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. 2021 Jun 21;8(8):ofab328.
doi: 10.1093/ofid/ofab328. eCollection 2021 Aug.

Transmission of SARS-CoV-2 in Inpatient and Outpatient Settings in a Veterans Affairs Health Care System

Chetan Jinadatha  1   2 , Lucas D Jones  3 , Hosoon Choi  4 , Piyali Chatterjee  4 , Munok Hwang  4 , Sarah N Redmond  5 , Maria E Navas  6 , Trina F Zabarsky  7 , Davinder Bhullar  8 , Jennifer L Cadnum  9 , Curtis J Donskey  5   10
Affiliations

Transmission of SARS-CoV-2 in Inpatient and Outpatient Settings in a Veterans Affairs Health Care System

Chetan Jinadatha et al. Open Forum Infect Dis. .

Abstract

Background: Health care personnel and patients are at risk to acquire severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in health care settings, including in outpatient clinics and ancillary care areas.

Methods: Between May 1, 2020, and January 31, 2021, we identified clusters of 3 or more coronavirus disease 2019 (COVID-19) cases in which nosocomial transmission was suspected in a Veterans Affairs health care system. Asymptomatic employees and patients were tested for SARS-CoV-2 if they were identified as being at risk through contact tracing investigations; for 7 clusters, all personnel and/or patients in a shared work area were tested regardless of exposure history. Whole-genome sequencing was performed to determine the relatedness of SARS-CoV-2 samples from the clusters and from control employees and patients.

Results: Of 14 clusters investigated, 7 occurred in community-based outpatient clinics, 1 in the emergency department, 3 in ancillary care areas, and 3 on hospital medical/surgical wards that did not provide care for patients with known COVID-19 infection. Eighty-one of 82 (99%) symptomatic COVID-19 cases and 31 of 35 (89%) asymptomatic cases occurred in health care personnel. Sequencing analysis provided support for several transmission events between coworkers and in 2 cases supported transmission from health care personnel to patients. There were no documented transmissions from patients to personnel.

Conclusions: Clusters of COVID-19 with nosocomial transmission predominantly involved health care personnel and often occurred in outpatient clinics and ancillary care areas. There is a need for improved measures to prevent transmission of SARS-CoV-2 by health care personnel in inpatient and outpatient settings.

Keywords: SARS-CoV-2; health care personnel; outpatients; transmission.

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Figures

Figure 1.
Figure 1.
Number of COVID-19 cases diagnosed in outpatients, inpatients, hospital employees, and employees based in community outpatient clinics. Abbreviation: COVID-19, coronavirus disease 2019.
Figure 2.
Figure 2.
Dendrogram displaying the SNP differences between SARS-CoV-2 viral sequences that were related (<2 SNP differences) or possibly related (3–5 SNP differences) in the 5 transmission clusters and in 3 employee controls with COVID-19 infection. Clades were determined based on the Nextstrain classification system. The Wuhan-Hu-1 reference genome is shown for comparison. Dates indicate the date of specimen collection. Abbreviations: COVID-19, coronavirus disease 2019; Emp, employee; Pat, patient; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; SNP, single nucleotide polymorphism.
Figure 3.
Figure 3.
Dendrogram displaying the single nucleotide polymorphism differences between SARS-CoV-2 viral sequences of individuals implicated in suspected transmission clusters based on contact tracing and in 17 patients with COVID-19 after community exposures and 10 employee controls. Clades were determined based on the Nextstrain classification system. The Wuhan-Hu-1 reference genome is shown for comparison. Abbreviations: COVID-19, coronavirus disease 2019; Emp, employee; Pat, patient; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; SNP, single nucleotide polymorphism.
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