Recommended PPEs
# 8586
Robert Roos, writing for CIDRAP NEWS, does a terrific job teasing out some of the details of America’s 1st imported case of MERS, including some discrepancies in the original reports. As has been mentioned here in the past, early reports – even from official sources - are often `subject to revision’.
We were told, originally, that the patient only become symptomatic after arriving in this country, but in a WHO statement on Monday, were informed the patient began feeling unwell 10 days before he left Saudi Arabia.
And herein lies a major problem with many viral illnesses, even exotic ones like avian flu and MERS; they can present in mild, almost benign fashion during the first few days (or, as in the case of this US case, more than a week) of infection.
Symptoms may resemble a `cold’ or allergies, be primarily gastrointestinal in nature, or fall into the `general malaise’ family of complaints – none of which is likely to prompt red flags in the patient, or in healthcare workers who might see them during the prodromal stage of their infection.
First the report from Robert, after which I’ll return with a few more comments.
Official: US MERS patient's first symptoms preceded travel
Robert Roos | News Editor | CIDRAP News
|
May 07, 2014
An official with the hospital caring for the first US MERS-CoV (Middle East respiratory syndrome coronavirus ) patient confirmed today that the man had some illness symptoms before he flew from Saudi Arabia to the United States, though they were not respiratory.
The patient, a US citizen who works in a healthcare job in Riyadh, Saudi Arabia, flew from Riyadh to Chicago on Apr 24. After experiencing respiratory symptoms, he was admitted to Community Hospital in Munster, Ind., on Apr 28 and tested positive for MERS-CoV on May 2.
The patient was reported to be in good condition and improving yesterday.
Of note, while the hospital spokesperson stated that the patient has been in negative-pressure rooms for his entire time in the hospital, he also said that MERS wasn’t suspected until the afternoon of the 29th, the day after admission, and that then infection control and enhanced respiratory precautions were put in place.
The WHO report stated: Negative pressure room and airborne precautions were reportedly implemented on 29 April 2014; full isolation (standard, contact, and airborne) precautions were implemented on 30 April 2014.
As I have no inside knowledge of exactly when specific infection control steps were taken in this case, all I can do is point out these statements aren’t exactly in complete alignment.
They do illustrate just how difficult it is to detect, isolate, and contain a virus like MERS, that may be slow to fulminate in some patients, and may present with a variety of non-specific symptoms.
In the short run, recent travel history (or contact with travelers) to the Middle East remains the best cause for suspecting MERS. An advantage that could be negated should the virus ever spread substantially beyond the Arabian peninsula.
Reassuringly, so far we’ve seen no signs of secondary transmission of the virus here in the United States, and that has been rarely reported outside of the Arabian peninsula.
Suggesting – that at least for the time being – the MERS virus isn’t ready for prime time.
But as you might expect, today’s threat assessment is `subject to revision’ as well.
