Don't Isolate, Don't Test!
Jersey Hospitality Association Head Simon Soar has been suggesting only testing symptomatic cases of Covid.
He said: “We’re facing risks left, right and centre at the moment. We surveyed [around 100 JHA members] at the end of last week to find out the state of play. Out of those surveyed, over 50% had staff off currently because of covid. 81% of those with staff off had had to reduce their offering – whether service times or menus. Furthermore, 7% are closed – they simply don’t have the staff to operate and that could get worse.”
And he added that the key issue was that “most fed back that the staff off are asymptomatic or have such mild symptoms that, had this been another time, it would not have been an issue.”
He previously suggested direct contacts should only be tested if symptomatic.
Bailiwick Express noted that: "Mr Soar further emphasised that the difficulties caused by asymptomatic individuals being forced to quarantine were being felt outside of hospitality"
So we are being presented with two options here.
Direct Contacts
Firstly, he previously suggested direct contacts should only be tested if symptomatic.
Firstly, he previously suggested direct contacts should only be tested if symptomatic.
Current guidance says:
"If you are notified that you are a direct contact of a positive case, you are not required to isolate unless you have symptoms, but you must think very carefully about the activities you undertake and the places you visit for the next 10 days, even if you receive a negative test result."
"If you are notified that you are a direct contact of a positive case, you are not required to isolate unless you have symptoms, but you must think very carefully about the activities you undertake and the places you visit for the next 10 days, even if you receive a negative test result."
This is because otherwise the numbers in isolation would now be impossible to manage. There are
13,845 direct contacts of active cases, and it takes time to test them. It is simply not possible to test fast enough - the system is finite and the numbers keep increasing.
13,845 direct contacts of active cases, and it takes time to test them. It is simply not possible to test fast enough - the system is finite and the numbers keep increasing.
But contrary to what the "feedback" suggests, the statistics show that the ratio of symptomatic to asymptomatic is about 2/3rds to 1/3rd. In other words, most cases of Covid are symptomatic - or equally may be pre-symptomatic, not showing systems at first but showing symptoms later.
It is at least possible that the high numbers of symptomatic cases come in part, at least, from pre-symptomatic cases which were initially showing no symptoms, but do by the time track and trace catch up with testing them.
As one person observed: "I don’t think I would like to stay in a hotel or eat in a restaurant if I thought that some of the staff possibly had Covid, therefore possibly passing it on to me and my family."
So Mr Soar could tell members that staff can return, but it would seem to run counter to government advice, and clearly what he wants is for the government to legitimise that position, so that they become responsible for the spread of Covid as a result, and not his members.
I can appreciate his desperation, but there is a very good reason for testing to find asymptomatic cases.
Asymptomatic Transmission: The Science.
Studies show that roughtly 30% of individuals with infection never develop symptoms - which is in line with Jersey figures. These are 75% as infectious as those who do develop symptoms. This implies that persons with infection who never develop symptoms may account for approximately 24% of all transmission.
This reduces with vaccinated individuals. The latest studies suggest that vaccination usingeither the Pfizer or AstraZeneca vaccine reduced the chance of onward virus transmission by 40-60%. This means that if someone became infected after being vaccinated, they were only around half as likely to pass their infection on to others compared to infected people who weren’t vaccinated.
How to get population vaccine herd immunity
A study of cruise liners is instructive. This is one case, but another also seems to follow the same pattern. The Celebrity Cruises' Celebrity Millennium ship was carrying "fully vaccinated crew and guests". Children aged below 16 were not required to be vaccinated.
There were more than 1,200 people on board the ship ( 600 passengers and 700 crew). There were fewer than 10 children on board and said no other vaccine exemptions had been granted.
Two passengers tested postive. The tests came back positive during end-of-cruise testing, which is completed 72 hours before passengers return to the U.S. The individuals were asymptomatic . Close contacts tested negative
Protocols for contact tracing were thorough. Through interviews and reviewing onboard security camera footage, Celebrity identified other passengers and crew that had been in contact with the infected pair, including the other 19 people that had taken an excursion with them. No additional cases were detected and the cruise finished on schedule.
In fact, out of the more than 100,000 guests on over 150 cruises that the company had carried during the pandemic, only 10 people tested positive for the Covid-19 virus.
