‘Dutch corona policy causes more suffering than it prevents’

How did a clinical ethicist and a psychologist from the Faculty of Business Administration come together to write a paper on the measures being taken to combat Covid-19?

Erwin Kompanje replies: “It was her idea – she should explain.”

Michaéla Schippers says: “I was worried about the measures that were being taken. When people go into lockdown, that’s intense, even if it only lasts two weeks. But it soon became apparent that it would last longer. People were terrified; vulnerable people had hardly any access to care or psychological support, and my mother was locked up in a nursing home. I thought: This is going to have huge negative consequences across all sorts of areas – social, psychological, and economic, not just public health. But around me there was scarcely any interest in criticism. People waved it away. I contacted Erwin after I read a story on his blog in which he also expressed his concerns.”

EK: “You set up a policy to achieve a goal. Here the goal was to reduce the influx of patients into the healthcare system to prevent it from becoming overburdened, causing even more people to die. That seemed to work at first, and the curve flattened out a bit. But every remedy has side effects, even now. As an ethicist, it’s my job to constantly weigh up the good and bad outcomes of a measure that has been introduced.”

In the piece you wrote together, you systematically outline the main adverse effects one by one. An economic crisis, increasing inequality, inhumane conditions in nursing homes. You also state that the measures are endangering public health. In what ways?

EK: “We have a natural resistance to all kinds of diseases because we have an immune system. It is generally quite capable of rendering all kinds of pathogens harmless. But we know that the workings of that immune system are influenced by the environment. Stress, for example, reduces your resilience, while meaningful social contact, touch and sunlight actually boost your immune system. During the lockdown period, social contact had to be kept to a minimum and people were unable to go outside and, as various studies have shown, they consequently suffered significantly from more stress and anxiety. You could say that healthy adults still had some freedom of movement, but vulnerable people and the elderly did not. What really provoked me at one stage were the reports that came out of nursing homes, care homes and hospices. People had been placed in isolation, were no longer allowed to see their families and loved ones and could no longer even sit in the garden.

MS: “I call that ‘the corona paradox,’ meaning that we are actually weakening the people who we want to protect. This is reflected on all kinds of fronts. For example, the fact that people with other medical conditions – such as cancer, heart problems or neurological problems – have had less access to care in recent months because everyone was focused on COVID-19. And it has been calculated that the global economic slowdown may ultimately lead to as many as 100 million deaths. The lockdown was a drastic measure.”

Let’s go back to March for a moment. The intensive care units were filling up and we had to deal with an exponential increase in the number of patients. Erasmus MC was the epicentre of the Dutch corona battle with a press conference almost daily. It was not an inconceivable scenario that the patients would be dying in the corridors of hospitals within a few weeks. A major intervention was absolutely essential, wasn’t it?

EK: “In the beginning there was definitely something serious happening. It started in Brabant, where the first patients with COVID-19 turned up. We only knew what the situations were in China and Italy and had no idea what was about to happen here. But we are a pretty well-organised country, aren’t we? In the hospitals, we soon realised that the patients would never be lying in the corridors here, not even when the maximum IC capacity was reached. By that time, it had become clear that there were still two thousand beds available in Germany, where the peak had already passed.”

I’m having a little trouble with the suggestion that we were worried about nothing.

MS: “You didn’t hear us say that.”

EK: “No.”

MS: “There was definitely a problem. At one point I even taught my son – he was four at the time, and has just turned five – how to call the emergency number. I had heard about a woman in America whose child had sat next to her for two nights even though she had already died. That was an absolute nightmare scenario. But we learned about the virus very quickly. That, for instance, the average age of people who died in the Netherlands was 82.”

An estimated 9,000 people have died in the Netherlands. The official figure is 6,000. Have they all been elderly patients?

EK: “Of the more than 6,000 patients counted so far, only 15 were younger than 40. By way of comparison, 2,700 people in that age bracket die each year in the Netherlands from another cause, such as a traffic accident or cancer. Out of the seventeen million citizens, approximately 46 percent are under 40. Based on 15 deaths, there is a 0.00019 percent chance that you will die of COVID-19 if you are in that age group. Statistically speaking, that’s negligible.

MS: “I just read that young people overestimate their chances of dying from COVID-19 by five hundred percent.”

EK: “The vast majority of the fatalities are elderly people and many – in 70 percent of cases at any rate – were suffering from underlying conditions, as in comorbidity. COVID-19 affected almost exclusively elderly people and those with a failing immune system.”

So they would have died within the coming year anyway?

EK: “Yes, chances are that they would have. Every autumn, thousands of people also die of influenza -the seasonal flu -in care homes and nursing homes. As you get older, your immune system starts to deteriorate. That’s why old people are more susceptible to all sorts of disorders. Most men die aged around 70-75, women around 80-85. A few exceptions live to be 90, and even fewer to 100, but then it’s over and done with. At one point I heard someone on the radio say that his mother, who had just died of COVID-19 when she was 84, could have made it to 94 if only the measures had been stricter. Yet, during that ten-year period, there really are still a number of bumps ahead for someone of that age. We live under the illusion of immortality. But at some point, we are going to die of something. That’s also not such a bad thing, because frankly, in the meantime a lot of children are being born.”

Michaéla, in an interview you gave, the term mass hysteria came up. What did you mean by that?

