“We’re bridging a gap”

Jan Fehr, you direct the Department of Public & Global Health at the Epidemiology, Biostatistics and Prevention Institute at UZH, to which the Center of Travel Medicine also belongs. On the premises of the travel clinic you’ve now set up a COVID-19 test center, which commenced operation on Monday. How did the first day go?

Jan Fehr: The go-live went well. That’s no mean feat given the limited amount of time we had to set everything up. It was only possible thanks to a highly motivated team. What was especially pleasing was feedback from a patient who emphasized how well looked-after she felt.

What prompted you to set up the test center?

Given that there has been too little testing so far, the center can help tackle the current COVID-19 pandemic. It also bridges a gap between the tests offered by primary care providers and hospitals, and the kind of drive-through test facilities offered, for example, by some outpatient medical clinics. We test in accordance with the Swiss Federal Office of Public Health (FOPH) guidelines, meaning that initially only those with symptoms and vulnerable people will be tested.

Who is the center’s offering geared to?

Many family doctors are glad to be able to refer patients to a center, especially given the difficulty of maintaining strict hygiene arrangements. Not every patient wants to go to the emergency room of a hospital, and hospitals’ resources have to be kept available for serious cases, including those not involving coronavirus.

A drive-through can test many people, but it can only distinguish between SARS-CoV-2 positive and negative. There’s a risk that other diseases might be missed. For us it’s important to offer patients a thorough check of their state of health in addition to the test itself. That’s why we’ve also installed a mobile X-ray machine. This way we can help ensure that “normal” cases of pneumonia don’t go undetected.

You’re also involved in clinical and epidemiological research. Can you use the data you’ve gathered to model the course of the disease to be able to predict the spread of the pandemic?

Predictions are difficult at the moment, although we are working on models to be able to gauge developments in the next 30 days. Beyond this it’s not actually possible to make any forecasts. We have to learn to live with the crisis and deal with uncertainty. That requires enormous flexibility.

To what extent can the tests be used as a basis for comparing data from different countries? For example, Iceland has tested a lot and has a correspondingly high number of coronavirus cases.

For various reasons the possibilities for comparing are limited. One reason is discrepancies in the overall test activity. Other reasons include the question of at what point in the epidemic tests were done, who was tested, how they were tested, and the criteria applied. Here scientists and universities have an important role to play by working across borders on common protocols and setting standards on the basis of the evidence that has been gathered.

How exactly do you test at the new center?

We take nose and throat swabs and use a so-called PCR assay to directly test for SARS-Co-2 viruses. These tests detect the genetic material of the virus in the smears.

Do you also do antibody tests?

We’re not doing antibody tests yet. However, the question of immunity, in other words whether someone is protected, is of urgent interest, and has implications for the whole of society, as well as for business, which is under enormous pressure at the moment. But so far no one knows how reliable the existing antibody tests are.

Can I come to the test center if I have a fever?

Anyone who’s unsure whether they need to be tested or suspects they have coronavirus should contact their family doctor or employer (the University, ETH, childcare center, home care, or other employer in the healthcare sector) so that they can be forwarded to the triage hotline. There they’ll be asked about their condition and symptoms by one of our doctors, before being given an appointment. UZH and ETH employees who meet the test criteria even have the option of getting a test at the test center directly via the workplace medical officers, Dr. Guckenberger (UZH) or Dr. Sigel (ETH). Alternatively they can contact us direct by e-mailing coronatest-anmeldung@ebpi.uzh.ch. All in all we’re bridging a gap in the healthcare system and supporting family doctors. This could be a model for the whole of Switzerland.

It’s important to remember that we’re a COVID-19 test center, not a walk-in clinic; we want to have as few patients as possible on our premises at a time. This way we can avoid the risk of infection. We’re doing everything we can to protect both our patients and our staff by means of intelligent hygiene arrangements. That’s our number one priority. From other countries we know that up to one-third of healthcare personnel get infected and then can’t work, which threatens to bring the whole health system to a standstill.

Will the data you gather, which are anonymized, subsequently play an important role in research in epidemiology?

Yes. It’s an opportunity to learn more. We ask patients whether they agree to take part in a cohort study. We have a protocol that enables us to answer important questions about symptoms, presentation, and disease progressions.

How much longer will this pandemic last?

I guess nobody knows. Quite apart from that, by the time this article is published what I’ve said will probably be outdated already. But I suspect that we’ll be dealing with the novel coronavirus into the summer, and that we should also assume that we’ll have to prepare for a second wave as well.