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Objective: Much research on the early stages of the COVID-19 pandemic demonstrates the unequal impact on men and women in many countries but empirical evidence on later stages of the pandemic remains limited. The objective of this paper is to study differences between men and women in work location, the relative division of childcare, and perceived work-life balance across and throughout different phases of the pandemic using six waves of probability-based survey data collected in the Netherlands between April 2020 and April 2022 (including retrospective pre-pandemic measures). Method: The study used descriptive methods (longitudinal crosstabulations) and multivariate modelling (cross-sectional multinomial logits, with and without moderators) in a repeated cross-sectional design. Results: Results suggest the pandemic is associated with several phase-specific differences between men and women in where they worked and their relative division of childcare in the Netherlands. Men were less likely than women to work fully from home at the start of each lockdown and to work on location during the first lockdown. Amongst parents, fathers increased their share of childcare throughout the first phase of the pandemic, and this increase remains visible at the end of the pandemic. Women in the Netherlands did not experience worse work-life balance than men throughout the pandemic, but mothers did experience worse work-life balance than fathers at various points during the pandemic. Discussion: Our results suggest varying long-term implications for gender inequality in society. Gender differences in work location raise concerns about the possible longer-term impact on gender inequalities in career development. Our findings on childcare suggest that many households have experienced different divisions of childcare at different stages of the pandemic, with some potential for longer-term change. Conclusion: Inequalities between men and women in work, childcare, and wellbeing have neither been alleviated by nor unilaterally worsened during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

In this paper, we investigate the spread of COVID-19 and the impact of government measures at the early stage of the pandemic (before the introduction of the vaccines) in the Netherlands. We build a multiple linear regression model to predict the effective reproduction rate using key factors and measures and integrate it with a system dynamics model to predict the spread and the impact of measures against COVID-19. Data from February to November 2020 is used to train the model and data until December 2020 is used to validate the model. We use data about the key factors, e.g., disease specific such as basic reproduction rate and incubation period, weather related factors such as temperature, and controllable factors such as testing capacity. We consider particularly the following measures taken by the government: wearing facemasks, event allowance, school closure, catering services closure, and self-quarantine. Studying the strategy of the Dutch government, we control these measures by following four main policies: doing nothing, mitigation, curbing, elimination. We develop a systems dynamic model to simulate the effect of policies. Based on our numerical experiments, we develop the following main insights: It is more effective to implement strict, sharp measures earlier but for a shorter duration than to introduce measures gradually for a longer duration. This way, we can prevent a quick rise in the number of infected cases but also to reduce the number of days under measures. Combining the measures with a high testing capacity and with effective self-quarantine can significantly reduce the spread of COVID-19. [ABSTRACT FROM AUTHOR]

Objective: The COVID-19 pandemic is more than a public health crisis. Lockdown measures have substantial societal effects, including a significant impact on parents with (young) children. Given the existence of persistent gender inequality prior to the pandemic, particularly among parents, it is crucial to study the societal impact of COVID-19 from a gender perspective. The objective of this paper is to use representative survey data gathered among Dutch parents in April 2020 to explore differences between mothers and fathers in three areas: paid work, the division of childcare and household tasks, and three dimensions of quality of life (leisure, work-life balance, relationship dynamics). Additionally, we explore whether changes take place in these dimensions by comparing the situation prior to the lockdown with the situation during the lockdown. Method: We use descriptive methods (crosstabulations) supported by multivariate modelling (linear regression modelling for continuous outcomes; linear probability modelling (LPM) for binary outcomes (0/1 outcomes); and multinomial logits for multinomial outcomes) in a cross-sectional survey design. Results: Results show that the way in which parents were impacted by the COVID-19 pandemic reflects a complex gendered reality. Mothers work in essential occupations more often than fathers, report more adjustments of the times at which they work, and experience both more and less work pressure in comparison to before the lockdown. Moreover, mothers continue to do more childcare and household work than fathers, but some fathers report taking on greater shares of childcare and housework during the lockdown in comparison to before. Mothers also report a larger decline in leisure time than fathers. We find no gender differences in the propensity to work from home, in perceived work-life balance, or in relationship dynamics. Conclusion: In conclusion, we find that gender inequality in paid work, the division of childcare and household work, and the quality of life are evident during the first lockdown period. Specifically, we find evidence of an increase in gender inequality in relation to paid work and quality of life when comparing the situation prior to and during the lockdown, as well as a decrease in gender inequality in the division of childcare and household work. We conclude that the unique situation created by restrictive lockdown measures magnifies some gender inequalities while lessening others. Discussion: The insights we provide offer key comparative evidence based on a representative, probability-based sample for understanding the broader impact of lockdown measures as we move forward in the COVID-19 pandemic. One of the limitations in this study is the cross-sectional design. Further study, in the form of a longitudinal design, will be crucial in investigating the long-term impact of the COVID-19 pandemic on gender inequality. [ABSTRACT FROM AUTHOR]

