The contribution of hospital-acquired infections to the COVID-19 epidemic in England in the first half of 2020
This article has been Reviewed by the following groups
Listed in
- Evaluated articles (ScreenIT)
Abstract
Background
SARS-CoV-2 is known to transmit in hospital settings, but the contribution of infections acquired in hospitals to the epidemic at a national scale is unknown.
Methods
We used comprehensive national English datasets to determine the number of COVID-19 patients with identified hospital-acquired infections (with symptom onset > 7 days after admission and before discharge) in acute English hospitals up to August 2020. As patients may leave the hospital prior to detection of infection or have rapid symptom onset, we combined measures of the length of stay and the incubation period distribution to estimate how many hospital-acquired infections may have been missed. We used simulations to estimate the total number (identified and unidentified) of symptomatic hospital-acquired infections, as well as infections due to onward community transmission from missed hospital-acquired infections, to 31st July 2020.
Results
In our dataset of hospitalised COVID-19 patients in acute English hospitals with a recorded symptom onset date (n = 65,028), 7% were classified as hospital-acquired. We estimated that only 30% (range across weeks and 200 simulations: 20–41%) of symptomatic hospital-acquired infections would be identified, with up to 15% (mean, 95% range over 200 simulations: 14.1–15.8%) of cases currently classified as community-acquired COVID-19 potentially linked to hospital transmission. We estimated that 26,600 (25,900 to 27,700) individuals acquired a symptomatic SARS-CoV-2 infection in an acute Trust in England before 31st July 2020, resulting in 15,900 (15,200–16,400) or 20.1% (19.2–20.7%) of all identified hospitalised COVID-19 cases.
Conclusions
Transmission of SARS-CoV-2 to hospitalised patients likely caused approximately a fifth of identified cases of hospitalised COVID-19 in the “first wave” in England, but less than 1% of all infections in England. Using time to symptom onset from admission for inpatients as a detection method likely misses a substantial proportion (> 60%) of hospital-acquired infections.
Article activity feed
-
-
SciScore for 10.1101/2021.09.02.21262480: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code and data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:An alternative definition of hospital-acquired infection reliant on the date of first positive swab would have its own limitations: patients could enter with symptoms and not test positive until more than a week into their stay for example.26 Due to the delay from infection to symptom onset, hospital-acquired transmission of SARS-CoV-2 may be missed under common definitions of hospital-acquired. We estimated that nearly 20% of …
SciScore for 10.1101/2021.09.02.21262480: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code and data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:An alternative definition of hospital-acquired infection reliant on the date of first positive swab would have its own limitations: patients could enter with symptoms and not test positive until more than a week into their stay for example.26 Due to the delay from infection to symptom onset, hospital-acquired transmission of SARS-CoV-2 may be missed under common definitions of hospital-acquired. We estimated that nearly 20% of symptomatic COVID-19 patients in hospitals in England in the first wave acquired their infection in hospital settings. Whilst this is likely to have contributed little to the overall number of infections in England, the vulnerability of the hospital community means that this is an important area for further focus. Increased awareness and testing, especially of patients on discharge, as is now commonly in place, is needed to prevent hospitals becoming vehicles for SARS-CoV-2 transmission.
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
Results from scite Reference Check: We found no unreliable references.
-
