Policy responses for Switzerland - HSRM


Policy responses for Switzerland

5. Governance

5.1 Governance

The GOVERNANCE of the health system with regard to COVID-19 relates to pandemic response plans and the steering of the health system to ensure its continued functioning. It includes emergency response mechanisms, as well as how information is being communicated, and the regulation of health service provision to patients affected by the virus.

On June 19, the Federal Council downgraded the situation from “extraordinary situation” to “special situation”. The Federal Council also discussed how to manage a possible second wave. In contrast to the first wave, the prime responsibility in the event of a renewed increase of COVID-19 cases should be with the cantons. Cantons that observe an increase in the number of cases should be able to take suitable measures to manage the situation, focusing on those measures that have proven to be particularly effective against the spread of new infections. The Federal Council also issued the departments with different tasks to ensure, for example, rapid access to detailed data or the supply of necessary medication and protective equipment, in case of an outbreak of new infections.

The Federal Council also decided to dissolve the “Coronavirus Crisis Unit”, which had been set up on March, 20 to coordinate efforts of the government departments, the Federal Chancellery, the cantons and other crisis units. (The final report of the “Coronavirus Crisis Unit” with a detailed timeline is available here: https://www.newsd.admin.ch/newsd/message/attachments/61814.pdf) 

The Federal Council began to introduce measures to protect against the coronavirus on 28 February, and gradually tightened those measures up until 21 March, before gradually starting to ease them in three phases from 27 April (June 22, fourth phase). The number of new infections, hospitalisations and deaths has continued to fall despite measures being eased, and has stabilised at a low level.

On April 16, the Federal Council presented plans for the gradual relaxation of measures taken to combat the COVID-19 epidemic (see also section 1.2). Decisions on relaxation of measures were based on three main factors:
(1) How high is the risk of more infections? How many people may be at higher risk of infection?
(2) What is the risk of serious illness and death?
(3) What is the chance that no infections and serious illness will occur, for example by implementing and maintaining protective measures?

Other factors were:
• The acceptance of the Federal Council's decisions by the population and the economic benefit.
• The predictability of the measures: Which measures need how much lead time, for example for product orders or the introduction of protection concepts.

By 22 June, most restrictive measures that were put in place due to the coronavirus had been progressively lifted (phase four). Only the ban on large-scale events will remain in place until the end of August. This follows the decisions taken by the Federal Council at its meeting on 19 June in view of the continuing low level of new cases. All publicly accessible venues must have a set of precautionary measures in place. However, the Federal Council has simplified the applicable requirements. Hand hygiene and keeping an appropriate distance remain the most important protective measures.

In May 2020, the Confederation and cantons developed a joint monitoring program for the easing of protective measures. The program and the evaluation of it provides the Federal Council with an important basis for decisions on how to continue, adapt or ease protective measures and recommendations. The three key questions guiding the monitoring process are: 1. What is the current spread of the virus?, 2. What precautionary measures are in place?, 3. How is the public behaving?

A chronology of the easing of measures is given below:
On April 27, businesses with only a small number of direct contacts that can easily implement protection concepts and do not cause significant flows of people were allowed to reopen. This included also companies with personal services involving physical contact, for example hairdressers', DIY and garden centres as well as flower shops. In addition, unattended public facilities such as car washes were allowed to reopen.

On April 29, the Federal Council decided that primary and lower secondary schools could reopen on May 11. The Confederation, and the Conference of Cantonal Ministers of Education defined protection concepts, which had to be implemented by cantons and communes. Schools were given the opportunity to provide flexible classroom teaching. In addition, events with up to five people could again be held at upper-secondary schools and at vocational and higher education institutions. Examinations could be held if the rules of distance and hygiene were observed.

On May 11, shops, restaurants, bars, pubs and markets, museums and libraries were allowed to reopen . Restaurants were subject to strict requirements. In a first phase, no more than four people or a group of parents with children could sit at a table. All guests had to be seated, and groups of guests had to sit at least two metres from the next or be separated by suitable partitioning. Also, recreational sports training could resume for small groups of no more than five people, provided no physical contact was involved, and rules on distancing and hygiene were respected. Regarding competitive and professional sports, restrictions are less strict. Training sessions involving more than five people are permitted. Further from June 8, matches in the professional leagues can be held behind closed doors.

Update May 18: Demonstrations of up to five people are no longer regarded as events. In principle, they are allowed. However, the distance rules must be observed.

