MERS discussion thread

Emily · May 7, 2014

Re: MERS discussion thread

Giuseppe posted a link to an excellent ScienceInsider interview published in May 6 with Christian Drosten here:

MERS: A Virologist's View From Saudi Arabia

The differences he points out in the general stability of coronaviruses vs flu viruses might mean that a yearly coronavirus vaccine would not be needed after all. Also so far it does not look like the increased reporting is due to adaptation by the MERS coronavirus in humans:

C.D.: There has been a lot of discussion about whether the virus has mutated to pass more easily from human to human. But we have sequenced three genomes from samples taken early in April in Jeddah, where many of the cases occurred, two more from later in the Jeddah outbreak, and another one from a patient in Mecca. They all look completely normal.

C.D.: Exactly. And we do not see any changes there. The rest of the virus genome is also really closely related to previously sequenced MERS genomes. You really have to look quite hard to find any changes at all, and when you do find changes, there are other MERS genomes that had those changes, too. This is not like influenza viruses, which have a way higher mutation rate. Coronaviruses have correction enzymes so in general they are more stable genetically.

C.D.: You cannot compare the new numbers to those from a few months ago. Until the 26th of March, 459 tests had been done in all of Saudi Arabia this year. Then in just 1 month, just in the city of Jeddah, 4629 PCR tests were done. Something dramatic changed, and that is the case definition.

Before, tests were done on patients who had pneumonia and required [intensive care]. But now people are being tested not because they are sick, but because they had contact with a patient. Some of these tested positive, but many of them don?t really get sick.

Lots of good science information & no panic in that article.

Drosten does seem to favor a camel vaccine, though it sounds like MOH might be moving towards changes in the healthcare system to control MERS.

Vibrant62 · May 7, 2014

Re: MERS discussion thread

The only thing that is bothersome about this is that the unknowns are still creating a major upswing in case numbers. 28 new cases announced today.

http://www.flutrackers.com/forum/showthread.php?t=222860

Laidback Al · May 8, 2014

Re: MERS discussion thread

Dates of onset are more important to assess trends than that the number of reported cases on any given day.

Since May 1, about 92 cases have been reported. About 28 of these are asymptomatic cases. Asymptomatic cases can not be used as a measure of the rate of infection. Droston's comments about asymptomatic cases are relevant. "Asymptomatic people should not be tested with PCR."

About 50 of the non-asymptomatic cases have onset dates or hospitalization dates in April. Only about 14 of the 90+ reported cases in this period have onset or hospitalization dates since May 1. In order to have increasing rates of infections we will need to have a substantial number of new cases in the next seven days with onset or hospitalization dates in May.

Gert van der Hoek · May 8, 2014

Re: MERS discussion thread

This outbreak of the new Coronavirus reminds me of the Q-fever outbreak we experienced in the Netherlands, which peaked in 2009. Thousands of infected, several hundreds still have chronic symptoms, about 30 died. Q-fever (bacteria, not a virus) is related to infected goats and sheep, peaks in springtime when the lambs are born. TTrillions of bacteria circulating if animals are infected with the Coxiella Burnetii (= Q-ever) bacteria.

It could be a similar pattern we see in KSA. In April most young camels are born, more virus circulating, more human infections. Now April is over, we see a decline. Last year we saw the same pattern. (thanks to VDU-blog).

Similar to the Q-fever patients: the smokers and others with underlying health issues suffer most. KSA is 1 of the countries worldwide with the highest % - in fact the majority - of overweight in the population. Overweight means: higher risks of a lot of issues: high blood pressure, diabetes, etc. etc. etc..

Strategy could be: develop a camel vacine, find out how the virus is spreading from the camels to humans and stop that. Manure? Milk? Dust?

In the meantime: avoid contact with camels and camel products. For instance: Indonesian travel agencies arrange a complete Umrah, including a visit to a camel farm. The Indonesian Health Minister said: please stop doing that, go to a mosque, not to a camel farm.

Vibrant62 · May 8, 2014

Re: MERS discussion thread

Drosten also commented about the MERS testing pressure on labs, and said it was unsustainable, and that they currently could not cope.

I am wondering about how big the backlog is. It may be too early to assess the epidemiology. What we may be getting now is simply confirmations from the backlog with current suspect cases i.e individuals with disease onsets later than May 1st still waiting to be assessed.

Vibrant62 · May 8, 2014

Re: MERS discussion thread

Is there anyone with plotting skills able to plot the numbers of MERS exported cases, and take a look at the percentage vs numbers of KSA reported cases.

My thought is that a) there seems to be a lot of them emerging right now and b) if the confirmed numbers and percentages escalate it may give a clearer picture of numbers of community based infections in KSA/ UAE etc

We may not be able to track individual case numbers any more due to volumes in KSA but we could track exports?

Vibrant62 · May 8, 2014

Re: MERS discussion thread

Cant find thread, so pertinent points are:-

1. I thought I read a recent history of travel to KSA? Is this inaccurate?

2. If no travel history, is there a reported history of contact with a known case?

Laidback Al · May 9, 2014

Re: MERS discussion thread

Vibrant62 said:
Is there anyone with plotting skills able to plot the numbers of MERS exported cases, and take a look at the percentage vs numbers of KSA reported cases.

