When is a health emergency not a health emergency?

Today, on the other hand, we are facing a situation that (on paper, at any rate), appears to be much more volatile than anything we went through in the early phases of the crisis

The short answer, I suppose, would have to be: “When it’s not in the government’s interest to call it a health emergency, of course. When else?”

But while that does sum up the current situation rather neatly… it doesn’t address another bothersome little question that has been cropping up quite a lot recently: the one about who, within government, is actually calling all the shots when it comes to public health decisions.

Is it the same people who’ve been advising government ever since the COVID-19 pandemic was first declared in early March? And if so, then… um… why is the same government reacting so very differently to today’s scenario, than it did (so successfully, one might add) just a few short months ago?

Reason I ask is that… well, consider for a moment what Health Minister Chris Fearne said during Thursday’s press conference: “Malta’s success to control the pandemic in the previous months was the result of adequate social distancing measures, profuse testing and contact tracing, and immediate isolation of positive cases. […] We intend to keep this up.”

Naturally, he was referring to the (now universally-acknowledged) fact that Malta had indeed succeeded in keeping its local COVID-19 epidemic well under control, between March and July: so well, in fact, that we got agonisingly close to achieving a rate of zero active cases… until, that is, around this time last week (when it all came crashing back down to earth with a horrible thud).

As I recall, however, this same initial success – however short-lived it proved to be - was actually down to a good deal more than those few factors mentioned by Chris Fearne, above.

‘Social distancing’, ‘testing’, ‘tracing’, ‘isolation’, ‘quarantine’, etc… yes, all that certainly did help. But not by coincidence; and certainly not because of any innate self-discipline we may possess as a nation, either.

No: the way I remember it, people didn’t endure two whole months of isolation and social deprivation, just because their government had politely asked them to. There were, after all, a number of other restrictive measures put into in place between March and late June:  starting with the fact that the government itself declared an official public health emergency as early as 7 March – i.e., when the number of active cases stood at only three.

In so doing, government also handed over responsibility of the situation directly to the Superintendence of Public Health: invoking articles 14 and 27(c) of the Public Health Act, which decree (among a heck of a lot of other things) that:

> “The Superintendent may make, vary or revoke orders […] describing measures to guard against or to control dangerous epidemics or infectious disease” […]

> These measures may include [inter alia]: “regulating occupancy in premises or any parts thereof to  prevent  them  from  being  so overcrowded as to be dangerous to health”; as well as “such other action be taken as he may consider appropriate”, and lastly;

> “Any person who does not comply with any direction by the Superintendent given by virtue of this article shall be guilty of an offence against this Act.”

I need hardly add that the last proviso was by far the most crucial. The success alluded to by Faerne depended, in no small measure, upon his government’s ability to enforce health recommendations through legislation.

This same state of ‘public health emergency’ – declared at such an early stage in the crisis – paved the way to all the other subsequent restrictions and regulations introduced over the next few weeks: including the closure of the airports and harbour to all non-essential travel on 11 March.

The following day, government also announced the immediate closure of all schools, universities and child-care centres… a measure that was later extended to all restaurants, bars, cafes, hairdressers, retail outlets, kiosks, gyms, and so on.

There was also an immediate, overnight ban on all public gatherings of more than three people: including sports events, theatre, cinema, live music, religious feasts, and even picnics.

But it all started with that early recognition – back in the first week of March – that the situation was, in fact, an emergency; and it continued with drastic measures that could only ever be justified on the basis of an emergency.

So if people ended up dutifully following the health authorities’ instructions on the subject of social distancing – with such undeniably positive results for Malta’s struggle against COVID-19 – well, it was partly because they had no real choice in the matter.

With virtually all entertainment venues closed, and no bars or restaurants to even socialise in… it was almost impossible to get within three metres of anyone else anyway.

But that’s before factoring in the penalties. For none of these measures was in any way ‘voluntary’, you know. On 22 March, Chris Fearne himself announced that infringements of the new quarantine regulations would be liable to a €3,000 fine… which was later bumped up to €10,000.

Meanwhile, hardly a week went by without reports of random on-the-spot fines, handed down to anyone in groups of more than three… or who failed to observe the mandatory minimum distances while queuing at the vegetable van, or at an ATM.

Admittedly, his own government would go on to suggest the possibility of ‘refunding’ some of those fines through some form of ‘amnesty’... only to hastily retract the suggestion after a public outcry.

But both the idea of an amnesty, in itself - and also the irate popular reactions: mostly from people who argued (quite rightly) that it would ‘defeat the entire purpose of enforcement’ – also illustrate just how instrumental the role of enforceable regulations really proved, in the broader picture of Malta’s success against COVID-19 to date.

And… well, by now you will surely have worked out where all this is heading. ‘Restrictions’, ‘emergency legislation’, ‘enforcement’, ‘regulation’… these are all things that now seem totally absent from the same government’s strategy, when it comes to planning for a second wave that may already have started.

This brings me to the what is arguably the most surreal difference between the same government’s strategy today, and that of only four months ago (i.e., when we were, in Fearne’s own words, ‘successful’): the context.

In early March, we seemed to have been able to – in the first instance – recognise the possibility of a crisis, even before it started happening in earnest. Perhaps more importantly, though, government was also willing to take drastic action in the face of that emergency: even just by transferring legal jurisdiction to the health authorities, and agreeing to base its own health policies entirely on their recommendations.

Today, on the other hand, we are facing a situation that (on paper, at any rate), appears to be much more volatile than anything we went through in the early phases of the crisis.

In the space of just a few days, the total number of active cases has sky-rocketed from ‘almost nothing’ to 150… catapulting us right back to the scenario we were facing in early April (i.e., at the height of the ‘first wave’).

Unlike early April, however, this is also happening at a time when:

a) the airport has been reopened to multiple destinations – including some of the worst-hit regions of Europe;

b) Permits have been given for at least four major rave parties (or whatever they’re called these days) of the kind which collectively tend to attract tens of thousands of party-goers from all sorts of countries;

c) Government itself, through MTA, seems to be promoting said mass events;

d) All the above-mentioned regulations have been either relaxed (eg., mask-wearing at supermarkets), or removed altogether, and;

e) … without even entering the issue of how much of this recent spike is due to mass-event parties, or how much to large influxes of infected asylum-seekers…  well, we all heard it straight from the Prime Minister’s mouth, didn’t we?

Read his lips: ‘no emergency’. Which also means no need for any new restrictive measures; and certainly no penalties or fines, either.

Not only that: but he even told us that Malta is, and will continue to be, ‘open for business as usual’… even though, just a few months ago, the same Prime Minister had practically pulled the plug on the entire economy, at the very first hint of a possible epidemic.

I don’t know… it’s almost as though there was some kind of election in the meantime; and the government which proved so successful in handling the crisis last March, has somehow been replaced by an identical – albeit very different - clone of itself, while none of us were paying attention.

It might look the same; dress the same; act the same… yet suddenly, it seems to be pursuing not just a totally different public health strategy… but almost the clean opposite of all its own former policies.

You know: the ones that actually worked…

And this, I suppose, is perhaps the most bizarre aspect of this entire transformation act:  they still remain utterly convinced that it is possible to achieve the same successful solution to the same problem… only using a diametrically-opposed strategy.

But in any case: I can only hope, for all our own sakes, that they’re the ones who’ve got it right, in spite of everything… while everyone else – the doctors, nurses, virologists, epidemiologists, etc. (but not, of course, around four party-organisers, and maybe a couple of DJs) – is getting it all wrong…