Absence of nosocomial transmission of coronavirus disease 2019 (COVID-19) due to SARS-CoV-2 in the prepandemic phase in Hong Kong

Abstract

Background: To describe the infection control strategy to achieve zero nosocomial transmission of symptomatic coronavirus disease (COVID-19) due to SARS-CoV-2 during the prepandemic phase (the first 72 days after announcement of pneumonia cases in Wuhan) in Hong Kong.

Methods: Administrative support with the aim of zero nosocomial transmission by reducing elective clinical services, decanting wards, mobilizing isolation facilities, providing adequate personal protective equipment, coordinating laboratory network for rapid molecular diagnosis under 4-tier active surveillance for hospitalized patients and outpatients, and organizing staff forum and training was implemented under the framework of preparedness plan in Hospital Authority. The trend of SARS-CoV-2 in the first 72 days was compared with that of SARS-CoV 2003.

Results: Up to day 72 of the epidemic, 130 (0.40%) of 32,443 patients being screened confirmed to have SARS-CoV-2 by reverse transcription polymerase chain reaction. Compared with SARS outbreak in 2003, the SARS-CoV-2 case load constituted 8.9% (130 SARS-CoV-2/1458 SARS-CoV) of SARS-CoV infected cases at day 72 of the outbreak. The incidences of nosocomial acquisition of SARS-CoV per 1,000 SARS-patient-day and per 100 SARS-patient-admission were 7.9 and 16.9, respectively, which were significantly higher than the corresponding incidences of SARS-CoV-2 (zero infection, P <.001).

Conclusions: Administrative support to infection control could minimize the risk of nosocomial transmission of SARS-CoV-2.

Keywords: Coronavirus; Health care workers; Outbreak.

Fig 1

Command structure and activation of Hospital Authority preparedness plan. Note. CHP, Centre for Health Protection under the governance of Department of Health; HAHO, Hospital Authority Head Office; MICC, major incident control center, S1, serious response level 1; S2, serious response level 2. Central Command Committee is chaired by the Chief Executive of Hospital Authority. Emergency Executive Committee is chaired by the Chairman of Hospital Authority.

Fig 2

Epidemiological relationship of the first 130 confirmed case of coronavirus disease 2019 (COVID-19) in Hong Kong. Note. The cumulative number of case as of March 11, 2020 (day 72 after the official announcement of a cluster of pneumonia of unknown etiology in Wuhan, Hubei Province, China); Imported case is defined as patient developed symptoms suggestive of COVID-19 upon arrival to Hong Kong; Local case is defined as patient who had no history of travel during incubation period; Possibly local case is defined as patient who had local movement both outside and inside Hong Kong during the incubation period; Close contact in the community refers to household member or any person with face to face communication of more than 15 minutes in a confined area.

Fig 3

Comparative epidemiology of SARS-CoV (2003) and SARS-CoV-2 (2020) in Hong Kong. Note. The daily statistic of SARS-CoV was retrieved from the report of the Select Committee to inquire into the handling of the Severe Acute Respiratory Syndrome outbreak by the Government and the Hospital Authority July 2004 [https://www.legco.gov.hk/yr03-04/english/sc/sc_sars/reports/sars_rpt.htm ] (Accessed March 24, 2020). The imported case (65-year-old medical doctor who came from Guangdong Province, China and stayed in hotel M) was not included in the official statistical data in Hong Kong.