My thought is that a) there seems to be a lot of them emerging right now and b) if the confirmed numbers and percentages escalate it may give a clearer picture of numbers of community based infections in KSA/ UAE etc

We may not be able to track individual case numbers any more due to volumes in KSA but we could track exports?

Relative to the number of local infections in countries on the Arabian Peninsula, exported cases are very few. Since January 1, single or a few likely imported cases have been reported and confirmed by WHO from Egypt, Greece, Jordan, Kuwait, Malaysia, and the United States of America. However, a number of suspected cases have been reported in the media in additional countries.

Here is a partial list of countries with suspected imported cases and links:

Egypt

Cairo, Alexandria -8 cases not reported By WHO
http://www.flutrackers.com/forum/showthread.php?t=222393

Eastern Governorate - 1 case confirmed by WHO
http://www.flutrackers.com/forum/showpost.php?p=532820&postcount=3

Monufia Governorate - 1 case not reported by WHO
http://www.flutrackers.com/forum/showthread.php?t=222772

Port Said - 1 case not reported by WHO
http://www.flutrackers.com/forum/showthread.php?t=222729

Qalyubia Governorate - 2 cases not reported By WHO http://www.flutrackers.com/forum/showthread.php?t=222607

Red Sea Governorate ? 4 case not reported by WHO
http://www.flutrackers.com/forum/showthread.php?t=222863

Sharm el-Sheikh? 3cases not reported By WHO
http://www.flutrackers.com/forum/showthread.php?t=222544

Indonesia

Riau - 3 cases not reported By WHO
http://www.flutrackers.com/forum/showthread.php?t=222857

West Sumatra - 2 cases not reported By WHO
http://www.flutrackers.com/forum/showthread.php?t=222913

Kuwait - 2 cases not reported By WHO
http://www.flutrackers.com/forum/showthread.php?t=222867

Lebanon - 1 case not reported By WHO
http://www.flutrackers.com/forum/showpost.php?p=534334&postcount=2

Pakistan

Punjab ? 1 case not reported By WHO
http://www.samaa.tv/health/06-May-2014/saudi-s-deadly-mers-surfaces-in-punjab

This suggests that Egypt should be carefully monitored for the spread of MERS. Egypt is the 15<sup>th</sup> most populated country in the world. If MERS gets a foot hold in Egypt, it would be a serious problem, especially if the transmissibility of the coronavirus changes.
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Vibrant62 · May 9, 2014

Re: MERS discussion thread

Thanks Al.

I think if we keep an eye on the non KSA / UAE cases it will give us a clearer picture about what is going on.

Your point on Egypt clearly noted. A bigger concern is how equipped thier infrastructure is to detect cases in the current climate. That said, if a domestic problem emerged in Egypt, we would also see this emerging from exported case monitoring, especially if they have not been to Saudi.

Shannon Bennett · May 9, 2014

Re: MERS discussion thread

It would be informative if we knew which countries supplied KSA with workers. Especially those in the health care business so those countries could be more closely monitored. Those are the nations that would most likely be the center of a new outbreak. Emerging nations would have their hands full dealing with said outbreak. It would also be a great idea if they installed a temperature scanner at all airports. Preventing anyone from leaving that had an elevated temperature would be smart.

Shannon Bennett · May 9, 2014

Re: MERS discussion thread

This is a blog from H5N1 Thank you Crof. Also found here. http://www.flutrackers.com/forum/showthread.php?t=222986 It lists todays patients. My question is that it appears to me that we are seeing a shift in the age of the patients. Those suffering from MERS now appear to be significantly younger than those in the past. Or, am I mistaken? We have no idea though if these people are already suffering comorbities nor do we know if they are healthcare workers.

A. Riyadh:

1. A 33-year-old woman, who was admitted to a private hospital. She has not developed any symptoms.

2. A 62-year-old woman, who developed respiratory symptoms. She was admitted to a government hospital on May 8, 2014. Now, she is in stable condition.

3. A 31-year-old woman, who has been in contact with a confirmed case and has not developed any symptoms.

4. A 29-year-old man, who developed respiratory symptoms. He is in a stable condition. He has been in contact with a confirmed case.

5. A 37-year-old woman, who was admitted to a government hospital on February 18, 2014. She suffered from respiratory symptoms on May 8, 2014. Now, she is in a stable condition.

B. Jeddah:

1. A 26-year-old woman who developed respiratory symptoms on May 5, 2014. She was admitted to a private hospital on May 6, 2014. Now, she is in stable condition and is isolated at home. She has been in contact with a confirmed case

2. A 35-year-old man. He has been in contact with a confirmed case and has not developed any symptoms.

3. A 26-year-old woman. She has been in contact with a confirmed case and has not developed any symptoms.

4. A 34-year-old woman who developed respiratory symptoms on April 25, 2014. She suffered from Eclampsia and was admitted to a government hospital in Makkah on May 7, 2014. She was later transferred to a government hospital in Jeddah. She is now receiving IC treatment. May Allah grant her a speedy recovery.

