From time to time, until the crisis has passed, the HEPL blog series authors will be given the opportunity to provide short updates on their country/region’s continuing response to this worldwide catastrophe and their further reflections on those responses. Each update will be labelled accordingly with the original response at the bottom of each post.

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HEPL blog series: Country Responses to the Covid19 Pandemic

Switzerland’s response to the coronavirus pandemic – Update (May 2020)

Philipp Trein (philipp.trein@gmail.com) HEC, Université de Lausanne, IES UC Berkeley
Victor G. Rodwin (vgrodwin@gmail.com) Wagner/NYU and UniSanté, Lausanne

Evolution of Covid-19 mortality and cases

The epicenters of the pandemic were in the most urbanized areas of Switzerland:  Lausanne, Geneva, Zurich and Ticino. The number of new infections dropped from its peak of 1,447 new cases on March 27 to 88 on May 3. The daily percentage increase in new cases reached its highest point on March 16^th and fell to below 1% since April 13^th. Likewise, the percentage growth of hospital admissions reached its peak on March 14^th and decreased every day since April 5^th. Among Western European nations, the mortality rate, in Switzerland, is lower than in Belgium, Spain, Italy, France, and the Netherlands but higher than the rate Germany, Austria, and Denmark. Deaths have affected, disproportionately, older people. Of the 17,001 deaths registered as of May11^th , roughly 90.8 % were over 70 years old; 71% were over 80 years old.

Relief of pandemic measures

Sixty-three percent of employees report a deterioration of working conditions, 20% fear being laid off, and one-fourth of small business owners fear bankruptcy. In response to pressures to relieve the effects of the pandemic measures, the Minister of Health Berset summarized the Federal Council’s (FC) strategy in concise and memorable terms: “We will proceed as rapidly as possible; and as slowly as necessary.” More precisely, this strategy is proceeding in three steps.

First, since April 27, businesses with limited customer contact, including hairdressers, hardware stores and personal services, have re-opened. Also, elective medical treatments are now permitted. Second, as of May 11, all shops and markets, libraries and restaurants will reopen. All of these establishments must follow strict guidelines to ensure social distancing and availability of disinfectants. For example, in restaurants, four customers, at most, can share a table and a minimum distance between tables must be respected or a plexiglass barrier installed. Third, on June 8, non-compulsory schools, universities, and parks will reopen, and restrictions on assembly will be eased. On May 27, the FC will reassess the situation.

Events with more than 1,000 participants remain banned until the end of August. The FC decided not to make the wearing of face masks mandatory; it encouraged their use in public transport and larger group situations. Employers will make their own decisions in their workplaces. After May 11, cantons will resume contact tracing for all newly infected individuals as part of normal infectious disease containment. Meanwhile, the FC, in cooperation with the federal polytechnic universities, developed an app to support contact tracing. Also, the government, having already enabled among the highest testing rates in Europe after Germany, plans to continue this policy to identify asymptomatic cases and those with mild symptoms.

To relieve the economic consequences of the crisis, the FC increased its support for small businesses that were only indirectly impacted by the crisis and provided credit guarantees for Swiss and Edelweiss airlines. 

Preliminary Assessment and the Politics of reopening

Consistent with the logic of collegial government, the plan to ease Switzerland’s shelter-in-place policies has so far not provoked significant opposition from any of the political parties. Each party has voiced its views and critiques of specific measures, but there is no fundamental opposition against the plan to re-open the country.

On May 4, the Federal Parliament, whose members elect the FC, re-assembled for the first time since the FC’s declaration of the emergency situation. They debated the measures implemented since the ban and approved them ex post. One of the most contentious points were the credit guarantees for airlines. To balance this measure, Parliament demanded additional funds to support institutions in need, e.g. childcare facilities.

The FC – backed by experts from the Federal Office for Public Health – permitted the reopening of schools on condition that social distancing can be guaranteed for older children. Cantons are responsible for implementing this policy so there are likely to be differences across the country. There are also differences regarding financial support for childcare. Some cantons decided to support parents who continued paying their financial dues for these services; others support providers who reimbursed parents; still others decided not to offer any support. It seems that this situation will, once again, prompt the FC to assert its authority to ensure that childcare facilities continue to operate all over the country.

In retrospect, we believe that the plans for the reopening the economy were developed in a coordinated manner following the usual participation of major stakeholders in the Swiss economy. For example, Gastrosuisse – the umbrella organization representing hotels and restaurants – convinced the federal government to permit the reopening of restaurants earlier than planned, and agreed to establish plans for social distancing. Meanwhile, stakeholders and governments alike are focused on careful monitoring of the situation and policy changes, if necessary.

Switzerland’s response to the coronavirus pandemic – Original post (April 2020)

Philipp Trein HEC, Université de Lausanne, IES UC Berkeley
Victor G. Rodwin Wagner/NYU and UniSanté, Lausanne

Switzerland, a wealthy and multilingual nation (8.6 million population) with private universal health insurance (UHI) by federal mandate, is known for its decentralized federalism, direct democracy and comparatively high level of trust in its governments, healthcare system and medical profession. Covid-19 prevalence varies between the most affected cantons – Italian-speaking Ticino and French-speaking Geneva and Vaud – and the less affected German-speaking cantons (Covid-19-CH, 2020). Given Switzerland’s institutional context and regional variation, we present a brief chronology of the federal government’s response to the pandemic and our preliminary assessment.

