Infection prevention and control and MERS

Harriman, Brosseau and Triverdi have written to the Editor of the New England Journal of Medicine (NEJM) to express their concerns over the lack of apparent preventative measures undertaken during the Al-Ahsa Middle East respiratory syndrome (MERS) coronavirus outbreak communicated by Assiri et al (previously reviewed here).

The new letter indicates that with so little known about MERS-CoV transmission route(s), a safer bet would have been to protect healthcare workers as much as possible. They suggest use of  respirators rather than surgical masks (see Mike Coston's reviews of the differences here, here, here, here and here...likes his masks does Mike). 

Possibly eye protection as well given the transmission unknowns. 

I've previously listed these and other precautions for managing patients with endemic or with less well-defined respiratory pathogens. Worth a reminder read.

The authors highlight it would be prudent, in a well-resourced country like the Kingdom of Saudi Arabia, to roll out as many extra personal protective safeguards for the front-line healthcare workers as possible; at least while the slow hunt to understand how the virus is acquired and transmitted seeks some answers.

The reply to this letter by Memish, Al-Tawfiq and Assiri did not specifically agree with its specifics or address enhanced care for HCWs, instead restating what was done to respond. The key comment summing up the use of respirators indicates a reactive rather than proactive approach to HCW care in trying to prevent a case from spreading their laboratory confirmed infection. 

...putting surgical masks on all patients undergoing hemodialysis and particulate respirators (N95 masks) on any patient with confirmed MERS-CoV who was undergoing an aerosol-generating procedure...

As we've seen over and over again during this outbreak and others, by the time a laboratory confirmation is available, it is far too late to halt early transmission events. 

When those events occur in a hospital environment it's not just the relatively (to the MERS-CoV case averages) younger and more healthy HCWs that are at risk of infection and disease. MERS-CoV and other respiratory viruses are at their most lethal among the elderly with comorbidities. Delays in lab testing, in waiting for something to happen or in following other's guidelines to the letter rather than modifying or creating new ones based on front-line experiences, can have severe consequences.

I take the message from this letter as: Be proactive not reactive.