We know that omikron is much more contagious, but there are many questions about how sickening this variant is. You call your colleague intensivists abroad and you read the medical literature. What is your impression?
“At the moment there are no indications that omikron makes you sicker, more strongly: there are indications that omikron makes you less sick. But the data from South Africa, for example, are still difficult to interpret, because there are many infections there among young people. Comparisons with other countries are also difficult because, among other things, we have different vaccination rates of the population. Ultimately, we will have to see how it plays out here.”
RIVM boss Jaap van Dissel said during the last press conference that he don’t want to wait, because then it will be too late to correct it. He also said: suppose that omikron turns out to be much milder, then we will at least have reduced the number of infections with a hard lockdown. Is there anything to be said for that?
“I am ambivalent about that. The OMT uses a model in which more than a hundred people have to go to the IC every day. That looks disastrous, but those models contain a lot of uncertainty. What we do know is this: it is extremely helpful to vaccinate as many people as possible with a third shot as soon as possible. I don’t understand why the government uses so little imagination and improvisational power to fully focus on the booster campaign. School buildings are now empty, there are plenty of volunteers who want to test – the government should focus on that.
Another thing the government could do is address the population at risk. There must be more awareness come. If you are extra vulnerable to hospitalization due to known risk factors such as older age or underlying diseases and also have no or insufficient antibodies, pay extra attention. I also told my parents: ‘As long as you haven’t had the third shot, stay home as much as possible’. On the IC we almost exclusively see unvaccinated people between the ages of 50 and 75. Elderly people who have only had two injections are also at risk of a more serious course of covid. Very rarely do we see a person in their twenties or thirties, but they are just really unlucky, just like you can be unlucky due to a car accident.
The fact that we are now imposing this hard lockdown on all people who are at low risk, either because they have been vaccinated, or because they are young, or because they have been through covid, is quite something I think.”
Since May you have also argued for a broad debate with politicians, journalists, entrepreneurs, ethicists and philosophers, among others, about how we should deal with the scarce IC capacity. You don’t think it’s fair that covid always takes priority.
“I have felt that since the beginning of the pandemic, but I am starting to have more and more trouble with it. Someone said to me: ‘It seems like you can die from everything except covid’. There is a shortage of capacity, but everything that is available goes with priority to covid patients, thus declaring other patients as second-class patients. Last week during my shift at the non-covid-ic I moved heaven and earth to allow a patient to undergo a very serious oncological procedure. That did not work. In the meantime, I do get the message: ‘Armand, you need to make more covid spots’.
Within that IC scarcity, you should still try to distribute as effectively and fairly as possible. This means that we will have to adjust the admission criteria for IC Covid patients. That sounds harsh, but the admission criteria for the other patients have actually changed a lot since 2020. In one-on-one conversations with colleagues, I can sense that they agree with me, but nobody wants to join me in this. Everyone in society prefers to avoid this discussion.”
In the Netherlands, the bar for entering IC is already somewhat higher than in many other countries. Raising that bar even higher could cost the lives of covid patients.
“Yes, there is that risk. Just as much as people with other diseases are now at higher risk of dying. I estimate that that suffering and that disadvantage is already much greater in that category of patients than in the covid patients, certainly in the longer term.
Then we come to the part of what I call good talk. It’s very nice to say, ‘Everyone who has a chance to survive, we must give a chance’. We now know: thirty to forty percent of the covid patients who go to the IC die. Meanwhile, we all now reject people whose survival score is much better. If you have limited capacity, you have to make difficult choices. Now no choices are made. Yes, a choice is made by not choosing. We only look at the covid patients and what is happening left, right and behind us, we especially don’t want to look at that.
I want to keep looking 360 degrees around me, but I can’t do it on my own, while the others keep on good-talking. It’s time we talked about that elephant in the room.”
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