How COVID experts’ post-lockdown plan called for travel ban until September 2020

Superintendence warned of high risk of importation of COVID on 15 May 2020 • Travel abroad categorised as high-risk, to be allowed in early September according to 15 May transition plan

A May 2020 plan on the gradual easing of COVID-19 measures by the Superintendence of Public Health had proposed that travel abroad be only allowed 21 weeks after the end of the partial lockdown that contained Malta’s first wave of coronavirus cases.

In the report seen by MaltaToday, entitled ‘Transitioning Towards a New Normal’, an eight-phase transition was envisaged for the easing of COVID-19 restrictions, with three weeks separating each phase.

The timetable listed all the activities that could be allowed to resume, ranging from low-risk activities to very high-risk activities: travel abroad, and the easing of restrictions on vulnerable people, were the last activities expected to be allowed, a full five months after the end of the soft lockdown – sometime in September.

“High risk is associated with exposure to persons recently returning from abroad from countries with high prevalence of cases. The risk of importation of COVID infected individuals is still very high and the experience of countries who have started relaxing their borders has shown this is one most likely source of a second epidemic wave,” the Superintendence warned.

Malta reopened its airport fully to international travel from ‘safe countries’ on 1 July – six weeks after this report was distributed to the government.

The Superintendence had advised that any withdrawal of measures had to be taken in a “cautious, stepwise approach” to allow sufficient time to evaluate the response on transmission rates. “It is important to note that to effectively assess the effect of population mixing, planners need to wait for a period of three weeks (the incubation period of the COVID-19 is 14 days) to evaluate the effect of the down-scaling transition measures on the infection progression from one stage to another,” the report stated.

EU decision informed travel ban lifting

Phase 2 reflected a partial lockdown, which was the starting point for the transition plan, while phase 3 was the initial opening of low-risk activities at a low rate of infections with no growth in daily cases. But in between each phase, the Superintendence advised “a window of three weeks between Transition Phases… as this will allow for adequate assessment of the effects of previous phase changes and will also permit a review to guide decisions on whether to proceed to the next phase or not.”

The report stated that identifying the time when public health measures were to be suspended at each stage, was “a key strategic decision”: the main choice was whether to speed it up, or scale it down gradually on a longer time-frame.

“The main choice is between shorter time frames involving fewer steps with more measures being scaled down or completely suspended, or the converse, i.e. longer time frames with more steps and a lower number of measures rescinded at every stage. Three weeks need to elapse between one stage and another in the easing and withdrawal strategies to be implemented.”

In a reply to MaltaToday over the 1 July decision to lift the travel ban, the health ministry said this was made in accordance with the European Council Recommendation on the temporary restriction on non-essential travel into the EU, with several red zones remaining banned for travel. On 22 August, an amber list was introduced for incoming travellers who required a PCR test 72 hrs prior to arrival.

The health ministry told MaltaToday that it treated the document as a “baseline” recommendation, which was adapted according to the “successful mitigation of the risk for the various activities in each phase. For all measures which were lifted, there was never a complete lift of measures as standards were put in place for each measure for mitigation.” 

The health ministry also said it was encouraged by ITU occupancy as one of the critical variables as to whether it could relax public health measures. “Pressure on the ITU was below the established thresholds when gradually measures were being withdrawn last year. On the other hand, the ITU situation was also one of the considerations that led to more stringent measures in March 2021.”

Prior conditions before easing of restrictions

The 15 May plan also stated the conditions that had to be in place prior to the relaxation of any public health measures which, in the words of the Superintendence, would be “akin to walking a tight-rope”.

“A significantly decreased level of community spread of disease for a significant amount of time needs to be registered. A starting threshold is a Rt value below the self-sustaining value of 1, that is sustained for at least 14 days,” the report stated, a condition that was respected at the time of the May easing.

The Superintendence warned that Malta’s public health systems would be “too slow” to manage a resurgence of COVID-19 from an easing of physical distancing measures. It said it would need “resilient monitoring tools” and technology for a “certain level of digital surveillance of cases and their contact” in order to obtain rapid alerts on any re-escalating progression of COVID-19.

Indeed, the Superintendence used the word “months” to denote the length of the transition plan from mid-May onwards.

“The risk assessment and Transition Phases were mapped to present a Transition Plan outlining the introduction of several socio-economical activities over a period of a few months.  This is shown in Appendix 1, where each activity is classified according to mitigated risk and mapped to the 10 phases for the relaxation of measures, progressing from a complete lockdown to a complete relaxation of all measures.  Further activities have been added and will continue to be added according to demand. Current scores reflect the current reality, including the travel ban still being in place.”

10-phase transition plan

In its transition plan, the Superintendence for Public Health identified 10 phases, all ranked from low to high risk, between which a three-week period had to elapse between one step and the other.

The first and second phases were baseline scenarios of, respectively, a full and partial lockdown. Malta did not have a full lockdown, but a partial lockdown that included shuttered schools and the closure of non-essential shops.

The third phase – categorized as low-to-intermediate risk – was to allow the reopening of non-essential retail and malls, museums and indoor exhibitions, any drive-in cinema, the Gozo ferry, and allowing public gatherings of a maximum of four people.

The fourth and fifth phases – categorized as medium risk – allowed first the opening of outdoor cinemas, open-air theatres, sports venues, outdoor hotel pools but no hotel services, open-air markets, as well as hairdressers or beauticians, and then outdoor restaurants and beaches.

The sixth and seventh phases – categorized as high risk – allowed the reopening first of indoor pools, indoor restaurants, schools, indoor cinemas and betting shops; and then childcare centres, indoor mass, and gyms.

The eighth and ninth phases – categorized as very high risk – were the nightclubs, bingo halls, casinos, snack bars and clubs, organised public events such as festas, but not mass events; and then, travel abroad and the easing of restrictions on vulnerable populations.