Before the corona crisis, Ellis Jeurissen, director of public health at the GGD Brabant-Zuidoost, sometimes wondered whether she had not accidentally been given a defective service telephone. Compared to her previous job as a district police chief, it was very quiet.
She is now five corona waves further along with the 24 other GGD regions. “I’d be lying if I didn’t say I’m getting tired. You have been at the head of a GGD for two years during the crisis, and you simply have to run a shop, because all the other work also continues and – in the case of my GGD – you also have an ambulance service to run. ”
Not only Jeurissen is exhausted, it is clear to the entire GGD after twenty months of coronavirus: things have to change. This autumn, the GGDs will have to expand their capacity for the third time. More people than ever want to be tested, more people than ever are infected and need to be instructed about the rules to follow.
The maximum test capacity – based on forecasts set at 90,000 tests per day – was reached two weeks ago. Scaling up much further is not possible, GGD employees object NRC. The organization will have to be structured differently.
Worse than bad
In March 2020, the GGDs had to set up a completely new organization to combat the corona virus. Normally, the GGD manages consultation offices, is involved in the National Vaccination Program or provides health education. Sometimes there is also infectious disease control: for example in the case of a local outbreak of measles.
But it will never be this big and will it last as long as the corona crisis. It is of a totally different order; it takes gigantic test streets, an army of source and contact researchers and a massive vaccination campaign. In some regions, the corona branch grew to double the number of employees that the GGD normally employed. Last spring, Jeurissen employed 1,560 additional people, on top of about 750 employees. But in the summer, when the number of infections drops, there is much less to do. Again and again hundreds of employees have to be moved.
This was necessary again this autumn, when the virus came back harder than expected. „This is worse than it worstcasescenario”, says Jaap Eikelboom, Covid-19 program director at GGD GHOR. “It is hardly possible to recruit or work against this explosive growth.”
Nevertheless, the GGD already had more testing capacity in the past: last December, the GGDs were able to perform 130,000 tests per day on paper. “Now we are in a completely different situation,” says Eikelboom. Because the staff shortage is not only a problem for the GGD, says Henk Bril, director of public health in the GGD region of Gelderland-Midden. The labor market is tight everywhere. “If we hijack those people to come and work for us, the problem will shift. Then we have enough testers, but there are not enough hands on the bed.”
A major player has also been added: Stichting Open Nederland, the organization behind access testing, which can test almost as much as the GGDs. And then the booster campaign has yet to get underway, while – unlike the period of the massive vaccination campaign earlier this year – the demand for corona tests remains sky-high.
Source and contact research
Due to the high number of positive tests, the GGDs have to start thousands of source and contact investigations per day. That doesn’t work anymore. The research, important to prevent new infections and to monitor the course of the epidemic, has been completely stripped down in all regions. A possible source of only one in five infections has been traced.
Also read: ‘It beeps and it creaks until we can scale’
The new, worrying Omikron variant puts even more pressure on the available research capacity, says Bril, also national portfolio holder for source and contact research on behalf of the GGDs. RIVM asked the GGDs to carry out an ‘intensive contact investigation’ among travelers from southern Africa. “By working smarter and not burning everything up with calling and calling, we hope to free up capacity for research into specific contexts, places and variants.” The elderly (over 60) and young people (under 17) are still called as much as possible. But the vast majority of infected people receive a bulk e-mail from the GGD, with only an explanation about the rules of life.
Keeping staff on hand while the virus slumbers in the summer and work comes to a standstill is difficult to sustain, the GGDs notice. “People want to develop anyway, the majority do not sit on the couch and wait until they are allowed to do something,” says Eikelboom. Moreover, daily life started again last summer. Musicians, stage builders, people who worked in the catering industry: they started working for the GGD for the past year and a half, but were now able to pick up their old job again. Others went back to school.
Another problem is that – almost two years after the start of the crisis – the financing of the crisis is still incidental, a quarter or six months ahead. Anyone who has already received three temporary contracts must now receive a permanent contract. But there is no financial cover for that. Six weeks ago, Jeurissen had to say goodbye to two hundred personnel – source and contact researchers, employees of test streets and puncture centers that are sorely needed right now. “It is continuously letting people go and re-educating people.”
Last week, the Ministry of Health came up with a temporary solution: if someone with a permanent contract has to be fired after the corona crisis, the ministry will pay the severance pay and unemployment benefits. The GGDs are happy with the measure. Brabant-Zuidoost is already approaching the old staff again.
What’s the use?
Hiring more and more staff to fight an exponentially growing virus is always a losing game, the GGDs realize. Jeurissen: “Always thinking in terms of personnel, in terms of capacity, that has its limits. We should never stop with source and contact research, but to what extent and in what form that is really up for debate. There must be different answers to that than now. You will have to think per region about what you will need in the coming years, in the knowledge that we will get more waves.”
Bril wants to expand the infectious disease control department of the GGD Gelderland-Midden. “We now have a staff of fifteen, but we want to grow to fifty employees.” Another proposal is to set up a kind of voluntary fire brigade of source and contact researchers who were trained during the corona crisis. “In any case, to deploy an extra capacity in one go,” says Bril.
The GGD is scaling up the test capacity even further, says Eikelboom. Last Wednesday, nearly 105,000 tests were taken. What if it grows even faster? “Then you come to a point: how far are you going in that? What’s the use? With the current number of infections, the question is what ‘view of the virus’ still means, especially given the 42 percent willingness to test. You also have to make choices for source and contact investigations about what is still effective. The role of self-tests is now being considered, which is also stated in the latest OMT advice. If we can reach more people with this, that is very meaningful. And if the side effect is that you get a pre-selection of who will be tested at the GGD, that also helps to reduce the pressure.”
Also read: When testing capacity is reached, an important ‘weapon’ against the corona virus is squeezed
A version of this article also appeared in NRC in the morning of November 30, 2021