Martin Balzan | Fools rush in where angels fear to tread

The Medical Association of Malta is threatening industrial action unless government bans all mass-gatherings, in the light of a recent upsurge in COVID-19 cases. But as MAM chairman Dr MARTIN BALZAN argues, there is more than just a few rave parties at stake

For some time now, there has been talk of a ‘second wave’ of COVID-19 cases. Prime Minister Robert Abela had famously dismissed this notion, claiming that waves are found ‘in the sea’. Have recent events proved him wrong? Is this the second wave already with us?

I wouldn’t say that we are in a ‘second wave’, no. Let me explain: we are a small country. Because of the size of our population, and the prevalence of the disease, the graph here is not going to be a straight line. It will not be the same as larger countries such as the USA or Germany, where there was a steep, steady upward curve. Here, it will be more like a number of ‘bumps’. And by the look of things, we are in for a very bumpy ride.

So rather than a ‘wave’, we expect to have a series of ‘clusters’: for example, a batch of 22 cases one day; followed by another of 15; then a smaller group of seven cases; then another large cluster of 30, and so on.

Now: as MAM, we have acknowledged that you have to strike a balance between keeping the economy going, and protecting public health. But where do you strike this balance? Our position is that, when we re-opened the airport, we could have asked for swabbing tests to be carried out on passengers before departure; and rather than promoting large mass events attracting revellers, we should have promoted Malta as ‘the safe island’: where everybody is screened.

This way, we could at least minimise the number of new cases. There will still always be a few, mind you. But it’s the difference between stubbing out a cigarette, and extinguishing a bonfire.

If the numbers are big, it overwhelms your firefighting capabilities. And what are our fighting capabilities? We have a system of tracking and tracing. You call 111; you get tested; if you’re OK, fine; if not, you have to be isolated.

But then, there’s also contact tracing.

Take the recent hotel party, for instance. If it was attended by 700 people, you have to also trace all the people they were in contact with. Multiplied by 10 – for argument’s sake – and those 700 become 7,000.

And right now, our swabbing capacity is around 1,000 a day… though Health Minister Fearne has now said it will be increased.

So if a party attended by 700 can have such an effect… what’s going to happen when we host parties attracting 20,000 or more?

At the same time, however, government also argues that Malta’s health system is already prepared to handle a resurgence… just as it was when it came to successfully controlling the first outbreak in March. Are you suggesting, then, that we’re not as well-prepared as we’d like to think?

We are prepared, yes… but not if we do crazy things. We are prepared only insofar as the decisions we take are logical. It is one thing to allow events such as Mass to go ahead, with proper social distancing measures in place… because, yes, there’s still a risk – there always is – but it’s limited. The risk has been mitigated by other factors.

In the present circumstances, however, the Prime Minister has taken the attitude of ‘business as usual’… as though COVID-19 is dead. But no: it is not dead.

In other countries – including Italy, which has a reputation for being ‘undisciplined’ – you will not see one politician or civil society attending a meeting, or addressing a press conference, without wearing a mask.

They accept that you can go out; but if you don’t wear a mask, you will be fined.

Here in Malta, we’re doing the opposite. On one hand, government is giving the false impression that the emergency is over; and on the other, it has also removed all the enforcement measures. But that is precisely what the virus wants. It preys on human weakness…

In its press statement, MAM suggested that government may have been swayed by pressure from lobby-groups (in this case, presumably, party-organisers). Would you say that government is in denial about the severity of COVID-19… or that it is deliberately trying to minimise the danger, to appease business interests?

I personally think that the government’s overall intention, to support local businesses, is in itself good. It is the method that is wrong… because they are not following common sense, or expert advice.

All the same, I wouldn’t say that government is ‘in denial’. It’s more about spin. All politicians try to spin reality to match voters’ expectations. That’s politics. And it normally works… but not with disease.

First of all, it is unethical, from a medical point of view, to be untruthful about the situation. As doctors, we are obliged to tell our patients the truth. We might tell it gently, or slowly; but we can’t lie outright to our patients.

Secondly, the tactic can’t work with a virus. Disease calls your bluff. Epidemics can’t be hidden…especially epidemics which land people in intensive care, and cause deaths…

But government is not exactly hiding the figures; and as far as I’m aware there has been no attempt to cover up the extent of the epidemic…

The cardinal mistake is that we have decided that the emergency is over. And it was understandable, during those two weeks when we had no new cases at all. Back then, it made sense to relax the restrictions. But not now.

