“For the foreseeable future, we can expect COVID-19 numbers to go up and down in successive waves. This is what the experts, even internationally, are pointing towards,” says Prof. Charmaine Gauci, Superintendent of Public Health and an Associate Professor at the University of Malta.
Throughout an eye-opening hour-long conversation, Prof. Gauci made it clear that the best way to deal with the current reality is by adapting to it.
“We don’t know when a vaccine will become available, so we should adapt to this new way of living and accept it. If we don’t, it will be much harder.”
Before delving into the issue of vaccines, Prof. Gauci shares her assessment of the current reality, where, following days of no cases as well as very low numbers in July, the population was shocked by an overnight spike in the number of positive cases throughout August.
“What was worrying to me was the sudden upsurge,” states Prof Gauci. “At the very beginning, back in March, we started with imported cases and the contacts of these cases, and then we had community transmission.
“At that stage, we introduced strong mitigation measures and managed to reduce the spread within the community to a point where we had no reported cases for eight days. I say reported because surely there were some cases still out there in the community.”
Since reopening the airport and restarting the economy, which she states had to be done, numbers started going up again, but it was the steep increase – which peaked on 15th August with 72 new cases [a record now topped at 106 cases registered on 16th September] – that concerned the Superintendent.
“However, with the robust investigations that we do here, we identified the main clustering around potential sources, and we found that they were coming from parties and major events where large numbers of people gathered, especially youths.”
Prof. Gauci singles out youths – who she says even the World Health Organisation Director had alerted about, making this an issue not merely related to Malta – because “they are the ones who socialise most and, if I may say, their behaviour is harder to of higher risk, and acting on those areas.
She asserts that experts are pointing towards successive waves of cases, where numbers will continually go up and down. “Soon, University and schools will re-open, which will bring people together, and so we expect to see more cases.”
Prof. Gauci notes that many of the clusters reported in recent weeks originated from the workplace, making this a new area of attention.
In June, the Ministry for Health issued standards and guidelines for the workplace – namely keeping a physical distance of two metres between people, and the encouraging of frequent hand-washing and good personal hygiene – which Prof. Gauci states every employer should adhere to, because in doing so, they will contribute towards limiting the spread of the virus, but also safeguarding their own workforce and business.
“Having staff out on quarantine decreases productivity and impacts the work environment. When speaking to management and employees of companies that have been affected, we see that tension is high, and even those who are not affected become very apprehensive, which creates a problematic atmosphere at work,” says Prof. Gauci.
To this end, she asserts that, first and foremost, all companies should have a prevention strategy in place. But, in the instance that a team member tests positive for COVID-19, a lengthy procedure kicks off whereby the person is contacted by the COVID response case management team, who investigates the person in question, inquiring about symptoms, possible source of infection, and the people they were likely to expose.
The contact tracing team takes over to investigate the two days prior to the onset of symptoms and people exposed until the point of diagnosis. Those who were in close contact with the positive person are placed in mandatory quarantine and asked to get tested around the fifth day from exposure – which is the appropriate time needed for detecting the virus once exposed.
“We’ve developed good working relationships with Human Resources departments of companies with COVID-19 positive staff members.
“They help us with the risk assessment and, especially in the case of large companies, they help identify employees who might have been exposed. HR would know who was at work on specific days and the part of the office which might be impacted, and some HR teams have taken up the task of informing contacts to go into quarantine, while we book their tests.”
Prof. Gauci stresses that all companies are exposed to this risk, which is why preventive measures are crucial both to avoid infection and for business continuity. She also encourages that members of staff who are key to the company are kept apart from each other to minimise the impact on the company if one of them tests positive, as, while some work can be done via teleworking, other work cannot.
For many, the pandemic has ushered in an agonising kind of uncertainty, but what is certain, Prof. Gauci states, is that the way we work cannot go back to how it was before COVID-19. “The identification of different modes of working is important, such as working from home which has worked for many companies, and avoiding high-risk situations at work, such as get-togethers, which may lead to entire departments going away on quarantine, or worse, needing hospitalisation.”
With respect to a COVID-19 vaccine, Prof. Gauci plainly states that “it is very difficult to say” when it will be available.
