Symptomatic and asymptomatic cases, what changes will the compulsory green pass bring and what are the containment strategies?
On Wednesday, January 30th, everything is changing when the green pass will become compulsory on all public transport, in offices – public and private – and in entertainment venues. From schools to gyms, January 30th is destined to mark the divide between those who can and those who cannot anymore. Yet mandatory vaccination will not apply to all areas of life and from pharmacies to food stores the exemptions are more than a few, like those for personal grooming (but not cosmetics), newsagents’ (but not bookshops) service stations (but not tobacconist’s). The government’s plan – pending the letter from Roberto Speranza, the Minister for Health, – is almost complete, but is feeling the pressure from the regions who are trying to get round the rationale of the different colour zones that has been used up until now.
What will be the real discriminating factor? Assuming that, if compared to the previous waves, the current phase with the Omicron variant consists of a state of permanence of the illness (long Covid), Pierpaolo Sileri, the Undersecretary for Health, believes that making a distinction between those who are positive and those who are effectively ill is essential to adjust containment strategies, “above all to manage the hospitals”.
The WHO regional director for Europe, Hans Kluge, echoes Sileri. Kluge believes that this phase will peak in two to three weeks, much sooner than expected. This result is the outcome of the wise choices made so far and the reasons are different: 90% of the population over the age of 12 has been vaccinated (and in part with the booster dose too) and the restrictions. Not least in importance is the low aggressiveness of the Omicron variant in those who have already received three doses of vaccine. Even though it is reaping a high number of victims (over 300 deaths a day), when the fourth wave is spent the return to “normality” will be slow, gradual but constant. The first step will be the distinction between those who are positive and those who are actually sick.
In the new phase of the pandemic a distinction needs to be made between these two groups: in fact, despite the spread of the endemic is trenchant and its impact on the health service significant, the dominance of the Omicron variant (80%) and the fact that almost 90% of the population are vaccinated makes the scenario less alarming than before. The confirmation that we are at the forefront of a new phase of the pandemic also comes from the words of Pierpaolo Sileri, the Undersecretary for Health: “Let’s make a distinction between those who are sick and those who are positive; there are lots of the latter, but they are not sick”.
And the return to pre-covid normality without masks and restrictions hangs on this distinction, reworking the rules of life in society. In the management of hospitals for example, from dedicating more space to illnesses other than Covid-19, to the opening of spaces for interaction between patients and relatives. As Sileri himself points out, “it is another of those progressions that should mark the transit from the pandemic to the endemic, that is to say, from a state of emergency to coexisting with the virus”.
How will this transition come about? Drawing inspiration from the stars and stripes model, a reduced quarantine for a period of 5 days at most, could be introduced for those who have been vaccinated and are positive but asymptomatic. In the case of contact with positive persons it is already possible to proceed with self-monitoring: that is, wearing FFP2 masks is mandatory, but without having to isolate. In the future we will live with Covid-19 as we do now to protect ourselves from ‘flu, where it is not usual to go out if you are symptomatic. However, as the same Sileri reminds us, this “is not an ordinary ‘flu”. Indeed, the consequences for those who have not been vaccinated are still serious, particularly where the Delta variant is concerned, representing as it does for many their descent into the depths of critical care.