In a report that is strikingly similar to one we saw last summer, overnight (US time) Thailand's Ministry of Health announced the detection of a second imported MERS case, and as before, it comes from an Omani businessman seeking medical care after going undiagnosed after being hospitalized at home.
According to the MOH Statement (which doesn't translate particularly well), the patient is a 71 y.o. who flew to Thailand on January 22nd after a week of being hospitalized in Oman with a fever and cough, but without improvement.
It appears the hospital in Thailand quickly determined the patient's MERS positive status, and placed him in isolation, and he has been transferred to an infectious disease hospital. In his travels, and before he could be tested and isolated in Thailand, the patient had contact with a number of people.
The Bangkok Post reports:
The Public Health Ministry is looking for people who had contact with the patient. They included a relative who accompanied the patient, 218 crew and passengers who are still in Thailand, one taxi driver, a hotel employee, and 30 hospital staff.
These people will be kept under close surveillance for 14 days. Of them, 37 are categorised as high-risk. They are the patient's relative, 23 air passengers, the taxi driver, the hotel employee, and 11 hospital staff.
Those with a high risk will also be quarantined.
All of this raises questions (again) over the diligence or ability of hospitals in the Middle East - which arguably should be aggressively looking for MERS cases - to detect and isolate cases, and makes the low case counts they report to the WHO suspect.
Oman reported its most recent MERS case three weeks ago (see Oman: MOH Announces 7th MERS Case), which was the first new case since May of last year (excluding the exported case to Thailand last June).
Also last May, two truck drivers transporting camels from Oman to the UAE were found to be asymptomatically infected (see WHO: Asymptomatic MERS-CoV Case – UAE).
In November of 2013, we looked at a study published in The Lancet Infectious Diseases, that attempted to quantify the likely extent of transmission of the MERS virus in the Middle East. (Middle East respiratory syndrome coronavirus: quantification of the extent of the epidemic, surveillance biases, and transmissibility).
They calculated that for every case identified, there were likely 5 to 10 that went undetected.
The assumption is that most of these are mildly symptomatic patients, not ill enough to be hospitalized and tested. But when you consider that of the 9 MERS cases known to have originated from Oman - two were hospitalized and released without diagnosis - their `capture rate' is less than enviable.
This is also a reminder that MERS (and avian flu, Ebola, Lassa fever, etc.) can turn up at any hospital's front door, anywhere in the world, without warning.
Which is why every health care facility – large and small - needs to plan, train and equip themselves for the possibility that the next patient that comes through the ER entrance could be carrying something considerably more exotic than the flu.