Issue link: https://maltatoday.uberflip.com/i/1302895
9 maltatoday | SUNDAY • 25 OCTOBER 2020 INTERVIEW After those initial days of ze- ro new cases, following the end of the first wave, the numbers started going up: first in the 20s… then 40s… then 50s… Now, we are consistently in the 100s. And this is very worrying, because it translates into more hospital admissions… and more deaths. And this is already happen- ing. In the first wave, the num- ber of deaths was nine. Today, in the second wave alone, we are already at over 40. More than a 'wave', you could call it a 'tsunami'… From the outset, the health au- thorities' strategy was to 'flat- ten the curve': i.e., to limit the number of ITU admissions to the minimum, so as not to over- load the health system. In view of the current situation, where does that strategy stand? How close are we to breaking point? 'Flattening the curve' can only be achieved by proper meas- ures to limit the spread of the virus. You can have as many ITU beds as you like – up to 1,000 or more; but that doesn't tackle the virus itself. It can potentially tackle the com- plications that arise from it… but even then, you need high- ly trained doctors, nurses and hospital staff. The number of ITU beds, on its own, means nothing, without the necessary expertise and personnel. My colleagues in hospital tell me that there aren't enough. Meanwhile, the beds are slow- ly filling up with patients. Un- til a few days ago, there were around nine patients in ITU. And that's a lot: not just be- cause the number of ITU beds is in itself limited; but also be- cause other serious illnesses still happen. People still suffer from heart attacks and strokes. You still need to do serious cancer operations. So this is an added burden, over and above the ordinary capacity. And with the numbers as they are today – we've been in the hundreds now for around nine or 10 days – what we expect to see in the coming weeks are more admissions, and more deaths. Because there is always a lag between the onset, and hospitalisation. Even more worryingly, we are now going to see a peak in ITU admissions in winter: which is a bad time, because it also co- incides with seasonal influenza. Now: you could argue – and it's a good argument – that the mandatory imposition of masks might actually limit the spread of the conventional influenza, and common colds. It remains to be seen, naturally; but if so, that would be a good help. But the real problem is that the measures taken, until now, were never sufficient. For in- stance, you can still aggregate in groups of up to 10 people. But if you have one case among a group of 10 teenagers – all from different families – that, alone, can cause chaos. A few days ago, my son wanted to meet a cou- ple of friends; I told him: 'Don't. It's not worth the risk'. Meeting other people, at this stage, is simply not worth the risk. To put it another way: we are being inundated with statistics on a daily basis; but the most im- portant figures, I think, are the sporadic cases. Every day, there is a breakdown of new cases by 'cluster': whether its families, or workplaces, or people who attended mass gatherings, etc. But around half of the new cas- es – though it varies: sometimes less, sometimes much more – will be 'sporadic'. That is the most worrying statistic of all: because we simply don't know where the infection came from; or where these people even are. All we know is that they're out there, somewhere… infecting others, even as we speak. So far your comments have been limited to government's response when the crisis first began. What about today? Do the new measures, introduced this week, meet your expecta- tions? The new measures, in them- selves, are a positive step. But they cannot be effective with- out proper enforcement. For instance: the use of masks - which we have been advo- cating from well before it was instituted a few days ago - is important; but on its own, it is not enough. If people are still aggregat- ing in groups of 10, and going to bars and restaurants, where they will sooner or later take off their masks… they're still going to spread the virus. Clearly, we need to do more. Just a few days ago, the CDC issued a risk assessment: it concluded that the three plac- es where the virus is likely to spread the most, are bars, in- door restaurants and gyms. As I stated earlier, we are not advocating a return a full lock- down… but I do think we might be heading towards a point where we will have to introduce the so-called 'circuit breakers': for instance, a lock-down last- ing a couple of weeks… just enough time to prevent the vi- rus from spreading. Nonetheless, there are medical arguments against lockdown strategies, too. Prolonged iso- lation can have severe impact on mental health; not to men- tion the effect of an economic recession. Aren't these also is- sues that should be of concern to the medical community? The irony is that the present situation is also going to have an economic impact. Every- body's talking about 'striking a balance' [between health and economy]; but if you have loads of people who are unwell, or in quarantine… they won't be able to work. So the situation as it stands today is already severely impacting the econo- my. And we know that this is already happening. So I think that, once we realise that the use of masks, on its own, is not enough… we will have to resort to stricter measures anyway. In any case, we will only see the full effect of the new meas- ures in around 10 days' time. If the numbers don't start sig- nificantly dropping by then, we will either have to start selec- tively closing down places… or resort to something even more drastic. In other countries, for example, they have even pre- vented families from mixing… But surely that would come at a tremendous social cost? Yes; but only for a short period of time. And I think we should try and get it over and done with now… so that, by Christ- mas, we would at least be in a better situation. But whether we choose that strategy, or an- other… those numbers have to come down, one way or anoth- er. We have to start attacking somewhere… otherwise, there will be more hospitalisations, more ITU admissions… and ul- timately, more deaths. but a tsunami…