Empty hospitals and a ‘new normal’: the effects of corona on Dutch healthcare

As the corona crisis continues, some of its effects on the Dutch healthcare system have been brought to light. Not only have there been surreal pictures of empty hospitals around the country, it has also put the spotlight on the way things are run, and, warn experts, in order to be ready for the future, a new normal is needed when it comes to the Dutch health care system.

I’d rather stay home
Since corona appeared in the Netherlands, a worrying trend has been revealed: an increasing number of non-corona patients are deciding to not seek medical care, or postpone it. However, in some of the more serious cases, not seeking medical care can make a condition worse, experts warn. There is also the potential for an overburdened care system once the crisis has finally blown over and patients will resume their visits to their general practitioners and hospitals.

An article in Het Parool on 30 March had the significant title: ‘GPs: please come to us with your serious complaints.’ It was reported that patients in Amsterdam rather stayed at home than paying their GP a visit for ‘fear of corona’, or because they thought their doctors were too busy with corona and ‘didn’t want to bother the doctor’. GPs and emergency care providers called on residents with serious health complaints to visit their healthcare facilities ‘immediately’.

A spokesperson of the OVLG, the city hospital of Greater Amsterdam, said: “The number of non-Covid-19 patients has decreased significantly.” At the OVLG, the average number of patients coming into A&E had decreased from 350 to 40 per day. Instead of the daily average of four people coming to the hospital with heart attacks, only one came in; and whereas before, patients suffering a transient ischemic attack (TIA) – a mini stroke – would come into the Amsterdam hospital once a day, now only one a week came in.

The initial attempt by healthcare providers to avoid a possible overburdened healthcare system by calling on patients to refrain from seeking care with ‘medical ailments that can wait’, seems to have backfired, Het Parool stated, arguing that: “Now it seems that many patients with potentially serious conditions continue to walk around with them.”

Newspaper AD labelled the trend of patients staying home instead of seeking medical care a ‘possible silent disaster’. In an article called ‘Doctors are worried: non-corona patients are staying home’ on 3 April, it was reported that the national cardiologists’ association had been registering a 50 percent decrease in people seeking medical help with more serious complaints such as chest pain, strokes and acute paralysis. As a result, people may suffer permanent damage or even become disabled, they warned.

In a recent episode of tv show Jinek, cardiologist Wilco Tanis described the unreal feeling of seeing his colleagues on the IC department having to work so hard, whilst “we are just about sitting around drinking coffee”. Tanis too expressed his worry by predicting a bleak picture of a possible ‘unmanageable disaster’. If patients with heart disease “stop reporting [their health complaints], the disaster can no longer be predicted,” he told Dutch media. According to Dutch media, the two most important GP associations have shown concern with the unusually calm waiting GP rooms around the country.

Don’t put it off: we are still open
The response of the medical sector has been clear: please come in to get medical help. “Our message: the doctor’s surgery is still open. So just call us,” GP Stella Zonneveld told Dutch media. Michiel Gorzeman, an A&E doctor at OVLG, also heard patients saying there were afraid of contracting corona in the hospital. He made it clear that a neglected TIA, for example, can lead to more serious complications in the future. “People have seen the images of busy hospitals in Italy. They think everyone is sitting and lying in the hallway. But that is not the case here at all,” he said, explaining that patients with corona are separated from the rest of the hospital. “So you can still go to hospital with non-corona complaints.”

Elderly people, people who have had a heart attack, patients with diabetes or high blood pressure, and those with stroke complaints, chest pain or severe abdominal pain, were particularly urged to come in, and Gorzeman added: “Don’t put it off. It is certainly quiet now at the emergency room, but we will soon have a problem if people ignore serious complaints.” A spokesperson for the Dutch College of General Practitioners (NHG) also emphasised that people with minor complaints should visit their GP: “We don’t want people to ignore any acute symptoms that need immediate medical attention.”

Pregnant women
Although the RIVM (National Institute for Public Health and Environment) has continued to emphasise that pregnant women and their unborn children are not in particular danger of additional health risks, should they contract corona, a similar picture has been emerging with pregnant women. Many of them are reportedly opting to stay away from their medical professionals, newspapers such as AD reported. This worrying trend has also been noted by the national gynaecologist association; gynaecologist Jelle Schaaf from the Flevoziekenhuis told media: “We have created a completely separate department here for pregnant women and their partners who have complaints that may be related to a corona infection. By separating patients in this way, the chances of catching something here are very small.” Every hospital has taken such measures, he said. Schaaf also labelled the fear of overburdening healthcare as ‘unjustified’, explaining that hospitals have been specially equipped to run emergency care, including pregnancy.

Dutch healthcare system: ready for the future?
Since the crisis started, medical experts around the country have started to look at the question whether the current healthcare system is equipped to deal with similar situations in future, and whether it is responsive enough. In an opinion article in De Volkskrant on 15 April, a group of general practitioners and clinical professors put forward that, in order to be ready for future epidemics, the Dutch health sector needs to make some fundamental changes.

The authors of the article, entitled ‘Quality of care during crisis situations’, argued that a shift is needed from the current focus on IC capacity and mortality rates, which have been the focus of most measures taken during the corona crisis, to what they describe as a ‘broader social and medical perspective’. The experts argued that since it is currently unknown when a corona vaccine will be available, the care sector needs to establish a ‘new normal’, in order to be ready for the future: “The reality of the continued presence of the Sars-Cov-2 virus, and future epidemics with other pathogens, require us to reconsider the functioning of our healthcare system.”

The experts labelled as ‘admirable’ the ‘almost military-style operation of upscaling care for covid-19 patients’, which resulted in double the usual IC capacity as well as cohort isolation nursing units, but they also warned of the negative effects for other departments in the hospital. This situation should not last too long, they warned. “Whereas in the hospital the treatment of Covid-19 focusses mainly on intensive care, medical care outside of this cannot be organised through a strict decision protocol,” they said, explaining that the corona crisis has brought to light a few areas of improvement in the current system, and that “the most favourable care for an individual patient is one where the person and his or her context are more important than the disease alone”.

To improve the response of the current system to current and potential future needs, as well as the needs of each individual patient, the experts also identified some other key areas in need of improvement. They argued for example that there is a need for a more streamlined and optimised exchange of the various electronic patient records, as well better cooperation between health insurers and healthcare providers in order to be able to organise the right care fast. They also said there is a need for an ‘improved patient access to diagnostic facilities and medical specialists’.

As the corona crisis continues, it remains to be seen what its lasting effects will be on the Dutch national health system.

Written by Femke van Iperen