Not out of the woods yet | Dr James Degaetano

On Monday, Health Minister Chris Fearne announced that Malta had ‘won the war on COVID-19’. This view, however, does not seem to be widely shared by the medical community. The Malta Association of Public Health Medicine has described the lifting of further restrictions as ‘premature’. Where does the Malta College of Pathologists stand on this? Have we really ‘won the war’? 

The use of the phrase ‘won the war’ was a very unfortunate one, and has given the mistaken impression that this is over.  It is not. We have certainly won a major battle, if one wants to use a similar analogy; and so far, we must consider this a relative success. 

However, this is a ‘world war’; and until such time as the virus is around in other parts of the world, not only Malta, we still have to be on high alert.  

The College of Pathologists agrees that we are not yet out of the woods. The virus is certainly still present in Malta, and we agree with our medical colleagues that too many restrictions have been lifted, too quickly. We would have been more cautious and continue to lift restrictions in a more controlled manner.  

Regardless of whether the danger is fully behind us or not, the figures do show that Malta has been far more successful than other countries in containing this virus. What are the factors behind this success? Why do you think Malta did not suffer the same fate as countries such as Italy, Spain, etc? 

Our success has not been a fortuitous one. Thanks to a huge concerted effort by our own experts in virology and infection control, our colleague experts in public health, the health ministry, all front liners and not least of all, the public, Malta acted fast and effectively with measures put in place before the virus even got here.   

The relentless testing and tracing, with a high testing rate, has played a major role in limiting the spread of the virus.  Putting vulnerable people out of harm’s way was also a crucial factor. All this has had a major impact on how we controlled the situation and has greatly mitigated the effect of the virus.    

One need only look at the countries you mention, together with others like the UK and the US, to see the devastating consequences because things took too long to happen. 

Both the Health Minister and Superintendent of Public Health Charmaine Gauci cited statistical evidence to justify the easing of restrictions, including that ‘the rate of infection is now below 0.5, meaning each infected person passes it on to less than one other’.  Doesn’t this also mean that the virus is still spreading, albeit at a lower rate… so it may still pose a danger to vulnerable people who contract it? 

The answer is yes. The virus is still here and may still pose a threat, albeit to a lesser degree. All you need is one infected person in a crowd and that can start the ball rolling again.  We need to be sensible and careful at all times. We cannot let down our guard. 

Another justification is that prolonged lock-down would have health consequences of its own: both physical and mental. Has there been any evidence of worsening public health during the lock-down?  

I spoke to a psychologist colleague today, who tells me that the impact on mental health has been a major issue. There is fear, there is loneliness, there have been marital problems, economic problems, and others. These have all contributed, in varying degrees, to mental health problems. I believe this issue has been well discussed by experts in the field.  

I hope we do not return to the pre-COVID normal. I hope that we take the positives from all this, and slow down a bit; I hope we strive to safeguard our environment and start looking more at quality of life

Apart from the fact that mental ill-health can affect physical health, one of the collateral damages, if you like, of controlling the pandemic is that our physical health has not taken centre-stage.    

With everything fully focused on COVID-19, other diseases have not been given priority as can be expected.  This scenario is not peculiar to Malta and has been reported in many countries now.    

We know that we have had several deaths from heart attacks because patients were afraid to come to hospital.  We calculate that between mid-March and end May, at least 150 cancers that would normally be diagnosed routinely, are only now starting to come to light.  This will obviously impact prognosis.  

These are only two examples. There are many others.  Hopefully people with symptoms will now make sure they seek medical help. We encourage people not to neglect themselves.   

As of Wednesday, restrictions of vulnerable categories (eg, over 65) will be lifted. What is your message to those people who will once again be free to leave their homes, but may still be afraid of infection? 

Once restrictions are lifted, one has to be even more careful than before. Much more. The vulnerable people staying at home were at an extremely low risk of getting infected. Now that they can go out, we cannot stress enough the PROPER (in capitals on purpose) use of masks or visors, social distancing and regular hand washing/sanitising.  This cannot be over emphasised.    

