key: cord-0911264-2gigu0kf
authors: Dantes, Raymund B.; Jones, Tait T.; Neujahr, David C.
title: Delayed recognition of community transmission of COVID-19 resulting in healthcare worker infections
date: 2021-06-10
journal: Infection control and hospital epidemiology
DOI: 10.1017/ice.2020.285
sha: 142265cc92e62de343bad36735edc896a9b0ce98
doc_id: 911264
cord_uid: 2gigu0kf

We describe a case of delayed COVID-19 diagnosis due to unrecognized community transmission in Atlanta, Georgia in mid-February 2020. This case resulted in transmission of COVID-19 to three of the four healthcare workers present during a diagnostic bronchoscopy procedure where only procedural masks were worn.

and pulmonary consultation services; however, the patient did not meet the recommended CDC criteria for novel coronavirus testing at that time because he had no relevant travel history, contact with known cases, or severe illness. No commercial or other testing options were available at the time.

On the third day of his hospitalization, he underwent diagnostic bronchoscopy, and staff wore procedural masks. The patient was discharged later that day because he was feeling well and his fever had resolved. He was instructed to remain isolated at home for at least 1 week. Bronchoalveolar lavage fluid was sent for bacterial, fungal, and AFB cultures, which were negative. BAL fluid cellular differential was notable for having 94% macrophages. Cytology was negative for microorganisms, and a Biofire FilmArray Respiratory panel was negative. On March 11, as more SARS-CoV-2 testing capacity became available, his remaining bronchial fluid was mailed to Associated Regional and University Pathologists (ARUP), and it tested positive for SARS-CoV2 virus on reverse transcriptase PCR testing on March 14.

The patient was notified of his test results by telephone, and he reported feeling well with no reoccurrence of fevers or other new symptoms. Within the following week, 3 of the 4 healthcare workers present during the bronchoscopy tested positive for SARS-CoV-2.

This case provides evidence of community transmission of SARS-CoV-2 in Atlanta, Georgia, likely between February 10 and February 19, 2020, based on our current knowledge of the incubation period for SARS-CoV-2. 3 The precise source of this patient's COVID-19 remains unknown, but it may have been acquired from either his coworker or a family contact. Due to both restrictive CDC testing criteria and a lack of available SARS-CoV-2 testing outside of public health laboratories, this patient was not diagnosed when rapid public health actions, including contact tracing and isolation, could have limited community spread of this disease. This case also illustrates the risk of SARS-CoV-2 transmission to healthcare workers during bronchoscopy when COVID-19 is not recognized and procedural masks are used instead of N95 or other high-level respirators. 

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Acknowledgments.Financial support. No financial support was provided relevant to this article.

All authors report no conflicts of interest relevant to this article.