There has been a lot of discussion about the role of schools in the transmission of severe acute respiratory coronavirus 2 (SARS-CoV-2) during the coronavirus 2019 (COVID-19) pandemic, where many countries responded with school closures in 2020. Reopening of primary schools in the Netherlands in February 2021 was sustained by various non-pharmaceutical interventions (NPIs) following national recommendations. Our study attempted to assess the degree of regional implementation and effectiveness of these NPIs in South Limburg, Netherlands. We approached 150 primary schools with a structured questionnaire containing items on the implementation of NPIs, including items on ventilation. Based on our registry of cases, we determined the number of COVID-19 cases linked to each school, classifying cases by their source of transmission. We calculated a crude secondary attack rate by dividing the number of cases of within-school transmission by the total number of children and staff members. Two-sample proportion tests were performed to compare these rates between schools stratified by the presence of a ventilation system and mask mandates for staff members. A total of 69 schools responded. Most implemented NPIs were aimed at students, except for masking mandates, which preferentially targeted teachers over students (63% versus 22%). We observed lower crude secondary attack rates in schools with a ventilation system compared to schools without a ventilation system (1.2% versus 2.8%, p<0.01). Mandatory masking for staff members had no effect on the overall crude secondary attack rate (2.0% versus 2.1%, p = 0.03) but decreased the crude secondary attack rate among staff members (2.3% versus 1.7%, p<0.01). Schools varied in their implementation of NPIs, most of which targeted students. Rates of within-school transmission were higher compared to other studies, possibly due to a lack of proper ventilation. Our research may help improve guidance for primary schools in future outbreaks. [ABSTRACT FROM AUTHOR]

Introduction: The COVID-19 outbreak disrupted regular health care, including the Emergency Department (ED), and resulted in insufficient ICU capacity. Lockdown measures were taken to prevent disease spread and hospital overcrowding. Little is known about the relationship of stringency of lockdown measures on ED utilization. Objective: This study aimed to compare the frequency and characteristics of ED visits during the COVID-19 outbreak in 2020 to 2019, and their relation to stringency of lockdown measures. Material and methods: A retrospective multicentre study among five Dutch hospitals was performed. The primary outcome was the absolute number of ED visits (year 2018 and 2019 compared to 2020). Secondary outcomes were age, sex, triage category, way of transportation, referral, disposition, and treating medical specialty. The relation between stringency of lockdown measures, measured with the Oxford Stringency Index (OSI) and number and characteristics of ED visits was analysed. Results: The total number of ED visits in the five hospitals in 2019 was 165,894, whereas the total number of visits in 2020 was 135,762, which was a decrease of 18.2% (range per hospital: 10.5%-30.7%). The reduction in ED visits was greater during periods of high stringency lockdown measures, as indicated by OSI. Conclusion: The number of ED visits in the Netherlands has significantly dropped during the first year of the COVID-19 pandemic, with a clear association between decreasing ED visits and increasing lockdown measures. The OSI could be used as an indicator in the management of ED visits during a future pandemic. [ABSTRACT FROM AUTHOR]

