I have worked in Switzerland for most of the last 18 years. Almost 14 of those were with Roche, with a detour through China, followed by the last 4 years with Versant Ventures, based again in Basel.
Oh, and the last four weeks I’ve been working from home like so many of you.
Switzerland, in the heart of Europe, shares borders with five countries and is a country marked by rich history, culture and strong economic development.It is typically near the top of many per capita metrics, be it GDP, number of Nobel Prizes, pharmaceutical patents, and chocolate consumption.
Since last week, Switzerland unfortunately also has ranked at or near the top of countries, in terms of the highest per capita rate of confirmed COVID19 infections. As of this writing Mar. 31, Switzerland had 1,885 cases per 1 million residents, just behind Spain’s rate of 2,005 infections per million residents, according to WHO data. Yet, at the same time, Switzerland has recorded 395 deaths from COVID19, compared with 8,269 in Spain.
What has been going right? What went wrong? What’s happening now, and what kind of prospect does Switzerland have with regard to containment and mitigation?
I feel Switzerland actually did many things right as illustrated below, and yet in hindsight there were some things where we could have obviously done better.
Watching the Avalanche Hit You
In early December 2019, I traveled with a few of my Ridgeline Discovery colleagues to China to visit our CRO network that we work with for our company-building efforts. Starting in Shanghai, we took the high-speed train to Wuhan to visit our 100 FTE-strong research team. The visit went smoothly. Excellent scientific discussions in the morning, working lunch, an award ceremony for the top talent of our team and finally a lab and facility tour.
None of us knew anything about the novel coronavirus, which some scientists believe started circulating in Wuhan around that time, or perhaps as early as November.
Having lived in China between 2011-2013, I noticed how much cleaner Wuhan had become since then. Streets were hosed down in the morning.The infrastructure was new. The standards, cleanliness and processes at our CRO were outstanding. After a successful week, we flew home to Switzerland.
During the holidays, the news broke that a new SARS-like virus was spreading in Wuhan. Having worked for good number of years in virology, I started tracking the news daily. It dawned on me that we had just missed something.
While the crisis in China unfolded, I couldn’t help notice that Europe and North America were watching it play out with somewhat folded arms. It was quickly apparent that this virus would spread. I was surprised that the media were passing more judgment and criticism of how things were being handled in Wuhan than calling for us to get prepared. For two months, we in Switzerland were watching an avalanche rumbling toward us in slow motion — but most of us were continuing to ski as normal.
Basler Fasnacht as the Turning Point
The turning point came on Feb. 28. This was the weekend preceding the famous Basler Carnival. Less than two days before the event, the city decided to cancel the iconic celebration known as the “the three most beautiful days” in Basel. This is a time people look forward to all year, as more than 150,000 participants and visitors flood the city center. Canceling the event was a shock to the Baslers and Switzerland. Except for a few die-hards, most accepted the decision. The city, and Switzerland as a whole, started focusing on what was to come.
Having realized the seriousness of SARS-CoV-2, our Versant office had already shifted to home-office mode the week before, given that our global team is well used to video communication on a weekly basis. Daily meetings followed to prepare our companies and research labs, trying to look ahead. Over the next weeks, many businesses started strongly encouraging people to work from home. Switzerland’s Federal Office for Public Health launched a massive information campaign encouraging social distancing, hand washing and self-isolation.
What Went Right
The Swiss are rarely the fastest to implement a new change, but they are never slow, and when they do, it is efficient and with high quality. On a daily basis, several cantons introduced stricter measures such as closing shops and schools, until the Swiss federal government took control from the cantonal authorities. The Swiss have a very strong sense of freedom and independence. Remarkably, the country never introduced a top-down complete stay-at-home lock down.
On Mar. 16, the Federal Council announced the ”revised ordinance”. One of the most effective speeches across Europe at the time came from Simonetta Sommaruga, President of the Swiss Confederation. In the video below, she showed decisive leadership, eloquently calling for discipline and compliance to protect the vulnerable to ensure that Switzerland’s excellent healthcare system would not be overwhelmed. The Swiss military was mobilized.
After this speech, the remaining few that were still congregating outside to enjoy the nice spring weather switched to more disciplined home isolation.
I hope it is disciplined enough.
Hospitals had prepared separate buildings and even repurposed churches nearby as separate holding facilities for potential COVID19 patients, so as not to mix COVID19 patients with other emergency room patients.
Interestingly, except for a day or two, there was little panic buying of food or other general items.
