香港醫學會對新冠變種病毒疫情的最新建議
新冠變種病毒Omicron肆虐全球，本港更首次發現有Omicron變種病毒流入社區，導致出現感染群組，第五波疫情一觸即發，情況令人憂慮。面對Omicron 變種病毒的威脅，市民必須提高警覺，盡早接種新冠疫苗以建立免疫屏障；而政府亦需在收緊社交距離、推展「疫苗氣泡」外，同時完善現有檢測、接種疫苗的行政安排，並加強外防輸入，多管齊下抵禦Omicron變種病毒對本港的衝擊。
- Omicron變種病毒傳染力強，在英、美等地更已取代Delta 成為主要流行病毒株，雖然有指Omicron 死亡率與重症率均較過去的變種病毒低，惟仍需要更多數據佐證。而長者、長期病患者感染Omicron後死亡的個案在全球零星發生，市民絕不能掉以輕心。根據英國研究顯示，與未接種疫苗的Omicron患者相比，已接種兩劑和三劑疫苗的人住院風險較低，其中接種三劑疫苗人士，住院風險更減低81%[1]。因此，接種第三劑疫苗至為重要，特別是長者需盡快接種，減低一旦感染後患重症及死亡的風險。
- 政府應開始向5-17歲的兒童推廣新冠疫苗接種，從而增加整體疫苗接種率以達致群體免疫。加上最近有報導指美國有愈來愈多兒童感染新冠病毒重症入院[2]，情況不容忽視。由於現時5-11歲兒童只能接種科興疫苗，醫學會建議政府盡快要求藥廠申請調低復必泰疫苗的可接種年齡，讓兒童及家長有更多選擇。政府亦需積極爭取家長同意，並理順在學校進行大規模疫苗接種計劃的物流安排，以便利兒童接種。
- 截至1月6日，本港已出現一百多宗Omicron感染個案，政府雖然已收緊社交距離限制兩星期，但面對本地感染人數進一步擴大，政府有必要就未來疫情發展作評估及制定應對計劃，如何時需進一步收緊社交距離、停課甚至推行在家工作等，並盡早與公眾公布相關決定及理據。此外，由於現時每天強制檢測的人數大增，不少市民指檢測中心安排混亂，醫學會建議政府立即設立中央檢測實驗室，以加大檢測量及完善相關行政工作。
- 政府宣布將於2月24日進一步擴大「疫苗氣泡」，屆時市民進入食肆、戲院等表列場所均須接種新冠疫苗，安排亦適用於如學校、博物館等。「疫苗氣泡」影響的市民眾多；加上政府已擴大新冠疫苗接種計劃，不論接種兩劑科興或復必泰的市民，均可預約打第三針；導致近日多間社區疫苗接種中心爆滿，市民更需大排長龍。醫學會促請政府盡快加開社區疫苗接種中心及增加可接種新冠疫苗的私營機構數目，特別是現時能接種復必泰疫苗的地點較少，不少更位於商廈地區，政府應在基層社區增加接種點以便利市民。政府並需密切監察接種數字，確保本港有足夠的疫苗供應。
- 現時由維園跳舞群組引申的外傭傳播鏈繼續擴大，香港外傭人口高達37萬，而其工作性質主要為照顧家庭成員，外傭一旦感染，可能會傳染僱主家庭成員，特別是長者及小童這類低接種率人士。而外傭有定期社交聚會，加上Omicron 變種病毒株傳染性高，更可能會導致跨家庭交叉感染，因此政府應考慮為全港所有外傭進行強制檢測，以徹底截斷任何可能出現的社區傳播鏈。在進行大規模強制檢測時，政府亦必須先優化其行政、人手、物流等安排，讓外傭能有序地接受檢測。
- 是次本地爆發由輸入個案引起，政府必須嚴防再次有輸入個案流入社區，包括增加檢疫設施並收緊豁免檢疫的條件。政府亦應就如何避免在檢疫酒店、機場等高風險場所出現交叉傳播訂定具體指引，如為指定酒店入住的旅客數量設人數限制、以及加強機場消毒及抽風量等。對於有食肆出現感染群組，政府亦需加強監管，如定期抽查食肆的換氣要求，確保將傳播風險減至最低。
- 21/22年度65歲或以上人士接種流感疫苗的比率僅得35.3%[3]，比過去兩年大幅減少一成。但在新冠疫情下，市民如同時感染新冠病毒和流感，併發症及死亡率均會大大增加。根據研究，同時感染新冠病毒及流感人士的死亡風險，比只感染新冠病毒的人高出一倍以上[4]，因此接種新冠疫苗和流感疫苗同樣重要。不論是新冠疫苗或是流感疫苗，均需時兩週才能有效發揮作用，而接種兩款疫苗之間需隔14天，因此市民應預算時間盡快接種。
為阻遏新冠病毒疫情蔓延，並讓市民回復疫前正常生活，接種疫苗是重要的一步。醫學會呼籲所有市民接種三劑新冠疫苗，加強自身保護力。特別是長者、長期病患者及免疫力較弱人士更應盡快接種，護己護人，各界齊心戰勝疫情。
二零二二年一月七日
資料來源：
[1] UKHSA, “SARS-CoV-2 variants of concern and variants under investigation in England Technical briefing: Update on hospitalisation and vaccine effectiveness for Omicron VOC-21NOV-01 (B.1.1.529)”, 31 Dec 2021.
