Department of Medicine, Mater Dei Hospital, Msida, Malta.
Department of Infectious Diseases, Mater Dei Hospital, Msida, Malta.
PLoS One. 2020 Oct 15;15(10):e0239389. doi: 10.1371/journal.pone.0239389. eCollection 2020.
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.
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.
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.
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.
COVID-19 大流行给医疗保健的各个方面都带来了重大挑战。马耳他的人口密度大、老年人口比例高、糖尿病和肥胖症患病率高，这使得该国面临病毒传播失控和高死亡率的风险。尽管如此，与海外数据相比，马耳他的死亡率仍然较低。本文旨在确定促成这些有利结果的关键因素。
这是一项回顾性、观察性的全国性研究，评估了 2020 年 3 月 7 日至 4 月 24 日马耳他第一波大流行期间患者的结果。数据收集了人口统计学和传播途径。还分析了马耳他主要综合医院 Mater Dei 医院的住院率、住院时间、重症监护病房入院和 30 天死亡率。
总共有 447 例确诊病例；19.5%为输入性病例，74.2%与社区传播有关，6.3%为医院内传播。93 例（20.8%）患者住院，其中 4 例为儿童。中度至重度疾病患者接受羟氯喹和阿奇霉素治疗，符合当时的证据。共记录了 4 例死亡，总死亡率为 0.89%。重要的是，所有中度至重度疾病的住院患者均存活至 30 天随访。
有效的公共卫生干预措施、广泛的检测、对社区患者的远程监测以及较低的入院门槛可能促成了这些有利结果。医院感染控制措施是防止严重医院内传播的关键。这些概念可能有助于阻止未来病毒性疾病的爆发。中度至重度疾病患者的预后良好，30 天随访时无死亡报告。
