In Israel, a dialysis patient started an outbreak involving 41 people (only three unvaccinated, the others immunized for over 5 months). Five patients with previous illnesses died while health workers remained asymptomatic
Covid masks and vaccines were not enough to avoid an important one outbreak which occurred in July 2021 in a hospital in Israel. This was told by a study published in Eurosurveillance, the European journal on the surveillance, epidemiology, prevention and control of infectious diseases. What happened at the emblematic Meir Medical Center: an elderly dialysis patient, not tested for Covid on his admission, but then tested positive, infected 41 other people including patients, hospital staff (who wore the mask) and family members. As many as 39 of the infected (96%) were fully vaccinated, all for over five months. This does not mean that vaccines do not work because, as the analysis explains, it was elderly, hospitalized and previously ill patients who suffered the most, while younger doctors and nurses remained mostly asymptomatic. For this reason, the third dose of the anti Covid vaccine can be useful to better protect the most fragile patients but, at the same time, especially in the most at risk environments, air management with efficient forced mechanical ventilation should be better evaluated. And even masks must always be worn appropriately, even among patients hospitalized in the same room: you must never let your guard down because the virus is sneaky and spreads easily via aerosols.
The anti Covid provisions
Meir Medical Center has 780 beds and most of the rooms can accommodate 3-4 patients. As of March 2020 i patients were encouraged to wear the surgical mask and, although the indication was not always followed to the letter, personal protective equipment was used by both parties during medical examinations. In the Covid wards, healthcare personnel always wore N-95 masks, visor, gown, gloves and hair cover.
The epidemiological investigation
The study details how the epidemiological investigation was conducted to identify the index case and other people who became infected after a health worker tested positive. The index case was a 70-year-old fully vaccinated hemodialysis patient hospitalized in mid-July with fever and cough along with three other patients in the same room. The manor not tested for Covid because his symptoms have been mistaken for a possible bloodstream infection. Four days after admission, after being moved to the dialysis unit a few times to undergo the procedure, the patient was diagnosed with Covid. Soon after too his three roommates tested positive and all were transferred to the Covid ward. The epidemiological investigation of the contacts of the index patient found others 27 positive cases: 16 patients, including the index case, nine healthcare professionals and two family members. All diagnosed cases were transferred to the Covid ward which at that time was actually operating as a mixed ward since there were few Covid patients and consequently the healthcare workers worked with full Covid protection (N-95 mask, visor, gown, gloves and hair cover) only strictly in the contagion risk area.
A health care worker took the virus to another ward
The index case was followed up in treatment by a health worker who a year earlier (July 2020) had recovered from Covid and then it was vaccinated with a single dose how Israeli guidelines lay out. This health care worker also attended the ward that was thought to be Covid free where two out of three patients developed Covid symptoms and actually tested positive for Sars-CoV-2. The epidemiological investigation of this department identified a total of 19 almost Covid: 10 health workers (including the one who moved from the ward and carried the virus to another area of the hospital), eight patients and a family member. As many as 238 out of 248 people exposed to the virus had been vaccinated. (96% were therefore vaccinated).
The characteristics of the patients of the outbreak
A phylogenetic analysis was performed on the patients and four cases had a different genetic sequence therefore it was recognized a single outbreak consisting of 42 cases: 38 fully vaccinated with double dose of Pfizer, one with single dose after recovery from Covid and three unvaccinated. The median age of Covid patients was 55 years: 23 patients, 16 health workers and three family members. On average from the end of the vaccination cycle to the infection between 5 and 6 months had elapsedthe. All the healthcare workers who remained asymptomatic or with mild illness. Between patients, and average 77 years, eight became seriously ill, five were in critical condition and among the latter, five died. The patient population was considerably larger than health care workers and all had comorbidities (eight immunocompromised).
the transmission between doctors-patients occurred between vaccinated with masks
The transmissibility rate among patients exposed to the virus exceeded 23%, among health personnel 10% with a very high total vaccination rate: 96.2%. The study reports that most likely several transmissions occurred between two health workers who regularly wore the face mask (one of which used full protective equipment). Although the population exposed to the virus was highly vaccinated,infection spread very quickly – the authors write – and many cases became symptomatic within two days of exposure, with high viral load. Since it seems now confirmed that the vaccine is less effective against Delta infection and immunity decreases over time, at the same time it is widely believed that the mix between vaccines and masks can be enough to protect against Covid disease. However, in the case of the Israel hospital all transmissions between patients and staff occurred between masked and vaccinated individuals. We cannot rule out that the protective measures were not worn optimally, however, transmissibility in summer 2021 differs from our experiences in the previous 18 months point out the authors concluding: Data from Israel signal that the main reason for the‘increase in Covid-19 cases in the summer can be attributed to decreased immunity and a third dose of vaccine, 5 months after the second dose, could lead to a turnaround particularly in individuals with severe Covid-19 risk factors. Indeed, Israeli data indicates that the third dose of the vaccine works and Pfizer’s efficacy rises to 95%, however the vaccine still appears to provide protection (asymptomatic infection) to individuals without comorbidities.
October 7, 2021 (change October 7, 2021 | 11:32)
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