Dear Minister Lenert, thank you for your leadership during this unprecedented period of COVID crisis. Our members and readers applaud the strength and wisdom of the actions you have taken to ensure the health of the nation and welcome this opportunity to better understand how you and your team have addressed the challenges we all have faced. The relatively low level of mortality within Luxembourg is a credit to the quality of the Luxembourg health system. We compliment you on what you and your team have done and ask you to explain the details of this effective strategy to our readers:
AMCHAM -How did the knowledge of the Corona medical crisis first come to your attention and how did the status of the situation evolve over time?
Minister Lenert– When I took over the mandate as Health Minister on 4 February 2020 from my predecessor Etienne Schneider, overcoming a health crisis like the one we are experiencing this year was certainly not on my list of priority issues that I had planned to bring forward. But there was no time for lengthy reflections and I immediately started to work with my team and other concerned ministries in a crisis modus – and I still do so today.
The Health Directorate had been monitoring the situation in China since the beginning, even before there was an indication of the global scale the virus would take. We paid particular attention to the risk evaluations of the WHO and of the ECDC and soon after I took over my mandate as a Health Minister it became evident that we were facing much more than just a new virus or a new form of seasonal influenza. The challenge was to anticipate the worst and to gear up our capacities as quick as possible in order to protect our citizens and our health system.
Today we know already much more about SARS-CoV-2 and still, many unknowns remain. We have to prepare for every possible scenario. We know that this virus will continue to preoccupy us for a long time to come, and we are learning to live with this new health challenge. The biggest challenge over time will be to strike the right balance between managing to keep up some sort of normality for our citizens while at the same time putting into place the measures that are necessary to control and fight the virus.
AMCHAM – How did you and your colleagues in the Ministry of Health first view the seriousness of the medical situation and what were the chronology of steps which were considered, which were rejected (and why) and which were adapted into a cohesive Luxembourg strategy?
Minister Lenert – Already before the first case of COVID-19 infection in Luxembourg on 29 February, an intense exchange with the national crisis cell in close collaboration with the Ministry of State and the High Commission for National Protection had taken place, together with all the ministries and administrations concerned by the subject in question.
Quite quickly, I took the decision to set up an internal crisis cell within the Ministry of Health. It was crucial to be fully operational at all times and to take decisions quickly when needed. We put into place a whole system around different working groups: logistical, monitoring, sanitary reserve, hotline, contact tracing, testing, crisis communication, hospital, primary healthcare and elderly care homes. The whole health sector had to be reorganized from bottom up in a record time. It was a huge challenge, but we managed thanks to the solidarity of all the actors. Rather early substantial investments were made in the increase of our PCR testing capacities, which has allowed us to become the country with the highest test rate worldwide.
The evolution of the situation was assessed daily, not to say hour by hour by our newly installed monitoring platform. The scientific assessments of the research taskforce were, and still are, of great importance in this process.
Our first objective was always to keep our health care system running smoothly for as long as possible. Separate pathways for COVID and non-COVID patients were put into place throughout the whole system: in hospitals, primary care and elderly care homes. Very soon, we offered teleconsultation to patients and put into place specific tariffs for doctors. At the same time, with the support of the Army, we set up support structures for hospitals, and the Advanced Care Centers.
One of the biggest challenges was the supply of protective equipment, i.e. alcohol gel, hygienic masks for health professionals first, and then for the population, blouses, but also ventilators and critical medicinal products which became all of a sudden very scarce. The logistical team negotiated literally day and night with the Asian market.
In times of crisis, communication is also a key element in getting people to buy into political decisions. It is very important that people understand why a particular decision has been taken. We have therefore regularly informed the press and the public, answered the many questions from our citizens and developed various information campaigns. A hotline had been installed right at the beginning of the crisis. It was important that people knew where to address when in need and how to behave in front of this new virus. In addition, we drew up the necessary legislative bases. Declaring a state of crisis is not an easy decision to make, nor is the decision of a lockdown.
Today we are facing a second wave and our response builds on the lessons learned of the previous months. We have perpetuated many instruments from the first phase while allowing enough space for flexibility and new solutions.
AMCHAM -What modification have you made to your initial strategy over time and why?
