Dutch colleagues working together to save lives

Professional solidarity in The Netherlands

Nic Reus MD, PhD, spoke with EuroTimes contributing editor Dermot McGrath on the response to the COVID-19 pandemic in his country

What is the current situation in The

Netherlands? I live in Rotterdam and while schools and universities have been closed, we are not in lockdown mode as has been applied in Italy and France. People are still allowed to freely circulate and most of the shops are still open. However, restaurants, cinemas and theatres have closed and all public gatherings cancelled.

Most people are adhering to the guidelines in terms of social distance to try to contain the spread of the virus. However, there have been reports of people crowding in parks and on beaches.

What about your hospital? Are you still continuing to

operate on patients? No, we stopped surgery in the O.R. under anaesthesia to try to reduce the demands on key staff and reduce the pressure on the intensive care units. We did complete some cataract surgeries before we took the decision to stop to protect ourselves and our patients. It simply didn’t feel safe to continue operating under the current circumstances so it was decided that it was better not to take the risk. Even with protection, there is the issue of proximity and we are obliged to administer drops in the eye and then at the end of surgery to remove the drapes, which increases the risk of exposure.

What about for emergency cases such as retinal detachments?

Are they still being treated? We are continuing to treat emergency cases. In our outpatient department there are now only emergency cases or those that we know that we have to see and which can’t be postponed. We have streamlined our schedules and scaled down all our activity enormously. We have taken several measures to ensure everything runs smoothly.

There are 12 ophthalmologists in our department, five residents in training and two residents who are not in training yet. We also have four optometrists. Normally, one ophthalmologist serves as the supervisor of the outpatient department and one resident-in-training does the emergency clinic. The others are doing general clinics, specialised clinics or surgery.

But now, to spread the flow of patients, we have two residents doing the emergency cases to ensure greater space between each patient and reduce the risk of contamination. The supervisor focuses on keeping the entire operation running smoothly. We then have one ophthalmologist for triage who receives calls from non-ophthalmologist specialists in hospital and from general practitioners in the area and also patients who call the hospital. Our triage specialist then decides what course of action is most appropriate for each individual case and whether urgent intervention is required.

What about patients who require intravitreal injections?

We are still doing intravitreal injections where absolutely necessary but with a lot of precautions. We use several waiting areas for the patients and use controlled circuits to keep contact to a minimum. The retinal doctors carefully examine each patient’s charts in advance and decide if it is safe or not to postpone the injection. But monocular patients and those deemed at high risk of visual loss are still being treated.

Have there been clear guidelines from the national authorities in terms of what measures to take in terms of

treating patients during the COVID-19 epidemic? Up until now, it has been up to the individual hospitals the measures that they take. But there is a lot of dialogue with the Dutch Ophthalmological Society, which is starting to coordinate the national response.

I am working in the Amphia Hospital in Breda, which along with Uden, Tilburg, and ‘s-Hertogenbosch is one of the areas with the highest concentration of coronavirus cases. The hospitals in these three areas have been hardest hit by the crisis. Other areas in the north of the country are less affected for the moment.

However, the situation is evolving rapidly and the situation is changing almost hour by hour and we have to adapt to deal with new developments. We are working closely with other medical centres in the northern part of The Netherlands to organise transfers of surgical cases that can no longer be performed in our hospital in Breda.

This crisis looks like it will last weeks and probably months. Is The Netherlands equipped to deal with this epidemic over the longer term and how will it affect ophthalmic care

going forward? I think the Amphia Hospital is doing a really good job at the moment in terms of its outbreak management and forward planning for what potentially lies ahead. They are scaling up a bit earlier than other hospitals, and have been transferring patients, including some COVID-19 patients to other centres in The Netherlands to reduce the pressure.

Every department in our hospital has been asked to assign onequarter of their doctors to go and help in the hospital to deal directly with COVID-19 patients. I am currently on standby to resume work as a general doctor and help with treating the expected upsurge in patients over the coming days and weeks, not in intensive care units but in the general clinic to help my colleagues.

I am having to rapidly brush up on both basic and emergency medicine in order to be able to do this effectively. Professional solidarity is very important at times of crisis like these. We are all in this together and I have been impressed by the level of dedication of my Dutch colleagues who are working together to tackle this epidemic and save as many lives as possible.