Issue link: https://maltatoday.uberflip.com/i/1243341
9 maltatoday | SUNDAY • 3 MAY 2020 INTERVIEW curring have any implication for this prospect? And what would happen if it turns out to be im- possible to vaccinate against this virus? The limitations of the herd im- munity approach apply to the reliance on an effective vaccine. If the virus only undergoes mild mutation over time, then a sin- gle vaccine will be effective. If it undergoes major mutations, however, annual vaccines for the different strains will have to be produced, just as in influenza. In the latter case: will the vaccine, say for 2021 still give partial pro- tection from the virus of 2022? Again, we do not yet know. Prolonged self-isolation may al- so have health effects of its own – e.g., lack of exercise, poor diet, and mental health issues. Meanwhile, the focus on COV- ID-19 also implies that fewer re- sources are available for other illnesses/conditions. Could our current health strategy there- fore be causing other health problems that may return to haunt us in future? From my current experience, there are two main health issues that have arisen from our policy of social distancing and self-iso- lation. The first is that, out of fear of visiting a clinic or hospital, peo- ple have forgotten that there are thousands of diseases that can harm their health or kill them, and those diseases have not gone away. So they seek help when it is already too late. The second is the effect on mental health. The stress of fi- nancial and employment issues, the effect of loneliness and isola- tion from loved ones, the simple fact of hearing alarming news online or on TV every day, has had a huge impact on people psy- chologically. We need to address this aggressively, and fast. You expressed doubts (in a Facebook post on 24 April) about whether we are carrying out enough tests to ascertain the precise extent of the spread. Given that the number of tests has increased since then: are you still concerned about this? And do you think that the deci- sion to partially lift restrictions should be contingent on the number of tests per day? I expressed my concern that the number of daily tests had dropped from over a thousand, to just 600 at the time. The gov- ernment has now opened free testing to those without symp- toms, with a subsequent rise in the number of those being tested. It is imperative that we maintain those numbers so that future decisions can be based on reliable facts. You also said (on 21 April) that "It is a known fact that the test is only 70% accurate. Meaning it gives 30% false negatives." This inaccuracy may well lead to a false picture of the actu- al extent of the virus in Malta. Doesn't this also suggest that our present state of confidence may be misplaced? Yes, and no. Yes, the test is not 100% reliable. This is not pri- marily due to laboratory error, but due to sampling error: that is, the way the swab sample is taken. This is a known variable all over the world, and the De- partment of Health seems to be aware of this fact. [Superin- tendent for Public Health] Prof. Charmaine Gauci herself has re- peatedly pleaded to people who have had one negative swab, but have persistent symptoms, to firstly self-isolate; and, second- ly, get themselves re-tested. She would not have done this with- out a solid reason. No, because despite the im- perfect reliability of the test, we have not seen a disproportionate number of people dying or be- coming critically ill because of COVID-19. Those numbers do indeed suggest we currently have the situation under control… by how much, is the current ques- tion. The only way to reduce the ef- fect of a significant number of false negative tests is by testing more widely; and if necessary, testing the same people more than once. Reliability, until an- tibody tests are freely available, will never be 100%, but it can certainly improve. Lastly, we have heard various conflicting projections about how long the emergency will last: with some predicting and end in sight within months, and others fearing it may last for two years or more. Realistically speaking, what are the factors involved in this calculation? And what are your own expec- tations? I have addressed several of the possible factors in previous an- swers. Will the virus mutate in- to a less or more harmful form? Will it simply die out? Will pre- vious infection guarantee future immunity? Will a reliable vac- cine be available, and cover fu- ture mutations in the virus? Etc. Meanwhile, many of the model projections are based on previ- ous pandemics, in particular the Spanish Flu of just over 100 years ago, and the more recent H1N1 (Swine) flu. But Sars-Cov-2 is not an influ- enza virus. It is a coronavirus and may act completely differently. It is like comparing the behaviour of a chicken to that of a dog. If there is anything this pan- demic has shown us so far, it is the fact that all the experts in the world have been proven wrong time and again regarding the cause, the effect, the spread, the lethality and how to best contain COVID-19. The very fact so many countries are taking so many different ap- proaches in handling it is proof of this point. Malta has so far handled our local emergency very well. We have the local talent to continue to do so. With few exceptions, the public has so far proven to be remarkably co-operative and disciplined in following public health instructions, putting our supposedly more disciplined Northern European neighbours to shame. But while we can control what happens within our borders, we cannot control what happens without. We should definitely keep that in mind when we take decisions regarding opening our ports and airport. Sars-Cov-2 is not an influenza virus. It is a coronavirus and may act completely differently. It is like comparing the behaviour of a chicken to that of a dog