'Respirators' needed to deal with new variant
The government must prevent the Omicron wave from wreaking havoc with healthcare and the economy by immediately revising Covid measures.
What it needs to do is: acknowledge the evidence that shows neither vaccine boosters, infection-induced immunity, nor currently-recommended surgical masks, offer realistic protection against the Omicron strain; declare that Covid is predominantly an airborne disease that can be effectively suppressed by universal use of N95-type respirators, and recognise that preventing all further infection is critically necessary.
Any infection, despite so-called "mild" symptoms, carries a high risk of long-term disability and illness for all people, especially small children.
The government must empower people to protect themselves by mandating respirator use in public and providing free consumer-grade respirators to everyone, which will cost a tiny fraction of the enormous public health and economic bills we are guaranteed to pay otherwise.
That is because the public cannot depend on vaccination or herd immunity.
This month, Pfizer-BioNTech and Moderna acknowledged that Omicron, the new variant, escapes their existing vaccines almost completely. A third dose briefly provides neutralisation against Omicron, similar to that of the two doses against past variants, before rapidly dropping to 25% within three months. The companies are developing Omicron-based boosters, and expect to deliver them in March.
We have known all along that an adaptive immune response to human coronaviruses is brief, and repeat reinfections are normal.
Omicron can effectively escape previous immunity, from either past vaccines or previous infections. Furthermore, Omicron spike mutations, particularly at the N-terminal domain, aka the NTD region, mean future vaccines are likely to be categorically less effective than the 2020 vaccines.
Given the present situation, any discussion about which vaccines are better is moot.
Meanwhile, as long as people are being infected (and re-infected), the virus will continue to mutate. We are only a few mutations away from infections becoming chronic; should further mutation allow viral binding affinity to outpace our antibodies, we would have an airborne equivalent of HIV.
The claims over the past month that Omicron patients are facing "milder" symptoms are also untrue. Omicron causes exponentially more infections and re-infections than Delta, so any benefits from a slightly lower relative rate of hospitalisation that some are claiming are, in reality, erased in less than one day by the greater total number of hospitalisations, especially of small children.
Before Omicron, we had already seen patients categorised as having "mild" and "asymptomatic" infections suffering from immune damage, along with persistent neurological symptoms. In many cases, these chronic symptoms continue to devastate survivors' abilities to work or even care for themselves. We may soon see Omicron cause more Long Covid than all previous variants combined, unless we try something new to stop it.
Only heavy suppression with a path towards elimination will work.
Suppression of community transmissions is simple. We propose that the public be provided with the correct type of masks -- called respirators -- that can filter aerosols and prevent airborne infection. They must use them in public and at workplaces without fail.
Recent biophysics research from the Max Planck Institute in Germany shows respirator use provides remarkably high protection against infections, even when used poorly in real-world conditions, implying that a universal deployment will prevent virtually all infections happening today and end all super-spreader events.
While reusable respirators have been used in industrial and healthcare settings for decades, disposable respirators made of non-woven meltblown fabric are commonly available and known by country-specific industry standards such as KN95, KF94 or FFP2.
Thailand now has domestic production capacity for consumer-grade disposables that are cheap and easy to produce and supply to the entire population. The cost of this more efficient mask could be cheaper than the Covid vaccines medical scientists invented, and the price is much less -- about 3 baht per person per week.
Before even considering a vaccine mandate, the government must distribute free respirators to all households, make them freely available in all shops and public places, and impose a strict respirator -- not mask -- mandate.
Wearing cloth or surgical masks not fitted tightly offers insufficient protection and false comfort. For real protection against airborne transmissions, only respirators will work. The government also needs to launch a large-scale communication campaign to educate the public about the real way Covid spreads -- through inhaling air that infected people exhale -- and repeat public education until every man, woman and child in Thailand knows why they must wear a respirator and what situations call for it.
People must know when to remove or not remove their respirators in high-risk situations or make exceptions of convenience, such as lunch with co-workers. Group dining is obviously out of the question until we have suppressed the pandemic.
To get the total case number down to zero without relying on lockdowns, which require massive economic support, we need to try an affordable yet effective intervention. Respirators indeed have been used by healthcare workers. It is absurdly that it has never been made freely available to the public.
We cannot blindly continue to allow the population to be infected with a virus that causes a lifelong immune and neurodegenerative disease.
With universal respirator use by a well-informed population, we can rapidly suppress and eliminate the virus, likely in less than one month from a full roll-out.
Using the same strategy, we can then prevent future imported cases from turning into community clusters without closing borders, until the rest of the world gets it together to do the same.
For the sake of Thailand, we must do this now.
ML Rangsithorn Bhanubandh is a spokesman for Zero Covid Thailand -- an information resource that promotes accurate science-based communication to eliminate Covid-19 in Thailand.