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Rapid nosocomial spread of SARS-CoV-2 in a French geriatric unit

Published online by Cambridge University Press:  30 March 2020

Philippe Vanhems*
Affiliation:
Service d'Hygiène, Epidémiologie et Prévention, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France Laboratoire des Pathogènes Emergents - Fondation Mérieux, Centre International de Recherche en Infectiologie, Institut National de la Santé et de la Recherche Médicale U1111, Centre National de la Recherche Scientifique, UMR5308, Ecole Normale Supérieure de Lyon, Université Claude Bernard Lyon 1, 21, Avenue Tony Garnier, 69007Lyon, France
Mitra Saadatian-Elahi
Affiliation:
Service d'Hygiène, Epidémiologie et Prévention, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France Laboratoire des Pathogènes Emergents - Fondation Mérieux, Centre International de Recherche en Infectiologie, Institut National de la Santé et de la Recherche Médicale U1111, Centre National de la Recherche Scientifique, UMR5308, Ecole Normale Supérieure de Lyon, Université Claude Bernard Lyon 1, 21, Avenue Tony Garnier, 69007Lyon, France
Michel Chuzeville
Affiliation:
Service de Gériatrie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
Elodie Marion
Affiliation:
Service d'Hygiène, Epidémiologie et Prévention, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
Louise Favrelle
Affiliation:
Service d'Hygiène, Epidémiologie et Prévention, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
Delphine Hilliquin
Affiliation:
Service d'Hygiène, Epidémiologie et Prévention, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
Geraldine Martin-Gaujard
Affiliation:
Service de Gériatrie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
Robin Gourmelon
Affiliation:
Service de Gériatrie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
Mathilde Noaillon
Affiliation:
Service de Gériatrie, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
Nagham Khanafer
Affiliation:
Service d'Hygiène, Epidémiologie et Prévention, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France Laboratoire des Pathogènes Emergents - Fondation Mérieux, Centre International de Recherche en Infectiologie, Institut National de la Santé et de la Recherche Médicale U1111, Centre National de la Recherche Scientifique, UMR5308, Ecole Normale Supérieure de Lyon, Université Claude Bernard Lyon 1, 21, Avenue Tony Garnier, 69007Lyon, France
*
Author for correspondence: Philippe Vanhems, E-mail: philippe.vanhems@chu-lyon.fr
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Abstract

Type
Letter to the Editor
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

To the Editor—SARS-CoV2 nosocomial transmission has been reported among healthcare professionals and patients.Reference Wang, Zhou and Liu1 However, few studies have focused on nosocomial clusters in elderly patients at high risk of morbidity and mortality.Reference Wang, Zhou and Liu1

With >6,600 cases, France is the fourth most affected European country. Edouard Herriot University Hospital (1,100 beds) is the largest emergency hospital in the Lyon area. We report the extremely rapid spread of COVID-19 in a 24-bed geriatric unit.

Epidemiological investigation revealed the existence of 2 potential index cases. The first was a 97-year-old male admitted to the emergency room (ER) with fever and dyspnea on February 29. The nasal swab for influenza and respiratory syncytial virus collected the same day was negative by polymerase chain reaction assay (PCR). The patient was transferred to the geriatric ward without complementary precautions. A second nasal swab was collected on March 7 and was positive for SARS-CoV2 by reverse-transcriptase PCR (RT-PCR). The second potential index case was a 76-year-old man admitted to the ER with cough and fever on February 1. Infection control measures were set up and nasal swab for influenza and respiratory syncytial virus (RSV) was negative by PCR. On March 3, the patient was transferred to the geriatric ward, where preventive air and contact measures were in place. The nasal swab previously collected was retested on March 6 and confirmed positive for SARS-CoV2 by RT-PCR.

The first secondary case of COVID-19 was diagnosed on March 10, and 5 other cases (including a medical doctor) occurred in the same unit until March 13 (Fig. 1). Strict infection control measures and close monitoring of suspected cases of patients and healthcare professionals were subsequently performed to contain the intraunit transmission of the SARS-Cov-2 virus. The infection rate among patients was 20%. Two patients (28.6%) died on March 14. No additional cases occurred.

Fig. 1. Timeline of exposures and onset nosocomial COVID-19 cases in a geriatric unit, Lyon, France.

The likelihood of other sources of infection remains low, and no cases occurred in other areas of the ward. The area where the cases occurred was not primarily selected for COVID-19 hospitalizations, and only 123 cases had been reported to the Lyon Regional Health Agency as of March 14, for a metropolitan area of 2,300,000 inhabitants.

The rapid spread of nosocomial COVID-19 in this ward confirms the contagiousness of SARS-CoV-2 in healthcare settings and the high mortality rates in this population. The existence of super-shedders has been suggested,Reference Liu, Eggo and Kucharski2,Reference Riou and Althaus3 which could facilitate cluster emergence.

We wish to stress the urgency of strict application of COVID-19 infection control guidelines in healthcare facilities, particularly in geriatric units.

Footnotes

a

COVID-Outcomes-HCL Consortium (Edouard Herriot Hospital - Geriatric group, in alphabetic order): Adrait A, Benoist F, Castel-Kremer E, Chuzeville M, Dupin AC, Doh S, Escuret V, Favrelle L, Gourmelon R, Hilliquin D, Kim BA, Khanafer N, Marion E, Martin-Gaujard G, Moyenin Y, Noaillon M, Paulet-Lafuma H, Ricanet A, Vanhems P.

References

Wang, J, Zhou, M, Liu, F. Exploring the reasons for healthcare workers infected with novel coronavirus disease 2019 (COVID-19) in China. J Hosp Infect 2020. pii: S0195-6701(20)30101-8. doi: 10.1016/j.jhin.2020.03.002.Google Scholar
Liu, Y, Eggo, RM, Kucharski, AJ. Secondary attack rate and superspreading events for SARS-CoV-2. Lancet 2020;395(10227):e47. doi: 10.1016/S0140-6736(20)30462-1.CrossRefGoogle ScholarPubMed
Riou, J, Althaus, CL. Pattern of early human-to-human transmission of Wuhan 2019 novel coronavirus (2019-nCoV), December 2019 to January 2020. Euro Surveill 2020;25:2000058.CrossRefGoogle Scholar
Figure 0

Fig. 1. Timeline of exposures and onset nosocomial COVID-19 cases in a geriatric unit, Lyon, France.