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 7 th of March to the 24 th 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.

Please cite this article as: { doi: https://doi.org/ This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

There is an error in the thirteenth paragraph of the Discussion section of this article [1]. Prior to the publication of this article [1], reference 26 was retracted by The Lancet and should not have been cited. The following text in the thirteenth paragraph of the Discussion should be removed: "More recent literature showed that hydroxychloroquine was associated with decreased in-hospital survival and an increased frequency of arrhythmias when used for . This led to temporary suspension of the HCQ arm within the Solidarity trial, however this was resumed again on June 3rd 2020 after reassessment of the data [27]." As a result of this correction to the Discussion text, references 26-27 are no longer cited in the article. The authors are not aware of further studies that associate hydroxychloroquine with decreased in-hospital survival.The Data Availability statement for this paper is incorrect. The correct statement is: COVID-19 case data were sourced from the publicly available Superintendence of Public Health, Malta (https://infogram.com/covid-19-malta-superintendence-ofpublic-health-1h7k23gorvzv4xr) and the Malta Health Promotion & Disease Prevention Directorate (https://geosys-mt.maps.arcgis.com/apps/opsdashboard/index.html#/ c17848aba0f94d79a4f57a7a584c4e8e) following the protocol outlined in the Methods section. A de-identified dataset underlying the clinical results is available from the Dryad repository (