[2] https://www.nbcnews.com/health/health-news/covid-warning-symptoms-children-kids-hospitalized-record-numbers-rcna10741, 4 Jan 2022.
[3] CHP, “Statistics on Vaccination Programmes in the Past 3 years”, as of 27 Dec 2021.
[4] Public Health England, “Interactions between SARS-CoV-2 and Influenza and the impact of coinfection on disease
severity: A test negative design”, 18 Sep, 2021.
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7 January 2022
HKMA’s recommendations on the COVID-19 Omicron Variant
The Omicron variant of the COVID-19 disease has surged worldwide over the past few months; recently, the first local Omicron cluster was reported in Hong Kong, which poses a significant risk of a fifth-wave outbreak. Facing the danger of the Omicron variant, members of the public must stay vigilant and get vaccinated as soon as possible to strengthen our shield of protection. While tightening social distancing measures and launching the “vaccine bubble”, the Hong Kong Government should also optimise the administration of testing and vaccination arrangement and strengthen the inbound travelling and quarantine measures to prevent further breaching of the Omicron variants.
- The Omicron variant is highly infectious and has replaced Delta as the predominant strain of the virus in the US and the UK. Although it is pointed out that the Omicron variant has a lower rate of severe Covid-19 illness and death than prior variants, there is not enough data to be sure. The elderly and chronically ill patients who died after being infected with Omicron occurred sporadically around the world, and the public must not take it frivolously. According to a study from the UK, the risk of hospitalisation is lower for Omicron cases after 2 and 3 doses of vaccine, with an 81% reduction in the risk of hospitalisation after 3 doses compared to unvaccinated Omicron cases[5]. Therefore, the third dose of vaccination is crucial for protection, especially for the elderly, to reduce the risk of severe illness and death once infected.
- The Government should start promoting COVID-19 vaccination for children aged 5-17, thereby increasing vaccination coverage to achieve herd immunity. In addition, it is reported that the number of children hospitalised with Covid-19 is soaring in the US and such number is concerning[6]. As children aged 5-11 years old can only be vaccinated with SinoVac vaccines, the HKMA recommends that the Government promptly acquires pharmaceutical’s applications for lowering the age for BioNTech vaccination so that children and parents can have more choices. It is also essential for the Government to actively seek parental consent and smoothen the logistics arrangements for mass vaccination programs in schools to facilitate children’s vaccination.
- As of 6 January, there have been more than 100 cases of Omicron infections in Hong Kong. Although the Government has announced the tightening of social distancing measures for two weeks, in the face of the further increase in the number of local infections, it is necessary for the Government to make assessments and develop contingency plans for future developments, such as additional social distancing restrictions, school suspension, or even to work from home. The Government also needs to announce their decisions and relevant justifications as soon as possible to avoid misinformation. In addition, the number of people undergoing compulsory testing has dramatically escalated. Many pointed out that the arrangement of the testing centres was chaotic. The HKMA suggests that the Government immediately establishes a central testing laboratory to enlarge the testing capacity and improve related administrative work.
