“I have been teaching about infectious diseases for over 20 years, but never before have I included lockdown in my lectures”

Jaap van Dissel at a technical briefing in the House of Representatives (Dutch: Tweede Kamer, the Lower House of Parliament)

The coordinator of the COVID-19 response

Aura Timen

Primary task: I have two jobs, which have kept me working flat-out since mid-January, weekdays and weekends. I have only had two days off in all that time. I am leading the COVID-19 response, as head of the National Coordination Centre for Communicable Disease Control (LCI). My second job is the Scientific Secretary to the OMT. I am also Jaap van Dissel’s deputy for communicable disease control and questions from the press.

Struggled most with: The feeling of always playing catch-up and not being able to do much about it. We thought we understood how this virus behaves, but we still keep getting surprised at every turn. In the meantime, we still have to offer recommendations on how to fight it.

But as we discover new information about the virus in retrospect, it is quite a huge undertaking to adapt the recommendations. Standard practice for infectious diseases is to identify new insights and incorporate them into the response – but new information seems to be perceived differently here. In this case, we immediately get told, “Oh, so you were wrong, you saw it too late, you were not taking this seriously enough.” It is really hard to cope with, honestly, that everyone has an opinion that they need to get out there.

Gets energy from: My colleagues at LCI. They are all extremely motivated people who are there, day in and day out, getting things done. I never cease to be amazed at how driven and dedicated they are! And there are so many others who stay closely involved from a distance, are behind us, calling in, offering help. As a side note, it gives me great pleasure to tell you that we just celebrated an anniversary: on 13 June, the Centre turned 25!

Key weapon in the fight against coronavirus: The “intelligent lockdown”. I have been teaching about infectious diseases for over 20 years, for the last two as a professor at Vrije Universiteit Amsterdam. But never before have I included lockdown in my lectures, except from examples from past centuries. And I certainly never thought that I would ever be experiencing one in my working life. We have not seen an entire society shut down, or even partially shut down, for a hundred years.

The virologist

Marion Koopmans, professor of virology at Erasmus MC

Primary task: Contributing my expertise in virology to the OMT. Our department at Erasmus MC, the Viroscience department where I work as a professor of virology, is doing a tremendous amount of research on viruses at the human/animal interface, particularly looking at the viruses that pose a pandemic threat. We devote this expertise to research and advisory assistance. 

As soon as the first signs started coming out of Wuhan at the end of December, we have been fully focused on SARS-CoV-2 [the full name for the novel coronavirus that can cause COVID-19 -- eds.]. Our contribution is in the form of clinical research, development on diagnostics, pathogenic research [research into the emergence, development and course of diseases -- eds.], immunity research, molecular epidemiology studies and research on treatments.

Struggled most with: The fact that I am suddenly such a public figure. I cannot say anything at all now without everyone in the world having an opinion about it. Thinking out loud is usually part of how I process a situation like this, but it is not really possible anymore. I also have difficulty with the lack of international cooperation and the fragmented approach being taken in the research world. I worry that this fragmentation is going to mean that it will take us a lot longer to arrive at any conclusions. And yes, it also pains me that – despite all our knowledge and experience – we are still empty-handed at the end of the day.

Gets energy from: Being able to contribute to the response with my knowledge and my team’s knowledge.

Key weapon in the fight against the coronavirus: That we will be able to closely monitor the development of the virus with genetic analysis and supplemental studies in the near future. We also have focus on research into treatment and prevention. I expect that this virus will keep coming back, so we are going to need that.

In the past few months, fundamental new insights into the pathogenesis of this virus have been discovered, which could give us new starting points for treatment. We all have to come together now to ensure that these scientific advancements go as fast as possible and that includes partnering in trials.

Goals: In a subsequent wave, I want us to have access to something that can protect the most high-risk patients, for example plasma therapy. And, most of all, I hope we learn from this pandemic that we absolutely need systemic, large-scale investment in preparedness research: studying the best way to be prepared for large-scale outbreaks. These types of viruses had been on the list of pandemic threats for years, these and a whole host of others. I think that this has been a real wake-up call.

The modeller

Jacco Wallinga

Primary task: I am head of the department of Infectious Disease Modelling. The modellers in my department are hard at work running the numbers on how and when to introduce measures or open up more, forecasting the demand for care, calculating the required intensity of control, and determining the reproduction number (R) of the virus. We also set up surveillance tools based on online technologies and mobility.

Right now everyone is being pushed incredibly hard. My most important task is to make sure that the critically important things are being handled properly and that everyone has what they need to keep doing their jobs right.

Struggled most with: Not having enough time to read and answer all the e-mails with offers for help. It was heartwarming to see how everyone came together in offering assistance. But the questions that we faced in this crisis were very unpredictable, so it turned out to be difficult to make use of all the help that was offered. Setting up new partnerships is no easy task in the midst of a crisis. Setting up triage points for this was an obvious choice.

Gets energy from: The family at home, where building with Lego is much more important than the coronavirus epidemic. And satisfaction comes from the tremendous amount of work getting done inside RIVM. Sometimes we get cards and e-mails from random strangers from all over, thanking us for our work. So extraordinary, and it is really motivating to get that encouragement.

Key weapon in the fight against coronavirus: Perspective! Epidemics like this one do not happen often in the Netherlands, but if you look back through the centuries, they have happened on more than one occasion. And as bad as it is, people have always found a way to adapt and go on living.

