WA Government mis-steps in regulating community response to omicron strain of SARS-CoV-2

The Tasman Medical Journal is politically neutral but government decisions in health based on misapplication of science and/or causing widespread community confusion justify comment as they must have health consequences.  In a previous (1) and supplementary blog we summarised information demonstrating from four studies that the Omicron strain of SARS-CoV-2 is resistant to currently available vaccines until the “booster” or 3^rd dose has been administered.  A further two studies confirm that conclusion (2,3).  Thus the description of double-vaccinated persons as “fully vaccinated” is wrong for the omicron strain, which is the strain currently feared most by the WA authorities.

In response to the perceived risk of the omicron strain and in order to reduce its impact on the state hospital system, the WA government has recently reversed its ‘binding’ policy of opening the state borders on 5 February 2022 and introduced further restrictive regulations that even the state Premier has admitted are inconsistent.  Examples are variation of self-isolation periods on an occupational basis and variation on the treatment of international arrivals depending on whether they arrive directly or via another State.

In addition, the government has embarked on a state-wide policy of non-admission to any venue according to vaccination status.  The policy has resulted in discrimination of a minority on health grounds that is questionable in principle as well as being clearly flawed scientifically.  This is because it is based on continuation of the concept of being “fully vaccinated” after 2 doses of vaccine, though this is demonstrably untrue for the Omicron variant.  As of 2 February 2022, 37.6% of the adult WA population had received a booster dose (4). If the totally unvaccinated minority is 5% of the population, we are therefore in the situation in which about 60% of the individuals being admitted to venues because they are ostensibly “fully vaccinated” are NOT immune to infection with the Omicron strain.  This situation stretches all credulity.

Another problem lies in the quarantine rules.  What is the justification for imposing any 14-day quarantine requirement on any person who arrives in a state with PCR evidence of non-infection with SARS and is triple vaccinated, whilst residents who may be carrying the feared strain are free to roam the streets without testing?  Why are persons in a protected occupation with known contact with a case permitted to self-isolate for only 7 days?

The COVID pandemic has demonstrated that restrictive rules designed to slow down viral spread by isolating individuals in a personal bubble lead to severe mental health problems and profound economic consequences while at the same time (as shown in the eastern states) fail to halt the spread of the omicron strain.  We respectfully propose that the WA government should relax the state’s borders by abolishing quarantine for triple vaccinated entrants who are PCR-negative, and (as previously suggested) redefine “fully vaccinated” to mean having been vaccinated thrice. We recognise that the latter suggestion would render the “proof of vaccination” pass system unworkable, but as we previously suggested, inaccurate nomenclature of full vaccination is likely to increase community spread of Omicron.

(Added 8 February 2022)

Since posting the above I have realised that the Journal’s responsibility does not stop at revealing scientific truths truth.  Rather, it has an obligation to avoid the potential criticism of creating mischief by not proffering advice to the authorities, and to describe current options. I note the reduction from 14 to 7 days quarantine for important groups announced on 6 February 2022, since this article was originally posted.

To summarise, the problems created by mandatory vaccination declarations in the face of an Omicron strain outbreak are

1. The policy takes an implicit binary view of COVID immunity, infectivity and spread – vaccinated, no disease present and zero chance of infection spread; unvaccinated, danger to self and the public.  This binary classification is misleading.  It does not take account of variation in individual immune responses to vaccination or that individuals with a strong immune response can infect or be infected.
2. The policy does not take account of the effect of vaccination on immunity against Omicron, namely that persons with only two doses of vaccine are not immune, whereas those who have had a booster have reasonable immunity (see above).  Instead, the policy wrongly confers the immunity of the second group onto members of the first, with the result that about 60% of persons currently entering venues in WA are counted as immune, protected and protective when they are not.  This percentage will gradually fall over several months as the “boosted” proportion of the population slowly increases, but for the time being the likely result is that community spread of the Omicron strain will be encouraged rather than prevented. In a new study, it has been shown that a booster dose increases cell-mediated immunity that is persistent (5) as well as antibody-based immunity. 
3. The policy is socially divisive as it removes rights of assembly from the unvaccinated minority, on the basis that it confers protection for the majority.  This is an unprecedented step for a democratic government to take.  The quantitative effect of excluding the unvaccinated on spread of Omicron is uncertain, but under current conditions it is unlikely to be substantial as 60% of the allegedly ‘fully vaccinated’ but actually non-immune majority will already have that same effect, whatever it is.
4. The policy creates an obligation on all businesses, clubs, hospitals, entertainment venues and shops to demand evidence of the health details of individuals, under threat of prosecution and enormous disproportionate fines if proven guilty.  This is also an unprecedented step.
5. The steps currently in place are not preventing a steady increase in COVID cases in WA.  Whether they are slowing the trend in case rates is presumed but uncertain.

The options facing the WA administration are:

1. Retain the current policy.  We do not support this option (though it appears the most likely) because it is unscientific and likely to be promoting rather than preventing community spread of SARS-CoV-2, as the majority of the community is in effect unvaccinated against the prevailing strain. It produces a feeling of immunity from disease that is illusory, and fails to educate the community of the facts.
2. To obtain consistency with facts (and without changing the underlying assumptions implicit in the policy), limit social access to those who are triple vaccinated.  Such a response would leave only 40% of the adult population eligible to mix in the community, and hence is likely to cause severe social disruption. This option is also unsupported.
3. Abandon the policy.  This option resolves all the problems listed above in a single step, but may modestly increase community spread of the Omicron variant. We recognise the delicacy of the balance and suggest that the epidemiological modelling available to the government be directed at this option on an urgent basis.

Alasdair Millar PhD FRACP FRCP
Editor, Tasman Medical Journal

References
1. Tasman Medical Journal.  Omicron strain demands new terminology to describe vaccination status against SARS-CoV-2 infection https://tasmanmedicaljournal.com/2022/01/omicron-strain-demands-new-terminology-to-describe-vaccination-status-against-sars-cov-2-infection/.
2. Accorsi EK, Britton A, Fleming-Dutra KE et al.  Association between 3 doses of mRNA COVID-19 vaccine and symptomatic infection caused by the SARS-CoV-2 omicron and delta Variants.  J Am Med Assoc Jan 21 2022.  doi:10.1001/jama.2022.0470.
3. Pajon R, Doria-Rose NA, Shen X et al.  SARS-CoV-2 omicron variant neutralization after mRNA-1273 booster vaccination.  New Eng J Med. 26 January 2022. DOI:10.1056/NEJMc2119912
4. WA Government. https://www.mediastatements.wa.gov.au/Pages/McGowan/2022/02/Third-dose-vaccination-blitz-to-keep-Western-Australians-safe.aspx
5. GeurtsvanKessel CH, Geers D, Schmitz KS et al. Divergent SARS CoV-2 Omicron-reactive T- and B cell responses in COVID-19 vaccine recipients. Sci Immunol 10.1126/sciimmunol.abo2202 (2022).