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COVID-19

What needs to happen before European countries lift coronavirus restrictions?

With signs in some European countries that the coronavirus pandemic may have reached a plateau, governments are looking at how to lift lockdown restrictions on their crippled businesses and restless populations.

What needs to happen before European countries lift coronavirus restrictions?
AFP

But what are the conditions that countries should meet before they can start safely easing these strict measures and return to some kind of normalcy?

Don't act too quickly

Experts fear that governments will bow to economic and social pressure to lift their lockdowns prematurely, and warn that such a move could allow COVID-19 to return.

“Lifting the restrictions too quickly could lead to a deadly resurgence,” World Health Organization chief Tedros Adhanom Ghebreyesus has said.

Christian Brechot, Institut Pasteur president and former head of French national medical research institute INSERM, said we must be “very humble and very careful” with a virus that many nations have already underestimated.

“It's not clear with a pandemic of this scale how everything can miraculously return to normal,” Brechot told France Info radio.

European nations begin lifting

Despite such advice, in the hardest-hit continent Europe — where more than 78,000 people have died from the virus — several countries have already started partially lifting confinement measures.

Germany, which has seen new cases drop and was already less affected than some of its neighbours, appeared Monday to be moving towards lifting restrictions in stages.

Austria will allow small businesses to reopen after the Easter break, believing it has sufficiently flattened its infection curve.

Denmark will reopen daycare nurseries, kindergartens and primary schools from April 15, while the Czech Republic has already begun to gradually ease restrictions, including opening some shops.

The countries are following in the footsteps of China, which has loosened its unprecedented lockdown on the city of Wuhan, where the coronavirus emerged in December, after the strict measures appeared to have paid off.

'Very high plateau'

Elsewhere in Europe, however, there are fewer signs that restrictions will soon ease.

Britain passed the grim milestone of 10,000 deaths on the weekend while France is expected to extend its lockdown for at least several weeks.

France's national health service director Jerome Salomon said a slight decrease in intensive care admissions was a “pale ray of sunshine,” adding that “a very high plateau” seemed to be setting in.

The continent's hardest-hit countries Italy and Spain also seem to have reached such a high plateau, with their daily death rates gradually falling.

But after such a devastating period, neither country is letting down its guard — Italy has extended its confinement measures until May 3, while Spain has done the same until April 25. Ireland, Portugal and Belgium have also extended their measures.

Gradual relaxation from mid-May?

“It's not when we have arrived at a plateau that we should lift confinement measures which have helped avoid massive congestion in hospitals,” said Antoine Flahault, a specialist in public health and epidemiology at the University of Geneva.

It must only happen “when we see a decline,” he told broadcaster France 2.

Researcher Brechot said he “hopes that from mid-May we will be in a situation of deceleration” which will allow a “gradual relaxation” of restrictions.

Jean-Francois Delfraissy, who leads the coronavirus science council advising the French government, said “we are not going to go from black to white, but from black to grey, with continued confinement”.

“We can start to discuss post-confinement, but the essential and principal factor is to pursue strict confinement for several weeks.”

Three conditions

Delfraissy said there were several prerequisites for lifting confinement measures.

First, there would need to be an established decline in the number of COVID-19 cases in intensive care.

This would give exhausted health workers a badly needed respite and allow hospitals to restock equipment and supplies.

The transmission rate of COVID-19 — the number of people an infected individual infects in turn — would need to have dropped below one, compared to 3.3 people at the start of the outbreak.

And finally there would need to be a sufficient number of masks to protect the populace and tests to closely monitor the virus's spread. 

For example in France, screening capacity would need to increase from the current 30,000 tests a day to 100,000 or even 150,000 a day by the end of April, Delfraissy said.

Unknowns

Of course, these conditions are subject to much uncertainty, including the possible development an app that uses smartphones to trace the contacts of infected people.

Mobile operators have already been providing location data to health researchers in France and Germany.

Another major unknown is the effect that summer has on slowing COVID-19's spread in the northern hemisphere. 

Respiratory viruses are generally less prevalent in warmer months — flu season is in winter — but will the coronavirus be the same?

“If there is no summer brake, then it will be more complicated” to lift confinement measures, said epidemiologist Flahault.

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HEALTH

How is Swiss healthcare system different from the rest of Europe?

Switzerland’s health infrastructure is consistently rated among the best in the world, but how does it compare with other countries?

How is Swiss healthcare system different from the rest of Europe?

