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

Micallef S.,
Piscopo T.V.,
Casha R.,
Borg D.,
Vella C.,
Zammit M.-A.,
Borg J.,
Mallia D.,
Farrugia J.,
Vella S.M.,
Xerri T.,
Portelli A.,
Fenech M.,
Fsadni C.,
Azzopardi C.M.
Document Type
Source Title
Public Library of Science


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. Copyright: © 2020 Micallef et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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azithromycin; hydroxychloroquine; antivirus agent; azithromycin; hydroxychloroquine; adolescent; adult; all cause mortality; Article; computer assisted tomography; coronavirus disease 2019; coughing; cross-sectional study; demography; disease severity; disease surveillance; dyspnea; female; fever; follow up; general hospital; hospital admission; hospital infection; hospitalization; human; infection control; intensive care unit; isolation; length of stay; major clinical study; male; Malta; mass screening; mortality rate; observational study; outcome assessment; pandemic; polymerase chain reaction; prognosis; public health service; quarantine; retrospective study; Severe acute respiratory syndrome coronavirus 2; survival rate; thorax pain; thorax radiography; virus transmission; aged; Coronavirus infection; drug utilization; Malta; middle aged; mortality; survival analysis; virus pneumonia; Adult; Aged; Antiviral Agents; Azithromycin; Coronavirus Infections; Drug Utilization; Female; Hospitalization; Humans; Hydroxychloroquine; Intensive Care Units; Length of Stay; Male; Malta; Middle Aged; Pandemics; Pneumonia, Viral; Survival Analysis