Stefano Di Pietro

Mar 17, 2020

7 min read

Is there an alternative to Lockdown for Covid-19?

Why the Netherlands (and other countries) might be widely underestimating coronavirus

On March 11th I made a post on Facebook after looking at the data of positive cases to COVID-19 in the Netherlands and I noticed some shocking similarities while confronting it with the trends globally.

Already on the day before I assumed, following those global trends with a particular focus on the growth rate in Italy, that there would be an increment of 25% per day, in the following days.

On the same night, exactly three hours after my post, Andreas Voss, professor of infection prevention at Radboud UMC, a person much more qualified than me, was being interviewed at NOS and was making the same claims. He noticed that the trends of the Netherlands were astonishingly similar to the ones of Italy which now has more than 25K cases.

The total number of Covid-19 cases in The Netherlands is now 1413 but, unfortunately, it is going to rapidly grow.

Stefano Di Pietro’s graph on the number of total cases of Covid-19 in the Netherlands (Updated Mon 16th)

After 5 days of monitoring, I found that my forecast was accurate to a 97,88% degree. The daily growth of cases on average has been 24,47% in the past 5 days.

Stefano Di Pietro’s graph on the number of total cases of Covid-19 in the Netherlands in the last 5 days VS projections

Considering the (mild) measures taken, this number is destined to grow. It will probably be less than 25% in the next days, but if this trend continues it will be a complete disaster.

Consider that the data reflects perfectly what experts call exponential growth, a function where the number of new cases is directly proportional to the number of previous cases. If you are not familiar with these curves you can watch this video below.

Exponential Growth: a Commonsense Explanation (Source: Generally Interested)

The thing about exponential growth is that at the beginning the number grows just a little (in terms of absolute numbers) but the growth later becomes enormously higher because, as said, the previous number influences the next one. It becomes clear now why this applies very well to an epidemy.

The number of infected people is a huge factor in the number of people who can (and maybe will) be infected. This means that if the growth continues as it is now there will be

+6000 cases of Covid-19 by next Monday, March 23rd.

Maybe this number doesn’t look so scary but it grows exponentially. This means that by the end of the month, just another week, the cases of Covid-19 in The Netherlands could be more than 30.000. More than the current cases in Italy. I think (and hope) that because of these measures the growth will slow down but in an optimistic scenario I think it will be around 15%-20% a day which will mean still

+10.000 cases of Covid-19 in the Netherlands by March 31st

Data from the World Health Organization suggests that the fatality rate of the virus is between 2% and 6% (You can see a detailed report here). This will mean that given even an optimistic trend

+/- 500 people in the Netherlands will die for coronavirus by the end of the month

We also know that 75% of the deceased is male and the majority of them is over 70 years old. We also know that none under 30 years old died, at least in Italy, the country that provided the most reliable data now at a European level. However, the number of people who need medical attention in the hospital is around 20% and this includes also younger people. If that cannot be provided, 2000 people in the Netherlands will die for coronavirus in the next two weeks.

If you believed the story of the “herd immunity”

It has not been proven anywhere that patients recovered from coronavirus will not catch it again. Just a few days ago, a woman in Japan was found positive to Coronavirus for the second time.

But even if this seems a rare case, it has not been proved that such immunity will be developed without a vaccine. We should base our decisions on solid science and not on assumptions. But even if that was possible this is the scenario as analyzed in the UK by Prof Willem van Schaik, Professor of Microbiology and Infection, University of Birmingham:

“Unfortunately, a very rough estimate suggests that we will only reach herd immunity to Covid-19 when approximately 60% of the population is immune (and remember that immunity is currently only reached by getting the infection as we have no vaccine!). The major downside is that this will mean that in the UK alone at least 36 million people will need to be infected and recover. It is almost impossible to predict what that will mean in terms of human costs but we are conservatively looking at 10,000s deaths, and possibly at 100,000s of death…”

Could Dutch hospitals handle these numbers?

The number of hospital beds in the Netherlands for 1000 people is close to the one in Italy, the UK, and the USA and it is around 3.5.

Stefano Di Pietro’s graph of the number of hospital beds in several countries (Source: OECD)

So considering that the population of the Netherlands is almost 4 times smaller than the ones of Italy and the UK also the total number of hospitals beds is 4 times lower.

Number of critical care beds in Europe (Source: Intensive Care Med 38, 1647–1653 2012)

Furthermore, the number of intensive care beds in the Netherlands, which in some cases are necessary, is quite small compared to other European countries.

Italian hospitals are currently struggling with +27000 positive cases of coronavirus and Spain just called a state of emergency that allows the central government to legally confiscate goods and take over control of industries and private facilities, including private hospitals. They “only” have 11K positive cases of Covid-19 and more than 3 times the hospital beds of the Netherlands.

What will happen when the Netherlands will reach that number? And what if I tell you that, even in an optimistic estimation, it will happen in 2 weeks?

Stefano Di Pietro’s graph of total cases of COVID-19 projections (15% increment daily)

What shall we do then?

The only thing that we can do is to avoid the spread of the virus by containment, while researchers find a solution to slow down the contagion by developing a drug and/or find a vaccine.

But the wait is long. The USA started testing the first vaccine but, even if it will pass testing, it will not be ready before 2–3 months. In Utrecht, a team of experts developed a promising antibody that might stop the spread of the virus, but testing it will also take months:

The antibody still has to be tested on humans (and this will take months) and the article is under peer review before Nature will publish it. But Grosveld is hopeful: “We expect an email any moment”, says the Spinoza Prize winner in his lab on the tenth floor.

That is why containment, for now, is the only measure that has been proven effective and, given the numbers, while we explore other solutions, we have to stop the spread.

Containment worked in China (that now has an increment steadily below 1%) and is giving the first promising results in Italy after a week of lockdown. We need to act fast.

Shall we give away our freedom?

Containment doesn’t need to be a militarized situation. It can be different but it will need a huge sense of responsibility and respect for the rules by the people living in the Netherlands.

Photo by Bogdan Todoran on Unsplash

What made me fall in love for this country was, among other things, the great sense of community and the responsibility that people feel towards each other.

It is possible to carefully respect the indications of the World Health Organization, stop the spread, resist and go back to our normal life soon.

It is false that it will take 1 year, the outbreak in China was “only” two months ago and people are slowly going back to their regular lives.

Stefano Di Pietro’s graph of % of daily cases VS total cases in China

But this will be a horrible neverending story if we don’t contain the spread. This is not the flu, this is a painful disease and highly dangerous threat.

Saying we should all get it and develop an “herd immunity” as politicians are saying is not acceptable, this means treating people‘s lives like they don’t matter. People cannot afford to accept any decision based on weak assumptions and not science.

We should act now, and fight the virus. It is going to be hard, but it will not be the worst thing in the world. The worst thing would be to leave a virus like this spread. Most of the European countries are starting to realize it and applying strong measures to stop the spread but, as Ursula von der Leyen said clearly:

“Member states have taken measures to stop the spread of the virus. These measures are effective only when they are coordinated”.

Let’s show the world that this country can make it, that lives matter, and that we can take on the responsibility and fight this invisible enemy, together.