Sometimes Tildes users give people healthcare advice. Sometimes that advice disagrees with the advice already given by a qualified registered healthcare professional. That might be okay if the tildes advice was compliant with national guidance, but sometimes it isn't. Sometimes it's bad, dangerous, advice.

Should Tildes have rules about this?

Up until recently my girlfriend’s grandmother had a relatively good life. She’s taken care of, had some interesting allucinations, slept most of the day and had funny interactions with her grandaughter, some of which ended up on Instagram.

In recent weeks, she started refusing food and spent days at the hospital. The sudden lost in autonomy made her hostile. It’s a struggle to change her diapers. The situation was made worse by the feeding tube up her nose, which she attempts to remove non-stop, and can only be replaced at the hospital. We had to restrain her arm. That is no way to live.

She's made it very clear she does not want to be in this world any longer. Today I heard a hundred year old lady scream, multiple times: "just let me die!".

I don't know what to make of it.

Edit: I'd like to thank everyone's answers. I wasn't really looking for a solution since the legal situation in my country does not allow for any wiggle room. But it is always nice to read the smart people of Tildes passionately explore their ideas, sharing knowledge with compassion. Sometimes it is enough to feel less alone. Thank you and good night.

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.

I'm in line at a free covid testing site. It is a CVS minuteclinic. I have to use the normal drivethrough, and self administer the nasal swab.

What the hell is that bullshit? My wife went to a 'real' test site where a professional swabbed and she described it as a pap smear on the back of her eye.

So I'm going to a CVS so they can print a barcode, give me, an unqualified layperson a long qtip and a test tube to do my own test and drop in a collection box. Which they will likely ship to an actual lab.

And for all of this 'work', they get to bill my insurance for hundreds or more, which will likely mean rate hikes later.

Our healthcare system is a sham, and this is just further proof. Given I have to do it myself anyway, the government should just mail me a kit which I then drop off.

It would not shock me in the slightest if they actually just drop the tests in a dumpster and just send a 'negative' a few days later.

Edit: 40 min later, through line and swabbed. Yes, they just have Quest diagnostics empty the dropbox. 0 reason CVS should be involved.

My first memory after leaving the house to cycle was being taken by the ambulance to the hospital. I was evaluated by several medical professionals. One of them spent two hours stitching my mouth and forehead back into something that resembles a human being.

Brazilian SUS is not perfect by any means. It's unorganized and some procedures and operations can take a long time to happen. There's lots of corruption with doctors that work in multiple places at the same time.

But, a lot of the time, it freaking works. The paramedics were gentle, affectionate, and competent. Some in the street knew my mother so they when to my house and called her--she accompanied me in the ambulance.

The hospital was not pretty by any standard. There were burn victims screaming bloody hell and I'm pretty sure I saw a woman die--but hey, that's a hospital, people die there!

An actual orthopedist made sure I did not have any fracture. An actual neurologist made sure I have no neural damage. A surgeon stitched my mouth and forehead back together into something that doesn't look like a character out of Frankenstein. It still looks bad, but it'll improve with time. A very nice nurse cleaned up all my bruises and have me aftercare orientations.

On several occasions, we had to manually seek people and procedures that were supposed to happen automatically. The operation itself was a mess, but the doctors and nurses were extremely caring, competent, and dedicated.

This all cost me exactly zero dollars. I didn't even had to fulfill any absurd form or provide an excess of documentation: just my national registry (RG), something almost every citizen has unless they're a very specific kind of homeless.

This is in a very poor unstable country. It is absolutely not perfect, but on many occasions, it kinda works!