Sunday, 23 August 2015

Whether MERS-CoV spreads or stops is entirely up to the hospitals...

The very steep rises in Middle East respiratory syndrome coronavirus (MERS-CoV) cases seen in the graph below are not due to overwhelming and constant exposures to infected camels resulting in human cases of MERS. 

Those upwards inclines are mostly because humans are just numbskulls.

MERS-CoV cases worldwide up to 22-AUG-2015.
Click on image to enlarge.


We propagate epidemics. We create our own headaches in this arena. Many viruses wouldn't break out if we didn't create the circumstances for an outbreak. The biggest headache? Infected patients who spread virus to uninfected patients and health workers when they are in unprotected close contact in a healthcare setting.

We can go on and on bemoaning the many knowledge gaps in our understanding of MERS-CoV - we did and listed some recently - but that's really an academic endeavour in the short term. Three years later (not really short term) we are still seeing the basic problem of hospitals becoming hubs for MERS-CoV transmission, MERS disease and the death of some of those most vulnerable to MERS-CoV infection. Hospitals. Places filled with already sick people. Sick people who can be made much, much more sick by a MERS-CoV infection. 

In the case of MERS cases - as we have seen time and time and time again in the short space of time since 2012 - one or a few cases get into a hospital environment and catch the hospital completely unprepared for such a...poorly transmitting respiratory virus infection. 

It really doesn't matter if the earliest cases acquired virus from a camel or a community case or a family member - the containment of that infection is what matters to prevent a subsequent outbreak. 

And so they fail to contain it. Maybe the way we receive patients should be looked at afresh from an engineering perspective? Mainly though, this is a people problem. Those people receiving, managing and working in the hospital create the circumstances by which this opportunistic virus can spread well beyond what its capability suggests it should.
Heavier wet droplets versus 
near-weightless droplet nuclei.
Impact versus cloud.
Click on image to enlarge.

To stop transmission in hospitals, basic protocols of personal hygiene and personal protective equipment seem to work.

So, from a complete non-expert, here are my simplistic thoughts: 

  1. Wash off an infected patient's virus (which includes constant cleaning of surfaces around the patient and constant mindfulness about one's personal hygiene extending to those not caring for a patient-e.g. cleaning, ward, transport and administration staff
  2. Protect upper airway (mouth, nose and eyes) mucous membranes from being exposed to infectious droplets propelled from an infected patientIf that isn't working (but past fixes suggest it has) there are stepped up precautions to try to prevent airborne transmission by floaty clouds of infectious virus (if it can remain infectious in such clouds).
Once that protection is a standard procedure in the hospital, perhaps others could pick up their feet on trying to sort out the specifics of how the virus manages to transmit and which mucous membranes are the ones we need to cover up. 

Let's not forget this is all just as relevant to infections by much better studied pathogens including measles virus, respiratory syncytial virus, human metapneumovirus, adenoviruses, influenza viruses, other coronaviruses and rhinoviruses. They can all be spread in healthcare settings - and more efficiently than MERS-CoV it seems. They can also have a big impact on vulnerable patients.

But baby steps.