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CASE SERIES REPORT
Year : 2022  |  Volume : 66  |  Issue : 1  |  Page : 80-82  

SARS-CoV-2 cluster among security guards, Chennai, Tamil Nadu, India, June–July 2020


1 Greater Chennai Corporation, Government of Tamil Nadu, Chennai, Tamil Nadu, India
2 ICMR-National Institute of Epidemiology, Chennai, Tamil Nadu, India

Date of Submission19-Sep-2021
Date of Decision16-Nov-2021
Date of Acceptance17-Nov-2021
Date of Web Publication5-Apr-2022

Correspondence Address:
Polani Rubeshkumar
ICMR-National Institute of Epidemiology, TNHB, Ayappakam, Chennai - 600 077, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.ijph_1813_21

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   Abstract 


Congregate work settings are at increased risk for SARS-CoV-2 transmission and predispose to super spreader events. We investigated a COVID-19 outbreak among security guards to identify the risk factors and propose recommendations. We defined a COVID-19 case as a laboratory-confirmed reverse transcription polymerase chain reaction-positive case. We traced the contacts actively and described the cases by time, place, and person. We conducted a case–control study and collected data on potential exposures. We identified 20 (27%) COVID-19 cases among 75 security guards. Among the cases, 17 (85%) were male and 12 (60%) were symptomatic. We recruited all the 20 COVID-19-confirmed cases and 55 COVID-19-negative controls for the case–control study. SARS-CoV-2 infection was higher among those had high-risk exposure (60%, [12/20]) than who did not (16%, [9/55], adjusted odds ratio = 5.9, 95% confidence interval = 1.6-22.1). Having had high-risk exposure with COVID-19 cases led to COVID-19 outbreak among the security guards. We recommended avoiding the activities predisposed to high-risk exposure.

Keywords: COVID-19, disease outbreaks, SARS-CoV-2 infection, SARS-CoV-2 transmission


How to cite this article:
Viswanathan V, Rubeshkumar P, Sakthivel M, John A. SARS-CoV-2 cluster among security guards, Chennai, Tamil Nadu, India, June–July 2020. Indian J Public Health 2022;66:80-2

How to cite this URL:
Viswanathan V, Rubeshkumar P, Sakthivel M, John A. SARS-CoV-2 cluster among security guards, Chennai, Tamil Nadu, India, June–July 2020. Indian J Public Health [serial online] 2022 [cited 2022 May 18];66:80-2. Available from: https://www.ijph.in/text.asp?2022/66/1/80/342596




   Introduction Top


Congregate work and shared accommodations are at increased risk for SARS-CoV-2 transmission and predispose to super spreader events.[1] A team of security guards was involved in guard duties around the clock in a large government office in Chennai. Amajority of the security guards stayed in the dormitory of the respective gender inside the campus, while a few senior security guards stayed outside the campus with their families. On June 23, 2020, a 54-year-old male senior guard reported fever and cough underwent a real-time reverse transcription–polymerase chain reaction (rRT-PCR) test for COVID-19. On June 26, 2020, he was declared positive for COVID-19, and seven contacts were tested and quarantined. Among the tested, five were positive for COVID-19 on July 1, 2020. On July 2, 2020, a team of epidemiologists investigated the outbreak to identify the risk factors and propose recommendations.


   Public Health Response Top


We adopted the Ministry of Health and Family Welfare, Government of India, case definition of COVID-19.[2] We defined a “probable case” of COVID-19 as a case of fever, sore throat, cough, breathlessness, myalgia, loss of taste or loss of smell, and “confirmed case” as a laboratory-confirmed case of COVID-19 by rRT-PCR through nasal/throat swabs irrespective of the clinical symptoms, among the security guards of government office, Chennai, June–July 2020. We defined a contact of COVID-19 as a person who had contact with a confirmed COVID-19 case. We actively searched for the cases and traced contacts, and tested them for COVID-19. We calculated the attack rate by age, gender, and place of stay and computed frequencies of clinical symptoms.

We conducted a case–control study to identify the risk factors of COVID-19. We defined a “case” as a laboratory-confirmed positive case of COVID-19 and “control” as a laboratory-confirmed negative case of COVID-19 by rRT-PCR among the security guards of the government office during June–July 2020. We grouped the exposures contact >15 min at work or dormitory, eating together, and playing with the COVID-19 case as “high-risk exposure”. We collected data on potential exposures and hygiene practices using semi-structured data collection tools by a telephonic interview. We computed the odds ratio (OR) and 95% confidence interval (95% confidence interval [CI]) for the potential exposures. We conducted a multivariate analysis and calculated the adjusted OR (aOR) and 95% CI.

