Despite COVID spike, hospitalisations far lower now compared to previous wave

Governments have had two primary aims when taking decisions to combat COVID-19: the first to keep the death toll as low as possible; the second not to overwhelm national hospitals.

With over 80% of the population vaccinated, government has been able to do both while easing restrictions considerably.

The partial lockdown announced in March provided almost instant relief for Malta’s hospitals. Two weeks after schools and non-essential shops closed down, hospitalisations fell from 245 to 143. In just one month, they fell further to 64 patients.

This sharp decline cannot be fully attributed to rising vaccinations. It was only between April and May that the vaccination drive went into full force. Those who took their first dose of the AstraZeneca vaccine in February were now eligible for their second jab, and vaccinations were rapidly opening to lower age groups.

Hospitalisations before and after

Hospitalisations are correlated with infections, so any drop in active cases would lead to fewer hospital admissions. However, the vaccine seems to be weakening this correlation.

The recent spike in cases isn’t the first time Malta had 2,000 active cases on its shores, but hospitalisations were far higher back then. Last Wednesday, there were 15 patients being treated at Mater Dei Hospital. Last March, hospitalised patients numbered at around 250.

This despite that the Delta variant is between 40-60% more transmissible than the Alpha (UK) variant, and that fewer measures are in place now compared to the winter months. However, it must be said that the Delta variant has not become the main strain among local cases yet.

Public Health Superintendent Charmaine Gauci said on Wednesday that there have been 64 cases of the Delta variant in Malta. For comparison, Malta registered well over 2,000 new infections since June.

Other factors may be keeping hospitalisations low.

New cases are mostly being registered in the 10-39 age group, where hospitalisations were never too common. According to information from the health authorities, the highest proportion of cases is being seen among the under-19s.

The effects of the current spike might be delayed slightly. Active cases started to rise exponentially two weeks ago, so a mild spike in hospitalisations could still be on the cards.

Vaccine efficacy

Vaccines appear to be working, but scientists don’t yet know for how long vaccine immunity will persist, nor if booster shots will be required.

Pfizer-BioNTech confirmed last April that the companies’ COVID-19 vaccine showed a 91.3% efficacy up to six months after the second dose. Meanwhile Kate O’Brien, director of the Department of Immunisation, Vaccines and Biologicals at the WHO, said that there isn’t enough data yet to inform a decision on whether booster doses will be needed.

The vaccines work, and do so for long periods of time. Now, government must change its decision-making outlook away from rising cases and more towards hospitalisations. The closure of English-language schools and the introduction of mandatory quarantine on unvaccinated travellers were more likely to have been knee-jerk reactions to the spike in active cases, rather than to what could have been a 15-person increase in hospital admissions.

Any spike in cases ought to be avoided, especially given that some groups of the population are still unable to take the jab, including pregnant women and children.

The situation gets more complicated in a country that depends on tourism. Incoming travellers provide a continuous influx of potential new cases that can put undue pressure on the health system.

In this context, mandatory quarantine for unvaccinated tourists could well provide a necessary buffer against rising cases, as Malta would effectively only be open to fully vaccinated travellers.

However, there is scope for a country like Malta, with such a high vaccination rate, to toy with ideas that were unthinkable before the vaccine came about – including controlled mass events beyond the 100-person limit.

The blanket quarantine measures, dubbed unreasonable by the Malta Chamber of Commerce last week, could also afford a revision from health authorities, at least in those cases involving fully vaccinated people.

If government chooses not to budge in these areas, it risks undermining the message that vaccines are the vehicle to normality. Being among the most vaccinated countries in the world has its challenges, but it also offers an opportunity to get creative with policy and explore the new possibilities offered by the vaccines.

Additional reporting by Kurt Sansone