Dutch Cooperation Made an ‘Intelligent Lockdown’ a Success

(Bloomberg Businessweek) -- Across a small square from Amsterdam’s Mint Tower, where the Dutch Republic manufactured coins in the 17th century, begins Kalverstraat, one of the busiest shopping streets in the Netherlands. Dozens of major brands such as H&M, Nike, Swatch, and Swarovski are here. On a pre-Covid-19 Saturday, about 7,000 people an hour might pass a storefront along the pedestrian thoroughfare..The morning of May 15, of course, is different. Almost all the stores are open, but construction workers taking advantage of the reduced traffic to make improvements practically outnumber shoppers. Among those on the street is Gerard Zandbergen, chief executive officer of Locatus, a Dutch research house that provides data on the Benelux region and major European cities to customers such as banks, retailers, and government agencies..“Our clients want to know how many people pass by their store each hour and each day and how many come in,” Zandbergen says, sipping a takeout coffee near the Begijnhof, a 14th-century courtyard. Sensors strategically positioned in shopping areas gather signals from nearby phones, which the company analyzes to determine how many people move through a particular location at any given time. Locatus’s data are similar to what Google and Apple have been making available to health authorities and others seeking to understand the effects of lockdowns on mobility around the world, but in greater detail..On March 12, two weeks after the first Covid-19 case was diagnosed in the Netherlands, Prime Minister Mark Rutte held a press conference at which he asked—asked, not ordered—everyone in the country to work from home as much as possible. Two days later, Locatus data showed that foot traffic on busy retail streets such as Kalverstraat dropped by roughly 80%. In Paris and Madrid, after national governments instituted mandatory stay-at-home measures, visitors to destination shopping streets fell by about 95%, Zandbergen tells me as we sit at opposite ends of a long bench to maintain an appropriate distance..But 2 kilometers away in the De Pijp district, Ferdinand Bolstraat—with its Albert Heijn supermarket, Ron Verboom bakery, and Simon Levelt specialty coffee and tea shop—was a different story. Neighborhood commercial districts in the Netherlands have seen little change in foot traffic since Rutte’s request. “People still need to eat and take care of themselves,” Zandbergen says..And by and large, the Dutch did so responsibly. Shopkeepers rearranged shelves and affixed construction-site tape to guide customers through the aisles so they could maintain safe distances. The number of people allowed in is controlled by limiting available shopping baskets, and employees at the door make sure everyone takes one. Most shoppers will stand aside to let another pass so they don’t come too close..All this was quickly improvised in the first couple of weeks after Rutte’s request. While restaurants are struggling to survive, Thijmen de Loos, the owner of the Simon Levelt where I buy my coffee, says business is actually up since the lockdown—even as his delivery service to offices has collapsed. “Nobody’s getting their coffee at work right now,” he says with a grin..While Paris, Milan, Madrid, and most other major European cities became virtually unrecognizable when they went into extreme lockdown, life in Amsterdam has been little changed. Children in Spain were barred from leaving their homes for six weeks. Parisians faced a fine if they failed to fill out and carry a form explaining why they were outside whenever they left home. Although traffic in Amsterdam is down, on the way to Kalverstraat to meet Zandbergen, I still needed to dodge pedestrians, bikes, cars, delivery vans, and trams. More than three months into the outbreak here, the Netherlands hasn’t seen a single day of the strict lockdowns common elsewhere..“Controlled distribution among groups that are least at risk is our scenario of choice,” Rutte said in an address to the nation on March 15. The idea was to “build up population immunity.” In Europe, only Sweden has instituted fewer closures and restrictions—and it has suffered greater mortality..The strategy is perilous. Almost 6,000 people have died from Covid-19 in the Netherlands, and estimates suggest that less than 6% of the population has been infected, which would leave a lot of room for any subsequent waves. “You have to be vigilant,” says Eileen Choffnes, the immediate past director of the U.S. National Academy of Medicine’s Forum on Microbial Threats and now a consultant on infectious diseases. Allowing some spread, she maintains , is tantamount to letting some people die. Maggie de Block, Belgium’s minister of public health, has been sharply critical of the Dutch approach. “They’re letting the virus run loose,” she told Brussels newspaper De Morgen. “It’s a dangerous approach.”