The case of cruise liners shows that in a population of nearly 100% coverage by vaccination, the spread is exceedingly small. Unfortunately, while the headline is "Two thirds of adult Islanders fully vaccinated", that's 60,036 individuals, out of an estimated population of 110,000 to 120,000.
Studies show that roughtly 30% of individuals with infection never develop symptoms - which is in line with Jersey figures. These are 75% as infectious as those who do develop symptoms. This implies that persons with infection who never develop symptoms may account for approximately 24% of all transmission.
This reduces with vaccinated individuals. The latest studies suggest that vaccination usingeither the Pfizer or AstraZeneca vaccine reduced the chance of onward virus transmission by 40-60%. This means that if someone became infected after being vaccinated, they were only around half as likely to pass their infection on to others compared to infected people who weren’t vaccinated.
How to get population vaccine herd immunity
A study of cruise liners is instructive. This is one case, but another also seems to follow the same pattern. The Celebrity Cruises' Celebrity Millennium ship was carrying "fully vaccinated crew and guests". Children aged below 16 were not required to be vaccinated.
There were more than 1,200 people on board the ship ( 600 passengers and 700 crew). There were fewer than 10 children on board and said no other vaccine exemptions had been granted.
Two passengers tested postive. The tests came back positive during end-of-cruise testing, which is completed 72 hours before passengers return to the U.S. The individuals were asymptomatic . Close contacts tested negative
Protocols for contact tracing were thorough. Through interviews and reviewing onboard security camera footage, Celebrity identified other passengers and crew that had been in contact with the infected pair, including the other 19 people that had taken an excursion with them. No additional cases were detected and the cruise finished on schedule.
In fact, out of the more than 100,000 guests on over 150 cruises that the company had carried during the pandemic, only 10 people tested positive for the Covid-19 virus.
Jersey Vaccination Status: Still Cause for Concern
Missing out the school age children and below is missing one major vector of transmission within the community. Nevertheless, if we can get to nearly 100%, especially for the 18 to 29 year old age range - and then also perhaps look at vaccinating those of 16 and over, we should be in a good place.
Working with Mild Covid
Mr Soar's second suggestion seems to be that mild or asymptomatic cases should go back to the workplace because it is either asymptomatic or mild. This is his idea of "living with Covid".
Even for mild cases, COVID-19 can take a toll. The CDC reports that normal symptoms include fever, chills, shortness of breath, nausea, headache, vomiting, and loss of taste or smell. And those are the symptoms that don’t require immediate medical attention. While a cold or flu will likely last a few weeks at most, some people who have mild COVID-19 end up having symptoms for months.
A study out in January found that many people with lingering COVID-19 symptoms, sometimes called “long-haul” COVID-19, originally had seemingly mild infections.
“Even if people are feeling fairly well, they’re highly contagious, and that’s the real danger,” said Dr. Robert Murphy, a Northwestern University infectious disease specialist and global health expert.
The Shadow of Long Covid
Sam Fazelli notes that recent research from the U.K. on the health effects of Covid-19 found that even mild cases could cause significant changes to the brain, and the "brain fog" reported may well be related to a reduction in the functioning of the brain.
I had been wondering when we will get over our obsession with case counts and focus more on hospitalizations and deaths, given that vaccines are very effective in reducing the latter as compared with mild infections, especially with the rise in variants. But if even mild cases cause issues that store up real morbidity for the future, then we should continue to be obsessed with crushing even mild cases of Covid.
Some of the issues reported with long Covid are directly related to the pathology of Covid-19 disease. These include shortness of breath as a result of lung damage, chest tightness, joint pain, etc. But the “brain fog” that is one of the key issues reported by those suffering long-term consequences after a case of Covid could be related to exactly what this new research has found.
In conclusion: Living with Covid and Vaccination Status
There are no easy answers to the issues faced by hospitality. As numbers of cases increase, more people will be less likely to eat out. One person wrote:
"It’s not just the absence of staff that may be affecting the hospitality industry - I was attending a dinner for six at a local restaurant on Friday we cancelled because of infection rates and I am aware in my immediate circular another booking of four for the same reason. The numbers will deter people not just because a particular establishment is closed."
Working with Mild Covid
Mr Soar's second suggestion seems to be that mild or asymptomatic cases should go back to the workplace because it is either asymptomatic or mild. This is his idea of "living with Covid".
