Monday, 13 July 2015

MERS simmers down in South Korea...did we learn anything this time?

No new cases reported in 8 days and the most recent known date of illness onset now 10 days ago, are good indications that the Middle East respiratory syndrome coronavirus (MERS-CoV) hospital-driven outbreak in South Korea is pretty much over. At the least, it's contained. Finally.

Roughly speaking - based on the data from the South Korean Ministry of Health and Welfare, the World Health Organization and KBS news - there were four rounds of infection. In all, 186 cases of MERS have been reported, with 36 (19.4%) resulting in death up until the 13th July AEST:
MERS case spread among hospitals in South Korea
between the 11th May and the 19th June.
Cowling et al. Eurosurveillance Vol 20,
Issue 24, 25-JUN-2-15.
[4]
Click on image to enlarge.

  • the 1st round was the person who flew into South Korea after visiting all over the Arabian Peninsula - he became ill on the 11th of May.[1,2]
  • the 2nd round included approximately 45 cases.[3] This group started becoming ill on the 19th of May, continuing until the 4th of June.[5]
  • the 3rd round included approximately 108 cases.[3] These people started showing signs and symptoms of disease between the 27th of May and the 13th of June.[5] 
  • the 4th round included approximately 22 cases.[3] This group became ill between the 5th of June and the 2nd of July.[5]
We've learned a few things (perhaps "relearned"?) and had a few things reinforced (even more) during this latest successful test of our healthcare systems ability to defend against a case becoming an outbreak...successful from the coronavirus' point of view that is. 

For example we saw that..
MERS-CoV detections, deaths, sex and age distribution in
the South Korean hospital outbreak.
From my MERS-CoV in South Korea page.
Click on image to enlarge
  1. MERS-CoV doesn't spread efficiently between humans - over 16,100 contacts did not develop MERS.[6] 186 did.
    While there were probably more infections among contacts (and future studies from South Korea will hopefully investigate and answer this), disease did not develop among many of those exposed to infected people.
  2. Closing schools, wearing masks in public, putting thermal imaging cameras in office buildings and quarantining zoo camels when not a single case has been acquired without link to a hospital was an exercise in failed communication between government and public.
    There was no indication that any of these costly, high profile measures prevented any transmission. There was also no point to them, precisely because transmission outside the hospital setting did not occur.[3]
    We have to learn to talk more, more often, and more clearly to our populations about the realistic risks of a new and scary virus when it shows up on our shores. We need to build trust here. Trust and respect takes time to build. In these outbreaks, we're always forced to rush because we seem incapable of investing in this before an event. Gods forbid we'd teach these concepts at school. We need to make a bigger deal about educating and informing our public about virus transmission. That is best done if the materials and the processes to roll the messages out to the public are already in place
  3. Holding back information that you have already collected doesn't build confidence in you.
    Whether that is not releasing the name of a hospital or the detailed data about deidentified cases, or presenting a list without discussion, engagement or correction when necessary 
  4. Hospitals are great places to spread infections, if infection control is not constantly running.
    Viruses aren't big on forgiving. Neither are zombies. The undead really suck that way. But the truth may well be that hospitals need to be on guard, cleaning surfaces and in PPE 24 hours  day, 7 days a week if they are dealing with cases of infectious disease that can be expelled from a human in the form of coughing, sneezing, bleeding or vomiting. Judging whether to use "standard precautions", "droplet precautions" or "airborne precautions" at some point after a coughing and sneezing patient has been sitting in the waiting area for hours, is going to be too little too late to stop new healthcare worker infections
  5. Allowing the public - that is, the otherwise healthy - to co-care for patients within hospitals and to sleep in rooms or wards with infected people expelling virus (as per #4) - is a bad idea if trying to contain an acute viral infection
  6. People with other underlying diseases get more seriously sick after MERS-CoV infection.
    Adult health in richer nations is not in a good way. When a wimpy spreader like MERS-CoV comes to town, it may do little damage to the young and otherwise healthy population, but we are not all healthy. 
We all have a role to play in protecting those among us who will suffer more greatly from an otherwise simple acute viral infection by even a rare and obscure camel-cold virus. Whether that is getting a vaccine to prevent us from becoming a hijacked virus production facility, being mindful of others when we cough and sneeze, or seeking out information from trustworthy sources to learn about the realistic threats from a new (or old) virus when it comes to town, we can all make some difference here. 

At some point, one of these viruses may well be better at hopping between us and may cause severe disease not just in those who have an existing ailment. If that day comes, we have proven yet again, that no facet of our response will be up to the task of halting its spread. 

We're not ready.  

But hey - that virus' arrival is probably many, many cycles of leadership change, war, and petty bickering away yet. We'll be ready by then. Right?

References..