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More than 50 patients were infected with Covid-19 in a Dublin hospital over six weeks, and 14 of them died, according to a pioneering study of the genome by Irish scientists.
In most cases, patients contracted the virus from healthcare workers, while an older patient who was agitated and “wandered” through the hallways was identified as a potential “super spreader.”
The study, conducted at the height of the pandemic, investigated the genome sequences of 52 cases of Covid-19 acquired at the hospital during March and April to trace their transmission routes.
The research sheds new light on how the virus spreads through wards and among healthcare workers and finds that in most cases, healthcare workers transmitted the virus to patients, not the other way around.
The scientists analyzed 50 cases of Covid-19 acquired at the hospital. The first was detected on March 23, and over the next six weeks or so, outbreaks of the virus affected multiple wards and infected more than 50 people.
The first healthcare worker to develop a hospital-acquired Covid-19 infection worked in a different ward. Three patients of the healthcare worker also tested positive, while five other patients who were not seen by the healthcare worker also tested positive.
A fourth outbreak occurred in two medical wards between April 2 and 9. Although the patients were in individual rooms with bathrooms in both rooms, nine tested positive for the virus.
They had been treated by the same nursing team and clinical teams.
At the same time, two more outbreaks occurred in operating rooms where seven patients contracted the virus. Five patients were in individual rooms and two shared a room. But there was no obvious link between these outbreaks and the outbreaks in medical wards.
At this point, the hospital expanded testing criteria for healthcare workers, fearing cases would be overlooked, and staff were asked to wear masks for all interactions with patients, not just Covid patients. -19.
Tellingly, there were no more Covid-19 hospital outbreaks for 10 days.
Then, on April 28, a new hospital-acquired case emerged in an elderly, agitated patient “wandering” down the hall with a designated caregiver.
According to the study, the patient was unable to maintain physical detachment and “characteristically yelled directly into the faces of passing staff members.”
An agency nurse who treated him became symptomatic and a week later, on April 28, the patient tested positive for Covid-19.
In the end, six health workers in the ward tested positive for the virus, as did 11 patients, despite the fact that most of the patients in the ward would not have been considered close contacts because they were immobile.
The outbreak came at a time when staff had been told to wear masks when interacting with patients.
“Upon questioning, staff reported that surgical masks were frequently removed at the nurses station when communicating with each other and replaced for interactions with patients,” the study said.
The scientists analyzed all 50 positive tests using a genome sequencing process and identified six clusters of the virus in the hospital at the time.
They found that the first three groups generally came from the same hospital strain of the virus.
The second group included two patients in two separate wards who had contracted the virus.
Sequencing showed that they both had the same virus strain.
The researchers were able to tell that the strain they had was the Ward 3 strain, from which it turned out that both patients had been discharged the previous week.
Outbreaks in four hospital wards previously considered unrelated were found to be related.
The scientists identified a single strain of the virus that was “indistinguishable” in all four wards.
One of the healthcare workers in this group who tested positive was identified as a “floater” taking care of highly dependent patients in different wards on a daily basis.
The study concluded that 52 patients were infected with Covid-19 during their hospital stay between March 23 and May 7. Most of them were sick and 14 patients died from complications from Covid-19.
Given the ongoing threat to vulnerable patients in hospitals, the report said it was “essential” to identify how the virus is transmitted to prevent hospital outbreaks.
The study claimed to “highlight for the first time the analytical power” of whole genome sequencing in hospital outbreak research and using the data to improve infection controls.
The data also suggested that the majority of hospital-acquired cases were transmitted through healthcare workers, as many patients were immobile or in individual rooms with a bathroom.
Genomic sequencing identifies slight mutations or changes in the sequence of the virus as it passes from one human to another, allowing scientists to investigate how it spreads, whether there are one or more sources of an outbreak, and sometimes of where it comes from.
Other countries have been implementing genome sequencing for months; the process was credited with mapping the second surge in Melbourne, Australia.
The study aimed to trace the route of transmission of the virus in the hospital, in a context of high levels of infection among healthcare workers and significant infection among patients.
It was clear from the findings that “ongoing communication between advisory organizations and frontline workers” was “paramount” in shaping public health policy, according to the study.
The study, Whole Genome Sequencing to Trace SARS-CoV-2 Transmission in Nosocomial Outbreaks, was completed by UCD scientists.
Among them were Mary Lucey, Dr Guerrino Macori, Professor Séamus Fanning and Professor Kirsten Schaffer, from the Department of Microbiology at St Vincent’s Hospital in Dublin.
Online editors
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