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Hospital-Acquired SARS-CoV-2 InfectionLessons for Public Health

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

From the outset of the coronavirus disease 2019 (COVID-19) pandemic, it was clear that hospitals were an important setting for viral transmission. A review of 2 early case series in China estimated that 44% of 179 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections were hospital acquired.1 An illustrative example of the devastating potential for health care transmission of SARS-CoV-2 came from St Augustine’s Hospital in Durban, South Africa, a facility with 469 beds, including 18 wards, 6 intensive care units, and 735 clinical staff.2 Through a detailed epidemiologic study supplemented by phylogenetic analyses, investigators documented how a single unsuspected case of SARS-CoV-2 led to 6 major clusters involving 5 hospital wards and an outside nursing home and dialysis unit, with infection ultimately confirmed among 80 staff members and 39 patients, 15 of whom died.2

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Article Information

Corresponding Author: Aaron Richterman, MD, 3400 Spruce St, Philadelphia, PA 19104 (aaron.richterman@pennmedicine.upenn.edu).

Published Online: November 13, 2020. doi:10.1001/jama.2020.21399

Conflict of Interest Disclosures: None reported.

References
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Zhou  Q , Gao  Y , Wang  X ,  et al.  Nosocomial infections among patients with COVID-19, SARS and MERS: a rapid review and meta-analysis.   Ann Transl Med. 2020;8(10):629. doi:10.21037/atm-20-3324 PubMedGoogle ScholarCrossref
2.
Lessells  R , Moosa  Y , de Oliveira  T . Report into a nosocomial outbreak of coronavirus disease 2019 (COVID-19) at Netcare St. Augustine’s Hospital. Published May 15, 2020. Accessed September 13, 2020. https://www.krisp.org.za/manuscripts/StAugustinesHospitalOutbreakInvestigation_FinalReport_15may2020_comp.pdf
3.
Seidelman  J , Lewis  S , Advani  S ,  et al.  Universal masking is an effective strategy to flatten the SARS-2-CoV healthcare worker epidemiologic curve.   Infect Control Hosp Epidemiol. Published online June 24, 2020. doi:10.1017/ice.2020.313PubMedGoogle Scholar
4.
Wang  X , Ferro  EG , Zhou  G ,  et al.  Association between universal masking in a health care system and SARS-CoV-2 positivity among health care workers.   JAMA. 2020;324(7):703. doi:10.1001/jama.2020.12897 PubMedGoogle ScholarCrossref
5.
Baker  MA , Fiumara  K , Rhee  C ,  et al; CDC Prevention Epicenters Program.  Low risk of COVID-19 among patients exposed to infected healthcare workers.   Clin Infect Dis. 2020;ciaa1269. Published online August 28, 2020. doi:10.1093/cid/ciaa1269PubMedGoogle Scholar
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Rhee  C , Baker  M , Vaidya  V ,  et al; CDC Prevention Epicenters Program.  Incidence of nosocomial COVID-19 in patients hospitalized at a large US academic medical center.   JAMA Netw Open. 2020;3(9):e2020498. doi:10.1001/jamanetworkopen.2020.20498PubMedGoogle Scholar
7.
Nguyen  LH , Drew  DA , Graham  MS ,  et al; Coronavirus Pandemic Epidemiology Consortium.  Risk of COVID-19 among front-line health-care workers and the general community.   Lancet Public Health. 2020;5(9):e475-e483. doi:10.1016/S2468-2667(20)30164-X PubMedGoogle ScholarCrossref
8.
Advani  SD , Yarrington  ME , Smith  BA ,  et al.  Are we forgetting the “universal” in universal masking? current challenges and future solutions.   Infect Control Hosp Epidemiol. Published online July 16, 2020. doi:10.1017/ice.2020.333Google Scholar
9.
Baystate Medical Center (BMC) identified COVID-positive patients and employees on a non-COVID clinical unit, and took immediate steps to respond. Accessed October 5, 2020. https://www.baystatehealth.org/covid19/cluster-information
10.
Brigham and Women’s Hospital. Statement for media regarding COVID-19 cluster. Accessed October 5, 2020. https://www.brighamandwomens.org/about-bwh/newsroom/press-releases-detail?id=3684
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