Minister Lenert – The Government has adapted our strategy every time this was necessary in the light of the epidemiological situation and whenever new scientific evidence was brought forward. The knowledge about the virus and its transmission patterns have been changing daily since the onset of this crisis. Flexibility and responsiveness are key elements of the management of this crisis.
Our first objective was of course the protection of our population and the maintenance of the health system, as already mentioned. Our main focus was on isolation and quarantine of the people found positive and their contacts. We also put a lot of efforts in the acquisition of protective equipment and ventilators as well as in creating additional ICU capacities. The images from the impact of the virus in some European countries and in our neighbouring regions left strong impressions and motivated us to decide rather quickly to go into lockdown, on 16th March to be precise, followed by the state of crisis 2 days later.
The effects of the lockdown became quickly tangible. With the arrival of sufficient protective equipment and the consequent decrease in new infections, we began to deconfine gradually as from end of April onwards, while continuously assessing the situation, always guided by several considerations such as the protection of public health and of our health system, as well as the consequences for the economy and on the moral and physical well-being of our citizens.
Our strategy has been accompanied by the so-called large-scale testing since the month of August, as a means to identify positive cases quickly and isolate them. LST has also been used to test specific economic sectors before their respective deconfinement and after the summer break. The LST has entered its second phase since October and its focus has been adjusted to allow for a more flexible according to the evolution of the epidemic in Luxembourg.
At the same time, the capacities of our tracing team have been considerably increased to be able to face the second wave.
Of course, the various restrictive measures in place have been adapted regularly over time in order to adjust to the dynamics of the virus. In doing so, we have put a lot of effort in the monitoring of the situation based on a range of indicators and by looking into the situation of our neighbouring countries. The mandatory wearing of face masks in certain places was never completely abandoned even when the incidence rate was very low.
You might have noticed that our communication strategy has also varied according to the situation. However, our main message has always remained the same: everyone should always remain vigilant and show personal accountability.
AMCHAM -On a long-term basis, what steps will be taken to enhance the self- sufficiency and increase the capacity of the Luxembourg medical system? Are there plans to ensure less reliance on medical workers who live outside of Luxembourg and increase the number of Luxembourg based medical staff?
Minister Lenert -This health crisis has shown in an intense way, to what extent Luxembourg is dependent on foreign health professionals. But the Ministry of Health has not waited for a crisis to make this finding. Already in 2018, a study on our health workforce has been commissioned. Amid the conclusions was the recommendations to put into place the necessary means in order to attract a bigger number of residents towards the profession of healthcare workers.
The “Health Professional Service” within my ministry has been strengthened by a Chief Nursing Officer, who is in close contact with those working in the field and who is in charge to enhance the value of the health professions and to draw up proposals to make these professions more attractive to young Luxembourgers.
This is a long-term process, and one of my political priorities.
I have insisted on integrating the important topic of medico-social demography within the “Gesondheetsdësch”. Other topics include the use of new technologies and prevention in the health sector, as well as the financial sustainability of the health system. All those themes are interlinked, and the discussions should help to define concrete solutions to address the various challenges.
AMCHAM -What is the level of medical interoperability and cooperation within the Grand region, is it sufficient and what is being done to increase it?
Minister Lenert -Luxembourg is not an island and we are highly dependent on the cross- border workers, also in the critical field of healthcare services. It is therefore only natural that we have always put a lot of efforts in maintaining a good relationship with the countries of the Grande Region. Our relationship with our neighbour countries is built on mutual trust and openness and the fact that we have a ministry which is dedicated to the Grande Region underscores this bond.
A structural exchange on COVID-19 related topics between Luxembourg and the Grande Region is in place, allowing for weekly exchanges on the evolution of the epidemic and the measures planned and in place in each of our countries. It has enabled us to gain very valuable insight into the way how Belgium, France and Germany deal with the various challenges. I am a firm believer of the learning by doing approach.
On top of that, every resident from another country is notified by our Health Directorate to the corresponding health authority in the country of residence, and vice versa.
AMCHAM -How does Luxembourg identify and deal with “hot spots” of contagion.
