Coronavirus – Credit CDC PHIL
Since early May we’ve seen three major outbreaks of MERS around the world - and while all three undoubtedly began with a community exposure (likely via camel, camel product, or an infected human) – almost all of the (hundreds) of cases that followed came about due to nosocomial transmission of the virus.
- Between May and July (see WHO: A Saudi MERS Infographic) the city of Hofuf saw more than 40 cases spread across at least two healthcare facilities. The first case - reported on April 20th - involved a case with camel contact (see here), which then evolved into a family cluster, and then a full hospital outbreak.
- In mid-May, a MERS-infected traveler returning from the Middle East visited four South Korean clinics/hospitals before being diagnosed and isolated, sparking the largest MERS outbreak (186 cases) outside of the Middle East. While 16 hospitals admitted patients, two hospitals (St. Mary’s in Pyeongtaek =36 and Samsung Seoul =90) accounted for roughly 70% of all cases (see Mackay On The Lessons Of MERS).
- Starting in mid-July, the Saudi capital city of Riyadh has seen a growing cluster of MERS cases, one that appears to have involved a large family cluster to start, but has exploded into a multi-hospital cluster of more than 90 patients.
We’re it not for the uncontrolled spread of the virus through healthcare facilities in both Saudi Arabia and South Korea - instead of looking at 300 MERS cases over the past four months - we’d probably be looking at fewer than 30 `community acquired’ cases this summer.
Remarkably, many of those infected in hospitals had no known direct contact with infected patients. Just being seen in the same busy Emergency department, being admitted to the same crowded ward, or receiving treatment from an exposed (but not necessarily sickened) HCW, was enough to enable their infection.
If a single community or camel exposure was the spark for these outbreaks, poor hospital infection control practices provided the gasoline.
Yet despite these high-profile failures, we’ve seen other medical facilities where MERS cases have been successfully treated without further transmission of the virus (see Eurosurveillance: Estimating The Odds Of Secondary/Tertiary Cases From An Imported MERS Case).
So we know that good infection control practices can stop the virus if uniformly applied.
Sunday, 23 August 2015
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.