Position papers at a glance and the aerosols at the Ministry of Health, Welfare and Sport

“Letter to Parliament on long-term strategy COVID-19
Ministers Kuipers (Health, Welfare and Sport) and Van Gennip (Social Affairs and Employment) sent a letter to the House of Representatives about the long-term approach to COVID-19 (the coronavirus). This letter has also been sent to the Senate”

Here can be read on the website of the Dutch government.

What is the state of politics?

In the terminology above, it is striking that people speak of "long-term strategy COVID-19". However, the clinical picture "Covid-19" has not existed for a year and certainly not in a form that is (over)burdening for healthcare. It is not made clear why a long-term strategy is still needed for this a year after its disappearance. If you read on, you start to understand the somewhat muddled train of thought that one has to navigate through.

What I mean by muddled is that with -and that a flaw in the foundation of everything that follows- "COVID-19" and "the coronavirus" are effortlessly interchanged with each other, as if you can mention one when you mean the other. This happens even in legal texts.

Does that lead to confusion? Strangely enough, not because people talk with one mouth and understand what's behind it. The shared ideology runs away with the facts. Group think. For example, today we would also be able to read documents on a long-term strategy Spanish Flu (the influenza virus) can expect. After all, that virus is still with us and is not going away. It can mutate again at any moment and cause hundreds of thousands of deaths. Incidentally, it does so every year: WHO estimates between 290,000 and 650,000 deaths per year, which is considered perfectly acceptable. It has not even been considered whether anything can be done about it.

We have also been carrying coronaviruses with us for millions of years. The strange and sudden Wuhan variant was the first since living memory that many believed caused major health problems. This Wuhan variant was followed by a series of rapidly weakening and more contagious mutants that provided near-complete immunization. The Covid-19 long-term plan is now a non-discussion. That's understandable: drivers simply want more grip, more control, and the pandemic provided a good handle for that – but that pandemic is now really over.

Incidentally, there were plans, guidelines and scenarios for a pandemic approach much earlier, including from the WHO. All of these were largely put aside when the need really arose. It is not clear to me what is expected of a new plan and how its implementation will be safeguarded in times of serious crisis. It has become apparent that this is simply not the way it works.

The focus on respiratory diseases (respiratory viruses)

So let's broaden the issue: how do we better protect ourselves against respiratory viruses? COVID-19 is gone, but for many years we have been accepting an average of 6,500 flu deaths per winter when that might not have been necessary at all. Without flu infection, most of these would have survived the winters. No thought is given to the extent to which this is actually desirable, but it is a natural instinct to want to keep each other alive for as long as possible: an ethical subject that falls outside the scope of this article.

You would think that respiratory contamination is an important starting point for thinking about control. Is this reflected in the reflections on the long-term approach? The remedy is air hygiene with the most important part: 'ventilation'. See especially the column by Rosanne Herzberger of today. Finally, someone in a 'quality newspaper' calls a spade a spade:

"The Greatest Collective Scientific Error in Modern History"

Rosanne Herzberger in NRC, 14 May 2022

(Would she ever go for coffee with her colleague columnist Maarten Keulemans? Poor man...)

The Ministry of Health, Welfare and Sport on aerosols

On page 12 of the 39-page document on the long-term approach to COVID-19, just one paragraph is devoted to ventilation. So clean breath certainly doesn't have a prominent place.

On page 35, the word 'ventilation' is also used again in a row about communication of preventive behaviour: "hygiene, keeping distance, face masks, ventilation, testing, vaccination and staying at home in case of complaints". Climbed to fourth place, true to the OMT adage, so only after mentioning three behavioural measures that do not or hardly work is it the turn of ventilation. The phenomenon lockdown is not further elaborated.

(There have been more letters from Kuipers after this, but a 180-degree pirouette is not obvious when I look at it that way.)

Position Papers roundtable discussions 16-5-2022

Monday as. the round tables will take place. We know the position of the government and there are no signs yet that they are coming to their senses. The interlocutors have indicated in preparatory documents how they stand on it: the "Position papers".

Each position paper is dedicated to the conversation in question. Each "block" lasts only an hour, that's fast talking!