MS: “The choice was made very clearly for a certain slant: we are at ‘’war’’ with an ‘unknown enemy’. There were daily updates on the number of ‘casualties’, there was talk of healthcare staff on the ‘front line’. At first there was still some dissent, even in the mainstream media. There was talk that COVID-19 was not much more serious than an average flu outbreak, for one thing, but they were quickly stifled. Apparently, there was only one course of action to be taken. The editor-in-chief of de Volkskrant literally admitted in a radio interview that some information never made it into the newspaper.”

Surely, there must also be something wonderful about a society that is able to do this?

MS: “The great thing about human beings is that an individual is willing to make sacrifices for the greater good. However, the sacrifices that are now being made are pointless. The problem is that people are not willing to hear that. Cognitive dissonance sets in. They tend to think: I have gone bankrupt, that must be for the greater good. People literally ask me to stop sending them critical articles about the measures.”

Are you experiencing that within the university as well – which is supposed to be a place for critical debate and independent thinking?

MS: “Yes. What surprises me is that intelligent people don’t realise that all sense of proportion is lost here. Apparently, people do not see much beyond their own circle.”

Who is to blame for this?

EK: “I think a lot of damage has been caused by the media. Every day people ask me: Do you know how many people have died today? But I never kept track of that, not of any illness, by the way. The relentless flow of information has generated a lot of anxiety and unrest.”

MS: “The media have played a very damaging role. There is always less room for dissidents in a crisis situation. In our article we refer to a number of classic social experiments – by Asch and Milgram and the Stanford Prison Experiment – and it shows time and again that people are very keen to obey. That can be explained, by the way. In prehistoric times it was often a case of either fight or flight. Someone who wanted to seriously discuss the policy at some point might prove to be deadly. But that group behaviour has become dysfunctional in this case. Look at what we have done. And it’s not over yet. It’s not for nothing that I demonstrated against something for the first time in my life. I wrote a letter to Mark Rutte. These are things I’d never done before. It takes up an incredible amount of time of my time and I would have preferred to continue writing papers, but I don’t want my son to grow up in a kind of police state.”

Is that really what you’re afraid of?

MS: “I don’t know if you’ve read the new bill, but the plan is to suspend all civil liberties indefinitely.”

Are you also afraid of that Erwin?

EK: “Well, perhaps I see things slightly more detached. But in this kind of metre-and-a-half society, I do see a lot of negative consequences for the psychosocial development of young people in particular. We are social animals.”

Your critical analysis is received with enthusiasm in various quarters, including among groups who have a deep-seated distrust of the government and science. Interviews with you have been quoted by the anti-vaccination movement and conspiracy thinkers. Does that bother you?

EK: “That is the risk of giving interviews. They’re cut and pasted, and there’s always a caption that’s overly exaggerated. Then all of a sudden you turn up amongst the anti-vaxxers, whom I have absolutely nothing to do with. Well, evidently, that’s my fate.”

MS: “I think we both have a very nuanced story to tell. But what’s happening now is on such a scale that people are seeking a way to deal with it. One of the potential forms of coping is conspiracy thinking, even though there doesn’t necessarily have to be any malicious intent behind the draconian corona policy. It could very well have happened by accident as a kind of bandwagon effect. We saw what happened in China and thought: We should do that, too. So everyone went into lockdown.”

You say it could very well have happened by accident. Does this mean that you are keeping an open mind on the possibility that there is definitely malicious intent at play?

MS: “I am absolutely not a conspiracy thinker, yet I cannot rule it out. Look, a conspiracy theory is by definition an unproven theory. As long as it is unproven, then I say somebody else should figure that out. I can still explain everything without there having to be a master plan behind it.”

EK: “I find it all so uninteresting, those conspiracies. I am a scientist; I want to be able to prove things. The first thing I did when I wanted to understand something about the situation in nursing and care homes was to delve into the scientific literature on isolation and quarantine and their effects on the psyche, physical health and the immune system. That is my foundation. I have no affinity at all with conspiracies, zilch.”

There has been much criticism of the fact that virologists initially determined policy. Should this be done differently next time?

MS: “There are a number of techniques for getting around groupthink. What they have in common is that you organise reflexivity and bring various perspectives together. Let another team, one with philosophers, economists or behavioural scientists, take a shot at your plan.”

EK: “Early on, it was logical that we listened to the virologists. They understand best how such a virus behaves. But if halfway through it turns out that the number of hospital admissions is decreasing, you also have to look at other perspectives. That has not happened enough, at least not in the mainstream media.”

In the meantime, the obligatory easing of measures has been announced. Where do we go from here?

MS: “As far as I am concerned, the measures should be phased out even faster and replaced by evidence-based measures. And a delta plan must be put in place to address all the problems that have now arisen. Not only an economic support package, but also to remedy the damage inflicted upon the mental and physical health of the Dutch.”

EK: “We have required enormous sacrifices from a large group of people to protect a small one. I think we need to start thinking about solidarity in some other way. We now know that a large percentage of those who became seriously ill from this virus already had another health condition. Many of them are diseases caused by an unhealthy lifestyle, such as obesity or diabetes. We have all shown solidarity. I think we can expect this group to change some things in their unhealthy habits to make any ensuing pandemic somewhat milder. I am quite willing to say: Lifestyle diseases belong to us as human beings, but fungi, bacteria and viruses like the coronavirus are part of it, too.”