The rapid spread of coronavirus disease 2019 (COVID-19) required swift preparation to protect healthcare personnel (HCP) and patients, especially in light of personal protective equipment (PPE) shortages. Due to a lack of a pre-existing bio-containment unit, we needed to develop a novel approach to cohort patients while working with the pre-existing physical space.

Prevent disease transmission to non-COVID-19 patients and HCP caring for COVID-19 patients, optimize PPE usage, and provide a comfortable and safe working environment.

An interdisciplinary workgroup developed a combination of approaches to convert existing spaces into COVID-19 containment units with high-risk zones (HRZs). We developed standard workflow and visual management in conjunction with updated staff training and workflows. Infection Prevention created PPE standard practices for ease of use, conservation, and staff safety.

The interventions resulted in one possible case of patient-to-HCP transmission and zero cases of patient-to-patient transmission. PPE usage decreased with the HRZ model while maintaining a safe environment of care. COVID-19 unit staff were extremely satisfied with PPE availability (76.7%) and efforts to protect them from COVID-19 (72.7%). Approximately half of COVID-19 unit HCP agreed (54.8%) that PPE monitors played an essential role in staff safety.

The HRZ model of containment unit is an effective method to prevent the spread of COVID-19 with several benefits. It is easily implemented and scaled to account for census changes. Our experience suggests that other institutions do not need to modify existing physical structures to create similarly protective spaces.

We quantified hospital-acquired COVID-19 during the early phases of the pandemic, and we evaluated solely temporal determinations of hospital acquisition.

Retrospective observational study during early phases of the COVID-19 pandemic, March 1-November 30, 2020. We identified laboratory-detected SARS-CoV-2 from 30 days before admission through discharge. All episodes detected after hospital day 5 were categorized by chart review as community or unlikely hospital-acquired, or possible or probable hospital-acquired.

Two acute-care hospitals in Chicago, IL.

All hospitalized patients including an inpatient rehabilitation unit.

Each hospital implemented infection-control precautions soon after identifying COVID-19 cases, including patient- and staff-cohorting, universal masking, and restricted visitation policies.

Among 2,667 patients with SARS-CoV-2, detection before hospital day six was most common (n=2,612; 98%); days 6-14 uncommon (n=43; 1.6%); and, after day 14, rare (n=16; 0.6%). By chart review, most episodes after day 5 were categorized as community-acquired, usually because SARS-CoV-2 had been detected at a prior healthcare facility (68% of cases on days 6-14; 53% of cases after day 14). Incidence for possible and probable hospital-acquired cases, per 10,000 patient-days, was similar for ICU- and non-ICU patients at Hospitals A (1.2 vs 1.3, difference = 0.1; 95% CI, -2.8 to 3.0) and B (2.8 vs 1.2, difference = 1.6; 95% CI, -0.1 to 4.0).

Most patients were protected by early and sustained application of infection-control precautions, modified to reduce COVID-19 transmission. Using solely temporal criteria to discriminate hospital- vs community-acquisition would have misclassified many “late-onset” SARS-CoV-2 positive episodes.

In March 2020, New York City (NYC) became the epicenter of the COVID-19 pandemic in the United States (US). As healthcare facilities were overwhelmed with patients, the Jacob K. Javits Convention Center was transformed into the nation’s largest alternate care site (ACS): Javits New York Medical Station (Javits). Protecting healthcare workers during a global shortage of personal protective equipment (PPE) in a non-traditional healthcare setting posed unique challenges. We describe components of the healthcare worker safety program implemented at Javits.

Javits, a large convention center transformed into a field hospital, with clinical staff from the US Public Health Service Commissioned Corps (USPHS) and the Department of Defense (DoD).

Key strategies included ensuring one-way flow of traffic on and off the patient floor; developing a matrix detailing PPE required for each work activity and location; PPE extended use and reuse protocols; personnel training; and monitoring adherence to PPE donning/doffing protocols when entering or exiting the patient floor. Javits staff who reported COVID-19 symptoms were immediately isolated, monitored, and offered a SARS-CoV-2 reverse transcriptase polymerase chain reaction (RT-PCR) test.

