Hospitals deliver damning verdict on Belgium's handling of first wave

Members of Belgium’s Covid-19 Special Commission listened to damning assessments of the handling of the crisis by the authorities of the Brussels region when representatives of three major Brussels hospitals gave their testimonies in parliament last week.

The commission, tasked with determining whether mistakes were made in the management of the first wave of the epidemic, heard accounts of drastic action being taken due to lack of protective equipment, failures by ministers to act in time to prevent a second wave, and directives to carry out only essential care.

"I'm going to make remarks," said Marc Noppen, managing director of UZ Brussel located in Jette, at the outset of the hearing, "not reproaches because I don't know any country in the world that was perfectly prepared for what we went through."

But after this first gentle reflection, Noppen’s tone changed. "The authorities didn't see the second wave coming, that's true,” he continued. “However, in July, I alerted all the ministers I knew, and they did not want to react. I became incredibly angry because we then started to see patients coming back to the hospital again. I sent pictures to the ministers and said, come and see what is going on. And at the same time, they said: it is not true, it's worse in Antwerp and we have to relax the restrictions. Our staff didn't understand and there was almost civil war in the hospital."

Michèle Dusart, chief medical officer of the Saint-Pierre Hospital, then spoke up, explaining that she had been deeply affected by the crisis she experienced at first hand: "At the beginning of the epidemic, I had contact with the official in charge of supplying masks in Belgium,” she told the commission. “I asked if they had a reserve stock and he said no. When I got back to the hospital, I said to our pharmacist: try to find something in terms of stock, because we're going to have a big problem."

The supply of protective equipment at Saint-Pierre soon started to run out with no replacements readily available. "For masks, you end up doing things you never thought you'd do,” Dusart continued. “I felt a bit like a drug dealer. Some people would call me and say, I have masks for sale. I want the money in cash. Are you ready to take them?”

“It was unbelievable. I found myself in the hospital yard looking at stock as if I were tasting merchandise,” she added. “You see, like a drug dealer. All this to say in the end: well, listen, these are bad masks."

Meanwhile, the FFP2 masks eventually delivered by the federal government were ultimately not compliant, while other orders were cancelled or could not be met. "But I don't blame anyone, because officials who don't know what a mask is, have been asked to buy masks,” said Dusart. “There really is a problem at this level."

Deputy chief medical officer Yves Horsmans of the Saint-Luc clinics then told the committee of orders received from the authorities at the end of last winter to only carry out “essential care”.

“What is essential care? You can't define when someone should die, you don't even know how to ask,” he said. “And yet, we doctors must define what essential care is. I made the decision; we did the treatment. Yes, in Saint-Luc, we transplanted livers in March and April because it is impossible to do dialysis for the livers. So, is it normal when you transplant a six-year-old? Is that essential? Isn't that essential? I still hope that the politicians can realise that we are still the ones who have to decide.”

“Whatever crisis there will be tomorrow, we have to define what the essentials are,” Horsmans continued. “We abandoned heart patients, cancer patients simply because we said: we have to take care of Covid. Of course, a life of 85 or 88 years is worth something, it is worth saving. But the life of a six-year-old who does not have Covid is worthless? Well, no. It is worth something. I'm sorry, it's worth something.”

While the hospital representatives made their frustrations clear, they also presented proposals to be considered in the event of a third wave, which they fear will happen.  

First, the doctors asked for more trust from the authorities. "For example, in Brussels, Cocom (Brussels' common community commission, which manages health issues in particular) has never invited us to the discussion table," said Marc Noppen.

"There are also so many administrative concerns due to the different levels of power in our country. It complicates everything!" explained Philippe Leroy, managing director of the Saint-Pierre Hospital. "For example, doing a PCR test, doing the smear I mean, it takes between 10 and 30 seconds. But in the end, it took more than 15 minutes per patient because of all the paperwork that had to be completed. You can imagine the impact on the number of tests we were able to carry out."

"We sometimes received different directives and had to deal with different levels of power, almost at the same time: the federal government, the French-speaking community, the Brussels region and, even sometimes, the municipalities," added Renaud Mazy, the administrator of the Saint-Luc clinics. "And you ask us why have we repeatedly been shouting warnings in the media? Now you can understand."

The hospital representatives, with support from the city’s general practitioners, called for a centralisation of crisis management at a single level of power to save time, increase understanding and remove inefficiencies. They also called for more leadership from the government. Finally, and perhaps most importantly, they called for the authorities to give full their confidence to the doctors on the ground and listen to what they say.