The first few patients to test positive for the coronavirus in Malta were worried they would be shunned by their families and friends, a hospital doctor has said.

They were not just concerned about their health but about the stigma surrounding the virus, said resident specialist Manuel Fenech, who works at Mater Dei Hospital’s Infectious Diseases Unit.

By Saturday afternoon, Malta had a total of 73 confirmed COVID-19 cases.

Most of the patients have been in such good condition that they did not require hospital treatment, the doctor said, as he opened up about his experience working at the heart of the outbreak.

“The first few patients certainly worried they would be shunned. I think that this will become less important as the viral infection becomes more common,” Fenech said.

He has experienced this stigma himself: some regarded him “suspiciously” while he was out shopping, even though he was not in uniform, he recalled.

Those testing positive had been “invariably quite anxious”, but this was understandable given what he described as the “media hype” about the outbreak.

Patients who needed to be admitted to hospital were mostly “very cooperative” and appreciated the need to be isolated for a short period of time.

A significant proportion of patients have had minimal symptoms

“As healthcare workers we do our best to make the patient feel at ease and explain that they will get better and make a full recovery and that we are there to take care of them.”

Only about 30 people have had to be admitted as in-patients so far, although these were still “early days”, he added. Most of the others were healthy and not in the older age bracket associated with more severe symptoms. 

“The most common symptoms noted were a headache, fever and a dry cough. However, there have been a significant proportion of patients with very minimal symptoms, if at all.

“We have so far only had one patient where the infection caused lung inflammation, which is what defines those that can be more unwell,” he said.

An important part of treating these patients is infection control: personal protective equipment has to be worn by all staff while patients must remain in isolation at all times.

Preventing transmission to staff and to other patients is “extremely important” as this would rapidly decimate the number of available staff and cause unchecked transmissions to other patients. “Supportive care means observing the patient for complications while treating fever and low oxygen levels until the natural healing process occurs. This may mean mechanical ventilation for the sickest patients. So far none of our patients has required this level of care,” he said.

‘We had a head start’

Fenech believes the fact that the onset of local transmission occurred a month after it did in mainland Europe gave Malta a head start. This allowed the health authorities to better prepare for the outbreak.

“I was impressed at the way the hospital authorities created a huge number of extra hospital beds, including a large intensive care extension, in a few weeks, and how they are organising training for all the healthcare workers who may have work they are not accustomed to.

“These were changes that under normal circumstances would have taken months, if not years to organise.

“The public health staff have also worked extremely hard to make sure we delay and slow down community transmission as much as possible, with the least disruption possible,” he added. 

It was “impossible”, however, to predict how the epidemic would behave.

Fenech believes the hospital will inevitably start to see sicker patients among older people with pre-existing medical conditions.

While he continues to live with his wife and children, many of his colleagues have moved away from family members to prevent transmission, especially if they are frail, elderly or suffer from any chronic conditions.

“The level of apprehension both within the healthcare service and the community at large is very palpable and infectious,” he said.

“I am confident that the equipment we use as protection is very effective and am careful to use it properly. My main worry is that we may at some point be so busy that this may impinge on staff and patient safety.”