Goals: Preventing the epidemic from getting out of hand. Think about what the Netherlands would look like if the healthcare system were overwhelmed, hospitals were overflowing, and someone in your household was deathly ill but could not arrange access to healthcare. When you look around and see what is happening elsewhere in the world, you know that it could have happened here. That has been prevented in the Netherlands.

 

Would you like to know more?

Read more about the Outbreak Management Team (OMT) and the fight against infectious disease

Read more about modelling at RIVM

Read more about COVID-19

 

Epidemics then and now

Novel coronavirus: experts on air quality and infectious diseases join forces to look for answers

Since the start of the outbreak of the novel coronavirus, which causes COVID-19, there have been questions in the Netherlands about a potential connection between livestock farming, air quality, and the spread of this disease. We still do not have the answers, but experts in a wide range of sectors, from infectious diseases and zoonoses to health and the environment, are working together to compile more knowledge in this area.

Joke van der Giessen, veterinary microbiologist at RIVM and programme leader of the VGO-III research programme on livestock farming and the health of local residents, says, “The first outbreak of COVID-19 was in the province of Brabant, and then shifted more towards north-eastern Brabant, which has a high concentration of livestock farming. That area was also hardest hit by the outbreak. It is the same area where Q fever ran rampant during that outbreak. So there were questions about that – in Parliament, from journalists and from the public. ‘Can it be coincidence that it is hitting hardest in north-eastern Brabant? Is there a connection between air quality and livestock farming?’ Well, we do not know yet.”

“We do know that right before the outbreak, the province of Brabant celebrated Carnival. In any case, such large gatherings are a known vector for virus transmission. Infectious diseases spread easily through large groups of people who are partying. At the request of two government ministries – Agriculture, Nature & Food Quality, and Health, Welfare & Sport – we published a policy paper exploring what studies might enable us to answer these questions.”

Air quality and health

Van der Giessen is working on this subject in collaboration with Miriam Gerlofs-Nijland, an expert on air quality and health, particularly specialising in toxicology. That is one of the advantages of having a wide range of disciplines under one roof at RIVM. “In areas with high air pollution, we see increased mortality rates,” says Gerlofs-Nijland. “That has been common knowledge for some time, and is completely unrelated to the novel coronavirus. For example, air quality affects the lungs. When the air quality is poorer, pneumonia is more common. Air pollution research tends to ask: is the concentration of air pollutants within the legal limits? We look at air pollution from a public health perspective.”

 

“When the air quality is poorer, pneumonia is more common.”

 

A Harvard University study showed that people living in areas with higher air pollution had a significantly increased risk of death from COVID-19. Joke van der Giessen and Miriam Gerlofs-Nijland see this as an indication, but not as direct evidence in itself: “This Harvard study is an ecological study. That means that it offers indications that there might be something there, but it does not prove a connection.”

Focus on people with respiratory sensitivity

At the beginning of this year, even before the COVID-19 outbreak, the Dutch government signed a new accord with the provinces and municipal authorities: the Clean Air Agreement. “It contains a whole range of measures to achieve cleaner air,” says Gerlofs-Nijland. “The Clean Air Agreement devotes special attention to risk groups, like people with genetic predisposition or extra sensitivity to pulmonary diseases, as well as to people who are exposed to high concentrations. The goal of the Agreement is to achieve an improvement in health outcomes of at least 50% in 2030 over 2016 for domestic sources.”

 

“We look at air pollution from a public health perspective.”

 

Better air quality due to lockdown?

Other questions about air quality and the novel coronavirus were also addressed by the RIVM Centre for Environmental Quality. Senior scientist on air quality and climate change Guus Velders says, “Did the lockdown measures have a demonstrable effect on air quality? That is a question that came up fairly quickly, triggered by the first satellite images from China which showed that NO2 concentrations had decreased considerably as traffic and industrial activities almost disappeared during the lockdown. Satellite photos also showed an improvement in NO2 concentrations in the Netherlands, but it was not immediately possible to say how big of an effect the lockdown measures had".

"We are now doing a broader analysis. What is natural variation – in other words, how much do we attribute to the weather conditions, and what can be attributed to the lockdown measures? If the measures stay in place, any effects will become more clearly apparent in our measurements as time goes on.”

Research opportunities

As this suggests, for the time being there are more questions than answers about air quality and the spread of COVID-19. Van der Giessen and Gerlofs-Nijland coordinated the policy paper, consulting with a great many experts to identify various areas for potential research. Some of this exploratory research could be carried out within the existing VGO consortium, explains Van der Giessen. “VGO-III, the programme on livestock farming and health of local residents, is set up to collect more knowledge about the health of people living in the vicinity of livestock farms. In recent years, we have seen an increase in pneumonia occurring near goat farms – but we do not know why.

We are set to launch a study on the causes of pneumonia around goat farms, probably in September. Many GPs in north-eastern Brabant are participating, conducting widespread diagnostics on patients with pneumonia. Of course, that research is not related to the novel coronavirus, because the pneumonia cases started long before the COVID-19 outbreak.”

 

Would you like to know more?

Questions and answers (only in Dutch)

Letter to Parliament on COVID-19 and potential connections to animals

RIVM as a WHO reference laboratory for COVID-19