A well-designed and implemented healthcare worker safety plan can minimize the risk of SARS-CoV-2 infection for healthcare workers. The lessons learned from operating the nation’s largest COVID-19 ACS can be adapted to other environments during public health emergencies.

To assess the validity of Antigen rapid diagnostic tests (Ag-RDT) for SARS-CoV-2 as decision support tool in various hospital-based clinical settings.

Retrospective cohort study among symptomatic and asymptomatic patients and Healthcare workers (HCW).

A large tertiary teaching medical center serving as a major COVID-19 hospitalizing facility.

Ag-RDTs’ performance was assessed in three clinical settings: 1. Symptomatic patients and HCW presenting at the Emergency Departments 2. Asymptomatic patients screened upon hospitalization 3. HCW of all sectors tested at the HCW clinic following exposure.

We obtained 5172 samples from 4595 individuals, who had both Ag-RDT and quantitative real-time PCR (qRT-PCR) results available. Of these, 485 samples were positive by qRT-PCR. The positive percent agreement (PPA) of Ag-RDT was greater for lower cycle threshold (Ct) values, reaching 93% in cases where Ct-value was <25 and 85% where Ct-value was <30. PPA was similar between symptomatic and asymptomatic individuals. We observed a significant correlation between Ct-value and time from infection onset (p<0.001).

Ag-RDT are highly sensitive to the infectious stage of COVID-19 manifested by either high viral load (lower Ct) or proximity to infection, whether patient is symptomatic or asymptomatic. Thus, this simple-to-use and inexpensive detection method can be used as a decision support tool in various in-hospital clinical settings, assisting patient flow and maintaining sufficient hospital staffing.

Describe a SARS-CoV-2 hospital outbreak and the role of serial testing of patients and healthcare personnel (HCP) in interrupting transmission.

Outbreak investigation

Medical floor of a tertiary care center in Minnesota

Serial testing for SARS-CoV-2 and whole genome sequencing (WGS) of positive specimens from HCP and patients was used. An outbreak-associated case was defined as a positive SARS-CoV-2 molecular test in HCP who worked on the floor prior to testing positive or in a patient who was hospitalized on the medical floor during October 27–December 1, 2020. WGS was used to understand potential routes of transmission.

The outbreak was detected after a patient hospitalized for 12 days tested positive for SARS-CoV-2. Serial testing of patients and HCP was conducted in response. Overall, 247 HCP and 41 patients participated in serial SARS-CoV-2 testing. Fifty-two (21%) HCP and 19 (46%) hospitalized patients tested positive. One additional HCP tested positive outside of serial testing. WGS of specimens from 27 (51%) HCP and 15 (79%) patients identified three distinct transmission clusters. WGS and epidemiologic evidence suggested intrafacility transmission. The proportion of asymptomatic and pre-symptomatic patients who tested positive (63%) and HCP who worked during their infectious period (75%) highlight the need for serial testing of asymptomatic patients and HCP during outbreaks.

Coupled with preventive measures such as personal protective equipment use and physical distancing, serial testing of HCP and patients could help detect and prevent transmission within healthcare facilities during outbreaks and when nosocomial transmission is suspected.

In response to the 2014-2016 West Africa Ebola virus disease (EVD) epidemic, the Centers for Disease Control and Prevention (CDC) designated 56 US hospitals as Ebola treatment centers (ETCs) with high-level isolation capabilities. We aimed to determine ongoing sustainability of ETCs and identify how ETC capabilities have impacted hospital, local, and regional COVID-19 readiness and response.

An electronic survey included both qualitative and quantitative questions and was structured into two sections: operational sustainability and role in the COVID-19 response.

The survey was distributed to site representatives from the 56 originally designated ETCs; 37 (66%) responded.

