'OMT members should not sit in talk shows'

‘I should record this,’ Jan Kluytmans thinks soon after the outbreak of the corona virus in the Netherlands. “This is going to be a special piece of history.”

As a medical microbiologist of the Amphia Hospital in Breda and the Elisabeth-Tweesteden in Tilburg, he will be directly confronted with the outbreak of the enigmatic new virus at the beginning of 2020, and he has been asked to join the Outbreak Management Team (OMT). “It was so hectic, and I’m not much of a diary writer,” says Kluytmans in his new office at the UMC Utrecht, where he has been head of the medical microbiology department since October.

Journalist and director Roy Ferwerda, who also joined, was in regular contact with Kluytmans at that time – they knew each other from a previous project, he says. Ferwerda also realizes how exceptional this time is. In April he proposes to follow Kluytmans. They take more than thirty walks together through the Brabant forests. He wrote a cinematic, personal book in which Kluytmans looks back on the first year and a half of the pandemic.

That book, Virus. Jan Kluytmans – scientist in times of crisis, is the account of a time when he lost his candor. From an exhausting year of overcrowded hospitals, screaming shortages, busy night shifts, sleepless nights, endless meetings. From openly critical colleagues, political scheming, allegations and threats. Physician microbiologists normally work in the dark: they do not cure people, but prevent them from becoming ill and advise on treatments. But in the pandemic, the whole country suddenly looked at them.

He decides to test his staff outside the rules. “The WHO line was that you had to have complaints and have been in China or Italy. There were signs that the virus was further along.” He is the first to note that the virus is much more widely spread than RIVM thinks. Fumbling with a British calculation model found on Twitter, he sees on 15 March that the hospitals will no longer be able to handle the numbers of patients within a few days. “That has accelerated everything.”

You raised the alarm, but it slowly dawned on the OMT.

Kluytmans: „The OMT meeting on 17 March, for the first time remotely, was hectic. There was a lot going on. Wide distribution was not discussed. Should I have said it more emphatically? I thought: this is dynamite. But it was not yet confirmed.

“The message got through to the Ministry of Health, Welfare and Sport through hospital director Bart Berden. Just in time, the country was locked down six days later and hospitals that still had room were no longer allowed to refuse patients from other hospitals. An ICU patient is expensive and complicated, and some hospitals have held back. They are private institutions. We then went along the edge of the abyss. If it had happened a week later, we would never have made it.”

You were also ahead of the pack when validating the home test. Self-testing was not allowed by law.

“Corona was a disease that you had to report by law to keep an eye on the pandemic, the diagnosis had to be made under the responsibility of a doctor. I knew: if I show it works, it can’t be used by that rule. I just started. That’s what to do in a pandemic. Minister Hugo de Jonge had to make an emergency law to be able to offer this for home use.”

Would you like to account for that period with this book?

“We certainly didn’t start that way. In April they were still applauding the care workers. It was not until the autumn of 2020 that a checkout culture increasingly emerged. I think this book is a great way to put things into context. When you look back, you have to look at things very carefully in the circumstances of the moment.”

Does the Dutch Safety Board do so in the first report on the approach to the corona crisis, dated mid-February?

“Most things are carefully written down. At the point about the nursing homes [waar duizenden ouderen onbeschermd waren en stierven – red.] is the problem deeper, it is not just a matter of a mask shortage. If you have not anchored infection prevention in your organization for years and such a contagious virus comes along, then you have no chance in advance.

“The OVV report on the second phase will be more robust. In the first wave we didn’t know what was coming at us, understandable mistakes were made there. The second wave was simply too late to intervene. We knew what was coming our way. All summer the R value, which shows how quickly the virus spreads, was above 1. Then the number of infections rises quickly. Some OMT members warned: the second wave is going to start sooner than you think. That signal was not picked up in the OMT meeting.”

Another important topic that was not discussed in the OMT meeting. Why not?

“It was following daily rates. We received so many requests for advice, they dominated the entire agenda. Then you have delays everywhere, you can’t have that with such an exponentially spreading virus. When things go wrong, you have to be very decisive. Everything that comes with it is disruptive. There are often as many as forty people in those OMT meetings. There is not always room to properly discuss a point raised by one or two members.

“We then had OMT consultations after the Catshuis consultation about the measures on Sunday. The relationship between advice and policy was not right. That has been adjusted, but has caused a lot of frustration in the run-up to the second wave. It was not until October 14 that there was a partial lockdown. During that time, I considered leaving the OMT a number of times.”

