By Adam Hamdy
Governments have reacted with uncharacteristic swiftness in response to the emergence of a new SARS-CoV-2 variant designated Omicron by the World Health Organization.
I’ve been writing about Covid-19 since February 2020 and have collaborated with scientists around the world on initiatives and papers published in numerous peer-reviewed journals.
For almost two years, some scientists and commentators (myself included) have argued that a vaccine only approach will not provide a long-term solution to the Covid-19 pandemic. Countries that have tried a vaccine only approach to managing the pandemic are seeing rising cases, more incidence of Long Covid, and increased all-cause mortality. Vaccines are a powerful tool, but waning immunity and viral mutation mean vaccine effectiveness will be under constant pressure. Countries that have implemented a multi-layered strategy are coping better with the public health and economic challenges of the pandemic.
‘With a high reliance on tourism, Mauritius can ill afford the disruption of quarantine. Balancing economic needs against public health is extremely important, and there is an argument that if visitors are encouraged to wear N95 masks at all times, the risk of onward transmission would be very low even if they were infected…’
In order to help better understand what Omicron means for the world, and Mauritius in particular, I asked my longtime collaborator Dr Deepti Gurdasani for her views. Dr Gurdasani is a trained physician who specialized in infectious diseases and later went on to become a clinical epidemiologist and public health researcher at Queen Mary University in London. She is an internationally recognized authority on Covid-19.
“The rapid growth of Omicron, where it has reached dominance within the Guateng region in two weeks, accompanied by a surge in transmission, and an increase in R is very concerning and suggests the variant currently has a substantial growth advantage,” says Dr Gurdasani about the speed and strength of global response to the emergence of the variant. “We don’t know the reasons for this yet, but early action is vitally important. Every single variant of concern has the chance to change the course of the entire pandemic, as we’ve seen with Delta, and can make control much harder, even in elimination zones. Time will tell what Omicron brings, but the potential threat is of grave concern.”
Dr Gurdasani and I co-authored a paper with research immunologist Dr Anthony Leonardi and virologist Dr Marc Desforges on the long-term risks of Covid-19, and we highlighted the vast mutational landscape available to SARS-CoV-2. At a time when some researchers were saying Delta was the fittest variant the virus had to offer, we cautioned it was only beginning its journey in humans. We should expect further evolution, and as part of that process, we should prepare for the virus to become more transmissible, develop greater immune escape, and increased ability to cause other long-term public health problems. We might get lucky and see the emergence of a milder variant, but we should not plan for such an eventuality.
When it comes to how to respond and balance public health measures against economic needs, Dr Gurdasani says, “I think Mauritius and other countries should look at long-term economic end points, rather than short-term, and it’s very clear that protecting the economy is intricately linked to protection of public health and controlling the pandemic. Strong, multi-layered mitigations; high grade masks, ventilation, vaccination, boosting, and test, trace and supporting isolation have to be central, alongside border quarantines to contain the import of emerging new variants.”
There is extensive scientific evidence that SARS-CoV-2 is an airborne virus, and the United States Centers for Disease Control and Prevention, Japan and South Korea all recognize that airborne is the primary mode of transmission. This might sound scary but once you acknowledge and understand airborne transmission, it is possible to control it, as Japan and South Korea have done using their multi-layered strategies.
Mauritius has a tremendous advantage when it comes to airborne precautions. Not only does the climate encourage an outdoors lifestyle, but many buildings here are naturally well ventilated. Regular air changes and the circulation of fresh air has been shown to be one of the most important measures to reduce the risk of transmission of SARS-CoV-2.
Where it isn’t possible to ventilate premises, organisations should install HEPA filters, which have been proven to reduce viral transmission in a wide variety of settings, including schools and hospitals. These filters need not be costly, and Corsi-Rosenthal Boxes can be built at home, school or in offices for a few dollars each and are extremely effective. Instructions on how to build these devices can be found on the Internet or YouTube, and they make a great school project. In America, schools and colleges that have installed these devices have seen a reduction in on-site transmission.
