a normal life”.

That was in May 2020, roughly twenty-five thousand deaths ago. Yet almost exactly a year later, in May 2021, the rhetoric remains strikingly similar. In this week’s press conference, Rutte again said that although the pandemic remains a serious threat, and infections remain high, “the direction is good”. Although hospitals are still badly strained, the authorities are willing to take the calculated risk of allowing restaurants and cafes to reopen mostly as normal, as long as they respect distancing rules. Museums, gyms and brothels will probably also be able to reopen soon, as part of a sequence of steps to open the economy up again. The country is taking, Rutte says, “the first step on the way back to normal life”.

Out in the real world, it’s clear that many of those steps towards a normal life have already been taken. In the towns and villages around where I live, shops are busy and café terraces are already full (albeit with restricted opening hours). Dutch grandparents are seeing their grandchildren again, and birthdays are once again being celebrated with the horrendous traditional “circle parties” at which people make awkward conversation while drinking bad coffee and eating disappointing cake. After a winter in semi-hibernation, the country is coming alive again.

This is in many ways all quite lovely, and from a public policy perspective understandable. As Rutte has repeatedly pointed out, although infections remain high here, they have remained fairly stable, despite the lifting of some restrictions. The government’s testing data has been plagued by delays and inaccuracies lately, but appears to show infections fluctuating around 7-8,000 per day for about the last six weeks, and declining a little in the last week or so. Hospital admissions and deaths have also held quite steady, while the R0 “reproductiegetal” has hovered around 1 for a couple of months now. Most importantly, many of the most vulnerable people have been vaccinated. As I’ve documented elsewhere, the Dutch vaccination programme had an appalling start, and has moved slowly and erratically thereafter, undoubtedly costing many lives. But even the harshest critic now has to admit things have improved rapidly in recent weeks, and even if we’re not exactly sprinting, we are now moving forward at a decent clip, with (according to the government) around 900,000 vaccinations scheduled this week. Official data shows a total of nearly seven million shots have now been administered – a lot for a country with only seventeen million people. On 6th January, 174 people in this country died of coronavirus; on 6th May it was 24.

In this context, for the country to accept a few extra deaths in exchange for millions of people gaining freedom could be a fair (if ethically tricky) trade. However, there are also serious reasons for concern. The WHO recommends countries should only consider lifting lockdowns if fewer than five percent of coronavirus tests are coming back positive; in the Netherlands the figure is currently eleven percent, and hasn’t been below seven percent since September. Like a Hollywood starlet with a Botox addiction, the Dutch pandemic also seems to be getting younger, with intensive admissions among younger age groups rising fast. And Dutch hospitals are also very strained. At the time of writing, around fifty people are being admitted to intensive care every day – the highest level for thirteen months. “We currently have the highest number of contagious people ever. Hospitals are overcrowded, are withdrawing [from routine healthcare] en masse, and have to postpone heart and cancer operations, to the limits of acceptability” medical association head Ernst Kuipers said last week. Watching Rutte’s latest press conference, I found myself thinking not about the data, but about people like the thirty-year-old ICU nurse who I’d seen profiled in the NRC newspaper recently, who drives 55 kilometers to work every day, and who after a night shift sometimes sleeps in the hospital for two hours before driving home to see her baby son. “We currently have thirteen Covid beds in the ICU”, she told the newspaper, “and yesterday the fourteenth patient was admitted anyway. One of them then went by helicopter to another hospital, and two more were added this morning.” Ministers naturally argue that the system can cope, but it feels as if we’re accelerating along a tightrope while the crosswinds are increasing.

The government seems keen to present the relative stable infections data as an achievement: if things are not getting worse, then they must be under control, right? But the truth is that infections are still very high: in October, everyone was horrified when Mark Rutte said daily infections might eventually pass five thousand a day, but we’re now consistently sitting over six thousand. At the time of writing, the Netherlands has roughly as many daily confirmed coronavirus cases as the UK, Belgium, Denmark, Ireland and Norway combined. Ministers have taken to describing the current situation as a “plateau”, but the graphs only really look that way to someone who lives in a country with no hills. And although the vaccination programme has got far better – and now arguably sits at about the European average – it remains patchy and often feels disorganised. About thirty per cent of Dutch people have now received some form of vaccine, compared with well over half of all Brits. At the very least, it’s fair to say the Netherlands is attempting something like a UK-style reopening of the economy without having the UK’s level of vaccinations, which is…. bold. And after a year of ambitious promises unfilled, it’s hard to take the government’s pledges seriously. Watching the proud peacocking of health minister Hugo de Jonge, I’m often reminded of Del Boy, the lovable British sitcom star famous for his hapless inability to get anything right, who’s always knee-deep in catastrophe but perpetually telling everyone they shouldn’t worry, because “this time next year, we’ll be millionaires!”