.The mitigation phase of the Dutch response to coronavirus largely worked when compared to its neighbors. The Netherlands, like much of Europe, was hit very hard early in the pandemic—but the country also had among the world’s briefest peaks in new cases. On March 26, the death count was doubling every five days; two weeks later that had slowed to 11 days, and the death rate has continued to fall while testing has accelerated. Daily new hospitalizations plunged from 610 at the peak on March 28 to an average of one per day by the last week of May..The mortality rate compared to the same period last year (a measure for estimating the true death toll of coronavirus in the absence of precise data) leapt by half during the worst of the outbreak. But it fell to zero by May 22, Dutch government data show. According to EuroMomo, a mortality monitoring organization, the jump is less than the rise in Belgium, Italy, or Spain, all of which had stricter measures (though Germany has fared better, with a lockdown that was less restrictive than most of Europe but tighter than the Netherlands). In Amsterdam, the mortality rate this spring has been pretty much the same as it always is. Dutch intensive-care units never maxed out, and now they’re empty enough that regular non-elective surgeries have recommenced..The Netherlands has both flattened the curve and kept life tolerable..Rutte’s government was slow in its initial response to Covid-19. France reported the first case of the coronavirus in Europe on Jan. 24, suggesting that China’s insistence that there was no clear evidence of human-to-human transmission wasn’t to be trusted. A Belgian on an evacuation flight from Wuhan to the Netherlands was diagnosed on Feb. 4; at that point, it could be safely assumed that SARS-CoV-2 was in the country. Yet Rutte allowed Carnival celebrations to continue on the weekend of Feb. 21, with revelers crowding into stifling bars throughout the largely Catholic south, which quickly became a hot spot..It wasn’t until March 9 that the prime minister and the coalition government led by his center-right People’s Party for Freedom and Democracy advised against shaking hands and asked people in the southern province of Noord-Brabant, with almost half the cases at the time, to work from home if possible. The Netherlands already had 321 documented infections. Three days later, the work-from-home advice was extended across the country. Rutte banned events of more than 100 people and asked medical professionals not to leave the country..On March 15 he closed schools, though he left some open as day-care facilities for children of essential workers. More than three people not of the same household were required to keep a 1.5-meter distance from each other. That restriction remains in place, enforced by an uncompromising €390 ($435) fine. Cafes, bars, restaurants, gyms, and any profession requiring contact or close proximity to customers, such as dentists and hairdressers (and, this being the Netherlands, brothels) were required to close within the hour. But parks, beaches, and stores—not just “essential” ones like groceries, pharmacies, and gas stations—could remain open..The Netherlands was opting for what Rutte termed an “intelligent lockdown.” In a nationally televised address, the first by a Dutch prime minister in more than four decades, he noted that restrictions have a price, even if they’re not immediately visible. “We will continue to search for the balance between needed measures and allowing ordinary life to continue as much as possible,” he said..Rutte’s guiding principles—allowing people to go out but trusting them to practice safe distancing—asked a lot of his constituents. “The whole plan relied upon public support,” says Daan Roovers, a medical doctor, professor of philosophy at the University of Amsterdam, and the “thinker of the fatherland” (an unofficial title bestowed by Philosopher magazine and the newspaper De Trouw). “When you impose a rule in the Netherlands, there will be a lot of resistance—we’re not that obedient,” she says. “So if you leave people a little room to maneuver for themselves, to think for themselves, you’ll gain more support and it will be more successful.”.This is grounded in Dutch history and—to the extent such a thing can be said to exist—the national character. Bas Heijne, a columnist for Amsterdam newspaper NRC who lives part-time in Paris, says France “is very much about procedures—the ornament, the ritual of bureaucracy.” In the Netherlands, by contrast, “the attitude toward the crisis was much more talking about people’s own responsibility—it must all come from the inside, not from rules.” Indeed, on March 12, Rutte said, “I want to call on everyone to keep an eye on one another. Help each other where possible.” Automated announcements on the Amsterdam Metro echo him and ask riders every few minutes (in Dutch and English) to keep a distance of 1.5 meters..For the Dutch, sacrificing a measure of freedom to achieve a shared goal is a notion that goes back to the 11th century, when Netherlanders started cooperating to drain bogs and beat back the ocean to reclaim land that was later divided among the volunteers as farms. Nine out of 10 Dutch people said in March they were “willing to give up some of their individual