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MERS discussion thread

Re: MERS discussion thread

Welcome Gemineye.

If the Saudi's didn't feel they were forced to divulge the bare minimum of data, I am certain they would clamp down on all information both to nationals and to foreigners. One poor man was sentenced to a 1,000 lashes and 10 years in prison for 'rumormongering' details about MERS. Doctors have lost their jobs. Saudi Arabia is going to take a major hit to its tourism dollars if they don't get a handle on the situation fast. And another factor that has not been discussed much is nearly half of the work force are foreign nationals. What happens to the oil and gas industry, hospitals, schools and universities if those foreign workers decide Saudi Arabia is not a safe place to live and work? The result would be a catastrophe.
 
Re: MERS discussion thread

IMO it would be best to give the HCW status when reporting cases from the perspective of avoiding widespread panic.

Ian Lipkin does a great job of explaining why MERS has been so successful in the hospital environment:

http://www.kspr.com/news/nationworld/Lipkin-Will-MERS-become-a-global-threat/21051646_26071130
Lipkin: Will MERS become a global threat?
By W. Ian Lipkin
POSTED: 06:45 AM CDT May 20, 2014

...
Hospitalized patients with pneumonia-like MERS receive vigorous respiratory interventions such as intubation, assisted ventilation, drugs that dilate airways and chest percussion. These interventions may bring virus into the environment in aerosols and on the surfaces of medical equipment, resulting in infection of hospital personnel and other patients. Since the MERS coronavirus has been shown to be stable for up to 48 hours, it may be difficult to determine the source of infection as people and equipment circulate in the health care environment...
Click to expand...

Saudi Arabia will make a breakthrough soon as far as hospital control and patient treatment, I think. Some of the scientist/doctors on Twitter were discussing the possibility that what is doing some patients in is actually an autoimmune response to the virus starting about 7 days after infection. They hope to time prednisone administration just right so they avoid fueling early viremia yet suppress autoimmune lung damage in time.

The antibody research DARPA is sponsoring in the humanized mouse lab looks promising, too, along with the frugal repurposing of approved drugs as antivirals.
 
Re: MERS discussion thread

Emily - but are viremia and septicaemia are the same thing? While septicemia can be triggered by any pathogen, viremia is the same cascade but the term only applies to viral infections?

I have a good reason for asking:)
 
Re: MERS discussion thread

Vibrant, I think I steered you wrong by using the term 'viremia'. I went back to Twitter and the doctor said that early steroids 'might enhance viral replication.' My current understanding of viremia is that the virus has to have gotten into the blood to earn that status, so I misquoted the doctor. He did use the term 'autoimmune', though and referenced this article:

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2249.2005.02864.x/full

So clearing the MERS virus might not mean a patient is on his/her way to health.

Now as far as your question:

but are viremia and septicaemia are the same thing? While septicemia can be triggered by any pathogen, viremia is the same cascade but the term only applies to viral infections?
Click to expand...

The way I understand sepsis is that it is a systemic host reaction to viremia, rather than the activity of the virus. You might not even need to have a pathogen infection in blood to have sepsis according to this:

http://www.justcoding.com/297100/clinical-information-queries-help-reduce-confusion-when-coding-sepsis

That coding article gives me the impression that they are moving away from the term 'septicaemia', but I think it was used in place of both viral infection+sepsis and bacterial infection+sepsis.

What I'm wondering now is does viremia or bacteremia always result in sepis, or can the host response still vary from person to person once an infection gets to be that severe. :confused: More reading to do on that unless someone here knows....
 
Re: MERS discussion thread

I suppose what I am trying to get at here, is, IS viremia a precipitator of sepsis (it would seem so) and therefore is sepsis a clinical feature of severe cases of MERS? Is it this that is causing ARDS and death in the course of infection? Where sepsis is defined as

sep•sis (ˈsep-səs) n. Sometimes called blood poisoning, sepsis is the body's often deadly response to infection.
Click to expand...

See http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2043413/
Sepsis: definition, epidemiology, and diagnosis

Because if so there is interesting research in stopping sepsis generated innate immune response cascades and dysregulation that could apply here.
 
Re: MERS discussion thread

Emily, I totally agree that "it would be best to give the HCW status when reporting cases from the perspective of avoiding widespread panic". But I think Saudia Arabia was miffed that the WHO found inadequate infection-control procedures in their hospitals so they just stopped reporting the numbers. Didn't the SARS outbreak teach counties that transparency is the best policy to control outbreaks?
 
Re: MERS discussion thread

what SARS, MERS - you name it -teaches us is that countries are unteachable. if the risk of economic loss is high enough then obfuscation will win over transparency
 
Re: MERS discussion thread

Sadly, I agree. As governments change, priorities alter, and the lessons learned evaporate into thin air. Good people within health authorities get retasked, leaving those that remain to do their best with the resources left to them.
 
Re: MERS discussion thread

That is a good article. It covers everyone's positions. Too bad Memish and Lipkin are no longer working together. I really was impressed by Lipkin's work during the XMRV crisis. He seems very trusted by the long-suffering CFS/ME community and also he was very restorative towards the colleague who initially thought there was a link between the retrovirus and the disease.

But I guess the positive side of that is that after the split there were two independent teams investigating the matter.

