As Malta moves into the COVID transition phase, it is salutary to review the COVID-related events of the past few months both locally and internationally.

Different countries have had wildly different experiences. Some countries, such as New Zealand, have almost completely suppressed the pandemic but have had to remain on high alert as the virus easily resurfaces.

Other countries, such as the United States, are still experiencing their first wave due to inadequate suppression efforts and uncoordinated leadership. A few countries, such as Sweden, have attempted to minimise lockdowns and social distancing, with high infection rates and death rates – to the country’s regret.

Yet others are in complete denial with catastrophic outcomes, such as Brazil with 50,000 coronavirus deaths and no peak in sight.

In Malta, we have had (at the time of writing) less than a dozen deaths and a very low doubling rate. Locally, in February, even a 20 per cent population infection rate was calculated to overwhelm hospital services with potentially thousands of deaths.

The country prepared itself to the hilt – Mater Dei Hospital could care for an extra 600 (and even more) COVID patients and intensive care facilities for the very sick increased from 20 to 100. And yet, because of Malta’s low infection rate, these facilities were hardly touched. Why?

None of us wanted these countries’ disaster inflicted on our own vulnerable. Cooperation with our Public Health experts’ measures was near total

In February and March, we Maltese were aghast at the events unfolding in neighbouring Italy and in the UK and New York. Italian medical colleagues electrified us: “I’m a doctor in Italy. We have never seen anything like this.” Medical services were overwhelmed: “London hospitals facing ‘tsunami’ of patients.”

What happened? Malta’s lockdown was never an official total lockdown, unlike, for example, that imposed on the first viral epicentre, Wuhan in China. But crude modelling based on early (albeit not totally accurate data) produced frightening numbers, and seeing the disasters faced in badly affected countries led almost all of the country into a self-imposed lockdown, with empty streets.

None of us wanted these countries’ disaster inflicted on our own vulnerable. Cooperation with our Public Health experts’ measures was near total. Were the models for Malta wrong? According to the Sydney-based epidemiologist Professor Gideon Meyerowitz-Katz:

“Modelling cannot ever capture the truth, because that is not its purpose… We don’t categorise models into ‘right’ or ‘wrong’, because it’s a waste of time – they’re all going to be wrong to some degree… We can never fully realise the complexity of human experiences with even the most complex maths, because our inputs are confined to the things we know.

“Imagine trying to account for every single potential transmission of COVID-19, from the casual contact of two people on public transport to the lengthy exposure in a movie theatre. Even the best, most sophisticated models only take the first steps in the tangled web of interconnectivity that we call society… Models aren’t meant to predict the truth, they allow us to look at what might be.”

The benefit of models is that they can be used to provide a wide range of scenarios, from best case to worst case. Melbourne-based Professor Hassan Vally, an infectious disease epidemiologist, noted that “it’s important to understand that the models projected what would have happened if we did not act decisively.”

Back in February and March, it was also impossible to know how successful public health strategies could be. His comments pertaining to Australia apply equally well to Malta:

“It’s important to understand that the models projected what would have happened if we did not act decisively to limit the spread of COVID-19 in Australia, and so these give us an indication of what we averted. In many ways the model gave us a peek into a possible future for us. This is one of those situations where if you have any doubt as to what we prevented, you only need to look as far as US, Brazil, Italy or a number of other countries that have been severely affected to see what could have happened here…

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“Many lives have been saved… thanks to strong leadership, government listening to experts, and people making sacrifices for the good of the broader community.”

It is equally important, as restrictions are eased, to note in Vally’s own words: “This virus is still here, even though numbers are low, and there will be many disruptive things we need to continue for a while to keep it at bay.”

Victor Grech is a consultant paediatrician and Michael Borg is a consultant in hospital infection control.

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