Minister Lenert -We have given ourselves a great deal of flexibility in the context of large- scale testing which is unique in the world and which allow us to get a good overview of the way the virus evolves in our society and where possible clusters – which otherwise would have remained undetected – are located. If we detect a possible hotspot, our mobile teams travel to the site to test potential contacts immediately. By testing a lot of people, we can quickly identify new transmission chains, isolate positive cases and their contacts and limit the further spreading of the virus.
Alongside our very ambitious testing strategy, contact tracing is a key element in the fight against the spread of the virus. For months, the teams have been doing a remarkable job in contacting people who have tested positive to COVID and tracing their close contacts. We have massively reinforced the contact tracing team. Currently, 220 people are tracking positive people and their contacts 7 days/7, and working long evenings. This has enabled us to identify the main sources of contamination and to adapt our measures accordingly, in particular by limiting the number of people a household can invite into the home.
Finally, we have targeted our communication strategy to different audiences in order to make sure that our messages and sanitary measures are equally followed throughout our society. If we want to fight this virus for good, everyone must be on board.
AMCHAM -When do you expect to have a vaccine available, what will be the priority for immunization of the population, and will immunization be free to all Luxembourg inhabitants and employees?
Minister Lenert -This is a very tricky question. According to the EU Commission, the first vaccine will get a market authorization by mid-December the earliest. When exactly the vaccine will arrive in Luxembourg will depend on the production capacity of the producers.
We are currently elaborating a vaccination strategy based on international recommendations. This strategy will be presented soon, and it will also address the question whether the vaccine will be free of charges and which categories will be vaccinated when.
Vaccination, whether against measles, influenza or other serious diseases, has never been compulsory in Luxembourg. Vaccine hesitancy is a topic in our country too, but I am confident that with the arrival of a safe and effective vaccine, a majority of citizens will adhere to the COVID-19 vaccine. Our role is still and always to inform, to explain the advantages of the vaccine, as well as the possible side effects. Transparency is key.
AMCHAM -Are you satisfied with the level of voluntary cooperation by inhabitants or under what circumstances will you see a need for additional fines or other punitive measures to ensure compliance with required safe practices?
Minister Lenert -We have learned over the last few months how unpredictable the virus is and how quickly a new peak of infections can occur.
At the beginning of the crisis, we have seen a very broad adherence of our citizens to the measures imposed, and above all an enormous solidarity. But the longer this crisis lasts, the more people are beginning to tire of it. I can understand them very well. We all want to get back to our habits and return to our “normal” life. The Government is aware of the pandemic fatigue phenomenon and takes it absolutely seriously. However, it is absolutely crucial that we don’t give up at this stage.
The government has decided on new restrictions until December 15 and I have great hope that by then the alarming figures of new infections, which we have unfortunately been experiencing since the end of October-November, will significantly decrease.
I therefore hope that, thanks to a collective effort over the next few weeks, we will at least be able to experience a merry Christmas.
AMCHAM -How has your experience dealing with this crisis changed you as a person, your leadership style, and your objectives as a leader of the Ministry of Health?
Minister Lenert -I have learned through this crisis that patience is a key element in managing difficult situations. Even in situations of stress and great tension, you have to keep cool and react with caution, because every decision also has its downside.
Transparency and honesty are values that are dear to me. If we want our people to buy into our decisions, we have to explain them transparently. If we see in hindsight that a decision taken has not have the desired effect, we must have the courage to change course.
As a newcomer to politics, I have also learned that we can only move forward and manage well if we work together. The solidarity of our citizens and of the actors of the health system, the support of my colleagues and of my team, and the common ambition to get out of this crisis have given me the strength to continue. There is always a solution, and together we can make it happen!
AMCHAM -Are there any other pieces of advice or wisdom you would like to share with our members and readers?
Minister Lenert – Solidarity, solidarity and solidarity! Together we are strong, and we can overcome difficult moments.
It is so important in these times to care about each other. Caring about your family and friends, caring about elderly and vulnerable people, your neighbours and caring about oneself. Caring about one’s health, not only during a sanitary crisis, but every day.
And finally: patience. This crisis isn’t over yet but as long as the vaccine or an efficient treatment hasn’t arrived, we must remain patient and learn to think on a long-term basis.
Thank you again Minister Lenert for your leadership during this period of profound crisis!