“Critical limits of our health care system will be reached between the 8th and the 18th of November”

Very serious situation reports of the Swiss National Covid-19 Science Task Force

The debate about Covid-19 has become rather derailed in recent months. If it had been conducted on a more objective basis and without the completely unnecessary playing off of economics versus health and other issues, we could probably have spared ourselves the current situation. Fact is, that the cynical – and factually also wrong – talk “‘only’ people elder than 80 willl die” collides with reality. Also, the debate about freedom and the concept of freedom are at a level that is rather frightening.
  
If our health care system reaches the limits of its capacities, which can happen very soon, this affects everyone of us – from toddlers to the eldest, from the currently very healthy to those who have been less fortunate in terms of health. Then “restrictions” of a completely different, quite actually existential kind will occur – without us then being able to influence them. But then, there will be “limitations” of existential nature – beyond our personal control. If we ourselves or someone close to us, a friend or acquaintance, suffers an accident or falls seriously ill – where do we turn to? This has nothing to do with panic-mongering – another completely inappropriate term in this context – but a lot of it is about common sense.
  
We already knew about it in spring – but it has obviously fallen into oblivion among all these debates. Now we are where we are. Now we are all asked to use our common sense, and to prevent this development for the sake of us and our fellow men. And, of course, the protection of human life and health oft he population is the State’s supreme and most important task. At least, the right to life is the absolute fundament of all other rights – it doesn’t require too much insight to understand this.
  And if in these times – we (and especially the healthy among us) realise more clearly again what a high good the protection of health and the best possible care for sick people is, we should take this as another reason to think about our health care system. We must finally get away from the “economization” of the medical system, since it is of existencial importance for all of us. Concerning this matter, Current Concerns has repeatedly published valuable suggestions (see Current Concerns of 16 October 2020, 7 July 2020, 19 April 2016, 13 February 2015).
  
The following excerpts from the reports of the Swiss Scientific Task Force are clear, comprehensible and understandable for everyone. They are ralities – and realities should be the basis of our actions, at the individual, state or economic level.

Erika Vögeli

From the situation report of the National Covid-19 Science Task Force (NCS-TF) as of 23 October 2020

Summary and recommendations
Switzerland is facing exponential growth in the number of SARS-CoV-2 cases, hospitalisations and ICU admissions. This is a situation of extreme urgency where every day counts. We must take immediate action to prevent hospitals and intensive care units from becoming overflowing and to maintain standard-of-care.
  The Science Task Force recommends a number of measures to quickly reduce the reproduction number R to well below 1.0. These measures should be realisable for society and protect the core of the economy (with compensation measures for particularly affected economic sectors). These measures should be sustainable over a long period, which may realistically extend to March/April 2021:

  1. wearing of masks by young people and adults in all indoor and crowded outdoor areas (street markets, etc.)
  2. home-office teleworking for all employees for whom this is possible.
  3. closure of entertainment and recreation facilities in confined and poorly ventilated indoor spaces where conditions allow the transmission of coronavirus between people in close contact.
  4. restriction of private gatherings, for example to fewer than 10 people.
  5. restriction of public gatherings, for example to fewer than 50 people.
  6. restriction of the opening hours of restaurants and bars, for example to 21.00 hours.
  7. stopping activities with a high risk of coronavirus transmission, such as sports with direct contact, singing or concerts with wind instruments.
  8. switching to exclusive online education in all secondary and higher education institutions for which such education is possible.
  9. increasing the number of coronavirus testing centers and the number of contact tracers.
  10. regular testing of employees in high risk environments.

The exact thresholds for recommendations 4, 5 and 6 can be adjusted according to the situation.

The objectives of these interventions are

  • to prevent the Swiss healthcare system from collapse and to ensure the quality of medical care,
  • to ensure continuous access to education,
  • to secure the basic needs of social life and avoid social isolation,
  • to protect economic activity under the given circumstances.

These measures are to provide stability in autumn and winter and avoid yo-yo effects as far as possible. Their effects and acceptance by the population should be reviewed regularly. If the proposed measures are not implemented or if the spread of coronavirus fails to be contained quickly, a national “lockdown” to protect the healthcare system from collapse should not be ruled out. Every day counts.
  We emphasise that measures need at least two weeks to show an effect on reducing the number of admissions to intensive care units. Even a complete and immediate lockdown would still put immense pressure on the ICU system.