Update May 28th: the Federal Council decided that further businesses and institutions are allowed to reopen. Also events and demonstration of up to 300 people are allowed to take place if a set of precautionary measures is in place. If close contact is likely, the contact details of those concerned are taken in order to be able to trace the chain of transmission. Also all forms of religious services and religious celebrations, privately or in a community, are permitted again.

Since June 1st, collecting signatures in public spaces is allowed.

On June 6, several further institutions/businesses were allowed to re-open:
• establishments such as casinos, amusement parks, animal parks, zoos and botanical gardens, spas, swimming pools
• summer tourism businesses such as camping sites, mountain rail and cableways, toboggan runs, bike tracks and rope parks
• strip clubs, escort services and services offered by sex workers
• holiday camps for up to 300 children and young people
• Hospitality sector 1: activities such as pool, darts and live music performances may reopen with restricted opening hours but guests have to be seated (except in nightclubs and discos)
• Hospitality sector 2: Visits to restaurants for groups of more than 4 people seated at tables are allowed if contact details of at least one member of the group are recorded 
• political and civil society demonstrations of up to 300 people
• classroom teaching at upper secondary and vocational schools, higher education and other educational institutions
• sports training involving physical contact such as wrestling, boxing, American football and rugby
• sports competitions with up to 300 people
• other events with up to 300 people

On June 22, events and gatherings for up to 1000 people were once again permitted. However, contact tracing must be possible at all times. Event organizers must ensure that the maximum number of people that may need to be contacted does not exceed 300. This can be achieved by dividing the venue into sectors. The cantons may see fit to apply a lower number. Large-scale events for more than 1000 people will be permitted from the beginning of September, as long as there is no deterioration in the epidemiological situation.
Also customers at restaurants do not have to be seated anymore and the fixed closing times for restaurants, discos and nightclubs were lifted.

Starting October 1, major events are allowed if they have a permit from the canton. At its meeting on September 2, 2020, the Federal Council, after consultation with the cantons and associations, laid down authorization requirements. A protection concept must be submitted for every event with more than 1000 persons. On the one hand, the epidemiological situation in the canton or region concerned must allow the event to take place. On the other hand, the canton must also have the necessary capacities for contact tracing. In addition, at major events, seating is generally compulsory for the spectator area. The cantons may exceptionally authorize standing room at open-air events such as ski, cross-country or bicycle races as well as village festivals in open terrain.

For matches of the national ice hockey and football leagues, masks are also compulsory and capacity limits apply. The cantons can revoke permits if the epidemiological situation deteriorates.

Sources and references:
• Federal Council to gradually ease measures against the new coronavirus: https://www.bag.admin.ch/bag/en/home/das-bag/aktuell/medienmitteilungen.msg-id-78818.html
• Wie entscheidet der Bundesrat, welche Massnahmen zuerst gelockert werden?:https://www.bag.admin.ch/bag/de/home/krankheiten/ausbrueche-epidemien-pandemien/aktuelle-ausbrueche-epidemien/novel-cov/haeufig-gestellte-fragen.html#accordion_16834742231587728960012
• Federal Council to gradually ease measures against the new coronavirus: https://www.bag.admin.ch/bag/en/home/das-bag/aktuell/medienmitteilungen.msg-id-78818.html
• 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
• Pressekonferenz des Bundesrats 29.04.2020: https://www.nzz.ch/schweiz/coronavirus-in-der-schweiz-die-neusten-entwicklungen-ld.1542664
• Die neusten Entwicklungen 19.05.2020: https://www.nzz.ch/schweiz/coronavirus-in-der-schweiz-die-neusten-entwicklungen-ld.1542664
• New coronavirus: Measures, ordinance and explanations: https://www.bag.admin.ch/bag/en/home/krankheiten/ausbrueche-epidemien-pandemien/aktuelle-ausbrueche-epidemien/novel-cov/massnahmen-des-bundes.html
• Coronavirus: Grossveranstaltungen sind unter strengen Auflagen wieder möglich (02.09.2020): https://www.bag.admin.ch/bag/de/home/das-bag/aktuell/medienmitteilungen.msg-id-80277.html

A pandemic plan was in place before the outbreak of COVID-19, but it was specific to pandemic influenza and was last updated in 2018. It is aimed primarily at the responsible authorities at federal and cantonal level.

The Epidemics Act (which has been in force since 01.01.2016) stipulates that the Confederation and the cantons must take preparatory measures for pandemics. This includes the development of operational and emergency plans. The Swiss Influenza Pandemic Plan forms the basis for the preparation of operational and emergency plans at cantonal, regional and local levels. Based on the Epidemics Act, it defines the division of responsibilities and tasks between the Confederation and the cantons:

Responsibilities of the Confederation: Provision of information, strategy development, definition of benchmarks for the implementation of measures (guidelines, recommendations) and coordination of cross-cantonal processes. The FOPH is responsible for defining benchmarks for the preparation and management of a pandemic (guidelines, recommendations) and the coordination of cross-cantonal processes.

