“This is the new normal”

By Neva Newcombe

On Thursday, September 17, several members of the Institute’s Covid-19 Coordination Team met for a Q & A Session on the latest developments and protection measures on the IHEID campus. The Institute’s new director Marie-Laure Salles was joined by Director of Studies Andrea Bianchi, along with Bruno Chatagnat, Claudia Saviaux Druliolle, Dr. Suerie Moon and Professor Vinh-Kim Nguyen for the session. Though Auditorium Ivan Pictet was sparsely populated by attendees in masks, nearly 100 people were tuned into the event’s livestream.

Co-director of the Global Health Centre Dr. Seurie Moon opened the session by reviewing the state of the pandemic on both a global and a national scale. She began with the obvious: since the Coordination Team last held a Q & A in May 2020, the pandemic has worsened. COVID-19, Dr. Moon said, has affected every country on earth, and a second wave of infections is expected to arrive in the coming months.

She went on to say that although the pandemic situation has worsened, we are better prepared. Hospitals have a better understanding of what therapies are effective for COVID-19 patients, and governments have experience with which measures works and what collateral effects those measures can produce economically, politically, and socially. Throughout the session, several other panelists would reiterate this point: the pandemic is stronger, but so are we.

Within Switzerland, daily case counts have been steadily increasing since June, and the country is currently up to “about 500 new cases per day.” Dr. Moon added that although cases are increasing, it’s a slow increase, and national authorities believe the situation is more or less under control. 

Geneva has been one of the hardest hit cantons in all of Switzerland; during the first wave, public health authorities believe that about 11% of the cantonal population was affected. However, in recent weeks Vaud has surpassed Switzerland as the canton with the highest number of cases. 

Dr. Moon went on to say that although it’s imperative that we all continue to exercise caution, there are some positive signs. She noted that Switzerland and the city of Geneva have high testing rates, and in recent months they’ve had relatively low hospitalizations and a very low fatality rate compared to the early months of the Swiss outbreak. She also mentioned that there may be early signs that we are reaching a plateau in Switzerland. These low hospitalization and fatality rates could be explained by a demographic trend that public health officials observed over the summer: there was an upsurge in cases among 20-40 year olds. However, following the new measures adopted by the Swiss government in recent weeks, the age distribution of new infections has evened out. Professor Vinh-Kim Nguyen noted that many of the cases among young people have been asymptomatic, which is yet another reason why the IHEID student body must be vigilant: once infections start to reach high risk groups, the hospitalization and fatality rates are likely to rise again.

Professor Nguyen opened by addressing the prospect of a vaccine. Nguyen said that realistically, a vaccine won’t be a solution for 2-3 years—this is the new normal, so we need to adjust to the safety measures. 

He went on to say that “small changes done by most people, most of the time, make a huge difference.” Forming new habits and new norms around the safety guidelines is key.

Professor Andrea Bianchi spoke more to the externalities that the new norms inflict upon the community. He maintained that for now, and for a while going forward, we will all have to live with uncertainty. Bianchi also noted that “people seem happy,” and that through suffering and hardship, communities become more robust. Whether or not students agree with this sentiment remains to be seen. For many students, especially those participating remotely, the hybrid semester is already posing a vast array of unfamiliar challenges and hardships.

Most of the questions came in from online participants. Questions from the audience and answers from the panel during the second portion of the event are listed out below.

What is the likelihood that Geneva will require confinement for everyone again? What should we do to prepare for this?

Moon: I can’t predict the future, of course, but I think the fervent hope is that the restrictions that have been put in place will slow down and plateau the virus. There are early signs that perhaps we have hit a plateau like that. One of the big challenges is that the canton is not a huge area, and we have travel all the time from the rest of Switzerland and from neighboring countries. The authorities on both cantonal and federal level are very, very hesitant to have any kind of confinement similar to what happened in the spring because of all the social and economic impacts. So, before that would happen, we would see a gradually increasing set of stricter and stricter and stricter measures, rather than a sudden lockdown. 

