A new variant of COVID has been found and named ‘omicron’. Travel bans have been put in place in various countries throughout the world. The new variant has been declared a variant of concern by the WHO Organisation.
Here are certain steps that governments should avoid and other steps they should be considering tackling the new threat.
Steps to avoid
Firstly, imposing restrictions indiscriminately does more harm than good. It failed to reduce the number of cases during the last 3 waves in South Africa, keeping in mind 60%-80% of people were infected by the virus based on serosurveys and modeling data. These restrictions should only be imposed on indoor gatherings because otherwise, the economically destructive restrictions only prolong the period of time over which the infections take place for around 2-3 weeks.
Secondly, do not have domestic (or international) travel bans. The virus will spread irrespective of this as can be learned from the past. Unless you are an island nation that shuts off all contact with the rest of the world, the virus will spread across the globe.
The lack of reporting of the variants in countries that have limited sequencing capacity does not by any means indicate the absence of the variant. Moreover, unless all countries place travel bans on “red-listed” countries, the variant will one way or the other still reach countries that are imposing selective travel bans.
Additionally, there is a high likelihood that the variant would have already been spread by the time countries placed travel bans.
This is already obvious from countries such as Belgium reporting the infection in a person with no links with someone from Southern Africa.
Instead of imposing travel bans on selective red-listing countries, carrying out rigorous exit and entry screening programs can help in identifying potential cases and mandating vaccination.
Thirdly, refrain from announcing regulations that are not enforceable in the local context. This includes banning alcohol sales while failing to effectively police the black market.
Another measure governments should not be taking is don’t delay and make hurdles to boosting high-risk individuals. The government should be targeting adults older than 65 and provide them an additional dose of the Pfizer vaccine after their first two shots. The same thing goes for other risk groups such as people with any other sort of underlying immuno-suppressive condition.
The fifth measure is to stop promoting the herd immunity concept. Although the first-generation vaccines are highly effective in providing protection against severe COVID-19, they are less predictable in protecting against infection and mild COVID-19 owing to the waning of antibodies and ongoing mutations of the virus. Vaccination still reduces transmission modestly, which remains of great value but is unlikely to lead to “herd-immunity” during our lifetimes.
Instead, the discourse should revolve around adapting and learning to live with the virus.
There are also a number of factors that should be considered in the wake of the omicron variant.
Steps to take
Firstly, make sure the health care facilities are well-prepared on the ground. They should be resourced with staff, personal protective equipment, and oxygen, etc.
There are 2000 interns and community service doctors in South Africa waiting for their 2022 placement confirmation. We cannot once again be found wanting with under-prepared health facilities.
Providing booster doses of J&J or Pfizer to all adults who received a single dose of J&J is required to help in increasing protection against severe COVID-19.
Research confirmed that a two-dose schedule of the Johnson & Johnson vaccine is better in protecting against hospitalization than a single dose. In order to get the durability of protection, you need booster shots.
There is enough evidence supporting the fact that the type of immune responses from a heterologous approach of AZ or JJ followed by an mRNA vaccine such as Pfizer/Biontech induces superior neutralizing and cell-mediated immune responses compared to two doses of the non-replicating vector vaccines.
The third step that governments should be considering is the implementation of vaccine passports for entry into any indoor space where people gather which should include places of worship and public transport.
Although vaccination is a choice at the moment, there is a price for the choice. Even if vaccines only lower transmission modestly, over and above the infections they prevent, a breakthrough case in a vaccinated individual poses less risk of transmission to others than infection in an unvaccinated and previously uninfected individual.
The fourth measure is to continue efforts to reach out to the unvaccinated and under-immunized. These efforts should comprise the use of pop-up facilities where people are likely to gather and other targeted community outreach programs.
Fifth, authorities should work on immediately boosting high-risk groups older than 65 and others who have immunosuppressive conditions. Therefore, the main goal of vaccination should be to reduce severe disease and death. This requires targeted strategies for prioritizing the various groups of the populace.
Sixth, promote responsible behavior to prevent re-imposing alcohol and other restrictions to penalize allowing to irresponsibility on part of a minority.
Seventh, authorities should devise a plan to monitor bed availability at the regional level to aid in deciding on regional action to avoid overwhelming facilities. A larger number of restrictions should be tailored for times when overwhelming health facilities are expected. As hospitalization typically lags behind community infection rates by 2-3 weeks, carefully monitoring case rates and hospitalization rates could help forecast which facilities in which regions may fall under threat.
This allows for a more focused approach in terms of imposing restrictions to relieve anticipated pressure on health facilities 2-3 weeks before expected. Granted it will not lower the total number of hospitalizations but it will spread it out over a longer period of time and make it more manageable.
The eighth step is to learn living with the virus and choose a more holistic approach to the direct and indirect effects of the pandemic on livelihoods. The damaging indirect economic, societal, educational, mental health and other health effects of a sledgehammer approach to dealing with the ongoing pandemic threatens to outstrip the direct effect of COVID-19.
Ninth, trust the science and refrain from distorting it for political expediency.
Tenth, learn from the mistakes made in the past and be bold in the future.
