Let me start this article by declaring myself as a non-health expert. I’m more of the managerial no nonsense guy, but due to my recent past experiences I believe I know more about health systems today than I knew a few years back.
The COVID-19 restrictions debacle is heating up. This item will be on the agenda of many governments across the world for the foreseeable future.
The pressures will be huge. New political risks as never experienced before are here to stay, with room for error being close to nil. Literally, a life and death situation. Policy U-turns will be the new norm. Predictive forecasting is the new Chernobyl. Volatility is the name of the game.
Back at the beginning of March, Malta diagnosed its first COVID-19 patients.
The administration justifiably ramped up its efforts to protect the nation from a meltdown experienced by other, bigger, much stronger, nations. Health systems were aligned to focus on this new reality, schools were shuttered, restrictions to protect the most vulnerable went in uncontested.
New work-from-home policies were efficiently applied by many. All ports were subsequently closed, the natural borders we’re surrounded with helped in no small way to make this measure doubly effective.
Large sectors of the economy ground to a halt. With all this in place there were others, not necessarily in their senses, asking for more. Lockdown was the new buzzword.
Evidence-based decision-making was another victim of COVID-19.
These decisions were generally meant to protect the most vulnerable from being exposed to this new virus and to avoid health systems from becoming overwhelmed. The now world-famous 'tsunami vs river' figurative quote by Health Minister Chris Fearne will surely go down into the history annals.
There was no way to stop the virus, just its spread. This was clear from the very start. A virus whose nature we know so little about. And as with anything unknown, panic and fear abounded.
We surely can’t afford to keep everyone closed- Ivan Falzon
Many real leaders did their utmost to apply what was known till then to bring stability, peace of mind and workable solutions. The public cooperated, ignoring the few voices in the wild that were ready to jump at the first opportunity to exploit the fragility of the moment.
Two months down the line, we know for a fact that health systems were protected. The added ad hoc facilities put in place and manned so efficiently by many unknown masked heroes were fortunately generally unused. The added costly equipment flown directly from around the world was parked in empty wards, near unutilised beds. So be it. National mortality rates remained stable.
One can go in a never ending argument about why some deaths were tagged as COVID-related when other more serious conditions were present.
This happened elsewhere too. Reporting is never easy, more so in these strenuous times. Each death, out of the six registered, got the exclusive treatment by our media houses. God forbid every influenza-triggered death gets the same attention come January. Again, this happened elsewhere too. With hindsight, one can argue that some of the restrictions and preparation measures applied went overboard, but as they say, hindsight is 20/20.
That brings us to the now. Today we’re experiencing a collective administrative effort to reverse many of the restrictions that were applied. We surely can’t afford to keep everyone closed, everyone getting a standard government allowance forever, for staying in bed. But there are some that believe otherwise. They believe that with this new virus we should all get a Mr Wilson and cast ourselves away. If we’re trusting the authorities to resume non-life threatening non-essential medical procedures, why are we then not trusting those same authorities to gradually open up sectors of the economy that are essential to prop up those same health services?
Which world are we living in? Where do we believe we will get all the money to support the services we’re so proud to offer as a nation? How do you think Malta trebled its health budget, from €250 million to €700 million in the last decade? Estimates for this year, including ad hoc measures mentioned above will push that figure closer to a billion euro.
History teaches us a lesson here. In periods of great difficulty, our forefathers protected the most vulnerable and they went out to war, to work, to fight the enemy from overwhelming the country. Back then there were still the few that were preaching, raising the white flag as the viable alternative, the easier option.
But Malta didn’t get the gallantry and ‘Nurse of the Mediterranean’ accolades by staying home, safe in our shelters. Our fathers left behind their dearest and most vulnerable and doubled their efforts to regain normality, in some cases building whole countries from scratch.
Decades later, we remember the fallen, the ones who fought in the interest of the many, not the ones who deserted and protected themselves.
The “it is better to live one day as a lion than 100 years as a sheep” apparently uttered by Mussolini comes to mind.
Today, we should have enough data to map a more robust way forward, to be better prepared, to put more light on the unknown and the many attached variables. Early numbers of diagnosed COVID-19 patients indicate that 80 per cent of such patients do not require acute hospitalisation, 15 per cent require it and five per cent require high dependency or intensive treatment admissions.
With this data in hand, one can build workable models that will compare the nation’s COVID-19 specific assigned capacity against admission rates, active infective cases and hospital length of stays.
Once we have that, the public should be informed about what is acceptable and what’s not in terms of numbers, and a defined escalation plan to follow based on science and never on the opinion of individuals or groups with specific interests. Erring on the side of caution is never a bad thing in such scenarios.
Managing of peaks and transmission rates remains key throughout. Better face an outbreak in a summer devoid of tourists and activities than in winter with services creaking under normal seasonal pressures.
Discipline in what we do is imperative, there is no post-COVID-19 world. I hasten to add that not even a vaccine will solve this issue from the word ‘go’.
We need to learn to live anew but live we must.
We need to trust the people that repeatedly put our collective interest first, a prime minister that performs best when under pressure, surrounded by a team that despite the difficulties, despite the adversity is not weary of ‘war’.
We owe it to our children, to our future generations to prevail. This virus will not break us. I’d rather be a lion.
* The E in title is for economy… the H is for… you guessed it.
Ivan Falzon is Water Services Corporation CEO and former Mater Dei Hospital CEO.