Two other points to remind everybody of: the number of cases we see today cannot be compared directly to the number of cases we saw in February and March leading up to the first lockdown. That’s because we have far more testing capacity today than we did then, and different criteria to be eligible for testing. We’re testing much more today than we did back in March. Because of a different age distribution and an increased understanding of the virus, I think it’s less likely that we’ll see an all-or-nothing lockdown measure like what we saw in March. I hesitate to say definitely not. Many of you have seen the news that Israel became the first high income country to institute another a temporary heavy lockdown for at least three weeks. France and Spain are the countries that have seen rapid growth and a high number of cases per day. Because we’re epidemiologically very closely tied to France, we’ll have to keep monitoring the situation.

Do you think a vaccine will be mandatory for everyone in Switzerland?

Moon: This is being debated in the public and within government. One of the hats I wear is as a member of the National Scientific Taskforce for COVID-19 in Switzerland, and there is a very active debate. My understanding is that in some limited cases, there is a legal basis to require immunization for some professional groups. Whether or not that would be used for COVID-19 in the population of Switzerland is a very different matter. I don’t hear a lot of voices for compulsory vaccination right now. Maybe for certain professional groups, such as healthcare workers.

Is there a plan for if or when there are confirmed cases at IHEID?

Nguyen: There is a plan. The first point to make is that the management of contact tracing and of measures to be taken around a case is not done by us; it is the public health authorities, as it is everywhere else. If there is a case, we encourage it be brought to our attention, but the actual measures to be taken are dictated by the public health authorities. We have no legal basis there. What we will do is meet on an ad hoc basis, because every case will be different. There’s no standard operating procedure. Everything that is standardized is on the website. We will meet and assess on a case-by-case basis to decide what needs to be done in consultation with the public health authorities. 

The second question is “What if I’ve been exposed? What constitutes a contact?” Just being in the same place for 5 minutes is not a contact. There is public health criteria for who has been meaningfully exposed. The authorities determine that, and they would then be responsible for contacting people who have been meaningfully exposed and are considered contacts.

What is the risk of surface contamination?

Nguyen: Just to review transmission: the bulk of transmission of Covid is when someone is infected—and usually we’re more infectious when we’re healthy—through micro-droplets via speaking. So a door handle could be risky if somebody has been speaking to it, it could get contaminated. More likely is that we contaminate our hands and then touch the door handle. This is where handwashing becomes so important. What we’ve seen from where there have been outbreaks in professional settings, it is from people working together closely without masks for long periods of time. So yes, there is a theoretical risk from someone talking to a door handle, contaminating it, not washing their hands, sticking their finger in their mouth, etc. That chain of transmission is entirely plausible. Is it likely, is it what we actually see in real life? No. It’s good enough to wear a mask and wash your hands most of the time.

If the current increase in cases is not accompanied by an increase in fatalities, should we pay more attention to fatalities or hospitalizations than to case numbers?

Moon: That’s a great question, and what I think it’s really asking is “What is happening?”. We’re trying to observe something that is very difficult to observe, so the more data points we can use to triangulate and paint a picture of what is happening, the better off we are. We should still pay attention to the numbers of new cases; we should pay attention to the number of hospitalizations, the number of people in the intensive care unit—and this data is available for Geneva and for Switzerland. Deaths, of course. We should also pay attention to how many tests are being administered and what percentage of those tests are positive. We can also look at clusters—do we see clusters popping up in homes for the elderly, schools, etc. By taking into account all these different pieces of information, you can have some idea of what’s happening and the implications for the health system.  

If I’ve already tested positive for coronavirus once, can I get it again?

Nguyen: There are now a handful of reported cases of people who had coronavirus, with a positive test, were then negative, got sick again and were positive again. Clearly there appear to be rare cases of re-infection. This question came up 6 months ago, and back then what I answered is that it has to do with test reliability, so maybe the first test was falsely positive, the second test was falsely negative—that kind of thing. I think now there are well documented cases [of re-infection] which we didn’t have before. It seems to be an extremely rare phenomenon. Clearly, if re-infection were a widespread and significant phenomenon, we would be seeing it, and we’re not.

