Malta recorded three days of zero new COVID-19 cases this week. One 
of the country’s top infectious disease specialists, Neville Calleja speaks on why the country has been successful in controlling the outbreak.

1. Talks with contacts in China early on:

One of the crucial decisions that helped Malta get on the right track early on was the already-established contact with those in China battling the virus. The World Health Organisation is usually instrumental in facilitating this exchange. Also, having a Maltese public health physician in the WHO office in China helped, according to Calleja.

“I believe that a key event was when we had a telephone meeting with our counterparts in Wuhan to discuss the issues. It was very early days but that meeting was crucial and helped us understand what we would be dealing with, at a point in time when Europe was just starting to wake up to the presence of the epidemic in its midst.”

2. Malta’s small island status:

Malta had an advantage in the COVID-19 fight being both an island and Europe’s smallest country, with a population of almost half a million. 

Control of borders, for instance, is easier when there are few, Calleja said.

The island’s size could have also contributed to the health systems being “quicker in their response”.

“Being small gives you the flexibility to adapt quicker and timeliness is key here. In fact, we have been asked by counterparts abroad how we managed to contain the outbreak so well,” Calleja said.

And being such a small nation with a free public healthcare service also made it easier for people to reach the health services. Patients did not need to travel for hours to get tested, for instance, so those with symptoms could be traced promptly.

3. Lockdown of vulnerable people:

Those over 65 and people considered ‘vulnerable’ because of chronic illnesses have been advised to stay at home since March 28, and Calleja describes this early decision as “major”.

“Our culture helped implement this initiative with rigour. Where else did carers lock themselves up for weeks on end with the elderly to protect them? In other countries, outbreaks in homes for the elderly were catastrophic,” Calleja said.

“We love and respect our elderly and so we had people coming together to deliver groceries. That also helped.”

4. The public’s reaction:

While pictures of Floriana football fans celebrating their Premier League win last Monday might suggest otherwise, Calleja believes the majority of people followed social distancing rules, making it easier for the authorities to control the outbreak.

Malta had an advantage in the COVID-19 fight being both an island and Europe’s smallest country

“Ultimately, it is up to the responsibility of the people to follow advice on how to keep themselves and other safe, just like they have been doing for so many weeks already.”

5. Closures of airport, schools:

The closure of schools, the ban on commercial flights preventing importation of new cases and shutting down non-essential shops also contributed to Malta’s results.

According to Calleja, other measures would not have worked had flights not been banned and schools not closed.

“The closures of schools, for instance, served as an incentive for people to work remotely and so, in turn, more people stayed home. This made it easier for other measures to be enforced.”

6. High testing rates:

For weeks, over 1,000 tests for the virus have been carried out daily, bringing the total number since the start of the pandemic to 66,664. The rate per capita is among the highest in the world.

“The best way to manage a pandemic is by tracing and isolating cases and that can only be achieved through testing,” Calleja said.

This, he said, has been key to the country’s success as it enabled the health authorities to better understand the country’s general situation.

7. Economic measures:

While not getting into the merit of the government’s economic measures rolled out to help those negatively impacted by the outbreak, Calleja suggested they made it easier for people to adhere to the rules.

“If you have to choose between going hungry and getting COVID-19, people will choose the latter and so it helped that people were not put in such a position despite the hardships,” Calleja said.

What about our weather, genetics and weaker strains?

With the virus being new and not much being known about it, people have asked what other factors could have had an impact on Malta’s numbers. The type of strain of the virus and whether Malta’s has been ‘weaker’ has also been a topic of discussion.

Some have wondered whether the warm, humid climate could be another reason, while others have suggested genetics might have had something to do with it.

Calleja, however, dismisses all these theories as speculation.

On climate, he says not enough data is available to support the suggestion it helped Malta.

On genetics, he said Malta’s situation was similar to other countries, and with reference a weaker strain, he does not believe this is relevant since Malta’s first cases were imported.

“We had cases from people who were coming from all over the world and so I’m sure we have had many of the different strains,” Calleja said.