Every year, on the first Saturday evening in February, Ernst Kuipers meets in a restaurant with the other physician assistants with whom he started his long career in care in 1986 in the Deventer hospital. They have been doing this for 35 years – until last year, because of the lockdown. And it was canceled this year too, the relaxation of mid-February came just too late. “And it is so in our system that it is early February, that organizing later does not seem an option,” says Kuipers.
The question is also whether he would have dared to use the relaxations he himself announced, while tens of thousands of people are infected every day. “Of course,” says Kuipers. “But just because we are relaxing does not mean that the virus is no longer there. We have to keep using our common sense.” By doing a self-test for a visit to grandma, for example, he says.
Kuipers sits at the head of the long wooden table in his office at the Ministry of Health. For a month and a half, the D66 member has now been leading the ministry that is at the forefront of the fight against corona – a vanguard that he has also been in for the past two years as chairman of the National Acute Care Network (LNAZ) and director of the Rotterdam Erasmus Medical Center. The view from his office at the ministry is different from the one in the hospital. There he looked out over the entire city from the fourteenth floor of the Erasmus. Here curtains obscure the view of the endless windows of the adjacent Ministry of Education.
But many of the files on his desk remained unchanged. “It is exactly the same problem as far as corona is concerned,” says Kuipers. “In my previous role, the focus was very specific on the hospital, on the bed capacity. Now it is more remote, others have to take care of it. At the same time, I have to form an opinion about, for example, advice from the Health Council. In the past I could still say: I’m not going to talk about it.”
Others have to take care of it, you say. The OVV concluded last week that no one was really in charge of the crisis response. As a minister, what are you actually about in the fight against corona?
“I am not going to say anything about the OVV report now, the cabinet will come up with a response. But in any case I am not talking about individual hospitals and nursing homes, not about the bed capacity, not about the degree of scaling up, not about the deployment of staff, not about whether or not to take over patients. Nor about which patients are given priority.”
Isn’t it a problem that the minister is not talking about anything?
“We had a minister who is not about everything and certain crisis structures were missing. But in the end we did get corona under control in our polder country. It was possible to get hospitals to work together, to receive patients. I don’t know whether it would have helped if the minister had dealt with hospitals and the GGD. Can it be better? We’re going to look at that. Perhaps more national control is sometimes needed. But always in consultation. That is different from: the minister is talking about it.”
As a hospital foreman, Kuipers often took part in the public debate about the fight against the corona virus. The Netherlands had to take measures, he said regularly, weeks before the cabinet actually intervened. Vaccinations had to start much faster, Minister Hugo de Jonge (CDA) sometimes had to make decisions before there was a positive advice from the Health Council. He also thought that the Netherlands should prepare for new waves of contamination.
The virus won’t go away. We have to take into account that there will be a more sickening variant.
Last week, the WHO warned of the “false narrative” that the pandemic would be over and of a resurgence of the virus in the fall. How is the Netherlands preparing for this?
“I fully agree with that warning. That we are now easing is something completely different from saying that the virus is nothing anymore, that it has just become a cold. The virus won’t go away. We have to take into account that there will be a more sickening variant. We don’t know for sure, but you have to prepare for it.”
How?
“You have to monitor new variants, you have to test, you have to be ready to organize a new booster campaign if necessary: to everyone or to a specific target group. You should be able to do that with a short advance notice and accelerated execution.”
There has been a positive advice from the Health Council on your desk for a week to give the elderly a fourth shot. What are you waiting for?
“If I make a positive decision about that, it can be done quickly. In addition, if a new booster round is needed for everyone, it can be done within a few weeks.” (The day after the conversation, Kuipers indeed decides on a fourth shot, the campaign should start next week.)
Ultimately, says Kuipers, preventing a new wave is not just ‘a problem of care, as I hear over and over again’. He means: don’t just look at the number of hospital beds. “Germany is a country with many more hospital beds. But they had to take similar measures at various times. If the virus grows exponentially, more beds will only buy you a few days.”
As a national ‘bed manager’ you had to arrange extra (IC) beds throughout the country for two years because the Netherlands had too few. Then, as a new minister, you are the first to focus on expansion?
(Shakes head). “That’s the last thing you should bet on. I hear people talk a lot about raising our dikes. As if the dikes were high enough, we wouldn’t have to worry about anything anymore. My answer is: that won’t help. You cannot increase the capacity in such a way that you no longer have to take these kinds of measures in the event of a next wave or pandemic.”
It has often been framed that we took measures to relieve the burden on care. That gave me pimples
Whether the hospitals kept up was decisive for whether measures were taken. In order to keep the Netherlands open, the capacity must be increased, right?
“It has often been framed that we took measures to relieve the burden on care. That gave me pimples. It was not to relieve the burden of care. It was because we thought it was important that everyone who needed care had access to care.”
This winter, many European countries with more hospital beds did not need a lockdown, the Netherlands did. Then does it really matter?
“I often hear the comparison with England. Then we have to realize that at many times access to care for people simply wasn’t there. An American newspaper recently published a wonderful article about the health care situation in London, where two completely different worlds coexisted. The outside world, where you could go into the pub to party, and the hospitals, where it was all about Covid. That had a huge impact, also on other patients they could not treat.”
But England made it through and remained open.
“Yes, but what have you saved then? The British have long halted their transplant programs. Then you are just out of luck if your partner or child urgently needs an organ.”
Do you want to increase the number of hospital beds towards the autumn or not?
“We map out per region where the bottlenecks are, in addition to hospital beds, this can also be the connection to home care. We shouldn’t think that we don’t have to do anything more.”
What is the government focusing on?
“We must continue to monitor the emergence of new variants and keep in touch with international colleagues about this. The question is whether you should continue to test everyone with complaints or whether there are other ways. I think that at some point we will stop testing every individual at the GGD, especially now that there are good self-tests.
The question is also very broad, also to my colleagues and therefore to all kinds of sectors. What can you do yourself to limit the number of infections if the infection pressure increases in your area? That’s where it should start, it’s a problem for all of us. What are you doing at ‘s office NRC† Are there rules that with a certain number of infections you go to work from home, do you use walking routes, do you look at the ventilation?”
Is the responsibility for combating corona shifting from the cabinet to society?
“It belongs to society.”
So whether the country stays open is decided by people themselves.
“Yes, you do it together. You want to see what everyone can do. It can no longer just be something from the cabinet or the Minister of Health.”
How realistic is it that society will remain open?
“That is realistic if you stay in the scenario with variants that we are well protected against. But it is absolutely conceivable that we will end up in a more negative scenario. Then you cannot rule out measures.”
That is what more and more parties in the House of Representatives want, for example by permanently withdrawing the corona pass.
“You have to distinguish between the possibility of betting something and actually using it. I like to use the term ‘coat rack’ for this. We have now abolished almost all measures, but the stepping stone to be able to take measures in an emergency is still there. If you want to get rid of that, you can, but then you have to think about how you are going to take measures in a crisis situation.”
Is it then naive that the House wants to get rid of those measures permanently, or is it reckless?
“No, I will not use those words. We’re all looking for what’s proportional, when you want to use what. As a cabinet, we have said that we no longer want to close the schools. But can I guarantee it? No, because the experience of the past two years has taught us that something we thought would never happen, is reality.”
Behavioral studies have shown for some time that fewer and fewer people want to comply with corona rules. Don’t you trust too much that things will be okay?
“I am not naive, but it is quite right that sectors say: let us arrange things ourselves. I see that people take responsibility for themselves by regularly doing a self-test. Something like this has an important impact on life with corona. We no longer want a minister who says: here you have these measures, good luck. But then we will all have to tackle it together.”