Background: An outbreak of the coronavirus disease 2019 (COVID-19) occurred in Saskatchewan from September 12 to October 20, 2020. The index event, attendance at a local gym, seeded six additional clusters/outbreaks in multiple settings. These included a high school, a hospital, three workplaces (A, B and C) and several households. The overall cluster comprised 63 cases, 27 gym members and an additional 36 second, third and fourth generation cases.
Methods: All outbreak-related, laboratory-confirmed cases of COVID-19 were included in the analysis. Local public health authorities interviewed all cases and contacts and conducted environmental investigations of the fitness facility. We used descriptive epidemiological methods to understand transmission dynamics of the gym-associated cluster using case investigation, contact investigation and laboratory data, including whole genome sequencing.
Results: Sequencing data confirmed the unique lineage of cluster-related cases (n=32 sequenced; severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] lineage B.1.1.72). In addition to gym attendance, infectious cases attended high school and were involved in other activities. Despite ongoing transmission in the fitness facility, no secondary cases were identified in the high school where four student belonging to the cluster attended class during their infectious period.
Conclusion: We describe an outbreak of COVID-19 where the index case(s) attended a fitness facility, and further spread occurred for 38 days despite active-case finding and isolation of positive cases over this period. Due to gym attendance over time, short-term closing and cleaning may not interrupt chains of transmission. Targeted, preventive public health action in fitness facilities may be warranted. Control measures worked to limit in-school acquisition.
Keywords: COVID-19; SARS-CoV-2; active case finding; cluster investigation; gym; physical distancing; public health; ventilation; whole genome sequencing.