After dealing with the first wave of Covid-19 cases and coming very close to eliminating community transmission, the virus has returned with a vengeance. Cases are again increasing exponentially, and this time at a faster rate.

And it is the Prime Minister who is to blame. It was he who sabotaged his own health minister (but party rival) and the Superintendent of Public Health at every turn. It was he who lulled the Maltese into a false sense of security. It was he who almost seemed to have dismissed the existence of a pandemic and the severe repercussions it can have on individual people's health, paying only lip service to the sterling work done by all healthcare professionals.

Instead of heeding sound scientific advice that would have allowed for a gradual, steady but certain re-opening of the economy, Prime Minister Robert Abela and his coterie of nincompoops buckled under the pressure of big business, and not only removed all restrictions but went a step further: to promote Malta as a destination for mass parties, replacing Ibiza.

How short-sighted can one be?

And look at us now: hitting the international headlines once again, not on money laundering, fraud or financial crime this time, but as an exporter of COVID-19 cases to the rest of Europe. The result? Countries are re-imposing quarantine periods or requesting swab tests on passengers returning or travelling from Malta, and a whole marketing campaign up in flames. The strategy has spectacularly backfired.

So much for Julia's imaginary mechanisms.

To further aggravate matters, Abela has already made it amply clear that the "economy will remain open". He has no intention whatsoever to shut down commercial activity, come what may. And now that he has made such premature and uncalled for statements, it's not only a matter of economic policy, but of saving face too. It doesn't seem to occur to him that the country is bleeding dry anyway from the number of people who are being put into quarantine and the medical attention they're requiring. 

He insists that hospital admissions from Covid-19 are low, which is true. But that of course completely ignores the fact that the increase in the number of hospital admissions follows the increase in the number of cases. This statement of his does beg the question, however: is that the metric Abela intends to use for him to act decisively? A health system stretched to its limit with Covid-19?

If yes, then it's probably the first time in history Malta had such an irresponsible Prime Minister, ready to sacrifice the health of tens of people for the short term material gain of the few.

Now let us have a closer look at what is going on and the several questions which remain hanging in the air.

Prevention

Social distancing and wearing masks remain the most effective strategies in preventing the acquisition and transmission of SARS-COV2. How is the government planning to enforce these measures in bars and clubs when it cannot even control what is happening in the streets of Paceville? Live footage circulating on Facebook over last weekend shows crowded roads with no social distancing and no police controlling and separating crowds. Do the police have legal powers to stop crowding outside establishments?

Testing 

Two new testing hubs are set to open in Qormi and Burmarrad this week. These will help to reduce the waiting time for a SARS-COV2 test. But we must look beyond the waiting time to get a test. During the first wave, podologists and dentists working for the government were deployed to the swabbing centres. Private professionals were also employed for three months to meet the demand for tests. Can the Minister for Health assure us that the swabbing centres will be operated by professionals who have been well-trained in taking the swabs? 

The tests need to be processed by our single medical laboratory at Mater Dei. The daily target is 1,500 with a capacity of 2,000. As is, the lab can process up to 2,500 tests in a day. In last Friday's press conference, the Deputy Prime Minister and Minister for Health Chris Fearne said that eight lab scientists have recently joined the existing team.

How does this affect other PCR tests required for other health conditions, including, but obviously not limited to, sexually transmitted infections? Are there caps in place on other PCR tests, in order to maintain such a high output of SARS-CoV-2 tests? Will testing for one disease inadvertently cause a pandemic from a different disease?

Contact tracing 

Once the tests are processed, details of individuals who tested positive are sent to the Infectious Disease Prevention and Control Unit (IDPCU). It's here that the most laborious Public Health task takes place. 

Contract testing has time and time again been proven to be hugely successful in containing the transmission of the virus. Trained individuals call the persons who tested positive and ask them to take them through the activities they engaged in the days before receiving a positive test. They must then perform a risk assessment of the activities, map the contacts and the likelihood that they have been exposed to the virus. 

An individual may, say, have been to work, the gym, out for dinner and to a party. In such a scenario, the number of contacts that individual would have had can be quite high.

Imagine the number of contacts an average individual may have and multiply that figure by the daily new positive cases. Up to early last week, the calls and paperwork were being conducted by four people. 

Tests and patients in Gozo 

The daily figures on the 'Saħħa' Facebook page are aggregate. They do not show the number of tests per hub or the location of positive cases. They certainly do no differentiate between Malta and Gozo. Frankly, the virus does not care if you live in Gozo or in Malta and unlike Santa; it does not care if you have been naughty or nice.

Knowing the number of tests being conducted in Gozo is essential if we want to keep a tab on the spread of the virus in Gozo. The more tests we do in Gozo, the more cases we will detect and can put in isolation and quarantine preventing further spread. 

Knowing how many people are living with the virus on the island will also stop the misinformation that goes around social media. It would also stop Gozo Minister Clint Camilleri from having to write Facebook posts denying the number of positive cases in Gozo but without giving the number of positive cases. 

For the public health's sanity and public health can the data be split? 

Prefabricated Hospitals

On May 17th, Prime Minister Robert Abela said that the idea to build a prefabricated hospital in the grounds of Mater Dei was scrapped. The number of cases back then was dramatically lower than it is now. Less than three months later, the numbers are what they are. 

Does Mater Dei have the capacity and resources to meet the possible increase in the number of hospitalised patients? Are prefabricated hospitals back on the table? When is the tender going to be issued?

Medical clinicians 

Malta has been lucky in that we have not had many SARS-COV2 positive patients requiring intensive care. But with the numbers being what they are, unenforceable social distancing rules, and the flu season around the corner, this number may and will go up. 

Prime Minister Robert Abela reassured us that Malta is well equipped when it comes to ventilators. But he could not and cannot give us the same reassurance about medical staff, especially if we add the prefabricated hospitals to the list. 

How many adequately trained clinicians do we have? Do we have enough to meet a sudden increase in patients in ICU? 

It's now up to us. We live in a country where its government has effectively abdicated its responsibility to protect the people and safeguard their wellbeing and is leaving it up to individuals to ensure they protect themselves. Do so: avoid crowds, wash your hands as often as you can, sneeze in your elbow or a tissue-paper, wipe down any surface or equipment you use, help your elders.

You owe it to yourself, and your loved ones.