Lockdown now or later? Maltese professor’s graphs are why we have to trust public health experts

Take it from Prof. Victor Grech, who helps run the paediatric cardiology services at Mater Dei Hospital and is also a researcher with an interest in epidemiology: “our public health colleagues are guiding us to the necessary steps,” says the health expert on the COVID-19 outbreak and Malta’s precautions to contain the virulent spread.

In a blogpost where he posted the data on the coronavirus, Prof. Grech explained why an early lockdown, as is being demanded by unions as well as the Nationalist Party, could be premature and even lead to a secondary spike in infections.

In a series of graphs, Prof. Grech presents the data of what is happening, or what will happen in Malta in the coming weeks and months.

With a Maltese population is circa 500,000 and assuming an infection rate of only 20%, 100,000 people will become infected.

14% of that is 14,000 admissions to hospital. 5% of 100,000 requiring intensive care equals 5,000 ICU admissions.

2% mortality equals 2,000 deaths. By comparison, annual seasonal influenza has a mortality of about 0.1%.

“If we manage to contain the spread so that ‘only’ 100,000 are infected over the course of 14 weeks, this equals 1,000 admissions a week and 350 intensive care admissions a week. The system will struggle desperately to cope.

“If the infection rate is double (40%), with 200,000 infections: double the numbers above. If the infection rate is triple (60%, not inconceivable): triple the numbers above. There is no way that any healthcare system can prepare well in advance for this onslaught - but we are doing our best.”

Sounds stark.

But in one graph, Prof. Grech says that whatever the eventual number infected, if this number is spread out over months (grey hill) instead of weeks (pink mountain), the hospital may be able to cope. “Our public health colleagues are guiding us to the necessary steps,” he says.

So what about an official lockdown? This is how Prof. Grech breaks it down.

“The red curve represents an uncontrolled epidemic. This is what we must avoid. “The green curve is the ideal curve. Social distancing and other measures as described below help.

“The blue curve represents a prematurely halted disease spread. Disease spread is inevitable until a vaccine is available. Excessive measures early on may lead to a resurgence, i.e. a second and higher spike in infections.

“In any case, the public has responded with extensive and self-imposed social-distancing measures. Many establishments have self-imposed a lockdown. The timing of any official lockdown should be left to our expert public health physicians.

“My colleagues in the Health Department have rallied magnificently. Supplies have been procured (no expenses spared), staff have been trained and prepared and contingencies have been planned. Several areas have been prepared so as to provide additional bed space, including corridors and medical school.” 

Prof. Grech once again reiterated the importance of social distancing. “Avoid gatherings. If you have to be around others, keep 2m between you when possible. These measures will slow down the rate of spread of the epidemic. The best is not to socialise and to keep your distance. And wash your hands. Soap and water probably better than alcohol. Cough into your elbow. Do not touch your face.”

And lastly, though most importantly, Prof. Grech has reminded people to heed medical advice, “not social media advice.”