Policy responses for Switzerland - HSRM


Policy responses for Switzerland

1.4 Monitoring and surveillance

On April 16, the Federal Council presented a plan consisting of three phases for the relaxation of measures taken to combat the COVID-19 epidemic (see section 1.2). Part of the plan was that as soon as the number of Corona cases in Switzerland has fallen sufficiently, the cantons would resume the consistent tracing of infection chains.

On April 29, the federal government published a plan for the containment phase. Once the number of new infections would fall sufficiently, all cantons would be required to conduct interviews to trace transmission chains throughout the country (contact tracing

Currently the following applies (status 24.06.2020):
Contact tracing is recommended for all persons with laboratory-confirmed COVID-19 or for hospitalized persons with probable COVID-19. The responsible cantonal office identifies and contacts persons who had close contact, as defined below, with a confirmed or probable symptomatic case of COVID 19 or with a case 48 hours before the onset of symptoms. For COVID-19 cases without symptoms, contact tracing involves all contacts up to 48 hours before sampling and continues until the tested person is isolated.

The following are considered close contacts (higher risk of infection):
• persons living in the same household with over 15-minute contacts of less than 1.5 metres
• contact of less than 1.5 metres and for more than 15 minutes without protection (without a Plexiglas partition or a hygiene mask worn by the case and/or the contact person)
• care or medical examination or professional activity involving physical contact (less than 1.5 metres), without the use of protective equipment
• direct contact with respiratory secretions, body fluids without protective equipment used

On the plane:
• Passengers who had sat in the same row as the case or in the two rows in front or behind it, regardless of the time of flight.
• Crew members or other passengers, if any of the above criteria apply (e.g. more than 15 minutes' discussion with the case).

Not considered close contact (low risk of infection)
• persons who had contacts of less than 1.5 metres for more than 15 minutes with protective equipment (e.g. Plexiglas partition or hygiene mask worn by the case and/or contact person)
• persons who were in the same room as the case (e.g. at the workplace) but who had no cumulative contact with the case for at least 15 minutes of less than 1.5 metres.
• persons in the same aircraft but who had been seated more than two rows in front or behind the case and had no other relevant contact.
• persons living in the same household (e.g. shared apartment) who have not had contact for at least 15 minutes of less than 1.5 metres.
• children of pre-school or school age among themselves, especially in the school environment (compulsory school) or in supplementary family care facilities, if there is no accumulation of cases (≥2 cases).
• laboratory personnel working with replicable SARS-CoV-2 viruses, provided that adequate protective measures are taken.
• medical personnel who were in the same room, but who were never within a distance of 1.5 metres.
• medical personnel with contact of less than 1.5 metres (e.g. case during care or medical examination), if adequate protective equipment was worn during the entire time of contact.

Mobile app for contact tracing
An extended test strategy and an app were developed at national level, together with the Federal Institutes of Technology in Lausanne and Zurich. The SwissCovid app for mobile phones (Android/iPhone) has been available since 25 June in the Apple Store and Google Play Store. Using the SwissCovid app is voluntary and free of charge.

The application is based on the “DP-3T” (Decentralized Privacy-Preserving Proximity Tracing) concept developed by an international consortium. Initially, the Swiss efforts to develop a tracing app were part of the pan-European “PEPP-PT” project. However, due to a controversy around two alternative technical approaches – centralized vs. decentralized storage of information – Switzerland eventually left the program being in favour of a decentralized approach. The launch of the app was originally planned for May 11. A test version for selected users was available since May 18.

The SwissCovid app uses Bluetooth to detect nearby mobile phones. It anonymously registers contacts with people who are less than 1.5 meters away for more than 15 minutes in any one day and who also use the application. If a person tests positive for the coronavirus, the cantonal authorities issue them with a code (the Covidcode), which allows them to activate the notification function in their app. This warns other app users that have had an encounter with the infected person in the period starting two days before that person first experienced symptoms of the disease. When the code is entered the app notifies these other app users automatically and anonymously. People who have been notified can then call a number listed in the app to find out what to do next.

Detailed information on the app  can be found here: https://www.bag.admin.ch/bag/en/home/krankheiten/ausbrueche-epidemien-pandemien/aktuelle-ausbrueche-epidemien/novel-cov/swisscovid-app-und-contact-tracing.html

On April 23, the Political Institutions Committee of the National Council submitted a commission motion calling for a legal basis for contact tracing apps. On May 13, the Federal Council approved a temporary ordinance (valid until June 30th) for the pilot phase of the app. It is based on the Data Protection Act and regulates the organisation, operation, data processing and use of the proximity-tracing app for the duration of the pilot phase. In its next meeting on May 20, the Federal Council intends to adopt and pass the legal basis for the regular operation of the app to parliament, which is to be discussed and adopted by the parliament during the summer session in June.

Study to test for antibodies
Supported by the FOPH, the Swiss School of Public Health (SSPH+), a network of twelve Swiss universities is launching a nationwide study on the topic of how many people in Switzerland have already been infected with the new coronavirus and if they are immune afterwards (search for antibodies). https://www.corona-immunitas.ch/

The aim of the study is to find out:
• How many people in Switzerland have already been infected with the new coronavirus?
• Are people who have been infected immune to re-infection with the new coronavirus?
• And if so, how long does immunity last?

