30 Jul 2022

Europe's summer of Omicron subvariants has immunologists pleading for the world to embrace a 'vaccine-plus' lifestyle

2:39 pm on 30 July 2022

With demand for travel roaring back, European cities are heaving with tourists, and Covid-19.

Crowds at an event in Montmeló, Barcelona, shortly before summer. Photo:

As temperatures soared across the continent, men and women crowded around Rome's Trevi fountain, lazed on Barcelona's famous beaches and wandered among the remains of the ancient Acropolis in Athens.

People are on the move again, more than two years after a pandemic which forced many countries to close their borders, bringing money back into tourism-dependent economies.

But just as travel has returned in full swing, so too has Covid-19.

Cases tripled across Europe in the six weeks prior to 19 July, accounting for nearly half of all infections globally, according to the World Health Organisation.

The new wave of disease across the continent is being driven by new variants, this time sticky sub-lineages of Omicron referred to by a collection of letters and numbers as BA.2 and BA.5.

While intensive care admissions have remained low, hospitalisation rates have doubled during the recent surge, according to the World Health Organisation.

"It's now abundantly clear we're in a similar situation to last summer," WHO Regional Director for Europe Dr Hans Henri P Kluge warned.

What is different this year is how authorities are responding to the wave.

Instead of treating the surge in cases as an emergency, Europe appears to be committed to living with the virus, free from lockdowns and mandates and with borders wide open.

Tourists flock to Europe's hot spots as sticky Omicron spreads

In Greece, the warmer weather has coincided with the lifting of most restrictions and an influx of foreigners arriving on its shores.

A mixture of tourists and locals linger on Athen's cobbled streets or navigate the many narrow alleyways of Mykonos and Santorini, their cruise ships docked somewhere nearby.

"We do have a lot of work. It became really busy in May and [it will keep] going till the end of July and August as well," Greek tour guide Anna Kouri said from the Hosios Loukas monastery, near Delphi.

Greece is on the path to a tourism recovery as the only country with total and direct air connectivity now exceeding pre-pandemic levels, according to the Airport Industry Connectivity Report for 2022.

But the surge in tourism has been accompanied by an explosion in cases. Health authorities in Greece announced 136,077 new cases of Covid-19 and 271 virus-related deaths during the week of 18 to 24 July.

Cases are most concentrated in popular tourist regions, the Greek health ministry has said.

After more than two years of uncertainty of whether Greece's tourism would ever return to normal, Kouri has greeted the flood of visitors to her country with a mixture of relief and happiness, even as Covid-19 cases have spiked.

"I do feel safe, of course, and many times I take precautions, for instance, when we line up and it is very crowded, I wear a mask… but I don't feel threatened. I know that [the pandemic] cannot be over, so we have to live with this," she said.

Locals are more likely to wear masks on the streets, in shops and on public transport than tourists, Kouri observed.

Tourists and locals mingle on the streets of Bordeaux, France. (File photo)

Tourists and locals mingle on the streets of Bordeaux, France. (File photo) Photo: Unsplash/ Clovis Wood Photography

"People are just not talking about Covid at all. They want to move on," said Professor Jaya Dantas, an expert in international health at Curtin University.

With vaccinations leading to a drop in serious disease and death rates, pandemic-era restrictions have been steadily wound back in the past year.

In May, the European Union dropped its mask mandate for passengers on flights.

In the same month, Greece lifted Covid-19 restrictions on foreign and domestic flights, requiring passengers and crew only to wear a mask onboard, while Italy did away with the health pass that had been required to enter restaurants, cinemas, gyms and other venues.

People who catch Covid-19 are no longer required to go into self-isolation in Spain.

And in Germany, travellers no longer have to prove that they are vaccinated to enter the country, although the Federal Health Minister has recommended younger people who want "to enjoy the summer without the risk" of contracting Covid-19 should get a second booster in consultation with their family doctor.

For travellers, these were indications the world was returning to normal, but some experts say given the pandemic's unpredictability, relying only on vaccines has come too early, particularly as sub-variants drive new spikes in infections.