Whether in terms of politics, social system or economy, the Swiss often chart their own course, which fundamentally diverges from that of its European neighbours.

Healthcare is no exception.

The differences lie primarily in who finances the scheme — public versus private — and how the overall system functions.

Like much of the European Union, Switzerland has a universal health system, which means everyone in the country is covered by insurance and has access to medical care.

In most countries, the government typically has control, to a lesser or greater extent, over funding, health insurance, and health providers.

In France, for instance, most healthcare costs are covered by the state healthcare system, known as assurance maladie, and this is funded by taxes – healthcare costs account for about 13 percent of the average person’s gross salary.

In Germany, health costs are shared by employers and workers, with employees paying 7.5 percent of their salaries into a public health insurance fund, and companies matching that amount.

Italy’s national, system, called the Servizio Sanitario Nazionale, or simply SSN, which is financed mainly though federal and regional taxes, automatically covers all residents. Medical care is largely free of charge at the point of service.

Public healthcare also exists in Austria, with certain portions of salaries being automatically deducted to fund the scheme. However, healthcare is free of charge for low-income people or those who who are disabled, studying, or retired.

Although no longer part of the EU, the UK health system is also based on state healthcare via the NHS. It is funded by taxes which account for about 4.5 percent of the average citizens’ gross income.

What about Switzerland?

The system here is fundamentally different in that it is not tax-based or financed by employers, but rather by individuals themselves.

Everyone must have a basic health insurance coverage and purchase it from one of dozens of private carriers.

Basic insurance — KVG in German and LaMal in French and Italian — is compulsory in Switzerland. It doesn’t come cheap — premiums are based on the canton of residence and age, costing 300 to 400 francs a month on average — but it is quite comprehensive; it includes coverage for illness, medications, tests, maternity, physical therapy, preventive care, and many other treatments.

READ MORE: Everything you need to know about health insurance in Switzerland

There are no employer-sponsored or state-run insurance programmes, and the government’s only role is to ensure that all insurance companies offer the same basic coverage to everyone and that they have the same pricing.

While companies can’t compete on prices or benefits offered by the basic compulsory insurance — which are defined by the Health Ministry — they can, and do, compete on supplemental polices which offer perks not included in the basic coverage.

READ MORE: What isn’t covered by Switzerland’s compulsory health insurance?

All policies have deductibles (also called co-pays) that can range from 300 to 2,500 francs a year.

After the deductible is reached, 90 percent of all medical costs will be covered by insurance, with 10 percent being paid by the patient; however, this co-pay is capped at 700 francs a year for adults and 350 francs for children under 18.

The government does subsidise healthcare for the low-income individuals and households – defined as those for whom insurance premiums exceed 10 percent of their income.

What percentage of a person’s income goes to health insurance premiums?

This depends on wages and premiums, for instance, whether a person chose the cheapest option with a high deductible or the expensive one with a 300-franc deductible.

Generally speaking, however, based on the average monthly income of just over 7,000 francs, about 6.5 percent is spent on premiums.

What happens if you don’t take out an health insurance policy?

Anyone who arrives in  Switzerland must get insured within three months. If you don’t, the government will choose one for you and send you the bill. If this happens you may end up with more expensive premiums than you might have gotten if you shopped around yourself.

If you are still delinquent on your payments, your healthcare will be restricted to emergencies only; any other non-urgent medical treatment will be denied, unless you pay for it out of pocket.

The pros and cons of the Swiss system

Let’s look at the ‘cons’ first. Basically, there is one: the cost.

Not only are insurance premiums high and steadily increasing, but, at 7,179 francs per capita, Switzerland has the third most expensive healthcare scheme in the world — behind only the United States ($12,318) and Germany ($7,383).

Unlike taxpayer-funded models, there is no price grading according to income, so people on a low income pay a high proportion of their income for healthcare than higher earners. 

However, the system is generally efficient, has an extensive network of doctors, as well as well-equipped hospitals and clinics.

Patients are free to choose their own doctor and usually have unlimited access to specialists.

READ MORE: EXPLAINED: How to see a specialist doctor in Switzerland without a referral

Waiting lists for medical treatments are relatively short.

According to a survey by the Organisation  for Economic Cooperation and Development  (OECD) on how long patients in various countries typically wait for an appointment with a specialist, the share of people in Switzerland waiting a month or more is 23 percent, compared to 36 percent in France, 52 percent in Sweden, and 61 percent in Norway.

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