D. Al Taif:

1. A 33-year-old man, who has been in contact with a confirmed case and has not developed any symptom.

Deaths from previously reported cases:

1. A 94-year-old man passed away on May 8, 2014. He was previously recorded as a confirmed case in Jeddah. May Allah have mercy upon him.

2. A 51-year-old man passed away on May 7, 2014. He was previously recorded as a confirmed case in Jeddah. May Allah have mercy upon him.

3. A 42-year-old man passed away on May 8, 2014. He was previously recorded as a confirmed case in Jeddah. May Allah have mercy upon him.

4. A 74-year-old man passed away on May 8, 2014. He was previously recorded as a confirmed case in Taif. May Allah have mercy upon him.

5. A 71-year-old woman passed away on May 8, 2014. She was previously recorded as a confirmed case in Riyadh. May Allah have mercy upon her.

6. An 81-year-old man passed away on May 8, 2014. He was previously recorded as a confirmed case in Riyadh. May Allah have mercy upon him.

7. A 25-year-old man passed away on May 8, 2014. He was previously recorded as a confirmed Corona case in Riyadh. May Allah have mercy upon him.

Recovered and discharged cases that previously tested positive and are now negative:

1. A 54-year-old man, who was discharged from a private hospital in Jeddah.

2. A 19-year-old man, who was discharged from a private hospital in Jeddah.

3. A 38-year-old man who was discharged from a government hospital in AlKharj.

4. A 46-year-old man at a government hospital in Tabuk. He tested negative for MERS Corona virus and remained at hospital for other health reasons.

5. A 10-year-old boy at a government hospital in Jeddah. He tested negative for MERS Corona virus and remained at hospital for other health reasons.

More at Crofsblog.

http://crofsblogs.typepad.com/h5n1/

Emily · May 12, 2014

Re: MERS discussion thread

Shannon said:
It would be informative if we knew which countries supplied KSA with workers. Especially those in the health care business so those countries could be more closely monitored. Those are the nations that would most likely be the center of a new outbreak. Emerging nations would have their hands full dealing with said outbreak. It would also be a great idea if they installed a temperature scanner at all airports. Preventing anyone from leaving that had an elevated temperature would be smart.

Even if Saudi Arabia does not monitor departures though I agree it would seem wise, especially those who have been inside their hospital for any reason, CDC could monitor at risk arrivals.

Laidback Al · May 17, 2014

Re: MERS discussion thread

In post #91 above, Shannon asks whether the average age of MERS cases is lowering, possibly indicating a change in the coronavirus. Plotting the reported ages of 435 MERS cases reported from Week 9 to week 20 (starting February 24th and ending May 18th, 2014) provides the following graph. It does seem that that average age of reported cases is declining, but it is important to note that these cases include numerous asymptomatic contacts that may skew the trend line.

MERS Average Age by week Number 201405016.webp

Nox · May 17, 2014

Re: MERS discussion thread

Concerning temperature monitoring (non-contact infrared thermometers) at departure or entry points, it has shown limited efficiency and low cost effectiveness with the data currently available. However, I agree that with improved standards and protocol, using NCIT would probably prove effective, it's probably a question of cost and experience.

I'm a MSc. Public Health student and this was a fun debate last semester

Source:
http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=19115

Emily · May 17, 2014

Re: MERS discussion thread

Thanks very much for the insight, Nox!

I don't have a public health background, so had no idea there was controversy over temp screening, but last night I belatedly saw this Afludiary post:

http://afludiary.blogspot.com/2014/04/mers-limitations-of-airport-screening.html

Indeed, there is debate.

AlaskaDenise · May 17, 2014

Re: MERS discussion thread

A radio discussion on temperature monitoring pointed out that people fly with fevers for a wide variety of reasons. To not allow them all to fly while the cause was being investigated would not be tolerated by the flying public and probably leave the airlines open to legal action.

.

Emily · May 20, 2014

Re: MERS discussion thread

I don't know where the radio show got the idea that MERS screening would end up quarantining all feverish airline passengers.

And I would assume the government would do the screening so though I'm not a lawyer, I don't see airlines as having liability from that anymore than they do for the actions of TSA or Customs.

I think it is possible that CDC could do a good job of screening including taking temps as needed, but there is no guarantee CDC would be in charge, I suppose. That makes me have second thoughts about the whole idea.

The U.S. flying public is generally cooperative to a fault if they can be frightened enough, so who knows where MERS screening would end up?

Also, one of the references on Afludiary mentioned that people were taking fever reducers to beat SARS screening...

gsgs · May 20, 2014

Re: MERS discussion thread

make it illegal to infect others carelessly

require sick people to wear a mark/warning

Gemineye · May 20, 2014

Re: MERS discussion thread

Shannon, you ask a number of good questions. I'm especially concerned that Saudia Arabia has stopped identifying healthcare workers among the infected. Does this mean that MERS is out of control in their hospitals?

sharon sanders · May 20, 2014

Re: MERS discussion thread

Welcome Gemineye!

I think it means the Saudi government does not like the criticism it was receiving about the continuing and numerous health care worker infections.

MERS discussion thread

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