More broadly, the government’s messaging remains baffling, and often seems designed to nudge people towards behaving badly, rather than the opposite. Hand washing is promoted obsessively, and there seems to be some special Dutch variant of the virus which is completely non-contagious if people make a vague effort to sit about a metre apart. Last time infections were this high, the public seemed cautious and afraid, but now the atmosphere is far more carefree. An office building I visit occasionally is now packed with people having meetings and chatting over coffee, mostly maskless, and mostly uninterested in even pretending to keep their distance. Government surveys show only about half of people stay home or get tested if they have coronavirus symptoms. “I’ve got a cough and a runny nose, but I’ll be fine, it’s all just genetics!” one cyclist bellowed last week as he cycled with a friend past my front door. Such behavior is largely the fault of individuals, of course, but does, I think, point to systemic problems with way Dutch society treats the infection risk, which are in turn rooted in the government’s actions. I’ve never been fan of sweeping critiques of Evil Capitalist Neoliberalism, but Rutte’s current approach does feel a bit like the logical endpoint of centrist neoliberalism: cut back state intervention to a minimum and “trust the people” to look after themselves, and then express outrage when things go wrong; like parents who leave the front door wide open and get angry with their kids for wandering away.

This laissez-faire approach finds its ultimate expression in the notorious “experiments” run by FieldLab and other organizations, in which major events (football matches, running races, music concerts, museum tours, theme parks) are opened to thousands of people, at ten-figure expense, with no distancing or masks allowed, purely to see whether infections spread. After protests some events were abruptly cancelled, but dozens went ahead, with tens of thousands of participants. In March, for instance, five thousand people attended a football match together on the same day that the country soared back past nine thousand infections. In theory some experiments might be a good idea, I suppose: it would, for instance, be helpful to know more about how dangerous concerts are for those who attend. But the problem is that there’s often little pretense of scientific protocols, and many events have about as much in common with a clinical trial as the Vondelpark does with the Andes. Someone on Twitter astutely pointed out that the whole FieldLab endeavor seemed like Japanese whaling: an unacceptable practice rebadged as “science” to try and make it more palatable. To me, it looks more like the kind of stunt a teenage delinquent would pull; throwing a lit firework into a petrol station “just to see what happens”.

On certain corners of the internet, it’s long been argued that the government has secretly been pursuing a policy of letting infections run wild until herd immunity is achieved. The government did make some early statements implying this was the goal, but to me the conspiracy theories have always seemed a bit far-fetched: as a general rule in life, cock-up is more likely than conspiracy. Now, though, the theories seem to have come partly true. For me and many others, the most striking part of this week’s press conference wasn’t when the lifting of lockdown was announced, but when Hugo de Jonge urged people planning holidays to “keep in mind that other countries may see the Netherlands as a high-risk country, because we still have so many infections here”. Together with other statements, this felt like a quietly remarkable tipping point: while other nations still battle to push infections towards zero, the Dutch now openly acknowledge that the situation here is worse than elsewhere, and adopt policies which they know will increase infections further. Vaccination of the elderly means this approach isn’t quite the same as the “build herd immunity” of old, but it is a version of it, involving (hopefully) low deaths but a very high level of illness in the “healthy” population. Diet herd immunity, if you will.

