Investigating Nosocomial Outbreaks of COVID-19

Policy recommendation

Investigate the transmission dynamics of COVID-19 in hospitals, nursing homes and dormitories, using classic investigative methods of testing, interview and graphics to reconstruct an outbreak.

Supporting evidence

The recommendation is based on the content of the report of the independent investigation into an outbreak at St. Augustine’s Hospital, Durban, South Africa. The outbreak took place between 9 March and 30 April 2020 with 119 confirmed cases were identified at (39 patients and 80 staff). There were 15 deaths among elderly patients with multiple pathologies. The investigation was carried out by inspection, medical record review and interviews

Lack of separation of potentially COVID-19- infected patients from other patients, probably beginning at the Emergency Room led to a nosocomial outbreak claiming the lives of 15 patients who were mostly elderly with pre-existing multiple pathologies.

A lack of suspicion and awareness of the threat together with frequent movement of patients inside the hospital contributed to the swift spread. The mode of transmission appears mainly to be indirect, through fomites and health care workers contact. Emergency Room (ER)  with bays opening on a single corridor probably facilitated initial transmission.

The report contains excellent graphics which reconstruct and document the spread inside the hospital.

Together with infection control measures, rebuilding and internal restructuring of care facilities is necessary to minimise direct or indicted transmission

Evidence summaries

Title Bottom line Transmission mode Country
Hospital outbreak of COVID-19 in South Africa

Separate access and segregation of potentially infected patients are required to prevent or control nosocomial outbreaks of COVID-19.

Fomites, Person to Person South Africa

Evidence uncertainties

The study needs replication across a wide range of settings and nations.


Lessells R, Moosa Y, de Oliveira T. Report into a nosocomial outbreak of coronavirus disease 2019 (COVID‐19) at Netcare St. Augustine’s Hospital. KwaZulu‐Natal Research Innovation and Sequencing Platform (KRISP). 2020.