Ethical approval

The study was approved by the Institutional Human Ethics Committee of ICMR-National Institute of Epidemiology, Chennai, India.


   Discussion Top


75 security guards were on guard duties in the government office during June–July 2020. The median age was 26 years (range: 21–54 years), and 42 (64%) were male. Sixty-three (84%) security guards stayed in the dorms of the respective gender inside the campus and 12 (16%) stayed outside the campus.

Among the 75 guards, we identified 20 (27%) COVID-19 confirmed cases. Among the cases, 17 (85%) were male, and 12 (60%) were aged 21–26 years and 8 (40%) were aged 27–54 years. Males (35%, [17/48]) had higher attack rate than females [11%, (3/27), P < 0.05]. The attack rate did not differ by the place of stay (male dorm – 34%, [14/41]; female dorm – 9%, [2/22]; and outside the campus – 33% [4/12]; P = 0.08). Twelve (60%) of the 20 cases reported symptoms. The reported symptoms were myalgia (67%), fever (58%), loss of smell (58%), loss of taste (33%), sore throat (25%), cough (17%), and breathlessness (17%). Based on discussion with the case-patients, eating or playing with a COVID-19 case were the potential risk factors for COVID-19 [Figure 1].
Figure 1: Probable mode of SARS-CoV-2 transmission among the security guards of the bank, Chennai, India, June–July 2020.

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We recruited all the 20 COVID-19-confirmed cases and 55 COVID-19-negative controls for the case–control study. SARS-CoV-2 infection was higher among those had high-risk exposure (60%, [12/20]) than who did not (16%, [9/55], aOR = 5.9, 95% CI = 1.6–22.1) [Table 1].
Table 1: Risk factors of SARS-CoV-2 infection among the security guards of the bank, Chennai, India, June–July 2020

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The inspection of the dormitories indicated the closely placed cots in a poorly ventilated hall. Furthermore, the occupancy of the male dormitory was nearly twice compared to the female dormitory. The mask compliance was good during the duty hours; however, there was a lack of mask compliance or physical distancing inside the dormitory. The shared accommodation and poorly ventilated settings predispose the SARS-CoV-2 transmission.[1],[3] Close contact with COVID-19 case, activities such as eating together, and attending any gathering increase the risk of SARS-CoV-2 infection.[4],[5] In our setting, poor compliance with COVID appropriate behaviors during and after working hours caused the SARS-CoV-2 transmission among the security guards.

On July 2, 2020, all the security guards underwent COVID-19 RT-PCR tests, and they were quarantined in a different facility. The dormitory and duty areas were disinfected, and the guards were replaced with a new team. We established ILI surveillance and encouraged self-reporting of symptoms. We recommended individual accommodation for the security guards, mask compliance, and avoiding eating and playing in groups. The COVID-19 prevention guidelines should be disseminated and implemented among the workplaces, which involve group interactions at the workplace and residential areas.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initial s will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
James A, Eagle L, Phillips C, Hedges DS, Bodenhamer C, Brown R, et al. High COVID-19 attack rate among attendees at events at a church-Arkansas, March 2020. MMWR Morb Mortal Wkly Rep 2020;69:632-5.  Back to cited text no. 1
    
2.
National Centre for Disease Control Directorate General of Health Services MoH & FW, GOI, New Delhi the Updated Case Definitions and Contact-Categorisation. Available from: https://nirth.res.in/virology/Revised_case_definitions_for_COVID_19.pdf. [Last accessed on 2021 May 15].  Back to cited text no. 2
    
3.
Chau NV, Hong NT, Ngoc NM, Thanh TT, Khanh PN, Nguyet LA, et al. Superspreading event of SARS-CoV-2 infection at a bar, Ho Chi Minh City, Vietnam. Emerg Infect Dis 2021;27:310-4. [doi: 10.3201/eid2701.203480]  Back to cited text no. 3
    
4.
Teran RA, Ghinai I, Gretsch S, Cable T, Black SR, Green SJ, et al. COVID-19 outbreak among a university's men's and women's soccer teams – Chicago, Illinois, July-August 2020. MMWR Morb Mortal Wkly Rep 2020;69:1591-4.  Back to cited text no. 4
    
5.
Hobbs CV, Martin LM, Kim SS, Kirmse BM, Haynie L, McGraw S, et al. Factors associated with positive SARS-CoV-2 test results in outpatient health facilities and emergency departments among children and adolescents aged <18 years – Mississippi, September-November 2020. MMWR Morb Mortal Wkly Rep 2020;69:1925-9.  Back to cited text no. 5
    


    Figures

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    Tables

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