Adaptation to measures
The first confirmed COVID-19 case in Switzerland was reported in the
Canton of Tessin by the the Italian border. At that time, Italy had 322
cases [17] although assumingly many cases were unreported yet due to
restrictive COVID-testing in the early phase of the pandemic. Close
economical and working relationships, including cross-border commuters
traveling back and forth all contributed to an early and rapid
dissemination of COVID-19 in Switzerland. For the first five days, all
positive results in Switzerland could be retraced to a physical contact
with people from the northern part of Italy. In a week, the numbers in
Switzerland increased rapidly. Most of the new infections thereafter
were gathered within the own national borders.
Long before WHO declared the pandemic, the Swiss Federal Office of
Public Health (Bundesamt für Gesundheit – BAG/FOPH) took measures to
protect its citizens and prevent a collapse of the national healthcare
system. Surely, the federalist political system and trust of the Swiss
people in the national healthcare system has proven to be helpful in
that matter. By keeping the transmission paths for official instructions
short, running national campaigns in TV and on billboards, a continuous
flow of information was ensured to all socioeconomic classes.
The first official measures included a close control of people
travelling from COVID-hotspots and filling storages for protective
medical gear to the best possible extent. Plans and strategies for an
imminent lockdown were discussed early on. The border to the southern
neighboring country was closed by March 11, 2020 when 1,168 people were
reported to be tested positive for COVID-19 in Switzerland and 12,462 in
Italy[17, 18]. By decree of the Federal Council from March 17, 2020
on most retailers, public buildings and recreational parks remained
closed and mandatory physical distancing was implemented putting local
law enforcement in charge to transpose that law. Employees were asked to
stay at home whenever possible and recommendations on working from home
were given. Controversially discussed, as still unknown to what extent
kids and younger people contribute to a rapid spread of the virus,
schools and Universities, kindergartens and most daycare facilities for
children also closed their doors during the peak incidence of COVID-19.
Elective surgery was banned from March 17 on. Only operations where a
delay might lead to a shortening of life expectancy, permanent damage,
worsening of the clinical status or if postponement was associated with
severe impact in life-quality were allowed. In Switzerland there are
38,000, hospital beds with around 1,000 beds in 82 Intensive Care Units
(ICU) [19]. Under pressure of the expected COVID-19 crisis, the
healthcare providers in Switzerland succeeded to increase the number of
ICU beds up to 1,500 by closing operating theatres, reopening ICU wards,
buying and reactivating outsourced ventilators.
By the end of April, Switzerland had 30,000 patients tested positive for
COVID-19, one of the highest incidences worldwide (up to 1,500 new
infections per day, i.e. 17/100,000 inhabitants) surpassed only by Hubei
province in China, Italy and later on the pandemic spread in Spain and
the US. Despite all fears, the healthcare system in Switzerland did not
collapse under the first flood of patients. Since SARS-CoV-2-tests were
not widely available at that time, the initial strategy intended testing
of vulnerable patients (>65y of age) and patients requiring
hospitalization only [11]. This testing strategy limited the
assessment of the overall COVID-burden, allowing no statement on
prevalence or asymptomatic infections, but surely led to a proper
identification of patients in need for hospitalization or immediate
medical care. Switzerland has a reasonably high physician density of 4.4
doctors per 1,000 inhabitants but not higher than the surrounding
countries (Germany: 4.2, Austria 5.1, Italy 4.0, France 3.2) [20].
What may be different is the role of the primary care physician (PCP) in
the national healthcare system. Most PCPs in Switzerland are organized
in a network, have a close accountability for their patients and are
capable to do a first-line screening for patients with potential
COVID-19 infection. The highly structured PCP-network prevented an
overload of patients in the secondary and tertiary hospitals allowing
them to focus on sick patients. The main involvement of cardiac surgery
was in treatment of COVID-19 patients when they needed ECMO support. The
following section will focus on that. No patient underwent cardiac
surgery on an urgency or emergency setting with an ongoing COVID-19
infection at our Department during the first wave.
The healthcare system in Switzerland never collapsed. The first couple
of weeks, hospitals faced shortness of protective medical gear,
especially in the southern part of Switzerland, one of the first
hotspots. The government supported the healthcare facilities with
medical supplies and required equipment was flown in before partial
lockdown. Shortness on staff was overcome with short-term employment of
medical students, supportive care for supply-chains etc. came from 8,000
armed forced.
By April 27, 2020 the federal council started to stepwise ease down on
the lockdown measures allowing retailers to reopen again and people to
meet in smaller groups. For two months, the number of new infections
remained low until the incidence started to increase again at the end of
June. Immediate countermeasures were taken, now obliging commuters to
wear facemasks in the public transport. Since the numbers did not grow
far beyond 100 new infections per day and backtracking mechanisms were
implemented for public gatherings, there is hope, that a second wave can
be averted without going into a second lockdown and another economic
crisis.
By July 19, 2020 out of 726,806 tests performed in Switzerland, 33,431
were reported to be positive for COVID-19 (4.6%), leading to 1,687
deaths so far. None of our fellow co-workers in the clinic for cardiac
surgery was infected with COVID-19. Fifty-three out of 8,480 hospital
employees were tested positive. Most of those employees reportedly had
no contact to COVID-19 patients. Not a single infection could be traced
back to an in-hospital contact with an infected patient, proving
protective measures to have worked effectively. Overall, 143 patients
with COVID-19-infections had to be hospitalized in the USZ, 130 had a
successful recovery, 12 (8.4%) deaths were reported.