Kintsugi is Japanese art in which broken ceramics are meticulously mended with a lacquer resin mixed with gold or silver. This turns broken objects into magnificent pieces of art. Well, let’s hope that this pandemic makes us stronger and even more resilient to change. And who knows? Maybe we will also see more medical students choose public health as career. In the meantime, Dr Ian Ellul catches u p with the Superintendent of Public Health Prof. Charmaine Gauci, who is also a Public Health Medicine Consultant, to d iscuss the current management of Covid-19.

DESCRIBE HOW YOUR FAMILY’S LIFE CHANGED DURING THESE LAST WEEKS SINCE COVID· 19 TREAD ED ON OUR SHORES?

I have been Superintendent of Public Health for the last three and a half years. Long hours have always been characteristic of my work, even in my previous role as Director of Health Promotion and Disease Prevention Directorate within the Superintendence of Public Health. Nonetheless, Covid-19 was a game changer. My hours of work had to stretch even more simply because the workload increased; I have to deal with different teams on a daily basis to arrive at informed decisions. My family feels part of this all and have been fully understanding and supportive. I am grateful for such a blessing.

WHAT ARE YOUR VIEWS ON THE FACT THAT IN THE INmAL PHASE, HEALTHCARE WORKERS WERE INADVERTENTLY IMPORTING THE DISEASE, AFTER TRAVELLING ABROAD, AND SPREADING IT TO COLLEAGUES?

Everyone has responsibilities. However, one must also understand that during those initial times nobody had a precise foresight of the infection trajectory which Malta would experience; presumably, back then, these healthcare professionals had not envisaged that going for commitments abroad, booked months before, would have resulted in infection and subsequent transmission. In keeping with this, even WHO dragged its feet in declaring Covid-19 as a public health emergency of international concern. I am not here to judge people. My role is to support anyone affected by any means during this pandemic and protect the Maltese nation. Fortunately for us Malta was prepared since we had been expecting this pandemic since December 2019. Our first cases got delayed and so we also managed to gain precious time to learn lessons from what was happening in other countries.

MEDIA HAS RECENTLY REPORTED THAT FIVE DAJLY CASES IN MALTA ARE EQUIVALENT TO 600 PATIENTS IN ITALY, CONSIDERING POPULATION SIZE. IS THIS CORRECT?

When comparing statistics, one must factor in the testing capacity. To data, when compared to Italy, Malta’s numbe r of tests per capita has been threefold. Our testing strategy has evolved gradually to become more comprehensive. Initially we tested symptomatic people who returned from abroad, then we included symptomatic people who d id not go abroad, ah:erwards we expanded testing to include other symptoms such as GI-related ones. Finally, we started doing outreaches to industry and to people who have contact with others, so as to maximize the chances of identifying asymptomatic carriers, including healthcare workers.

IN MAY MALTA PLEDGED €400K DURING THE EU-LED TELETHON WHICH RAISED $8BN TO DEVELOP COVJD-19 DIAGNOSTICS, TREATMENTS AND VACONES. DOES THtS GIVE MALTA PREFERENTIAL ACCESS TO THE VACCNE, WHEN AVAILABLE?

Countries did not have any direction on how much money is expected of them. However, obviously Malta pledged that amount to be part of the research framework, and ensure access to the vaccine for our nation when it is marketed.

THE GOVERNMENT IS PROCURING OVER 800 TONNES OF PPE AND NOW WE ALSO HEARD THAT A NUMBER OF LECTURE HALLS IN THE UNIVERSITY OF MALTA’S GATEWAY BUILDING ARE BEING CONVERTED INTO HOSPITAL FAC1LmES. ALL THIS IS OCCURRING IN PARALLEL TO EASING OF SANCTIONS. CAN YOU CLARIFY THIS?

The current situation is stable with a small number of cases ebbing and flowing. When one considers the total number of tests done per confirmed case, one realises that currently we have a lower number of positive cases when compared to the period when we started importing them from abroad, back in March. Currendy these cases include symptomatic as well as asymptomatic cases, with some cases being identified through contact tracing and enhanced testing. When we started relaxing measures which involved low and medium-risk areas, we were aware that this could herald an increase in infection transmission rates. Such decisions are always calculate-cl through and through, and are supported by ongoing risk assessments, with mitigation measures to limit Vol 9 2020 • Issue 03 possible increases in cases. We are constantly vigilant and if need be, we will re-introduce the restrictions as necessary. That is why the general population as well as businesses must heed the advice given on social distancing and prevention measures. We have always been prepared, through effective preparedness plans, a trained workforce, adequate PPE supplies and hospital facilities, and also, through the implementation of the latest evidence-based training protocols.

