The risk of SARS-CoV-2 transmission in the healthcare setting and potential impact of cohorting strategies (preprint)

ABSTRACT

Background Since its onset, the COVID-19 pandemic has caused significant morbidity and mortality worldwide, with particularly severe outcomes in healthcare institutions and congregate settings. To mitigate spread, healthcare systems have been cohorting patients to limit contacts between uninfected patients and potentially infected patients or healthcare workers (HCWs). A major challenge in managing the pandemic is the presence of currently asymptomatic individuals capable of transmitting the virus, who could introduce COVID-19 into uninfected cohorts. The optimal combination of personal protective equipment (PPE) and testing approaches to prevent these events is unclear, especially in light of ongoing limitations in access to both. Methods Using stochastic simulations with an SEIR model we quantified and compared the impacts of PPE use, patient and HCWs testing, and cohorting. Findings In the base case without testing or PPE, the healthcare system was rapidly overwhelmed, and became a net contributor to the force of infection. We found that effective use of PPE by both HCWs and patients could prevent this scenario, while random testing of apparently asymptomatic individuals on a weekly basis was less effective. We also found that even imperfect use of PPE could provide substantial protection by decreasing the force of infection, and that creation of smaller patient/HCW subcohorts can provide additional resilience to outbreak development. Interpretation These findings reinforce the importance of ensuring adequate PPE supplies even in the absence of testing, and provide support for strict subcohorting regimens to reduce outbreak potential in healthcare institutions.