100 days later: how Malta successfully contained the coronavirus

Malta’s response to COVID-19 was one of the most effective, held by the WHO as the standard in health strategies, but also aided by its small, city-state population, a strong rallying call for unity, and economic fundamentals in place

Politics: Rallying behind the leader
James Debono

In a time of crisis people tend to look up to their leaders to offer them a sense of security. A previous MaltaToday survey showed Abela getting a record trust rating of 62% in April. The latest surveys showed Labour in government surpassing the 51% mark in absolute terms (without excluding don’t knows and non-voters).

The government reaped the fruits of an effective health strategy, which has not only contained infection rates but also paved the way for an incremental lifting of measures. Reality vindicated the government’s choice not to go for a total lockdown as initially proposed by the Opposition, which at first was shooting from the hip before rallying behind a national consensus informed by expert opinion.

The health crisis catapulted Public Health Superintendent Charmaine Gauci (left) to the national stage. She distinguished herself as the reassuring face of Malta’s front-line health defence
The health crisis catapulted Public Health Superintendent Charmaine Gauci (left) to the national stage. She distinguished herself as the reassuring face of Malta’s front-line health defence

But the successful health strategy comes as a mixed blessing for Robert Abela, as he now finds himself having to contend with Chris Fearne, a widely trusted Deputy Prime Minister whose health portfolio catapulted him back to the national stage. And while Fearne and Abela were in the same boat when it comes to the imposition and lifting of measures, Fearne came out as more statesmanlike and cautious, while Abela seemed more prone to Trumpian gaffes in his eagerness for a return to normality.

Fearne’s handling of the coronavirus crisis has earned him top marks across the board with 91.4% giving him a high score in a MaltaToday survey. The deputy PM received high marks from Nationalist and Labourite voters alike – 86.2% of PN voters gave Fearne a high score and 96.4% of PL voters did likewise. Yet Abela’s more optimistic tone may have struck a chord not just with business lobbies but also with a working-class constituency which, unsheltered by domestic comforts, was just as eager to return back to normality in its daily struggle to make ends meet.

Moreover, the attempt to score political points by pushing the migration button has returned to haunt Abela following the Captain Morgan fiasco. Abela showed certain subservience to strong lobbies like the hunters by opening the season right in the middle of the health crisis. The lockdown of the courts even shielded the government from damning evidence from the middlemen’s testimony and recordings in the Daphne Caruana Galizia assassination case.

Michael Borg, head of the Infectious Diseases Unit, was part of a cadre of health experts in whom the nation had full faith
Michael Borg, head of the Infectious Diseases Unit, was part of a cadre of health experts in whom the nation had full faith

But the return to normality also means Abela is expected to deliver on police reforms which clear the way for an investigation on key political figures of the Muscat era. Failure could spur a new wave of protests and inevitably raise questions in international circles, where Malta’s reputation has nose-dived again from the bad faith diplomacy of the Captain Morgan stand-off.

Abela has still maintained a feel-good factor with a stimulus budget aimed at restoring consumer spending, albeit one too focused on restoring business confidence than addressing inequality. The rush for a quick recovery could expose contradictions within Labour on land use issues. It’s a gamble on a quick recovery but which may hit a snag if a second COVID-19 wave does hit Malta. If this does happen, his inane comment of only seeing waves in the sea will come back to haunt him.

Health: A nation’s pride
James Debono

Malta’s national health system, a product of Dom Mintoff’s brand of socialism and the introduction of national insurance in the 1970s, was resilient and effective in containing the fight-back against the virus, also thanks to the sacrifices of front-liners and a large number of foreign nurses and health workers. The healthcare system benefitted from the financial surplus which permitted government to boost health expenditure by €30 million, which ensured increased investment in valuable equipment like ventilators, something which may come handy if there is a second wave.

On a global level, the response to the pandemic vindicated the wisdom of having a nationalised, tax-funded health system like Malta’s, which are not dominated by profit logic, something that contrasted with the messier response in countries with privatised health systems like the USA. Had the pandemic not been effectively contained, the only hiccup would have been the privatisation of valuable hospital space at St Luke’s.

The pandemic is likely to arrest public-private partnerships which were partly responsible for the less effective response in hotspots like the Lombardy region in Italy. The health crisis also catapulted Public Health Superintendent Charmaine Gauci to the national stage. She distinguished herself as the reassuring face of Malta’s front-line health defence. Her assertive and calm delivery gave the country an institutional reference point; her non-political role as a public health professional was a breath of fresh air for a country where politicians appropriate most of the airtime. Gauci’s confident and professional response to questions from media, and her focused message, also ensured wide compliance to health restrictions.

