RESTARTING BELGIUM

GEES
CONFIDENTIAL WORKING DRAFT

April 20, 2020

“Dit document bevat advies van de experten die deel uitmaken van de GEES.
Het gaat daarbij onder meer om persoonlijke meningen die uit vrije wil en op
vertrouwelijke basis worden verstrekt aan de federale regering”

CONFIDENTIAL AND PROPRIETARY

 How to think about the coming months

Health system
capacity No return to zero. Ongoing steering of
Seroprevalence / social contacts surveys restart to stay in acceptable zone.
Overall medium-long term reduction of
Max
contacts required.
Long term equilibrium of how much we can
Hospital
occupancy reopen depends on number of contacts and
type of contacts rather then starting situation
of number of confirmed cases.
Phasing to allow increase of overall number
Tests
of contacts only in steps (therefore some
Contact investigation shops can open and other not even if risk in
Prevention & protection (hygiene, masks, …) single shop is similar; this is to be explained).
Phase 0 Phase 1 Phase 2 Phase 3 Time Phasing of re-opening mostly to learn and
test and ensure pre-requisites are even
more robustly in place (full capacity testing
and contact investigation, masks availability)

FOR DISCUSSION PURPOSES ONLY – NO FINAL RECOMMENDATION GEES 2

Key principles of restart approach

Phased Balanced Conditional

Uncertain “Contact budget” Preserve public health Positive evolution by May 4

Based on up-to-date data Reignite Economy and beyond

Minimize risk of resurgence Fulfil educational missions Hygiene & masks

Country vs. local level Preserve social well-being
Protect the most vulnerable
Testing & contact
investigation at scale
Protocols implementation
General population
information

FOR DISCUSSION PURPOSES ONLY – NO FINAL RECOMMENDATION GEES 3

Tentative scenario for medium-term restart
Building blocks Phase 0 Phase 1 Phase 2

Industry and B2B Essential ok Essential ok

services1 Non-essential if social Non-essential if Idem
distancing respecting protocols
Same + click-and-collect,
Wholesale, retail food,
vehicle delivery/alternative Same + other retail and
pet food, pharmacies,
Retail and wholesale transport, textile, construction wholesale if respecting
DIY, garden centers,
Private and material, if respecting protocols
newspapers ok
public sectors protocols

Horeca / Arts, entertain- Closed, hotels

can open without Idem Idem
ment and recreation3
bar/restaurant
Essential ok Restart/increase
Public/ non-profit4 Non-essential if social capacity of critical Idem
distancing services

COVID/non-COVID;
Healthcare urgent consultations Selective restart + Idem
and surgery COVID-buffer

Closed, limited Closed, extended back-up for

Education Limited re-opening
back-up for working parents ; tele-education
for selected years
working parents primary / secondary

Limit contacts beyond

Sports, culture, leisure, religion and life people living together Single private gathering max 10 Various elements
moments Walk with one other people during WE; non contact under review
person allowed outdoor sport activity with 2
1 Agriculture, forestry and fishing (A), Mining and Quarrying (B), Manufacturing (C) and other Industry (D,E), Construction(F), Transportation and storage (H), Information and Communication (J), Financial and insurance activities (K), Real estate
activities (L), Professional, scientific and technical activities (M), Administrative and support service activities (N), Other service activities (S), Activities of households as employers (T), self-employed
3 Accommodation and food service activities(I)/ Arts, entertainment and recreation (R); Hotels are open, take-away and delivery allowed
4 Public administration and defense; compulsory social security(O), Public transport (H)
FOR DISCUSSION PURPOSES ONLY – NO FINAL RECOMMENDATION GEES 4
Guidelines for Individuals
Across all phases PRACTICE GOOD HYGIENE
Wash your hands with soap and water or use hand sanitizer, especially after
touching frequently used items or surfaces
Avoid touching your face

Continue to Sneeze or cough into a tissue, or the inside of your elbow

adhere to Disinfect frequently used items and surfaces as much as possible
guidance, MAINTAIN PHYSICAL DISTANCING / USE MASKS
particularly with Maintain 1.5-2m physical distancing when possible
regards to
Strongly consider (impose?) using disposable or reusable masks while in
hygiene, public, and particularly when using mass transit, i.e. whenever risk of not
distancing and respecting physical distancing

masks PEOPLE WHO FEEL SICK SHOULD STAY HOME

Do not go to work or school (suggested daily temperature check)
Contact and follow the advice of your medical provider

VULNERABLE INDIVIDUALS
Strong advice to continue to protect yourself
FOR DISCUSSION PURPOSES ONLY – NO FINAL RECOMMENDATION GEES 5
Guidelines for Employers
Across all phases FURTHER PREVENT
Continue to strongly encourage tele-working
Minimize business travel to strictly necessary

Restrict common areas

Continue to
adhere to DEVELOP AND IMPLEMENT SAFETY PROTOCOLS
guidance, Physical distancing
particularly Protective equipment
with regards to Temperature checks by or for employees
hygiene, Disinfection of common areas
distancing and Using masks when physical distancing is not possible
masks
MONITOR AND SUPPORT WORKFORCE
Monitor indicative symptoms
Support employees where needed

