Viral Sequencing to Investigate Sources of SARS-CoV-2 Infection in US Healthcare Personnel

Author:

Braun Katarina M1ORCID,Moreno Gage K2,Buys Ashley3,Somsen Elizabeth D2,Bobholz Max2,Accola Molly A34,Anderson Laura34,Rehrauer William M34,Baker David A2,Safdar Nasia5,Lepak Alexander J5,O’Connor David H26,Friedrich Thomas C16

Affiliation:

1. Department of Pathobiological Sciences, University of Wisconsin–Madison, Madison, Wisconsin, USA

2. Department of Pathology and Laboratory Medicine, University of Wisconsin–Madison, Madison, Wisconsin, USA

3. University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA

4. William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA

5. Department of Medicine, Division of Infectious Diseases, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA

6. Wisconsin National Primate Research Center, University of Wisconsin–Madison, Madison, Wisconsin, USA

Abstract

Abstract Background Healthcare personnel (HCP) are at increased risk of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We posit that current infection control guidelines generally protect HCP from SARS-CoV-2 infection in a healthcare setting. Methods In this retrospective case series, we used viral genomics to investigate the likely source of SARS-CoV-2 infection in HCP at a major academic medical institution in the Upper Midwest of the United States between 25 March and 27 December 2020. We obtained limited epidemiological data through informal interviews and review of the electronic health record and combined this information with healthcare-associated viral sequences and viral sequences collected in the broader community to infer the most likely source of infection in HCP. Results We investigated SARS-CoV-2 infection clusters involving 95 HCP and 137 possible patient contact sequences. The majority of HCP infections could not be linked to a patient or coworker (55 of 95 [57.9%]) and were genetically similar to viruses circulating concurrently in the community. We found that 10.5% of HCP infections (10 of 95) could be traced to a coworker. Strikingly, only 4.2% (4 of 95) could be traced to a patient source. Conclusions Infections among HCP add further strain to the healthcare system and put patients, HCP, and communities at risk. We found no evidence for healthcare-associated transmission in the majority of HCP infections evaluated. Although we cannot rule out the possibility of cryptic healthcare-associated transmission, it appears that HCP most commonly become infected with SARS-CoV-2 via community exposure. This emphasizes the ongoing importance of mask wearing, physical distancing, robust testing programs, and rapid distribution of vaccines.

Funder

National Institute of Allergy and Infectious Diseases

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Microbiology (medical)

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