COVID-19 has made working from home routine for many. People who have had to maintain their productivity, particularly in physically and/or socially unacceptable home-working situations, experienced one of the pandemic's disadvantages. The experience can vary substantially among individuals as well as by country. This study presents the results of a comparative study of the Netherlands and Korea. Working from home was not uncommon in the Netherlands before the pandemic; however, in Korea, employers adopted working from home from its start, and that increased rapidly. An online survey enabled us to compare the physical and social conditions of current home workspaces in both countries, to understand how well-equipped they were to support people who had to work from home. We studied the changes in productivity and physical/mental health before and during COVID-19, to learn how people coped with working from home in both countries. Contrary to expectations, Koreans showed better scores than people in the Netherlands, in terms of changes in health and productivity. This article discusses various aspects of that result, such as satisfaction with home workspace, housing type, job position and prior experience, compulsoriness, and frequency of working from home. Relieving stress and concentration appeared to be the most important dimensions of telecommuters' satisfaction with working from home environments in both countries. The results are the basis for suggesting the development of strategies for a desirable WFH environment, considering different background contexts, experiences and cultures. [ABSTRACT FROM AUTHOR]

Previous literature shows that university students are particularly vulnerable to psychological ill-being. Also throughout the COVID-19 pandemic, stressors ranging from uncertainty to disruption of social lives have influenced their well-being. Resilience as a psychological resource could help students deal with such crises. Furthermore, students' learning environment can substantially determine their well-being and resilience, by satisfying their basic psychological needs for autonomy, competence, and relatedness. The present study aims to longitudinally investigate students' well-being and resilience in relation to their learning environment. To this end, we interviewed six participants, of which two were university students, two university teachers, one study advisor, and one student psychologist. With a longitudinal interview study with four dates of measurement, spanning the pre to mid-COVID-19 pandemic period, we gathered commentary about the evolution of student well-being, resilience factors, and the effects of the learning environment. To analyse the interview data, we used thematic inductive and deductive coding. The participants confirmed the postulated stressors, but also positive consequences for student well-being, including resilience growth. Interviewees also reported a variety of resilience factors, both within the individual (e.g. social support) and within academia (e.g., impaired student-teacher relationship, diminished sense of belonging). Furthermore, the interview data indicate changes in teaching related to students' needs for autonomy, competence, and relatedness, which in turn have consequences for learning and engagement, including challenges, opportunities, and positive outcomes. These findings, connecting the learning environment to student well-being and resilience, may help reshape academic systems for the post-pandemic future. [ABSTRACT FROM AUTHOR]

Background: Worldwide, non-pharmaceutical interventions (NPIs) were implemented during the COVID-19 crisis, which heavily impacted the daily lives of citizens. This study considers public perspectives on whether and how public engagement (PE) can contribute to future decision-making about NPIs. Methods: An online survey was conducted among a representative sample of the public in the Netherlands from 27 October to 9 November 2021. Perceptions and preferences about PE in decision-making on NPIs to control COVID-19 were collected. Preferences regarding four NPIs were studied: Nightly curfew (NC); Digital Covid Certificate (DCC); Closure of elementary schools and daycares (CED); and physical distancing (1.5M). Engagement was surveyed based on the five participation modes of the IAP2 Spectrum of Public Participation, namely inform, consult, advice, collaborate and empower. Results: Of the 4981 respondents, 25% expressed a desire to engage in decision-making, as they thought engagement could improve their understanding and the quality of NPIs, as well as increase their trust in the government. Especially for the NPIs DCC and NC, respondents found it valuable to engage and provide their perspective on trade-offs in values (e.g. opening up society versus division in society by vaccination status). Respondents agreed that the main responsibility in decision-making should stay with experts and policy-makers. 50% of respondents did not want to engage, as they felt no need to engage or considered themselves insufficiently knowledgeable. Inform was deemed the most preferred mode of engagement, and empower the least preferred mode of engagement. Conclusion: We reveal large variations in public preferences regarding engagement in NPI decision-making. With 25% of respondents expressing an explicit desire to engage, and considering the benefit of PE in other areas of (public) health, opportunities for PE in NPI decision-making might have been overlooked during the COVID-19 pandemic. Our results provide guidance into when and how to execute PE in future outbreaks. [ABSTRACT FROM AUTHOR]