FOR DISCUSSION PURPOSES ONLY – NO FINAL RECOMMENDATION GEES 6

Phase 0 (20/04)

Private Industry and services: Continued operation of essential sectors; Sports, Sports: Individual physical activity and
Mandatory tele-working for all non-essential sectors; if not feasible horse-riding in the presence of one (and
and public physical distancing (>1.5m) culture, the same) friend
sectors Retail and wholesale: Closed except for (pet) food, pharmacies,
leisure Leisure / culture: No mass events; only
newspaper stores, do-it-yourself stores, garden centers and essential travel
wholesale
Horeca: Closed except for delivery and take-away (hotels open)
Arts / entertainment / recreation: Closed
Public / non-profit: Continued operation of essential administrations
(e.g. police) ; mandatory tele-working for all non-essential
administrations

Education Preschool, primary, secondary: Classes suspended ; Schools Life Weddings: Only in presence of witnesses
remain open for the care of children whose parents (1) work in health
care or other essential sectors (2) have no other options for child care moments Funerals: Maximum 15 people
while they are working ; tele-education as of April 20 for primary and and religion
secondary
Higher education: e-learning only

Healthcare Only urgent consultations and surgery1

1. Met ingang van 14 maart 2020 werden door het Comité Hospital & Transport Surge Capacity richtlijnen uitgevaardigd met het oog op de annulatie en het uitstel van alle niet-essentiële consultaties, onderzoeken en ingrepen in alle
algemene, universitaire en revalidatieziekenhuizen en privé-klinieken in ons land, om de capaciteit te waarborgen om patiënten COVID-19 de best mogelijke zorg toe te kunnen dienen. Deze maatregel is vervolgens door een richtlijn van
Sciensano ook van toepassing verklaard op de ambulante zorg in privé-praktijken.

FOR DISCUSSION PURPOSES ONLY – NO FINAL RECOMMENDATION GEES 7

Current assumption - Restart phase 1 (tentative: 04/05)
TENTATIVE AND CONDITIONAL DATES

Private Industry and services: Implementation of sector-specific protocols Sports, Social: One private gathering between
facilitates re-start of activities in companies also when physical close family or friends during the weekend,
and public distancing (>1.5m) can not be respected at all times culture, with maximum 10 people
sectors Retail and wholesale: Re-start of select activities, e.g. click-and-
leisure Sports: Outdoor sports with maximum
collect services, vehicle delivery, sales of alternative means of 2 people; outdoor group sports training in
transport, textile shops who support the production of face coverings, club context
and shops that sell construction materials. Illustrative line definers to Leisure / culture: Local authorities can
be refined, e.g. housing equipment, car showrooms. decide on re-opening of parks and public
Public / non-profit: Re-start of critical services in administration or spaces; no mass events; only essential
operated at higher capacity (in support of re-opening of private sector travel (incl. travel to sports facilities)
& broader population)

Education Preschool, primary, secondary: Classes remain suspended ; tele- Life Weddings: Only in presence of witnesses
education as of April 20 for primary and secondary, daycare open for
working parents moments Funerals: Maximum 15 people

Higher education: e-learning only

and religion
Healthcare COVID: All measures taken by the Surge Capacity-committee remain
in place until at least [2-3] weeks after relaxation of measures in other
sectors ; development of “resurgence plan” by HTSC
Non-COVID: RAG to set up a working group that clarifies the
definition of “electief”, “dringend”, “noodzakelijk”, “degradatie van de
gezondheidstoestand”, etc. and, on that basis, develops
recommendations on re-start of each sub-sector
FOR DISCUSSION PURPOSES ONLY – NO FINAL RECOMMENDATION GEES 8
Current assumption - Restart phase 2 (tentative: 18/05)
TENTATIVE AND CONDITIONAL DATES

Private Retail and wholesale: Re-start of entire sector Sports, Leisure / culture: Examination with local
authorities if and how day trips to coast
and public Horeca: Remains closed (with exception of hotels) culture, and other touristic hot-spots as well as the
sectors Arts, entertainment and recreation: Remains closed leisure use of second residences/rentals can be
allowed; no mass events

Education Kindergarten: Classes remain suspended

Note: based on VG input;
ongoing discussions FWB
and DG
Primary: Re-start of in-person classes for a maximum of 3 grades1
Secondary: Students in the 6th grade, 7th grade professional
education, HBO5 nursing last module: 1 day/week for 6ASO and max
2 days per week for others Life Weddings / funerals: Examination how
protocols can be adjusted
Higher education: e-learning only moments
and religion

Healthcare COVID: All measures taken by the Surge Capacity-committee remain

in place until at least [2-3] weeks after relaxation of measures in other
sectors ; development of “resurgence plan” by HTSC
Non-COVID: [Selective restart of operations depending on advice
from working group]

1. First priority: 6th grade; second priority: 1st grade; third priority: 5th grade- Students of the 1st grade come to school ‘full time’, but their classes are split into smaller groups and receive classes simultaneously, students of the 5th and 6th
grades are half time present at school in small groups (2 days/week), so that the viva classes at school can be combined with tele-education at home on the 3 other days.

