On 9 March, a patient who had recently traveled to Europe and had symptoms of COVID-19 visited the emergency department of St Augustine’s, a private hospital in Durban, South Africa. Eight weeks later, 39 patients and 80 staff linked to the hospital had been infected, and 15 patients had died—fully half the death toll in KwaZulu-Natal province at that time.
Now, scientists at the University of KwaZulu-Natal have published a detailed reconstruction of how the virus spread from ward to ward and between patients, doctors, and nurses, based on floor maps of the hospital, analyses of staff and patient movements, and viral genomes. Report into a nosocomial outbreak of coronavirus disease 2019 (COVID-19) at Netcare St. Augustine’s Hospital
Their 37-page analysis, posted on the university’s website on 22 May, is the most extensive study of any hospital outbreak of COVID-19 so far. It suggests all of the cases originated from a single introduction, and that patients rarely infected other patients. Instead, the virus was mostly carried around the hospital by staff and on the surfaces of medical equipment.
The report, which reads like a detective novel, tracks the virus’s spread through five hospital wards, including neurology, surgery, and intensive care units (ICUs), as well as to a nearby nursing home and dialysis center. Remarkably, no staff infections seem to have taken place in the hospital’s COVID-19 ICU, arguably the riskiest area of the hospital. That may be because patients are less infectious by the time they are admitted to intensive care, or because staff there are more diligent about preventing infection, the authors note.
The first patient, who sought help for coronavirus symptoms, only spent a few hours at the hospital, but likely transmitted the virus to an elderly patient admitted the same day for a stroke. ...