• Block 1: Scenarios for the future (10.00-approx. 11.00 hrs)
  • Prof. André Knottnerus and Prof. Dr. ir. Tanja van der Lippe (authors) WRR/KNAWreport "Navigating and anticipating in uncertain times");
  • Dr. A.H.E. (Xander) Koolman (health economist VU Amsterdam).
• Block 2: Bottlenecks from practice (11.00-approx. 12.00 hrs)
  • Jaap Eikelboom (Director of the National Coordination of COVID-19 Control) GCD);
  • Dr. Susan van den Hof (head of the Centre for Epidemiology and Surveillance of Infectious Diseases) Rivm).
• Block 3: Communication (12.00-approx. 13.00 hrs)
  • Marino van Zelst (former Red Team, researcher and modeller infectious diseases Wageningen University (WUR);
  • Prof. J.C.M. (Julia) van Weert (Professor of Health Communication at the University of Amsterdam);
  • Ginny Mooy (former Red Team).
• BREAK
• Block 4: Lessons from abroad (14.00-approx. 15.00 hrs)
  • Marc van Ranst (Belgian 'Scientific Committee Coronavirus', Professor of Virology, Epidemiology and Bioinformatics at the Catholic University of Leuven).
    [The only one on his own, so no rebuttal from Streeck, Tegnell, Jimenez, vandenBossche (also Belgium), Malone- or Mc Cullough-like. Belgium as a representative of 'the rest of the world'... ]
• Block 5: Social/fundamental rights (15.00-approx. 16.00 hrs)
  • Prof. K. (Kim) Putters (director of the Netherlands Institute for Social Research (SCP);
  • Prof. W.J.M. (Wim) Voermans (Professor of Constitutional and Administrative Law, Leiden University);
  • Jan-Peter Loof, LL.M. (vice-chairman of the Netherlands Institute for Human Rights).
• Block 6: Ventilation (16.00-approx. 17.00 hrs)
  • Prof.dr.ir. P.M. (Philomena) Bluyssen (Professor of Indoor Environment (TU Delft);
  • Dr. Roberto Traversari, MBA (senior researcher and consultant TNO);
  • Ir. W. (Wouter) van den Bos (Simulation expert and researcher TU Delft);
  • Drs. Maurice de Hond (data specialist View/Ture).
• Block 7: Vaccinations (17.00-18.00 hrs)
  • Prof. M. (Marjolein) van Egmond (Professor of Immunology Amsterdam-UMC VUmc);
  • Agnes Kant (director of the Lareb Pharmacovigilance Centre).

I read through the papers and immediately wrote down some keywords. Below are my notes.

GGD GHOR NETHERLANDS mainly focuses on the logistical and personnel challenges that arise.

The contribution of rivm consists of 7 PowerPoint slides in which a lot of attention is paid to improving data collection and exchange: "Data available and interchangeable from all domains". Would they also mean the public domain or only CBS and the GGDs?

Julia van Weert, professor of health communication, member of the independent scientific advisory board of the RIVM Corona Behavioural Unit and of the KNAW committee 'Pandemic Preparedness' starts rather rashly: "Research from the first phase of the pandemic shows that the effect of good communication (as an intervention) is comparable to the legal establishment of measures such as social distancing. It is well known that health interventions (communication and behavioural interventions) that are theory-based are more effective than interventions that are not." [...] "Research by the RIVM Corona Behavioural Unit shows that between April 2020 and November 2021, trust in the corona policy fell from 69% to 15%.12″ [...] "Be transparent about the assessment framework used4 and about uncertainties14, be consistent and specific where possible8, and have an eye for perceived fairness”
A critic can do something with this. But yes, it's still an RIVM-er: "Vaccination is one of the most successful public health interventions." It also stresses the importance of debunks of disinformation... Without mentioning that this disinformation mainly consists of washing hands, keeping a distance of one and a half meters and wearing face masks. However, like Van Egmond, she points out the importance of a healthy lifestyle.

M. van Zelst reflects on communication. It contrasts a bit starkly with Julia van Weert's fine piece. Definitely a sentence like "There is a world to be gained in communication about the potential consequences of an infection, such as the risk of long covid and/or an increased risk of all kinds of complications" raises my eyebrows. Should people be scared even more with more pervasive messages about how bad it could be?

