The horse’s medicine for the lockdown should be removed as soon as possible, says professor Rudi Westendorp, member of the Danish covid advisory group. Covid-19 is an old human disease. To protect them, we should not close national borders, but think about which borders around this group. “Let’s ask the over-80s who it is.”
Rudi Westendorp (1959) – the Netherlands’ best-known professor of geriatric medicine until his departure for Denmark – knows the tricks of the trade. Trained as an internist-intensivist, he spent years on IC, including during the neck spasm epidemic in the 1990s. Then came the realization that illness and death mainly affect the old man and his choice for elderly medicine followed. He was the founder and director of the Leyden Academy on Vitality and Aging. When he realized that morbidity in the elderly is also a reflection of how society works, he went for public health.
Public health is big in Denmark. Since 2015, Westendorp has been professor of public health and the elderly in Copenhagen in a department of more than 250 people, the largest department within the medical faculty. He is the only non-Dane who is also a member of the Covid Advisory Group of the Danish Health Ministry.
How far does his influence extend? “When I say sensible things, it is heard and weighed. But there is a clear separation of powers. The advisory group advises, the political decision. And everyone can have their say. For example, the Prime Minister announced the lockdown on March 13 at noon and the Secretary of the Health Ministry said in the evening that there were no scientific arguments to do so. “
In early March, Westendorp addressed the World Health Organization regional committee, which is based in Copenhagen. There he compared the epidemics of corona and Alzheimer’s. “Both must be caged with public health measures, for both a drug or vaccine seems far away. The risk of Alzheimer’s has decreased considerably in one generation. We live healthier, smoke less and high blood pressure is treated. What is good for the heart is also good for the brain. We must tackle both epidemics with good hygiene: proper nutrition, more exercise. You can also consider Corona as a lifestyle disease: social promiscuity. “
How do you view corona from public health?
“Like Alzheimer’s, Covid-19 is an old human disease. Most victims are over-80s who are vulnerable. A few under 60 die from covid, under 40 it actually does not occur. I see these accents too little in the image. Corona is mainly identified with care on the IC. That is crazy. If we had realized that the disease mainly affects the elderly, we would have wondered where they actually stay: in home care and in nursing homes. There are three categories or faces that have been neglected: home care and nursing home care, regular care and the economy. From all these perspectives, we need to come up with a new strategy that is different from the intelligent lockdown. If we calculate the loss of healthy life years associated with delayed regular care, we are very shocked. A recession will also have major health effects, because long-term unemployment leads to more cardiovascular diseases, obesity, depression, etc. “
If a lockdown is not a solution, what is the right thing to do?
“I’m not saying we shouldn’t do anything. But I think we can reduce this virus to drastic proportions with hand washing, a degree of social distancing – especially not celebrating carnival, just filling in Dutch – and not let covid patients get sick at home and infect the whole family, but elsewhere quarantine. We’ve always done it that way, with all kinds of infectious diseases. It is completely understandable that we got into the lockdown, but now we have to get out as soon as possible. “
“You must install a sanitary cordon to prevent contamination of frail elderly people”
How do the Danes handle it?
“It is an enrichment to be able to experience what is happening up close in two countries. I think the Scandinavian countries place more emphasis on proportionality. In the Outbreak Management Team, for example, we discussed a report from the Norwegians who already took stock of covid, regular care, the economy and oil at the beginning of March. From the beginning of the lockdown, Denmark has also thought about what society can sustain. There was much concern that parents were at home with young children. Domestic violence should not be the price of the corona epidemic. When it seemed to be going in the right direction, the schools were allowed to open again in mid-April. In doing so, I indicate that from the outset thinking was focused on proportionality. Everyone in Denmark has a voice and is heard. The prime minister listens and translates the consensus. Monkey rocks are not allowed here. There is continuous polder here. Another important difference with the Netherlands is a well-functioning national health service. The Danish hospitals and nursing homes are not private entities. We have a central registration in Denmark, in the EPD you can, for example, follow exactly when someone is discharged from the hospital or has died. We are now going to make dashboards in the Netherlands. They have been around in Denmark for decades. If you are overwhelmed by a virus and you want to have a national overview, then you are in a completely different situation if such a registration already exists. “
How do we get out of this pandemic?
“Let’s figure out how to protect vulnerable and older people. The longer this continues, the clearer it becomes that the solution lies somewhere here. We will not lose that virus. The country must open, you can no longer delay it. That virus is going to circulate. Then there will be more infections, but please do not panic and do not set a new lockdown. Then we only take more damage. We should not close national borders, but think about age and vulnerability limits. In that respect it is very clear. You must install a sanitary cordon to prevent infection of vulnerable and older people. I am not saying that this cordon should be instituted by the government. I’m telling you to think about that limit. And will we agree with the people themselves? Then something completely different might come out. My professional attention is focused on the question of what is currently happening in households. 80 percent of infections are contracted there. These households are different everywhere: in Scandinavia the generations live independently of each other, in Southern Europe often three generations live in one house. That’s the most dangerous thing you can have: the grandchildren bring in the virus and they hug grandma to death. However, we must be careful that institutions or professionals will prohibit this. They will have to explain how it works and leave the choice to the people themselves. If they are willing to take that risk, will we leave that decision to them? ”