• FW
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  • Omicron changes to COVID regulations, Westminster, 30 Nov 2021

The Omicron variant should be a reminder that no one is safe until everyone is safe.

I first of all would like to just say Happy Saint Andrews Day to all Scots across the Parliamentary Estate whether born in Scotland or adopted Scots like myself.

Obviously we’re here to talk about this new variant of concern Omicron and it’s quite clear that we’re in the early days of this, and we need more research.

But it is a heavily mutated variant, and looking at the mutations, it includes mutations that do suggest increased transmitability, and also mutations that are associated with immune escape.

And that’s what’s causing the concern.

We see cases surging in South Africa, but we do not yet have proof that those surges are directly related to Omicron. One thing that has emerged from South Africa is evidence of re-infection of people with previous proven COVID infections. And that’s something that we haven’t seen so often during the pandemic.

To respond to the member for Altrincham and Sale West, I would have to say, he talks about people’s freedom to choose what they do, but the person they might infect actually has the choice removed from them.

Particularly people who are immuno-suppressed, or who are vulnerable. It is a network. And, if you’ve ever seen that little GIF – where someone drops a pingpong ball onto mousetraps – you will realise the way things spread.

YOU may have a choice; I, as an immuno-suppressed person, may therefore not.

Intervention: Isn’t exactly the same thing true of flu?

The thing is, we don’t suffer the same deaths, hospitalisations or outcome from flu. We don’t. If you look at 170,000 deaths over the last 18 months in the UK. We certainly have bad flu winters, where we can get up in the teens, towards 20,000, but we have never got close to 170,000 over 18 months.

Intervention: She’s referring to a period when we didn’t have vaccination; am I not right in thinking that in a vaccinated population, the case fatality rate of COVID is not actually remarkably different from that of influenza.

We are actually still seeing hospitalisations and deaths in people who are double vaccinated. The reason that we are delivering boosters in all 4 health services is because that immunity is waning.

What we’re concerned about with omicron, is if it is able to immune escape, it could push us backwards. We simply don’t want it to become re-established, and undermine the achievement that vaccines have made.

And, things like masks, and hand-washing, which were reviewed in the British Medical Journal, it showed that masks had as BIG an impact as hand-hygiene, so surely we should be doing both. And, both of them have no major economic impact. You’re not talking about locking down; you’re not talking about shutting businesses. You’re talking about everyone trying to protect everyone else.- So that they can continue to be active; can continue to be out in society.

It’s important to remember that if our current vaccines were shown to be less effective against omicron,that doesn’t mean they would have no impact. We already see that impact on delta with regards spread, where the reduction is only about 50%. It has markedly reduced hospitalisation and death. We would therefore be still hoping for that with omicron.

So, pushing vaccination, encouraging people to get boosted, remains as important as it always was.

Delta is still by far the most dominant variant circulating in the UK.

There’s no evidence as yet of differing symptoms or severity, but one of the weaknesses of the data we have from South Africa is the initial outbreaks were in students, and therefore young people already tend to get milder infections, and we don’t yet know what omicron will be like in an older or more vulnerable population.

We do have one advantage in its diagnosis.
That is that the S-gene, one of the 3 genes looked for in common PCR tests, is missing in omicron. Rather than having to wait for genomic testing, which takes quite a long time, you get a heads up, or an early warning, on that PCR test, that you’ve got this sub-group with S-gene dropout, which means the chances are it could be omicron. These patients could be warned. These samples can then be sent for full genomic testing.

In Scotland it’s a retrospective review of recent PCR results, looking for S-gene dropout, that’s identified the 9 patients in Scotland. I assume similiar work is happening in the other nations across the UK. In contact tracing of the 9, there’s no evidence of connections either to COP26, or to the South African rugby game. But, of course tracking continues.

This does mean that PCR testing is even more important.

