key: cord-0832954-qngkf4b6 authors: Tilmanne, Anne; De Crombrugghe, Gabrielle; Al-Husni Al-Keilani, Mouna; Le Loc’h, Guillaume; Delvenne, Véronique; Smeesters, Pierre R. title: A well-controlled Covid-19 cluster in a semi-closed adolescent psychiatry inpatient facility date: 2020-08-14 journal: Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases DOI: 10.1016/j.cmi.2020.08.007 sha: 5d5506d37f919a73d877be7ca208f606025ff33e doc_id: 832954 cord_uid: qngkf4b6 nan A well-controlled Covid-19 cluster 2 in a semi-closed adolescent psychiatry inpatient facility 3 4 Intended category: Letter 5 6 Keywords : SARS-CoV-2, infection control, transmission, children 7 8 Authors: Anne Tilmanne PhD 1 , Gabrielle De Crombrugghe MD 1 , Mouna Al-Husni Al-9 Keilani MD 2 , Guillaume Le Loc'h MD 2 , Véronique Delvenne PhD 2 , and Pierre R. 10 Smeesters PhD 1,3,4,5 11 12 1 Children are less frequently ill due to SARS-CoV-2 compared to adults [1] . However, the role 40 of asymptomatic children and adolescent in disease transmission is still unknown and 41 represents a major question in time of schools reopening. 42 We report a pauci-symptomatic SARS-CoV-2 positive 14-years-old boy in a semi-closed 44 child psychiatry inpatient facility. This unit welcomes 15 young people aged from 8 to 15 45 years old, in crisis for an average period of 6 weeks to 3 months. They are admitted for 46 different purposes: suicidal attempt, depression, anorexia, behavior disorders, psychotic 47 disorders. 48 On Day 0, the patient complained of a runny nose with no other symptoms. On day 1, SARS-49 CoV-2 antigenic test returned positive on a naso-pharyngeal swab a week after a contact with 50 a SARS-CoV-2 positive and hospitalised parent. The patient could neither be sent home nor 51 transferred to a paediatric ward for reason linked to his symptomatology. After team 52 discussions, we decided to keep the patient in our facility and enforce strict infection 53 prevention measures to protect both inpatients and health-care workers (Table 1) . From day 8 54 to day 43, a total of 14 patients were tested per protocol twice a week for SARS-CoV-2 in 55 their nasopharynx. All remained asymptomatic. The inpatient length of stay ranged from 1-5 56 weeks. All patients stayed in the facility all the time once admitted. The index case was tested 57 twice a week. He tested positive from day 1 to his discharge on day 13 and an asymptomatic 58 14-years-old girl was also positive from day 8 to day 29. Given the 4-12 days incubation 59 period, we do not know whether the transmission to the secondary case occurred before or • Positive patient bedroom was individual and considered as a contamined space • Health-care workers had to wear a protection gown and gloves to go into that bedroom. • Access to the bedroom was not granted to other children. • Infected patient had to wear a surgical mask at any moment outside the bedroom. • Infected patient had to disinfect the hands with hydroalcoholic solution before leaving the bedroom and at each time he touched his mask or his face. • Infected patient had an own bathroom and toilet which could not be used by other patients • Social distancing (1·5 meter) was required between all inpatients and with the health-care workers • The infected patient had non reusable cutlery and plate, which were thrown away after use in a contaminated garbage can. • Group activities were adapted to be preferably undertaken outside, with no shared materials • Each patient had a personal locker with his craft material, pencils • Cards play, books exchanges were not allowed but board games through connected tablets were promoted • Home visits were cancelled Ag PCR PCR ---------2 13·8 -neg neg neg --------3 12·8 13·8 ----neg neg neg neg ---neg 10 14·3 ----neg neg neg neg neg neg neg neg 11 13·5 --------neg neg neg neg 12 13·5 --------neg neg neg neg 13 9·9 --------neg neg neg neg 14 11·3 ----------neg neg J o u r n a l P r e -p r o o f CDC COVID-19 Response Team. Coronavirus Disease 2019 in Children -United States The characteristics of household transmission of COVID-19 Cluster of coronavirus disease 2019 (Covid-19) in the French Alps COVID-19 in Children and the Dynamics of Infection in Families Epidemiology and transmission of COVID-19 in 391 cases and 1286 of their close contacts in Shenzhen, China: a retrospective cohort study