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Elimination could be the optimal response strategy for covid-19 and other emerging pandemic diseases

BMJ 2020; 371 doi: (Published 22 December 2020) Cite this as: BMJ 2020;371:m4907

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Re: Elimination could be the optimal response strategy for covid-19 and other emerging pandemic diseases

Dear Editor

Elimination of Sars-cov-2 in UK (GB) will be an uphill struggle. Had the government shut all ports and airports in March and closed all sporting events we might have had a different outcome. Alas, the government singularly failed to have a plan in place to anticipate a global respiratory pandemic. Having run down its manufacturing sector during the 1980s-90s and converting to a deliveroo service economy left UK unable to source vital PPE, and other essential supplies.

The plan to insist on mandatory PCR tests for all those travelling from outside UK is flawed. The PCR test only detects viral RNA, it cannot tell if someone is infectious. A negative PCR does not necessarily mean that person is not infectious, they could be incubating the virus. A positive PCR test result does not necessarily mean the person is infectious, the PCR can also detect RNA fragments from a previous infection. It cannot distinguish RNA from live virus and RNA from an earlier infection, where the person has recovered, but can still give a positive result weeks afterwards but is no longer infectious.

To differentiate PCR results simultaneous viral cultures should be taken. If the viral culture shows live virus for a person with either positive or negative PCR, they are infectious. If no virus is found by viral culture they are not infectious. Is viral culture carried out at airports before departure?

The vaccines at present have no definitive proof they can prevent viral transmission and the duration of immunity is unconfirmed. They may possibly attenuate covid-19 symptoms so reducing hospital admissions, however their long term unintended adverse effects are as yet unknown and work in progress. The recent deaths in Norway of 23 elderly care home residents after they received the Pfizer vaccine is causing concern and is being investigated.

I am in the under 65 age group, so far I have managed to avoid Covid-19, however I am reluctant to accept either vaccine until I am convinced they are safe and efficacious. Recent articles in BMJ suggest the trials were never designed to show the vaccines save lives, improve health outcomes, reduce admissions. It seems the entire population has been sleepwalked into a massive cohort challenge study with an uncertain outcome. By next year, there will be other vaccines for example protein sub unit and inactivated, non-GMO type, which in my opinion seem a lot safer and less risky than the recombinant/viral vector type. Only time will tell.

There are now 33 documented cases of Covid-19 reinfection listed on the cov-19 reinfection tracker site. The mean interval between infections being 87 days, just under 3 months, which means that extending the time between vaccine jabs to 12 weeks, risks exposing people to infection before they receive their second jab.

Competing interests: No competing interests

17 January 2021
Richard de Clare
Chipping Sodbury