‘Vaccines are not the only answer’: experts call for more public health measures to curb Omicron
Epidemiologist Prof. Mary-Louise McLaws has spent the past week dialling in to meetings of the World Health Organization’s [WHO] infection prevention and control group, and said: “I don’t know of any outbreak manager who would not support wearing masks at the very minimum” in cities where Covid-19 cases are rising.
“WHO keeps reminding the world that vaccines are not the only answer because this virus keeps changing,” McLaws said. “Vaccines certainly reduce the risk of death and severe infection. But you do need other measures, like physical distancing, and masks.”
The New South Wales premier, Dominic Perrottet, continued to resist additional measures to mitigate the spread of Omicron on Monday, saying; “The pandemic is not going away. We need to learn to live alongside it,” while ruling out mask mandates and further restrictions for now. “The government can’t do everything,” he said. Like Perrottet, the prime minister, Scott Morrison, said booster vaccines are key to living with the virus, a view echoed by Dr Nick Coatsworth, one of Australia’s deputy chief medical officers, on Twitter.
But most eminent virology, infectious diseases and epidemiology experts agree that it is clear public health measures beyond vaccines are needed, especially as Omicron spreads rapidly. There is some disagreement, however, as to whether governments should mandate those additional measures, and which measures would be most useful to mandate.
In a joint comment piece, experts from Australia’s leading infectious diseases research institutions including John Kaldor, a professor of epidemiology with the Kirby Institute in NSW, the director of the Doherty Institute, Prof Sharon Lewin, and Prof Greg Dore, an infectious diseases physician and epidemiologist all agreed that while booster vaccinations will be critical, some restrictions are needed.
They called for the return of indoor mask mandates in NSW (Victoria already requires masks for indoor retail), and for density limits to be reintroduced for indoor venues over Christmas. These measures should remain for at least a few weeks, they wrote, until more information on Omicron’s severity and its ability to evade vaccines is gathered.
Kaldor said throughout the pandemic to date, he has broadly supported public health measures implemented by the NSW government.
“This is the first time that I feel that there’s a divergence between my perception of what is needed to manage public health and clinical resources in the coming few weeks, and what seems to be actually happening.
“That divergence is because we’ve got this new variant, and there are potential knowledge gaps around that. We understand people want to wait until we have more data about Omicron. But we can put up some barriers now to make sure that we don’t lose the game while we’re waiting.”
“Mandating things is not just about saying; ‘You’ll get a fine if you don’t do it’. It’s about saying, ‘We as a government have listened to the experts and have come to the conclusion that we need to do this together’,” he said.
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McLaws agreed, saying; “There should be a partnership between the public and government to prevent the pandemic from continuing”.
“And by asking people to make up their own mind about what they do, they could be making up their own mind from a non-scientific perspective.”
Prof Peter Collignon, an infectious diseases physician and microbiologist said it would be more useful for governments to mandate density limits rather than masks. It could be worthwhile to implement limits in crowded indoor venues given how much close con
tact drives spread, otherwise restrictions may be implemented and then revoked periodically for months, especially if further variants emerge.
“My own view is that until we get really on top of this, which may be another year or two, we should just implement density limits, and those should probably still be in place until the end of our next winter.”
Chair of epidemiology at Deakin University, Prof Catherine Bennett, said she believes people need to wear masks indoors. But she is less certain as to whether mandating this will be effective. “We need people to be wearing masks, but if compliance is already high without mandates, and masks are already strongly recommended, I am not sure there is enough evidence that a mandate will make a difference,” she said. “I do know here in Melbourne, not everyone is wearing a mask even with a mandate. Maybe we need to look at the overarching public health messaging, if mandates aren’t always working anyway.”
Bennett also believes QR code check-in should be kept up in stores and other venues in NSW, even if they are not being used by contact tracers, because they act as a reminder to people about where they have been.
“People may not have to use them because the health department is no longer following up casual contacts unless it’s an extreme situation, in which case they use other means of contact tracing,” Bennett said.
On Twitter the president of the Australian Medical Association [AMA], Dr Omar Khorshid, said ‘Even IF Omicron turns out to be mild in vaccinated people, an explosion of cases will have a devastating effect on healthcare”. This includes GPs looking after community cases, furloughing of exposed workers, and an unknown proportion of cases who will need to be treated in hospital, Khorshid wrote.
Coatsworth responded to Khorshid by saying; “This adopts the ‘a small percentage of a huge number is still a big number’ fallacy that has swept through #covid19aus and #auspol since #omicron emerged”.
“Adapt the policies,” he wrote. “Don’t furlough as many staff as we did prevaccine.” He said masks should only be mandated if hospital cases rise, and that booster vaccines will be key. “Recognise that control measures are less effective for Omicron, it’s now about bolstering the health system.”
Kaldor said he agreed with Coatsworth that boosters are critical, but that “we don’t know what the small percentage of that big number is at this stage”.
“If this variant evades vaccines and even if it has slightly reduced effectiveness at preventing severe disease, and the overall case numbers are high, then that does potentially translate into a very big strain on our health systems”.