Three years since first the Covid-19 lockdown was imposed, the Director of Public Health has attributed Gibraltar’s ability to bounce back from the virus to a high vaccination rate among the vulnerable and the elderly.
From a public health perspective, protection is key for these individuals as Gibraltar returns to its pre-pandemic ways.
Looking back over the past three years, the “surreal” silence on the Rock has since been replaced with a bustling town, events and socialising becoming the norm once again.
In an interview with the Chronicle ahead of the third anniversary of the first lockdown on Friday, Gibraltar’s Director of Public Health, Dr Helen Carter, looked back at the past three years and lessons learnt about Covid-19.
“I often find when I talk to people you get different groups when it comes to the virus,” she said.
“There are some people who are still quite frightened by Covid and some who want it to just be all over.”
“We have learnt so much over the past three years and we have got a good vaccine, which is a good position for us to be in, and in Gibraltar we are a highly vaccinated population.”
“That has enabled us to keep the number of deaths really low.”
She compared this with UK figures were there are “a significant number of people still in hospital and still dying from Covid”.
Latest figures from the Gibraltar Government published just over a week ago revealed Gibraltar had a total of 20,462 Covid-19 cases and 111 deaths in the community since the start of the pandemic in March 2020.
A high vaccination programme and bi-monthly Strategic Coordination Group meetings are key for “continuing to protect the most vulnerable”, Dr Carter said.
“We are accepting that it is a milder virus now and we have got a highly vaccinated population,” she said.
“So those blanket measures [such as the lockdown] that we put in place before we had the vaccine and the anti-virals, we don’t have to do them now because we have got a vaccine that works.”
Dr Carter explained that hospitalisation rates for over-75s triple six months after a vaccine booster shot and she puts that down to their immune systems.
Vaccine hesitancy and vaccine fatigue have been a concern for her, but looking at the latest programme from last autumn, some 5,800 people have received the booster jabs.
Those who are still being hospitalised with Covid-19 have either been an “incidental finding” and that individual has had to move wards within the hospital, or they are extremely vulnerable people who are unable to fight the infection.
“When you look back at three years ago, when we were in that world where we started seeing young people hospitalised, we didn’t have vaccines, we didn’t have anti-virals,” Dr Carter said.
“There was so much that we didn’t know at that time and we are in a much better position now to enable us to live with Covid.”
There are lessons learnt from the Covid-19 pandemic.
From a “public health hospital perspective”, one of Gibraltar’s main takeaways was the need to have an infectious disease isolation ward, Dr Carter said.
“This has been absolutely vital to enable us to separate any infectious disease, not just Covid-19,” she added.
“This has enabled us to have isolation facilities and safely nurse and treat patients.”
The other thing is the importance of infection prevention control, and “going back to the basics” with staff and the wider public.
“From a far more operational perspective it is the ability of the organisation to scale up and to look at what is needed, for example, if people need to be ventilated, how to do it safely and what are the environment constraints and building needs,” Dr Carter said.
With regards to staffing needs, she stressed the importance of having a “resilient, flexible, adaptive” workforce, with the GHA experiencing compromised staffing levels due to Covid-19 outbreaks.
The GHA has been reviewing emergency plans and a consultant from the UK has been working with the health authority to look at the airport infectious disease plan and how it links in with the GHA emergency plan.
These will be based on plans in place at the John Lennon Airport in Liverpool “which is similar in size”, in order to make it “appropriate in the Gibraltar context”.
“I think it has been a wake-up call globally how rapidly these diseases can spread and the risks to local populations,” Dr Carter said.
When the pandemic first started proxy measures such as temperature control were used, but the ease of access to lateral flow tests have made testing for Covid easier.
PCR testing is still available in the GHA, but it is now used for those who need anti-viral medication.
“PCR can also be used for testing for other viruses and bacteria as well,” Dr Carter added.
“We use the machinery and the kit and our laboratory has been outstanding in terms of the developments we have made in in-country testing and our ability to test.”
Before Covid-19, Dr Carter’s previous work in public health ruled out the possibility of lockdowns over concerns that the public would not comply.
Quizzed on whether this is a concern if Gibraltar were to face another public health emergency, she said: “It depends.”
“The difference with Covid was that we had young people dying very suddenly, and although the bulks of the deaths in Gibraltar were among our elderly population, globally we saw young people young, fit, healthy, typically healthcare workers dying.”
“This brought into focus was that the reason why we did the lockdowns was to break the transmission to prevent the hospitalisations to buy time for the vaccine.”
“I am not sure whether if we had another virus like Covid in the future we would get far more push back from the population.”
“We now know the wider adverse effects of lockdown in terms of people’s mental wellbeing, in terms of schooling, the economic impacts of that are going to have long-term legacies.”
She said the need for a lockdown had been a “trade off” but added that it was “hard to disentangle” whether higher demand for mental health services after the pandemic was due to lockdowns or more awareness about reaching out for help.
However Gibraltar’s gradual easing of Covid-19 measures has contributed to the “good position the Rock is in now”, Dr Carter said.
There is much discussion on Long Covid, and globally there are discussions on how this is diagnosed and what treatments are in place for it.
Long Covid is being used as an “umbrella term” for different groups of patients, namely those who required to be on a ventilator and whose lungs sustained damage, or those who continue to suffer post-viral fatigue.
“This is still a relatively new disease so what treatment do we give while learning from other treatments already in place for post-viral fatigue, the brain fog, the tiredness,” she said.
“Those trials are happening globally.”
Questioned on what is happening for Long Covid treatment within the GHA, Dr Carter said this is now a good time to take stock of where the health service is at and whether it is able to meet the “holistic needs” of a person.
The GHA has a “yellow card reporting system” in place that allows health professionals to flag any concerns about the effect of the vaccine.
Since Dr Carter’s arrival in September 2021, no yellow cards have been sent off, but said she cannot comment if any were sent off before she arrived.
She stressed the importance of “contributing globally to the knowledge and understanding” of possible vaccine side effects.
“Vaccines go to trial and it is important that we continue to monitor that safety data to then inform us what have been the risks on a much greater scale,” she added.
Last week, Chief Minister Fabian Picardo told MPs final arrangements are being made for the Covid Inquiry to be held in Gibraltar in a question and answer session in Parliament.
In response to a question tabled by Together Gibraltar leader, Marlene Hassan Nahon, Mr Picardo said: “The Government has an eye on the UK inquiry to deliver the best inquiry for Gibraltar to learn the lessons of this pandemic before the inevitable next one – although I sincerely hope it will not come for many decades and generations.”
Pushed on whether this will be held before the upcoming general election, Mr Picardo said it will be convened in “this lifetime of Parliament”, but it may very well run into the next term.