Here’s the full text of  Dr Rawal’s opening statement at yesterday afternoon’s COVID-19 briefing:

Good afternoon everyone. I hope everyone is well and safe at home.

I know you have not seen me on the screens for a few days. I can assure you that I am extremely well, as is my amazing family and my colleagues working so hard.

In fact, the reason for the change in the faces is because as we build our teams, we have some very interesting people and points of view to offer and so you will see new faces.

However I am very glad to be here and I have plenty of things to tell you about.

1. Pertinent Statistics

COVID-19 Test Stats - Normal 

• Total swabs – 1512 (24 since yesterday)
• Pending – 36
• Results received – 1476 (17 since yesterday)
• Negative – 1305 (17 since yesterday)
• Confirmed – 122 (0)
• Active – 11 (0)
• Recovered – 111 (0)

 Random Sampling: 

• Total Swabs – 400 (0)
• Pending – 0
• Results Received – 400 (0)
• Negative – 390 (0)
• Confirmed – 10 (0)
• Active – 1 (0)
• Recovered – 9 (0)

Grand Totals: 

• Total Swabs – 1912 (24 since yesterday)
• Pending – 36
• Results Received – 1876 (17 since yesterday)
• Negative – 1695 (17 since yesterday)
• Confirmed – 132 (0)
• Active – 12 (0)
• Recovered – 120 (0)

Overall summary – 24 swabs taken in the last 24 hours, 17 results received, all negative.

2. Bed Statistics

Total beds across all sites = 756, of which 333 occupied and 423 free beds.

This can be broken down as:

SBH – 205 beds, of which 46 occupied and 159 free beds;

Nightingale – 238 beds, all free;

Elderly Residential Services – 313 beds, of which 287 are occupied and 26 free beds.

3. Intensive Care Statistics

This is in response to a question from the press that I was unable to answer last time.

The COVID CCU or CCU 1, was opened on 23 March 2020.

First patient was admitted on 24 March 2020

As of 18 April there have been 13 patients admitted, 4 had COVID detected on a swab test and 9 not detected.

No patients have needed a ventilator, one needed high pressure oxygen through a mask.

4. Visitor Policy

A reminder of the GHA’s Visitor Policy.

Visitors must clean/wash hands when entering the ward and on each occasion they leave the bed.

They must sign in.

They must also leave external garments at the entrance of the ward.

Visitors will only be considered in exceptional circumstances where one visitor – an immediate family member or carer – will be permitted to visit.

With regards to those patients receiving end of life care:

Given the limitations of wearing PPE, only designated visitors (1-2 per end of life patient) may be allowed to visit the dying patient for a maximum of 2 hours per visit.

There are notable exceptions to this rule:

Elderly Residential Services: No visitors allowed;

COVID Ward, CCU1: No visitors allowed;

Captain Murchison: No visitors allowed;

Victoria, Dudley Toomey, CCU 2: 1 visitor allowed;

Accident and Emergency: No visitors allowed;

Field Hospital: No visitors allowed;

With regards to those patients receiving end of life care:

Given the limitations of wearing PPE, only designated visitors (1-2 per end of life patient) may be allowed to visit the dying patient for a maximum of 2 hours per visit. 

5. Medical Treatments Not Related to COVID-19.

We have absolutely not forgotten that medical issues need to be managed and follow-ups and treatments are of course ongoing, albeit perhaps by telephone/video call.

Urgent and emergency treatments, such as the 2 week wait cancer referrals are still being managed 

But my medical teams are now looking closely at what additional services we can restart.

This will be based on many different criteria including how long someone has been waiting to be seen, what the medical issue is, what the procedure may be, the risk of waiting versus the risk of being exposed to COVID, the risk of perhaps an anaesthetic on your own defences, the risk of recovering from a procedure and having COVID-19 as well.

Nothing is firm as yet but we are looking at it.

We are looking at all those measures and changes in practice that have been such a success that we would like to keep them in place, such as the 111 line.

Lifestyle, exercise – help and support for those who need it and request it.

6. Care Assistants

We have had an overwhelming response to our call for Care Assistants (over 300) and for this we are truly grateful.

However, we are now not accepting any further applications.

So far we have trained 70 people and this is enough for our staffing at this point. All those who have applied but not undertaken the training, we will keep your details and contact you if we need further help.

