Extended summary in English (pdf version):
After two years of COVID-19 policy in Switzerland it is
time for a strategy of the cantons
Rudolf Hauri a, Martin Pfister b,
Yvonne Gilli c, Dunja Nicca d, Andrée
Friedl e, Simon Fuchs f, Samuel Erny g,
Thomas Plattner h, Eva Martin-Diener i,
Brian Martin j.
a Chief Medical Officer, canton of Zug,
Switzerland; President of the Association of the Chief Medical
Officers of the Cantons of Switzerland (VKS); b
Minister of Health of the canton of Zug, Switzerland; c
President of the Swiss Medical Association FMH, Bern,
Switzerland; d Epidemiology, Biostatistics and
Prevention Institute of the University of Zurich, Switzerland;
e Infectious Diseases and Hospital Hygiene Unit,
Kantonsspital Baden, Switzerland; f Chief Medical
Officer, canton of Basel-Stadt, Switzerland; g
Chief Medical Officer, canton of Basel-Landschaft,
Switzerland; h Chief Medical Officer, canton of
Fribourg, Switzerland; i Epidemiology,
Biostatistics and Prevention Institute of the University of
Zurich, Switzerland; j Military
Health Service, Swiss Armed Forces; Epidemiology,
Biostatistics and Prevention Institute of the University of
Zurich, Switzerland.
On 31 March 2022, the “particular” situation according to the
Epidemics Act (Federal Act on the Control of Communicable
Human Diseases) ended in Switzerland. Health policy can now
again rely on its usual structures and can again define goals
and objectives beyond the functioning of emergency services
and intensive care units. This allows a change of perspective,
abandoning the crisis mode for a more integral health policy.
The first case of the Corona pandemic in Switzerland was
reported on 24 February 2020 (illustration 1). Four days later
already, the Federal Council as the government of Switzerland
declared the “particular” situation according to the Epidemics
Act and a ban on all events with more than 1’000 participants.
As in other countries, the original goal was to keep the virus
from gaining a foothold in the Swiss population. This
“suppression” approach failed due to the transmissibility of the
virus before the appearance of symptoms as well as due to the
great proportion of asymptomatic but nevertheless infectious
individuals. On 16 March, the Federal Council declared the
“extraordinary” situation, drastic population-based measures
were introduced, and the incidence of COVID-19 cases fell within
a few weeks. On 19 June 2020, the situation changed back to
“particular”. In the following months, this “containment”
approach was successful in keeping the case numbers low.
However, it failed during the second wave of COVID-19 beginning
in October 2020 which became far more serious. During this
period, the approach changed to “mitigation” and the aim was
reduced to slowing the spread of the disease. This was
explicitly stated for the first time on 12 May 2021 in the
“three phase model” of the Swiss Federal Government: the first
or “protection” phase with a low vaccination rate is still
calling for the need to contain the spread of COVID-19. In the
“stabilisation” phase all vulnerable population groups have
already been offered the vaccination. In the “normalisation”
phase all adults have had the opportunity to be vaccinated.
Since then, the public and the political discussion has almost
entirely focussed on the stated main goal of the third or
“normalisation” phase, which is to avoid the collapse of the
health system and mainly of the intensive care units.
Currently the danger of such a development seems to be averted.
By reverting from the “particular” to the “normal” situation,
there is a transfer of responsibilities back from the federal
level to the level of the cantons. Table 1 gives an overview of
the distribution of tasks between the different levels according
to the Epidemics Act [1, 2].
After a transition phase, the different players will again
assume their roles according to the normal epidemiological
situation, and COVID-19 policy will also become a responsibility
of the health directorates of the cantons. This opens the
opportunity to go beyond the functioning of the critical
infrastructure and to include again aspects such as the
precautionary principle, quality of life, health care for all
and working conditions in the health sector. Outbreak control
and vaccinations services can be adapted to the new situation,
rules and regulations can be replaced by behavioural
recommendations, new social norms can be developed, innovative
approaches can be tested, and health services can be tailored to
meet demands.
Future actions should be defined by the goals and objectives as
they can now be developed for the COVID-19 strategies of the
cantons and for their collaboration. As in other diseases, the
goals can be to minimise the number of infections and their
consequences, to contribute to a sustainable development of
health services and to do the same for other aspects of society.
These include education, work, culture and leisure, travel and
tourism. Last but not least, also at the local level and at the
level of the cantons the experiences from the last two years
must be used to be better prepared for the pandemic threats of
the future.
The complete article has been published on 6 April 2022 in
German and in French in the Journal of the Swiss Medical
Association. It illustrates these experiences, it recommends
possible goals and objectives of a future COVID-19 strategy, and
it outlines the development of such a strategy for individual
cantons as well as for the collaboration between them.
References
- Office fédéral de la santé publique. Plan suisse de
pandémie influenza. 5e édition actualisée. Berne; Janvier
2018. p. 19 (fig 1.3.1).
- Martin B, Klaey H, Müller A, Gügler C, Koepfli A, Gross B,
Pfister M, Hauri R. Das Konzept des Kantons Zug für die
zweite Welle von COVID-19. Bulletin des médecins suisses
2020; 101:928–32.
https://doi.org/10.4414/saez.2020.19087
[The concept of the canton of Zug for the second wave
of COVID-19 in Switzerland: extended summary in English at www.panh.ch/covid19]