Data were coded and analyzed using descriptive statistics.

Of the 37 responding ETCs, 33 (89%) reported they were still operating while 4 had decommissioned. ETCs that maintain high-level isolation capabilities incurred a mean of $234,367 in expenses per year. All but one ETC reported that existing capabilities (e.g., trained staff, infrastructure) before COVID-19 positively affected their hospital, local, and regional COVID-19 readiness and response (e.g., ETCs trained staff, donated supplies, and shared developed protocols).

Existing high-level isolation capabilities and expertise developed following the 2014-2016 EVD epidemic were leveraged by ETCs to assist hospital-wide readiness for COVID-19 and support response for other local and regional hospitals However, ETCs face continued challenges in sustaining those capabilities for high-consequence infectious diseases.

To assess characteristics and perceptions associated with vaccine hesitancy among healthcare workers in order to increase COVID-19 vaccine uptake in this population.

Cross-sectional quantitative survey

Southwest Virginia

A convenience sample of 2,720 employees of a not-for-profit healthcare system

Between March 15-29, 2021, we conducted an Internet-based survey. Our questionnaire assessed sociodemographic and work-related characteristics, vaccine experience and intentions, agreement with vaccine-related perceptions, most important reasons for getting or not getting vaccinated, and trusted sources of information about COVID-19. We used χ2 analyses to assess the relationship between vaccine hesitancy and both characteristics and vaccine-related perceptions.

18% of respondents were classified as vaccine-hesitant. Characteristics significantly associated with hesitancy included Black race/ethnicity, younger age, not having a high-risk household member, and prior personal experience with COVID-19 illness. Hesitancy was also significantly associated with many vaccine-related perceptions, including concerns about short-term and long-term side-effects and a belief that the vaccines are not effective. Among acceptant participants, wanting to protect others and wanting to help end the pandemic were the most common reasons for getting vaccinated. Personal physicians were cited most frequently as trusted source of information about COVID-19 among both vaccine-hesitant and vaccine-acceptant respondents.

Educational interventions to decrease vaccine hesitancy amongst healthcare workers should focus on alleviating safety concerns, emphasizing vaccine efficacy, and appealing to a sense of duty. Such interventions should target younger adult audiences. Personal physicians may also be an effective avenue for reducing hesitancy among their patients through patient-centered discussions.

Characterize and compare SARS-CoV-2–specific immune responses in plasma and gingival crevicular fluid (GCF) from nursing home residents during and after natural infection

Prospective cohort

Nursing home

SARS-CoV-2–infected nursing home residents

A convenience sample of 14 SARS-CoV-2–infected nursing home residents, enrolled 4–13 days after real-time reverse transcription polymerase chain reaction diagnosis, were followed for 42 days. Post diagnosis, plasma SARS-CoV-2–specific pan-Immunoglobulin (Ig), IgG, IgA, IgM, and neutralizing antibodies were measured at 5 timepoints and GCF SARS-CoV-2–specific IgG and IgA were measured at 4 timepoints.

All participants demonstrated immune responses to SARS-CoV-2 infection. Among 12 phlebotomized participants, plasma was positive for pan-Ig and IgG in all 12, neutralizing antibodies in 11, IgM in 10, and IgA in 9. Among 14 participants with GCF specimens, GCF was positive for IgG in 13 and IgA in 12. Immunoglobulin responses in plasma and GCF had similar kinetics; median times to peak antibody response was similar across specimen types (4 weeks for IgG; 3 weeks for IgA). Participants with pan-Ig, IgG, and IgA detected in plasma and GCF IgG remained positive through this evaluation’s end 46–55 days post-diagnosis. All participants were viral culture negative by the first detection of antibodies.

Nursing home residents had detectable SARS-CoV-2 antibodies in plasma and GCF after infection. Kinetics of antibodies detected in GCF mirrored those from plasma. Non-invasive GCF may be useful for detecting and monitoring immunologic responses in populations unable or unwilling to be phlebotomized.