DURING A RECENT INTERVIEW WITH PROF. SANDRO GALEA. DEAN AT THE BOSTON UNIVERSITY SCHOOL OF PUBLIC HEALTH, US, WE DISCUSSED THE CONCEPT OF THE ‘HEALTHIEST GOLDFISH’. REGARDLESS OF THE MEDICINE WE CAN ACCESS OR OUR PERSONAL CHOICES ABOUT HEALTH, THE ‘WATER’ OF OUR DAILY LIVES – POLITICS, ENVIRONMENT, ECONOMY – ARE EQUALLY IMPORTANT FACTORS THAT SHAPE HEALTH. HOW DO YOU VIEW THE RELATIONSHIP BETWEEN POLITICS AND PUBLIC HEALTH DURING THIS PERIOD?

I strongly believe in good governance. I equally believe that the concept of common wealth of a nation and of its citizens should be top agenda of any government. I am a public health medicine specialist which means that I must equate the best interests of the individual person with that of the entire population. This entails considering the social and economic determinants of health. A person can only be healthy and have a good quality of life if one has access to basic education, adequate housing, is employed, has adequate income, and surrounded by a good environment In this pandemic one could have easily instructed everyone to stay indoors for a year or so until a vaccine is made available. However, is this good governance? Certainly not. The people and the nation as a whole need to move forward and adapt to a new normality, obviously through the implementation of robust risk management plans.

MALTA HAS BEEN A TRAILBLAZER IN MITIGATING THE EFFECTS OF THE PANDEMIC. WERE YOU EXPECTING THIS?

Our decisions have always been backed by fine-grained evidence-based protocols. In keeping with this, we have treaded prudently, with willingness to learn and adapt. Fortunately, our hard-working teams, largely composed of public health specialists, have e xceeded expectations in this regard. However, truth be told, we had to implement some pretty hard measures, at times risking backlash … it was not nice to have people telling you that since WWII, Malta has never shut schools. Nonetheless, we took decisions with great responsibility and we have consistently been open to public scrutiny; since the very beginning, we adopted a transparent approach, updating the Maltese population on a daily basis. Public health specialists, health professionals from all entities and other involved sectors were also all over the media to disseminate information.

APART FROM MALTA CAN YOU MENTION ONE OTHER COUNTRY THAT HAS BEEN EFFECTIVE IN MITIGATING THE EFFECTS OF COVID 19?

It is very difficult to compare countries since each has its own unique social fabric. Maltese people are accustomed to visit family or friends on a regular basis, going out on every weekend, etc. This scenario is very different to what is found in e.g. Nordic countries. This means that the mitigation measures implemented by specific countries have affected the social and economic d eterminants of health to a different degree of others. Thus, a direct comparison is very challenging.

ANY LESSONS LEARNT FROM MISTAKES POSSIBLY DONE IN MALTA DURING THIS PERIOD?

Our Public Health Covid-19 Response Team boasts a flat organization. There are d ifferent teams dedicated in the management of the helpline, swabbing, case manageme nt, communications, contact tracing, data management and statistics, patient discharge, transition team and e pidemic intelligence. We meet frequently to discuss all forms of strategic actions. We also have a central management team as well as a senior advisory team which takes high level decisions. Data is collated in a central repository – Go.Data – which is an outbreak investigation tool manged by WHO and utilised for field data collection during public health emergencies. It was initially used for Ebola, and Malta, together with other countries, has adapted it for Covid-19. All this gives us peace of mind that any possible shortcomings which are identified, are handled responsibly and in a timely manner by our response team.

YOUR MOST DIFFICULT MOMENT DURING THIS PERIOD?

Giving news relating to deaths. Deaths which are avoidable are ultimately always difficult to confront.

COVID-19 CERTAINLY PROVIDED TAILWIND FOR TELEMEDICINE AND ECME. WHAT ARE YOUR VIEWS ON THIS?

I agree perfectly. In keeping with what you are saying, primary care physicians follow Covid-19 cases that remain in community through telemedicine. Also, speaking for myself, I have days which are jam-packed with o n line meetings, back-to-back. How could this be possible if I had to travel back and forth between meeting venues? Although I miss human interaction, I strongly believe that some concepts are here to stay.

HOW DO YOU ENVISAGE YOURSELF IN 10 YEARS TIME?

I love what I do. My career revolves around the wide aspect of public health, and specialized further in infectious diseases epidemiology where I also read a PhD on this subject. Nonetheless, I will embrace any path which life chooses for me.

I READ THESYNAPSE MEDICAL JOURNAL BECAUSE …

The Synapse is a platform that I access regularly as I consider it as a reliable source of evidence-based information. I have the peace of mind that I can use The Synapse in my work as public health specialist and share its content with colleagues. Stay Healthy & Safe!