Saturday, May 30, 2015

Hong Kong: Two `Contacts' Of MERS Case Refuse Quarantine

Lady MacLehose Holiday Village in Sai Kung

# 10,114

Quarantines - like jury duty - while often an expedient means to an end, aren't exactly warmly embraced by those caught up by them.  Some people will go to extremes to avoid either.

Here in the United States - except in extraordinary circumstances - `quarantine' is likely to mean staying home and limiting household contacts for a prescribed period of time.  

But in places like Hong Kong - where the memory of SARS remains fresh - quarantine usually means a two-week stay at the Lady MacLehose Holiday Village in Sai Kung (description below).

Lady MacLehose Holiday Village
Special Notice
In view of the latest development regarding Middle East Respiratory Syndrome (MERS), the Lady MacLehose Holiday Village has turned into a quarantine centre from 29 May 2015 onwards. Camping services at the Village are suspended until further notice.
For enquiries, please contact the staff of the Village on 2792 3084. 

Located within Sai Kung Country Parks at Pak Tam, Sai Kung, the Lady MacLehose Holiday Village has an air of tranquility and presents a charming view of the woody hillsides. Each bungalow, which can accommodate 3 to 15 persons, is self-contained with a sitting room, bedroom(s) and a toilet with shower facilities. The Camp has a capacity of 280 campers. Hirers please note that Camp facilities, such as bungalows, recreational facilities, canteen, etc., are located on different spots of a slope and connected by pavements.

Despite the amenities offered, getting people to willingly (and abruptly) drop everything and move into a quarantine camp isn't always easy, as the following Xinhua News report shows.

Two People Refuse To Go Into MERS Quarantine   2015-05-30
HONG KONG, May 30 (Xinhua) -- Two Korean nationals having close contact with a Middle East Respiratory Syndrome (MERS) patient who passed through Hong Kong are refusing to go into quarantine, said Health Secretary Ko Wing-man. 
The two Korean nationals are among 18 plane passengers who sat close to the MERS patient, probably against medical advice, Ko said. 
Hong Kong's health authorities have made plans for the 18 plane passengers to go into quarantine for two weeks at the Lady MacLehose Holiday Village in Sai Kung. But two of them are refusing to be tested and isolated, Ko said, adding that authorities can only contact them by phone. 
Ko said the Immigration Department is tracking them down, and the government could force them to be quarantined using Hong Kong laws.
As the incubation period of the disease could be more than ten days, the two could spread the deadly virus, he added.

During the SARS epidemic twelve years ago, no city was harder hit than Hong Kong, which saw 1750 cases and 286 deaths.  It took a while, but eventually the virus was contained (see Hong Kong’s Coronavirus Response), with quarantines regarded as perhaps the most effective weapon in the public health department’s arsenal.

During that epidemic, Isolation was used in the United States for patients who were ill, but since transmission of the virus was very limited here, quarantine was not recommended for those exposed (cite).

In other countries, where transmission risks were far greater, quarantines were used – quite successfully – in order to contain the virus. 

  • Singapore was one of the first countries to mandate quarantines when more than 800 family members of SARS patients were ordered to stay in their homes. 
  • Hong Kong sealed part of the Amoy Gardens Apartment complex after scores of cases erupted there, and later moved all remaining residents to two holiday camps where they were quarantined.
  • And Toronto, Canada closed schools and quarantined thousands in their bid to contain the virus (see The SARS Experience In Ontario, Canada). 
As we've discussed often, some people can contract MERS and not show symptoms.  

Whether or not asymptomatic carriers can transmit the virus to others is still up for debate, but the high number of `unknown risk exposures' among Saudi cases makes it at least a plausible risk (see WHO EMRO: Scientific Meeting Reviews MERS Progress & Knowledge Gaps). 

Although one could argue that we are going about this the hard way, our knowledge and understanding of the MERS virus is likely to grow considerably over the coming weeks as Korea, Hong Kong, and mainland China learn to deal with its recent arrival. 

A pity that after three years we still don't have a proper case-control study from the Saudis, as many of those questions might already have been answered.

No comments: