Characteristics of patients admitted to hospital with COVID-19 during the first wave of the pandemic in Malta

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.