I've started seeing lots of stories or posts elsewhere on the internet about people managing to schedule appointments for their COVID vaccinations even if they're not in the current phase and I'm curious what people's thoughts are about it.

To be clear, I am specifically not asking about people who are able to snag leftover or "thawed" doses that would otherwise have to be tossed at the end of the day.

Today, Belgium announced no changes in current protection measures.

After a fairly successful handling of the first wave (all things considered, especially the fact it was actually unprecedented at the time), Belgium's handling of the pandemic has been getting progressively worse. All countries have suffered their fair share of incompetence during this crisis, but today, we'll talk about Belgium (and a bit about the EU), because I live there.

Context and restrictions

Belgium works a little bit like a miniature version of the USA: Three regions (Flanders, Wallonia and Brussels) which function somewhat independently as states, with a federal government overseeing all three. Flanders is primarily flemish (dutch-speaking), Wallonia is primarily french, and Brussels is a mix but mainly french.

Excellent article detailing restrictions: https://www.politico.eu/article/belgium-coronavirus-lockdown-rules-restrictions-overview/ -- Some highlights below.

• A 10PM curfew is in place since October 2020 in Brussels and Wallonia; Midnight for Flanders.
• Bars, cafes, restaurants are closed to non-takeout business since October 2020. All alcohol sales prohibited after 8pm.
• Museums, swimming pools, hairdressers, are currently open.
• Remote work is mandatory.
• Belgium is currently forbidding non-essential travel outside of the country, much to the EU's dismay.
• There is a complicated social bubble system which tells you how many people you are allowed to see every week.

The "long lockdown"

Like most other western countries, Belgium experienced its first wave between March and May. We strictly locked down in March, reopened in June. The lockdown was successful at reducing the number of cases for all summer. A new lockdown happened in October but this time, driven by the fear of being "too strict", Belgium instead adapted a long checklist of a variety of measures, evolving more or less weekly, so that some things can be allowed. Most importantly, Belgium did not close schools at all.

The effects of this by comparison can be marveled at here: https://twitter.com/NikoSpeybroeck/status/1365257345941520385/photo/1

In essence: Belgium plateau'd high. So for October, November, December, January, February and now March, the country has been suffering nearly all the casualties of a normal lockdown… instead of a 10 week, slightly stricter lockdown (like countries such as South Korea are able to achieve), we're getting what looks to be a 24+ week, slightly less strict, highly-damaging lockdown.

The importance of consistency

The #1 complaint from everyone I've talked to about the rules are their inconsistencies. Because when you impose rules that affect people negatively, their first reaction will be: "Why are you forbidding X, which affects me, but allowing Y, which is worse and doesn't?"

You all know I'm a skater. For me it's the swimming pools: I'm at a loss why safe ice rinks are closed, but swimming pools are open. Something something chlorine. But there are plenty of examples that affect the general population; the one I hear most often as a comparison point is: "Why are we allowing people to be packed like sardines in the metro and in buses?" (And yes, people really are packed up in there at peak hours, I'm sure it's one of the primary transmission vectors)

Or: "Why are you forcing me to work remotely, when you are keeping the schools open? " -- Most countries did notice how much of a transmission vector schools and campuses are, especially with teenagers not exactly being incentivized to take precautions. Belgium, throughout the whole soft lockdown, has kept schools open for nearly the entire time they were going to be on a normal year.

Inconsistencies drive people to distrust the rules, and those making the rules. They make the rules feel arbitrary, which makes them feel irrelevant as a whole. It gets people thinking: "If this is not logical, then the explanation is that they don't know what they're talking about, and I can't trust what they say about COVID".

The importance of simplicity

What are the current measures? (official government website)

Now, I think info-coronavirus.be is one of the better-organized and well-marketed successes of Belgium's handling of the pandemic. Unfortunately it also nicely showcases how complex the rules are when there are sections such as "Can dog groomers remain open?" and "Can hunting continue?".

Belgium's social bubble system is easily the most complicated part of it and the people I know who do follow the rules, don't actually necessarily understand them and end up accidentally either being too strict, or breaking the rules. I can't tell you what it is myself without looking it up, as the rules around it change regularly; what I know is that you're more-or-less allowed to see 4 people per week. There is a "cuddle-contact" rule that dictates how many people you're allowed to be intimately close with each week. The rules are different based on your age, based on whether you live alone, based on whether you tend to people in certain groups…

Over winter, the rules got utterly ridiculous and I've written about this before, with a checklist of exceptions, ifs-and-buts for Christmas and New Years, dictating different rules for whether you're outside, inside, how many people can go to the toilet in your home, etc.

