The number of people that can infect other people with the coronavirus (SARS-CoV-2) has been estimated this week at almost 118,000 (lower limit: 83,000 – 150,000: upper limit).  The number of contagious people in the Netherlands has been decreasing much slower in October and November than during the first wave in March and April (Figure 1). This is clearly visible in how the number of contagious people is trending. On 24 March, there were 169,000 contagious people in the Netherlands. That number dropped by 43% in three weeks, down to 96,000 contagious people on 14 April. On 15 October, there were 159,000 contagious people in the Netherlands. In the past three weeks, that number has dropped by 25%, down to 118,000 contagious people on 5 November. 

Figure 1: The estimated number of contagious people in the Netherlands. The figure shows the number of contagious people based on the number of hospitalisations reported by the NICE Foundation, displaying the most plausible value (the line) and the 95% confidence interval. Due to the interval between the first day of illness and delayed reporting, we can arrive at reliable estimates of the number of contagious people more than 7 days ago. Estimates within the past 7 days do not have a reliable confidence interval, so the most plausible value for this period has been omitted. How the number of contagious people is calculated. 

Number of reported COVID-19 infections and differences between regions

37,706 new confirmed COVID-19 cases* were reported last week, 5,915 (-14%) less than the week before. This decrease is less than the week before, when a decrease of 32% was reported. Once again, a downward trend can be observed in all age categories (Figure 2). In addition, the decrease is visible in all regions. The largest decrease in the number of newly reported COVID-19 infections per 100,000 inhabitants this week was observed in the regions of Kennemerland and Rotterdam-Rijnmond. Still, the number of people who tested positive for COVID-19 is still very high: 20 out of 25 regions are still in a serious phase of the COVID-19 epidemic, with more than 150 infections per 100,000 inhabitants. None of the regions are in a controlled phase with under 50 infections per 100,000 inhabitants.

*COVID-19 is a notifiable disease, so it is legally required to report a positive SARS-CoV-2 test result to the Municipal Public Health Service (GGD). Everyone, including commercial test providers, must comply with that legal requirement. The Health Inspectorate oversees compliance. The government has published guidance documents (in Dutch) 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. From early November 2020 until now, it is estimated that about 1% of all newly reported infections were detected by positive antigen tests.

Figure 2: 

GGD test lanes and percentage of positive tests

In the week of 9 to 15 November, 226,094* people were tested in the GGD test lanes, nearly 19,000 fewer than in the week before. The test results for 226,083 people are known, and 31,219 people tested positive for COVID-19. The percentage of people who tested positive is 13.8%, a slight decrease compared to the previous week. However, the percentage of positive tests is still high, comparable to early October (week 41), when the positive percentage was 13.6%. 

The time between making an appointment and receiving the test result in the GGD test lanes has been greatly reduced in recent weeks. Someone who telephones via 0800-1202 or makes an appointment online will now receive the results of the coronavirus test somewhere between less than 24 hours up to a maximum of 38 hours.  

**Source: GGD GHOR

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. Another 156 new nursing home locations with confirmed cases were added in the past week, compared to 182 in the week before. 

Mortality higher than expected, but upward trend has not continued

Statistics Netherlands (CBS) reports that mortality did not increase any further in the week of 2 to 8 November, compared to a week earlier. As in the week before that, there were nearly 700 more deaths than expected for that week. 

RIVM also keeps track of mortality figures on a weekly basis. In the most recent RIVM data for 29 October to 4 November, just as in the week before that, mortality was significantly elevated in the age categories of 65-74 years and of 75 years and older. Mortality was elevated in all regions.  
The rising number of additional deaths coincided with the second wave of the coronavirus epidemic in the Netherlands. 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.

Reproduction number R

The reproduction number for 30 October* is 0.89 (lower limit: 0.86, upper limit: 0.91), a minimal change compared to the week before. A reproduction number of 0.89 means that 100 people with COVID-19 will collectively infect another 89 people with the virus. The lower the reproduction number, the better. 
 ***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. RIVM publishes open data every day. Everyone can access the open data. The information can also be found daily on the coronavirus dashboard. 

	Last week1	Two weeks ago2
COVID-19 reports by Municipal Public Health Services (GGDs)
Newly reported COVID-19 infections	37,706	43,621
Number of hospital admissions to nursing wards (Source: NICE)	1496	1520
Number of hospital admissions to Intensive Care (Source: NICE)	224	275
Deaths	479	565
GGD test lanes per calendar week3	week 46	week 45
Total number of tests of which results are known	226,083	244,019
Number of people who tested positive	31,219	35,492
Percentage of positive tests	13,8%	14,5%

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

¹GGD reports to RIVM between 10 November 10:01 and 17 November 10:00 as published 17 November 2020 in the weekly epidemiological update on COVID-19 in the Netherlands.
²GGD 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.
³As published on 17 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.