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    Belgium pays a high price for lack of tracing

    Prof. Steven Van Gucht © Belga

    The high number of deaths in retirement and nursing homes in Belgium and other countries have aroused concerns and questions whether the figures are comparable.

    Belgium has included both confirmed and suspected cases and other countries have started to recount their death toll.

    To clarify the figures, The Brussels Times contacted the federal public health authority (Sciensano), which is publishing daily reports about the situation in Belgium.

    In an interview with virology professor Steven Van Gucht, we covered not only the statistics but also other issues. Van Gucht, with a doctorate from Ghent University, is Sciensano’s spokesperson and was the right person to talk to.

    WHO informed the national focal points about a virus in Wuhan already in beginning of January but declared a pandemic only on 12 March. How did Belgium react to the information from WHO?

    “In fact, I received the first report about a virus in Wuhan already on New Year’s Eve (31 December 2019) from the Chinese authorities”, Van Gucht replied. “The report didn’t mention any human-to-human transition of the virus but we understood that something worrying was happening there.”

    “We started to follow the situation and became more involved when a lockdown was declared in Wuhan and the first European citizens were repatriated from there on 21 January. As a scientist, I understood that it was the beginning of pandemic and we didn’t wait for the WHO to define the outbreak as a pandemic. “

    Van Gucht’s comments in media on suspected COVID-19 related mortalities have seemed to differ from what other experts were saying. He has been quoted as saying that the suspected cases in nursing and retirement homes are “very probable” and that it’s “standard good practice” to include them in the death toll.

    “Absolutely, this is what I said about our measuring methodology. In most countries there were no sufficient tests and they have been underreporting the number of mortalities in retirement homes. We think that it’s really important that all cases are included based on the indications we have.”

    He gives the example of a retirement home, where two residents were tested for corona and the rest not. “But if others have the same symptoms, I would say that they have also been infected by the virus, especially when in each case a physician has attested it. We didn’t invent something new but are following the guidelines of ECDC (the European Centre for Disease Prevention and Control).”

    Van Gucht admits that there was a risk that Belgium was overestimating the number of COVID-19 related deaths but this cannot be claimed any longer after an analysis of the figures which was presented yesterday (23 April).

    The analysis shows that the total number of deaths have risen rapidly since 16 March with an excess mortality of 80% compared to previous years.

    “We think that we are very close to the truth,” he summaries.

    Some statistics however is still lacking. Is there a statistical breakdown of mortalities in the hospitals, showing if the people who passed away there were sent from the retirement homes or were living on their own?

    “The hospitals should have these figures. I think that a large part of those above the age of 80 who were hospitalised were brought from the retirement and nursing homes.”

    Protecting retirement homes

    What should be done now to protect the retirement homes and prevent staff and residents from infecting each-other, after all staff and residents have been tested?

    “It’s a difficult question,” he replies. “The virus entered the retirement homes via the staff. From the very start, visitors weren’t allowed to enter the homes but there was a lack of training and protective equipment and the first masks they had were mostly home-made.”

    “Now, the retirement homes are getting support and equipment from the hospitals. Furthermore, we are better in taking care of infected residents with milder symptoms. They are now isolated in intermediate facilities, revitalisation homes, and don’t have to be brought to the hospitals unless they have severe symptoms.”

    What was the reasoning for the decision to keep medical personnel with COVID-19 symptoms working as long as they didn’t have a fever?

    “The hospitals have no choice but to keep infected staff because of shortages in personnel. Of course, they have to wear masks but they are only caring for infected patients so there is no risk that they will infect others. If there is sufficient staff, they are sent home.”

    Sufficient ICU capacity

    In other countries, there is a shortage of ICU-beds or they risk being overwhelmed. In Belgium, less than half of the ICU-beds are occupied for the time being. Is there enough staff to manage all ICUs (ca 2,250)?

    Van Gucht reassures that the situation in Belgium is satisfactory. “When we talk about ICU capacity, it includes both ICU-beds, respirators and the staff required for them.”

    Only about half of the capacity is used currently. The only shortage has been medication for sedation and tubes. Some smaller hospitals ran out of ICU beds but in that case the patients were transferred to other hospitals in the country.

    In the beginning of the crisis, there was obviously a lack of test kits. How many diagnostic (laboratory) tests are carried out now on a daily basis and what is the goal? And how long time does it take from a test until the results are ready? During this time an infected person without symptoms can infect others.

    “We had a problem in the beginning,” he admits. “Since then, we have built up our capacity and increased the number of laboratories in collaboration with pharmaceutical companies. Currently, we are carrying out 8,000 – 10,000 per day and the goal is to reach 40,000 per day.”

    Contrary to other countries, Belgium manufactures the reagents and the sticks by itself and don’t have to compete with other countries in the international market. The bottleneck is in the field when staff is not available to carry out the tests. Ideally, the test results should be ready in one day but this is not always the case. According to Van Gucht, doctors have complained that it has taken up to three days.

    Failure to trace

    Tracing all persons who have been in contact with a confirmed case, as was done in South Korea, is important to flatten the curve. How is this done in Belgium?

    Van Gucht replies that there is no tracing. “There was some tracing in the beginning but we became overwhelmed by the rate of infections and for the moment there is no tracing because of the lockdown restrictions. We plan to do it in the future when some of the restrictions have been phased out.”

    Do you recommend people to always wear a mask when outside in order not to infect others (if you are infected yourself but without symptoms)?

    “In Belgium it’s not an obligation to wear a mask and we haven’t recommended it until now”, he explains. “For the next phase, when some of the lockdown restrictions will be lifted, we’ll recommend to wear a mask in closed spaces, such as shops and public transports, to protect others if you are infected. This is also in line with WHO’s guidelines.”

    Exiting the lockdown

    Belgium is planning an easing of restriction measures in May and other countries have already started to phase out their lockdowns. The European Commission last week issued guidelines on lifting the measures.

    A common methodology for all EU countries would be desirable to coordinate the phasing out of restrictions. In Belgium, a task force is working with modelling and determining the thresholds for deciding when the restrictions can be lifted but their work is internal material and is not made public.

    Has Belgium defined epidemiological indicators, e.g. the number of infected persons, hospitalisations and mortalities per day, to determine when the restrictions can be lifted?

    “The problem is that when we set a date in the near future for lifting some restrictions, based on the figures at the decision date, the situation can change until the lifting enters into force,” explains Van Gucht. “Today we have about 900 new cases per day which is too high and it’s impossible to trace all their contacts.”

    Steven Van Gucht is optimistic about the near future. “The coming week will probably be OK.” What he fears is that there might be a new wave of infections in Autumn on Winter. “If we loosen up the restrictions to fast, we might have to reimpose them again.”

    Compared to for example Sweden, with only 16,755 confirmed cases and 2,021 deaths (23 April), the situation in Belgium seems worse. Sweden is apparently counting on group immunity and has estimated that already 26 % of the population in the Stockholm region has been infected and possibly recovered with lasting immunity.

    “Sweden wasn’t hit so hard as Belgium and was ahead of the curve,” Van Gucht comments. “Its strategy to fight the coronavirus is a kind of experiment and gambling and we would need to know more about their figures. If the strategy works, we can surely learn from Sweden.”

    M. Apelblat
    The Brussels Times