There was more disturbance. You were not happy with the Red Team, a group of experts who were critical of corona policy.

“It’s fine if people have a different opinion, but it became a political contradiction: us versus them. That should not be the intention.”

In your book you say: “The last thing we need in this crisis is constant public disagreement. That undermines trust, so you play into the hands of populists.”

“It’s not constructive. I also got off Twitter and stayed out of the media for a while. I don’t want to get into a polarizing debate. Our chairman Jaap van Dissel said: ‘OMT members, feel free to say what you want, but in a personal capacity’. Many of us, myself included, felt compelled to explain the advice in the talk shows. Is that the best way? You are introduced as an OMT member and the aggression then focuses on that person. Or you have to indicate whether, for example, there should be a curfew. That’s not my expertise. I’d like to come and tell you about something I know a lot about, but not as a general pointer.”

Some OMT colleagues, such as intensivist Diederik Gommers, did.

“That’s his choice. You can checkmate politics with your statements. The Health Council advised starting vaccinations with people over 80, Gommers and Ernst Kuipers [voorzitter van het Landelijk Netwerk Acute Zorg] felt that the healthcare staff had to go first, and Minister De Jonge had no choice left. What Gommers said had so much weight. We spoke to each other about it.”

And then there were the many threats. Someone even snooped around your house?

“Our house was for sale. That man made a viewing appointment, looked everywhere, and sent anonymous e-mails with allegations. Our camera caught that, we traced it. He turned out to be an internist, with children studying. It’s done now, he’s stopped. It has a huge impact on your family.”

Would you adapt the pandemic scenario for prospective OMT members?

“The OMT must remain a medical advisory team and not be too large. OMT members should not appear in the media on their own initiative, but should have a spokesperson. Don’t join talk shows every evening, and stay away from that role of interpreter of a social situation. I also think it is a journalistic responsibility of the talk shows. Of course you should not be silenced, but journalists should also think about what their role is after the pandemic and where they have not contributed positively or have frustrated processes.”

Follow The Money stated that you were concealing financial interests: you would be profiting disproportionately from the huge numbers of PCR tests by testing facility Microvida.

“There, tendentious journalism has created wrong images. Microvida is not a commercial laboratory, but a BV in which a number of hospitals are shareholders. Profits go to those hospitals, and a percentage of the GGD’s turnover goes to the partnership of medical microbiologists. You can find all kinds of things about that, but that’s how it is arranged in our country.”

That hurts, public money from which people earn exorbitantly.

“That’s how we organized care. Outside the academic hospitals, the vast majority of medical specialists are freely established, they are independent entrepreneurs. You earn from your transactions. More work means more income. There is a limit to insured care, but not to uninsured care, such as tests for the GGD. That has been under discussion in recent years. But if the journalism suggests that we have made money in a shady way, I think that is completely wrong.

“I told Roy back in May that it wouldn’t end up in my pocket. It had to go back to public care.”

Other sizes thought differently?

“Everyone makes their own decision. As a loner you cannot determine that the contract will not be executed. I have partly returned it to the GGD. I have been an independent specialist for 25 years, with a well above average income. Then you can make a different decision than young colleagues who bought into the partnership two years ago and have a large debt.”

You left the partnership and left Amphia Hospital. Why?

“I had been considering doing something else for some time, these situations were part of it. I have a moment break taken, I was ready for that. Then came this vacancy at UMC Utrecht.”

We are two years later, March 23 all measures are going overboard. Are we now able to react quickly to a new worrying variant?

“I hope that the cabinet will prepare for things to go wrong again this autumn. You have to ensure that you can scale up, such as with vaccinations and tests, and in the meantime make society more resilient. For example, by keeping the option to work from home, by ensuring that people with cold complaints stay at home, by using mouth masks if it increases quickly.

“In addition, we need to involve society more in the elaboration of measures. For example, you could ask the catering industry: there should be 30 percent fewer contacts, make your own plan. This is how every sector has to think along. And we have to do that in the summer, in preparation for the autumn.”

Is that happening now?

“I hope so. I mainly just want to do my new job now, I don’t see a major role for myself in the transition phase.

Would you rejoin the OMT in the event of a new pandemic?

“I think it’s a social duty, there are very few people with this expertise. And that was also realized with public money, thanks to my training and specialization. But if there are successors, I say: be my guest!

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