Our Sicilian neighbours have just removed Spain and Portugal from the list of countries that need a swab test on arrival besides the certificate. They have extended this requirement for people travelling from Malta for another three months. Why is this happening when we are in much better shape than Sicily and Spain? Can our authorities discuss this issue with the Sicilian authorities with an aim to reduce the frustration of both Maltese tourists and Sicilians who work here? – Mario Genovese

To slow down the spread of coronavirus and protect health and well-being, travel restrictions have been necessary during the pandemic. Those who can travel can still be subject to health-related measures such as requirements for vaccination, testing and quarantine according to regulations within the country.

Member states in Europe regularly review the situation of other member states to evaluate the risk for incoming travellers from these respective countries. As Malta has progressively had lower rates of COVID cases, lower positivity rates and even moved to green categorisation by ECDC criteria, we expect to have lesser restrictions for travellers from Malta to other countries.

Is the booster having any impact on the situation? – Johann Grech

Israel started providing boosters to those aged over 60 years at the end of July. This had led to a drop within just two weeks in the 60+. They then proceeded to give boosters to everyone else, reaching the 12+ population by the end of August (right).

A similar result has been observed in Malta. Positive cases in those aged over 80 years started visibly rising mid-August and hospitalisations and deaths had indeed started rising in early August. Booster vaccination started early in September and, indeed, within a week or two, we saw a drop in cases in the 80+ population. This drop is probably not only due to booster vaccination but is also compounded by a drop (albeit slower) in incidence in other age groups too.

That said, the 80+ group has seen a sharper drop in cases, thus effectively reaching the same incidence rate as for the other age groups. This clearly shows the impact of the booster dose and the importance of maintaining a high level of immunity within the population.

From the recent cases, how many of them had contact with a positive case? – Mariella Agius

Positive cases are investigated to identify the possible source, contact with a positive case and identify other contacts to control the chain of transmission. From an evaluation of the cases reported during August and September, 40 per cent reported that they had contact with a positive case. This highlights the importance of prevention measures as many of the positive cases reported were not actually aware of having been exposed or to whom.

All positive cases are isolated for a period of 14 days from date of positive test and contacts are quarantined for 14 days from last exposure to avoid further exposure to others. For vaccinated primary contacts, this can be reduced to seven days if they test negative on the seventh day.

Digital proximity-tracing apps, known as contact-tracing apps, can lead to faster notification and identification of contacts who would not have known they were exposed and, hence, supplements classical contact tracing.

The local contact-tracing app, COVID-Alert Malta, which is functional across many European member states, can be downloaded from https://covidalert.gov.mt/. Anyone alerted to have been a contact of a positive case is asked to take a test.

The World Health Organisation continues to emphasise that contact tracing, along with robust testing, isolation  and care of cases, is an important strategy for interrupting chains of transmission of SARS-CoV-2. Ensuing population coverage with vaccination is essential and reaching out to pockets of unvaccinated persons.

In crowded environments – such as planes and restaurants – I have an inkling that airconditioners are high risk vis-à-vis COVID-19 transmission. Is this a misnomer? – Joseph Brincat

It is to be stressed that, in common areas, the primary risk of COVID-19 transmission remains by people movement, proximity and sharing of common areas such as toilets and lifts. Appropriate measures aimed at generally reducing the risk of infection via respiratory and hand hygiene measures, personal protective measures, social distancing measures, and cleaning and disinfection of commonly touched areas and environments are assumed.

Proper use of air-conditioning and ventilation systems are important measures for risk reduction of COVID-19 diffusion. Establishments with multiple occupancy and transient visitors need to ensure regular maintenance of air-conditioning and/or mechanical ventilation systems. Where fresh air exchange is possible, this should be encouraged. 

When will the authorities decide whether the ‘general’ population will need a booster dose? – Angela Grech

The European Medicines Authority has concluded in a release issued on October 4 that booster doses with Comirnaty may be considered at least six months after the second dose for people aged 18 years and older. They further state that “the implementation of vaccination campaigns in the EU remains the prerogative of the national immunisation technical advisory groups guiding the vaccination campaigns in each EU member state. These bodies are best placed to take into account the local conditions, including the spread of the virus (especially any variants of concern), the availability of vaccines and the capacities of national health systems.”

Currently, various national health authorities, including Malta, are assessing the data available to consider booster doses for the different population groups and the time from primary vaccination series until a booster dose should be given.

Why is positivity rate quoted frequently? – Mary Camilleri

As with all surveillance systems for infectious diseases, it is not possible to know exactly how many people are infected with COVID-19. We can only know of those cases that come forward for testing. Hence, testing is our visual on how the pandemic is progressing and understanding the control.

The number of positive tests from tests carried out is known as the positivity rate. This looks at how adequately a country is testing and helps us understand the spread of the virus as we continue to assess the impact of vaccination. Positivity rate is also an early predictor because an increasing positivity rate can suggest that the virus is spreading faster than the growth seen from confirmed cases.