This is a joint press release of the Medical Association of Malta with the Malta Association of Public Health Medicine

The Medical Association is concerned that advice given to the public regarding the ongoing pandemic is on occasion unclear.

Together with the Malta Association of Public Health Medicine, we are publishing this expert advice for people to make up their own minds about their risk tolerance, aware that the risk of illness is never zero, conscious that the economy needs to work and in the knowledge that people expect clear medical advice.

Current situation

There is still sustained spread of Covid-19 within the community. Although thanks to the efforts of the front line professionals, the professional leadership and the ability of the country to make all resources available, this is at a low level.

It is important that people remain vigilant and follow public health recommendations. This will reduce their risk of contracting COVID-19.

Testing and Responsible behaviour by all

Everyone is responsible for their actions in reducing the risk of infecting themselves and the prevention of transmitting the coronavirus to others especially the most vulnerable. If you or anyone you know develops any of the symptoms suggestive of coronavirus it is important to organise a swab test by calling the Public Health helpline (111). Keeping up the rates of swab tests is very important at the individual level to ensure appropriate medical treatment and stopping further spread. Keeping up the daily rate of swab tests ensures good monitoring of the spread in the community.

Travel

Everyone who has travelled in the last 14 days should avoid vulnerable people and get tested if any symptoms appear. This applies to tourists too. Call 111 to organise a test and isolate until the results are out.

People who are ill or elderly

Persons who suffer from severe chronic illnesses, the elderly (over 65 years) and those who have low immunity due to illness or as a result of certain prescription medication, are more likely to suffer from complications or severe disease if they had to become infected.

These groups of people should be even more careful, be conscious of their actions, who they meet and where they choose to go always remaining vigilant and adopting the necessary precautions.

The following key principles are applicable to everyone to help prevent themselves from getting infected with the COVID-19 virus: SARS-CoV2.

Protective measures against contracting coronavirus

• Maintain a physical distance of at least 2 metres from others
• Meticulous regular hand hygiene using soap and water or a hand sanitizer containing at least 70% alcohol for 30 seconds
• Adopt mitigation measures – use masks and/ or visors when carrying out activities within the community

Since it is now possible to carry out most activities (including travel very soon), it is important for everyone to think about the risk they are placing themselves in, and whether the activity is worth the risk.

Since the virus is most commonly spread directly from person-to-person, risk increases based on the number of different persons you could encounter, how close to others you would need to be during this activity, and how long this encounter lasts. Keeping these in mind can give you an indication of how likely you are of contracting the virus. Another factor to consider is that the larger the number of ‘higher’ risk activities you undertake within a short time frame, the higher your chances of getting infected and spreading infection are.

Activities which can take place outdoors, with less people, and those which are of shorter duration pose a smaller risk.

When going about essential activities such as shopping, it would be best to attend at a time when the shop is less busy or would have recently been cleaned such as in the morning.

Work and Hospital visits

For other activities such as attending hospital visits or going to work, unless there are virtual means by which these activities can still be carried out, it is important to try to reduce the risk as much as possible by keeping in mind the protective measures mentioned above:

Maintaining physical distance, hand hygiene, and using a mask/visor.

Using Other Essential HealthCare Services in the Community.

When visiting Health centres, private hospitals, doctors’ clinics and Pharmacies always wear a mask/visor and follow the directions given by the healthcare professional staff.

Exercise and recreation

Engaging in exercise and recreational activity is beneficial for one’s mental and physical wellbeing and is encouraged. However, it is important to choose an activity with the least possible risk. For example, individual exercise in open air would be the least risky activity. Exercising in a closed space in close proximity with other people for a long duration would be of highest risk.

Mitigation factors such as frequent disinfection of shared exercise equipment, and ensuring physical distancing may help reduce the risk somewhat. The choice is ultimately that of the individual.

The same concept applies to recreational activities – opting for an activity which can take place outdoors and where an adequate physical distance can be maintained between individuals, such as an outdoor cinema, or outdoor restaurant would be less risky than an activity where it is more difficult to maintain social distance such as an indoor reception or activity which in itself would draw larger crowds.

Meeting with friends and family

At this stage of the pandemic it is understandable that persons want to reunite with their loved ones whom they might not have met for a long time. Here it is important to avoid unnecessary close contact such as hugging and kissing, limit the duration of the visit, and meet outdoors or in the residence of the elderly or vulnerable person.

It is not advisable for children attending childcare who may be exposed to a larger number of social contacts, to also be left under the care of a vulnerable person. (Chronic disease or elderly)

Safety and confidence

In conclusion, the most important factors to consider are that one should avoid persons who are sick or who have been in close contact with a confirmed case of COVID-19. When deciding which activities to engage in, the proximity of contact with persons, duration of contact, and number of people are factors to consider, together with the mitigation or COVID protective factors which can be safely adopted.

In this circumstance, where the government has lifted virtually all restrictions which have protected us so well from a bigger outbreak than we’ve had, it is now up to individuals to be responsible and refrain from participating in activities which would put them at a higher chance of becoming infected with coronavirus.

Part of the ‘new normal’ means practicing the three protective behaviours mentioned above: maintaining an adequate physical distance of 2 metres others , appropriate hand hygiene, and using a mask/visor wherever possible. Where these are not possible, it might be worth considering avoiding the activity altogether depending on the value such an activity has in one’s life. It is recommended to always follow the advice of reputable entities to ensure healthy and safer choices.