FOR DISCUSSION PURPOSES ONLY – NO FINAL RECOMMENDATION GEES 9

Economic implications
DIRECTIONAL ESTIMATES

Phase 0 Phase 1 Phase 2

# people physically at work

1.5 2.0 2.4
Millions

# people tele-work
1.3 1.5 1.9
Millions

# people temporary
unemployment or absent 2.0 1.3 0.5
Millions

FOR DISCUSSION PURPOSES ONLY – NO FINAL RECOMMENDATION GEES 10

Impact of contemplated restart on public transportation:
Phase 1 and 2 overall within capacity, yet urgent measures to be taken

Number of passengers in rush hour (7-9am) PTOs to start preparations to return to

Thousands people
nominal transport plans by May 4 (need 2-
weeks preparation) as a support to restart.
Current 1302 Capacity constraints will arise in specific
lines (e.g. to or in Brussels) as of Phase 1 or
2, at broad level for following phases. PTOs
Phase 1 170
thus advise mandatory masks / face
cover as a complement to physical
distancing.

Phase 2 2401 Reserve capacity for home-work & home-

school travel – clear instructions to
population required.
200 320
Recommend alternative transport (walk,
Estimated capacity (range) based on bike) for short distances to further limit
enforcement of physical distancing
1. Includes ~30k primary school students
demand.
2. Based on high end of PTO estimates of demand during confinement period (75-130k passengers during rush hour - 7-9am)

FOR DISCUSSION PURPOSES ONLY – NO FINAL RECOMMENDATION GEES 11

Specific populations may require support

Vulnerable individuals Example: Werkende ouders met jonge kinderen (<12)

naar opvang behoefte
Social / care institutions Aantal personen (1,000s, %)
4,663
Families with young children especially
with both parents working or mono- Jonger dan 12,
23%
parental, as long as kindergarten / éénouder of beide werkend
schools not opened Jonger dan 12,
9%
één van beide ouders niet werkend
People living under poverty threshold
(expected increase from 20 to 25%) 12 en ouder 18%

Strong demand of social Geen kinderen 50%

partners for dialogue this
week re working parents

Note: Werkende bevolking: inwoners die tewerkgesteld zijn volgens definitie van ILO
Werkende bevolking
Source: Eurostat, StatBel

FOR DISCUSSION PURPOSES ONLY – NO FINAL RECOMMENDATION GEES 12

What needs to be in place to launch phase 1

EPIDEMIC UNDER TESTING AND CONTACT

CONTROL INVESTIGATION PRE-REQUISITES

“Safe space” zone Testing at scale (both Population informed on

healthcare and community) social norms, large adoption,
availability of masks if phys.
Epidemic in closed distancing not possible
communities (elderly homes) Contact investigation: at
contained least 1,000 FTEs trained and
deployed, to be scaled to Protocols defined and
2,000 approved in most sectors
Control on imported
infections
Compliance control on
workplace

Clarity on liability

FOR DISCUSSION PURPOSES ONLY – NO FINAL RECOMMENDATION GEES 13

Conditions to trigger next phase (being refined)
Positive evolution of leading
indicators (e.g. Covid-like
symptoms by GPs)
Be in “safe space” zone
AND
Daily growth rate
of new +20% Very high Critical Critical Critical Critical Critical
hospitalizations Hospital overload
Evolution in # new hospital
(7-days average)
+10% High Very high Critical Critical Critical Critical admissions over 7 days stable or
negative
+5% High High Very high Critical Critical Critical

AND
+2.5% Intermediate High High Very High Critical Critical

Daily # hospital admissions below

Stable Low Intermediate Intermediate High Very high Critical
threshold
-2.5% Extremely Low Low Intermediate High Very high
Low AND
10 30 100 200 400 800
Significant ICU beds available in
New hospitalizations per day (Belgium)
To replicate at local (Province) level case of flare-up

FOR DISCUSSION PURPOSES ONLY – NO FINAL RECOMMENDATION GEES 14

How to steer: where we come from
Daily growth rate of 15/3
new hospitalizations
(7-days average) +20% Very high Critical Critical Critical Critical Critical
22/3

+10% High Very high Critical Critical Critical Critical

+5 % High High Very high Critical Critical Critical

+2.5 % Intermediate High High Very High Critical Critical

29/3
Stable Low Intermediate Intermediate High Very high Critical
05/04

Extremely
-2.5 % Low
Low Low Intermediate High Very high

Extremely 19/04 12/04

-5 % Extermely Low Low High Very high
Low
Low

10 30 100 200 400 800

New hospitalizations per day (Belgium)

FOR DISCUSSION PURPOSES ONLY – NO FINAL RECOMMENDATION GEES 15
To replicate at local (Province) level