MERS discussion thread

[Shannon Bennett]

I believe it is time we opened up the floor to discuss what we think is going on in the Middle East.

Why the news blackout. To stem panic inside Saudi Arabia? To prevent business losses? Saving face?

How many cases are unreported. How age and health statistics are changing for the infected.

How many medical personnel have been infected and the implications of their infection.

Why there have been so many cases inside the Middle East and so few outside.

 

[curiosity]

Re: MERs discussion thread

Re: MERs discussion thread

The economical hardship associated with an epidemic that has pandemic potential is enough to prevent many countries from being transparent.

If, for instance, the virus is effectively moving through their population, the only thing they can do for this particular virus is isolate and quarantine.

However, if they share that information with the world, boycotts, trade restrictions, travel restrictions, (big money in religious visits), etc..., will create havoc in their economy.

The most recent example is Mexico City in 2009 when H1N1 was first announced. The city shut down for several days, took several weeks to recover, the pork market suffered AND tourism stood still for months. I've not seen the hard data on how severe the economy damage was in Mexico City - surely in the millions/billions.

What would a country have to gain by being the "index country" for their own people? Nothing.

For humanity, surely, it would be a benefit to everyone to let them know, but that takes great leadership - to be so openly vulnerable - AND the leader must have an INTEREST in the potential impact on other countries.

 

[sharon sanders]

Re: MERs discussion thread

Re: MERs discussion thread

I moved this discussion thread into the discussion forum.

 

[Shannon Bennett]

Re: MERs discussion thread

Re: MERs discussion thread

Given the number of cases in total, the burgeoning spread, the clusters and the medical professionals among the sick, what is the point of attempting to quell any discussion either inside or outside of the country? To put it in simpler terms, the cat is already out of the bag. Yet, it would appear the crackdown in sharing information is getting even stiffer. At some point, probably in the very near future, no amount of censorship will hide what is happening. The nurses are angry as too are some of the doctors who are willing to ignore the news embargo and tell outsiders just what is happening inside the hospitals. Quarantine obviously isn't working. What the decision amounts to is an escalation in anger, fear and frustration when the truth does emerge.

 

[curiosity]

Re: MERs discussion thread

Re: MERs discussion thread

Imagine the world response IF the country were to release information that indicated the virus is demonstrating rapid spread through the population in a pattern similar to influenza.

 

[Shannon Bennett]

Re: MERs discussion thread

Re: MERs discussion thread

Exactly my point, this could be another 'flu-type' disease. No matter what a country might decide to do politically, the disease will spread. A nation in this position is in a no win situation. If they curb the release of information and the disease spreads, then that country is vilified after the disease is out of control. China is a good example of that kind of thought during the SARs outbreak. If a country opens the doors to the sharing of information, then they take an economic hit but are not vilified. As you stated earlier Mexico bears testament to that kind of behavior. So what this apparently boils down to is they are gambing on the disease dying out and not spreading. Which seems unlikely at this time.

I believe it is time to put pressure on the Saudi's to release all the information. I shudder to think how bad this could be if the world is not alerted to the danger MERs could become.

 

[Giuseppe]

Re: MERs discussion thread

Re: MERs discussion thread

KSA has been quiet during early months of '14 as China grappled with 200+ H7N9 cases: it was an useful distraction for the world.

Current nosocomial outbreak is large, but 50% of cases seem to be asymptomatic; we do not have at this point a clear picture on the epidemiological role of asymptomatic cases, if any.

We must known how long these cases returned PRC+ for MERS-CoV, because the duration of viral shedding (and the source: nose-throat, lungs, urines and faeces), and the asymptomatic cases' close contacs follow-up.

Because most people carry a lot of viruses in their nose/throat but are not infectious...

No data, no conclusions, no prevention, no safety...

 

[curiosity]

Re: MERs discussion thread

Re: MERs discussion thread

... A nation in this position is in a no win situation. If they curb the release of information and the disease spreads, then that country is vilified after the disease is out of control...

