Hospital-acquired COVID-19: a New Dilemma for the Infection Control Practitioner (preprint)

BackgroundPreliminary reports show that nosocomial SARS-CoV-2 infection is not associated with increased mortality compared with community acquired infection.MethodsRetrospective comparison of COVID-19 adult patients who were classified according to probable time of acquisition of SARS-CoV-2 and symptom onset. Data from hospitalized patients that were hospitalized in non-COVID-19 areas were reviewed.All patients were classified as community-acquired/Community-onset (CA-CO), Community- acquired/hospital-onset (CA-HO) and Hospital-acquired/Hospital-onset (HA-HO) cases. All patients without respiratory symptoms were tested on day one and if negative, hospitalized in non-COVID-19 areas.Results We identified 59 patients that fulfilled the definition of CA-HO or HA-HO COVID-19. Patients in the CA-CO group were less likely to have multiple comorbidities than the patients in the CA-HO and HA-HO groups. Mortality was lower in the CA-CO group (21.8%) compared to the other groups, although it did not reach statistical significance. DiscussionWe identified 9 clusters of HA-HO cases arising from multiple-bed rooms from the non-COVID-19 areas. There was no significant difference for HA-HO COVID-19 between patients placed in a common-room bed compared to patients placed on single bed rooms (p=.19). Nevertheless, the RR for HA-HO COVID-19 was 105 (95% CI 62.9 to 177.6) for patients treated in a common-room allocating another COVID-19-detected patient within the immediate 24 h time frame (P=<0.01).ConclusionHospital-acquired COVID-19 is newly described and poses a challenge for infection control. We identified small clusters related to multiple-bed rooms from non-COVID-19 hospitalization wards and propose a simple time-based classification for hospital surveillance and isolation precautions.

Ethnic disparities in COVID-19 mortality in Mexico: a cross-sectional study based on national data (preprint)

ObjectiveTo analyze the mortality associated with ethnicity, particularly of Indigenous peoples, in a large sample of patients with COVID-19 in Mexico. DesignNational, cross-sectional study. SettingMexico. Participants416546 adult patients; 4178 Indigenous peoples with COVID-19 were the primary population under study. Main outcome measuresThe primary outcome was mortality from COVID-19 up to August 3rd, 2020. Logistic regression was used to calculate odds ratios while adjusting for confounders. ResultsAmong all patients with COVID-19, whether hospitalized or not, a higher proportion of Indigenous peoples died compared to non-Indigenous people (16.5% vs 11.1%, respectively). Among hospitalized patients, a higher proportion of Indigenous peoples died (37.1%) compared to non-Indigenous peoples (36.3%). Deaths outside the hospital were also higher among Indigenous peoples (3.7% vs 1.7%). A higher proportion of Indigenous peoples died in both the private and public health care sectors. The adjusted odds ratio for COVID-19 mortality among Indigenous peoples with COVID-19 was 1.13 (95% confidence interval 1.03 to 1.24). The adjusted odds ratio for COVID-19 mortality among Indigenous peoples with COVID-19 was higher among those who received only ambulatory care (1.55, 95% confidence interval 1.24 to 1.92). ConclusionsIn the large sample of patients with COVID-19, the findings suggest that Indigenous peoples in Mexico have a higher risk of death from COVID-19, especially outside the hospital. These findings suggest Indigenous peoples lack access to care more so than non-Indigenous people during the COVID-19 pandemic in Mexico. More research is needed regarding the impact of the COVID-19 among racial and ethnic minorities in Mexico.