Investigation of an early 2020 COVID-19 outbreak in a vulnerable population, at a psychiatric health facility in Victoria, Australia

  • Vaccine preventable diseases
  • Healthcare related infections
  • Mental health
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Background:
On 1 April 2020, the Victorian authorities were notified of a confirmed COVID-19 case linked to a psychiatric healthcare facility. We conducted an investigation to support the management and control of this outbreak and to inform future practice.

Methods:
Descriptive case series, laboratory investigation and site review. We interviewed laboratory confirmed cases using a standardised questionnaire. Data collected included clinical data, facility maps, rosters and patients’ locations and activities. All staff and inpatients were tested onsite on 24 April 2020. Infection prevention control (IPC) and cleaning protocols were reviewed.

Results:
The facility was temporarily closed on the 26th of April, and all inpatients transferred, to support the outbreak management. We epidemiologically linked 18 cases to this outbreak: five staff, eight inpatients, and five household/family contacts. Median age of cases was 44 years (range 21-65), and 12 (67%) were female. All identified cases reported symptoms, six cases were hospitalised, no associated deaths were reported. Fifteen cases were whole genomic sequenced, thirteen belonged to a genomic cluster. Multiple waves of transmission occurred in the facility, localised to two of four wards, through direct patient care or in group therapy sessions where patients and staff had daily contact for more than one hour per session. The facility had established physical distancing measures, however we found IPC practices including personal protective equipment use and management of presumptive or confirmed cases were insufficient to meet needs, including significant diagnosis delays.

Conclusions:
This was the first reported outbreak of COVID-19 in a psychiatric healthcare facility in Australia. We found that established preventive measures were insufficient to manage this outbreak, as such, improvements were made to IPC guidelines at the facility and across health facilities in Victoria. Our investigation reinforces the importance of rapid case identification, diagnosis, management and isolation, and robust and unique IPC protocols for sensitive healthcare settings.

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