{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T01:04:43Z","timestamp":1788570283286,"version":"build-2803163510"},"reference-count":40,"publisher":"eLife Sciences Publications, Ltd","license":[{"start":{"date-parts":[[2022,7,19]],"date-time":"2022-07-19T00:00:00Z","timestamp":1658188800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2022,7,19]],"date-time":"2022-07-19T00:00:00Z","timestamp":1658188800000},"content-version":"am","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2022,7,19]],"date-time":"2022-07-19T00:00:00Z","timestamp":1658188800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001711","name":"Schweizerischer Nationalfonds zur F\u00f6rderung der Wissenschaftlichen Forschung","doi-asserted-by":"publisher","award":["4078P0_198363"],"award-info":[{"award-number":["4078P0_198363"]}],"id":[{"id":"10.13039\/501100001711","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100018336","name":"National Institute for Health Research Health Protection Research Unit","doi-asserted-by":"publisher","award":["NIHR200908"],"award-info":[{"award-number":["NIHR200908"]}],"id":[{"id":"10.13039\/100018336","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["elifesciences.org"],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2022,7,3]]},"abstract":"<jats:sec id=\"abs1\">\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>There is ongoing uncertainty regarding transmission chains and the respective roles of healthcare workers (HCWs) and elderly patients in nosocomial outbreaks of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in geriatric settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs2\">\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      We performed a retrospective cohort study including patients with nosocomial coronavirus disease 2019 (COVID-19) in four outbreak-affected wards, and all SARS-CoV-2 RT-PCR positive HCWs from a Swiss university-affiliated geriatric acute-care hospital that admitted both Covid-19 and non-Covid-19 patients during the first pandemic wave in Spring 2020. We combined epidemiological and genetic sequencing data using a Bayesian modelling framework, and reconstructed transmission dynamics of SARS-CoV-2 involving patients and HCWs, to determine who infected whom. We evaluated general transmission patterns according to case type (HCWs working in dedicated Covid-19 cohorting wards: HCW\n                      <jats:sub>covid<\/jats:sub>\n                      ; HCWs working in non-Covid-19 wards where outbreaks occurred: HCW\n                      <jats:sub>outbreak<\/jats:sub>\n                      ; patients with nosocomial Covid-19: patient\n                      <jats:sub>noso<\/jats:sub>\n                      ) by deriving the proportion of infections attributed to each case type across all posterior trees and comparing them to random expectations.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs3\">\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      During the study period (1 March to 7 May 2020), we included 180 SARS-CoV-2 positive cases: 127 HCWs (91 HCW\n                      <jats:sub>covid<\/jats:sub>\n                      , 36 HCW\n                      <jats:sub>outbreak<\/jats:sub>\n                      ) and 53 patients. The attack rates ranged from 10% to 19% for patients, and 21% for HCWs. We estimated that 16 importation events occurred with high confidence (4 patients, 12 HCWs) that jointly led to up to 41 secondary cases; in six additional cases (5 HCWs, 1 patient), importation was possible with a posterior probability between 10% and 50%. Most patient-to-patient transmission events involved patients having shared a ward (95.2%, 95% credible interval [CrI] 84.2%\u2013100%), in contrast to those having shared a room (19.7%, 95% CrI 6.7%\u201333.3%). Transmission events tended to cluster by case type: patient\n                      <jats:sub>noso<\/jats:sub>\n                      were almost twice as likely to be infected by other patient\n                      <jats:sub>noso<\/jats:sub>\n                      than expected (observed:expected ratio 2.16, 95% CrI 1.17\u20134.20, p=0.006); similarly, HCW\n                      <jats:sub>outbreak<\/jats:sub>\n                      were more than twice as likely to be infected by other HCW\n                      <jats:sub>outbreak<\/jats:sub>\n                      than expected (2.72, 95% CrI 0.87\u20139.00, p=0.06). The proportion of infectors being HCW\n                      <jats:sub>covid<\/jats:sub>\n                      was as expected as random. We found a trend towards a greater proportion of high transmitters (\u22652 secondary cases) among HCW\n                      <jats:sub>outbreak<\/jats:sub>\n                      than patient\n                      <jats:sub>noso<\/jats:sub>\n                      in the late phases (28.6% vs. 11.8%) of the outbreak, although this was not statistically significant.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs4\">\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>\n                      Most importation events were linked to HCW. Unexpectedly, transmission between HCW\n                      <jats:sub>covid<\/jats:sub>\n                      was more limited than transmission between patients and HCW\n                      <jats:sub>outbreak<\/jats:sub>\n                      . This finding highlights gaps in infection control and suggests the possible areas of improvements to limit the extent of nosocomial transmission.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"abs5\">\n                    <jats:title>Funding:<\/jats:title>\n                    <jats:p>This study was supported by a grant from the Swiss National Science Foundation under the NRP78 funding scheme (Grant no. 4078P0_198363).<\/jats:p>\n                  <\/jats:sec>","DOI":"10.7554\/elife.76854","type":"journal-article","created":{"date-parts":[[2022,7,4]],"date-time":"2022-07-04T06:15:39Z","timestamp":1656915339000},"update-policy":"https:\/\/doi.org\/10.7554\/elife.76854","source":"Crossref","is-referenced-by-count":19,"title":["Reconstruction of transmission chains of SARS-CoV-2 amidst multiple outbreaks in a geriatric acute-care hospital: a combined retrospective epidemiological and genomic 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