Lateral flow tests (which we are all doing, hopefully, on a regular basis before coming here) can’t detect variants. It is a simple yes/no that you do yourself. There’s no access to take further analysis.

Lateral flow tests had been allowed as part of the travel testing.

In the Netherlands, they tested 600 passengers arriving from South Africa.
And found 1 in 10 had COVID. That is an incredibly high incidence. Much higher than what we have anywhere in the UK.
And a fifth of those were already omicron.

Omicron is not just in Southern Africa, it’s not just in the UK.
Because of the use of lateral flow tests, it’s probably more widespread than we think.

I therefore welcome that the government has returned today to PCR testing, rather than lateral flow, for travellers, and is quickly re-establishing quarantine.

They should have a PCR test before they travel.
It’s rather shutting the stable door.
If you find someone’s positive, when they’ve just spent 8 hours on a plane with hundreds of other people.

Intervention: Is she not concerned there is too much emphasis on PCR testing, for tracking variants of concern.
Over a 3 week period in July, there were 500,000 PCR tests, 7,000 tested positive for COVID, and 5% of those 7,000 were tested for variants of concern.
So, it’s not quite the silver bullet on variants of concern that she might hope it would be.

I wasn’t claiming it was, because genomic testing takes a couple of weeks, and therefore you are too late to isolate.
What I’m saying is that in THIS variant, as in alpha, but not in delta, there is this missing S-gene which means that in the initial test, which is taking 6 hours, or the next day, you are already getting a heads-up that you’re dealing with a case of omicron. You then can go on and do the genomic analysis.
You’re already able to reply to that patient, and say “We think you have this variant. You need to isolate; you need to isolate thoroughly; you need to isolate longer.”

Intervention: I don’t know what magic goes on within the lateral flow test; we put the drips on one end, and the band, one band hopefully, appears and not two.
Could the lateral flow test be adapted to be specific for this type of variant?

You’re talking abour redesigning for a whole new antigen. It’s just one of the advantages from the PCR. PCR is looking at genes; that is basically what it’s doing; I’m not going to talk about what PCR stands for, we’re given this little advantage that is a benefit to us, that we already get that heads-up, I don’t think it is feasible in any reasonable time scale to change lateral flow tests.

I think we’re lucky that this one has S-gene drop out and we will get an early warning.

One of the issues about only focussing on a day 2 PCR, and if you are negative you are then released, unlike what is being discussed for domestic isolation, is that the incubation period for COVID, generally, is much longer than 2 days.
It has generally been reported as an average of 5 days and can extend up to longer than that. There’s a real danger that if you have arrived in the UK, and you may have had contact, you get a negative PCR day 2, and you go about your business, but actually its false reassurance.

That is why the Scottish and Welsh governments have asked for a COBRA meeting to debate the evidence that is there, on a 4 nation basis, and discuss about having 8 day isolation for travellers, with a day 8 test being negative required before people could release.

The Prime Minister should listen to that. One of the issues we had in Scotland when we tried to maintain stricter and broader hotel quarantine is the majority of long-haul passengers arrive through hubs such as Heathrow.

The devolved nations have no ability to have an impact on that.
We should be looking at trying, at working with the Republic of Ireland, to have the whole Common Travel Area safer from the point of view of how we move about inside it.

Intervention: Since she is speaking on behalf of the SNP, and with the (censure) debate later, I presume the SNP will be supporting the government when the vote comes forward at the end of this debate.

The reason my colleagues are not here, this debate is largely about the regulations within England, we don’t normal vote on English matters; we haven’t normally voted on your COVID regulations.
The one aspect is this around testing and isolation of travellers, so we support it.
We just think it should go further.

With regards to domestic precautions, Scotland never got rid of mandatory masks.
On public transport, in shops, and in schools.
What we haven’t heard the minister refer to is are they planning to reintroduce mask wearing in schools.
At the moment, with vaccination, and its impact, what we’re seeing is that the bulge and peak of cases is moving down and is in younger and younger teenagers and primary school children among those who are unvaccinated. If it is not masks in schools, is there a plan to install CO2 monitoring; is there a plan to install ventilation, how do we reduce the incidence in schools?