“Vaccines go through three phases of clinical trials. There are vaccines in phase two and others in phase three. Malta has joined the European Commission for a procurement of a vaccine for member states, and there is already an agreement with a pharmaceutical company for the provision of this vaccine,” says the Superintendent.
From what we know, work is in progress on the licensing of this vaccine and its manufacturing, but an estimated date cannot be confirmed as yet. On a positive note, a lot of investment and money is going into the research, which has not happened with all vaccines. As absurd as it sounds, when the economy is hit hard, everyone is willing to invest money to get it back up again.”
Asked if the vaccine should be administered to the whole Maltese population, Prof. Gauci insists that indeed it should be, and in fact, that is what Government is catering for. Once available, the vaccine will first be given to priority persons who are more vulnerable due to the condition of their health, as well as essential workers who are frontline workers.
It will then be available to all the population. The speed with which COVID-19 vaccines have been developed has raised questions about their safety and effectiveness.
It took years for countless other vaccines to be developed, so should this be a cause for concern? Prof. Gauci says that for the European Medicines Agency to license a vaccine, specific criteria need to be followed and met, including passing all phases of the clinical trials.
“The evaluation of vaccines is extremely rigorous, and, as the COVID-19 vaccine will be rolled out to the whole population, one cannot afford to have a vaccine that isn’t safe, both in terms of the health consequences it can have on the public, and also because it won’t be taken up by the public if it causes major side effects.
“Therefore, the European Medicines Agency is fully focused on this and monitoring the phases of the clinical trials closely.”
A COVID-19 vaccine not only offers the security of preventing infection; it also gives hope of a return to normality.
But, as Prof. Gauci states, such a ‘return’ may not be clear cut. “Honestly, COVID has taught us many things, some of which I believe should remain, such as hygienic measures. In Australia, they’re reporting less cases of influenza than usual, which could be due to the non-pharmacological measures that are being adhered to. Changes to the way we work is another positive consequence – having online meetings, where possible, saves a lot of time in a day’s work.”
With the cooler months around the corner, and the impending arrival of flu season, Prof. Gauci says the Superintendence of Public Health is working on an influenza strategy with various other entities that maps out their response to the presence of both the flu and COVID-19 viruses, given the similarity of symptoms of both viruses.
The strategy includes a plan for testing, the mitigation measures needed, as well as treatment for both influenza and COVID-19. Despite this, however, she asserts that there’s no way of knowing what will happen, and can only hope for a similar scenario to Australia.
“We hope to have a greater uptake of the flu vaccine. In fact, we ordered 200,000 vaccines this year – twice as many as last year, and we encourage the vulnerable in particular to take it, meaning those who are over 55 and children under five years of age, people with chronic diseases and essential workers,” says Prof. Gauci.
“However, what we hope is that the measures of wearing masks and frequent hand washing, which are now ingrained in people’s minds, will reduce the spread of the usual seasonal viruses like flu. Of course, this depends a lot on people’s behaviour, and behaviour is not easy to predict.”
On a personal level, Prof. Gauci says that, although she has worked on contingency plans with her team for Avian flu, Ebola, and other infectious diseases, she never imagined she would have to prepare for a pandemic that would hit the globe so hard. “This is where my public health training fit in perfectly,” she states.
“The biggest challenge was to make sure we had enough human resources to deal with the surge in cases as the team that deals with infectious diseases is small, but the response of the public health COVID-19 team was amazing, and suddenly, there was an influx of public health specialists who stopped their usual work and joined our team. That was beautiful.”
Hundreds of workers are involved across several teams, namely the 111 helpline, swabbing centres, the case management team, contact tracing team, follow-up team, communications team, central coordination team, the data management team, enforcement team and a senior advisory team, who informs the Superintendent of the latest evidence-based developments going on around the globe.
Other entities within and outside of health are also doing their utmost in this extraordinary situation. “We’re like a large family,” she concludes, “and have supported each other through it all.”
This interview was first carried in the September edition of the Commercial Courier
Main Image:Charmaine Gauci - Superintendent of Public Health / Photos taken by Matthew Cutajar