Thursday, June 04, 2015

Korea: 36th MERS Case (3rd death) Announced

# 10,143

Yesterday there were reports that a patient that had shared the same room with others infected with the MERS virus, had died and he was being tested for the virus. Today we've confirmation that this 82 y.o. man has become Korea's 36th victim, and 3rd fatality of this outbreak.

According to the Korea Herald's report (see Seoul confirms third MERS death), this patient shared a room with patient #16, and when tested on Tuesday was negative for MERS. He died on Wednesday, was re-tested posthumously, and this time returned a positive result.

A second posthumous test confirmed those results. They describe his exposure as:

With the diagnosis, the deceased is the sixth tertiary MERS infection case in the country, and the first death among them. He had been staying at the facility since May 9 for pneumonia, and shared a six-person hospital room with the 16th confirmed patient from May 28 to 30.

The always cryptic official release follows.

82-year-old male deaths Homers test results tested positive

□ Department of Health and Human Services ' central Homers management task force " has announced that the final decision to Homers positive test results for 82-year-old male who died 6.3 days .

○ deaths - was to have the asthma, bacterial pneumonia underlying disease , fever and difficulty breathing since 5.9 days of treatment in hospital , the patient was on 16th between 5.28 to 5.30 days and the same room as the first patient 23,24 .

This Korean Herald story also examines the official stance that tertiary transmission of the virus had not occurred prior to Monday's announcement of 25 cases & 2 Deaths.

As of Thursday, 28 out of 35 confirmed patients had all been infected at the same facility, which is the second of the four hospitals the first patient stayed at prior to his May 20 diagnosis. He stayed there from May 15 to 17. Up until Wednesday, the Health Ministry had been claiming that the first patient was the sole spreader of the disease in the facility, meaning all 28 of them were infected by the 68-year-old only, not by each other. 
Yet Thursday, Kwon Jun-wook, a senior Health Ministry official leading an emergency task force team, said there is a possibility that tertiary infection cases may have already occurred at the facility from May 18 until May 29, the day the hospital was temporarily shut down. During this period, the first patient was not present in the facility. 
“We acknowledge that what took place at this specific facility is very unusual,” Kwon told reporters. “We have been studying the cases that occurred in the facility very thoroughly and plan to take necessary action accordingly.”

Since the infection process is invisible, and can only be deduced by looking back over the sequence of events, there is always a certain degree of ambiguity in their reckoning. The notion that 1 patient infected 28 people - while possible - would suggest a `super-emitter' scenario.

We've looked at super emitters before (see Influenza Transmission, PPEs & `Super Emitters), and they have been documented with both influenza and SARS infections. But 1 person infecting 28 others over a period of 3 days is a bit of a stretch. 

If, as is suggested in the above article, the chain of infection was active and ongoing after the patient was transferred to another facility, it would cast this outbreak into an entirely different light.

While it may all boil down to inadequate hospital infection control protocols, establishing the chain of infection among these cases would be of considerable value, as it could tell us a lot more about how MERS spreads in a healthcare environment.

Stay tuned.

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