From the situation report of the National Covid-19 Science Task Force (NCS-TF) on 30 October 2020

General overview of the situation; outlook of reaching capacity limits in the healthcare system:
Since the beginning of October 2020, the daily number of positive SARS-CoV-2 tests, hospitalisations, ICU admissions and deaths are doubling approximately weekly. As a consequence, we expect that critical limits of our healthcare system will be reached between the 8th and 18th of November, based on the predictions of October 29th. Here, we discuss limits in the capacity of hospital wards and intensive care units based on the available data.
  Hospital beds: As reported in the Informations-und Einsatz-System of the Koordinierter Sanitätsdienst, there are over 24’300 hospital beds available in Switzerland, of which about 6’000 beds are currently free. If the number of hospitalisations increased at the current level, the limits of the capacity could be reached soon.
  There is therefore a high risk of Switzerland reaching and then exceeding the capacity of hospital beds and ICU beds between the 8th and 18th of November, based on the predictions of 29 October. Such a situation would compromise care for COVID-19 and non-COVID-19 patients alike. As discussed below – while we expect that the measures taken on a cantonal and national level in October 2020 will improve the situation, there is a substantial probability that their effect will manifest after the limits of the healthcare system have been reached or exceeded.
  Even if the risk of reaching and exceeding the limits of the healthcare system is imminent, it is, of course, extremely important to reduce the extent and the duration of capacity overflow. Reducing the extent and the duration means that fewer patients will be in a situation where standard-of-care cannot be maintained.
  It is important to note that this situation – an overflow of the capacity of the health care system – can fundamentally only be solved by strongly reducing the transmission of SARS-CoV-2 and thereby decreasing the number of COVID-19 patients. Increases in the capacity of the health caresystem can mitigate the situation in the short term, but do not offer a sustainable solution. This is because, without stopping the spread of SARS-CoV-2, any capacity increase would rapidly be offset by an increase in case numbers. Strictly as an example, if it was possible to add 200 fully staffed ICU beds, then, at a doubling time of one week, this would delay the moment when the limits of the capacity are reached by less than two days.

What needs to be done so that the measures are effective? In October 2020, a number of national and cantonal measures were taken. The goal of these measures is to reverse the trend described above and achieve a reduction in case numbers, hospitalisations and deaths. Here we discuss the factors that determine the effectiveness of these measures.
  The key determinants to achieve a high degree of effectiveness of the combination of measures that have been put in place are timeless as well as:

  • Compliance by all stakeholders and the providers of the health and social services,
  • Adherence of the people, decision makers and stakeholders to the measures in a spirit of solidarity and joint responsibility. Compliance and adherence are of particular importance in a situation where the interventions aim at protecting the health care system while also protecting the economy, social life, freedom and access to education.

Consequently the implementation of measures need to be well understood by the whole population. Clear communication is key.

Protecting the health care system: what parameters need to be observed, and what decisions are coming up?
[…] The main question is whether the measures in Switzerland are successful in leading to a reduction in the number of new positive tests, hospitalisations, ICU admissions and deaths per day. There are indirect indicators that can offer first insights into the effect of measures on travel, mobility, home office activity, and more. These indicators are valuable and can potentially reveal with almost no time delay whether implemented measures show an effect. However, since these measures are indirect, it remains to be established whether these indicators can reliably predict whether a reduction of case numbers will be achieved. To do so, one needs to monitor the development of positive tests, hospitalisations, ICU admissions and deaths.
  Measures implemented today and thus reducing transmission today will become manifest [...] only with a substantial time delay. The mean time delays are:

  1. 8 days from infection to the confirmation of a case (more specifically, assuming a mean of five days until onset of symptoms and a mean of 3 days from symptoms to a positive test),
  2. 9.5 days from infection to hospitalisation,
  3. 12 days from infection to ICU and
  4. 17 days from infection to death. [...]

For the measures imposed at the national level on 29 October, we therefore expect to know their effect with some degree of certainty on 17 November. Individual cantons took comparable measures at an earlier time point that are comparable to the national measures imposed on 29 October. The canton of Valais took such measures on 21 October, and we expect to be able to evaluate their effect with some certainty around 9 November.
  It is important to keep in mind that, if additional measures are taken at these time points (e. g. on 9 or 17 November), then it will again take 12 days until these measures would start to have an effect in terms of reducing ICU hospitalisation.
  With the current ICU occupancy (227 cases based on database query on 28 October 2020 at 17:26) and the current doubling time (7 days) the expected number of patients requiring ICU hospitalisation is around 1,450 in two weeks (on 12 November) and thus already beyond the estimated capacity of beds (1,400 beds) at which the current high quality of ICU care can be maintained. With a range of doubling times from 5-10 days, that 1,400 ICU bed limit is expected to be reached between the 7th and the 17th of November. Moreover the graph shows that in recent times elective procedures have already decreased, demonstrating that already at present the increase in COVID-19 ICU patients affects the health care in Switzerland.  •


Source: National COVID-19 Science Task Force Status Report of 23 and 30 October 2020 (excerpts)

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