Aim: A population-based COVID-19 cohort was set up in the Netherlands to gain comprehensive insight in the short- and long-term effects of COVID-19 in the general population. The present study aims to describe the methodology and infrastructure used to recruit individuals with COVID-19, and the representativeness of the population-based cohort. The second aim was to characterize the population by description of their symptoms and health care usage during the acute COVID-19 phase. Method: The starting point of the set-up of the cohort was to recruit participants in routinely recorded, general practice electronic health records (EHR) data, which are sent to the Netherlands Institute for Health Services Research Primary Care Database (Nivel-PCD) on a weekly basis. Patients registered with COVID-19 were flagged in the Nivel-PCD based on their COVID-19 diagnoses. Flagged patients were invited for participation by their general practitioner via a trusted third party. Participating patients received a series of four questionnaires over the duration of one year allowing for a combination of data from patient reported outcomes and EHRs. Results: In this study, results from the first questionnaire are used. The Nivel Corona Cohort consists of 442 participants and is population-based, containing a complete image of severity of symptoms from patients with none or hardly any symptoms to those who were hospitalized due to the COVID-19. The five most prevalent symptoms during the acute COVID-19 phase were fatigue (90.5%), reduced condition (88.2%), coughing/sneezing/stuffy nose (79.3%), headache (75.4%), and myalgia (66.7%). Conclusion: The population-based Nivel Corona Cohort provides ample opportunities for future studies to gain comprehensive insight in the short- and long-term effects of COVID-19 by combining patients' perspectives and clinical parameters via the EHRs within a long-term follow-up of the cohort. [ABSTRACT FROM AUTHOR]

This 'cohort profile' aims to provide a description of the study design, methodology, and baseline characteristics of the participants in the Corona Behavioral Unit cohort. This cohort was established in response to the COVID-19 pandemic by the Dutch National Institute for Public Health and the Environment (RIVM) and the regional public health services. The aim was to investigate adherence of and support for COVID-19 prevention measures, psychosocial determinants of COVID-19 behaviors, well-being, COVID-19 vaccination, and media use. The cohort also examined specific motivations and beliefs, such as for vaccination, which were collected through either closed-ended items or open text responses. In April 2020, 89,943 participants aged 16 years and older were recruited from existing nation-wide panels. Between May 2020 and September 2022, 99,676 additional participants were recruited through online social media platforms and mailing lists of higher education organizations. Participants who consented were initially invited every three weeks (5 rounds), then every six weeks (13 rounds), and since the summer of 2022 every 12 weeks (3 rounds). To date, 66% of participants were female, 30% were 39 years and younger, and 54% completed two or more questionnaires, with an average of 9.2 (SD = 5.7) questionnaires. The Corona Behavioral Unit COVID-19 cohort has published detailed insights into longitudinal patterns of COVID-19 related behaviors, support of COVID-19 preventive measures, as well as peoples' mental wellbeing in relation to the stringency of these measures. The results have informed COVID-19 policy making and pandemic communication in the Netherlands throughout the COVID-19 pandemic. The cohort data will continuously be used to examine COVID-19 related outcomes for scientific analyses, as well as to inform future pandemic preparedness plans. [ABSTRACT FROM AUTHOR]

Background: Guidelines on COVID-19 management are developed as we learn from this pandemic. However, most research has been done on hospitalised patients and the impact of the disease on non-hospitalised and their role in transmission are not yet well understood. The COVID HOME study conducts research among COVID-19 patients and their family members who were not hospitalised during acute disease, to guide patient care and inform public health guidelines for infection prevention and control in the community and household. Methods: An ongoing prospective longitudinal observational study of COVID-19 outpatients was established in March 2020 at the beginning of the COVID-19 pandemic in the Netherlands. Laboratory confirmed SARS-CoV-2 infected individuals of all ages that did not merit hospitalisation, and their household (HH) members, were enrolled after written informed consent. Enrolled participants were visited at home within 48 hours after initial diagnosis, and then weekly on days 7, 14 and 21 to obtain clinical data, a blood sample for biochemical parameters/cytokines and serological determination; and a nasopharyngeal/throat swab plus urine, stool and sperm or vaginal secretion (if consenting) to test for SARS-CoV-2 by RT-PCR (viral shedding) and for viral culturing. Weekly nasopharyngeal/throat swabs and stool samples, plus a blood sample on days 0 and 21 were also taken from HH members to determine whether and when they became infected. All participants were invited to continue follow-up at 3-, 6-, 12- and 18-months post-infection to assess long-term sequelae and immunological status. [ABSTRACT FROM AUTHOR]

