HMS Dean, Professor Outline How Brigham and Women's Hospital Contained Sept. COVID-19 Outbreak

Harvard Medical School Dean George Q. Daley ’82 praised epidemiologists at the affiliated Brigham and Women’s Hospital for quickly extinguishing a late September COVID-19 outbreak in an interview Friday.

In total, the hospital identified 42 employees and 15 patients with COVID-19 cases potentially linked to the cluster, though no new connected cases had been detected since Oct. 3, according to an Oct. 16 press release.

An infection control team used whole genome sequencing to confirm that the 57 cases were related, according to the release. The hospital performed more than 10,000 tests of employees between Sep. 25 and Oct. 16 in addition to testing inpatients every three days and new patients upon arrival.

“Because of an extraordinary amount of testing and contact tracing control, they were able to squelch it very, very quickly,” Daley said.

He specifically cited Medical School professor Michael Klompas, who serves as a hospital epidemiologist for Brigham and Women’s, for his “extraordinary” response to the outbreak.

In an interview Thursday, Klompas said that when the hospital identified the outbreak, the Brigham's infection control team immediately tried to establish the cluster’s scope while beginning containment efforts such as contact tracing.

“What that meant was identifying the people who’d already tested positive and finding all their contacts and alerting those contacts, and arranging for testing for them,” Klompas said. “Those who tested positive, we asked to stay home.”

The infection control team members also closely monitored all patients in the hospital who were potentially associated with the cluster. Once they pinpointed the outbreak’s source to a specific set of wards and healthcare teams, they implemented additional measures for those patients and employees, according to Klompas.

“All the employees who work in those areas and had been identified through contact tracing were asked to test and to continue testing on an every-few-days basis, just in case there was ongoing transmission, or if their infections were still incubating,” Klompas said.

In the aftermath of the outbreak, Klompas said the team is analyzing the cluster to identify the hospital’s weak points where additional precautionary measures may be needed, such as additional testing for patients getting high-risk procedures.

At the same time, as infection rates have risen in recent weeks in the United States and many other countries across the globe, the team is preparing to implement measures that grew out of months of planning for the pandemic’s potential second wave.

Coronavirus infections in Massachusetts in the last 14 days are 79 percent higher than the previous two-week period, and coincide with a rising number of COVID-19 patients in hospitals, according to the New York Times.

Klompas’s team is monitoring a variety of surveillance parameters, including daily case counts in Massachusetts and at Brigham, he said.

“We have a modeling group that’s trying to put those variables and others into systems to try and anticipate what’s the likely inpatient volume going to be over the next two weeks,” Klompas said. “They are using that to know when we have to pull the various triggers for the different scenarios, of small, medium, large amounts of COVID.”

“They’ve tried to think for each of those scenarios, what would we do in terms of bed availability, critical care services, staffing models, canceling of elective procedures,” he added.

Klompas said the overlap between the flu season and a potential second wave presents a new set of challenges.

“There is a lot of flu that leads a lot of people to present with respiratory illness, and you won’t know whether it’s flu or COVID until you test them,” Klompas said. “There could be extra demand upon hospital admissions and critical care support services, which is a worry point around which we’re having to make sure we have adequate capacity and planning.”

—Staff writer Virginia L. Ma can be reached at virginia.ma@thecrimson.com.