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

On October 28, 2020 the Federal Council decided that as of November 2, 2020, in addition to PCR tests it would be possible to conduct rapid antigen tests all over Switzerland, also outside licensed laboratories. In addition to medical practices, hospitals and test centers, rapid antigen tests can also be carried out in pharmacies. The availability of rapid antigen tests will increase steadily, although it will be limited in the introductory phase. Even so, given the fact that PCR testing capacity is currently limited, the FOPH believes it makes sense to use rapid antigen tests. This is because significantly more people can be tested and go into isolation if the result is positive.

A rapid antigen test is a possible option if the following criteria are met:
• symptoms started fewer than 4 days ago.
• individual does not belong to a vulnerable group.
• individual does not work in healthcare with direct patient contact.
• individual is treated on an outpatient basis.
A rapid antigen test can also be considered if:
• individual receives a notification from the SwissCovid App that he/she has been in contact with someone who has tested positive.
• the doctor or the cantonal office responsible orders a rapid test because individual has been in contact with someone who has tested positive.
Status 24.11.2020 : The FOPH currently does not recommend serological tests to detect antibodies against coronavirus, in the blood.

As of January 27, 2021 the FOPH recommends preventative and repeated testing as part of precautionary measures and on people’s own responsibility in care homes, socio-medical settings and in organizations providing care and assistance at home. The extended testing strategy is also intended to help recognize local infection outbreaks early on and contain them. The federal government will cover the costs, regardless of whether the test is conducted on a precautionary basis, as part of an infection outbreak that has already occurred, or within the framework of a larger uncontrolled infection outbreak. In the case of preventive testing and in the event of a major uncontrolled outbreak of infection (hotspot management), the canton should submit a plan to the FOPH.

On October 28, 2020 the FOPH made available a new webpage with information on testing and rapid antigen testing: https://www.bag.admin.ch/bag/en/home/krankheiten/ausbrueche-epidemien-pandemien/aktuelle-ausbrueche-epidemien/novel-cov/testen.html
It provides information on testing strategy and coverage of the cost of tests, an overview of the types of tests available and information on when and where to get tested.

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
• FAQ - extension of the testing strategy: https://www.newsd.admin.ch/newsd/message/attachments/65160.pdf