Responsibilities of the cantons: Organisation of the cantonal health system and in particular the implementation of measures. A detailed description of the necessary structures and processes within the framework of their operational and emergency plans are their responsibility.

On 28 February, the Federal Council passed the Ordinance on measures to combat the coronavirus, which was replaced on 13 March by the present Ordinance (COVID-19 Ordinance 2) and has since then been amended several times at high frequency. On 1 April, the Ordinance was reviewed and revised in terms of its systematics and terminology. Among others, it grants the government to restrict or prohibit private and public gatherings, to prohibit entrance into Switzerland (except from Liechtenstein) and to ban classroom teaching at all educational establishments.

The Federal Council can authorise the cantons to limit or suspend the activity of certain branches of the economy for a limited time and for specific regions if the epidemiological situation indicates a particular risk to the health of the population. Initially, on March 22, the southern canton of Ticino, which has been particularly affected by the virus, had decided without the approval from the Federal Council that all private companies, except those in essential sectors such as food or pharmaceuticals, and construction sites had to cease operations. On April 3, the Federal Council approved the restrictions to be extended in the canton until April 13.

On March 19, the FOPH mandated the Swiss School of Public Health (SSPH+) to host a communication platform between academic experts and public authorities that is closed to the public and the media to facilitate and structure the communication channels between these constituencies. With the increase of social media, SMS, emails and open or closed letters it became a major challenge for authorities to assemble advice. The SSPH+ Public Health Resource platform for COVID-19 was launched on 23.3.2020. Whereas FOPH places data and questions on the platform, the "open science" academic community discusses issues, adds information, links and readings and shares analyses and data with authorities in a timely manner. Within two weeks, >270 registered on the platform.

On March 31, a “Swiss National COVID-19 Science Task Force” was set up headed by the president of the National Research Council at the Swiss National Science Foundation SNSF. The Task Force will act as an advisory body to the Federal Council, the head of the Federal Department of Home Affairs (FDHA), and to the federal and cantonal offices concerned. Task Force members have access to the SSPH+ "open science" platform and receive its outputs on a regular basis.

Starting March 27, the expert groups of the Swiss National COVID-19 Science Task Force have developed policy briefs in which they address urgent issues regarding the COVID-19 crisis. Issues are discussed and approved by the Advisory Panel and published on the website of the task force: https://ncs-tf.ch/en/policy-briefs. If required, policy briefs will be updated in light of new studies and additional/new data. About 40 policy briefs have been so far published so far (date: 06.08.2020).

On April 29, the Federal Council initiated the process to transpose into federal law the emergency ordinances – in particular the COVID-19 Ordinances 1 and 2 - which were issued since March 16 in accordance with the Epidemics Act or directly based on the Federal Constitution. The procedure for converting them into a parliamentary decree must be initiated after a period of validity of no more than six months. If the Federal Council does not issue a dispatch within this period, the emergency ordinances will cease to have effect and may not be extended.

The content of the future COVID-19 law will depend largely on further epidemiological developments and the relevant Federal Council decisions in the coming weeks and months. In particular, the extent to which emergency ordinances still have to be adapted or may possibly be repealed will be decisive. The Federal Council intends to open a consultation procedure in June and to send the corresponding message to parliament at the beginning of September. It will ask parliament to consider the COVID-19 transposition law as urgent matter.

Sources and links:
• Swiss Influenza Pandemic Plan: https://www.bag.admin.ch/bag/en/home/krankheiten/ausbrueche-epidemien-pandemien/pandemievorbereitung/pandemieplan.html
• April 8 announcement of FOPH on extension of measures against COVID-19: https://www.bag.admin.ch/bag/en/home/das-bag/aktuell/medienmitteilungen.msg-id-78744.html
• Coronavirus: Überführung der Notverordnungen des Bundesrates in ein dringliches Bundesgesetz: https://www.admin.ch/gov/de/start/dokumentation/medienmitteilungen.msg-id-78929.html
• Swiss National COVID-19 Science Task Force – Policy Briefs: https://ncs-tf.ch/en/policy-briefs
• July 20 FOPH news release on Swiss National COVID-19 Science Task Force: https://www.bag.admin.ch/bag/en/home/das-bag/aktuell/medienmitteilungen.msg-id-79879.html