The new 2019 coronavirus has already resulted in more than 1,000 deaths. Some experts estimate that without measures, two-thirds of the world's population could come into contact with it. So far the infections have mainly been in China, but a number of European countries are already reporting infections with the 2019 coronavirus. So it only seems a matter of time before the Netherlands has to deal with the virus. What measures can the Dutch government take?
Public Health Act (Wet publieke gezondheid)
The control of infectious diseases in the Netherlands is regulated in the Public Health Act, a rather unfamiliar act. This act contains several 'dormant' powers for the government, which can be 'awakened' in the short term in the event of an outbreak of a dangerous disease. This is how it works: the government can take strict measures for Group A diseases. Until recently these were smallpox, polio, SARS, MERS and viral haemorrhagic fever (e.g. Ebola). SARS and MERS are also coronaviruses and consequently 'family' of the 2019 coronavirus.
The Minister for Medical Care has now added the 2019 coronavirus to group A. This was effected further to an order of 28 January that was published on the Ministry's website and came into force immediately.
Duty to report, forced admission, quarantine
The placement in group A means that as of 28 January, every doctor in the Netherlands who 'suspects or diagnoses' that a patient is infected with the 2019 coronavirus, must report this immediately to the municipal health service. Any laboratory that finds the 2019 coronavirus in blood must also make such a report. The municipal health service immediately notifies the National Institute for Public Health and Environmental Protection (RIVM) which coordinates government action on behalf of the Minister.
As a result of these reports, doctors are violating medical confidentiality. Because the law obliges the doctor to do so, he or she cannot be held liable under civil law nor be liable to disciplinary action.
Subsequently, the chair of the security region in question (who is always a mayor) can have the patient admitted to a hospital for isolation. This is possible only if (i) there is a serious danger to public health by spreading, (ii) this danger cannot be averted in a less far-reaching way and (iii) the patient does not wish to be admitted voluntarily. The patient can be forcibly examined in the hospital.
The chair of the security region may subject a person to quarantine if
"there is reason to believe that the person has recently had such contact with a sufferer or suspected sufferer from a group A infectious disease, that that person may have been infected with the same disease."
Again, the forced measure is permitted only if there is a serious threat to public health and the person concerned is not willing to go into quarantine. The Dutch citizens recently repatriated by the government from the Wuhan region of China were all voluntarily quarantined.
Who protects the citizen from the government?
These are far-reaching measures that severely restrict citizens' freedom (see also link and link). The law therefore provides for a number of checks and balances, which ensure that the government cannot use the measures arbitrarily.
The government must involve parliament by submitting a bill confirming this Group A status within eight weeks of the Minister adding a disease to Group A. Consequently, Bruno Bruins, the Minister for Medical Care, has until 24 March to do so.
In addition, a public prosecutor and a court must review each individual measure. The chair of the security region informs the public prosecutor of a measure taken (e.g. forced admission).
If the public prosecutor does not consider the measure to be justified, it will be terminated. If the public prosecutor agrees with the measure, he or she will request the court to issue an 'authorisation to continue'. The court is then obliged to hear the person in question 'at his or her domicile'. The court then takes a decision (see link for a recent decision on isolation in the case of tuberculosis). The procedure is quick and simple: the court has to decide within three days and there is no appeal.
Conclusion
It is reassuring in a way that Dutch legislation is prepared for possible 2019 coronavirus cases. Nevertheless, I hope that the application of such legislation will not be necessary.
The new 2019 coronavirus has already resulted in more than 1,000 deaths. Some experts estimate that without measures, two-thirds of the world's population could come into contact with it. So far the infections have mainly been in China, but a number of European countries are already reporting infections with the 2019 coronavirus. So it only seems a matter of time before the Netherlands has to deal with the virus. What measures can the Dutch government take?
Public Health Act (Wet publieke gezondheid)
The control of infectious diseases in the Netherlands is regulated in the Public Health Act, a rather unfamiliar act. This act contains several 'dormant' powers for the government, which can be 'awakened' in the short term in the event of an outbreak of a dangerous disease. This is how it works: the government can take strict measures for Group A diseases. Until recently these were smallpox, polio, SARS, MERS and viral haemorrhagic fever (e.g. Ebola). SARS and MERS are also coronaviruses and consequently 'family' of the 2019 coronavirus.
The Minister for Medical Care has now added the 2019 coronavirus to group A. This was effected further to an order of 28 January that was published on the Ministry's website and came into force immediately.
Duty to report, forced admission, quarantine
The placement in group A means that as of 28 January, every doctor in the Netherlands who 'suspects or diagnoses' that a patient is infected with the 2019 coronavirus, must report this immediately to the municipal health service. Any laboratory that finds the 2019 coronavirus in blood must also make such a report. The municipal health service immediately notifies the National Institute for Public Health and Environmental Protection (RIVM) which coordinates government action on behalf of the Minister.
As a result of these reports, doctors are violating medical confidentiality. Because the law obliges the doctor to do so, he or she cannot be held liable under civil law nor be liable to disciplinary action.
Subsequently, the chair of the security region in question (who is always a mayor) can have the patient admitted to a hospital for isolation. This is possible only if (i) there is a serious danger to public health by spreading, (ii) this danger cannot be averted in a less far-reaching way and (iii) the patient does not wish to be admitted voluntarily. The patient can be forcibly examined in the hospital.
The chair of the security region may subject a person to quarantine if
"there is reason to believe that the person has recently had such contact with a sufferer or suspected sufferer from a group A infectious disease, that that person may have been infected with the same disease."
Again, the forced measure is permitted only if there is a serious threat to public health and the person concerned is not willing to go into quarantine. The Dutch citizens recently repatriated by the government from the Wuhan region of China were all voluntarily quarantined.
Who protects the citizen from the government?
These are far-reaching measures that severely restrict citizens' freedom (see also link and link). The law therefore provides for a number of checks and balances, which ensure that the government cannot use the measures arbitrarily.
The government must involve parliament by submitting a bill confirming this Group A status within eight weeks of the Minister adding a disease to Group A. Consequently, Bruno Bruins, the Minister for Medical Care, has until 24 March to do so.
In addition, a public prosecutor and a court must review each individual measure. The chair of the security region informs the public prosecutor of a measure taken (e.g. forced admission).
If the public prosecutor does not consider the measure to be justified, it will be terminated. If the public prosecutor agrees with the measure, he or she will request the court to issue an 'authorisation to continue'. The court is then obliged to hear the person in question 'at his or her domicile'. The court then takes a decision (see link for a recent decision on isolation in the case of tuberculosis). The procedure is quick and simple: the court has to decide within three days and there is no appeal.
Conclusion
It is reassuring in a way that Dutch legislation is prepared for possible 2019 coronavirus cases. Nevertheless, I hope that the application of such legislation will not be necessary.