Friday, 23 May 2014

MERS by day, testing by night...

Now that we can look back over more than a month (from 20-April to the latest Kingdom of Saudi Arabia [KSA] Ministry of Heath [MOH] report of 7 cases dated 22-May), we see that the downwards trend in MERS-CoV detections  has been pretty consistent.

Click on image to enlarge.

I noted it looked likely to be dropping at the beginning of May, but it's much more clear now. 

So now we wait and see what happens next. 

None of the pressure is off the KSA to try and reduce animal-to-human exposures, to determine how those exposures lead to human infection/what bits of animal are virus positive, to tighten hospital infection and prevention protocols, to see how much of the community has been exposed to or is currently infected by MERS-CoV, to sample more of 2014's MERS-CoV variants and determine how the virus is evolving with more time among, and passages through humans...and other things! 

It was interesting to read recent Lancet articles on Mass Gathering Medicine which, apart from a backgrounder to its "Father", Dr Ziad Memish, make note of the preparedness required each year by the healthcare sector in the KSA to ready hospitals to receive and treat ill pilgrims during their mass journey for Hajj. Clearly the hospitals, having played such a central role in the spread of most human MERS-CoV detections to date and so they have a lot of work ahead them, in a very short period, to ensure a much bigger MERS-CoV outbreak does not result from Hajj-2014. And of course MERS-CoV is neither the only nor the major respiratory virus in town when people descend on that town from all seasonal corners of the globe.

Respiratory virus testing, as I understand it from discussions on Twitter, is not a regular nor a routine tool to support clicnial decision-making in the KSA. Not like it is in the UK, USA or Australia for example. If that's true, then it really should be. he fund exist to support it and clearly Central labs is capable of getting good RT-rtPCR results. It's perhaps just a mater of scale then. Such testing supports and complements a modern healthcare system. And it's important for public health. Respiratory viruses are one of the most common causes of hospital visits. Among the elderly and those with comorbidities, as we have seen with MERS-CoV, these viruses play a big role in stressing or damaging an already damaged tissue/organ/system and spreading among individuals with underlying disease (e.e. those undergoing dialysis) conveniently gathered under one roof within range of each others aerosols. Some disease can be prevented (flu vaccines, which are already used in the KSA), some can be quarantined but knowing which virus is present may lead to better patient management, cohorting and understanding of prognosis. Such a testing system would devolve to the MOH to initiate, organize and manage I suppose.