For example: over the past week, two boatloads of immigrants were rescued and brought to Malta. Now, I have nothing against immigrants myself; I can see the humanitarian side of the crisis. But as the test results indicate: over two-thirds of them have COVID-19. It’s not the government’s fault, naturally… but it’s still an emergency.

Likewise, when 700 attend a weekend party, and 14 of them test positive… not to mention all the contact-tracing that now has to be done – that’s an emergency.

And yet, while the numbers are back at April levels, MAM is only demanding the cancellation of a number of organised mass-events. By your own argument, however: shouldn’t we also go back to the same health measures that were in force at the height of the crisis?

MAM is not, at this stage, recommending another lockdown, no. What we are demanding is that we maintain a proper balance between public health, and the need to re-open the economy.

We had managed to reach a successful balance before this point: by re-opening travel channels only to safe countries; and by relaxing the lockdown, so as to let the economy breathe.

But what are we doing today? We have opened up to high-risk countries; and we are now encouraging mass events: something which no other country has done. It’s a classic case of ‘fools rush in where angels fear to tread’.

Meanwhile, there also seem to be divergent opinions between Health Minister Fearne – who has hinted at new restrictions – and Tourism Minister Julia Farrugia Portelli, who is resisting cancellation of the events in question. How do you interpret these contradictions?

First of all, I am all in favour of internal discussion within political parties. This is not – or shouldn’t be – a dictatorship, where the only thing that matters is ‘what the party leader says’, full-stop. It would be undemocratic for people within a political party, or government, to be unable to voice their own opinion.

So to me, the fact that there are divergent opinions within Cabinet, or the Opposition party… that’s a good thing. It’s healthy, and it should be taken as the norm.

In this case, however: it is very clear that Julia Farrugia Portelli is wrong. And besides: Chris Fearne is the Health Minister. As such, the Superintendence of Public Health advises him…

So the Health Minister’s opinion should override that of the Tourism Minister?

If not Fearne’s opinion… then that of Charmaine Gauci’s team. Those are, after all, the people who are trained in public health and epidemiology. They are the ones with the scientific training, specifically when it comes to how to deal with an epidemic…

Unfortunately, however, in this case the Maltese government is not listening to the experts; and it’s not listening to the social partners, either. Because it’s not just the health authorities who have urged the cancellation of mass events… but also the Malta Employers’ Association, among others…

Coming back to the issue at hand: by threatening industrial action, MAM has also invited criticism for ‘overreacting to the situation’. Some argue that the threat itself is excessive; others question why patients should be the ones to suffer. How do you respond to such criticism?

Let’s start with the obvious: as you yourself said, the numbers are back at the levels of last April. So what we are demanding is that we return to the same set-up we had in April… not in the sense of a lockdown, for all the reasons I’ve already explained; but in terms of medical practices.

Ultimately, we are killing two birds with one stone. On one level, we are simply protecting our members. Until recently, we had a procedure whereby patients could not simply walk into Mater Dei. They first had to get screened, and then placed into a transitional area until they were deemed safe enough to transfer toa normal ward. Meanwhile, outpatient and non-essential services were stopped… because we needed more hospital space.

You need space to deal with this kind of situation in a hospital. Otherwise, you’ll end up with people who don’t have COVID-19, getting it from other patients in hospital. And we can’t afford to allow that to happen.

So we’re not only protecting our own members – the medical practitioners who are on the front line – but also patients.

I’m not questioning your intentions; but rather, the method. Isn’t it excessive to resort to strike action, at this stage?

As I already explained: the government is not listening to expert advice. Now: as a union, you have to use the tools that are available to you in those circumstances. First, you use persuasion; but when that doesn’t work… [shrugs].

In my opinion – and this counts for all governments, not just the present – the real opposition, in any country, is actually provided by the unions, not political parties. Because only unions can issue directives. Opposition parties can’t do anything of the sort.

Ultimately, then, what we are trying to do is open the government’s eyes to the fact that its own actions are harmful: not just to public health, but even to the economy. First, we declared that there’s no emergency; then we encouraged complacency among the public; we removed enforcement; we let in tourists from high-risk countries… and now, we’re promoting Malta as a destination for mass-parties.

This, I would say, is ’excessive’… not the demands we are making as a union.

Do you expect government to backtrack? [Note: this interview was carried out before the cancellation of events on Saturday]

It’s not a question of ‘backtracking’. What I expect is for common sense and scientific advice to prevail. Now: If I were confident this was going to happen, we wouldn’t be threatening industrial action at this stage… nor would be we very prepared to do it.

Because the issue is real; the public concern is real; and we therefore feel we are justified in our actions. All the same, however: we are still leaving the door open to negotiations. But if negotiations fail… what options do we have left?