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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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Corresponding Author: Aaron Richterman, MD, 3400 Spruce St, Philadelphia, PA 19104 (firstname.lastname@example.org).
Published Online: November 13, 2020. doi:10.1001/jama.2020.21399
Conflict of Interest Disclosures: None reported.
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