freedoms to keep the coronavirus from spreading,” according to polling by Motivaction and the WIN/Gallup network..The Outbreak Management Team advising Rutte consists of epidemiologists, physicians, and public-health experts, but no economists or business interests. Although the group’s public statements don’t indicate that economic or long-term health effects were taken into consideration when deciding how to fight coronavirus, the Netherlands’ gross domestic product fell 1.7% in the first quarter, vs. a decline of 3.5% in the European Union..A growing body of evidence in the emerging field of life-course research suggests that the intelligent lockdown will benefit both the Dutch economy in the short term and the nation’s health in the long term. Poverty, in short, is bad for your health, and avoiding it lifts the economy through reduced medical costs. Strict lockdowns may produce social, economic, and health consequences that won’t be felt for years or even decades: Adult health and disease risk is linked to damaging experiences in childhood and even gestation. If your mother ate poorly during pregnancy, you’re at greater risk for cardiovascular disease. And a vicious 1998 ice storm in Quebec that knocked out electricity for 4 million people for days highlights the broader effects: Children of women pregnant at the time had low birth weights, which can cause lifelong health problems, and low fine motor skills, a predictor of diminished school performance in early grades..“What we do now for health will also contribute to the economic recovery,” Health Minister Hugo De Jonge wrote in an April 7 letter to parliament explaining his recommendations to Rutte. “This is no contradiction—these are two sides of the same coin.”.The Netherlands can afford to take a softer approach to the coronavirus because its population has more of what City University of New York economist Michael Grossman calls “health capital.” The Dutch are less likely than their neighbors to suffer from underlying ailments and habits that are disproportionately represented among serious cases and deaths from Covid-19. The Netherlands has lower rates of obesity and smoking than almost anywhere else in Europe, and its cardiopulmonary obstructive disease rate is the region’s lowest. Like a business that’s been ordered closed but has sufficient financial resources to stay afloat, the Dutch have relatively robust health reserves going into the illness..Dutch health agencies have been busy hiring people to carry out testing and contact tracing, and though some critics say they’re not ramping up quickly enough, on May 6 the country exceeded the World Health Organization benchmark for testing rates. Rutte lifted some measures on May 11. Primary schools were allowed to reopen on the condition that they alternate groups composed of half of each class. My younger daughter’s school added measures such as staggering arrivals and affixing yellow tape to hallway floors and making sure children walk to the right of it. Others require hand-washing between classes..Hairdressers and dentists (but not prostitutes) are back in business, taking extra precautions. Some library branches are open in Amsterdam. Data from Locatus show foot traffic on Kalverstraat back to almost half of pre-pandemic levels. In Sweden, coronavirus response czar Anders Tegnell on June 2 told national radio, “If we were to encounter the same disease again knowing what we know today, I think we would settle on something between what Sweden did and what the rest of the world has done,” Tegnell said. One such in-between spot would be, of course, the Dutch strategy..In the Netherlands, outdoor terraces at cafes, bars, and restaurants reopened on June 1—with tables spaced far apart and reservations staff asking if parties of more than three were from the same household. (Not that it mattered much: With so many hopeful diners desperate to get out, by the time restaurants were seating people it was almost impossible to get a table.).“We’ll do this as quickly as possible but no faster than is responsible,” Rutte told reporters on May 6. “Caution now is better than regret afterwards. This warning applies to everything we say today: We can only unlock the Netherlands if everyone continues to behave wisely.”.That will be a challenge. When temperatures climbed to the high 70s on a national holiday on May 21, crowds became too big to maintain social distancing in parks, and police closed them to new visitors. By the following holiday, June 1, the Amsterdam authorities had installed crowd-control fences and had painted circles in the grass to limit contact among groups. After so much time in isolation, “there’s going to be an enormous amount of traffic on the streets,” predicts Martijn Potgiesser, owner of the pizza place on my corner, De Pizzakamer. “More than last summer.”.©2020 Bloomberg L.P.

Dutch Cooperation Made an ‘Intelligent Lockdown’ a Success

On May 15, almost all stores were open but construction workers took advantage of the reduced traffic to make improvements.

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