Experiences with the concept of the canton of Zug for
COVID-19
Brian Martin a, Eva Martin-Diener b,
Martin Pfister c, Rudolf Hauri d. a until end of 2020 associate Chief Medical
Officer, canton of Zug, Switzerland; Epidemiology,
Biostatistics and Prevention Institute of the University of
Zurich, Switzerland; b Epidemiology, Biostatistics
and Prevention Institute of the University of Zurich,
Switzerland; c Minister of Health of the canton of
Zug, Switzerland; d Chief Medical Officer, canton
of Zug, Switzerland; President of the Association of the Chief
Medical Officers of the Cantons of Switzerland (VKS)
The alert system and the intervention concept of the canton
of Zug for COVID-19 have been developed by the Directorate of
Health, acknowledged by the government of the canton and
published in the Journal of the Swiss Medical Association in
July 2020. The summer and particularly the autumn of 2020 with
the second wave of the COVID-19 pandemic in Switzerland have
highlighted the potential but also the limitations of the
concept.
The COVID-19 monitoring system of the canton of Zug is used by
the COVID-19 staff of the Directorate of Health and its
inter-directorial support structure. Its core elements are the
COVID-19 incidence and its development and the canton’s alert
system [1]. Further elements for the canton of Zug include
contact tracing, hospital and COVID-19 mortality data, the
functioning of contact tracing and a summary analysis of the
interviews with the cases of the last seven days. Together with
the incidence data of the four neighbouring cantons and
Switzerland as a whole, they are the basis of the Chief Medical
Officer’s assessment of the epidemiological situation and the
situation concerning contact tracing (illustration 2).
Following the first wave of the Pandemic, very few cases
were observed in the canton of Zug. Beginning in June 2020, some
marked increases in incidence were seen, though at a very low
level of cases (illustration 1). Backward tracing during this
period identified increased contacts in an extended family, the
re-emerging party scene and people returning from high incidence
countries in south-eastern Europe as the main sources of
infection. Targeted measures were successful in controlling the
outbreaks. There was only one single day when the alert level
for Zug reached condition red.
After 17 consecutive days at condition green, the alert level
for the canton of Zug changed to orange on Monday, 28 September,
and to red on Friday, 2 October. On Monday, 5 October, the Chief
Medical Officer re-assessed the epidemiological situation as
requiring “heightened awareness”, on 9 October as “critical”. In
the following period the increase of the incidence slowed down
to a linear development, reaching the maximal 7 day incidence of
386/100’000 on 30 October, followed by a moderate decrease and
then essentially a stagnation of the incidence for the canton
(illustration 2). Applying the alert levels of the canton of
Zug, condition red at the national level was reached also on 2
October. The rise of the incidence was slightly delayed in
comparison, but then steeper and longer, reaching a maximum of
658/100'000 on 2 November. The neighbouring canton of Schwyz
showed a substantially stronger increase than Zug. In Zurich,
Aargau and Lucerne the rise was delayed, but steeper and longer.
The COVID-19 monitoring system and the Chief Medical Officer’s
assessment of the situation were useful elements for the canton
of Zug going into the second wave of the COVID-19 pandemic. They
provided transparency for the course of action of the canton and
facilitated the discussion with the communities and other actors
about specific measures, which allowed to control the situation
in summer 2020. They also were the basis for the first
tightening of restrictions already in the beginning of October
2020 and they may have contributed to a slightly milder course
of the second wave of the pandemic in comparison with
neighbouring cantons. The concept of the canton of Zug also
entered the public discussion in other cantons. Several of its
element were adopted by one of the neighbours when the canton
was identified by the media as being in condition red for
several days already in August 2020.
The second wave of the pandemic also highlighted the limitations
of the concept. The experiences of spring 2020 did not prepare
for a situation in which the public became accustomed to case
numbers stagnating at high levels for extended periods of time.
This led to normalising effects on the public opinion and the
political discourse, strain on the health care system and the
health authorities, and an increase in social tensions. The
increased need for action in such a situation was taken into
account in a revision of the alert level system in December
2020, specifically with respect to the threshold for decrease in
incidence in comparison with the previous week (illustration 1).
The developments of autumn 2020 also showed that swift reactions
of one canton alone were not sufficient to reverse the trend in
case numbers. More efficient measures in coordination between
cantons and at the national level would have been necessary for
this. Compared with the first wave, such measures were only
taken with considerable delay (illustration 2).
The second wave of the pandemic has demonstrated the necessity
for coordination between the cantons and the federal
administration and for timely and decisive action. An
evidence-based approach can contribute to a constructive
discussion in the public and the political domain and hopefully
also to a shortening of decision-making processes.
The complete article has been published on 24 February 2021 in
German in the Journal of the Swiss Medical Association.
Reference
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 [The concept of the canton of Zug
for the second wave of COVID-19 in Switzerland]. Schweiz
Ärzteztg 2020; 101:928–32 (extended summary in English at www.panh.ch/covid19]
Full article in German in the Journal of the Swiss Medical
Association (3 illustrations):
