Hospital biopreparedness in the Looming Presence of SARS-CoV-2/COVID-19

The recent analysis of 138 hospitalized patients in Wuhan, China, and their clinical characteristics, has given credence to stronger investments into hospital biopreparedness and overall infection prevention efforts.1 Within this analysis, researchers found two pieces that are particularly relevant to healthcare preparedness: first, that 26% of patients required admission to an intensive care unit, and second, that 41% of cases were related to healthcare transmission. Patients requiring medical care in an intensive care unit inherently burden the system more, both in terms of supplies in personnel, but also because they typically have greater lengths of stay. The volume of healthcare‐associated cases is an indicator of infection prevention breakdowns, which points to the potential for hospitals to further spread the disease. This is not a unique finding, however, and similar situations have been observed in previous coronavirus outbreaks. Indeed, hospitals can easily act as amplifiers for disease transmission during these events. In 2003, the Severe Acute Respiratory Syndrome coronavirus (SARS‐CoV) outbreak in Toronto highlighted this very real vulnerability, where busy emergency departments, delays in isolation, and improper personal protective equipment (PPE) use fueled the spread of disease in several hospitals.2 Enhanced infection prevention measures were eventually implemented (higher level of PPE, masking when in public areas, among others), which helped bring transmission to halt. After the outbreak was believed to be over, however, directives were given to discontinue those enhanced infection prevention measures. As a result of this and staff no longer routinely wearing masks in general hospital areas, a second phase of the outbreak began. An overwhelming majority of cases in Phase II of the Toronto SARS‐CoV were related to healthcare transmission.3