Advice from a Dutch doctor

Advice From A Dutch Doctor

Originally published on Cortes Radio.ca. This radio broadcast was funded by a grant from the Community Radio Fund of Canada and the Government of Canada’s Local Journalism Initiative

Dr. Erik Hockheimer was a general practitioner in the Netherlands before giving up his practice to work with Doctors Without Borders which he did in many countries throughout the world and continues to support an advisor. As a GP he was very involved in the HIV epidemic and that led him to co-author and edit a book on viruses called Virology, published in 1991. While with Doctors Without Borders he continued to work with tropical diseases, HIV, Hepatitis B, and Ebola. He’s retired now but still consults with a number of NGOs particularly around helping refugees. 

Viruses and how they work

“Viruses are very small little things and they need a cell to live in unlike bacteria or fungi,” says Dr. Hockheimer. They then use the factory of the human cell to reproduce themselves. This is why it’s harder to fight a virus with medication because when you attack a virus you attack a cell. It’s a very different story fighting a virus versus other bugs. Much of what we know about testing and treating viruses, including SARS and ebola come from what was learned from HIV.  “We don’t know yet if we can implement what we know on this virus,” says Dr. Hockheimer, who reminds us that though there are four or five coronavirus that pop up every year, we don’t know much yet about this version of the virus.

“I Like Viruses. Not Particularly This One”

Dr. Hochheimer reminds people that: “Viruses aren’t all bad. We wouldn’t be sitting here if theres’t weren’t viruses built into our DNA. They have been useful in our development.” 

There is a lot of panic around coronavirus and Dr. Hochheimer says that in his opinion some of it is hype, created by media coverage, but it is legitimate to be afraid in the face of a new virus that “there is no immunity in the world for it.” 

Though he reminds us that it is not truly novel, these things happen from time to time. The most well known is the Spanish Flu… an enormous amount of people died. The difference is that now the old people died and then the young people died, especially young men. 

What is it like in the Netherlands?

The government listens to the scientists and experts and follow their expectations. The whole purpose is to contain in at the moment rather that to eradicate it. “I am pretty okay with it [the Dutch response]. I don’t know how I would have done it different in this world.”  In Netherland, the whole purpose is to contain it, rather than to eradicate it. 

“For Holland it works, the people are pretty obedient, but of course we get reactions from France, Belgium, Germany, we are much to slack, etc., etc., but Sweden, Denmark, we do the same as in Holland. We try not to have actions based on panic, or so called gut feelings, we try to follow the models that the statisticians and virologist make and see how we can contain it the best. And Also take into account the psychology of the people and the economy. Because they are important to. It’s a balancing act.”

Even as the Dutch government announces loosening up the rules, Dr. Hochheimer says: “The way the Dutch government is doing it is quite good, they have the support of the population, they are very open about why they do it and what they do and a lot of explanation.”

“Children are hardly very ill with COVID, so the big discussion is whether they can open the schools or not,” says Dr. Hochheimer. The Dutch government announced right after the interview that they would be sending their young children back to childcare centres and schools.

What is the appropriate use of technology, such as Intensive Care

“If you are 80+ and you have any other disease or 70+ and co-diseases, don’t go to the IC, you won’t come out of it.  If you come out of it alive then your quality of life will never be what it was before,” says Dr. Hochheimer. The realization that many, many older people don’t come out of intensive care or come out with a very low quality of life has opened up quite a bit of discussion in the Netherland about quality  of life and the legitimacy of choosing to stay home or not go into intensive care. 

“Not doing things because we can do things but doing things because it’s useful to do things; which is a general problem in medicine. In many countries dying is such a taboo that people just do things because they can do and not thinking about the consequences of their acts are.” He noticed when he lived in Canada and the U.S. that this was quite an issue. 

“Euthanasia has always been something that has been in the Dutch public discourse. ….  It comes up now, when you hardly any chance to come alive or with a good quality of life out of the hospital, is it not much better to die at home with your family around, versus the hospital where you die alone?” He says when he gets COVID-19, he’d not go to intensive care as he’s 71 and a smoker and he knows it wouldn’t make sense for him. Rather, he’d choose to fight the disease at home, or maybe get oxygen. 

Advice From A Dutch Doctor With Global Expertise In Viruses

“You can’t keep it out,” says Dr. Hochheimer, but you “can learn from what is happening in the world and how it is going in other places and what is the best way to tackle it and that way you can learn what to do, but don’t close the island.” He reinforces what an advantage it is to be able to be able to learn from other places in the world and to be better prepared than Italy or New York. He’s advice for getting prepared boils down to:

  • When people have symptoms, isolate
  • Ensure there are places for people to isolate
  • Make sure there are enough tests on the island and people to do the tests
  • Come up with a plan for how people will get to the hospital if needed
  • And have a discussion about the problems with intensive care and whether people want to go there knowing the issues and lifetime health consequences from intensive care treatment 

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