Dr Victor Luca
Published, Whakatāne Beacon, Wednesday 29-Dec-21
Air pollution is a leading cause of global mortality, being responsible for seven million annual deaths [1]. Second on the list of deadly global killers is smoking at six million annual deaths, followed by drinking and obesity.
Smoking is in fact a good analogy for the present COVID situation. It was an analogy I tried to make on 8-Apr-20 when I submitted to the Beacon a picture of a fellow smoking outside Countdown supermarket in Commerce Street. The picture was never printed. It is now apt that almost two years later, I try to make the analogy again.
On 10-Dec-04, Aotearoa became the third country in the world to make all indoor workplaces smoke-free, including bars and restaurants. The law, which has since been extended, came into force following half a century of accumulated scientific evidence showing unequivocally that smoking is extremely harmful and a significant cause of death and morbidity. As such smoking imposes a significant burden on the health system.
Despite the fact that the scientific case for the harmful effects of smoking was ironclad, it still took way too long to legislate a ban. This was due primarily to the assiduous and disingenuous efforts of cigarette companies who spewed out copious false information in order to keep the profits rolling in. In the end however, in the interests of the common good, governments had to step in and attempt to stamp smoking out. Whilst this remains a work in progress, the efforts did result in significant reduction in death and morbidity.
When a person blows smoke into the air they are letting loose into the environment so-called smoke aerosols [2]. These smoke aerosols consist of tiny ash particles that carry with them a vast array of highly toxic chemicals. Because the tiny particles are so small and light they linger in the air and can travel great distances. I recall the days when my father used to have to paint the ceiling of our home every year or two because of the discoloration due to the deposition of these smoke particles.
Smoking in an indoor setting is harmful, not just to the smoker, but also to the non-smoker that is forced to breathe in the smoker’s exhaust air. I think that nowadays, we can all agree that a smoker does not have the right to cause harm to others and this is the reason for the ban on smoking in indoor public spaces.
As with smoking, persons who are infected with the SARS-CoV-2 virus that causes COVID-19 disease shed virus into the surrounding air when they cough, sneeze, shout and even speak and breathe. The aerosols linger in the air and can be breathed in by both vaccinated and unvaccinated individuals. For the unvaccinated, the risk of contracting the disease, being hospitalized and dying are 6-, 11- and 15-times higher respectively compared with the vaccinated. In other words, vaccinated people have lower risk but they do not have no risk.
The latest science is suggesting that COVID-19 vaccines for current variants are not just effective at reducing severe illness and death, they are also relatively effective at preventing SARS-CoV-2 infection and onward transmission [3-8]. The importance of this from a public health perspective cannot be overemphasized.
It can be concluded that the weight of evidence that is available today is strongly suggesting that fully vaccinated persons might in some instances still become PCR-positive for SARSCoV-2 but only play a minor role in the transmission of SARS-CoV-2. Reducing the ability of a person to become infected and transmit is like stopping the smoker being able to share their smoke with others in enclosed spaces.
By getting vaccinated you reduce your chances of causing harm to others. Hence the implementation of vaccine passports seems totally justified.
References
[1] Ourworld in Data. Data Review: How many people die from air pollution?
[2] Sahu, S.K., Tiwari, M. Bhangare, R.C., Pandit, G.G.Particle Size Distribution of Mainstream and Exhaled Cigarette Smoke andPredictive Deposition in Human Respiratory Tract. Aerosol and Air Quality Research, 2013,13, 324-332.
[3] de Gier et al., Vaccine effectiveness against SARS-CoV-2 transmission to household contacts during dominance of Delta variant (B.1.617.2), the Netherlands, August to September 2021. Eurosurv. 2021, 26(44), 1
[4] Harder et al., Efficacy and effectiveness of COVID-19 vaccines against... Eurosurv.2021, 26(28), 2100563.
[5] Prunas et al., Vaccination with BNT162b2 reduces transmission of SARS-CoV-2 to household contacts in Israel. MedRxiv 2021.
[6] Salmon et al., Transmissibility of COVID-19 among vaccinated individuals - A Rapid Literature Review: Update #2. Date of Literature Search: 8/23/2021 Date of Submission: 9/24/2021.
[7] Haridy, R. mRNA vaccination found to reduce COVID-19 infectious viral load. NewAtlas, 13-Apr-22.
[8] Puhach, O. et al., Infectious viral load in unvaccinated and vaccinated individuals infected with ancestral, Delta or Omicron SARS-CoV-2. Nature Med. 2022. https://doi.org/10.1038/s41591-022-01816-0