(20d) How to slowdown and stop the spread of a virus?

How to halt a virus? Schools as an example

In America, President Biden asks that teachers are vaccinated because they are considered a priority and many States do; indeed, their vaccination is essential to be able to keep schools open. 

Not so in Belgium and I think in the EU because decision-makers have chosen to vaccinate first immobile people, i.e. elderly people in care homes because they are vulnerable, I accept they are. Still, although they can become ill and have a big chance to die, as they don't leave the home, they don't spread the virus. And thus, when people who don't leave the house are vaccinated first, it is as if no-one is vaccinated in society.

And thus, while the Flemish Minister of education advocated in favour of urgent vaccination of teachers, teachers were told they will not receive priority vaccination, even when schools are told they should remain open as that is important for children's development, something we all accept. And thus the Minister of education suggests his department should be able to vaccinate its own employees. Yes, federalism can have its advantages when politicians want to do it differently within a larger context, i.e. people needs to be vaccinated but the order how this is done may differ between states whereby the outcome may show what is preferable, or maybe both ways are good. Thus, a framework is needed in which smaller entities can act according their situations. This is as in the USA where certain states decided to prioritise the vaccination of teachers while other states focus on other groups of groups; I can understand that in states with a large number of big manufacturers where social distance is difficult, these employees are prioritised. Of course, also after the healthcare professionals and those who sell food in supermarkets.

Indeed, schools have hundreds if not over a thousand students plus teachers, all packed in a small place: the school, and thus the perfect place for the virus to spread when someone is a carrier. Fortunately, children don't become very ill (yet?) and I don't know the data on how easily children infect others.

In contrast, teachers are more vulnerable, certainly the older ones. Thus, it is almost as if some decision-makers say: teachers should be prepared to sacrifice their lives while schools are told to do the unimaginable to keep human contact to a minimum so schools can remain open. 

Still, even when teachers are vaccinated, it will remain important to prevent that children spread the virus to adults and thus measures are important to follow. But, vaccinate teachers and at least they are protected so schools are less likely to close because a teacher has COVID-19 and thus the school closes for the safety of all teachers and children. I do accept, tests are useful to minimise that someone with COVID-19 enters the school. Yes, vaccination and testing in tandem to find those with the virus and send them home whereby children in one bubble can't spread the virus to other bubbles from which they are separated while teachers move between bubbles as they teach in different classes and thus they are able to carry the virus around, unless they are vaccinated when their viral load remains lower.

Although COVID-19 tests will help, in small closed places with hundreds of people such as schools, teachers should be vaccinated priority to prevent them catching and spreading the virus so certain people may become very ill. Because, I repeat, people who move around and certainly meet many people need priority vaccination to reduce the risk they catch the virus and may become serially ill and even die but also to prevent they spread large amounts of virus as vaccination means the body can fight off the infection from the start and thus reduce it can multiply to a high viral load. 

Vaccinate the people in essential jobs to protect society

General principle: mobile people, and certainly those in essential jobs whereby they meet many people, should be vaccinated first or expect lockdown after lockdown and people who start to resist

The problem now is that people who move around are insufficiently fast vaccinated and instead are told to stay apart and wear a mask. We notice this is no longer possible, and certainly not another one, two years before everyone receive their vaccine, certainly when no longer only the EU faces delivery problems but also the UK - and this was to be expected during this huge task to vaccinate the whole world. 

Thus, closer contact without masks can be expected, partly because most people don't know many deaths (I think genetics of people are important: is it mainly related family members who suffer or is it at random? It seems even that people with genes from neanderthals are more protected (indeed, racists who inbreed die out eventually)) but also because people need to earn a living. And thus the virus can continue to spread. 

Examples are demonstrations by the "Viruswaanzin" group in Brussels (the same group that protested against the curfew in the Netherlands), in London and elsewhere but also 6 500 people in Marseille, France and about 500 in Brussels were celebrating unauthorised carnival. In all these events, many people didn't wear protective masks because they stick up a middle finger to those in power. And thus, while a year ago people clapped in their hands for healthcare professionals, this may turn into verbal and even physical aggression when certain people start to consider them as "doom speakers" who can't stop spoiling people's fun or bringing the economy to a halt. Yes, Belgian doctors and scientists are saying we need, again, serious action for the next few weeks to stop the increase in cases. People understand by now it will take weeks longer, just in spring while it would have been more acceptable during the winter months. 

SARS-CoV-2 - The coronavirus and its consequences

As the coronavirus came from animals (although a large number of people continue to believe it was engineered by China or with the involvement of Bill Gates), it was not yet fully adapted to humans and thus quiet nice although already caused devastation. However, as the UK, South African and Brazilian variants already demonstrated as they can spread more easily, the virus adapted, i.e. it likes us more. Not only faster, also more younger people are now admitted to hospital. Why? 