Correct, a no win situation - but what would be the repercussions of NOT sharing an alarming development? Their population will still be affected.

It is possible a country like Saudi Arabia, with the hand holding the oil cap, doesn't care if anyone thinks they're the villain - especially if there is nothing to lose.

Wikipedia - "Saudi Arabia has an oil-based economy with strong government control over major economic activities."


On the other hand, maybe they just don't know and are trying to figure it out, but don't have enough information to reaffirm this is an isolated incident. Or whatever they have found is so concerning they're trying to figure out how to break the news without causing panic.

 

[Nika]

Re: MERs discussion thread

Re: MERs discussion thread

Or - secrecy is a result of institutional practices and thus is the SOP - the standard response to anything that is unpleasant for the country/royal family would be well worn security measures. A reflex. Would we really expect them to change this in the middle of a crisis?

 

[Laidback Al]

Re: MERs discussion thread

Re: MERs discussion thread

I would speculate that, as a novel disease, MERS is getting away from the Saudi Arabian public health officials. The asymptomatic cases suggest that MERS-Cov might be widespread and human-to-human transmission is frequently occurring both inside and outside of hospitals. Saudi Arabia may not be prepared to handle the media fallout from a locally spreading epidemic.

 

[Giuseppe]

Re: MERS discussion thread

We can't assume asymptomatic PCR+ cases are playing a role in MERS-CoV epidemiology.

We haven't essential data on duration of PCR+, viral shedding, and possible source of infection for close contacts (ie airborne, body fluids, feces).

These cases may be PCR+ but not infectious.

Critical data are lacking.

One possible scenario is a nosocomial outbreak with secondary cluster of cases in community, for example through symptomatic HCWs or patients relatives.

EID paper Yesterday was really interesting in comparing 2013-14 fecal isolates of MERS-CoV from KSA camels with known human isolates; the persistence of viruses in feces, and the re-infection of camels are in clear contrast with Ziad Memish statement about the not relevance of these animals in current epidemiological situation in KSA.

 

[Shannon Bennett]

Re: MERS discussion thread

Some very good points being made. Insular and entrenched thinking processes due to a government based on monarchy. We can take care of this problem ourselves, we don't need outside help. Problems arise, however, when a country starts dealing with a disease with global potential. Especially one that appears to be moving toward efficient human to human transmission and a nasty case fatality rate. We can but hope for enlightenment among Saudi leadership. The problem is obviously beginning to spiral out of control with denials coming in from multiple sources as twitter feeds suggest the disease is certainly spreading.

Giuseppe brings up a good point. We have little information about how this disease is actually spreading. The clusters would indicate increasingly efficient h2h infection but, verifiable test results are sadly lacking. I'd also like to know how many asymptomatic cases there are and who those cases are infecting.

 

[Shannon Bennett]

Re: MERS discussion thread

Now a hospital is closing its doors to new patients because of overcrowding by MERs patients? see here: http://www.flutrackers.com/forum/showthread.php?t=221593

Lack of information and misinformation because of deliberate media manipulation is nothing short of criminal. Multiple cases occurring outside of Saudi Arabia indicates we are fast losing any possibility of controlling the disease. Suggesting that only those patients who are already immune compromised is disingenuous. It also raises the specter that it is okay if those are the only victims. I have sincere doubts that all of the current victims have advanced kidney disease and/or AIDs. It is difficult to reconcile such suggestions when so many health care professionals are succumbing.

see here: http://www.flutrackers.com/forum/showthread.php?t=221414

 

[Vibrant62]

Re: MERS discussion thread

Sharon. If the above is true it will only be a matter of time before MERS reaches the Phillipines, given the high number of migrant workers, both health professionals and others. Since the Phillipines have no camels, it will rapidly become apparent just how far h2h spread is playing a part in outbreaks. If it is a significant part it will indicate that the disease is proably beyond easy containment; unlike SARS where the intermediate vector was a rare animal with little human/animal interaction, the camel is an integral part of life in the middle east, just as cattle are in the West and other nations.

