Gregory Y Warner1, Bennett H Penn2,3, Derek J Bays2, Minh-Vu H Nguyen2, Stuart H Cohen2, Sarah Waldman2, Carla S Martin4, George R Thompson2,3, Christian Sandrock5, Joel Tourtellotte5, Janelle Vu Pugashetti5, Chinh Phan5, Hien H Nguyen2,6. 1. Department of Internal Medicine, Division of Infectious Diseases, NorthBay Healthcare, Fairfield, California, United States of America. 2. Department of Internal Medicine, Division of Infectious Diseases, University of California Davis Medical Center, Sacramento, California, United States of America. 3. Department of Medical Microbiology and Immunology, University of California, Davis, Davis, California, United States of America. 4. Executive Director - Patient Care Services at University of California Davis Medical Center, Sacramento, California, United States of America. 5. Department of Internal Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of California Davis Medical Center, Sacramento, California, United States of America. 6. Department of Internal Medicine, Division of Infectious Diseases, Veterans Affairs Northern California Health Care System, Sacramento, CA, United States of America.
Abstract
OBJECTIVE: To describe the pattern of transmission of SARS-CoV-2 during 2 nosocomial outbreaks of COVID-19 with regard to the possibility of airborne transmission. DESIGN: Contact investigations with active case finding were used to assess the pattern of spread from 2 COVID-19 index patients. SETTING: A community hospital and university medical center in the United States, in February and March, 2020, early in the COVID-19 pandemic. PATIENTS: Two index patients and 421 exposed health care workers. METHODS: Exposed staff were identified by analyzing the EMR and conducting active case finding in combination with structured interviews. Staff were tested for COVID-19 by obtaining oropharyngeal/nasopharyngeal specimens, with RT-PCR testing to detect SARS-CoV-2. RESULTS: Two separate index patients were admitted in February and March 2020, without initial suspicion for COVID-19 and without contact or droplet precautions in place; both patients underwent several aerosol generating procedures in this context. A total of 421 health care workers were exposed in total, and the results of the case contact investigations identified 8 secondary infections in health care workers. In all 8 cases, the staff had close contact with the index patients without sufficient personal protective equipment. Importantly, despite multiple aerosol generating procedures, there was no evidence of airborne transmission. CONCLUSION: These observations suggest that, at least in a healthcare setting, a majority of SARS-CoV-2 transmission is likely to take place during close contact with infected patients through respiratory droplets, rather than by long-distance airborne transmission.
OBJECTIVE: To describe the pattern of transmission of SARS-CoV-2 during 2 nosocomial outbreaks of COVID-19 with regard to the possibility of airborne transmission. DESIGN: Contact investigations with active case finding were used to assess the pattern of spread from 2 COVID-19 index patients. SETTING: A community hospital and university medical center in the United States, in February and March, 2020, early in the COVID-19 pandemic. PATIENTS: Two index patients and 421 exposed health care workers. METHODS: Exposed staff were identified by analyzing the EMR and conducting active case finding in combination with structured interviews. Staff were tested for COVID-19 by obtaining oropharyngeal/nasopharyngeal specimens, with RT-PCR testing to detect SARS-CoV-2. RESULTS: Two separate index patients were admitted in February and March 2020, without initial suspicion for COVID-19 and without contact or droplet precautions in place; both patients underwent several aerosol generating procedures in this context. A total of 421 health care workers were exposed in total, and the results of the case contact investigations identified 8 secondary infections in health care workers. In all 8 cases, the staff had close contact with the index patients without sufficient personal protective equipment. Importantly, despite multiple aerosol generating procedures, there was no evidence of airborne transmission. CONCLUSION: These observations suggest that, at least in a healthcare setting, a majority of SARS-CoV-2 transmission is likely to take place during close contact with infectedpatients through respiratory droplets, rather than by long-distance airborne transmission.
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