RIVM: An increase in the number of infections does not necessarily mean more hospitalizations

In their last press conference on Corona policy, more than a week before the elections, outgoing Prime Minister Rutte and Minister Hugo de Jong dropped some tough conditions for easing measures. In the Words from De Jong: “If the R number can be kept around 1 and if the hospitals can not be overburdened much more, then there will be more relaxation around Easter.”

Suddenly, the number “R”, which is the number that indicates the number of people affected by a single infected person, no longer has to fall below 1. The number of admissions to hospital may increase slightly without endangering any relaxation.

How does Jaap Van Dessel, the government’s top virus advisor, view these statements?

And what do Van Dissel and model RIVM Jacco Wallinga think about criticism from the scientific community for the alleged lack of transparency about the arithmetic models used?

On Tuesday, it appears that the R has increased slightly to 1.06, and hospital admissions and international center admissions are up again. Do you agree with Rutte and De Jonge’s analysis that relaxation is possible with an R of about 1 and maybe a little more than hospitalization?

Van Dissel: “A number of circumstances have been mentioned, which were also suggested earlier in OMT, which are actually indicative of epidemiology. It will become clear if we are still meeting her at the OMT meeting (yesterday, ed.). If it is valuable. R is less than 1 or if we expect R to fall below 1, there is of course a very different situation than when R is above 1. We know exactly how this works if we use new computations by Jacco and his group. “

At the OMT meeting on Friday, March 19, it was announced that the R value had risen to 1.13.

What role does the increasing number of infections play?

Van Dessel: “It is complicated to interpret the numbers without further ado. We have people who have been tested for complaints and some of them are positive. We have people who have been tested on the fifth day of quarantine, but we have no complaints. There has been a noticeable increase in the number of children being tested. Children are positive less often, but they contribute to the total number of tests as well as the number of positive tests. So the shift in the amount of tests and the percentage that positive tests ask questions is for more clarification rather than just proving that the streak is on the rise.

Wouldn’t this additional infection necessarily translate into additional hospitalization?

Van Dessel: “This is one element that requires an explanation. There is a certain dynamic in the relationship between tests, positive reports and hospital admissions, which reflects, among other things, an increase in the number of young people being tested. Another factor is that some general practitioners are introducing more Care at home. Fits with the goal of treating more patients at home for a longer period of time, as well as with oxygen and medication. All this affects the burden on hospital care. “

Are signal values ​​indicating when mitigation is possible and then obsolete?

Van Dissel: “You should always give a good explanation for epidemiology. You can’t interpret the numbers immediately at first glance. There’s a story behind the numbers.”

Scientists, for example public health economist Jochen Mirau and infectious disease designer Sacchi de Vlas, criticize RIVM’s lack of transparency around modeling that is so crucial to government policy. How do you display this?

Jacco Wallinga: “Op Our Location It describes the forms we use, where our search is published, where the code can be found, where the data can be found, and what we’re still working on, so I don’t understand that very well. Of course people could say: It is not enough. But then you also have to indicate what we need to do and why. “

“Three weeks ago, I called Sacie De Vlas for an hour and offered him the site. Jaap van DeSeel also gives a comprehensive explanation every two weeks in his briefings in the House of Representatives. To be honest, I don’t know if those scholars who criticize us show their research results to others every two weeks.” .

Sake de Vlas recently stated during a webinar that it is advisable to use more calculation models for the estimates.

Wallinga: “This is really the case. We use several models. The information about them is on our site. The modeling strength is that it is very close to the current hospital data. At the patient level. There are limitations in transparency. Of course we cannot share this patient data due to privacy provisions. Moreover, the data is not ours, but it is owned by NICE. “

“For people who want to know whether we are doing our job properly, data that does not contain privacy-sensitive information is available in the form of Open data From RIVM and the type of form we use on the site. Finally, I’d also like more Publication about our workBut we are in a crisis. We are constantly receiving questions from the ministry that they want immediate answers to. As a result, we don’t actually have time to produce those scientific publications now. If we act on this now, the timing of the advice will be jeopardized. In any crisis, timing is the most important. “

Do you work with exhibitors in other countries?

Van Dissel: “Often times, visits are done by an international group of leading experts. It happened that the Jacco Group recently conducted such an audit of all aspects of their work, the quality, transparency, applicability, and everything. Score well. Moreover, we are not the only ones working with models and estimates. This happens in all countries. In general, this results in the same estimates and the same uncertainty margins everywhere. “

Wallinga: “There is a European modeling network in which all kinds of groups, like ours, work together and models develop together. Thus, there is mutual control, colleagues check each other’s work, also internationally. We’re not just messing around.”