MERS Virus Raising Global Alarms – Story and Preparedness Resources

On May 12, 2014, AlertsUSA issued the following
related flash messages to subscriber mobile devices:

5/12 (b) – CDC: 2nd MERS case a healthcare worker who flew SA Flt 113 from Jeddah > London > Boston > Atlanta. Now hospitalized in Orlando. 500+ exposed & being notified.

5/12 (a) – CDC: 2nd confirmed US case of deadly Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Florida patient. Awaiting more details from 2:00 PM press conf.

WHAT YOU NEED TO KNOW

Twice this week AlertsUSA subscribers were notified via text messages to their mobile devices regarding a 2nd confirmed case the deadly Middle East Respiratory Syndrome Coronavirus (MERS CoV) here in the U.S.. This week’s case also involved an individual who traveled from Saudi Arabia through via flights through London, Boston, Atlanta and into Orlando. CDC’s Div. of Global Migration and Quarantine is working with Pan-American Health Org. (PAHO), Public Health England, Public Health Agency of Canada, and U.S. state and local public health authorities to contact and interview all travelers that may possibly have been exposed to the Florida patient between when he left Saudi Arabia and was ultimately diagnosed and quarantined here in the U.S..

As of May 12, 536 laboratory-confirmed cases of MERS-CoV infection across 18 countries have been reported by the WHO, of which 145 have died. All reported cases have been directly or indirectly linked through travel or residence to seven countries: Saudi Arabia, UAE, Qatar, Oman, Jordan, Kuwait, and Yemen.

As previously reported by AlertsUSA and Threat Journal on multiple occasions since the virus was first identified in the Spring of 2012 (see this and this), public health and epidemiology professionals tend to cringe each year when the annual Hajj pilgrimage to Mecca rolls around, planned this year for the first week in October. It goes without saying that when millions of international travelers from all points on the globe converge in one city for a physically active, horrendously overcrowded, hot and humid gathering involving communal shaving, touching common surfaces and staying in tightly packed quarters, one is considered lucky to leave without having contracted some respiratory or digestive bug, if not worse. Even a cursory search of the Internet shows that cholera, pneumonia, meningitis, all forms of hepatitis, measles, mumps, typhoid, dysentery and a host of other communicable diseases run rampant during the Hajj. Then the Pilgrims, just a quickly, return to their countries of origin.

While this year it is widely reported that camels appear to be the primary hosts for the virus, readers may recall that in 2012 and 2013, health authorities were reporting that genomic analysis suggested that the coronavirus circulated among bats before jumping to humans.

CDC WARNING TO CLINICIANS

In the May 14th edition of the Morbidity and Mortality Weekly Report, the CDC cautioned clinicians and other healthcare professionals of the need to consider MERS-CoV infection in persons who have fever and pneumonia or acute respiratory distress syndrome and either a history of travel from countries in or near the Arabian Peninsula within 14 days OR close contact with a symptomatic traveler who themselves have traveled to the region within 14 days. Additionally, the CDC points out that individuals who have recently traveled may seek medical care far from cities that are served by international flight connections. Therefore, all health care professionals should be cautious and “prepared to consider, detect and manage cases of MERS.”

On Wednesday the World Health organization reported that while concern about the virus had “significantly increased,” the disease was not yet a global health emergency. Late this week Saudi health authorities reported 20 new cases as well as 10 more deaths.

Despite the WHO statement, 22 international airports across the U.S. this week began prominently displaying health advisory posters from the CDC warning of the MERS virus. In addition to educating travelers about the symptoms of MERS, the posters warn those who travel to the Arabian Peninsula (including Bahrain, Iran, Iraq, Israel, Jordan, Kuwait, Lebanon, Palestinian territories, Oman, Saudi Arabia, Syria, the United Arab Emirates, and Yemen) to wash their hands often, avoid touching their face, and to avoid close contact with sick individuals.

RESOURCES

World Health Organization (WHO)

MERS-CoV page
Latest Case Updates
Latest Risk Assessment (Apr 24, 2014)
Interim Case Definitions (Jul 3, 2013)
Interim Surveillance Recommendations (Jun 27, 2013)
Risk Factors for Health Care Personnel (Jan 27, 2014)
Clinical Management (Feb 11, 2013)

Centers for Disease Control (CDC)

MERS-CoV page
Case Definitions (Aug 19, 2013)
Infection Prevention and Control Guidelines (May 4, 2014)
Interim Guidance for Healthcare Professionals (May 2, 2014)
Interim Guidance for Home Care and Isolation (Sep 27, 2013)
Information and Guidance for Travelers (May 12, 2014)
Information and Guidance for Clinicians (Jun 18, 2013)
Information and Guidance for Airline Crews (Mar 10, 2014)

Public Health Agency of Canada (PHAC)

Risk Assessment (May 12, 2014)
Interim Case Definition (Sep 23, 2013)
Public Health Notice (May 7, 2014)
Travel Health Notice (May 8, 2014)
Infection Prevention and Control Guidance (Oct 4, 2013)

PERSONAL RISK MITIGATION

In public health emergencies, officials will ALWAYS downplay a threat so as to minimize panic. Thus, while it is important to follow what officials SAY, it is equally important to watch what the professionals actually DO.

If the CDC is hanging MERS warning posters in airports and issuing guidance to healthcare professionals on identifying, isolating, caring for infected individuals and protecting staff (see this and this), these are clues that perhaps you should be taking some steps on your own to protect yourself and family. In the event that the MERS coronavirus infections become more widespread, the following items will disappear from availability overnight:

Medical Grade Skin Cleanser

In principle, it is the current understanding that the MERS-CoV can be transmitted by 3 routes: aerosols, large droplets, and direct contact with infected surfaces and secretions. One of the best risk mitigation steps you can take is to acquire a medical grade skin and surface cleanser. One of the gold standards in hospitals and other clinical settings is Chlorhexidine Gluconate, which is sold under the product name HIBICLENS. The product is intended for use as a surgical scrub and personnel hand wash, a patient pre-operative skin preparation and a skin wound cleanser. The antimicrobial cleaner bonds to the skin to create a persistent antimicrobial effect and protective germ-killing field against a wide range of microorganisms.

Hibiclens Chlorhexidine Gluconate
Medical Grade Skin Cleanse
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Particulate Masks / Respirators

An ESSENTIAL risk countermeasure for reducing the spread of MERS-CoV, not only for caregivers but also for the sick, is to acquire a supply of N95 particulate masks. The N95 respirator filters at least 95% of airborne particles, is in wide use within hospitals and will be impossible to find during a major outbreak or pandemic. These are (currently) inexpensive and an critical element to one’s preparedness supplies.

NIOSH-Approved N95
Particulate Masks / Respirators

AlertsUSA continues to closely monitor the overall situation with the spread of the MERS virus and will immediately notify service subscribers of reports of new U.S. cases or the release of updated information from health authorities indicating an increased threat environment as events warrant.