Investigation of nosocomial SARS-CoV-2 transmission from two patients to healthcare workers identifies close contact but not airborne transmission events.

OBJECTIVE: To describe the pattern of transmission of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) during 2 nosocomial outbreaks of coronavirus disease 2019 (COVID-19) with regard to the possibility of airborne transmission. DESIGN: Contact investigations with active case finding were used to assess the pattern of spread from 2 COVID-19 index patients. SETTING: A community hospital and university medical center in the United States, in February and March, 2020, early in the COVID-19 pandemic. PATIENTS: Two index patients and 421 exposed healthcare workers. METHODS: Exposed healthcare workers (HCWs) were identified by analyzing the electronic medical record (EMR) and conducting active case finding in combination with structured interviews. Healthcare coworkers (HCWs) were tested for COVID-19 by obtaining oropharyngeal/nasopharyngeal specimens, and RT-PCR testing was used to detect SARS-CoV-2. RESULTS: Two separate index patients were admitted in February and March 2020, without initial suspicion for COVID-19 and without contact or droplet precautions in place; both patients underwent several aerosol-generating procedures in this context. In total, 421 HCWs were exposed in total, and the results of the case contact investigations identified 8 secondary infections in HCWs. In all 8 cases, the HCWs had close contact with the index patients without sufficient personal protective equipment. Importantly, despite multiple aerosol-generating procedures, there was no evidence of airborne transmission. CONCLUSION: These observations suggest that, at least in a healthcare setting, most SARS-CoV-2 transmission is likely to take place during close contact with infected patients through respiratory droplets, rather than by long-distance airborne transmission.

Efficacy of a Physician Assistant Student-Developed Behavior Change Program at a Local Free Clinic.

PURPOSE: A quality assurance and quality improvement assessment was conducted to evaluate the efficacy of a behavior change program developed by physician assistant (PA) students at a local free clinic. METHODS: Physician assistant students developed and implemented a program using motivational interviewing and healthy lifestyle behavioral counseling at a local free clinic. Twenty-eight patients participated in the program over 5 cohorts. A retrospective chart review was used to collect data. RESULTS: Weight and body mass index (BMI) data were gathered retrospectively from patients' charts corresponding to the 6 months before the program, at the start of the program, at the end of the 12-week program, and at 3 and 6 months after the program. Significant differences were found between the start and end of the program for weight (P < .001) and BMI scores (P < .001). The mean weight decreased from 111.98 (standard deviation [SD] = 33.47) to 109.00 kg (SD = 33.93). The weight loss ranged from 0.45 to 9.53 kg, and 75% of participants lost weight. The mean BMI decreased from 41.21 (SD = 10.64) to 40.13 (SD = 10.98). Differences were maintained at 3- and 6-month follow-ups. However, only half the sample's data were available at follow-ups because some patients did not return to the free clinic during that time period. CONCLUSIONS: A program facilitated by PA students and designed to help patients make healthy diet and exercise changes can be a valuable resource for free clinics and patients and an excellent clinical opportunity for PA students. To strengthen the program's commitment to maintenance of weight loss, program components of continued follow-up and engagement of patients should be explored and developed.