On 14 September 2020, the Swiss National COVID-19 Science Task Force issued its latest ‘Policy Brief’, under the heading: “Widespread community spread of SARS-CoV-2 is damaging to health, society and the economy”.
The Policy Brief sets forth in detail why a strategy – now often referred to in lay terms as ‘herd immunity’ – of relaxing current containment measures so that large proportion of the population is infected is not advisable, neither from a public health nor from an societal or economic perspective. The Policy Brief prefers the term ‘community infection approach’, stressing that it is unclear at this point whether infection leads to long-lasting immunity.
Importantly, the Policy Brief includes developments regarding an aspect of the pandemic that has received relatively little coverage in Switzerland so far: the long-term health effects of COVID-19. To the best of the author’s knowledge, this represents the clearest and most documented account from expert sources in Switzerland to date, affirming that COVID-19 infection is not a ‘binary’ issue of living or dying.
While insisting that the state of knowledge is continuously evolving and that it is difficult at this stage to make definitive calls on causality, the Science Task Force nevertheless makes it clear that health sequelae are not limited to so-called ‘severe’ cases, and are factors to be considered in policy decisions:
“In addition to the death toll, SARS-CoV-2 causes severe disease in a fraction of the patients. And among the patients with milder acute disease, between 10% and 30% experience persistent symptoms more than a month after the initial diagnosis (and ). The type and frequency of deleterious long-term health effects is currently not well understood, and exposing the population at large to infection would represent a major risk” (our emphasis).
The Appendix includes further details on the categories of health effects, as well as links to scientific publications.
It seems essential that these aspects of the Science Task Force Policy Brief are given due consideration by local (‘cantonal’) authorities when weighing benefits and costs of implementing additional protective measures within their scope of competences. As data is accumulating on long-term effects of COVID-19, including on active adults populations, such data is bound to have an impact on the balance of interests between protecting health and securing the economic future of the country.
The Science Task Force also emphasizes the need for transparent and open communication of health authorities to foster buy-in within the population:
“The federal and cantonal authorities should develop a clear and transparent narrative that gives an honest vision for the future, while acknowledging the challenges and uncertainties”.
Obviously, policy measures which represent considerable encroachments upon individual’s freedoms must go hand-in-hand with appropriate communication about the rationales behind those measures. Absent such communication, no informed societal debate can take place. As a society, we may envisage a diversity of possible responses to the threats involved in COVID-19. It is also unavoidable – and legitimate – that the attitude of each individual will be shaped by their personal history, risk propensity and other life circumstances. However, as the latest Policy Brief demonstrates, we also need to keep in mind that the reality of the pandemic is more complex than what the current daily – newly, excepting weekends – case and death figures reports by the Federal Office of Public Health reflect.
Other public health authorities and science advisory bodies have issued warnings and guidance regarding persistent COVID-19 effects, including the National Health Services in the UK, and the Center for Disease Control and Prevention in the US. The Science Task Force has now given the Federal Office of Public Health sufficient ground to address these issues in its communication and recommendations, including where necessary incorporating appropriate caveats regarding uncertainty in a rapidly evolving environment. The Swiss population has the capacity to understand this uncertainty and adjust accordingly. When authorities count on the collective responsibility of their citizens to participate in fighting the spread of the pandemic, they need to treat these citizens as responsible.