Abstract
ProblemOne month after the initial case of coronavirus disease 2019 (COVID-19) in Tasmania, an island state of Australia, two health-care workers (HCWs) from a single regional hospital were notified to public health authorities following positive tests for SARS-CoV-2 nucleic acid. These were the first recognized cases in an outbreak that overwhelmed the hospital’s ability to function.ContextThe outbreak originated from two index cases. Both had returned to Tasmania following travel on a cruise ship and required hospital admission for management of COVID-19. A total of 138 cases were subsequently linked to this outbreak: 81 HCWs (most being nurses) and 23 patients across three hospitals, one resident of an aged-care facility and 33 close contacts.ActionThe outbreak was controlled through the identification and isolation of cases, identification and quarantining of close contacts and their household members, closure of the affected facilities and community-level restrictions to reduce social mixing in the affected region.Lessons learntFactors that were likely to have contributed to ongoing transmission in this setting included workplace practices that prevented adequate physical distancing, attending work while symptomatic, challenges in rapidly identifying contacts, mobility of staff and patients between facilities, and challenges in the implementation of infection control practices.DiscussionMany commonly accepted hospital practices before the COVID-19 pandemic amplified the outbreak. The lessons learnt from this investigation changed work practices for HCWs and led to wider public health interventions in the management of potential primary and secondary contacts.
Highlights
On 19 March 2020, 2671 passengers and 1146 crew disembarked from a cruise ship after a 12-day international cruise that began and ended in Sydney, Australia; they travelled on to other destinations.[1]
Two thirds of the passengers were Australian; of these, 40% were subsequently diagnosed with coronavirus disease 2019 (COVID-19), including 18 who were diagnosed after returning to Tasmania, an island to the south of mainland Australia with a population of 528 000
Both were later identified as index cases of an outbreak that affected another 138 people comprising health-care workers (HCWs), patients and other close contacts
Summary
The two index cases were admitted to the medical ward of Hospital 1 for the management of COVID-19 on 20 and 26 March 2020. Their respective dates of diagnosis and notification to the Department of Health were 19 and 26 March. All three HCW cases worked on the medical ward of Hospital 1, none provided direct care to the two index patients. 81 were HCWs, 23 were patients across the three hospitals, one was a resident of the aged-care facility and 33 were close contacts. 11 April – Quarantine of HCWs from the medical and surgical wards of Hospital 1; additional sta support provided from Hospital 2
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