Risk of nosocomial transmission of coronavirus disease 2019: an experience in a general ward setting in Hong Kong

Published:April 04, 2020DOI:https://doi.org/10.1016/j.jhin.2020.03.036



      Coronavirus disease 2019 (COVID-19) was first reported in Wuhan in December 2019 and has rapidly spread across different cities within and outside China. Hong Kong started to prepare for COVID-19 on 31st December 2019 and infection control measures in public hospitals were tightened to limit nosocomial transmission within healthcare facilities. However, the recommendations on the transmission-based precautions required for COVID-19 in hospital settings vary from droplet and contact precautions, to contact and airborne precautions with placement of patients in airborne infection isolation rooms.


      To describe an outbreak investigation of a patient with COVID-19 who was nursed in an open cubicle of a general ward before the diagnosis was made.


      Contacts were identified and risk categorized as ‘close’ or ‘casual’ for decisions on quarantine and/or medical surveillance. Respiratory specimens were collected from contacts who developed fever, and/or respiratory symptoms during the surveillance period and were tested for SARS-CoV-2.


      A total of 71 staff and 49 patients were identified from contact tracing, seven staff and 10 patients fulfilled the criteria of ‘close contact’. At the end of 28-day surveillance, 76 tests were performed on 52 contacts and all were negative, including all patient close contacts and six of the seven staff close contacts. The remaining contacts were asymptomatic throughout the surveillance period.


      Our findings suggest that SARS-CoV-2 is not spread by an airborne route, and nosocomial transmissions can be prevented through vigilant basic infection control measures, including wearing of surgical masks, hand and environmental hygiene.


      To read this article in full you will need to make a payment


      Subscribe to Journal of Hospital Infection
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Zhu N.
        • Zhang D.
        • Wang W.
        • Li X.
        • Yang B.
        • Song J.
        • et al.
        China Novel Coronavirus Investigating and Research Team. A Novel Coronavirus from Patients with Pneumonia in China, 2019.
        N Engl J Med. 2020; 382: 727-733
        • World Health Organization
        Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV).
        (Available at:)
        • The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team
        The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) — China, 2020.
        China CDC Weekly, 2020 (Available at:) ([last accessed March 2020])
        • Wuhan Municipal Health Commission
        Report of clustering pneumonia of unknown etiology in Wuhan City.
        Wuhan Municipal Health Commission, Wuhan, China2019 Dec 31 (Available at:) ([last accessed February 2020] (In Chinese))
        • World Health Organization
        Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected: interim guidance.
        (Available at:)
        • Communicable Disease Network Australia
        Coronavirus disease 2019 (COVID-19): CDNA national guidelines for public Health units.
        The Department of Health. Australian Government, 2019 (Available at:) ([last accessed February 2020])
        • Centers for Disease Control and Prevention
        Interim Infection Prevention and Control Recommendations, for Patients with Confirmed Coronavirus Disease 2019 (COVID-19) or Persons under Investigation for COVID-19 in Healthcare Settings.
        (Available at:)
        • Public Health England
        COVID-19: infection prevention and control guidance.
        (Available at:)
        • Central Committee on Infectious Diseases and Emergency Response
        Interim Recommendation on Clinical Management of Adult Cases with Coronavirus Disease 2019 (COVID-19). Hong Kong Hospital Authority.
        (Available at:)
        • Varia M.
        • Wilson S.
        • Sarwal S.
        • McGeer A.
        • Gournis E.
        • Galanis E.
        • et al.
        Investigation of a nosocomial outbreak of severe acute respiratory syndrome (SARS) in Toronto, Canada.
        CMAJ. 2003; 169: 285-292
        • Lee N.
        • Hui D.
        • Wu A.
        • Chan P.
        • Cameron P.
        • Joynt G.M.
        • et al.
        A major outbreak of severe acute respiratory syndrome in Hong Kong.
        N Engl J Med. 2003; 348: 1986-1994
        • Wang D.
        • Hu B.
        • Hu C.
        • Zhu F.
        • Liu X.
        • Zhang J.
        • et al.
        Clinical characteristics of 138 hospitalized patients with 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China.
        JAMA. 2020 Feb 7; ([Epub ahead of print])https://doi.org/10.1001/jama.2020.1585
        • Guan W.-J.
        • Ni Z.-Y.
        • Hu Y.
        • Liang W.-H.
        • Ou C.-Q.
        • He J.-X.
        • et al.
        Clinical characteristics of 2019 novel coronavirus infection in China.
        New Engl J Med. 2020 Feb 28; ([Epub ahead of print])https://doi.org/10.1056/NEJMoa2002032
        • Ho A.S.
        • Sung J.J.
        • Chan-Yeung M.
        An outbreak of severe acute respiratory syndrome among hospital workers in a community hospital in Hong Kong.
        Ann Intern Med. 2003; 139: 564-567
        • Li T.S.
        • Buckley T.A.
        • Yap F.H.
        • Sung J.J.
        • Joynt G.M.
        Severe acute respiratory syndrome (SARS): infection control.
        Lancet. 2003; 361: 1386
        • Tran K.
        • Cimon K.
        • Severn M.
        • Pessoa-Silva C.
        • Conly J.
        Aerosol-generating procedures and risk of transmission of acute respiratory infections: a systematic review.
        CADTH Technol Overv. 2013; 3e3201
        • Tan Wenjie
        • Zhao Xiang
        • Ma Xuejun
        • Wang Wenling
        • Niu Peihua
        • Xu Wenbo
        • et al.
        A novel coronavirus genome identified in a cluster of pneumonia cases — Wuhan, China 2019−2020[J].
        China CDC Weekly. 2020; 2 (Available at:): 61-62
        • Chan J.F.
        • Kok K.H.
        • Zhu Z.
        • Chu H.
        • To K.K.
        • Yuan S.
        • et al.
        Genomic characterization of the 2019 novel human-pathogenic coronavirus isolated from a patient with atypical pneumonia after visiting Wuhan.
        Emerg Microbes Infect. 2020; 9: 221-236
        • Wu J.T.
        • Leung K.
        • Leung G.M.
        Nowcasting and forecasting the potential domestic and international spread of the 2019-nCoV outbreak originating in Wuhan, China: a modelling study.
        Lancet. 2020; 395: 689-697
        • Zhao S.
        • Lin Q.
        • Ran J.
        • Musa S.S.
        • Yang G.
        • Wang W.
        • et al.
        Preliminary estimation of the basic reproduction number of novel coronavirus (2019-nCoV) in China, from 2019 to 2020: A data-driven analysis in the early phase of the outbreak.
        Int J Infect Dis. 2020 Jan 30; 92: 214-217
        • Liu Y.
        • Gayle A.A.
        • Wilder-Smith A.
        • Rocklov J.
        The reproductive number of COVID-19 is higher compared to SARS coronavirus.
        J Travel Med. 2020 Feb 13; (pii: taaa021. [Epub ahead of print])https://doi.org/10.1093/jtm/taaa021
        • Chan J.F.
        • Yuan S.
        • Kok K.H.
        • To K.K.
        • Chu H.
        • Yang J.
        • et al.
        A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster.
        Lancet. 2020 Feb 15; 395: 514-523
        • Centre for Health Protection
        CHP investigates 10 additional cases of novel coronavirus infection.
        Department of Health, Hong Kong Special Administrative Region2020 (Available at:)
        • Centre for Health Protection
        Latest situation of cases of novel coronavirus infection.
        Department of Health, Hong Kong Special Administrative Region2020 (Available at:)
        • Wikipedia
        Coronavirus outbreak in cruise ships.
        (Available at:)
        • World Health Organization
        Home care for patients with suspected novel coronavirus (COVID-19) infection presenting with mild symptoms, and management of their contacts. Interim guidance.
        (Available at: 4 Feb 2002)
        • Centers for Disease Control and Prevention
        Coronavirus Disease 2019 (COVID-19): Healthcare Personnel with Potential Exposure to COVID-19. 2020 Feb 25.
        (Available at:)
        • Phin N.
        Expert interview: What is contact tracing? Public Health England.
        (Available at:)
        • European Centres for Disease Prevention and Control
        Public Health management of persons, including healthcare workers, having had contact with COVID-19 cases in the European Union.
        (Available at:)
        • Lau J.T.
        • Tsui H.
        • Lau M.
        • Yang X.
        SARS transmission, risk factors, and prevention in Hong Kong.
        Emerg Infect Dis. 2004; 10: 587-592
        • Wu J.
        • Xu F.
        • Zhou W.
        • Feikin D.R.
        • Lin C.Y.
        • He X.
        • et al.
        Risk factors for SARS among persons without known contact with SARS patients, Beijing, China.
        Emerg Infect Dis. 2004; 10: 210-216
        • Cowling B.J.
        • Chan K.H.
        • Fang V.J.
        • Cheng C.K.
        • Fung R.O.
        • Wai W.
        • et al.
        Facemasks and hand hygiene to prevent influenza transmission in households: a cluster randomized trial.
        Ann Intern Med. 2009; 151: 437-446
        • Suess T.
        • Remschmidt C.
        • Schink S.B.
        • Schweiger B.
        • Nitsche A.
        • Schroeder K.
        • et al.
        The role of facemasks and hand hygiene in the prevention of influenza transmission in households: results from a cluster randomised trial; Berlin, Germany, 2009-2011.
        BMC Infect Dis. 2012; 12: 26
        • Simonds A.K.
        • Hanak A.
        • Chatwin M.
        • Morrell M.
        • Hall A.
        • Parker K.H.
        • et al.
        Evaluation of droplet dispersion during non-invasive ventilation, oxygen therapy, nebuliser treatment and chest physiotherapy in clinical practice: implications for management of pandemic influenza and other airborne infections.
        Health Technol Assess. 2010; 14: 131-172
        • Hui D.S.
        • Chan M.T.
        • Chow B.
        Aerosol dispersion during various respiratory therapies: a risk assessment model of nosocomial infection to health care workers.
        Hong Kong Med J. 2014; 20: 9-13