Even for mild cases, COVID-19 can take a toll. The CDC reports that normal symptoms include fever, chills, shortness of breath, nausea, headache, vomiting, and loss of taste or smell. And those are the symptoms that don’t require immediate medical attention. While a cold or flu will likely last a few weeks at most, some people who have mild COVID-19 end up having symptoms for months.
A study out in January found that many people with lingering COVID-19 symptoms, sometimes called “long-haul” COVID-19, originally had seemingly mild infections.
“Even if people are feeling fairly well, they’re highly contagious, and that’s the real danger,” said Dr. Robert Murphy, a Northwestern University infectious disease specialist and global health expert.
The Shadow of Long Covid
Sam Fazelli notes that recent research from the U.K. on the health effects of Covid-19 found that even mild cases could cause significant changes to the brain, and the "brain fog" reported may well be related to a reduction in the functioning of the brain.
I had been wondering when we will get over our obsession with case counts and focus more on hospitalizations and deaths, given that vaccines are very effective in reducing the latter as compared with mild infections, especially with the rise in variants. But if even mild cases cause issues that store up real morbidity for the future, then we should continue to be obsessed with crushing even mild cases of Covid.
Some of the issues reported with long Covid are directly related to the pathology of Covid-19 disease. These include shortness of breath as a result of lung damage, chest tightness, joint pain, etc. But the “brain fog” that is one of the key issues reported by those suffering long-term consequences after a case of Covid could be related to exactly what this new research has found.
In conclusion: Living with Covid and Vaccination Status
"It’s not just the absence of staff that may be affecting the hospitality industry - I was attending a dinner for six at a local restaurant on Friday we cancelled because of infection rates and I am aware in my immediate circular another booking of four for the same reason. The numbers will deter people not just because a particular establishment is closed."
Perhaps an alternative solution would be to borrow the protocols by the US Cruise ships, and begin to only allow people in who have been double vaccinated, and get staff double vaccinated as soon as possible, making that an incentive because of reduced isolation. There is no reason why business cannot adopt whatever keeps staff and customers safest.
It would be interesting if Mr Soar got his members to conduct a survey of which of their staff have even just booked a vaccine. If take-up is poor among staff, that in itself is a hidden part of the problem.
In fact "Brunos" in town, even before mask wearing became legal, made it a necessity to enter the shop.
Having different policies in place for vaccinated and non-vaccinated staff, and restricting entry would actually make restaurants and hotels much safer. The downside is the loss of custom from the 18 to 39 year old age range, the upside would be the ability to keep the business open. But as we see from cruise liners, it works.
Boris Johnson's plan for nightclubs to be restricted to those double vaccinated by the end of September is both an incentive for people to get vaccinated, and a protective measure.
France is taking similar measures for restaurants, as is Ireland and Singapore. In Denmark, restaurants and public events require a digital pass showing you have been fully vaccinated or have a recent negative test.
Obviously there need to be measures to allow exceptions on medical grounds, but this is the "new normal", and this is what "living with Covid" is really going to look like.
Obviously there need to be measures to allow exceptions on medical grounds, but this is the "new normal", and this is what "living with Covid" is really going to look like.
Double Vaccinated Restrictions Worldwide - A Few Links
https://gulfbusiness.com/only-vaccinated-individuals-now-allowed-to-enter-malls-restaurants-gyms-and-salons-in-kuwait/
References:
https://www.healthline.com/health-news/what-its-like-to-survive-covid-19#Symptoms-during-mild-COVID-19-can-still-be-serious
https://theprint.in/opinion/even-mild-covid-can-cause-significant-brain-changes-research-shows/684214/?fbclid=IwAR0JE1KfJpr5pn3dUaGQWZvxCNEE6RV1c3WdI8l_vAADBEUQ6f7hYdg66Kk
References:
https://www.healthline.com/health-news/what-its-like-to-survive-covid-19#Symptoms-during-mild-COVID-19-can-still-be-serious
https://theprint.in/opinion/even-mild-covid-can-cause-significant-brain-changes-research-shows/684214/?fbclid=IwAR0JE1KfJpr5pn3dUaGQWZvxCNEE6RV1c3WdI8l_vAADBEUQ6f7hYdg66Kk
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