7. Questions still about in-house testing

We are now running two testing systems, one slightly quicker one in the morning for any samples that come in overnight, then the main system for swabs from the drive through, community and in the day.

We still send samples to Spain and we still maintain a careful approach to using up reagents and any materials that may be in short supply so that we will not run out if there is a surge in cases.

There are quick tests, 20 minutes, but these are still largely prototypes and need further testing to make sure they are accurate.

We must ensure that the focus of the test is accuracy and not simply speed.

8. Evidence

Strong predictor of COVID-19 infection – loss of taste and smell in 59%, no nasal congestion.

The diagnosis is particularly difficult due to so many non-specific symptoms, for example sneezing now is a hayfever sign as well.

Consistent symptoms seem to be cough, fever and shortness of breath.

Remdesivir – anti-viral agent originally for Ebola virus. But the trial was carried out by the company who make the drug (Gilead) and based on only 53 patients. 68% made some improvement.

We would only consider this with strong evidence, we will not experiment on patients.

9. Anticipated Questions

Perhaps things you may be wondering about at home.

1. Antibody tests – still very hit and miss. It would be amazing to test all of Gibraltar and tell how many are immune. But the immunity itself seems not guaranteed, hence why we are hearing reports of second waves of infection. 

Also the immunity that is to be tested is antibody immunity only and does not take in to account the immune response by the cells in the body as well.

Consider the common cold – caused by a number of viruses including a coronavirus. Every year we get colds.

But there must be some differences – different countries have different experiences so far, is it just fitness, lifestyle, is it genetic?

10. Mental Wellbeing

This has been a difficult weekend with 4 weeks of lockdown for those under 70 years old, longer for those over 70.

The Easter weekend was a traditionally family weekend but the weather was poor, this weekend has been a beautiful weekend. We are all feeling the strain now I am sure.

As you observe social distancing, you may find yourself becoming bored and frustrated more often. Your mood and feelings may be affected; you may feel low, worried or have problems sleeping and you might just miss being outside with friends and family.

At times like these, it is easy to fall into unhealthy patterns of behaviour which in turn can make you feel worse. Some simple things you can do that may help to stay mentally and physically active are:

• look for ideas of exercises you can do at home online;
• learn a new skill or take up a new indoor hobby;
• spend time doing things you enjoy but never had enough time for –  reading, cooking, other indoor hobbies or listening to the radio or watching TV programmes;
• try to eat healthy, well-balanced meals, drink enough water and try to avoid smoking, alcohol and drugs;
• keep your windows open to let in fresh air, get some natural sunlight if you can, or spend time in your garden;
• You can also go for a walk or exercise outdoors if you stay more than 2 metres from others;
• Draw on support networks via friends and family;
• Try to stay in touch with those around you over the phone, by post, or online; build that into your routine. This will help you to look after your own mental well-being too.

Just a reminder if you feel you need to talk or you need support:

Local support services include:

GibSams - Call them on 116 123

Clubhouse Gibraltar -  mental health support daily from Monday to Friday during standard opening hours as follows: 

Telephone help-line: 20068423

Email: [email protected]

Childline – 8008

11. Last Thoughts

I would start with an apology to all those waiting at about 730am one day last week to go in to Morrisons while I just breezed past all my colleagues jumping the queue. The amazing thing is not one cross word, although I am sure I deserved it. It struck me that we are all out of our routines, out of our comfort zones, missing our support networks.

And yet so many smiles, so much tolerance and understanding, so many hellos and greetings and warmth from everyone.

Thought are turning to the lockdown more and more.

But we have done so well, so few in intensive care, not a single death and statistics every day that show the rate of the virus spread reducing. To simply unlock now would be like doing all the revision but not the exam. Something I am sure many students will be feeling right about now.

So the balance is very fine and the decision not easy at all.

BUT remember – the incredible statistics that we are able to give every day about beds and medical statistics is not just because of the medical teams and their incredible hard work. This is also down to each and every one of you keeping at home, keeping safe, observing the restrictions, giving us time to prepare, time to stock up, time to practice.

This is a team effort in every way, we have done this, you have done this and you should be beyond proud of yourselves.

BUT – keep it up, keep strong, don’t lose focus or resolve.

There is no doubt in my mind we will beat this together.

We must, we have to, and we will.

Thank you.