Policy responses for Switzerland - HSRM


Policy responses for Switzerland

1.5 Testing

Policy on testing has been evolving in Switzerland according to the evolution of the spread of the virus. Between March 7 and April 22, patients with mild disease symptoms were not tested and there was no testing of close contacts of confirmed cases due to a shortage of sufficient laboratory reagents.

During this period, laboratory diagnostic clarification was recommended only for persons who met the suspect criteria (symptoms of an acute respiratory disease and/or fever ≥ 38ºC) and one of the following criteria:
• Severe symptoms, i.e. the existence of medical criteria for hospitalization
• Bilateral pneumonia (or ARDS) of indeterminate etiology with hospitalization
• Persons at particular risk (> 65 years, high blood pressure, diabetes, cardiovascular disease, chronic respiratory disease, immunosuppression, cancer)
• Healthcare professionals in contact with patients or residents of nursing homes

Since April 22, when testing criteria were adapted, the PCR test was recommended for all persons with symptoms (clinical criteria):
• of an acute respiratory disease (e.g. cough, sore throat, shortness of breath) with or without fever, feverish feeling or muscle pain
• and/ or sudden onset of anosmia or ageusia (loss of sense of smell or taste).

Cantonal doctors may order that asymptomatic persons be tested in hospitals and old people's and nursing homes (status update 18.05: in socio-medical institutions) if this is justified in order to prevent and control the spread of the virus (outbreaks of disease) within the institution.

Status 18.05.: Where availability of tests is limited, it is recommended that priority be given to those who meet the clinical criteria and at least one of the following criteria:
• Hospitalised persons regardless of the severity of symptoms
• Particularly vulnerable persons (at least 65 years of age and adults with hypertension, diabetes, cardiovascular diseases, chronic respiratory diseases, immunosuppression, cancer)
• (Health) professionals with direct contact (< 2m for > 15 minutes) with patients in hospitals or residents of old people's and nursing homes as well as other social-medical institutions (e.g. facilities for people with disabilities).

Status 18.05.: Epidemiological link to a laboratory confirmed case: close contact (< 2 m for > 15 minutes) or indirect contact with a laboratory confirmed COVID-19 case (e.g. during an outbreak in socio-medical institutions).

Status 24.09.: Test volume is a 7-day average of 11,799 tests per day.

Currently, the maximum testing capacity in Switzerland is 25,000 per day. In view of the flu season, the Minister of Health is aiming to double this figure to up to 50,000 tests per day until December 2020.

The cantons determine the procedure for diagnostic investigation of patients with suspected COVID-19. Cantons can designate a hospital that the suspected cases must visit, or have the doctors take the smear test in the doctors’ office. Samples can be sent directly to the National Reference Centre for Emerging Viral Diseases (NAVI) or to another laboratory offering the initial diagnosis of SARS-CoV-2. Testing approaches differ across cantons. For example, in the canton of Vaud, no special test centres are available and suspected cases are treated in separate rooms in the emergency wards of hospitals and in specialised medical practices. The canton of Geneva has set up four test centres and a mobile team that can test patients at home in case of emergency. Mobile drive-through clinics have been implemented in several cantons.

Sources and links:

• FAQ on coronavirus for health personnel: https://www.bag.admin.ch/bag/de/home/krankheiten/ausbrueche-epidemien-pandemien/aktuelle-ausbrueche-epidemien/novel-cov/information-fuer-die-aerzteschaft/faq-gesundheitsfachpersonen.html#780965857 
• Testing in Vaud: https://www.nzz.ch/zuerich/coronavirus-tests-die-kantone-nehmen-bund-zepter-aus-der-hand-ld.1549670?reduced=true 
• Überblick über Neuigkeiten und Anpassungen von bestehenden Inhalten der Webseite «Informationen für Gesundheitsfachpersonen 22.04.2020: https://www.bag.admin.ch/bag/de/home/krankheiten/ausbrueche-epidemien-pandemien/aktuelle-ausbrueche-epidemien/novel-cov/information-fuer-die-aerzteschaft/neuigkeiten-und-anpassungen.html
• Neues Coronavirus (COVID-19) Verdachts-, Beprobungs- und Meldekriterien: https://www.bag.admin.ch/dam/bag/de/dokumente/mt/msys/verdachts-meldekriterien-2019-n-cov.pdf.download.pdf/ADM_200421_Verdachts-%20und%20Meldekriterien%20COVID_d.pdf
• SRF - Das Neuste zur Coronakrise: https://www.srf.ch/news/schweiz/das-neuste-zur-coronakrise-forscher-melden-entdeckung-hochwirksamer-antikoerper
• SRF - Ziel des Bundesrats: Kantone und Labore: 50'000 Tests nicht unmöglich, aber schwierig https://www.srf.ch/news/schweiz/ziel-des-bundesrats-kantone-und-labore-50-000-tests-nicht-unmoeglich-aber-schwierig