Why removing the green certificate is a good idea

We call for the immediate abolition of the so-called "Green Certificates" as a requirement for admission to commercial, entertainment and other public facilities in Bulgaria. We welcome the government's forecasts that by March 20 there will be almost no need for any restrictive measures to prevent the spread of Covid-19, including green certificates. However, we at EKIP believe that even at this time the green certificate is a completely unnecessary measure.

The Omicron variant of Covid-19 is already dominant in the country. According to the most recent data from the National Center for Infectious and Parasitic Diseases on clinical samples taken from Covid-19 patients between January 3 and 20, 74.6% of them were found to have the Omicron variant. [1] Its spread is expected to become even more widespread in the coming weeks. This variant of Covid-19, initially identified in South Africa on November 24, 2021, has significantly different characteristics compared to previous variants of the virus, which make the requirement of green certificates as an anti-epidemic measure meaningless.

In this regard, we present two arguments based on two key differences between Omicron and previous variants of Covid-19. These differences concern the level of severe disease caused by the new variant and the level of effectiveness of existing Covid-19 vaccines against it.

1. The severity of the pandemic weakened significantly with the emergence of “Omicron”

Since the emergence of Omicron in South Africa, initial reports have suggested a much more contagious but milder variant of Covid-19. A detailed study of the characteristics and patterns of hospitalisations during the fourth wave of Covid-19 in South Africa, in which Omicron was dominant, clearly demonstrates this. [2] Published on 30 December, the study first showed that during the Omicron wave, a far smaller percentage of Covid-19 patients admitted to the emergency department with the virus required hospitalisation, a far smaller percentage of patients had acute respiratory distress, and a far smaller percentage of patients required oxygen therapy.

The development of the fourth wave of the pandemic in Bulgaria, in which Omicron became the dominant variant, is very similar. The peak of the third wave in the country was reached on October 27 with 6,816, after which the number of newly registered cases began to decline. This decline continued until the end of December, after which cases began to increase again, reaching a new peak on January 26 with 12,399 newly registered cases. Although this peak set a new record, and was about 2 times higher than that of the previous wave, hospitalizations and deaths were far lower. [3]

Official data shows that as of February 7, there were 6,238 hospitalized patients with Covid-19, and 593 in intensive care. Compared to the previous wave, this represents a 27% decrease from the peak of hospitalizations reached on November 10 and a 26% decrease from the peak of patients admitted to intensive care, reached on November 26.

2. The effectiveness of vaccines against Omicron is too low

The data also show a clear decline in vaccine effectiveness against the Omicron variant compared to previous Covid-19 variants. A study on the spread of the new variant in Canada, published on January 1, found that RNA vaccines were only 37% effective against Omicron infection 7 days after receiving a booster dose. The study also concluded that “two doses of Covid-19 vaccines are unlikely to protect against Omicron infection.” [4] An earlier study, based on data from South Africa, published on December 17, concluded that without natural immunity from previous Covid-19 infection, vaccinated individuals had only about 35% neutralization of the new variant of the virus. Protection was only high in those who were both vaccinated and pre-vaccinated, at 75%. [5]

With such a reduced effectiveness against infection, the requirement of proof of vaccination or recovery through the imposition of green certificates is practically meaningless. The spread of the virus is the main thing against which green certificates should protect as an anti-epidemic measure, in order to protect from infection that part of the population with a more vulnerable health profile, with a higher risk of hospitalization and death. But with the effectiveness of vaccines below 40% against the currently dominant variant of the virus, the imposition of such a measure clearly cannot achieve this goal, even approximately.

Based on the above data and the cited scientific studies, we call for the immediate cancellation of green certificates as a currently ineffective and unnecessary measure to limit the spread of Covid-19 and prevent overloading the healthcare system in Bulgaria.

[1] https://www.ncipd.org/index.php?option=com_k2&view=item&id=673%3Ancov-sequencing-190120222&lang=bg

[2] https://jamanetwork.com/journals/jama/fullarticle/2787776

[3] All cited data on the number of cases, mortality and hospitalizations due to Covid-19 in Bulgaria are taken from the official data of the Ministry of Health, provided at https://data.egov.bg/data/view/492e8186-0d00-43fb-8f5e-f2b0b183b64f

[4] https://www.medrxiv.org/content/10.1101/2021.12.30.21268565v1

[5] https://www.medrxiv.org/content/10.1101/2021.12.08.21267417v3

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