Can post-exposure prophylaxis for COVID-19 be considered as an outbreak response strategy in long-term care hospitals?

Abstract

In the context of the ongoing global outbreak of coronavirus disease 2019 (COVID-19), management of exposure events is a concern. Long-term care hospitals (LTCHs) are particularly vulnerable to cluster outbreaks because facilities for patient isolation and healthcare personnel to care for these patients in isolation are difficult to arrange in a large outbreak situation. Although several drugs have been proposed as treatment options, there are no data on the effectiveness and safety of post-exposure prophylaxis (PEP) for COVID-19. After a large COVID-19 exposure event in an LTCH in Korea, PEP using hydroxychloroquine (HCQ) was administered to 211 individuals, including 189 patients and 22 careworkers, whose baseline polymerase chain reaction (PCR) tests for COVID-19 were negative. PEP was completed in 184 (97.4%) patients and 21 (95.5%) careworkers without serious adverse events. At the end of 14 days of quarantine, all follow-up PCR tests were negative. Based on our experience, further clinical studies are recommended for COVID-19 PEP.

Keywords: COVID-19; Hydroxychloroquine; Long-term care hospital; Post-exposure prophylaxis; SARS-CoV-2.

Fig. 1

Timeline of exposure period, quarantine and post-exposure prophylaxis. Ⓐ Pink line indicates the route of patient A (the index case) while symptomatic, Ⓑ Red line indicates the route of patient B (the second case) while symptomatic, ① Patient A, attended a religious service in Daegu, ② Patient A, symptom onset, ③ Patient A, diagnosed with COVID-19, ④ Hospital closed and contacts quarantined, COVID-19 tests for all patients and hospital staff, ⑤ Patient B, diagnosed with COVID-19, ICU patients transferred to the other hospital, ⑥ Patients and careworkers, initiated post-exposure prophylaxis with hydroxychloroquine, ⑦ Patients and hospital staff, follow-up COVID-19 tests, ⑧ Discontinuation of isolation, quarantine and post-exposure prophylaxis with hydroxychloroquine. F, floor; GW, general ward; ICU, intensive care unit; OC, outpatient clinic; PT, physical therapy room; XR, X-ray room