Background: During the beginning of the COVID-19 pandemic there was an urgent need for accelerated review of COVID-19 research by Medical Research Ethics Committees (MRECs). In the Netherlands this led to the implementation of so-called 'fast-track-review-procedures' (FTRPs) to enable a swift start of urgent and relevant research. The objective of this study is to evaluate FTRPs of MRECs in the Netherlands during the COVID-19 pandemic and to compare them with the regular review procedures (RRPs). Methods and findings: An explanatory sequential mixed method study was conducted. Online questionnaires and four group interviews were conducted among MREC representatives and investigators of COVID-19 research. In addition, data from a national research registration system was requested. Main outcome measures are differences in timelines, quality of the review and satisfaction between FTRPs and RRPs. The total number of review days was shorter in FTRP (median 10.5) compared to RRPs (median 98.0). Review days attributable to the MRECs also declined in FTRPs (median 8.0 versus 50.0). This shortening can be explained by installing ad hoc (sub)committees, full priority given to COVID-19 research, regular research put on hold, online review meetings and administrative leniency. The shorter timelines did not affect the perceived quality of the review and ethical and legal aspects were not weighted differently. Both MREC representatives and investigators were generally satisfied with the review of COVID-19 research. Weaknesses identified were the lack of overview of COVID-19 research and central collaboration and coordination, the delay of review of regular research, and limited reachability of secretariats. Conclusions: This study shows that accelerated review is feasible during emergency situations. We did not find evidence that review quality was compromised and both investigators and MRECs were content with the FTRP. To improve future medical ethical review during pandemic situations and beyond, distinguishing main and side issues, working digitally, and (inter)national collaboration and coordination are important. [ABSTRACT FROM AUTHOR]

This study looks at population response to government containment strategies during initial stages of the COVID-19 pandemic in four high-trust Northern European countries–Denmark, Germany, the Netherlands, and Sweden–with special emphasis on expressions of governmental trust. Sentiment analysis and topic modeling analysis were performed using Twitter data from three phases during the initial European lockdown, and results were compared over time and between countries. Findings show that, in line with existing theory, assertive crisis responses and proactive communication were generally well-received, whereas tentative crisis responses or indications by the authorities that the crisis was manageable were generally met with suspicion. In addition, while government support was high in all countries during the height of the crisis, messages critical of the government as well as conspiracy theories were nevertheless widely circulated. Importantly, countries with the least assertive strategies, rather than clear negative responses, saw heightened polarization of sentiment in the population. Furthermore, in the case of Sweden, a laissez-faire strategy was generally accepted by the population, despite strong criticism from other countries, until mortality rates started to rise. Possible explanations for these findings are discussed with an emphasis of prior trust as a potential explanatory factor. Future research should seek to replicate these findings in other countries with different levels of prior governmental trust or with a different severity of the COVID-19 outbreak than the countries in this study as well as triangulate the findings of this study using alternative methods. [ABSTRACT FROM AUTHOR]