Ginny Mooij hands in a column. I can't really follow it. First, a whole story about malaria. Then I stumble upon "Whereas until now everything has been dominated by the consequences of measures, a switch will have to be made to the consequences of the virus itself. This is an important task to provide information, as the population is more likely to have the idea that 'goalposts are constantly being moved'." So the goalposts have to be moved to the disease itself (?) and because the population realizes that the goalposts are constantly being moved, there is a communication task...?
“What does a continuous flow of covid patients mean for healthcare providers? What risks do citizens expose their healthcare providers to by showing up at the consultation hour without a face mask?”
So there is/will be a continuous flow of Covid patients and face masks helping?
“As an endemic disease, covid-19 will still require an intensive control policy" Covid-19 hasn't been seen for almost a year. "The virus is (still) causing too much damage" – someone like Theo Schetters doesn't agree with that either.

The SCP Social Culturel Planning Bureau submits an interesting discussion paper on the trade-offs of solidarity. [If I may charge for a moment: 'do we make the vulnerable unhappy or do we make the rest of the population unhappy under the motto of solidarity']. "Public health is a part of quality of life and that is more than just physical health. It's also about mental well-being. Mental well-being depends on several aspects, including freedom of movement, feelings of loneliness, safety and livelihood." [...] "Public support for the policy benefits from decisions being in line with people's lives. And that they are explainable, effective and predictable as much as possible." [...] "This requires consideration of whether measures are proportionate and whether there are alternatives. And also about a broader social dialogue about this.“

Wim Voerman, Professor of Constitutional and Administrative Law in Leiden, after a legal description of the events, actually provides a critical point of discussion: "Emergency law must not be allowed to degenerate into an administrative toy to get along with the approach to any problem. Still, it's hard to guard against frivolous use. Parliament often has its back against the wall when it comes to dealing with problems that are perceived as crises. As a parliamentarian, insisting on a normal dialogue and regulation (e.g. through a law) quickly leads to the accusation of trivialization of the problems and irresponsible attitude (and thus also guilt for the consequences of not taking a straightforward approach).“

The College for Human Rights confirms how delicate the issue is, but otherwise everything remains very much in the middle. Proportionality and Subsidiarity come along and so does the 'wide margin of discretion in public health issues' that the government has. "The Board argues that the government should play a leading role in making this assessment and not leave it entirely to other social actors."I really don't know what to do with this.

The papers by Bluyssen, Traversari and De Hond [now with mention of title and expertise] have already been discussed in the previous article as respectively the best, worst and most constructive contribution to the restoration of 'the greatest collective scientific error in modern history'. I can't get enough of Rosanne Hertzberger writing that, I've been watching her in bewilderment for a year and a half. I always thought so highly of her. Finally, the penny has dropped.

W. van den Bos, also from TU Delft, begins in his paper by apologizing that "vaccines and medicines are the best remedy for a new outbreak of the COVID virusBut if that is not already there, he mentions ventilation as the next pesticide. He describes simulation models that are being worked on to map airborne spreads. I think it's super complex.

The piece of Marjoram Van Egmond (Prof. dr. Amsterdam UMC) is realistic, albeit too prick-oriented for my taste. It only talks about effectiveness and omits any comments on the negative effects. Nor is there a differentiated approach by age group. On the positive side, for the vulnerable groups (in her worldview, these are people who cannot tolerate a vaccine, such as people with immune problems), there are other medicines than vaccinations. She mentions "prophylactic and therapeutic monoclonal antibodies as well as virus inhibitors." I think such a remark is already quite brave! Especially when she also points to the promotion of a healthy lifestyle, to which I would add"and preventing Vitamin D deficiency".
[nice detail: an accessible publication on immunology was written by her the very first piece I posted on this topic]

Also side effects institute Lareb Hotels has sensible things to say: "When continuing vaccinations for less severe and less common corona infections, the balance between side effects and effect shifts." Look, the B-word has been mentioned. Furthermore, it reads like a brochure text on side effect monitoring. Also no comparison with classic vaccines or anything like that, so little can be deduced from it.

The 16 position papers can be downloaded here. https://www.tweedekamer.nl/debat_en_vergadering/commissievergaderingen/details?id=2022A02396