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Rise in cases requires careful management as Gib edges back to normality, Bhatti says

Photo by Johnny Bugeja.

The highest number of recent Covid-19 cases in Gibraltar has been in the 20s age group, highlighting the need for careful management of social and community events as new strains of the virus offer a reminder of the need for caution on the road to normality, Dr Sohail Bhatti, the Director of Public Health, told the Chronicle this week.

During an hour-long interview, Dr Bhatti gave a snapshot of the current situation and the months that lie ahead, reflecting on trends in cases, vaccination plans, new strains and the challenges of managing the removal of restrictions.

Dr Bhatti was speaking a day before it was confirmed that his contract would not be renewed by the Gibraltar Government, which said it wants to localise the post.

Tomorrow Dr Bhatti will work his final day as Gibraltar’s Director of Public Health, with locum Dr Natalie Wright set to take up the role in the short term.

Dr Bhatti pegged the rise in cases on recent sporting and large community events as Gibraltar’s social calendar springs back to life after a year of lockdown.

“All of that sort of happened together, and we had the same experience they’ve had in England but we’ve had ours a few weeks before them,” Dr Bhatti said.

“The youngsters who are desperate for a social life, go out and get their social life and then they spread the infection.”

“The biggest rise was in the 20 to 29 age range. That’s meant we had the sudden steep rise.”

“What we did in contact tracing was quickly identify that the problem was actually in 20 to 29-year-olds and the problem is we were finding a smaller incubation period.”

The smaller incubation period is a result of the Delta variant, which typically sees incubation last three or four days, as opposed to up to 10 days in other strains.

Dr Bhatti said the rise in cases of the 20 to 29 age group in turn led to a knock-on rise in the 50 to 59 age groups - their parents.

When asked if the recent large public events should have taken place, Dr Bhatti said: "Well, you kind of don't know until you've done it."

"Some of the things with the football match and others, we tried it out. The paradoxical thing is there was so little virus at the time, we weren't able to tell if it had an effect."

"But now, knowing how Delta spreads, I am less willing to accept a vaccine certificate."

"Actually, if we want to have events, my advice certainly from an epidemiological point of view, everybody should have a same-day lateral flow negative test."

"Why? Because clearly we've got vaccinated people going positive."

For now, large public events are banned and bars, restaurants and nightclubs have been told to “be cautious” in the events they organised.

Amid the continued uncertainty, the GFSB called for clarity from the government on what businesses should do.

Underpinning the latest guidance is the reality that every situation that allows the virus to spread presents a risk of developing a new variant at a time when both vaccinated and unvaccinated people are catching Covid-19.

In one case, some 400 people had to be contacted by contact tracing after going to the same restaurant.

“It’s disastrous for the business, it’s disastrous for the people who went to the restaurant and it’s disastrous for the workers,” Dr Bhatti said.

Another issue is people not being forthright with information on their close contacts.

“If you lie to us, the data doesn’t lie,” he said.

Dr Bhatti said the initial prediction at the outset of the pandemic in 2020 was that 300 people would die. He estimates that 100 lives were saved in the first lockdown.

But looking ahead, now that the public is largely vaccinated, lockdown is not a route he would recommend again, so long as people adhere to guidance on social distancing and mask use in crowded indoor spaces.

"I would be very, very disappointed if we did [lock down]," Dr Bhatti said.

IMMUNITY

But added to the complexity of advising on measures, not everyone that has been vaccinated has full immunity.

Dr Bhatti described how, overall, two thirds of active Covid cases are vaccinated with another third unvaccinated.

Earlier this year, Gibraltar rolled out the Pfizer/BioNTech Covid vaccine to the public, and take-up was high.

It is expected the majority of people have responded to the vaccine and have increased immunity to Covid-19, but Dr Bhatti explained that, for a small percentage (5-7%) of the community, the vaccine may not have enacted this immune response.

Giving this small group of people another booster of the same vaccine would have the same effect - no immune response.

"There is work and research that indicates that if you actually have a mix between the different varieties [of vaccine] you get a better response in general, so one of the things we're going to have to realise is, is it Pfizer again?"

He added small delivery of vaccines could be expected in August, and perhaps vaccination 12 to 15-year-olds could begin in September if UK regulators clear it.

The booster vaccines, however, might not be so simple.

Experts believe immunity wanes after six to eight months, with the elderly having less immune resistance.

This means the elderly will be the ones in need of a booster the most.

"This is where the people who don't vaccinate represent an ongoing risk," he said.

Vaccination has meant that around 90% of new cases recover without the need for hospital care and the figures appear to be peaking.

NEW MUTATION

And in yet another worrying twist, Public Health officials are on guard for the appearance of new strains in the community.

“There are new mutations appearing, in fact we found one in Gib," Dr Bhatti said.

"It's the same mutation that we found in the South African one and in the Nepalese one, which actually resists treatment by antibodies."

Dr Bhatti said this mutation was found in a person who had recently travelled into Gibraltar from Spain.

"We will continue to experience mutations, [and] with more mutations there's more risk."

Gibraltar has relayed this information to the UK.

"When we look at the viral load of people who are immunised and those who are not, the viral load is the same in both," he said.

"You would expect the people who are immunised to have some sort of an immune system that would fight it off [and would register a lower viral load].”

“I think that the difficulty that I'm faced with is, what’s the implication of that? Well, I think the potential implication of that is that these people are either not immune at all or their immunity has faded."

"So they are not responding. If the immunity had faded, I would expect some of them to have some response. So I would expect the viral load to be lower in the people that are immunised. That's the group of people we are looking at the moment."

Dr Bhatti added that vaccination has helped enormously in easing the restrictions and being able to manage the pandemic while returning to a degree of normality.

But there are challenges ahead.

"Even if we get to the extent that Gibraltar's fully vaccinated, it doesn't mean that the pandemic is over," he said.
"I think that's one of the mistakes we mustn't make."

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