Malta has been applauded for its exemplary response to the COVID-19 pandemic. Concerted action by the COVID Public Health Response Team, Health Services and a whole of government approach to COVID-19 policy prioritizing health drove this success. The real effort however starts now; we must carefully balance the emergency response with the societal and economic impacts of easing restrictive measures at a pace that will not overwhelm our health services, public health capacity, or endanger the lives of our vulnerable population and healthcare workers.
Our success in ‘flattening the curve’ is a result of timely action by the Superintendent of Public Health to impose a partial lockdown, implement an effective travel ban, and protect the vulnerable together with an effective public health response. We were able to ramp up testing such that in recent days the daily swab rate has reached 3 per 1000 population. As a result, to date approximately one swab was performed per 10 persons in our population. This has enabled us to trace and quarantine cases rapidly and minimise the transmission. A sustained low transmission rate has permitted Malta to consider and initiate a transition plan to ease some of the restrictive measures in place.
Figure 1 – Number of Active Cases – Source: Superintendence of Public Health
However, the initial effects of the first transition phase are that the number of active cases is increasing again. The R factor has been constantly back over 1 for the past week. Our number of new cases per capita is higher than that of Italy, Spain, Germany, and France. We may now very well be in the beginning of the second wave.
Public announcements suggesting that all is well, and that we are on track to return to normality very soon are misleading and dangerous. Now, more than ever we need to stick to public health measures that have protected us so well so far. We must continuously renew our commitment to maintain social distancing, avoid unnecessary contacts and trips outdoors and promote the correct use of masks in the community. This needs to be coupled with education and enforcement.
We urge government and policy makers to ensure that public health principles, epidemiological considerations and a sound evidence base set the pace for the responsible reversal of measures, and their timely reintroduction should the R factor increase again. This is the situation we are now currently in. Whilst acknowledging the devastating social, economic and mental health consequences of these restrictive measures, things will only get worse if the outbreak gets out of control. We should learn from the tragedies unfolding in our neighbouring countries and avoid an overwhelming resurgence of cases.
This cautious approach to relaxation of restrictive measures is in line with both the EU Roadmap for relaxation of community social distancing measures and WHO-Europe. The Director of WHO-Europe has claimed there is “no room for complacency”. We echo this sentiment since, despite our best efforts, our health system’s capacity will be rapidly surmounted if measures are relaxed too fast and if the population ceases to respect social distancing, mask and hygiene etiquette. Exceeding health system and resource capacity could all too easily result in difficulty not only in managing COVID cases but also the continuing non-COVID illnesses that our population face.
Ultimately, the economy is dependent on a healthy population. Let us walk this tight rope to a “new normal” with our heart in the right place continuing to put health first, otherwise the price to pay in lives lost may be dear.