[What does excess mortality tell us?]

Excess mortality due to covid-19 is estimatedas actual mortality minus expected mortality in the covid-19 period. Excess mortality in 2020-2021 in the Netherlands is estimated to be 30,000 persons. Excess mortality should be divided in mortality as consequences of covid-19 infections (direct effects) and mortality due indirect effects of the pandemic. As excess mortality assesses mortality under one single scenario (the actual scenario including its specific measures), it cannot directly be used to know what the number of deaths would have been under different scenarios. In line, it cannot be used to determine whether actual measures in the covid-19 pandemic were optimal (or not). And obviously, excess mortality only assesses the impact on mortality, not the impact on other relevant health-related, sociological or economical areas.

[A preview of COVID-19 vaccination and treatment]

Vaccination or recent exposure to infection with SARS-CoV-2 currently grants the vast majority of the population considerable immunity and thereby protection against severe disease. It is yet unknow how long this protection lasts. Continuous changes of the viral genotype and phenotype herein play an important role, in particular the variant-specific alterations of the spike protein. Protection by T-cell immunity seems to be more preserved in the event of changes in the virus as compared to antibody-mediated host defences. Furthermore, the continuous succession of virus variants also directly and indirectly affects the effectiveness of medical treatment. Regarding immune-modulating as well as anti-viral therapy, the viral characteristics of the circulating SARS-CoV-2 variant in combination with the level of host immunity will determine whether their use makes sense, and for which patients. The number of patients needed to treat to prevent a clinically negative outcome herein represents an important figure.

[The medicinal treatment of COVID-19: a brief update]

Much has changed in the medical treatment of COVID-19 after the first patient with an infection with SARS-CoV-2 in the Netherlands was diagnosed in February 2020. On the basis of limited data, at first only off-label use of (hydroxy)chloroquine seemed to be a treatment option. However, now based on the findings of several randomized studies, other medicines have been included in the Dutch guidelines about the treatment of COVID-19. In this article, we will briefly discuss the current state of affairs with regard to the drugs (hydroxy) chloroquine, remdesivir and corticosteroids. Again, it appears that only well-executed randomized clinical trials can determine the status of various supposedly effective drugs.