"As we move from the Delta era, into this now Omicron era and we're in this sort of multi sub-lineage Omicron era, it's clear that the vaccines are simply not enough," said Adam Macneil, an associate professor of Immunology at Brock University.

Along with the risk posed to vulnerable people, experts say allowing the virus to run unchecked gives it more opportunity to develop new mutations that evade immunity.

As new variants and sub-variants continue to emerge, it already feels as if we have become locked in a vicious cycle, with more transmission spurring more variants and more variants driving more transmission.

European health regulators, recognising the rapidly escalating situation on the continent, have already started to recommend further action, including a second booster for high-risk groups.

But pandemic fatigue remains an issue.

Theofanis Exadaktylos, a professor in European Politics at the University of Surrey, has studied the effectiveness of non-pharmaceutical interventions (NPIs) implemented by the national governments of Greece and Cyprus during 2020 to limit the spread of the virus and mitigate the pandemic's economic fallout.

Along with a team of scientists, Exadaktylos found mask-wearing and working from home in Greece better managed the pandemic by reducing cases and had less severe economic impacts than rolling lockdowns.

"It was a cheap and quick measure that if everybody was doing, maybe we wouldn't have [had] to resort to things like lockdowns, or restrictions of mobility or moving around the country in general," he told the ABC.

A man cools off in The Trocadero Fountains across from the Eiffel Tower in Paris on 18 June 2022, amid record high temperatures sweeping across France and western Europe.

A man cooling off in The Trocadero Fountains across from the Eiffel Tower in Paris. Photo: AFP

Yet, as the virus has changed, so too have our personal and public reactions toward it, according to Dr Macneil.

The sense of unity people felt at the start of the pandemic has given way to individual responsibility.

"Everybody likes public health when it's invisible, right? And there are invisible things that we can do, but when it's more visible, there's more resistance to it," Dr Macneil said.

Even as Europe has come to rely on a vaccine-only strategy, not enough people have taken up the three or four jabs necessary to prevent the spread of Omicron.

The WHO is encouraging European governments to "increase vaccine uptake in the general population" ahead of autumn and winter when other respiratory illnesses are likely to circulate.

People's behaviour, however, remains a challenge, according to Dr Macneil.

"[If] you're looking across Europe at the travel that's happening there, you would think everything was hunky dory," he said.

"... But, you know, we can't get back to that normalcy without making these adaptations to our lives."

A path back to normal, in his view, would mean developing what has been called a "vaccine-plus" strategy, which incorporates more public education about vaccination and masking and policy development to improve indoor air quality.

Some European agencies and health officials are encouraging similar measures, including Kluge who has called for greater mask use and improved ventilation.

The calls have also been echoed by experts in Australia.

Australia is behind Europe on learning to 'live with Covid-19'

With Australia currently in the grip of a third wave fuelled by Omicron sub-lineages, Europe's summer could provide lessons for the future.

"I'm sure everyone's watching and looking and learning from what's emerging from Europe currently," Professor Dantas said.

There are some key differences between Europe and Australia's situations, Professor Dantas said, including Australia's higher vaccination rates, lower population and less densely populated cities.

But Europe could offer some lessons in how countries are learning to live with the virus.

"Australia has been behind in some ways, because we had such hard border closures till November 2021 in the eastern states and March 2022 in Western Australia," Professor Dantas said.

"Other countries are ahead of us in terms of learning to live with the virus, and they have just gone ahead and learned to live with [it]."

With pandemic management increasingly becoming an individual responsibility, people will need to evaluate their own risks before leaving the house or travelling abroad.

"[Think] about what you do to come home safely, so you're not bringing the virus back into your family or your workplace," Professor Bennett said.

That includes all the usual considerations like where you are going, who you are meeting with, whether you are meeting indoors, how long you will be indoors and whether you will be wearing a mask.

But Professor Bennett said it was also important to take into account past infections.

It might not be wise for those that have already had three or more infections to be travelling to an area where infections are rising, she said, considering recent data on how the chances of experiencing worse health outcomes increases with each re-infection.

While vaccines have put us in a better position than two and half years ago, our path out of the pandemic may depend on striking the right balance between complacency and constant vigilance.


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