The CDC just reported the first case of MERS in the United States. A health care worker from Saudi Arabia recently traveled to the U.S. from Riyadh, Saudi Arabia, and became sick five days ago in Indiana. He has certainly been in contact with other people recently, not only on the flights, but also during a stopover in London. He also took a bus trip from Chicago to Indiana. As usual, Ian MacKay’s blog has some of the best information on this virus, including a truly chilling chart of case counts. This makes clear the rapid growth of cases over the last month. Recent analyses have not identified any mutations in the virus that might account for this change. Another possibility for the spike in cases may be that infection control measures are breaking down in Saudi Arabia now, much as there were such initial failures with SARS in Canada in 2003.
One argument against this hypothesis is that of the ten new MERS cases that Saudi Arabia recently reported, none were among health care workers. The Saudi government has sought to downplay the dangers posed by this virus. Still, Saudi Arabia announced a new health minister last week, who proved his willingness to take a hands on approach by visiting a MERS patient- while practicing proper infection control procedures. The government probably had to react because the panic had reached the point in the city of Jeddah that the main hospital’s emergency room was closed. One doctor said that the entire hospital should be closed until the situation with the virus was addressed. There were reports of ambulance drivers refusing to take patients who might have MERS, and nurses protesting to the health ministry. Doctors also were frightened: “At least four doctors at Jeddah’s King Fahd Hospital resigned earlier this month after refusing to treat MERS patients for fear of infection.” The government has been broadly criticized for not providing enough information, which has also perhaps contributed to a lack of public trust. People are avoiding public spaces and stockpiling masks.
Of course, people around the world are thinking about the Haj this October, when pilgrims will arrive in Saudi Arabia
from around the world. While this mass flow of people attracts attention, though, the recent cases in Greece, the U.S. and elsewhere make the point that large numbers of people already are traveling to the region to work. In 2003, Canada, Hong Kong, Vietnam and other nations were able to control SARS, another coronavirus, without a vaccine. It still may be possible to limit the spread of MERS with these basic public health measures. Meanwhile, H7N9 avian influenza is infecting people far more rapidly than H5N1 did, yet it is receiving less media attention. We’ll need some luck, as well as solid public health work, to manage these threats; the memory of the 1918 flu pandemic haunts all of these conversations. We are unlikely to have a vaccine for MERS at any point in the near future, but we do have more tools than at the end of World War One. Want to read more? Read my earlier posts on MERS and H7N9 influenza.
Shawn Smallman, Portland State University