What concerns me most right now is the total absence of pandemic plans in place or drills being run by the world health authorities. I hope that the WHO expert panel reconvenes. It is time for this to be labelled a disease of international concern IMHO so that countries kickstart their management plans.

 

[Nika]

Re: MERS discussion thread

In no way am I conspiracy theorist or truther (oy vey) but post 9/11 - with a listing of saudi nationals as having participated in the attack and the complete lack of US military response against Saudi Arabia (and deflected to Iraq) - its clear that there is a special preferred relationship between the US and Saudi Arabia.

Few talk about it. Im not a historian - am just using very simple critical thought regarding the situation without an agenda on my part.

All of this is to say - the US (others?) may indeed be taking MERS very seriously, preparing MERS specific stockpiles etc and doing surveillance at the borders as well as internally but not in a way that is publicized. The motive for this is to preserve a delicate relationship with a fellow Big Oil State.

The good thing about All Hazards training (done across the US at the local public health level on up) is that its not hazard specific. One preps for pandemic essentially the same whether is MERS, Ebola or the solanum virus.

 

[Shannon Bennett]

Re: MERS discussion thread

Nika, what you say may be true but that begs the question of what is going to happen in less prepared countries. I'd like to hope that if that was indeed the case, our government would be busy spreading the word to those nations which do not have the opportunity to investigate health threats on their own.

 

[Nika]

Re: MERS discussion thread

I know. It seems that all accountability for that sort of communication was "delegated" to WHO long ago.

 

[Nika]

Re: MERS discussion thread

With SA there is the Hajj to worry about. Its a mega-vector event.

I was expecting MERS to spread globally after the 2013 Hajj but it didnt.

2014 Hajj dates are Oct 1 - 6. Clearly the H2H transmission at the time of the 2013 Hajj was not efficient or sustained.

If MERS has now obtained enough mutations to confer efficient sustained H2H transmission then the 2014 Hajj will be the seminal event for pandemic.

 

[curiosity]

Re: MERS discussion thread

A bit of History -
Last pandemic with airborne virus - H1N1 pdm 09
All dates from Wikipedia

March 15 - first "probable" case in Mexico
March 30 - First California case detected
April 6 - Mexico investigating outbreak of atypical influenzas
April 13 - second case in CA
April 21 - Texas case confirmed

April 27 - Canada, Spain and UK report cases
April 28 - Israel, New Zealand
April 29 - Austria, Germany and South Africa

May 19 - 40 countries officially reported 9,830 cases
...


Now, at what point would have notification, warning, travel restrictions, etc... stopped or slowed this 1.5 month WORLDWIDE spread of an airborne infectious disease through a susceptible population?


If the MERS - CoV has not changed and continues to be the same virus as was detected two years ago - these cases will not be an issue.

If the MERS - CoV HAS changed to become more like the common cold (as corona viruses are also known for) IMO, it is too late. We do not have to wait for the HAJJ.

Perhaps the virus will not be as hardy in different climates - perhaps the cases are really the tip of the whole asymptomatic iceberg and the result will be an insignificant increase in mortality. Perhaps the virus will be similar to SARS and controllable through contact and droplet precautions. Perhaps ...

 

[curiosity]

Re: MERS discussion thread

Going back in time to the H1N1 pdm 09 event - I wonder how many healthcare workers would have tested positive as contacts to known cases. Contrary to the MERS CoV, the H1N1 pdm 2009 was an "unknown". This unknown created a delay in recognizing how quickly it was moving through the population.

I vaguely remember after the H1N1 pdm 09 virus was discovered that the contact tracing of the first cases in the US revealed extensive mild and asymptomatic secondary cases.