The nature of such an animal-born virus is that it has to improve itself, thus select itself to being better adapted to humans and thus it may become more dangerous but not necessarily as long as it can spread it is happy. But, with the variants of this virus that seem to be spreading faster, even when these viruses do not become more deadly, as they spread faster, more people may die as more people become ill at the same time so hospitals become overloaded. Still, even when we have more ill people, that doesn't mean more people will die as doctors know better how to treat people. At least, when there is no overcapacity or enough equipment remains available, including oxygen that is very needed by COVID-19 patients in addition to medicines. 

But, it is more than only COVID-19 patients; a young woman killed himself because the financial consequences became too big. In Japan, more people commit suicide than before. To be sarcastic, at least (great)grandparents will be able to go to the funerals as they are vaccinated. I fear to expect soon more of this kind of posts, maybe whole families when one parent is desperate that everything they build-up is gone except debts, certainly when governments stop the measures to help businesses. In contrast, other people may become angry. 

To remain in the economy, many people don't work as their company is closed, thus they don't pay taxes while the government has measures to pay them a compensation, resulting in decreased income and increased spending for governments but it helps struggling companies. Thus, we can expect that soon governments will have to safe money and (grand)children, of whom many don't work at the moment, may have to pay more to keep their (grand)parents in care homes. In addition, benefits may be lowered and subsidies cut down. Therefore, it is important that people can continue to work by being vaccinated so the economy doesn't face too much of a backlash. 

Prioritise easy-to-vaccinate groups who move around in society

I think that nurses and doctors and anyone, yes, also volunteers, who work in the healthcare sector should have been vaccinated first as they care for the ill and shouldn't become ill so they can continue to help the ill. Also those who sell food, and certainly in supermarkets where they meet many customers, are essential workers who meet many people and thus should be vaccinated as one of the first. This way, people who come in contact with important numbers of (potential) carriers of the virus are after their vaccination (1) protected and (2) less likely to have large viral load when they catch the virus as their body immediately starts to fight off this virus so a lower viral load means it is less likely they spread the virus to others, certainly when they use a mask. Indeed, vaccinated healthcare professionals feel safer as it is less likely they spread the virus to their family.

Also police and as discussed higher, teachers, come in contact with many people and thus are more likely to come in contact with (asymptomatic) carriers of the virus so they can become ill as many are older while if they are vaccinated, not only are they protected but probably they are also less likely to spread the virus, including to their family. 

I accept that elderly who live at home may receive the vaccine easier as they go out to buy food but also may look after the grandchildren when schools are closed and parents work from home. Still, even then I think those above 80 or even 70 shouldn't be priority as they are move likely to stay at home, certainly in winter and when bars and restaurants are closed and someone else can buy their food. Thus, I can also argue that (grand)children of elderly can be part of those who are vaccinated first so they can visit those who live in care homes and at home, although they should continue to keep distance, clean hands and face and use an unused mask.

Also younger vulnerable people such as those with heart, lung, kidney, ... problems who move around in society, should be vaccinated with priority, certainly when they have children. But, as statistics show that children are less likely to become ill (I'm not sure whether they spread the virus easily or not), the urgency to vaccinate them is less and thus they can wait. 

All these vaccinations of people who move around in society and meet many people would result in a society where increasing numbers of vaccinated people walk around and thus it is very less likely they but also the still not yet vaccinated people become seriously ill with COVID-19 because, the vaccinated will likely have a lower viral load as their body is prepared to fight off the virus; as a result of this lower viral load, the virus can't spread so easily. Less virus in society means fewer people catch COVID-19 and less chances the virus can mutate into a more dangerous variant. At the start of the vaccination, people still need to wear a mask as viral loads of non-vaccinated carriers can still be high. But, in societies where many people are vaccinated, fewer people become seriously ill. 

Figure shows the movement within society and between care homes for elderly and schools for children. What society can do to protect the elderly is to cut-off care homes so the interactions with society reduces to vaccinated healthcare professionals who continue their safety measures; this way elderly can meet within this closed community. In contrast, schools cannot be cut-off from society as children go home after school and may practice a hobby. Therefore, while children can remain within their own bubble, teachers come in contact with tens if not hundreds of people in schools whereby they may have to move from one class in one bubble to another class in another bubble. Thus, vaccinate them and they are protected while it is less likely they will spread the virus. In addition, they move around in society whereby they meet other people and thus are also less likely to catch the virus. 

The alternatives are: stop movements in society. Doctors don't need to take into account the wellbeing of people whose businesses go bankrupt. However, politicians must take into account everything to avoid a fourth lockdown as the third became unavoidable. Thus, prioritise the vaccination of people who move around in society will reduce the speed that the virus can move around. 

