The Dutch COVID-19 approach: Regional differences in a small country.: The Dutch COVID-19 approach.

Hoekman, Lieke Michaela; Smits, Marlou Marriet Vera; Koolman, Xander

OBJECTIVES: This paper describes the first months of the COVID-19 pandemic in the Netherlands, including policies to reduce the health-related and economic consequences. The Netherlands started with containment yet shifted to mitigation when a ‘mild’ lockdown was implemented. The initial focus was to obtain herd immunity while preventing Intensive Care Units from getting overwhelmed. METHODS: An in-depth analysis of available national and international COVID-19 data sources was conducted. Due to regional variation in COVID-19 hospitalization rates, this paper focuses on three distinct regions; the initial epicenter; the most northern provinces which – contrary to national policy – decided not to switch to mitigation; and the Bible Belt, as congregations of religious groups were initially excluded from the ban on group formation. RESULTS: On August 11(th), 6,159 COVID-19 deaths were reported with excess mortality rates about 70% higher. As a result of the pandemic, the economy took a severe hit and is predicted to reduce by 6.5% compared to prognosis. The hospitalization rates in the northern regions are over 70% lower as compared to the rest of the country (18 vs 66 per 100,000 inhabitants, respectively). Differences between the Bible Belt and the rest of the country were hardly detectable. CONCLUSION: the Dutch have shown a way to effectively slow down transmission while allowing more personal and economic freedom than most other countries. Furthermore, the regional differences suggest that containment with testing and tracing reduced the virus dissemination. The results should be interpreted with caution, due to the descriptive nature of this evaluation.