In the week to 9 October 2020, the reported number of new SARS-CoV-2 infections in Switzerland was 5,984, 137% higher than the 2,520 cases recorded the week before. The total number of recorded cases stood at 60,368 by 9 October 2020, representing 0.7% of the population.
The 7-day rolling average number of recorded daily new cases this week was 855, up from 360 the week before. On 9 October 2020, the number of new cases reported was 1,487.
Recorded infection rates per 100,000 in Switzerland are currently 99 and 70 over the last 14 and 7 days.
Geneva now leads on per capita infection rates. Today, 14-day infection rates per 100,000 were highest in Geneva (195), Schwyz (172), Vaud (159), Jura (147), Neuchâtel (143), Zug (128) and Fribourg (123). Over the week, Zurich experienced a significant rise in new recorded cases. The number there nearly doubled to 1052 cases over the week ending 9 October 2020.
This week, Switzerland’s Covid-19 death toll rose by 13 to 2,088.
On the face of it the low number of deaths (13) and number of reported new cases (5,984) this week might appear to be nothing to worry about. The total number of new cases this week represents 0.07% of Switzerland’s population and new deaths are running at less than 2 per million.
However, what concerns many epidemiologists is the risk of new infections getting beyond the point where they can be controlled. This happened early this year in places like Bergamo in northern Italy and New York City (NYC) where the number of infections were far above current numbers and many times higher than the numbers reported at the time. Spread was out of control and the disease ran through vulnerable segments of these populations killing many.
One of the challenges governments face is communication. Alternative theories on the disease’s spread and impacts abound. This can make effective collective action difficult.
Some point to low excess mortality in Switzerland and claim there is no cause for concern. But low excess mortality does not necessarily mean Covid-19 is harmless. It could reflect success in controlling its spread. Rates of antibodies in Switzerland’s population suggest the spread of the virus has so far been limited and skewed towards younger people. Antibody studies across Switzerland suggest only a minority of the population has been infected. Geneva (11%) and Ticino (11%) showed the highest antibody prevalence, followed by Vaud (7%), Basel (4%) and Zurich (3%). However, these tests are not perfect and uncertainty remains.
In addition, it is likely that antibody data is missing those without antibodies who were exposed to the disease and had a T-cell response, another kind of immune response. A Swedish study found that 26% of those with a SARS-CoV-2 T-cell immune response tested negative for antibodies. However, much uncertainty remains here too.
In places where the disease ran out of control and rates of antibodies across the population are high, excess mortality was also high. In NYC, where around 25% tested positive for antibodies, all cause mortality during the early period of the COVID-19 outbreak was 4.15 times higher than normal. An extra 33,465 among NYC’s population of 8,280,000 died of all causes during this period than would normally be expected. That is an extra 0.4% of the population.
Some claim the RT-PCR test is producing many false positives. A review and analysis of RT-PCR data shows a false positive interquartile range between 0.8% and 4%, with a median of 2.3% and suggests the main cause is contamination. This could have a significant impact if test positivity is low.
On the other hand, RT-PCR test false negatives are also an issue. A review of research shows a 90% prediction interval ranging from 2% to 54%. False negatives appear to be more likely when testing is done late.
So the RT-PCR test isn’t perfect. But it is the tool we have and its accuracy can be improved by avoiding contamination (to avoid false positives) and timely testing (to avoid false negatives). In addition, if positivity rates and testing practices remain relatively consistent, the results are likely to provide a decent indicator of whether infections are rising or falling. Positivity has risen recently in Switzerland, which would, by itself, reduce the impact of false positives. However, much uncertainty remains.
Finally, some claim most Covid-19 deaths are people dying with the disease rather than from it, a phrase sometimes used when referring to typically slow burn diseases such prostate cancer. If a death certificate lists Covid-19 alongside comorbidities, it is the comorbidities that killed the victim rather than the SARS-CoV-2 virus, they argue. However, many of these people could have lived for numerous years with the comorbidities that accompanied their death if they hadn’t been infected with SARS-CoV-2. In addition, some high risk comorbidities are reversible, something that is only possible if the patient remains alive.
Thankfully, treatments have improved and doctors are better able to save more Covid-19 patients with severe symptoms than they could earlier in the year. The drug Dexamethasone has had a meaningful impact. And progress is being made on vaccines and other treatments, which are likely to reduce mortality further.
In the meantime, scientists and epidemiologists will be forced to continue to work with large unknowns, and leaders will remain stuck with the unenviable job of making decisions with uncertain outcomes based on imperfect information, all while being subjected to intense criticism on nearly all fronts.