Background: Since the start of the global COVID-19 pandemic, countries have been mirroring each other's policies to mitigate the spread of the virus. Whether current measures alone will lead to behavioral change such as social distancing, washing hands, and wearing a facemask is not well understood. The objective of this study is to better understand individual variation in behavioral responses to COVID-19 by exploring the influence of beliefs, motivations and policy measures on public health behaviors. We do so by comparing The Netherlands and Flanders, the Dutch speaking part of Belgium. Methods and findings: Our final sample included 2,637 respondents from The Netherlands and 1,678 from Flanders. The data was nationally representative along three dimensions: age, gender, and household income in both countries. Our key outcome variables of interest were beliefs about policy effectiveness; stated reasons for complying with public rules; and changes in behavior. For control variables, we included a number of measures of how severe the respondent believed Covid-19 to be and a number of negative side effects that the person may have experienced: loneliness, boredom, anxiety, and conflicts with friends and neighbors. Finally, we controlled for socio-demographic factors: age, gender, income (categorical), education (categorical) and the presence of Covid-19 risk factors (diabetes, high blood pressure, heart disease, asthma, allergies). The dependent variable for each of the estimation models is dichotomous, so we used Probit models to predict the probability of engaging in a given behavior. We found that motivations, beliefs about the effectiveness of measures, and pre-pandemic behavior play an important role. The Dutch were more likely to wash their hands than the Flemish (15.4%, p<0.01), visit family (15.5%, p <.01), run errands (12.0%, p<0.05) or go to large closed spaces such as a shopping mall (21.2%, p<0.01). The Dutch were significantly less likely to wear a mask (87.6%, p<0.01). We also found that beliefs about the virus, psychological effects of the virus, as well as pre-pandemic behavior play a role in adherence to recommendations. Conclusions: Our results suggest that policymakers should consider behavioral motivations specific to their country in their COVID-19 strategies. In addition, the belief that a policy is effective significantly increased the probability of the behavior, so policy measures should be accompanied by public health campaigns to increase adherence. [ABSTRACT FROM AUTHOR]

Following the outbreak of COVID-19, governments took unprecedented measures to curb the spread of the virus. Public participation in decisions regarding (the relaxation of) these measures has been notably absent, despite being recommended in the literature. Here, as one of the exceptions, we report the results of 30,000 citizens advising the government on eight different possibilities for relaxing lockdown measures in the Netherlands. By making use of the novel method Participatory Value Evaluation (PVE), participants were asked to recommend which out of the eight options they prefer to be relaxed. Participants received information regarding the societal impacts of each relaxation option, such as the impact of the option on the healthcare system. The results of the PVE informed policymakers about people's preferences regarding (the impacts of) the relaxation options. For instance, we established that participants assign an equal value to a reduction of 100 deaths among citizens younger than 70 years and a reduction of 168 deaths among citizens older than 70 years. We show how these preferences can be used to rank options in terms of desirability. Citizens advised to relax lockdown measures, but not to the point at which the healthcare system becomes heavily overloaded. We found wide support for prioritising the re-opening of contact professions. Conversely, participants disfavoured options to relax restrictions for specific groups of citizens as they found it important that decisions lead to "unity" and not to "division". 80% of the participants state that PVE is a good method to let citizens participate in government decision-making on relaxing lockdown measures. Participants felt that they could express a nuanced opinion, communicate arguments, and appreciated the opportunity to evaluate relaxation options in comparison to each other while being informed about the consequences of each option. This increased their awareness of the dilemmas the government faces. [ABSTRACT FROM AUTHOR]

Purpose: Virus epidemics may be mitigated if people comply with directives to stay at home and keep their distance from strangers in public. As such, there is a public health interest in social distancing compliance. The available evidence on distancing practices in public space is limited, however, by the lack of observational data. Here, we apply video observation as a method to examine to what extent members of the public comply with social distancing directives. Data: Closed Circuit Television (CCTV) footage of interactions in public was collected in inner-city Amsterdam, the Netherlands. From the footage, we observed instances of people violating the 1.5-meter distance directives in the weeks before, during, and after these directives were introduced to mitigate the COVID-19 pandemic. Results: We find that people complied with the 1.5-meter distance directives when these directives were first introduced, but that the level of compliance started to decline soon after. We also find that violation of the 1.5-meter distance directives is strongly associated with the number of people observed on the street and with non-compliance to stay-at-home directives, operationalized with large-scale aggregated location data from cell phones. All three measures correlate to a varying extent with temporal patterns in the transmission of the COVID-19 virus, temperature, COVID-19 related Google search queries, and media attention to the topic. Conclusion: Compliance with 1.5 meter distance directives is short-lived and coincides with the number of people on the street and with compliance to stay-at-home directives. Potential implications of these findings are that keep- distance directives may work best in combination with stay-at-home directives and place-specific crowd-control strategies, and that the number of people on the street and community-wide mobility as captured with cell phone data offer easily measurable proxies for the extent to which people keep sufficient physical distance from others at specific times and locations. [ABSTRACT FROM AUTHOR]