RIVM withheld concerns over overtaxed hospitals at start of pandemic: report

Before the first case of Covid-19 was diagnosed in the Netherlands, the public health institute RIVM knew that hospitals would be overloaded in every scenario of a coronavirus outbreak. But the Ministry of Public Health never warned hospitals about this, leaving them unable to prepare, NOS reports based on their own research.

On 9 February 2020, RIVM modelers sent a memo to management. “There are approximately 37,000 hospital beds in the Netherlands, including 1,208 operational ICU beds. This capacity is insufficient,” the memo said, according to the broadcaster. “For the entire range of estimates of [the] possible severity (...) we calculate that the demand for care exceeds this available capacity.”

The Ministry of Public Health recently released this memo after NOS discovered that a package of RIVM documentation from February 2020 contained none of the cited email attachments. Whether the Ministry deliberately withheld this information is unclear.

The RIVM told NOS that it shared this information with the Ministry at the time, and it is up to the Ministry to decide how to proceed with the information. In this case, whether or not to warn hospitals. The Ministry would not tell NOS why it decided against warning the hospitals.

Several experts are unpleasantly surprised by this development. They consider it a missed opportunity to give hospitals more time to prepare.

“If we had known this, we could have scaled up a lot sooner. That would have saved a lot of stress,” said Diederik Gommers of Erasmus MC and then the chairman of intensive care association NVIC. He added that the memo was not discussed at the Outbreak Management Team (OMT) meeting on 27 February, in which the RIVM participated. “If we had discussed even part of this, I would have immediately raised the alarm. I ended up only doing so on 8 March, when I got a call from the European ICU association.”

Jan Kluytmans, now of UMC Utrecht and then of Amphia Hospital in Breda, told NOS that he was “very surprised” by the memo. He made his own calculations about the expected pressure on hospitals in Noord-Brabant in early March 2020. “When we showed those calculations to the Ministry, they fell off their chairs,” he said.

Amsterdam UMC board member Bart Berden, who was very involved in the crisis approach as the chairman of the Regional Consultation Acute Care Noord-Holland/Flevoland, wonders about the administrative route this memo traveled and how it never ended up with the hospitals. “For me, therefore, the big question is which department of the RIVM or the Ministry of Public Health stopped the formal progress of this memo and why that happened,” Kramer said to the broadcaster. “This knowledge should have been given to the security regions and the GGD GHOR. They could have involved the care partners, like hospitals in the region, and prepared in good time.”