Risk of Healthcare-Associated Transmission of SARS-CoV-2 in Hospitalized Cancer Patients

Chow, Karin; Aslam, Anoshe; McClure, Tara; Singh, Jessica; Burns, Jacquelyn; McMillen, Tracy; Jani, Krupa; Lucca, Anabella; Bubb, Tania; Robilotti, Elizabeth V; Babady, N Esther; Kamboj, Mini

BACKGROUND: There is limited information on the risk of hospital-acquired COVID-19 among high-risk hospitalized patients after exposure to an infected patient or healthcare worker (HCW) in a non-outbreak setting. METHODS: This study was conducted at a tertiary care cancer center in New York City from March 10, 2020, until February 28, 2021. In early April 2020, the study institution implemented universal SARS-CoV-2 testing at admission and retesting every three days through the hospital stay. Contact tracing records were reviewed for all exposures to SARS-CoV-2 positive patients and HCWs. RESULTS: From March 10, 2020, to February 28, 2021, 11,348 unique patients who were SARS-CoV-2 PCR negative at the time of admission underwent 31,662 post-admission tests during their hospitalization, and 112 tested positive (0.98%). Among these, 49 patients housed in semi-private rooms during admission resulted in 74 close contacts and 14 secondary infections within 14 days, for an overall attack rate of 18.9%. Among those exposed to a roommate undergoing an aerosol-generating procedure (AGP), the attack rate was 35.7%. WGS corroborated transmission in 6/8 evaluated pairs. In addition, three transmission events occurred in 214 patients with significant exposure to 105 COVID-19 positive healthcare workers (1.4%). CONCLUSION: The overall risk of hospital-acquired COVID-19 is low for hospitalized cancer patients, even during periods of high community prevalence. However, shared occupancy with an unrecognized case is associated with a high secondary attack rate in exposed roommates.