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Should vaccinated people have triage priority in Swiss hospitals?

As intensive care units in many Swiss hospitals are filled to capacity, some health professionals and politicians say vaccinated patients should be prioritised over the unvaccinated ones. Could this controversial measure be introduced?

Some experts believe the vaccinated should have priority access to Swiss ICUs, like this one, in La Chaux-de-Fond, canton Neuchâtel. Photo by Fabrice COFFRINI / AFP
Some experts believe the vaccinated should have priority access to Swiss ICUs, like this one, in La Chaux-de-Fond, canton Neuchâtel. Photo by Fabrice COFFRINI / AFP

With the number of coronavirus infections soaring in Switzerland, intensive care beds are becoming scarce across the country and triage of patients may be just around the corner.

This is why a number of health experts and politicians say it is justifiable to favour vaccinated people when it comes to allocating patients in ICUs.

“Triage guidelines need to be changed, as the majority of patients currently admitted to intensive care are unvaccinated”, said infectious disease specialist Andreas Widmer.

 “It should not be tolerated that unvaccinated patients steal the place of vaccinated people in intensive care, thus reducing their chances of survival”.

On the political front, many elected officials agree with this view.

“It is not acceptable that surgeries for vaccinated patients are postponed because unvaccinated people who get Covid are occupying intensive care beds”, said  Ruth Humbel, president of the National Council’s Social Security and Public Health Commission.

She suggested that the unvaccinated carry advance directives stating  they would forgo intensive care treatment in the event of a severe coronavirus infection.

“It is clear that unvaccinated people should not have priority over other urgent cases”, according to MP Philippe Nantermod.

Another MP,  Verena Herzog, also pointed out that “we cannot accept that vaccinated people, who have assumed their responsibility towards society, die due to hospitalisation of unvaccinated people.”

Could such a drastic measure could be implemented in Switzerland legally?

There is nothing in Swiss law that specifically addresses the issue of triage priorities. The only criterion is that, as everyone pays for the compulsory health insurance, nobody can be denied medical treatment.

Even those who don’t pay their premiums or are in arrears are entitled to emergency care.

The cantons are responsible for ensuring that their residents have access to the healthcare services on their territories.

The Federal Office of Public Health (FOPH), which sets rules relating to health insurance coverage, told The Local two organisations are responsible for establishing triage guidelines: the Swiss Academy of Medical Sciences (SAMS) and The Swiss Society of Intensive Care Medicine (ASSM).

The two organisations have jointly created the emergency protocol for triage of patients in intensive care units in cases when hospital overload can’t be resolved by other measures, such as postponing operations or transferring patients to other medical facilities; the final decision on who to prioritise, however, rests with the hospital and its intensive care unit.

Both SAMS and ASSM say that triage system should be based on equity — that is, resources must be made available without discrimination of any kind, in order to avoid any arbitrary decisions.

The rules clearly state that “vaccination status must be ruled out as a triage criterion”.

“Immunisation status is not a triage criterion. In Switzerland, all patients should be treated the same, regardless of their opinion and actions. The same goes for smokers. They will also not be at a disadvantage during triage, although they willfully consume harmful products.”

READ MORE: Do you need a Covid certificate to go to hospital in Switzerland?

What other triage criteria have been established?

“The guidelines provide assistance to ICUs, so that any triage decision can be made according to the same criteria across Switzerland,” said Franziska Egli, communications officer at the ASSM.

“The objective is to save as many lives as possible, but the short-term prognosis is the deciding factor for the decisions”, she added.

This means that patients whose prognosis for recovery or improvement is favourable with intensive care therapy, but unfavourable without this treatment, have top priority.

“The most important criterion for physicians is the prognosis for short-term survival. This means that the people treated are those most likely to survive. If several patients have a good chance, the second criterion taken into account is the investment of medical resources. Someone who, like so many Covid patients, spends a month in intensive care, has poorer chances than someone who only needs shorter treatment”.

Age in itself is not a factor, but it is indirectly taken into account in the context of the ‘short-term prognosis’ criterion, since the elderly often suffer from pre-existing chronic conditions, defined as two or more diseases. 

Official directives list illnesses that are deemed to be incompatible with hospitalisation if there is shortage of beds. They include advanced cirrhosis, cancer with a limited life expectancy, and severe heart or neurological problems.

What if ICUs are saturated to the point of having to turn away patients?

Even then, “we are strongly opposed to taking a patient’s immunisation status into account as a triage criterion”,  Sibylle Ackermann, head of ASSM’s ethics department told Switzerland’s Watson news site.

Only medical criteria should be taken into account when it comes to making a selection among patients, she added.

Michele Genoni, cardiac surgeon and president of the umbrella organisation of Swiss surgeons, agrees: “For me, it is obvious that vaccination status should never become a criterion in the allocation of intensive care beds”, he said.

“Even with severe triage, the person with the highest chance of survival should always be favoured, whether it is an unvaccinated Covid patient or an accident victim”.

READ MORE: ‘No more ICU beds’ in Zurich as Switzerland hits all-time Covid case record

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Covid face mask rule on flights in Europe set to be eased

The mandatory EU-wide mask requirement for air travel is set to be dropped from Monday, May 16th, but airlines may still require passengers to wear masks on some or all flights

Covid face mask rule on flights in Europe set to be eased

Europe-wide facemask rules on flights are set to be ditched as early as next week in light of new recommendations from health and air safety experts.

The European Union Aviation Safety Agency (EASA) and European Centre for Disease Prevention and Control (ECDC) dropped recommendations for mandatory mask-wearing in airports and during flights in updated Covid-19 safety measures for travel issued on Wednesday, May 11th.

The new rules are expected to be rolled out from Monday, May 16th, but airlines may still continue to require the wearing of masks on some or all of flights. And the updated health safety measures still say that wearing a face mask remains one of the best ways to protect against the transmission of the virus.

The joint EASA/ECDC statement reminded travellers that masks may still be required on flights to destinations in certain countries that still require the wearing of masks on public transport and in transport hubs.

It also recommends that vulnerable passengers should continue to wear a face mask regardless of the rules, ideally an FFP2/N95/KN95 type mask which offers a higher level of protection than a standard surgical mask.

“From next week, face masks will no longer need to be mandatory in air travel in all cases, broadly aligning with the changing requirements of national authorities across Europe for public transport,” EASA executive director Patrick Ky said in the statement. 

“For passengers and air crews, this is a big step forward in the normalisation of air travel. Passengers should however behave responsibly and respect the choices of others around them. And a passenger who is coughing and sneezing should strongly consider wearing a face mask, for the reassurance of those seated nearby.”  

ECDC director Andrea Ammon added: “The development and continuous updates to the Aviation Health Safety Protocol in light of the ongoing Covid-19 pandemic have given travellers and aviation personnel better knowledge of the risks of transmission of SARS-CoV-2 and its variants. 

“While risks do remain, we have seen that non-pharmaceutical interventions and vaccines have allowed our lives to begin to return to normal. 

“While mandatory mask-wearing in all situations is no longer recommended, it is important to be mindful that together with physical distancing and good hand hygiene it is one of the best methods of reducing transmission. 

“The rules and requirements of departure and destination states should be respected and applied consistently, and travel operators should take care to inform passengers of any required measures in a timely manner.”