A hospital in South Africa recently published a remarkable account of how a single patient in the emergency department (ED) introduced Covid-19 to the hospital which then managed to spread to 119 confirmed cases by 30th April.
The first patient, P1, appeared at the ED for a Covid-19 test on March 9 after recently returning from Europe and coming down with symptoms. They quickly whisked him off to a separate room but in the short time he was there he managed to infect another patient, P3, who was in the ED at the same time but for a separate issue. P1 and P3 were in close proximity to each other and were seen by the same medical officer. The map below shows the location of P1 and P3. P1 was in the triage area and P3 was opposite this room on a trolley (outlined in green in the map below).
P3 was admitted to the cardiac intensive care unit later that same day where she stayed for 4 nights. On the 13th March, she developed a fever. It did not occur to anyone that it might be Covid-19 related at this time because there was no Covid-19 in the hospital, or so they thought. The fever subsided and the patient was discharged on the 16th March. Her condition deteriorated on the 19th March and she was readmitted with suspected Covid-19.
The first staff case was on the 17th March in a nurse who cared for P3 on the night shift of 12 March – 13 March. From here the infection spread throughout the hospital infecting 39 patients and 80 staff in different wards and departments. They think the virus was transmitted by staff, patients, and medical equipment such as stethoscopes and thermometers.
They did a very thorough investigation and made a number of recommendations including early isolation of suspect Covid-19 patients, equipping health care workers with appropriate PPE, and regular cleaning and disinfection of surfaces and equipment. It’s not exactly rocket science but it shows how easily the virus transmits when we don’t follow these basic ideas.