Thursday, June 13, 2024

Hospitals are Covid super spreaders – scientists

Scientists appear to have confirmed fears that hospitals may be contributors to the spread of the Corona virus.

A new study conducted in Botswana suggests that the country’s hospitals are super spreaders of Covid-19.

It also shows that overcrowding in Botswana’s hospitals was responsible for spike in Covid-19 infections in the country. 

The study by scientists, Britt Nakstad, Thato Kaang, Alemayehu Mekonne Gezmu and Jonathan Strysko investigated a cluster of six SARS-CoV-2 (covid-19) infections occurring in a crowded neonatal (infants) unit in Botswana, including presumed transmission among mothers, postnatal mother-to-neonate-to-healthcare worker transmissions. 

The research shows that affected neonates (infants), born at 25 weeks’ gestation weighing 785g, had a positive SARS-Cov-2 test at 3 weeks of age which coincided with new onset of hypoxaemia (when levels of oxygen in the blood are lower than normal) and worsening respiratory distress.

The report says because no isolation facility could accommodate both patient (infant) and mother, they were separated for 10 days during which time the patient was switched from breastmilk to formula. The infant’s subsequent clinical course was marked by several weeks of supplementary oxygen, sepsis-like (body’s response to infection) presentations requiring additional antibiotics.

Despite these complications, adequate growth was achieved likely due to early initiation of nutrition, the report says. 

The report says this nosocomial (of a disease, originating in a hospital) cluster, highlights the vulnerabilities of neonates, caregivers and healthcare workers in an overcrowded environment and underscore the importance of uninterrupted bonding and breast feeding, even during a pandemic. 

The report also says that in October during a period of increased community SARS-CoV-2 transmission in Botswana, routine testing for SARS Cov-2 was performed in our hospital’s crowded postpartum ward, where mothers slept, and cared for their newborns in close proximity with one another. Masks were worn, but often inconsistently. Despite having tested negative on admission to the hospital, 2 of 12 mothers whose premature infants were hospitalized in a specified ward for preterm infants tested positive for SARS-CoV-2. both mothers were asymptomatic and reported having not left the hospital since being admitted.

The report says while early pandemic response efforts in many LMICs were thwarted by shortages of personal protective equipment, reducing overcrowding in facilities has become an important tool of COVID-29 prevention and control in these settings. Admittedly, implementation of policies aimed t decongesting hospital units is not always easy and often comes at with the need for additional staff. However, healthcare facilities should recognize that additional space and staff is a critical infection prevention and control (IPC)intervention and is likely to be cost-effective in the long run.

The report says that the clinical course of the child in question was complicated by an underlying diagnosis of severe RDS for which she was not provided surfactant therapy and ventilatory support per local care guidelines for infants. 

The researchers concluded that hospital overcrowding is likely a major driver of covid-19 transmission in hospitals in Botswana and other low/middle-income countries and should be prioritized as a target for infection prevention and control intervention in the locations.


Read this week's paper