I cannot stress how much this has negatively impacted the population. It is neither learned nor widely followed, but as an ever-present high-impact rule in people's day to day life, is a constant reminder of how arbitrary the measures are.

Simpler rules, whether they're stricter or looser, will be followed more widely and will be overall perceived less negatively.

The importance of a risk-impact balance

For every single additional rule created, people's patience is tested. Of course, stricter rules are a tougher test to go through, but the more rules, the more you test their patience as well.
So there is a careful balance to strike: When introducing a rule, it has to actually be useful. You want to maximize how much you are reducing hospitalizations, with as few rules as possible. Getting to zero is not the goal, getting to a manageable number is.

With some exceptions, people don't have an understanding of the impact most rules on the final numbers. So it's rare that people take into account how useful the rules are when evaluating whether they should respect them. More to the point, a good amount of people will take an "all or nothing" approach, where the moment they stop respecting some rules, they'll stop respecting most or even all of them.

So it is critical to limit the rules to those that have the highest impact in the final numbers, and enforce those; rather than have far looser enforcement of a lot of rules that may, on paper, be more effective.

People aren't machines and will not function perfectly. I have yet to hear experts and politicians take the simplest questions into account:

• Will this rule be respected?
• Will people who stop respecting this rule cause them to stop respecting other rules?
• Will people distrust vaccines as a result of distrusting rules?
• How does this affect the numbers when taking the above into account?

Something to keep in mind when taking arbitrary decisions such as forbidding outdoors lake skating when, after a winter of sports being inaccessible, lakes finally freeze in Belgium.

Vaccinations

Yes, vaccines, let's talk about them.
Now it's no secret that the EU has really botched vaccine supplies. And yet, Belgium is proudly and loudly "slightly ahead of the initial vaccination timetable".
You'd think this is good news, but what it means is that Belgium's vaccination timetable is horribly pessimistic. Distributing vaccines is the one thing getting us out of this mess, and it's being prioritized like a 4am car alarm. One example, which was eventually backtracked on, is how COVID nurses and caregivers were going to be in the second phase of vaccinations, only given the shot after all care homes had been vaccinated. Which means that in that awful timetable, they'd start receiving their shots… next week, as of the time I'm writing this.

The US quickly figured out that Pharmacies need to be involved. Now, here's a fun fact you can throw out at parties: Belgium has the most pharmacies per capita in the world, sitting at around ~5000 pharmacies in total for 11.5M people.

Guess which country has yet to even talk about involving pharmacies in the distribution of the vaccines?

I talked about this with my MD this week. He was on the floor. He keeps telling government officials: "Give me a box of 20 vaccines per day, I'll have them distributed to patients and I can follow prioritization strategies". They refuse.

There are 73% non-respondants to vaccine invitations in Brussels. The Heysel vaccination center alone is wasting 750 vaccination slots per day, instead of taking a page from what airlines learned and overbooking to keep all slots as close to full as possible.

This disorganized mess is costing millions of euros every day. It's lengthening a stressful period which will have lasting effects on the population. It causes distrust of governments, distrust of systems, distrust of scientists. The butterfly effect of fucking this up is unfathomable.

Masks

And now we get to the latest fuckup. Masks. One of the most effective, highest-impact, easiest-to-comply-with measures.

Belgian government says to stop wearing the free cloth masks they distributed ‘as a precaution’

Last summer, Belgium distributed free reusable cloth masks to the population. And yesterday, they warned that nanoparticles of silver are present in the mask and can be breathed in, warning to stop wearing them as a precaution measure.

I have no word for the amount of distrust this causes. Not just in Belgium but worldwide. Criminal incompetence.

And again, we are not talking about that. We're not talking about the fact that anti-maskers now have these huge talking points and are easily able to convince a fed-up population that COVID is harmless, wearing masks is a bad idea, vaccines are evil, and we should all just say "fuck it".

In the midst of such an enraging news, the Belgian government has decided that things are fine as-is, and measures should not be relaxed.

From my understanding, even the usual allergies to like the trace egg proteins of typical influenza vaccines (not some of the ultrapure, though) don't apply to the new mRNA vaccines. So all that's left, aside from some immune disorder I think, there are only personal reason left and I'm curious as to what those are.