The position of Dutch authorities was that only people with symptoms could transmit coronavirus. It was repeated by the government, national and local health authorities, justifying a cascade of decisions that allowed the Netherlands to keep up a "business as usual" attitude even as the virus exponentially spread.
The problem was, it was wrong. As early as February 21st, Chinese doctors published a case of apparent asymptomatic transmission; German doctors wrote to the New England Journal of Medicine on March 5th to warn of a case near Munich. The World Health Organisation advises transmission without symptoms is possible.
Despite this the Dutch government and health authorities stuck to looser quarantine advice than other European countries up to the time of publishing, telling people who had travelled from China, outbreak spots in Italy, and Iran, that they need only self-quarantine if experiencing symptoms.
As well as being underpinned by a flawed assumption, the advice relies on people knowing whether they have symptoms or not. This is questionable: Chris Higgins, a GP in Australia, provoked an outcry after treating 70 patients while he had what he thought was the tail end of a mild cold, before he tested positive for Covid-19.
It's also in stark contrast to the approach in the countries most successful at containing the virus, such as Taiwan and Singapore, where authorities drew on their experience of the Sars outbreak to implement strict travel checks and preventative quarantine before even registering a first confirmed case.
The case of the Netherlands shows how a flawed belief about transmission filtered down throughout society, enabling the virus to spread. It also makes for a grand experiment in what happens when a country takes a relaxed approach to the virus, placing the maintenance of normality, personal responsibility and individual freedoms first.
The first coronavirus diagnosis in the Netherlands was on February 27th. As authorities traced his contacts, they found he had attended Carnival in the city of Tilburg in the North Brabant region on February 21st-25th. "The patient was not contagious in the days he celebrated the carnival," the mayor of Tilburg Theo Weterings told media.
In the following days, two more people who were at Tilburg carnival were diagnosed with coronavirus. One of them was a worker at Bannink Packaging in Drenthe in the northern Netherlands. His partner was also infected.
Bannink Packaging continued to operate as normal, saying the employee was not sick when he came to work. “The chance that he has infected colleagues is therefore rather small,” the spokesperson told media.
On March 4th, another Bannink Packaging employee – who commuted from Germany – was diagnosed with coronavirus.
“In Germany they are a lot stricter with testing . . . We should not exaggerate. Production continues as normal. In that respect, it is business as usual,” a company representative told media. “We advise our employees to stay at home if they have symptoms. We cannot do more.”
"What if someone decides to go to work or take an exam? This is their own responsibility"
On March 5th a third employee was diagnosed as positive.
On March 7th four more people tested positive in Coevorden, where Bannink Packaging is based.
That day 900 students of the university society Vindicat returned from a mass ski trip in Piedmont in northern Italy in a convoy of buses to the Netherlands. Amid public concern, authorities met the students and tested four, who were found negative.
“Someone who has no symptoms is not contagious,” Jossy van den Boogaard, MD in infectious disease control at local health authority GGD Groningen told media.
“Can the students also infect others while they have no symptoms? No,” was the official advice. “What if someone decides to go to work or take an exam? This is their own responsibility.”
On March 8th it was announced that a cleaning lady married to a Bannink Packaging employee had tested positive. The director of the school she works at wrote to parents to say there was no reason to panic, and that children could go to school as normal.
By this point the outbreak in the carnival region of North Brabant had reached the point that there were shortages of protective equipment for health workers, and people were advised not to call their doctor unless their symptoms were serious.
Lawmaker Eva van Esch told parliament a friend of hers had tested positive who had been refused a test for a week after returning from Italy with symptoms. Once positive, the friend had been asked to keep the diagnosis quiet and not to tell her work or contacts, van Esch said.
Twelve days after the first diagnosis, confirmed cases of Covid-19 in the Netherlands had risen from 1 to 382
“My party therefore wonders whether this government is actually focusing on preventing the spread of the disease, or whether the health services are primarily concerned with preventing panic,” van Esch said.
Dutch testing capacity is limited, forcing authorities to prioritise testing people with a clear link. Roughly 6,000 tests had been done in the Netherlands as of March 7th, national public health institute the RIVM said, a figure that includes double-testing to exclude false positives, and testing for recovery.
Twelve days after the first diagnosis, confirmed cases of Covid-19 in the Netherlands had risen from 1 to 382.