It is understandable that people will remain afraid and some will prefer not to risk at all, but constant vigilance is key. In this way, they should feel safe.  At the end of the day, we cannot keep people locked up forever. 

Many of the fatalities worldwide were associated with ‘underlying health conditions’ that exacerbated the illness. For the benefit of people who might not realise they are vulnerable: can you give an indication of what such conditions may be?  

The commonest underlying conditions that have accounted for death in COVID-19 patients worldwide are hypertension (high blood pressure) and diabetes.  

Heart disease, lung disease, kidney and liver disease in general are also major important underlying conditions. 

Obesity is also a factor: as is age, of course (over 65) and even just being male are additional risks. There are many others, but I’ve only listed the important ones. 

It has been argued that we also need to strike a balance between people’s health, and the economy: in other words, to ensure that ‘the cure is not worse than the disease’. Do you agree with that view; and if so, how would you approach striking that balance? 

This is the million-dollar question.  As medical professionals, health is our priority, so we tend to look at health before economy. We do realise, of course, that the economy is very important, and we also know that there are “social determinants of health”.  People without jobs, with mental health problems, with undue stress, will suffer more than others from physical health issues.  

So yes, a balance has to be struck, and it’s not easy.  As I mentioned before, we agree with removing restrictions, but we would have been happier if these were done more slowly.   

Meanwhile the announcement of a ‘return to normality’ – and especially that the airport will reopen – has also raised concerns that Malta may be opening itself to a ‘second wave’. Do you share this concern? And is Malta prepared to handle this eventuality? 

My next statement is a personal one, and not necessarily reflective of the college’s point of view. 

I hope we do not return to the pre-COVID normal.  I hope that we take the positives from all this, and slow down a bit; I hope we strive to safeguard our environment and start looking more at quality of life; and I hope that we all show responsibility towards each other as we have done, in the majority, during the pandemic. 

It would be a real shame if we do not regard this pandemic as a wake-up call to a more holistic life style. It has also shown us that mankind needs this planet, because it is our home and it is becoming more and more urgent that we tackle the issue of sustainability.  The planet and all its other inhabitants can do perfectly well without us.  

As for the airport. Of course, all medical professionals are concerned that we may re-import the virus. It is a reality that may happen. Once again, we have to be very careful. As a college, we would have thought that screening passengers might be the way forward.  We shall see, but yes, it is a worry.   I think, unless we get totally swamped, we are prepared to handle the eventuality of numbers increasing again because contingencies for this are remaining in place.    

The virus is still here and may still pose a threat, albeit to a lesser degree. All you need is one infected person in a crowd and that can start the ball rolling again

We hope that until after the first wave (nothing to do with the virus!) of tourists arrives, we then wait, continue to test, and then decide if it’s safe to open other routes.  We cannot hurry this up.  

At the same time, there has also been a discernible backlash against the original lockdown measures: some now argue that the threat of COVID-19 had been exaggerated by the world health authorities from the start. Is it possible that Malta’s success could, in fact, be explained by the view that COVID-19 was not as dangerous as previously believed? 

We do not subscribe to the view that this was exaggerated. Look at the rest of the world.  There have been around 6.5 million cases so far and close to 400,000 deaths.  Countries that did not take this seriously did badly.  

There have also been a lot of conflicting reports about the current state of the pandemic: with some arguing that the virus has mutated to a less aggressive form (or that there is more than one strain) while others insist that COVID-19 still remains the same threat. On the basis of the most reliable scientific evidence, which of these views is more accurate? 

The World Health Organisation and Centre for Disease Control have recently confirmed that the virus remains the same strain, and that reports coming out of Italy are unfounded.  

Lastly, there is also a persistent belief that COVID-19 is a ‘man-made virus’; or that it may have some form of link to 5G technology. How do you react to such claims? 

There is absolutely no evidence to corroborate any of these conspiracy theories. Let’s keep our feet on the ground.