Overall, the pandemic reinforced people’s faith in medical science and may have further immunised the country from Facebook conspiracy theorists on themes like vaccination. But it also curtailed the freedom of movement of women seeking abortion abroad, highlighting the country’s shortcomings on reproductive health, reinforcing the need for safe abortion to be provided in the national health care system.

The pandemic could also have even more lasting consequences on health promotion measures. The ban on smoking at outdoor tables, introduced as restaurants had to shift more of their tables outside, may well outlast the pandemic. It may also be hard to roll back the additional tables mushrooming on pavements, undermining the quality of life of the elderly, disabled and people with mobility problems.

The pandemic also reinforced the need for more effective mental health services and psychological support for people experiencing anxiety in their daily lives. The provision of a number of hours for psychological support for employees may become more common in more workplaces, and the shift to online counselling and support could outlast the pandemic.

What a well-behaved lot... people wearing face visors
What a well-behaved lot... people wearing face visors

History: Lessons from the 1915 Spanish Flu
James Debono

Valuable lessons from history particularly during the Spanish Flu pandemic informed the choices made by today’s administrators. Past pandemics were vital in the emergence of a robust public health bureaucracy which remained intact from British times onwards.

Compliance to health directives may stem from the draconian impositions imposed by Sir Thomas Maitland, who governed Malta during the plague outbreak in 1813 which saw the British fencing off entire villages, something which the recent cordoning of the Hal Far open centre is reminiscent of. But Maitland’s directives also went as far as shooting to kill plague victims who tried to conceal their infection.

Hardened and informed by past experience in dealing with bouts of plague, Malta registered the lowest death rate across all of Europe during the Spanish flu pandemic of 1918. Only eight per cent of the population was struck by the deadly and infectious bout of H1N1 strain flu between 1918 and 1919, compared to 23% of the UK. By the end of the pandemic, Malta lost 0.3 per cent of its population, compared to Samoa’s 20%, Italy’s 1.3% and Great Britain’s 0.6%. Key to Malta’s success was a widespread awareness campaign and rigorous quarantine that ensured the island suffered the smallest number of casualties.

At the time of the Spanish Flu, the chief government medical officer, Attilio Critien, sent a leaflet in every household warning people about complications and ways to ensure the pandemic did not spread. Among other things he advised people not to spit on the floor or in the street asked people and to stay away from work and crowded places.

The Acting Chief Government Medical Officer Albert Bernard also recommended that schools remain closed to control the spread of the Spanish Flu. The Governor also ordered that every cinema and place of entertainment to keep all premises clean and thoroughly ventilated; not to exceed maximum capacity to prevent overcrowding; to have the place disinfected at least once daily; that all schools be kept clean and ventilated; and that the Superintendent for Public Health be given powers to close down any such premises that is not kept clean.

Valuable lessons from history particularly during the Spanish Flu pandemic informed the choices made by today’s administrators
Valuable lessons from history particularly during the Spanish Flu pandemic informed the choices made by today’s administrators

Economy: Testing the limits of prudence
Kurt Sansone

Unlike the rest of the Eurozone, Malta’s economy remained with its head above the water in the first three months despite COVID-19’s shock impact.

Figures released by the National Statistics Office last month showed how the economy grew by 0.5% in the first quarter. The growth is a far cry from what the country had been experiencing but given the exceptional circumstances created by the pandemic, it signalled resilience.

When the pandemic reached Malta’s shores in the second week of March, non-essential retail outlets were shut down, schools closed and public gatherings effectively banned. But it was the closure of all overseas travel that had a major impact because it starved the country of important export cash from tourism. The economy stalled, workers were placed on shorter work weeks, some lost their jobs, and many businesses unaffected by forced closures experienced lower incomes.

Government’s first reaction to the economic crisis came on 18 March, when it announced a package made up primarily of tax deferrals and loan guarantees to help maintain business liquidity.

The first package was greeted with scepticism. Companies asked for more direct support to help them sustain wages in a situation where income dried up suddenly. Government responded a week later by introducing a wage supplement of €800 per employee per month for the hardest hit sectors.

All the while, it resisted calls from some quarters to shut factories and stop construction work. The former allowed the country to continue tapping export cash and the latter kept many people in employment, even at the risk of inconveniencing residents who were asked to remain indoors.

When restrictions were lifted with limitations, the government unveiled a recovery package to stimulate consumption and mitigate business costs for the next three months. One notable absence from the package was a lack of funds to attract tourism. All measures will be financed domestically through government bonds.

Malta also entered the crisis with a debt-to-GDP ratio of just over 40%, an improvement over the 70% plus debt the country faced in 2013. This allowed the government enough room to manoeuvre comfortably.

There is still more firepower available, including the passport cash wealth fund. The government has so far resisted using the full arsenal, arguing for prudence to safeguard public finances.

Yet, as the world navigates uncharted waters, the limits of prudence will continue being tested severely.

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