Interview with microbiologist Alex Friedrich
‘COVID-19 is here to stay’
Prime Minister Rutte announced a first relaxing of the corona measure: elementary schools can start operating at 50 percent, and young children will be allowed to play sports again. How do you feel about this?
‘It mainly concerns elementary schools and sports facilities for children. Anyone who’s feeling ill should still stay at home. You could call that a relaxing of the rules, and it’s in line with how things have been going. The increase in patients has been declining, but hasn’t stopped completely yet. So it’s a good thing that we’re taking it slowly; it’ll give us enough time to adjust if the number of infections rises again.
What would a further relaxing of the corona measures look like, according to you?
‘First and foremost, we have to keep a close eye on the numbers. Things have calmed down a little bit, and if they continue to do that over the next few weeks, we can start to consider the next steps to take. Perhaps elementary schools could start letting in all children rather than just 50 percent at a time. High schools could slowly start back up again. It’s very important that we don’t do anything too hasty.
I also think we should consider relaxing the rules per region. Currently, there are effectively four different epidemic regions: the north, the middle, the south, and the west. This isn’t a homogeneous epidemic; it’s progressing differently in each region. The number vary greatly. This means you can’t use the national averages to predict what’s going to happen. You’ll overestimate it for one region while underestimating it for another.
Right now, we have to assume that COVID-19 is here to stay. We’re over the first hump now, but we have to keep it under control. Until we have a vaccine, we’ll probably be seeing it return in the winter for a period of time. People will have to get used to flexible measures. Schools might have to close again after a few months, and we might have to go back to working from home, for example. That’s a realistic scenario to take into account until this virus weakens, or until we have a vaccine or proper treatment. We have to adapt if we want healthcare to be able to keep up.’
The number of infections is at its lowest in the three northern provinces. Your policy to test more than they were doing in the rest of the country contributed to that. Why did you focus on testing healthcare staff rather than the potential corona patients who went to their GP with symptoms?
‘Our testing capacity is a finite resource that we have to employ as efficiently as possible. Healthcare workers can’t stay home and they come into contact with at-risk people. On average, a ‘regular’ person will infect two to three people, but healthcare workers can infect twenty to thirty people. By testing care workers, we were able to quickly weed out the worst spreaders.
So far, our policy has led to ninety positive care workers going home, which in turn prevented nearly a thousand infections. What also helped is that we were testing people who only displayed mild symptoms. They weren’t doing that in the rest of the country.
We’re not waiting until someone presents with a fever; we’re testing anyone with even a slightly raised temperature or a mild cough. We ask anyone who tests positive who they’ve been in contact with in the previous 48 hours. We’ll then test those people, as well as care workers’ family members who are presenting with symptoms. That’s how we found out that asymptomatic people can have the virus in their nose and throat, and that they are contagious. We also warn any contacts who tested negatively; they could still develop symptoms anywhere over the next few days.’
Is that the only reason the north is less affected than the other regions?
‘It certainly contributed, but it’s not the only reason. Brabant got hit by a perfect storm: people returning from holiday in infected areas in Italy, coinciding with the carnival season, which allowed the virus to spread quickly among a large group of people. The holiday period in the north was earlier, which meant fewer infected people coming back from vacation, and we don’t celebrate carnival. Our testing policy enabled us to track down positive healthcare workers coming back from holiday in Austria in a timely manner, slowing down the spread of the virus better than other regions did.
When the national measures were announced, the situation here was much less severe than in Brabant. That meant the ban on events, shutting down restaurants, and ordering people to work from home came at a good time for us. The same goes for the decisions the UMCG and the UG made, since the risk of infection from abroad as well as the rest of the Netherlands is great at those two institutes. The UG first made the decision to ban handshakes, and the UMCG announced a travel ban for its staff to prevent them from travelling beyond the north. All this allowed us to prevent the virus from peaking too high.’
If I understand correctly, the most important measures are still in place: the banning of events and ordering people to keep their distance and to stay home as much as possible.
‘Correct. It’s the best way to prevent the spread of the virus, in combination with testing care workers, both in and outside the hospital, and their families. We might have to start testing teachers and other people who can’t stay home because of their work.
Our main goal will always be to protect vulnerable people and those who work with them. We can do that by testing them and telling people to stay at home before they’ve even developed symptoms. The vulnerable and their carers spread the virus the fastest in hospitals and care facilities; stopping it there will allow us to slow down the epidemic. That’s our strategy. So keep your distance and stay home as much as possible. It’s the only way to stop the spread of the virus.’
One question that’s still on everyone’s minds: should we be wearing face masks or not?
‘Care workers and corona patients should have access to them. Not to protect ourselves, but to protect others from ourselves. Face masks were invented to prevent surgeons’ infected saliva from dripping into a wound during surgery. Again, the main reasoning behind wearing them now is also to prevent infecting others, but they also help to protect the wearer.
Outside of healthcare, they might come in use once we relax the current measures. Under certain circumstances, like in public transport, where you can’t install plexiglass protection sheets, they might come in handy. But in the open air, under the sun’s UV light, they don’t really work.
Theoretically speaking, face masks would be more useful in Brabant than in Groningen right now. Simply because their number of infected is higher. It might help if we gave them our face masks. People might not understand it, but it would actually help us if we gave our face masks to Brabant, since it could help slow down the epidemic over there.
So far, we’ve been told they’re not very useful, and the government is advising against using them. At the same time, they’re saying we simply don’t have enough masks.
‘They’re using the same argument they used when we were discussing our testing capacities. They said testing wouldn’t help in preventing the spread. That’s because there wasn’t enough personnel to administer the tests. Testing itself has definitely proved useful.
You shouldn’t say something doesn’t work if it can in fact be useful. I think they should be honest and tell people about what’s going on. Right now, we are indeed seeing a shortage of face masks. Healthcare workers need them the most. If they were to decide to make wearing a face mask compulsory, we’d need a lot more. We first need to find a solution to the shortage. Not by buying them, but by producing them in the Netherlands en masse.’