Urgent Call to prioritise a ‘COVID-19 First’ Policy in the Maltese Islands

The Malta Association of Public Health Medicine notes with concern the rising cases of COVID-19 in countries neighbouring Malta (31 countries out of 53 countries in the WHO EURO region).

Short of declaring a public health emergency, MAPHM is calling on the Government to immediately implement a ‘COVID-19 first’ policy, where all Government departments make the fight against the virus their top priority. Unless Malta prioritises the prevention and containment of this virus, we will end up in a situation where the country will be overwhelmed by sick people who might not be adequately cared for. The public health workforce, and healthcare professionals, need to be empowered to take all measures necessary to keep our population safe.

Increasing effort is being made by the local public health authorities to test all suspected cases, and as yet, no positive cases have been identified. With the current rate of spread in other countries, it is only a matter of time until we diagnose the first case in Malta. It is a matter of when, not if.

Whilst health authorities are increasing the capacity to care for the sickest, we should ideally avoid getting to such a situation in the first place. Prevention is better than cure. In order to prevent and possibly contain transmission in Malta, we need to urgently implement tried-and-tested public health measures. Malta’s public health authorities need to be empowered to take all actions necessary to prevent a worst-case scenario.

These measures include:

1. Universal population measures: The public health authorities are already pushing the importance of hand hygiene, respiratory etiquette, and social distancing from sick people through all available channels. These messages need to be taken up and repeated by everyone in media, schools, workplaces, clergy, and so on, so that the message gets across to everyone.
2. Case Isolation:Public health authorities require more capacity to deal with the expected increase in the number of persons who need to be tested, as well as eventually confirmed cases. Quick and rigorous case finding, contact tracing, and mandatory isolation in an identified site for all infected people will be required.
3. Close contact quarantine: Apart from the diagnosed cases, all close contacts of infected persons will need to be quarantined, to prevent further spread of the virus. This will require substantial input and support from other entities,including the Malta Police.
4. Suspension of public gatherings: Since the virus is transmitted through air droplets,crowds are an ideal place for it to spread. All public gatherings need to be prohibited for public health reasons.
5. Movement restrictions:Given Malta’s geographical situation, in theory it should be relatively simple to restrict movement and prevent the importation of positive cases. Whilst not advocating the complete isolation of our island, having multiple flights weekly to areas of high-risk is counterproductive to all public health efforts. Simply checking for temperature at points of entry is rudimentary and will do little to prevent the importation of the virus. All flights from countries with local transmission should be completely stopped. This includes Italy, Germany, France, Spain, UK, and others.
6. Voluntary quarantine is not stopping people from going shopping, sightseeing, and back to work or to school. Immediate mandatory quarantine needs to be imposed on anyone who has recently travelled to areas with local transmission. This should apply for both residents and non-residents. Again, this will require support from other entities.