The burden and dynamics of hospital-acquired SARS-CoV-2 in England

Abstract

Hospital-based transmission had a dominant role in Middle East respiratory syndrome coronavirus (MERS-CoV) and severe acute respiratory syndrome coronavirus (SARS-CoV) epidemics1,2, but large-scale studies of its role in the SARS-CoV-2 pandemic are lacking. Such transmission risks spreading the virus to the most vulnerable individuals and can have wider-scale impacts through hospital–community interactions. Using data from acute hospitals in England, we quantify within-hospital transmission, evaluate likely pathways of spread and factors associated with heightened transmission risk, and explore the wider dynamical consequences. We estimate that between June 2020 and March 2021 between 95,000 and 167,000 inpatients acquired SARS-CoV-2 in hospitals (1% to 2% of all hospital admissions in this period). Analysis of time series data provided evidence that patients who themselves acquired SARS-CoV-2 infection in hospital were the main sources of transmission to other patients. Increased transmission to inpatients was associated with hospitals having fewer single rooms and lower heated volume per bed. Moreover, we show that reducing hospital transmission could substantially enhance the efficiency of punctuated lockdown measures in suppressing community transmission. These findings reveal the previously unrecognized scale of hospital transmission, have direct implications for targeting of hospital control measures and highlight the need to design hospitals better equipped to limit the transmission of future high-consequence pathogens.

Assessing the impact of testing for COVID-19 using lateral flow devices in NHS acute trusts in England

“…Among 136 NHS acute trusts, we identified that nosocomial infections accounted for 2.9% to 3.5% of the total 106,377 hospitalised COVID-19 patients from October 2020 to March 2022. These estimates are around 1% higher than a previous estimate of nosocomial infections in England between June 2020 and March 2021 [28] but dramatically lower than reported from other studies that focused on the early days of the pandemic [3, 29–31]. The reported number of LFD tests from NHS acute trusts was likely to be an underestimate of the actual number of tests performed.…”

Hospital Acquired Infection Revisited: Route of Transmission

“…The adaptability of certain emerging pathogen [53], especially in specific areas of hospital [54], provides the pathogen's ability to penetrate the dynamics of hospital's prevention measures, for example in case of SARS-CoV-2 [55] regarding both the risk of exposure to accompanying caregivers that to look after the patients during their hospitalization [56] and the need to maintain quality of care, while at the same time, ensuring all the staff ready to serve and well prepared [57]. Hospital staff (not limited to doctors and nurses) contribute actively to the prevention and management of HAI [57,58] as they are involved in basic personal hygienic care of the patient [59], navigating and implementing quality improvement initiatives [60], conducted necessary automating surveillance [61] via correct microbiological sampling [62], and features of rigid antibiotic stewardship [63].…”

Vaccine Effectiveness against SARS-CoV-2 Infection during the Circulation of Alpha, Delta, or Omicron Variants: A Retrospective Cohort Study in a Tertiary Hospital in Serbia

“…Cooper et al point out that hospitalised patients are especially vulnerable to COVID-19-associated complications and that controlling the transmission of COVID-19 in healthcare settings is critical to reduce the burden of this infection. They also emphasise the lack of studies that consider the effectiveness of vaccines (VE) against COVID-19 in hospitalized patients [ 13 ]. In order to generate real-life evidence on the safety and effectiveness of vaccines in use, the ECDC and the European Medical Agency officially established and launched consistent protocols to design necessary studies [ 14 ].…”