Path to normality: Assessing the level of social-distancing measures relaxation against antibody-resistant SARS-CoV-2 variants in a partially-vaccinated population.

Introduction: Two years into the coronavirus 2019 (COVID-19) pandemic, populations with less built-up immunity continued to devise ways to optimize social distancing measures (SDMs) relaxation levels for outbreaks triggered by SARS-CoV-2 and its variants to resume minimal economics activities while avoiding hospital system collapse.

Method: An age-stratified compartmental model featuring social mixing patterns was first fitted the incidence data in second wave in Hong Kong. Hypothetical scenario analysis was conducted by varying population mobility and vaccination coverages (VCs) to predict the number of hospital and intensive-care unit admissions in outbreaks initiated by ancestral strain and its variants (Alpha, Beta, Gamma, Delta and Omicron). Scenarios were "unsustainable" if either of admissions was larger than the maximum of its occupancy.

Results: At VC of 65%, scenarios of full SDMs relaxation (mean daily social encounters prior to COVID-19 pandemic = 14.1 contacts) for outbreaks triggered by ancestral strain, Alpha and Beta were sustainable. Restricting levels of SDMs was required such that the optimal population mobility had to be reduced to 0.9, 0.65 and 0.37 for Gamma, Delta and Omicron associated outbreaks respectively. VC improvement from 65% to 75% and 95% allowed complete SDMs relaxation in Gamma-, and Delta-driven epidemic respectively. However, this was not supported for Omicron-triggered epidemic.

Discussion: To seek a path to normality, speedy vaccine and booster distribution to the majority across all age groups is the first step. Gradual or complete SDMs lift could be considered if the hybrid immunity could be achieved due to high vaccination coverage and natural infection rate among vaccinated or the COVID-19 case fatality rate could be reduced similar to that for seasonal influenza to secure hospital system sustainability.