Another thing that is definitely going right is that Swiss pharma and biotech have responded rapidly to providing solutions to COVID19. Roche’s new rapid COVID19 diagnostic was launched, its anti-IL-6 drug tocilizumab (Actemra) started clinical trials. Novartis donated millions of doses of hydroxychloroquine. Other biotechs are using their technology platforms to add value on diagnostic, therapeutic or vaccine approaches.
What Went Wrong
The seven Ps quote might come to mind. Here are six: Prior planning and preparation prevents poor performance.
Switzerland was generally comparatively well prepared for this crisis. Excellent health care system, leadership in diagnostics and pharmaceuticals, economic strength. But a few issues quickly became apparent:
1. Be fast, test fast:
As Michael Ryan from the WHO recently said (see video below, in English), “Be fast, have no regrets and you must be the first mover. If you need to be right before you move, you will never win.”
It took some time for the emerging global developments to sink in here until the cantons reacted and until the Federal Council took over for nationwide measures. It also still took too long, as almost everywhere, before we had sufficient testing capacity for broader screening.
2. Shortages of supplies, masks and protective equipment
Access to sufficient protective material by medical workers is paramount and certainly of much higher priority than masks for the public. But how can it be that hospitals — or an entire country — runs out of this material within weeks before the crisis may have even truly begun?
As mentioned above, on Mar. 20, Switzerland more acutely realized its dependence on importing medical supplies when Germany halted containers of masks and equipment from China to Switzerland in German ports. Luckily, two particularly sane European leaders, Ursula von der Leyen and Simonetta Sommaruga, were able to work out the issue quickly.
Access to masks is a giant elephant in the room in Europe and in stark contrast to Asian countries. Fact is, there just aren’t enough masks for everyone. Additionally, the Swiss and Europeans have a general aversion to wearing masks in public.
3. Confusing Communication
The local media channels were repeatedly stating that wearing masks for the public was not necessary nor effective, with hand washing being much more important. In any case, masks would have to be changed every 30 minutes to be effective.
The real reason for the statement is clear and appropriate – this equipment should be prioritized for the medical workers. But additional statements such as ”wearing a mask in public might give a false sense of safety and just makes you more complacent” sounded in logic to me like “wearing seat belts in cars makes drivers drive more aggressively.”
Masks do in fact lower risks of infection, reduce droplets exchange, inhibit wearers from unconsciously touching their mouths or noses and are for this reason used in any hospital or other hygiene situation for this exact reason.
However, despite protective equipment being a key element in most pandemic preparedness plans, perhaps not enough was done in the years after SARS, MERS, H5N1 bird flu, and particularly in the two months while the new crisis was emerging in China, to stockpile supplies of protective equipment for healthcare workers or even the public.
Masks for the public will be an important topic for when we all try to start things up again and the current measures are going to be relaxed.
Any commuter sitting on a morning Tram with hundreds of people enclosed for half an hour in a petri dish-like setting will quickly wonder whether masks might be an appropriate preventative measure to keep transmission contained and the curve flat.
So Why is Switzerland Now Leading the Per Capita COVID-19 infection?
As a small country with 8 million people and 5 neighboring countries, Switzerland has thousands of cross-border workers, in the North from France and Germany, and in the south from Italy. Many even work in the healthcare sector. This meant that closing the borders completely and containing the spread of COVID19 from Italy to Switzerland was impossible.
The months of February and March are also peak ski season with thousands of visitors — from all over Europe and other parts of the world — mixing and mingling with Swiss holiday and weekend skiers.
Despite an initially slower start, Switzerland actually has a relatively high testing volume among the different countries. High test volumes have been a big factor in driving up the higher number of positives on a per capita basis.
Importantly, the number of deaths are still comparatively low. This suggests that Switzerland’s hospitals are doing a good job at keeping their critical patients alive and isolating the vulnerable. Several hospitals have in fact taken in ICU patients from other countries to assist.
Moving forward, it is important that we adopt a new form of discipline. Both my parents were children during WWII. I cannot imagine the hardships and discipline required of them to survive the war.
With discipline in the next weeks, we will hopefully crush the COVID19 numbers back down to the low single or double digits of new cases per day. This will make it possible to isolate new cases, trace all their contacts, and contain the epidemic through these traditional means – without the extreme population-wide physical distancing measures that cause so much economic hardship.
As we all return to some normalcy, fast testing and case tracking infrastructure and protective measures may be able to keep a second wave at bay until we can develop vaccines, therapies or a deeper understanding for predicting who’s most vulnerable and protecting them.
And if a second wave comes, we will be prepared and able to move fast.
This article expresses the personal views and perspectives of the author. The views and perspectives expressed here do not necessarily represent the views or perspectives of Versant Venture Management, LLC or any officer, director, partner, member, manager or employee of Versant Venture Management, LLC or any of its affiliated entities.