Early in 2020, the highly infectious and dangerous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) made an unsettling appearance. It quickly spread around the world, sparking the novel coronavirus pandemic (COVID-19), endangering public health and safety. Hospitals and health care systems entered uncharted territory and quickly adjusted to the unfolding health crisis as the rest of the globe came to a standstill in order to care for their community and prevent possibly ill patients and healthcare personnel from transmitting the virus.
The extent of the response included the hospital’s reinforcement of the universal masking policy for both staff and patients, routine testing for SARS-CoV-2 on all staff and patients upon admission, regardless of symptoms, and stringent isolation procedures for those who were infected with the virus.
Researchers at the University of California San Diego School of Medicine employed cutting edge technology and a creative methodology to assess the efficacy of preventative measures put in place in healthcare settings during the final three waves of the pandemic, about four years after it was first reported.
The study, which was published online in Clinical Infectious Diseases on January 16, 2024, was the first of its kind to compare the physical transmission patterns of the various strains of the virus among hospital staff members and patients while also closely analyzing the genetic makeup of the virus using data from electronic health and contact tracing records.
Researchers discovered that the majority of SARS-CoV-2 transmissions were stopped by the infection prevention measures that were put into place in the healthcare context. These measures included universal mask use and ventilation regulations that required at least five clean air changes per hour. Personal protective equipment (PPE) protected and essentially eradicated health care-associated viral transmission in patients who tested positive for it.
“It was frightening when the pandemic first started because we didn’t have quick diagnostics or treatments, and we didn’t know exactly how the virus spread or if our infection control procedures were sufficient,” said Francesca Torriani, MD, the study’s senior author and an infectious disease specialist and program director at UC San Diego Health.
As a result, our top priority was to ensure the safety of both our patients and employees as well as to assess the possible effects of the virus. I saw healthcare professionals terrified of catching the illness at work and possibly spreading it to their families at home.”
According to Torriani, stopping the virus’s propagation and obstructing its source have taken precedence.
We reinforced infection prevention control methods to lower the risk of transmission between patients and healthcare workers, and we gained important life-saving lessons in response to the spreading epidemic, all with the trust and support of UC San Diego Health’s executive leadership. It was believed that the quick adoption and adjustment of infection control procedures in the medical field presented a chance to examine their efficacy in more detail.
In order to assess the many sample variations and determine whether they were momentarily or physically close to one another, indicating the possibility of health care transmission, the researchers employed a novel strategy that had never been employed previously. To categorize, isolate, and evaluate people exposed to particular virus strains, researchers used patient electronic health record data, whose identities were kept secret during the study, and metadata about staff access and movement to these records. They also implemented a comprehensive contact tracing program.
“Although the virus strains were easily identifiable in the second and third waves of the pandemic, we discovered that genetic data was insufficient during the explosive and uniform Omicron wave,” stated Christopher Longhurst, MD, the study’s co-author and executive director of the Jacobs Center for Health Innovation, and chief medical officer and chief digital officer at UC San Diego Health.
In order to determine what actually happened and how the virus was being spread, we had to go deeper into the electronic documentation, as well as social network analysis, for example, looking at individuals who shared the same virus strains, and taking into account their physical interaction in the hospital, to find out what happened and how it was spread.
In order to conduct the study, researchers examined the genetic makeup of SARS-CoV-2 during three successive waves and compared how closely one person’s genetic variant was related to that of another person.
During the period of November 1, 2020 to February 27, 2022, a total of 12,933 virus samples were collected from 35,666 patients and health care professionals for the purpose of this study.
As Joel Wertheim, PhD, co-senior author of the study and associate professor at UC San Diego School of Medicine, explained to me, “Even when hundreds of health care workers became infected every week during the peak of the Omicron wave, they were not more likely to contract the virus in the hospital system than they were in the general population,” during this study. It is evident from the results that viral transmission patterns can be revealed.
Using genetic and social networking analysis, the results showed that universal masking was essential for preventing transmissions, but airborne negative pressure rooms, universal N95 respirator masks, or even closing the door of a patient’s room were not essential for preventing transmissions in the health care setting.
As a matter of fact, most transmissions occurred outside of a healthcare facility, through physical contact between individuals in the community, between households or when universal masking wasn’t followed when the infection was unrecognized and unrecognized. In shared spaces like breakrooms and lobby areas, virus transmission was more likely to occur.
We believe that our analysis of the pandemic demonstrates that our health care system has been able to protect patients and health care workers during the pandemic by implementing safety measures such as ventilation standards, comprehensive viral testing, and universal masks from the beginning.” Shira Abeles, MD, co-author of the study, assistant professor in the Department of Medicine at UC San Diego School of Medicine, and infectious disease specialist at UC San Diego Health, is also a co-author of the study.
He adds that the type of technological approach used in this study can serve as a model for future research, as well as a tool for eradicating epidemics of highly contagious infectious diseases in the future.
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