Corona measure: the failure of the Swiss strategy

IIn Switzerland, the crown situation threatens to escalate, but the government continues to decide not to issue a nationwide blockade. At its meeting on Wednesday, the Federal Council decided not to tighten the measures, but focused on the package of aid to the economy, the volume of which will more than double from 400 million francs to 1 billion francs.

This means that Switzerland remains the only open country in an environment full of stringent measures: meanwhile, the governments of Germany, France, Austria and Italy have blocked their populations nationwide. In Zurich alone, restaurants and bars close at 11pm and no more than 50 event attendees are allowed. Although the cantons may impose stricter regional restrictions – and in some cases have – Switzerland remains the country with the least stringent Corona precautionary measures.

This laissez-faire strategy has been hotly debated in the country and beyond for weeks. Rightly so, because it is proving to be increasingly ineffective. The government apparently fails to slow the spread of the coronavirus simply by appealing to the population.

The number of infections and deaths is skyrocketing, and the Swiss Society of Intensive Medicine (SGI) warned in a trademark letter on Tuesday that the intensive care beds in the country have been fully used. France offered weeks ago to admit ICU patients from the neighboring country in an emergency.

A closer look at the figures shows how dramatic the situation is: in a European comparison, Switzerland records the highest number of new infections per day per million inhabitants with 670 new cases per day (current weekly average). To make a comparison: in Germany there are 219 cases, in Italy 580 and also in the Czech Republic only 596 cases.

The percentage of positive tests on the total test volume is also extremely problematic: in Switzerland it was recently 24.7%, in Italy 16.3% and in Germany only 8%. The Czech Republic alone is worse off with a positive rate of 26.3 percent.

Furthermore, there is an ominous increase in the number of deaths. Since Tuesday, Switzerland has left Italy and France behind on this negative indicator and reports 9.6 deaths per crown per million population every day, a figure that is currently only surpassed by Belgium and the Czech Republic in Europe.

The highest excess mortality in ten years

To this end, the Swiss “Tagesanzeiger” has published an analysis showing an “extraordinarily high excess mortality” in the country. As a result, in the week of November 2 to 8, the deaths of people over the age of 65 were “well above long-term expectations”: the Federal Statistical Office forecast 1,136 deaths for this period, but 1,702 people died, a whole 50 percent more. It is the highest value since the data was collected ten years ago. The newspaper’s conclusion: “Now it is clear: the second corona wave is more deadly than the first wave.”

Statistics already show a clear excess of mortality during the first wave – a rigorous blocking strategy was still in progress at the time. In one week it was 46% higher than expected, but shortly after the blockade began to take effect and from April 20 the death toll began to decline again. This time, with no blockade in sight, the death toll is unlikely to drop anytime soon.

Consequently, the appeal of SGI’s ICU doctors, who warn that the 876 certified and recognized ICU beds that are normally available in Switzerland for adult care, are “currently practically fully occupied” must be taken seriously.

In Germany – especially on Twitter – there is a rumor that the triages must be carried out in Switzerland. So we need to assess which patients have the best chance of survival and who should be denied intensive treatment due to lack of space. It is based on an article in the “Neue Züricher Sonntagszeitung” from the end of October, which describes the overloading of a hospital in Sion, in southwestern Switzerland, which is not an isolated case.

Upon request, the SGI informed WELT that the “Guidelines for triage in case of resource scarcity in intensive care units … are not currently applicable”. So triages aren’t actually taking place at the moment. The press departments of the hospitals in Bern and Geneva also confirm this on request.

In the cantons, however, the situation is currently very tense. And the spokesperson for the Insel group, which runs six hospitals in the canton of Bern, points out that it is not only beds and medical instruments that are in short supply, but also the lack of additional staff to properly care for the additional intensive care beds.

SGI further explains that it has so far been possible to avoid overloading the capacity of the beds only because “in many places non-urgent interventions and treatments have been postponed”. In addition, the capabilities have been expanded. ICU doctors warn: “However, it is of the utmost importance to contain the Covid-19 pandemic now and postpone non-urgent interventions and care across Switzerland to avoid quality losses in ICU treatment.”

Although triages are not yet underway, Switzerland has held a debate on updating relevant guidelines in recent days. This is now complete.

In March 2020, the Swiss Academy of Medical Sciences and the SGI published guidelines for triage in case of resource scarcity in intensive care units. The document has now been updated to take into account scientific knowledge and experience. It still only applies to admission and treatment in intensive care units, not to other areas of health care. The guidelines are not yet applicable.