On November 26th, 2021, the WHO designated the B.1.1.529 variant a Variant of Concern to be known as omicron. This variant, with its 50 mutations of which over 30 are on the spike protein, has raised several concerns including increased transmissibility and the potential for vaccine escape.

To date, the omicron variant is about two times more transmissible than the already highly transmissible delta variant. It’s shorter incubation period (time from infection to the onset of symptoms) of 2-3 days, means that more countries around the world are witnessing an explosion of new cases, particularly among the unvaccinated. With the higher rate of transmission, even a modest rise in hospitalizations can threaten to overwhelm healthcare systems.

The evidence to date, suggests a generally milder course of illness, especially for the fully vaccinated, and that a person with a history of previous COVID-19 infection is at greater risk of reinfection with omicron. We now know that the variant can evade immunization with two vaccine doses, but immunity is likely to be restored by a third (booster) vaccine. Scientists worldwide are following this new variant closely and several countries have reinstituted strong public health measures to deal with a rapid increase in cases.

Omicron has reminded us that border surveillance, especially genomic surveillance, is important. New COVID-19 variants will arise and some of them will be of significant health threats. Given that Barbados is a tourism hub, with source markets from many of the countries well established to have variants, we can expect importation of new variants, which may prove difficult to control.

The Barbados Association of Medical Practitioners (BAMP) has never wavered from our position of the need for surveillance at the border and within the country. Since the onset of the most recent local wave, the number of tests conducted have increased, this underscores the need for in-country surveillance. At the same time, we must be vigilant and continue border surveillance to guide our decision making. The battle against COVID-19 and its variants must be fought on both fronts and as a country, we must seek to optimize the apportioning of our resources.

The reinstitution of Stronger Border Surveillance Measures
• We recommend that Barbados should be marketed as a COVID-Vigilant country where priority is given to maintenance of protocols.
• Barbados has relied heavily on a standard PCR test done 72 hrs. (three days) before air travel. Given the increased transmissibility of omicron and the poor availability of this test in many source markets, we suggest that all travelers take an approved rapid PCR or standard PCR test (RT-PCR) 24-48 hours before travel to Barbados.
• We further recommend that all travelers be pre-approved for entry via the BimSafe App or any other approved application. Tests to be done post arrival should be pre-booked online prior to travel and evidence of this shown on arrival.
• We strongly recommend that a contact tracing app be downloaded by all travelers to Barbados before arrival. This app would be interrogated only when a traveler becomes positive. Residents of the island should be encouraged, through a national educational campaign, to download the app also.
• Upon arrival, fully vaccinated air travelers should be required to have a standard PCR test on day 2 (two) and a self- administered rapid antigen (lateral flow) test on day (5) with results uploaded and monitored electronically by the BimSafe App or any other approved application. An email should be automatically sent, from the MHW, following confirmation of negative test results.
• Fully vaccinated travelers to the island should be advised that bars and restaurants as well as attractions may request proof of their vaccination status and MHW clearance certificate.
• If the fully vaccinated traveler is in transit, no further testing should be required. If a traveler is staying for less than or equal to two days only, a standard PCR or Rapid PCR test should be the preferred test administered prior to departure, with interrogation of the contact tracing app if positive.
• Unvaccinated air travelers should, upon arrival, quarantine in their rooms at approved designated hotels. As is currently the case, they should have testing by standard PCR test on day five (5) with release conditional on a negative test result. An MHW certificate should be automatically emailed on day six following a negative test.
• For cruise passengers, we believe that an approved rapid PCR or standard PCR (RT-PCR) test done 24-48 hrs before boarding at the port of embarkation along with an approved rapid PCR or approved rapid antigen (lateral flow) test on arrival in Barbados as a port of call will suffice. For passengers home porting from Barbados, the same principles as for air travel would apply. Continued maintenance of the travel corridor between air and seaport and of bubble tours is vital.
• All travelers should receive information on what is the protocol if they test positive in Barbados. We recommend an initial isolation facility assessment for all visitors who test positive. Provided that most fully vaccinated travelers remain well, managed approved isolation in their rooms would be acceptable. However, there may be instances where the visitor may need closer monitoring and may need to transfer and stay within an isolation facility.
• The provision of private (paid) facilities with appropriate monitoring for non-nationals/residents and even for nationals/residents willing to pay, should be considered, with oversight by the MHW.
• Mask wearing should remain mandatory for all visitors and residents on the island with enforcement of penalties for failing to do so. Frequent hand hygiene and social distancing should be strongly encouraged as key non pharmacologic interventions.
• All frontline workers including those in hotels, restaurants, attractions, ports of entry, healthcare, and security services should be vaccinated and tested according to national policy and protocols.

Dr. Adanna Grandison
1st Vice President /President (Ag.), BAMP
For BAMP Covid-19 Task Force
December 23, 2021