The Dutch COVID-19 approach: Regional differences in a small country

Lieke Michaela Hoekman*, Marlou Marriet Vera Smits, Xander Koolman

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review

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Objectives: This paper describes the first months of the COVID-19 pandemic in the Netherlands, including policies to reduce the health-related and economic consequences. The Netherlands started with containment and shifted to mitigation within three weeks when implementing a ‘mild’ lockdown. The initial focus was to obtain herd immunity while preventing Intensive Care Units from getting overwhelmed. 

Methods: An in-depth analysis of available national and international COVID-19 data sources was conducted. Due to regional variation in COVID-19 hospitalization rates, this paper focuses on three distinct regions; the initial epicenter; the most northern provinces which – contrary to national policy – decided not to switch to mitigation; and the Bible Belt, as congregations of religious groups were initially excluded from the ban on group formation. 

Results: On August 11th, 6,159 COVID-19 deaths were reported with at the peak an excess mortality Z-score of 21.7. As a result of the pandemic, the economy took a severe hit and is predicted to shrink 6.5% compared to projection. The hospitalization rates in the northern regions were over 70% lower compared to the rest of the country (18 versus 66 per 100,000 inhabitants). Differences between the Bible Belt and the rest of the country were hardly detectable. 

Conclusion: The Dutch have shown a way to effectively slow down transmission while allowing more personal and economic freedom than most other countries. Furthermore, the regional differences suggest that containment prevented a surge of infections in the northern provinces. The results should be interpreted with caution, due to the descriptive nature of this study.

Original languageEnglish
Pages (from-to)613-622
Number of pages10
JournalHealth Policy and Technology
Issue number4
Early online date27 Aug 2020
Publication statusPublished - Dec 2020


  • COVID-19
  • Economic effects
  • Health effects
  • Health policy
  • Health system
  • Regulated competition
  • The Netherlands


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