It always seemed likely we’d end up somewhere around this point at around this time, with the elderly well-protected, everything reopening, infections spreading and many individuals being put in difficult and dangerous situations. That doesn’t make it less worrisome, though. In a European context, the level of infections and vaccinations in the Netherlands isn’t particularly unusual, but the combination of high infections plus lifting lockdown is. This week, Rutte said the country was “on our way to a hopefully beautiful summer thanks to the vaccinations”. This could be true, and I desperately hope it is – if only because I’m growing tired of writing grim little articles about dodgy Dutch Covid strategy, and would rather work on happier things. But the problem is that we’ve chosen to reopen at a time when there’s no room for error. Amid all the debate about curfews and distancing and opening times, it seems to me that only two questions really matter: will reopening mean infections stay at the same level? And if they don’t stay at the same level (or fall), can the health system cope? Unfortunately, the answer to both those questions is clearly “no”. It’s hard to avoid the conclusion that lockdown is being lifted not because the epidemiological data justifies it, but simply because everyone’s sick of lockdown. What looks like a coherent strategy is defeatism in disguise. A Prime Minister recently re-elected on a platform of bland split-the-difference managerialism is taking an epic gamble. And a caretaker government supposedly barred from making any controversial opinions is defying global consensus about infection control, and raising the white flag.

3 thoughts on “Diet Herd Immunity

  1. Hi Ben,

    Being Dutch but living in Berlin in Germany, I can only agree to everything in this post. The infection numbers are among the highest in Europe, and they start opening up, wtf?
    I have always seen my home country as a well-run country, but since the beginning of Corona I can only watch what is going on in disbelief. It is not only the incompetent Rutte government and the total denial of scientific evidence of the RIVM (for example with regards to wearing masks and the importance of aerosols), it also seems to be the mentality of the people.
    The Netherlands seems to have become the prime example of a western country where the neoliberal mindset of individualization has gone a bit too far! Where people act in their own interest only because it is their “freedom” to do so, without realising that their actions have impact on other people’s health as well.
    With the current premature re-opening steps it will almost certainly take longer for the Netherlands to get fully back to normal, if not worse and it comes to a fourth wave. At the moment I can only be happy that both my parents have got their first vaccine dose already.

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  2. Ben:

    This comment is more direct and visceral than the Dutch can put it about themselves. Part of their neo-liberal laissez-faire approach to a collapsed discipline over Covid parrots the failed leadership which treats the pandemic more as a social disease. Following King’s Day, the numbers who continue to follow their own path will prove how successful this approach to life is.

    Without any live survival experience in a wartime situation (Covid is a war without bullets and bombs but just as lethal) the Dutch have treated it the same way they allowed the Germans to march in during 1939. It took the Allied forces (Canada, UK, US) to liberate them from foreign control during that war. Four princesses hid in our house in Ottawa for four years waiting for our troops to end the occupation.

    One would have thought that was sufficient proof that listening to a clown wearing pink shoes would not defend the country from a killer disease. But no, as with the tens of thousands of dead Jews who bore the brunt of Nazi rule, there will be a similar cull amongst several age groups in this country who will pay the same price. But there will be no monuments built to remember those who died. Led by two failed school teachers turned politicians, rather than skilled public administrators with decades of private/public global enterprise behind them, the Rutte/de Jonge comedy act appears more like a Laurel and Hardy duet smiling their way through their scripts. Few politicians in any Western country have come through the pandemic with flying colours. It is highly unlikely these two will retire to higher functions unless of course graduating to the unelected post-secondary equivalent called the EU, masters of the collective failures on a grander scale.

    Your insights are excellent. Keep up the good thoughts, analysis and writing.

    Regards

    Robert S. Stewart

    Koloniepad 5

    LAREN Noord Holland

    1251 AH

    The Netherlands

    Tel: +31 35 538 8005

    Cell: +31 62 831 1701

    SKYPE: robert.s.stewart

    and

    42 Quai Jean Charles Rey

    MONTE CARLO, Monaco

    MC 98000

    Tel: +377 999 00 840

    http://www.interopag.com (personal home site)

    https://www.linkedin.com/in/robert-s-stewart-04384219/

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  3. Excellent and prescient comments above from two readers, and a very accurate assessment from you, Ben. Here we are in mid July, two months after your post and the comments from two readers, and the Netherlands is the EU pariah state, with infections rising at a world-record pace. The Rutte-De Jonge tag team horror show seems to be deliberately pushing the young to the covid front lines to become infected to achieve their herd immunity goal, whatever the human toll that will exact. It is beyond immoral – it is amoral. Words escape me.

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