The Response

        Chronology: Switzerland’s first case of Covid-19 was confirmed on February 25^th in Ticino, bordering on Italy. Two days later, there were two more confirmed cases in Geneva and Zurich. On the 28^th, the Swiss executive branch, the seven member Federal Council (FC), placed a ban on large-scale events with over 1,000 people. On March 14^th , there were 1,117 confirmed cases (Covid-19-CH 2020) and the FC restricted large gatherings to 100 people in entertainment and leisure establishments, including ski resorts. On the 16^th, the FC declared an “extraordinary situation” under the Federal Epidemics Act (EpidA) and imposed stringent measures to protect the public.

The measures mobilized up to 8,000 armed forces to assist with healthcare logistics and security. They banned immigration, recommended staying home, prohibited meetings (more than five people), closed schools, universities and other educational establishments, and prohibited public and private events, including sports and club activities. All retail stores were closed, including restaurants, bars and leisure facilities. Exemptions included grocery stores, food delivery services, hotels, health care facilities, pharmacies, post offices, telecommunications providers, banks, petrol and railway stations, public transportation, public administrations. Burials were restricted to close family circles (FOPH 2020).

In addition, the FC passed a stimulus package worth CHF 40 billion to relieve the economic consequences of the pandemic. These measures included low interest loans for businesses, compensation for loss of earnings for employed and self-employed individuals and workplace safety measures (SECO 2020). These economic policies were coordinated with key stakeholders. For example, the FC agreed on emergency credits for companies in concertation with major Swiss banks.

In devising these public health measures, the FC relied largely on its scientifically trained staff in the Federal Office of Public Health (FOPH) and other government agencies. On March 31^st, the FC established a National COVID-19 Task Force with experts from the Swiss National Science Foundation, which will advise the FC, the Federal Department of Home Affairs and “federal and cantonal offices concerned” (FC 2020).

Institutional context
Under normal circumstances, Swiss governance and policymaking are notorious for their reliance on its 26 cantons (Trein 2018). The process involves slow deliberation subject to general elections at the federal, cantonal and municipal levels; referenda and popular initiatives; and strong veto power for multiple stakeholders. In health policy, although the federal government has regulatory authority over private health insurers since the passage of UHI in 1996, most healthcare financing comes from the cantons, municipalities and out-of-pocket payments. The cantons are responsible for hospital planning, public health policies, disease surveillance and implementation of federal regulations (Vatter 2018).

Under the extraordinary situation that activated the EpidA in response to the Covid-19 pandemic, the FC has taken on far-reaching competencies to coordinate policy responses. On  the advice of its Federal Office of Public Health (FOPH), it is now empowered to pass binding public health regulations. Although leadership now rests with the FC (Trein 2015), the cantons may deviate if they determine that epidemiological situation requires it. Such measures could, e.g. entail temporary closures of non-essential enterprises in selected regions. The cantons may also require that private hospitals and clinics admit patients when needed. Hospitals, clinics, doctors’ and dentists’ surgeries may no longer perform elective operations and treatments. The FOPH now coordinates cantonal health care services (including the search for medical equipment, such as respirators), based on information that cantons are required to report on available hospital beds, Intensive Care Units, and number of new confirmed Covid-19 cases.

Preliminary Assessment
Since the initial outbreak, the FC has proceeded in orderly, carefully-timed, incremental steps, consistent with Swiss institutions and culture. In contrast to France and the United States, political discourse has not invoked a war on the virus. There have been no signs of panic within government although hospitals have been apprehensive of insufficient protective equipment, critical care capacity and respirators. There have been frequent calls for solidarity, responsibility and proactive action, but to date political parties and all of the cantons have supported the government in their response to the pandemic. However, when the FC decided to ration medication, there was strong criticism about the lack of preparedness as reserve supplies and hospital beds were evidently not stocked as planned. As this time, a scientific and political debate is brewing about how to transition from stay-at- home measures to the next steps in confronting the pandemic.

In closing we should emphasize that coordination between the federal government and the cantons was not an apolitical, technocratic process. The FC declared an “extraordinary situation” only after the canton of Ticino had already implemented restrictive measures and cantons had reacted in different ways. Although cantons are no longer permitted to adopt measures other than those decided by the federal government, Ticino required all non-essential manufacturing to close despite the FC’s decision to allow firms to continue production. Following this counter-measure, the FC allowed cantons to make some exceptions to the federal decree. There is now an east-west linguistic/cultural rift as to how long the stay-at-home measures should be maintained. Geneva and Vaud prefer to maintain the present situation; the eastern German-speaking cantons want to ease restrictions sooner (Bailat et Zuericher 2020). As for how to transition back to some semblance of normalcy, if the FC has a plan, it is not yet transparent. We imagine that it will depend on Covid-19’s resistance, experience worldwide, and many more uncertainties, but we do not foresee major shifts in regional variation among cantons or Swiss institutions and culture.

Bibliography:

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