Issue Early epidemiology established higher risk of morbidity & mortality amongst infected older individuals or those having specific chronic diseases, consuming most hospital care Also where demand exceeding supply of healthcare, mortality was very high As an island nation with one central main hospital, not overwhelming the healthcare system whilst avoiding total lockdown was key Description On the 27-03-2020, the Superintendent of Public Health enacted the Protection of Vulnerable Persons Order, specifying that these categories (or subcategories thereof) of persons are to be granted vulnerable status: age &gt;65;pregnant;persons suffering from diabetes;immunosuppressed;cancer;end stage renal failure;respiratory disease;cardiac disease;heart failure Such persons were entitled to stay at home, to be granted special leave from work, entitled to a monthly allowance by social services One could go out only to attend to essential or urgent personal matters, e g groceries, medicines, medical needs, bank etc with mitigation measures Exemptions were only granted to special categories such as healthcare workers, farmers, or headship positions In addition, the carers & staff of most nursing homes voluntarily decided to isolate themselves inside the homes for periods of 2/3 weeks Thanks to a very active family support network, offspring, relatives or neighbours ran basic errands for them, or else organised deliveries This legal status has been lifted on the 5th June 2020 Results This status was granted to 126 000 persons, including 14000 employed persons Only 9 deaths occurred in Malta out of 664 cases in a population of 500000 up till 20th June 2020, with a case fatality rate of 1 35% - one of the lowest in Europe Lessons Protection of vulnerable individuals can be a cornerstone of COVID-19 public health response if mobility is effectively restricted in this subpopulation Key messages Protection of the vulnerable reduces healthcare & mortality burden Effective legal & economic support measures, & extensive societal engagement required
'Cocooning' the vulnerable - a main pillar of Malta's COVID-19 response