To this end, more than 25,000 people from the general population and specific professional groups will be tested and examined in different stages until October 2020. The findings of the study will inform national and cantonal policy about future coping strategies, including a vaccination program.

Sources and links:

• Wie überwacht der Bundesrat die Auswirkungen der Lockerungen?: https://www.bag.admin.ch/bag/de/home/krankheiten/ausbrueche-epidemien-pandemien/aktuelle-ausbrueche-epidemien/novel-cov/haeufig-gestellte-fragen.html#accordion_16834742231587715060534
• Soll eine Tracing-App zum Einsatz kommen?: https://www.bag.admin.ch/bag/de/home/krankheiten/ausbrueche-epidemien-pandemien/aktuelle-ausbrueche-epidemien/novel-cov/haeufig-gestellte-fragen.html#accordion_16834742231587715060536
• NZZ: Die Contact-Tracing-App des Bundes soll im Mai starten (21.04.2020):   https://www.nzz.ch/technologie/die-contact-tracing-app-des-bag-soll-im-mai-starten-ld.1552867
• EPFL and ETH Zurich advance digital contact tracing project: https://actu.epfl.ch/news/epfl-and-eth-zurich-advance-digital-contact-tracin/
• Streit um das Corona-Tracing: Der Schweizer Epidemiologe Salathé verkündet den Ausstieg aus dem paneuropäischen Projekt: https://www.nzz.ch/technologie/streit-um-das-corona-tracing-der-schweizer-epidemiologe-salathe-verkuendet-den-ausstieg-aus-dem-paneuropaeischen-projekt-ld.1552279
• Coronavirus: Anwendung von Contact-Tracing-App nur mit gesetzlicher Grundlage: https://www.parlament.ch/press-releases/Pages/mm-spk-n-2020-04-23.aspx?lang=1031
• Coronavirus: Verordnung für Proximity-Tracing-App verabschiedet, Unterstützung für Kultursektor verlängert: https://www.bag.admin.ch/bag/de/home/das-bag/aktuell/medienmitteilungen.msg-id-79103.html
• New coronavirus: Situation in Switzerland – Smartphone app:https://www.bag.admin.ch/bag/en/home/krankheiten/ausbrueche-epidemien-pandemien/aktuelle-ausbrueche-epidemien/novel-cov/situation-schweiz-und-international.html#-2097806982
• Coronavirus: Federal Council to ease further measures from 11 May:https://www.bag.admin.ch/bag/en/home/das-bag/aktuell/medienmitteilungen.msg-id-78948.html
• Neues Coronavirus: Contact Tracing : https://www.bag.admin.ch/bag/de/home/krankheiten/ausbrueche-epidemien-pandemien/aktuelle-ausbrueche-epidemien/novel-cov/information-fuer-die-aerzteschaft/contact-tracing.html

Federal monitoring of the epidemiology of COVID-19 cases is based on information provided to the FOPH by laboratories, doctors and hospitals as part of their reporting obligations. The daily updates are based on data that is received every morning, hence daily updates might vary from the number communicated by the cantons during the day. Reporting criteria are regularly adapted to the current situation.
The latest comprehensive information on the epidemiological situation in Switzerland can be found here: https://www.bag.admin.ch/bag/en/home/krankheiten/ausbrueche-epidemien-pandemien/aktuelle-ausbrueche-epidemien/novel-cov/situation-schweiz-und-international.html

Initially diagnostic laboratories had to report all positive cases detected by PCR to the Cantonal Medical Office and the FOPH within 24 hours, and negative findings as a daily total in aggregated form to the FOPH.

Currently (last status update 18.05.2020) diagnostic laboratories have to report all positive cases detected by PCR to the Cantonal Medical Office and the FOPH within 2 hours, and negative findings within 24 hours to the FOPH.

Hospitals and doctors must report to the cantonal medical office and the FOPH within 24 hours the clinical findings of hospitalised COVID-19 cases that are laboratory confirmed by PCR and clinical findings after death of PCR laboratory confirmed COVID-19 cases.

Sources and links:

• FOPH reporting obligations for infectious diseases: https://www.bag.admin.ch/bag/de/home/krankheiten/infektionskrankheiten-bekaempfen/meldesysteme-infektionskrankheiten/meldepflichtige-ik/meldeformulare.html 
• April 16 Federal Council to gradually ease measures against the new coronavirus: https://www.admin.ch/gov/en/start/documentation/media-releases/media-releases-federal-council.msg-id-78818.html 
• COVID-19: Informationen und Empfehlungen für Institutionen wie Alters- und Pflegeheime sowie Einrichtungen für Menschen mit Be-hinderungen (Status: 02.04.2020): https://www.bag.admin.ch/dam/bag/de/dokumente/mt/k-und-i/aktuelle-ausbrueche-pandemien/2019-nCoV/covid-19-empfehlungen-pflegeheime.pdf.download.pdf/Factsheet_Sozialmedizinische_Institutionen.pdf