Of course, vaccinated people shouldn't bent over a seriously ill COVID-19 person as that person will cough out huge amounts of virus into the face of the other person, too large for the immune system to hold back; thus, healthcare professionals should continue to protect themselves but mainly when they treat seriously ill COVID-19 patients; in other cases a normal mask and regular hand washing may be sufficient to protect themselves and prevent the virus spreads around. 

Of course, the elderly should be protected (I don't argue to leave them on their own, the reason why I think it is important to first vaccinate healthcare professionals so services can continue) but, elderly don't spread around the virus as much unless among each other, certainly not during the winter when most of the very old stay inside. When the virus enters the building, this becomes quickly visible so the buildings is quarantined whereby vaccinated professionals can help the people and no-one else can enter the building. In the worst case, all elderly may die and the virus stops. Compare this with society: many people are asymptomatic carriers so they continue to spread the virus unless people in society are vaccinated, and those who come in contact with many people should be vaccinated first. Tests may help to stop the virus but testing everyone two times a week, 3 billion people in developed countries, we probably do not have enough tests. Therefore, mainly people who come in contact with many other people and first those with essential jobs should be vaccinated to showdown and halt the spread of the virus within society. This can also prevent the rise of possible mutations that may worse the pandemic as vaccinations may not protect (completely) against new variants as it seems is the case with the AstraZeneca vaccine and the South-African variant. 

Indeed, we are in a pandemic that is totally destroying our economy. Not only that, we notice more younger people become ill. Because, as most vulnerable people are vaccinated, why do we not notice a reduction in new cases that require hospitalisation, unless younger people become more ill because of a more dangerous variant? Thus, protect the public by vaccinating first people with essential jobs who come in contact with many people who also move around in public and have a family so the numbers of vaccinated within society increase. Vaccinate people who remain at home and it is as if no-one in society was vaccinated. 

In normal life, the elderly are rightly first vaccinated against e.g. influenza (flu) virus to prevent they become seriously ill and to avoid they will overwhelm the healthcare system. However, here we vaccinate BEFORE the flu arrives. Even when the vaccine is not 100%, most vaccinated will have some protection and thus will be less serious ill.

But, during a surprise pandemic, not only emotions are important. Vaccinate the general public, starting with those with essential jobs, to protect the vulnerable, i.e. children and elderly because those who are vaccinated will spread less virus while they can continue to help the vulnerable as they become less ill. Elderly died massively during the first wave because we didn't know much about the virus and thus people with the coronavirus were allowed to enter the homes so elderly became ill and died. We don't do that again but instead fewer visitors are allowed who have to take precautionary measures such as wash hands, wear a mask and keep distance so we have fewer deaths while tests discover potential carriers who will be isolated to avoid others become ill.

When the general population is vaccinated, it will also prevent increases in cases that may overwhelm the healthcare system and force society into lockdown. In addition, we need to prevent that the virus can mutate into a variant against which the vaccine offers little protection and thus this variant can kill again the vulnerable, i.e. the elderly. And we don't want the virus can mutate into one that may kill children.

I hope the right strategy is chosen. But, I think that during a pandemic, rules change and those who move around need protection first, to stop a virus moves around but also to prevent the collapse of the economy and anger among people.

How to vaccinate these groups with essential jobs easily as the organisation seems to be a problem?

I think the best way is that vaccination teams move towards those with essential jobs who need to be vaccinated. Indeed, it can be decided that teachers and administrative personnel in different schools in a certain region will be vaccinated. Those schools can be contacted and they need to provide the names of personnel who want to be vaccinated. This way their names can be removed from lists when the vaccination of the general public in vaccination centers start. The vaccination teams can then decide how many vaccines are needed and move from school to school whereby they inform schools when they will arrive so all personnel can be present with as little disruption of lessons as possible, maximum one day when a school decides to close during this vaccination. Something similar is also done for influenza vaccinations at work. The same can be done in care homes and hospitals. This way, large sections of society can be quickly vaccinated with as little movement as needed. 

For GPs and carers who visit people in their home, teams can't visit them but instead it may be possible they are vaccinated in the school or hospital when teams vaccinate in hospital or schools; this way many people are vaccinated in a short period. If needed, they may go to a vaccination centers. 

After the vaccination of people with essential jobs who come in contact with many (potentially ill) people, other members of the general public can be vaccinated in vaccination centers and as is already done by sending an invitation with date, time and location of the vaccination. 

Personal note

Although I would like to be vaccinated as that provides more freedom, I have an important job as I work at Belgium's medicine agency, but, it is not an essential job as I can work from home without meeting people. In addition, I am a single man, thus I am less important than parents with children. Yes, I am jealous that others are vaccinated while I am not yet. But, essential workers and parents need it first. Still, if I am called to be vaccinated or to show the vaccine is safe, with pleasure.