Correction: The first wave of COVID-19 in Malta; a national cross-sectional study.

[This corrects the article DOI: 10.1371/journal.pone.0239389.].

A novel use of telemedicine during the COVID-19 pandemic.

OBJECTIVE: The coronavirus disease-2019 (COVID-19) global pandemic brought with it many challenges but possibly the biggest was the best use of national hospital resources. With the aim to protect the hospital healthcare resources in the country whilst simultaneously safeguarding the health of COVID-19-infected patients, a telemedicine system led by experts was set up in Malta. METHODS: A team of local experts, called the 'Community COVID-19 Initial Assessment team' (CCIAT), co-ordinated the initial medical assessment and decisions for all newly diagnosed community patients. Data of all patients were collected prospectively and stored in one database. These data were then analysed to extract the demographics and outcomes of all these patients. RESULTS: Through telemedicine, the majority (91%) of 369 infected patients were managed safely in the community. Only a minority of patients (6%) was admitted to the main acute hospitals and there was no increased morbidity or mortality related to the medical decisions made using this telemedicine tool. CONCLUSIONS: This population-based study proves that this particular COVID-19 telemedicine project in Malta achieved its main goals, which were namely that of relieving the burden on the main local acute hospitals whilst ensuring the optimal medical management to infected patients.

The first wave of COVID-19 in Malta; a national cross-sectional study.

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.