The reproduction number (R) has dropped below 1 for the first time since mid-June; the confidence level is entirely below 1. This seems to be the effect of the measures that were implemented at the end of September and in mid-October. The number of contagious people remains high, reaching over 145,000 this week (lower limit 105,000 – upper limit 187,000). 

43,621 new COVID-19 cases* were reported last week, 20,466 (-32%) less than the week before. For the first time, this downward trend can be observed in all age categories (Figure 1). 

Figure 1: Number of confirmed cases per 100,000 inhabitants, by age group, from 28 Sep to 8 Nov.

Although there is a downward trend, the number of reported infections and hospital admissions remains high. The number of newly reported infections last week (4-10 November) is comparable to the weekly figures for the week of 7-10 October, when there were 43,903 newly reported COVID-19 infections. That was when the Cabinet announced the national measures. In that same week (7-10 October), there were 1,144 new hospital admissions and 192 new ICU admissions, compared to 1,520 new admissions to nursing wards and 275 new ICU admissions last week.

*COVID-19 is a notifiable disease, so it is legally required to report a positive COVID-19 test result to the Municipal Public Health Service (GGD). Everyone, including commercial test providers, must comply with that legal requirement. The inspectorate oversees compliance. The government has published guidance documents on coronavirus testing outside the GGD test lanes. When providing the test numbers to RIVM, the GGDs do not differentiate between positive tests reported by the GGD test lanes or by others. Test providers not only include commercial test lanes, but also hospitals and GP practices.

Differences between the regions

Although the number of newly reported infections is decreasing, the number of people who tested positive for COVID-19 is still very high. The regions with the highest number of reported infections per 100,000 inhabitants were Rotterdam-Rijnmond, Twente and Zuid-Holland-Zuid; these regions had over 350 reported infections per 100,000 inhabitants. 

A downward trend can be observed in all regions. The regions that saw the most significant decrease were Groningen and Noord- en Oost-Gelderland. These regions had a decrease of over 40% compared to the week before.  

GGD test lanes and percentage of positive tests

In the week of 2 to 8 November, 244,839* people were tested in the GGD test lanes, over 50,000 people less than in the week before. At least in part, this could be because people are having less contact with others, so fewer cold viruses are circulating. The test results for 243,341 people are known, and 35,349 people tested positive for COVID-19. The percentage of positive tests is still high (14.5%), but has decreased slightly compared to the previous week (Figure 2). 

*Source: GGD GHOR
 

Figure 2:  Percentage of positive tests and percentage of positive tests per calendar week at GGD test lanes.

Monitoring the virus and testing outside the GGD test lanes

COVID-19 is a notifiable disease. It is legally required to report a positive COVID-19 test result to the Municipal Public Health Service (GGD). All parties that provide COVID-19 testing must comply with that legal requirement, including GGD test lanes, but also commercial test providers, GPs and hospitals. The Health Inspectorate oversees compliance. When providing the test numbers to RIVM, the GGDs do not differentiate between positive tests reported by the GGD test lanes or by others. Nearly 75% of all people who tested positive for COVID-19 and were reported to GGDs were tested in the GGD test lanes.
The data from the test lanes, laboratories, nursing homes, hospital admission figures, ICU admission figures and results of RIVM analysis consistently show the same overview: there has been a clear shift in the past week. 

Nursing homes 

The number of new nursing home locations with at least one resident who has a confirmed COVID-19 infection has decreased in the past week. 104 new nursing home locations reported a confirmed case in the past calendar week (2-9 November), compared to 150 in the week before (26 October – 1 November).

Mortality continues to increase

Continuing the trend of the previous weeks, Statistics Netherlands (CBS) reported a higher mortality rate than expected in the week of 26 October to 1 November.  In that week, approximately 700 more deaths were recorded than normally expected in this period. A significant percentage of the excess mortality is expected to be related to COVID-19. How high that percentage is will become clear later on in the records stating cause of death. RIVM also keeps track of mortality figures on a weekly basis (data provided in Dutch). In the most recent RIVM data for 22-28 October, mortality was significantly elevated in the age categories of 65-74 years and of 75 years and older. For the first time during the second wave, mortality was elevated in all regions of the Netherlands. 

Reproduction number R: lower is better

The reproduction number for 23 October* is 0.91 (lower limit: 0.89, upper limit: 0.93). On 19 October, the reproduction number (R) dropped below 1 for the first time since mid-June; the confidence level is entirely below 1. A reproduction number of 0.91 means that 100 people with COVID-19 will collectively infect another 91 people with the virus. The lower the reproduction number, the better; even with this week’s reproduction number (R=0.91), the 145,000 contagious people in this week will still infect 131,000 new people. 

***The estimates for R from longer than 14 days ago are reliable. An estimated R based on data from less than 14 days ago involves more uncertainties. That is why we always look at the R from 14 days ago. 

Slow down the virus? Prevent the spread? Follow the basic measures!

It continues to be important to always get tested if you have mild symptoms that could indicate COVID-19 – even if you think it might just be a common cold. To prevent the virus from continuing to spread, it is important for everyone to comply with the measures and the basic rules. Stay at least 1.5 metres from others. Work from home. If you have symptoms, stay home and get tested. Wash your hands frequently, especially when you arrive at home. Sneeze and cough into your elbow.  

Daily figures

RIVM publishes a weekly overview of the number of infections, hospital admissions and ICU admissions, and people who have died from the consequences of COVID-19. Daily figures (which are corrected for later updates in some media, and not in others) may fluctuate dramatically as delayed reports come in, and are therefore less suitable for monitoring the course of the epidemic.

	Last week1	Two weeks ago2
COVID-19 reports by Municipal Public Health Services (GGDs)
Newly reported COVID-19 infections	43,621	64,087
Number of hospital admissions to nursing wards (Source: NICE)	1520	1966
Number of hospital admissions to Intensive Care (Source: NICE)	275	321
Deaths	565	435
GGD test lanes per calendar week3	week 45	week 45
Total number of tests of which results are known	243,341	293,876
Number of people who tested positive	35,349	48,728
Percentage of positive tests	14,5%	16,6%

Not all of the reported hospital admissions or deaths occurred within the last 24 hours

¹GGD reports to RIVM between 3 November 10:01 and 10 November 10:00 as published 10 November 2020 in the weekly epidemiological update on COVID-19 in the Netherlands.
²GGD reports to RIVM between 27 October 10:01 and 3 November 10:00, as published 27 October 2020 in the weekly epidemiological update on COVID-19 in the Netherlands.
³As published on 10 November 2020 in the weekly epidemiological update on COVID-19 in the Netherlands. The figures from the GGD test lanes were reported during the past week and current week, and may be updated to include any test results provided later.