Abstract
Patients with COVID-19 may present with respiratory syndromes indistinguishable from those caused by common viruses. Early isolation and containment is challenging. Although screening all patients with respiratory symptoms for COVID-19 has been recommended, the practicality of such an effort has yet to be assessed. Over a 6-week period during a SARS-CoV-2 outbreak, our institution introduced a "respiratory surveillance ward" (RSW) to segregate all patients with respiratory symptoms in designated areas, where appropriate personal protective equipment (PPE) could be utilized until SARS-CoV-2 testing was done. Patients could be transferred when SARS-CoV-2 tests were negative on 2 consecutive occasions, 24 hours apart. Over the study period, 1,178 patients were admitted to the RSWs. The mean length-of-stay (LOS) was 1.89 days (SD, 1.23). Among confirmed cases of pneumonia admitted to the RSW, 5 of 310 patients (1.61%) tested positive for SARS-CoV-2. This finding was comparable to the pickup rate from our isolation ward. In total, 126 HCWs were potentially exposed to these cases; however, only 3 (2.38%) required quarantine because most used appropriate PPE. In addition, 13 inpatients overlapped with the index cases during their stay in the RSW; of these 13 exposed inpatients, 1 patient subsequently developed COVID-19 after exposure. No patient-HCW transmission was detected despite intensive surveillance. Our institution successfully utilized the strategy of an RSW over a 6-week period to contain a cluster of COVID-19 cases and to prevent patient-HCW transmission. However, this method was resource-intensive in terms of testing and bed capacity.
Highlights
The remaining 115 patients were not initially admitted to an isolation ward or the respiratory surveillance ward (RSW), but they had a severe acute respiratory syndrome (SARS)-CoV-2 test, either because they were asymptomatic on admission but developed respiratory symptoms within 14 days of admission and approval for testing was given after discussion with an infectious diseases (ID) physician, or because they were admitted directly to the intensive care unit (ICU)
During an outbreak of SARS-CoV-2 with local transmission, an RSW to cohort all inpatients admitted from the community with respiratory symptoms may enhance case detection and reduce the potential of nosocomial transmission.[23]
This approach allowed high-risk COVID-19 suspects to be prioritized for management in limited isolation facilities while maintaining vigilance by managing potentially at-risk patients in designated zones to contain the risk of nosocomial transmission
Summary
Patients with COVID-19 may present with respiratory syndromes indistinguishable from those caused by common viruses. Among confirmed cases of pneumonia admitted to the RSW, 5 of 310 patients (1.61%) tested positive for SARS-CoV-2. This finding was comparable to the pickup rate from our isolation ward. Conclusions: Our institution successfully utilized the strategy of an RSW over a 6-week period to contain a cluster of COVID-19 cases and to prevent patient–HCW transmission. This method was resource-intensive in terms of testing and bed capacity. This method was resource-intensive in terms of testing and bed capacity. (Received 3 April 2020; accepted 30 April 2020; electronically published 8 May 2020)
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