A cluster of COVID-19 at a general hospital in Thailand, March–April 2020
Keywords:
COVID-19, outbreak investigation, nosocomial infectionAbstract
Backgrounds: On 6 April 2020, there was a notification of a COVID-19 patient from Medicine Female Ward, General Hospital A, then many COVID-19 patients related with this ward were reported soon after. The jointed investigation team conducted the investigation aimed to identify source of the outbreak, mode of transmission and give recommendation to control and prevent the outbreak.
Methodology: Descriptive study was performed, including active case finding among patients, health care workers (HCW), visitors of this ward during 20 March–12 April 2020, and the family and community contacts of these patients. Environmental survey in related wards was carried out.
Results: There were 21 COVID-19 patients (19 females and 2 males) with 3 fatal cases. The median age was 42 years old (range 2–85 years old). This cluster included 10 caregivers, 7 ward patients, 2 household contacts, 1 home visitor and 1 HCW. Among them, there were 5 asymptomatic cases. The highest number of patients found in zone 1, where the index case was admitted and treated with nebulizer. The index case was previously hospitalized at this ward during 20–26 March 2020 and then having onset just 1 day after discharged. She was re– admitted on 2 April 2020 and got nebulizer on that day. There were 6 patients contracted the disease before 2 April 2020. One of them was just moved from another hospital where having COVID-19 outbreak in Bangkok. For the remaining patients, most were in this ward while the index case got nebulizer. However, there were 3 patients came to the ward on next day but within 3 hours after the index case was moved to an isolation room.
Conclusion and Recommendation: This outbreak was likely linked with a patient who moved from a hospital in Bangkok. Main factor for wide spreading of the outbreak was the treatment of the index case with nebulizer, while airborne transmission from severe cough or environmental contamination seems to play a role in some cases. During active COVID-19 epidemic in the country, high caution of COVID-19 should be done in a patient with history of previous hospitalization, especially among those who moved from outbreak provinces.
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