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J Clin Med
. 2026 Mar 17;15(6):2290.
doi: 10.3390/jcm15062290.
Lessons from Two Early COVID-19 Hospital Outbreaks in Germany to Inform Strategies for Controlling Emerging Nosocomial Outbreaks of Highly Transmissible Respiratory Viruses
Sofia Burdi 1 2 3 , Felix Reichert 1 , Barbara Mühlemann 4 5 6 , Victor M Corman 4 5 6 , Terry C Jones 4 5 6 , Martin Hölzer 7 , Susanne B Schink 1 , Patrick Larscheid 8 , Jakob Schumacher 8 , Gudrun Widders 9 , Inas Abdelgawad 9 10 11 , Christian Brandt 12 13 , Nicole Dinsel 12 , Katharina Jelavic 12 , Nadine Kurzke 12 , Jörg Hofmann 5 14 , Janine Michel 15 , Annika Brinkmann 15 , Stephan Fuchs 7 , Christian Drosten 4 5 6 , Tim Eckmanns 1 , Muna Abu Sin 1
Affiliations
Background/Objectives: Nosocomial outbreaks of viral respiratory infections strain healthcare systems and endanger patients and healthcare workers (HCWs). We describe two large nosocomial outbreaks with the SARS-CoV-2 Alpha variant, during its initial emergence in Germany, to assess transmission dynamics, effectiveness of control measures, and challenges in managing highly transmissible respiratory viruses. Methods: Confirmed cases were inpatients, HCWs, or their contacts testing SARS-CoV-2-positive since 1 January 2021 (Hospital A [HA])) or 21 January 2021 (Hospital B [HB])) with N501Y and delH69/V70 spike gene mutations. We conducted case interviews, reviewed medical records and shift schedules, and performed sequencing, genome reconstruction, and phylogenetic analysis. We describe cases, transmission chains, and control measures. Results: HA reported 18 patient cases, 20 HCW cases, and 33 community cases (N = 71). HB reported 48 patient cases, 43 HCW cases (13 in a COVID-19 ward), and 27 community cases (N = 118). In-hospital transmission occurred patient-to-patient, HCW-to-patient, patient-to-HCW, and HCW-to-HCW. HA halted admissions immediately after the initial cases; HB implemented measures gradually. Regular testing detected pre-symptomatic (HA = 6; HB = 18) and asymptomatic cases (HA = 3; HB = 13). Testing of agency staff was incomplete. The suspected primary case was an HCW in HA and a patient in HB who required resuscitation shortly after admission. Conclusions: Early COVID-19 outbreaks offer valuable lessons for managing emerging nosocomial outbreaks of highly transmissible respiratory viruses. Our findings provide empirical evidence for effective interventions, including rapid response, testing, HCW protection, and rigorous contact tracing in high-risk emergency situations. Managing agency staff remains a major challenge.
Keywords: healthcare-associated infections; infection prevention and control; infectious disease outbreak; phylogenetic analysis; respiratory infections.
. 2026 Mar 17;15(6):2290.
doi: 10.3390/jcm15062290.
Lessons from Two Early COVID-19 Hospital Outbreaks in Germany to Inform Strategies for Controlling Emerging Nosocomial Outbreaks of Highly Transmissible Respiratory Viruses
Sofia Burdi 1 2 3 , Felix Reichert 1 , Barbara Mühlemann 4 5 6 , Victor M Corman 4 5 6 , Terry C Jones 4 5 6 , Martin Hölzer 7 , Susanne B Schink 1 , Patrick Larscheid 8 , Jakob Schumacher 8 , Gudrun Widders 9 , Inas Abdelgawad 9 10 11 , Christian Brandt 12 13 , Nicole Dinsel 12 , Katharina Jelavic 12 , Nadine Kurzke 12 , Jörg Hofmann 5 14 , Janine Michel 15 , Annika Brinkmann 15 , Stephan Fuchs 7 , Christian Drosten 4 5 6 , Tim Eckmanns 1 , Muna Abu Sin 1
Affiliations
- PMID: 41899213
- PMCID: PMC13026708
- DOI: 10.3390/jcm15062290
Background/Objectives: Nosocomial outbreaks of viral respiratory infections strain healthcare systems and endanger patients and healthcare workers (HCWs). We describe two large nosocomial outbreaks with the SARS-CoV-2 Alpha variant, during its initial emergence in Germany, to assess transmission dynamics, effectiveness of control measures, and challenges in managing highly transmissible respiratory viruses. Methods: Confirmed cases were inpatients, HCWs, or their contacts testing SARS-CoV-2-positive since 1 January 2021 (Hospital A [HA])) or 21 January 2021 (Hospital B [HB])) with N501Y and delH69/V70 spike gene mutations. We conducted case interviews, reviewed medical records and shift schedules, and performed sequencing, genome reconstruction, and phylogenetic analysis. We describe cases, transmission chains, and control measures. Results: HA reported 18 patient cases, 20 HCW cases, and 33 community cases (N = 71). HB reported 48 patient cases, 43 HCW cases (13 in a COVID-19 ward), and 27 community cases (N = 118). In-hospital transmission occurred patient-to-patient, HCW-to-patient, patient-to-HCW, and HCW-to-HCW. HA halted admissions immediately after the initial cases; HB implemented measures gradually. Regular testing detected pre-symptomatic (HA = 6; HB = 18) and asymptomatic cases (HA = 3; HB = 13). Testing of agency staff was incomplete. The suspected primary case was an HCW in HA and a patient in HB who required resuscitation shortly after admission. Conclusions: Early COVID-19 outbreaks offer valuable lessons for managing emerging nosocomial outbreaks of highly transmissible respiratory viruses. Our findings provide empirical evidence for effective interventions, including rapid response, testing, HCW protection, and rigorous contact tracing in high-risk emergency situations. Managing agency staff remains a major challenge.
Keywords: healthcare-associated infections; infection prevention and control; infectious disease outbreak; phylogenetic analysis; respiratory infections.