As Dr Gurdasani highlights, numerous scientific studies demonstrate the benefits of high-quality masks. KN95/N95/FFP2 masks protect the wearer and decrease transmission from infected people, so they have a dual benefit. They are the masks of choice in countries that have successfully controlled the Delta variant. In order to keep society open and avoid costly lockdowns, governments need to move beyond general mask mandates and educate the general public on the importance of high quality, protective masks.
If Mauritius implements a national KN95/N95 mask mandate, exploits its natural advantages when it comes to ventilation, and installs filtration in places that cannot be easily ventilated, it should be able to greatly reduce transmission of Omicron and any other variants that emerge.
With a high reliance on tourism, Mauritius can ill afford the disruption of quarantine. Balancing economic needs against public health is extremely important, and there is an argument that if visitors are encouraged to wear N95 masks at all times, the risk of onward transmission would be very low even if they were infected. Education and enforcement would be critical to ensure visitors took their obligations seriously and understood that the privilege of visiting a beautiful ocean state comes with a responsibility to help protect the local community.
When visitors are dining out, restaurant and bar staff would be protected by wearing properly fitted N95 or above masks themselves. The same logic would apply to schools; a universal N95 mask mandate should make it possible for in person schooling to resume safely given the protective qualities of such masks and the natural ventilation advantages schools have in Mauritius.
“It’s hard to know that the impact of Omicron will be,” Dr Gurdasani says, “but we’ve seen new variants spread rapidly across the globe, leading to huge surges of infection and an increase in long-term ill health and mortality. This will likely continue as the virus continues to evolve, and new variants emerge. The only way to address this, in my view, is a coordinated strong global effort at progressive elimination. This means global equity in vaccines, with tech transfer agreements, domestic manufacturing, and use of non-pharmaceutical interventions in parallel to suppress the virus. As long as transmission continues, the virus will have new opportunities to evolve and we will always be reacting to this rather than proactively taking the initiative.”
Dr Gurdasani, who spent the early part of her career as a medic in India before moving to the UK, continues: “Low- and middle-income countries in many ways are well-suited to the management of pandemics, given their experience with infectious disease containment. Now is the time to really put this to good use through strong public messaging on airborne measures – high grade masks and ventilation — as well as engagement to address vaccine hesitance, and rigorous infection surveillance. Decentralised and community-based efforts will be key to this.”
Countries such as Mauritius should take a long-term view and expect the pandemic to continue for some time. There are opportunities for countries that maintain low infection rates to establish green travel corridors with other low/no infection zones to promote safe tourism. There are also opportunities to encourage long-term migration of high-net-worth individuals and remote workers who are seeking more freedom as a result of low infection rates and who will contribute to the local economy. The Mauritian Premium Visa is a great example of such innovative thinking, but if the pandemic continues, the process of obtaining long-term residency should be made easier for the categories of individuals the government would like to encourage.
In the short-term, if Mauritius wants a quick win that doesn’t move too far from existing policies, making KN95/N95 masks freely available for everyone would be a step in the right direction, alongside a public information campaign educating people why the use of such high-grade masks is so important.
Adam Hamdy is an author and was formerly a strategy consultant to the medical industry with expertise in pandemic response. He has been writing about the pandemic since February 2020 and has collaborated with scientists around the world on a number of public health initiatives and has co-authored peer-reviewed papers on Covid-19 in the Lancet and other scientific journals.
Dr Deepti Gurdasani trained and practised as a physician before becoming a clinical epidemiologist. She is senior lecturer in machine learning at Queen Mary University of London. She has numerous publications on Covid-19 and the pandemic in a variety of peer-reviewed journals and is considered a UK authority on the subject by scientific groups and media outlets around the world.
* Published in print edition on 30 November 2021
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