Introduction

The first confirmed COVID-19 case in the Netherlands was reported on 27 February 2020. Two weeks later, the number of new cases had risen to around 200. It was decided not to conduct contact tracing anymore for all identified cases because the regional public health services could not handle the caseload. Over March, the number of new cases continued to rise, and so did the number of hospital admissions and deaths, a problem for the Netherlands, a country with a relatively small number of hospitals and, especially, intensive care beds. On 13 March, only 2 weeks after the first confirmed case, ‘code red’ was promulgated for hospitals in the (catholic) province of Noord-Brabant – where Carnival turned out to have been a super spreading event. All non-emergency surgeries were postponed, and the leaves of care workers were revoked. Many hospitals in other parts of the county took the same measures, preparing for a large influx of COVID-19 patients. In addition, many GPs contacted their older patients – either on their initiative or asked to do so by hospitals – to talk with them about whether they wanted to be treated in an ICU in case they contracted COVID-19.

Consequently, the public and political debate in the Netherlands and government policies throughout this first wave revolved around hospital capacity and, in particular, the capacity of ICUs. As a result, lockdowns were promulgated to avoid collapsing the healthcare system and the hospital sector.

By 15 June, the cumulative number of confirmed cases was nearly 50,000 (281 per 100,000 population); the cumulative number of hospital admissions was nearly 12,000 (68 per 100,000); and the cumulative number of deaths of confirmed COVID-19 patients was 6,000 (35 per 100,000).