The largest epicenter of the coronavirus outbreak in Vietnam

To the Editor—As of April 1, the total number of SARS-Cov-2–positive cases in Vietnam reached 218, and 37 of these were infected within a public hospital in Hanoi, the capital of Vietnam.1 Thus far, this hospital is the largest COVID-19 hotspot in the country. Three patterns of transmission occurred in the hospital: (1) between healthcare workers (HCWs), (2) from COVID-19 patients to HCWs, and (3) from nonclinical hospital staff to others. Figure 1 illustrates a timeline of the spread of the SARS-Cov-2 virus within the hospital from the first confirmed case on March 20 to the most recent case on April 1. The first SARS-Cov-2–positive case was a medical worker (P87), who was in close contact with a SARS-Cov-2–infected nurse (P86).2 With the exception of the 2 infected cases, P86 and P28, who contracted the coronavirus from the outside, no HCW, non–COVID-19 inpatients, or visitors had tested positive for the coronavirus. Since March 28, SARS-CoV-2 infections among nonclinical staff have emerged, and subsequently, 25 of the 37 COVID-19 cases (68%) were nonclinical staff working in the dining hall of the hospital. These catering workers were responsible for preparing meals and delivering food and hot water to patients and visitors across the hospital daily, and it is likely that these nonclinical staff are the main contributors to the spread of the virus within the hospital. Healthcare-associated infection is known characteristic of coronavirus-related diseases and a leading route of transmission.3