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Observational Study
. 2020 Oct 15;15(10):e0239389.
doi: 10.1371/journal.pone.0239389. eCollection 2020.

The first wave of COVID-19 in Malta; a national cross-sectional study

Sarah Micallef  1 , Tonio V Piscopo  2 , Ramon Casha  2 , Denise Borg  2 , Chantal Vella  2 , Maria-Alessandra Zammit  2 , Janice Borg  1 , Daniela Mallia  3 , James Farrugia  2 , Sarah Marie Vella  2 , Thelma Xerri  2 , Anette Portelli  2 , Manuel Fenech  2 , Claudia Fsadni  2 , Charles Mallia Azzopardi  2
Affiliations
Observational Study

The first wave of COVID-19 in Malta; a national cross-sectional study

Sarah Micallef et al. PLoS One. .

Erratum in

Abstract

Introduction: The COVID-19 pandemic has posed major challenges to all aspects of healthcare. Malta's population density, large proportion of elderly and high prevalence of diabetes and obesity put the country at risk of uncontrolled viral transmission and high mortality. Despite this, Malta achieved low mortality rates compared to figures overseas. The aim of this paper is to identify key factors that contributed to these favorable outcomes.

Methods: This is a retrospective, observational, nationwide study which evaluates outcomes of patients during the first wave of the pandemic in Malta, from the 7th of March to the 24th of April 2020. Data was collected on demographics and mode of transmission. Hospitalization rates to Malta's main general hospital, Mater Dei Hospital, length of in-hospital stay, intensive care unit admissions and 30-day mortality were also analyzed.

Results: There were 447 confirmed cases in total; 19.5% imported, 74.2% related to community transmission and 6.3% nosocomially transmitted. Ninety-three patients (20.8%) were hospitalized, of which 4 were children. Patients with moderate-severe disease received hydroxychloroquine and azithromycin, in line with evidence available at the time. A total of 4 deaths were recorded, resulting in an all-cause mortality of 0.89%. Importantly, all admitted patients with moderate-severe disease survived to 30-day follow up.

Conclusion: Effective public health interventions, widespread testing, remote surveillance of patients in the community and a low threshold for admission are likely to have contributed to these favorable outcomes. Hospital infection control measures were key in preventing significant nosocomial spread. These concepts can potentially be applied to stem future outbreaks of viral diseases. Patients with moderate-severe disease had excellent outcomes with no deaths reported at 30-day follow up.

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Conflict of interest statement

The authors have declared that no competing interests exist

Figures

Fig 1
Fig 1. A non-contrast CT showing extensive ground-glass changes in both lung lobes with predominant peripheral distribution, compatible with moderate-severe bilateral COVID-19 pneumonia.
Fig 2
Fig 2. Number of confirmed cases of COVID-19 in Malta [10].
Fig 3
Fig 3. Symptomatology of COVID-19 infection in admitted patients (n = 89).
Fig 4
Fig 4. Hospitalized patients during the first wave COVID-19 in Malta; study cohort highlighted in grey.
Abbreviations: MDH, Mater Dei Hospital; ICU, Intensive Care Unit.
See this image and copyright information in PMC

References

    1. European Centre for Disease Prevention and Control. Covid-19 Situation Update. 2020; Available at: https://www.ecdc.europa.eu/en/covid-19-pandemic. Accessed April 24, 2020.
    1. Malta National Statistics Office. Key Figures for Malta—Visuals and Words—2019 Edition. Malta National Statistics Office 2019.
    1. Grech K, Podesta M, Calleja A, Calleja N. Report on the Performance of the Maltese Health System, 2015. Ministry for Energy and Health (Health), Valletta, Malta 2015.
    1. Cuschieri S, Vassallo J, Calleja N, Camilleri R, Borg A, Bonnici G, et al. Prevalence of obesity in Malta. Obesity science & practice 2016;2(4):466–470. - PMC - PubMed
    1. Cuschieri S. The diabetes epidemic in Malta. South Eastern European Journal of Public Health (SEEJPH) 2020.

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