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“What are the Belgian authorities waiting for” says Flemish virologist in Italy

Flemish epidemiologist and virologist Iris De Ryck, who lives in Italy, has written an open letter to the Belgian authorities.  She is urging them to take greater action now while it is possible.  Comparing the situation in Lombardy to that in Belgium, she says: “What exactly are you waiting for in order to implement the entire package of available measures? History will be milder for those who are led by facts and not by fear or hope.”

“Situations without precedent and manual like the COVID-19 pandemic demand proactive and exceptional measures in which you, as policy-maker, only need to make one fundamental choice: accept either that the measures may have been excessive or accept the possibility that you didn’t intervene sufficiently.“

Iris De Ryck says that extending measures in Belgium on the basis of real time data isn’t possible, but that Lombardy shows Belgium’s future in nine days’ time.

The effect of measures becomes clear with a delay of two weeks.  Step-by-step changes based on the real time information from Belgium is not possible.

Belgium’s population size, hospital beds (37) and intensive care units (1.3) per 10,000 head of population mirrors that of Lombardy.  There is no reason to believe there would be any significant difference in health care capacity here.

Limited testing capacity means normal checks on the scope of the epidemic are no longer possible.  The number of cases is unknown.  Diagnosed cases are an underestimate of the real number by a factor of between 5 and 10.

Belgium is following the exponential trend in the increase in cases recorded in Wuhan and Italy before the lockdown with a delay of 9 days: Cases are doubling every 3 to 5 days.

Iris De Ryck points out that the health care system in Lombardy is reaching its maximum capacity. She predicts this will happen in Belgium, especially given the laxer measures.

On 15 March there were 1,420 deaths in Lombardy, 14,650 diagnosed cases including 6,171 hospitalisations, 823 people in intensive care.

There is a shortage of healthy, trained staff, protective equipment (masks) and ventilators.  Health workers are at high risk.  Many are infected.

In Milan there are not enough ambulances to take the sick to hospital.

95 to 100% of intensive care beds are occupied despite cancellation of non-urgent interventions, extra beds, and triage of patients and dispersal of patients over hospitals in other regions. Over 60% of intensive care beds are occupied by COVID-19 patients. Growth models show that total capacity will be surpassed by between 10% (linear model within a week) and 150% (exponential model).

Iris De Ryck points to Wuhan, Hong Kong, Taiwan and Singapore where a lockdown was ordered with 0.4 diagnosed cases per 10,000 head of population. She argues that by using all measures to check the epidemic available to the authorities exponential growth of new cases seems to have stopped and mortality figures have been limited.

In the Limit phase (phase 1) this meant test all possible cases, track down contacts and quarantine them; Phase 2 involves imposing and checking all possible measures the authorities can take to achieve social distancing in order to slow the epidemic and prevent excessive pressure on the health care system.

Lombardy went in lockdown with 6 diagnosed cases per 10,000 inhabitants.  Belgium probably exceeded this figure on 15 March.

“With a mortality rate of up to 5% and cases doubling every 3 to 5 days every day we wait to take extra measures means extra deaths that could be avoided” says Iris De Ryck.

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