Opinion: Air sanitation and free N95s and ATKs are the key to stopping Covid-19

ML Rangsithorn Bhanubandh, a spokesperson for Zero Covid Thailand, joins Thai Enquirer to talk about the challenges in overcoming the pandemic.

Here are some highlights:

Is Covid Over?

We are getting a wake-up call that COVID is not over or even ending

Recently, the World Health Organization warned that Europe was returning to being an epicenter of COVID-19. 

Almost 2 million new cases were reported in Europe in 1 week, the most in a single week in that region since the pandemic started. In that time, over 27,000 deaths were reported in Europe, more than half of all COVID-19 deaths globally.

The EU Member States have already started imposing stricter restrictions on their citizens and travelers.

A partial lockdown has been announced in some countries. 

Likewise, Singapore has had to halt its plan to reopen the country as healthcare services are severely stretched.

What about Thailand?

Thailand should learn the facts about COVID and about what does and doesn’t work before it’s too late

While in many European countries, authorities are trying to boost vaccination rates, what has happened in the UK and Singapore already tells us we cannot depend on vaccination to create herd immunity. This is because the vaccines we have are non-sterilizing and it is mathematically impossible for them to stop the spread.

Theoretically, the required percentage of the population who must get vaccinated to reach the herd immunity threshold is calculated from the virus basic reproduction number and the vaccine efficacy.

In the case of the Delta variant (let alone future variants), in which one infected person spreads the disease to an average of 5-8 others, the required percentage of vaccination would exceed 100% of the population – which means herd immunity is unattainable through vaccination.

Nor will natural infection lead to herd immunity. Studies have conclusively shown that protection from a previous COVID infection may only last a few months, and less so against different variants; some people have been re-infected within weeks.

It is a common misunderstanding that COVID will become endemic.

This is blatantly false and is based on both a misunderstanding about what the word “endemic” means and a lack of awareness of the epidemiological patterns we are actually facing. For a disease to become “endemic”, it has to achieve a steady-state, where one person will, on average, transmit the disease to roughly one other person.

COVID’s transmission pattern, in contrast, is that of a cyclic epidemic, like smallpox or measles, which comes in waves of explosive growth.

As seen in the cases of Singapore and the UK – whose populations have received the most effective vaccines we have in the world so far (Pfizer and Moderna) -, vaccines cannot prevent infections or transmission to others sufficient to stop the spread of disease. At best, they can reduce the odds of death or a severe acute infection. 

In Singapore, 94 percent of Singapore’s eligible population – those aged 12 and above – have completed their full regimen or received two doses of COVID-19 vaccines as of 16 November.

Among the total population, 85% have completed their full regimen or received two doses of COVID-19 vaccines, and about 86% have received at least one dose. About 22% have received their booster shots.

The number of new cases still surges in both countries.

In the UK, 38,263 confirmed cases were announced on Wednesday (17 November). Meanwhile, about 88% of those aged 12 and over in the UK have received their first dose, and 80% of people aged 12 and over have received a second vaccine dose.

Thailand is not as safe as some people may think

Prime Minister Prayut Chan-o-cha has insisted on reopening the country citing economic pressure and has highlighted vaccination as the key protection. 

Meanwhile, according to the MOPH Immunization Center, 63.9% of the Thai population has received their first COVID-19 shot, 52.7% got their second and 4.1% had their third shot of the vaccine as of November 18.

The percentage of vaccinated people is far lower than in Singapore or the UK. It is certainly far lower than the imaginary percentage (greater than 100%) that is needed to make a vaccine-dependent strategy realistic.

Now, 3 weeks after the country reopened and the school season began, we have almost 7,000 new cases and 50-70 deaths daily. We have heard calls for help from public health staff and volunteers in Chiang Mai, Tak, Songkhla, and the southernmost provinces.

Some schools in Bangkok and Nakhon Ratchasima have announced closures due to COVID-19 cases. 

The consequences of loosened measures are expected to be seen in a few weeks. The government has admitted we are likely to see a spike in infections again.

But how can we deal with COVID without destroying the economy?

People assume that we have to choose between public health and the economy.

This is absolutely not true, and not supported by the data. The evidence clearly shows two things: that in a pandemic, it is not social restrictions that cause economic damage but the pandemic itself, and that the economies of countries that pursue an elimination strategy out-perform those that choose to live with the virus. 

Moreover, aiming at keeping the lowest level of cases is less economically costly in the long run.

Economic analysis showing these results include ‘SARS-CoV-2 elimination, not mitigation, creates best outcomes for health, the economy, and civil liberties’ by Miquel Oliu-Barton of Université Paris Dauphine–PSL, Paris, France and ‘Lowest-cost Virus Suppression’ by Jacob Janssen of Netherlands Organisation for Applied Scientific Research and Yaneer Bar-Yam of the New England Complex Systems Institute. 

Thailand has reopened already, anyway. Here’s what we can do.

The economy is going to continue to falter if we proceed on the path that we are on. But we can save the economy by ending the pandemic and rebuilding public health.

We just have to take action. And it’s not that hard.

First and foremost, the government must equip the people with the knowledge and understanding that “COVID is predominantly airborne.”

The vast majority of people who catch COVID are not, and have never been, infected by touching a contaminated surface, nor by being sprayed by droplets from a cough or a sneeze.

We have literally zero scientific evidence, globally, for either of these two routes of COVID infection.

Meanwhile, the scientific evidence for infection through inhalation of airborne particles exhaled by another person is overwhelming, and it cannot be any more clear than it already is. This needs to be communicated to Thai people all day, every day until social behavior changes completely to acknowledge it.

We got rid of cholera by admitting that cholera transmits through contaminated water. We will get rid of COVID by admitting that COVID transmits through contaminated air.

Understanding this is the central issue will create the right intuitions in people, who will use their new knowledge to protect themselves correctly: by first and foremost, protecting their airways.


Air sanitation, as well as free N95s and ATKs for everyone, is the key

In practice, all people in public places must wear tight-fitting N95 respirators – which are masks that are able to filter aerosols as small as 0.3 microns – until COVID is eliminated. And all shared indoor spaces must have extremely high ventilation rates, to prevent any build-up of exhaled air.

But N95 masks and ventilation only offer probabilistic protection by significantly reducing the chances of infection. To really get the total case number down to zero without relying on more lockdowns, we need to rely instead on cheap, convenient, and fast saliva antigen (ATK) testing, which has been scientifically proven to reduce cases much more effectively than PCR tests when applied universally.

To use them correctly, everyone in society – and not only those with symptoms – must have free access to antigen test kits and be able to test themselves at least 2-3 times per week.

With the combination of a population that understands the truth of airborne transmission and the need for air sanitation and the widespread availability of N95 masks and at-home saliva antigen tests, we can easily eliminate COVID in less than one month and prevent future imported cases from turning into clusters.

For the quickest results, this must be a collective effort and have the government’s full support.

Given the seriousness of Long COVID – which is the real disease, not only the respiratory illness of the acute phase – and how it is causing irreparable harm to both our public health and economy, we must end COVID as quickly as possible.

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ML Rangsithorn Bhanubandh is the spokesperson of Zero COVID Thailand — an information resource that promotes accurate science-based communication to eliminate COVID-19 in Thailand.

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