How contaminated stethoscopes, thermometers led to 119 Covid-19 cases and 15 deaths at a hospital
The new coronavirus seems to have hitchhiked on medical instruments such as stethoscopes, thermometers to set off an outbreak in a South African hospital. It also made inroads into a neighboring dialysis center and nursing home. The incident resulted in 119 infections and 15 deaths, according to a report. The investigation holds lessons for hospitals. Some of them include sanitizing objects like medical instruments after every use and minimizing the non-essential movement of people in the hospital premises.
The report traces the footsteps of the virus, describing how the virus arrived at the St Augustine’s Hospital in KwaZulu-Natal, a South African province. It also explains how the virus exploited hospital conditions, where people and contaminated instruments moved from one ward to another. When authorities caught wind of the problem, the Health Department had to seal the hospital. "It’s a remarkable story and testimony to the virus’s capacity to spread through a facility if appropriate controls are not in place,” Michael Klompas, an infectious disease specialist at Harvard Medical School, who was not involved in the study, told ScienceMag.org.
How did it start?
To reconstruct the events that led to the outbreak, the team took samples from infected patients and sequenced the new coronavirus genome. The analysis helped them understand how it moved both in and outside the hospital. According to the analysis, the virus reached the hospital on March 9, when an infected person visited the emergency department. The person may have unwittingly passed on the virus to another patient suspected of stroke, who was also in the same room.
Their investigation shows that the virus mainly spread through contact with contaminated medical equipment. They also highlight the possibility of another mode of transmission: the frequent movement of patients between and within wards. It brought people who were unaware of their infection closer to other susceptible patients. "It seems this partly reflects the timing as the hospital was preparing for Covid-19 ( emptying wards to repurpose them as Covid‐19 wards) and then responding to the outbreak as it evolved," they wrote in the report.
"Overall, we estimate that the hospital outbreak and its spread to these other institutions accounted for about 14% of Covid-19 cases in KwaZulu-Natal reported up to 30 April. This highlights the risk that outbreaks like this become what we call ‘amplifiers’ of transmission, that is they fuel transmission in the wider community," Dr Tulio de Oliveira from the University of Washington, said in a statement.
In addition to disinfecting medical instruments, the team recommends dividing hospitals into three zones: red, yellow, and green. Red zones can be exclusive for people with confirmed infections, yellow zones for people with suspected Covid-19. The green zones can treat people who are unlikely to have the infection. Commenting on the report, Dr. Eric Topol, the director of the Scripps Research Translational Institute tweeted: "A patient w/ #Covid19 comes to the emergency department". He added, "A remarkable investigation at a South African hospital implicating stethoscopes, thermometers, BP cuffs ."