- The Government has proclaimed that the “vaccine bubble” would be further expanded starting from 24 February, and citizens must be vaccinated to enter restaurants, cinemas and other listed premises, and such arrangement would also be extended to schools and museums, etc. Whereas a large population would be affected by the policy, the Government has also stretched the COVID-19 vaccination program where people who have received two doses of SinoVac or BioNTech are eligible for the third dose. Both have contributed to the substantial increase in vaccination appointments and led to the massive queuing outside several vaccination centres. The HKMA urges the Government to promptly set up more community vaccination centres and increase the number of private medical institutes that enrolled in the vaccination program. In particular, there are fewer places where BioNTech vaccines are provided, and many of them are located in commercial areas. The Government should increase vaccination stations in grassroots areas to deliver convenient vaccination services. Likewise, the Government needs to closely monitor the vaccination figures to ensure adequate vaccine supply in Hong Kong.
- Currently, the transmission chain of foreign domestic helpers (FDH) caused by the “Victoria Park dancing” cluster continues to grow. The population of FDH in Hong Kong is as high as 370,000, and their work mainly involves taking care of family members. If an FDH is infected, the employer’s family may be infected as well, particularly the elderly and children who have low vaccination coverage. As FDHs have regular social gatherings, coupled with the high transmissibility of the Omicron variant, it is more likely to cause cross-household infection. Therefore, the Government should consider compulsory testing for all FDHs to entirely cut any possible transmission chain in the community. When conducting mandatory mass testing, the Government must first optimise its administrative, manpower, and logistics arrangements to complete the tests in an orderly manner.
- The local outbreak was stemmed from an imported case; hence, the Government must take action to prevent similar incidents from happening again, and it is essential to increase quarantine facilities and narrow the conditions for quarantine exemption. The Government should also formulate specific guidelines on avoiding cross-spreading in high-risk places such as quarantine hotels and airports—for instance, setting a limit on the number of tourists staying in designated hotels and reinforcing the disinfection and ventilation requirements of the airport. Regarding the recent restaurant cluster, it is the responsibility of the Government to strengthen supervision, such as regular checks on the ventilation requirements of restaurants to ensure that the risk of transmission is minimised.
- In 21/22, the coverage of influenza vaccination among people aged 65 or above was only 35.3%[7], which was a sharp drop of 10% over the past two years. However, under the COVID-19 pandemic, complications and the risk of death would increase enormously if a person were co-infected with the COVID-19 and influenza. According to a study, the risk of death is more than doubled for people who catch flu on top of coronavirus, compared to coronavirus alone[8]. Therefore, vaccinations for the COVID-19 and influenza would be equally important. Moreover, both vaccines take about two weeks to act, and there is a 14-day interval between each vaccinations. Therefore, the public should budget for time and get vaccinated as soon as possible.
In order to curb the spread of the COVID-19 virus variants and allow citizens to return to their everyday activities, vaccination is of utmost importance. The HKMA urges all citizens to receive three doses of vaccines to enhance their protection, especially the elderly, chronically ill patients, and people with weakened immune systems, should be vaccinated as soon as possible to protect themselves and others. Society must work together to defeat the pandemic.
Reference:
[5] UKHSA, “SARS-CoV-2 variants of concern and variants under investigation in England Technical briefing: Update on hospitalisation and vaccine effectiveness for Omicron VOC-21NOV-01 (B.1.1.529)”, 31 Dec 2021
[6] https://www.nbcnews.com/health/health-news/covid-warning-symptoms-children-kids-hospitalized-record-numbers-rcna10741, 4 Jan 2022
[7] CHP, “Statistics on Vaccination Programmes in the Past 3 years”, as of 27 Dec 2021
[8] Public Health England, “Interactions between SARS-CoV-2 and Influenza and the impact of coinfection on disease
severity: A test negative design”, 18 Sep, 2021
編輯備忘：香港醫學會成立於一九二零年，旨在聯繫政府、各公立醫療機構、大學及私人執業的醫務工作者，交流意見，團結一心。醫學會致力將最新的醫療資訊及醫務發展傳遞與會員，提倡會員遵行專業操守，進而服務社會，維護民康。
Notes to editors: The Hong Kong Medical Association, founded in 1920, aims to bring together Hong Kong's government, institutional, university and private medical practitioners for an effective exchange of views and co-ordination of efforts. The foremost objective of the Association is to safeguard and promote public health. The Association speaks collectively for its members and aims to keep its members abreast of medical ethics, issues and advances around the world. In fulfilling these goals, the association hopes to better serve the people of Hong Kong.
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