Hospitals may become hot spots as cases among health care staff rise

Person-to-person transmission in hospital clusters a high risk

NEW DELHI: Over 50 doctors and other health care workers have tested positive for the coronavirus disease across India, putting the spotlight on their vulnerability and the possibility of hospitals emerging as high-risk places to contract the infection.

Across the world, many health care workers have been infected; some while treating Covid patients and others through unknown sources. In the epicentre of the disease, China, a paper had warned on as early as February 7 – when the country had 34,546 cases – that hospitals could become the hot spots.

The study, published in The Journal of the American Medical Association, found that 41% of the 138 Covid-19 cases examined for it were likely person-to-person hospital-associated transmissions.

The authors of the paper, doctors at the Zhongnan Hospital in China’s Wuhan, studied 138 hospitalised patients with confirmed cases at the hospital from January 1 to January 28. The study said that “presumed hospital-related transmission was suspected if a cluster of health professionals or hospitalised patients in the same wards became infected and a possible source of infection could be tracked”.

A Lancet study on March 21 reported that figures from China’s National Health Commission show that more than 3,300 health care workers had been infected as of early March.

Such person-to-person transmissions in hospital clusters were also observed during the 2013 Middle East Respiratory Syndrome outbreak in Saudi Arabia, a study published in The New England Journal of Medicine in 2013 said. The study, ‘Hospital Outbreak of Middle East Respiratory Syndrome Coronavirus’, found that of the 23 cases of MERS-CoV infection reported in the eastern province of Saudi Arabia between April 1 and May 23, 2013, as many as “21 were acquired by person-to-person transmission in hemodialysis units, intensive care units, or in-patient units in three different health care facilities”.

In Spain, of the 40,000 Covid-19 cases reported till March 24, the country’s health ministry, said that 5,400 – nearly 14% -- involved medical professionals.

In an article published in the New England Journal of Medicine Catalyst on March 21, doctors from the Papa Giovanni XXIII Hospital in Bergamo in Italy’s Lombardy region, which is among the worst-hit regions in Europe, said, “Our own hospital is highly contaminated.”

The paper drew attention to the dire conditions in which the medical staff are working in the country. “Most hospitals in the region,” the doctors said in the paper, “were overcrowded, nearing collapse while medications, ventilators oxygen and PPE [Personal Protection Equipment] are not available.”

According to Medscape, as many as 61 doctors and healthcare workers have succumbed to the virus in Italy till March 31.

Highlighting that hospitals may be the main carriers of the infection “as they are rapidly populated by infected patients, facilitating transmission to uninfected patients”, the doctors said ambulances and personnel ferrying patients to the hospitals may also become vectors of the virus.

In their paper, the doctors warned that such hospital personnel, who get the infection from patients or contaminated hospital equipment, were probably carrying the contagion back into the community.

The most contaminated zones in hospitals were ICUs, (31.9%), obstetric isolation wards specialised for pregnant women with novel coronavirus pneumonia or NCP (28.1%), and isolation wards for NCP (19.6%), according to a yet-to-be peer-reviewed metaanalysis of 32 studies published in MedRxiv, a pre-print server for health sciences. The most contaminated objects, the study said, both hand sanitizer dispensers (20.3%) and gloves (15.4%) were the most contaminated PPE.

The Italian doctors called for replacing centralised, hospital based and patient-centered care with community-centred, telemedicine, to “avoid unnecessary movement and release pressure from hospitals”.

Of the over 50 doctors and healthcare workers that have tested positive in India over the last two weeks, many were not involved in treating Covid-19 patients. These included a doctor at the Delhi State Cancer Institute and a resident doctor of the AIIMS, Delhi, and his ninemonth pregnant wife.

“Indian hospitals have been adequately equipped so far... But controlling this pandemic needs cooperation of the government and the public... However, we will need more PPE and more equipment in the coming weeks, because if hospitals start becoming spreaders..., the situation could get much worse very quickly,” said Dr Dhiren Gupta, a senior consultant at New Delhi’s Sir Ganga Ram Hospital.

THE DOCTORS WARNED THAT HOSPITAL PERSONNEL, WHO GET THE INFECTION FROM PATIENTS WERE PROBABLY CARRYING THE CONTAGION BACK INTO THE COMMUNITY