Flattening the curve in 52 days: characterisation of the COVID-19 pandemic in the Principality of Liechtenstein - an observational study - Publication

Publication

Flattening the curve in 52 days: characterisation of the COVID-19 pandemic in the Principality of Liechtenstein - an observational study

Journal Paper/Review - Oct 16, 2020

Thiel Sarah Lucia, Copeland Sandra, Karajan Tomas V, Cusini Alexia, Fleisch Felix, Kahlert Christian, Vernazza Pietro, Risch Martin, Ritzler Michael, Hillmann Dorothea, Lung Thomas, Wohlwend Nadia, Risch Lorenz, Weber Myriam Carol, Paprotny Matthias

Citation

Thiel S, Copeland S, Karajan T, Cusini A, Fleisch F, Kahlert C, Vernazza P, Risch M, Ritzler M, Hillmann D, Lung T, Wohlwend N, Risch L, Weber M, Paprotny M. Flattening the curve in 52 days: characterisation of the COVID-19 pandemic in the Principality of Liechtenstein - an observational study. Swiss Med Wkly 2020; 150:w20361.

Type

Journal Paper/Review (English)

Journal

Swiss Med Wkly 2020; 150

Publication Date

Oct 16, 2020

Issn Electronic

1424-3997

Pages

w20361

Brief description/objective

BACKGROUND
The principality of Liechtenstein had its first COVID-19 case at the beginning of March 2020. After exponential growth, the pandemic’s first wave was contained, with the last case being diagnosed 52 days after the initial occurrence.

AIM
To characterise the COVID-19 pandemic in Liechtenstein.

METHODS
All patients diagnosed in Liechtenstein were followed up until recovery and again 6–8 weeks after symptom onset. They were contacted every 2 days to record their clinical status until the resolution of their symptoms. The diagnosis of COVID-19 was based on clinical symptoms and molecular testing. Household and close workplace contacts were included in the follow-up, which also comprised antibody testing. In addition, public health measures installed during the pandemic in Liechtenstein are summarised.

RESULTS
During the first wave, 5% of the population obtained a reverse transcriptase polymerase chain reaction test. A total of 95 patients (median age 39 years) were diagnosed with COVID-19 (82 who resided in Liechtenstein), resulting in an incidence in Liechtenstein of 0.211%. One patient, aged 94, died (mortality rate 1%). Only 62% of patients could retrospectively identify a potential source of infection. Testing the patients’ household and close workplace contacts (n = 170) with antibody tests revealed that 25% of those tested were additional COVID-19 cases, a quarter of whom were asymptomatic. Those households which adhered to strict isolation measures had a significantly lower rate of affected household members than those who didn’t follow such measures. The national public health measures never restricted free movement of residents. Masks were only mandatory in healthcare settings. The use of home working for the general workforce was promoted. Gatherings were prohibited. Schools, universities, certain public spaces (like sports facilities and playgrounds), childcare facilities, nonessential shops, restaurants and bars were closed. Social distancing, hygienic measures, solidarity and supporting individuals who were at risk were the main pillars of the public health campaigns.

CONCLUSION
The close collaboration of all relevant stakeholders allowed for the complete workup of all COVID-19 patients nationwide. A multitude of factors (e.g., young age of the patients, low-threshold access to testing, close monitoring of cases, high alertness and adherence to public health measures by the population) led to the early containment of the first wave of the pandemic, with a very low rate of serious outcomes. Antibody testing for SARS-CoV-2 revealed a substantial proportion of undiagnosed COVID-19 cases among close contacts of the patients.