I just found this mBiosphere post from 2/14 and was surprised that back when Memish and Lipkin were working together, Lipkin managed to get a camel virus into the U.S.
http://mbioblog.asm.org/mbiosphere/2014/02/camels-harbor-coronavirus-causing-middle-east-respiratory-syndrome-.html
Arriving home at New York?s John F. Kennedy Airport, Lipkin?s team found their samples held up by customs, while a series of government agencies including the Department of Homeland Security and the Department of Agriculture became involved. Eventually, says Lipkin, the samples were transported by special hazard truck to the National Biodefense Analysis and Countermeasures Center in Frederick, Md., where they were tested for foot-and-mouth disease. After the samples were cleared, the special hazard truck returned them to New York.
Click to expand...

It is much harder to get an animal virus into the U.S. than a human virus. Those food animals are very important. ;)
 
Re: MERS discussion thread

Doublespeak. The number of people arriving for pilgrimage is extremely low. Not because the pilgrims are afraid of MERS but, because the number of persons applying for pilgrimage was so high that the Saudi's decided to limit the applicants to the lowest allowable number....Right there were so many applicants that the Saudi's arbitrarily decided that only the minimum number of people would be allowed to enter the country.

http://www.flutrackers.com/forum/showthread.php?t=223765
 
Re: MERS discussion thread

http://www.flutrackers.com/forum/showthread.php?t=223732


The answer to why MERS has surged over the last few months is more than an academic inquiry. If the virus remained unchanged then why has it suddenly moved into humans? If it is ubiquitous in camel populations throughout the Middle East and parts of Africa and has been for at least a decade, then why didn't it infect humans prior to last spring? Something had to change. Humans do not suddenly mutate so we have to look elsewhere for an answer. Environments can change in a short span of time. Has something new been introduced into Saudi Arabia? Perhaps some infectious agent that lowered the immune response to MERS? Mayhap a new vector that helps move the virus from dromedary's to humans? As it appears to be very limited in its ability to infect subsequent victims, how is it infecting so many new victims? Neither warnings to not touch camels, nor drink or eat camel meat without through cooking appears to have not made much of a dent in the infection rate. Only 20% of new cases are actually almost certain to have come from hospital settings. So then where are the rest of the cases coming from? Why so many cases in the Middle East, primarily KSA but almost no new cases outside of the region? Why was there one case in the US that was acquired through a handshake but none through even closer contacts? So many questions and so few answers. Compounding the conundrum is the lack of transparency in KSA.

What does it gain the Saudi's to be straightforward? Zip, nada, nothing. They are probably losing a huge amount of money to loss of tourism. They also are probably running scared that much of their foreign workforce may decide that it isn't healthy to stay in Saudi Arabia. If more than half of medical professionals are not Saudi's, then the ramifications are dire if they all leave. Or even if a good number leave. What happens to the oil and gas industry if a huge number feel it is better to go home then subject their family to a deadly disease. These musings don't even touch on the pride of the Saudi's that might prompt shutting all information leaving the country to keep up appearances.

I cannot even imagine what must be going on in the mind of the leadership within Saudi Arabia. At this point it is primarily an internal problem. It does have the potential to be an international catastrophe but, then again maybe not. What do you share with outsiders if it means you are going to take a billion dollar economic hit if you do? How much do you share with anyone if it means you may suddenly lose your workforce? Many of them absolutely critical to your survival. On the other hand, social media prevents your ability to clamp down on information leakage. People chat, they gossip, they add rumors to their messages. If you have decided to shut down every bit of information about MERS, then you are forced to do things like send someone to prison for ten years and whip him 1,000 times to attempt to control others from spreading fact or fiction internally and externally. What does that do to your popularity within your country? Uneasy is the head that wears the crown. Meanwhile, the rest of the world watches and waits.




http://www.flutrackers.com/forum/showthread.php?t=223732
 
Re: MERS discussion thread

http://www.independent.co.uk/life-style/health-and-families/health-news/deadly-mers-virus-could-be-spread-by-cats-and-dogs-and-is-not-just-found-in-saudi-arabia-scientists-warn-9438368.html
Experts still know little about how the mysterious infection is transmitted
Adam Withnall Author Biography

Tuesday 27 May 2014
...

Dr Briese also pointed to another report showing that, far from being limited to Saudi Arabia itself, reservoirs of Mers have been found in Nigeria, Ehtiopia and Tunisia ? yet mysteriously there have been no confirmed deaths from the disease in these regions.
Click to expand...

No wonder CDC is reaching out to medical anthropologists. They can compare practices in Saudi Arabia to those in the most culturally similar countries with camels that have MERS-like viruses. If there is a human factor, an integrated approach between epidemiologists and anthropologists has a chance of finding it.
 
Re: MERS discussion thread

I attended a workshop with the Chief of Public Health Canada last night, Dr. David Butler-Jones and he was very clear and honest that the Saudis were being less than forthcoming with MERS data, but refused to elaborate.
 
Re: MERS discussion thread

Nox said:
I attended a workshop with the Chief of Public Health Canada last night, Dr. David Butler-Jones and he was very clear and honest that the Saudis were being less than forthcoming with MERS data, but refused to elaborate.
Click to expand...
:iagree:
 
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