A parallel path to reopening is needed

Margaret Keenan, 90, was the first patient in Britain to receive the Pfizer/BioNtech COVID-19 vaccine. - Photo: Reuters
Letter to the editor – By Dr. Michael Tibbetts, MD

The announcement that our Islands will receive the first doses of the approved Pfizer/BioNTech vaccine in early January, 2021 is cause for celebration. 

Michael Tibbetts

Premier Alden McLaughlin declared a reopening of our borders to visitors will commence once the highest risk residents are vaccinated with a target date of March 2021. 

In this next phase, all incoming residents and visitors who can show proof of vaccination and submit to testing at 5-day intervals will avoid quarantine.   

I fully support the emphasis on vaccination, commend the proactive and assertive path of the roll-out, and will proudly roll up my sleeve when my name is called. 

Now that the reopening plan for the vaccinated has been announced, I believe that a second parallel path needs to be defined for the unvaccinated. This path must obviously provide a higher level of safety and community protection.

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A plan for the unvaccinated is necessary because although the approved vaccines are safe and effective for most adults, there are still unanswered questions. 

Most notably, the safety and efficacy of the vaccines has not been studied in children under age 16.  The clinical trials for teenagers only recently began and the studies for children under 12 will not commence until 2021.

As a result, residents and visitors under 16 years old will be excluded from vaccination until the late summer of 2021 at the earliest.  Data is also lacking on the vaccine’s effects on pregnant women, the immunocompromised and individuals previously infected with COVID-19.   

Importantly, a vaccinated individual can still be a carrier and potentially transmit the SARS-CoV-2 virus. 

This means that the person may not get sick but could still pass the virus to someone else.  Whereas clinical trials showed the Pfizer/BioNTech vaccine reduces the risk of COVID-19 illness by 95%, BioNTech CEO Ugur Sahin believes that the vaccine may only reduce transmission by 50% – an important distinction. 

Vaccination by itself is unfortunately not the magical key to open our borders without additional safety measures such as repeated testing, on-island surveillance, sanitation protocols and contact tracing capability.    

In terms of feasibility, the COVID-19 vaccines will not be widely available for heathy individuals under age 60 for several months – likely not until the summer of 2021 in the U.S.

Advanced planning for travel and the reinstatement of commercial flights will not be possible given this uncertain timeline. 

Further, there are many individuals who oppose vaccination for ethical or religious reasons and would thereby be excluded from visiting without quarantine.  There may be other unforeseen pitfalls as no other countries have implemented a similar reopening strategy at this point.

A parallel protocol to permit unvaccinated residents and visitors should be provided along with the vaccination plan for March. 

The unvaccinated protocols should include additional layers of protection such as pre-arrival testing (in addition to on arrival and every 5-day testing) and specific sanitation and mask wearing protocols in place in approved accommodations, restaurants and attractions. 

Other elements such as a contact tracing app would further enhance the level of safety.  Combined these elements could provide a greater degree of risk mitigation against the community spread of COVID-19 than vaccination alone.

To be clear, this pathway would only be for unvaccinated arrivals that agree to pre-arrival testing and the enhanced protocols required. 

Not all returning residents may be able to comply with these stringent requirements.  As we have learned from Jamaica, Bermuda, Turks and Caicos, St. Lucia and other islands, returning residents are at a much higher risk of seeding outbreaks than visitors given the epidemiology of COVID-19. 

The SARS-CoV-2 virus is most commonly transmitted within homes, workplaces, houses of worship and other settings where friends and family gather in close confined spaces.

By launching a reopening protocol with heightened safety requirements for unvaccinated residents and visitors to begin in March, the businesses affected by the 11-month border closure can begin to make plans for rehiring and retraining staff, airlines can reinstate routes and hope will be provided to the thousands of struggling Caymanians.

I invite you to learn more at reopencayman.com and post your feedback and questions to the ReopenCayman.com Facebook page.

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