Intervention: What is her assessment of the impact in Scotland on mask wearing? In the case of younger children, is it not testament to how well we’ve done at keeping them apart. And proof that we cannot hide from the virus when we come back together.

It’s difficult, cases go up and down, we swap positions, at the moment Scotland has the lowest incidence, at 349 per 100,000; NI has the highest at well over 600 per 100,000.

We have whole baskets of measures, it is harder, other than in the review that the Royal Society published last June, and in the BMJ paper of just a week ago, to pick out exactly which measures are having the impact.
The BMJ found masks and hand hygiene were equal in their impact, and bigger in their impact than physical distancing.

They enable people to engage, and enable vulnerable to feel safe to come out, otherwise those who were shielding are going to be stuck in their houses all over again.

While mask wearing wasn’t mandatory in England, it still remained in the guidance of this government. If in a busy public space. That guidance has been undermined by the demonstration, on TV, every day, of members on the government benches.

Initially, when we came back in the autumn, there were approximately 5 people who wore masks; then it more than doubled, to 14. And, after it was being pushed, it’s about two-thirds.
That means about one-third of members, of the Government, when mask wearing in busy places is meant to be promoted are still not wearing masks.
People will be led by example.
Not just the PMs but every others.

As for the non-sensical claim by the Leader of the House that you cannot catch COVID from friends.
Words fail me. And that, as you can well believe, is not a common occurance.
It is clear that the commonest spread is within households.
If the Leader of the House thinks that husbands and wives and children are not friendly with each other, I really worry about his home circumstances.

It is early days but we should be following a precautionary approach.
As Dr. Ryan of the WHO has always said “Go early, and go hard.”

In the last 3 waves, the government often delayed making decision until the problem was proven. I welcome the changes they are making, to try and be ahead of the curve this time.
As well as masks, they should advise those who can easily work from home to do so.
They should be promoting “Hands; Face; Space” again, to push that to people who maybe go a little complacent.
They should be looking at how to support the installation and improvement of ventilation.

COVID is airborne. If you remember before the smoking ban, how smoke used to hang in a pub.
If any of you ever worked in pubs, as I did as a student, smoke was still hanging there the next morning.
That is the issue around poorly ventilated spaces.
We’ve seen it in this house in the outbreaks associated with committee rooms.

Finally, to finish, the arrival of such a variant was inevitable.
Last spring, we heard warm words about a global response to a global crisis.
While over 85% of adults in the UK have been double vaccinated, it’s less than 4% of those in low income countries.
Including many who have not been able to vaccinate their health care workers.

Intervention: The evolution of an immune escape variant which maybe omicron is…
does that occur because of the vaccination of an immune population, or because of a naive population.

It’s emergence in Southern Africa would suggest a naive population. One of the issues around the complacency and reliance on vaccinations here, while allowing very high case numbers, using Darwinism, you can be pre-selecting for vaccine resistant variants and mutations.
Those are the ones that will get a grip.
The vaccine succeptible will not because we are so vaccinated.
Allowing high spread, which means common mutations, is a problem wherever it is.
In the naive populations in the global south, there is a real danger.
They don’t have testing, they don’t have the materials, they don’t have genomics, they don’t have vaccines.
The danger is you get a variant that is building up, and then eventually will come to Europe, to the UK.
Sending occasional batches, that are almost out of date, as reported recently to the APPG on Coronavirus, doesn’t allow government in the global south to prepare and use those vaccines in date.

The UK is still among the countries blocking a TRIPS waiver.
We must realise that its not just a matter of sharing some leftover doses; we need to massively increase global production. Sharing intellectual property. Sharing technological expertise.

This variant should be a reminder that no one is safe until everyone is safe.

About the author 

Heather Knox

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