What accounts for the seemingly low fatality rate in the context of the recent surge in Switzerland, and do you think that it will continue?

Nguyen: The very low fatality is due to at least two things. For one, there are low numbers of people who are at high risk of dying from Covid getting infected—so once again, the bulk of transmission is in young healthy people who are staying healthy. We also treat this better. The fatality rates are non-existent really, currently, so it just hasn’t gotten to people who are at risk of dying. It will eventually, and if we do get a second wave with hundreds of cases being hospitalized, it’s safe to say that the fatality rate will be lower because we are better at treating [Covid].

If there is a decrease in cases, will IHEID do away with rotational attendance and the hybrid mode for classes this semester?

Bianchi: In terms of teaching, we have started this endeavor to ensure safety for students and for everyone. I think it was the safest move. I understand it’s a bit of an inconvenience; I understand it’s a little bit complicated, but it’s not and insurmountable obstacle, after all. We think it’s a fair system to give everybody the same chances of being physically present in class without jeopardizing the health of the students. I think the system as currently conceived is fairly sound. For the time being, there is no sign that we’ll be able to dispense with compulsory wearing of masks or the social distancing rules. I think common sense plays a role in all this. The measures we have been taking since day one have been inspired by the precautionary principle—that is, even when there is scientific uncertainty about particular aspects of the spread of the disease, we take measures that go beyond the requirements, and that’s what we’ll continue doing. We’ll monitor the situation closely and regularly.

Moon: I think one of preoccupations with that is “How long do we expect these measures to be necessary? How long do we expect the pandemic to continue?” Of course nobody knows the answer to that question, but two points might be useful to put on the table. One is that we can think about this virus as a fire. If you starve a fire of oxygen, it will burn down slower and lower and eventually go out. Doing that in Switzerland means a full lockdown, and the costs of that are simply too high. But what this also means is that we’re trying to reduce the oxygen supply for the virus, for this fire, but once we lift [the measures], it will burn again. We’ve seen that across multiple countries. It will not simply disappear. 

I want to emphasize that the control measures are necessary as long as we don’t have a surefire mode of prevention, which is a vaccine. We don’t expect to have a vaccine until, at the earliest, 2021. Most likely, young people will not be at the top of the priority list to get access to scarce vaccines. You can imagine that we’ll have to have some measures in place for a big chunk of the next calendar year. 

The second point I wanted to remind everyone of is that we’re still learning new things every day about this virus and the medical impact it can have on the body. There are deaths in younger people; there is severe illness and the need to be hospitalized in younger people; there is multiple organ damage; there can be long term affects. While statistically older people and people with underlying conditions are certainly at much greater risk, it’s also true that young people are at risk. It’s a new virus, we understand very little about it, and we understand almost nothing about its longterm effects, because there is no evidence yet. So, there’s not only an altruistic reason for younger people to protect older people; it’s also to protect ourselves.

What’s the criteria for when you should stay home vs. come in to the office?

Nguyen: If you are feeling unwell, stay home—not just for Covid, but for all transmissible diseases, particularly since we can do 99% of the work online. There are formal conditions, like cough, fever, etc., but I would encourage anyone who feels unwell to stay home and work from home. 

Are there any legal implications in Switzerland if I have Covid and pass it on to someone else when I should have been in quarantine?

Nguyen: Theoretically that person could probably sue you. 

What is currently expected for the winter semester? Will the hybrid teaching approach still be used? 

Bianchi: Hybrid teaching is an adjustment that under no circumstances will be changed. It does not lower the quality of the education. It offers something that was not offered before. We’re all well aware that to adjust means we might have to change some modalities for evaluation. Please don’t look at hybrid teaching as some sort of strange animal. It’s the most effective tool we have; we are privileged to be doing this with the adequate support of technology. It’s the new normal. The standards will remain pretty much the same even if the modalities might change. Rather than having an in-class, closed book exam, you might have a take-home, open book exam, but that doesn’t change what we aspire to give to students in terms of education, and it doesn’t change what students are expected to offer in terms of performance.