Abstract
Outbreaks of COVID-19 in hospices for palliative care patients pose a unique and difficult situation. Staff, relatives and patients may be possible sources and recipients of infection. We present an outbreak of COVID-19 in a hospice setting, during the UK's first pandemic wave. During the outbreak period, 26 patients and 30 staff tested SARS-CoV-2 positive by laboratory-based RT-PCR testing. Most infected staff exhibited some mild, non-specific symptoms so affected staff members may not have voluntarily self-isolated or had themselves tested on this basis. Similarly, for infected patients, most became symptomatic and were then isolated. Additional, enhanced aerosol infection control measures were implemented, including opening of all windows where available; universal masking for all staff, including in non-clinical areas and taking breaks separately; screening for asymptomatic infection among staff and patients, with appropriate isolation (at home for staff) if infected; performing a ventilation survey of the hospice facility. After these measures were instigated, the numbers of COVID-19 cases decreased to zero over the following three weeks. This outbreak study demonstrated that an accurate understanding of the routes of infection for a new pathogen, as well as the nature of symptomatic versus asymptomatic infection and transmission, is crucial for controlling its spread.
Highlights
We present an outbreak of COVID-19 in a hospice setting, during the UK’s first pandemic wave
26 patients and 30 staff were identified as SARS-CoV-2 positive by laboratory-based reversetranscription polymerase chain reaction (RT-PCR) testing, as shown in the epidemic curve
Patients in these facilities are usually admitted with an expectation of a short lifespan, with no ICU or resuscitation 5 requirement, yet they are required to be protected from infections and other ailments that may adversely affect the quality of their life that remains
Summary
The COVID-19 pandemic has been ongoing since January 2020 with multiple outbreaks reported in various healthcare [1] and non-healthcare settings, including public transport [2,3], workplaces [4], schools [5,6], churches [7,8], recreational [9,10] and entertainment venues [11,12].The various modes of transmission of SARS-CoV-2 have been investigated and debated in the context of infection control, to optimize the interventions used to reduce the spread of this virus [13,14,15]. Healthcare settings, long-stay residential homes, have been hardest hit by the pandemic, with very high infection and mortality rates in the early pandemic waves. Outbreaks of COVID-19 in hospices for palliative care patients (i.e. those expected to die shortly) pose a unique and difficult situation—and often include staff, relatives and patients as possible sources and recipients of infection. Such patients will not be considered for intensive care (i.e. admission to ICU—including intubation and ventilation) or for resuscitation, yet there is an emphasis on maintaining a reasonable quality of life, free from pain, anxiety and distress. In the context of an ongoing pandemic, when staff and laboratory resources may be redirected to more acute care settings, and where visitors are restricted or banned, maintaining such quality end-of-life care can be a challenge [21,22,23,24]
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