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 It's a memory that hangs fresh in the mind of Dr
Michael Bell, deputy director of the division of healthcare quality
promotion at the Centers for Disease Control and Prevention. The
Atlanta-based federal agency last week sent a team of infectious
disease experts to Community Hospital in Munster, Indiana, to attend
to the first confirmed U.S. case of Middle East Respiratory Syndrome
or MERS.
"We take this very seriously," Bell told Reuters in an exclusive
interview. "In a worst-case scenario, this could spread rapidly."
MERS is caused by a coronavirus, a family of viruses that includes
Severe Acute Respiratory Syndrome or SARS, which emerged in China in
2002-2003 and killed some 800 people.
"If you recall the SARS experience in Toronto, that was something
that managed to be transmitted into the healthcare facility, leading
to severe illness and death," he said.
"This is not something that we want to take lightly."
State health officials in Indiana report the man is in good
condition and improving daily. Hospital personnel who may have been
exposed to the virus are being kept in home isolation and watched
daily for the emergence of pneumonia-like symptoms. Generally the
incubation period of MERS is 14 days.
The patient is a healthcare worker who on April 28 was admitted to
the hospital just 30 minutes south of Chicago after having worked in
healthcare in Saudi Arabia, the center of the MERS outbreak that
began in 2012. So far, 262 people in 12 countries have had confirmed
infections that have been reported by the World Health Organization,
and another 100 MERS patients have been confirmed by other
ministries of health. So far, 93 people have died.
U.S. health officials are now checking airline manifests and
contacting patients who may have been seated near the man who took a
plane from Riyadh, Saudi Arabia, to London and then to Chicago,
where he then took a bus to an undisclosed city in Indiana.
'ABSOLUTELY METICULOUS'
To keep the infection from spreading within the hospital, the man is
being treated in an isolation room from which air is expelled
through a filter, preventing it from being shared in the hallway.
"It's not because we have proof that this virus spreads easily
through the air, but we don't want to take any chances," Bell said.
People who enter the room wear a respirator, a type of filtering
mask that keeps them from breathing in any airborne particles in the
room.
And because MERS is in a family of viruses called coronaviruses that
can also be spread through contact with the patient's stool, the
team is taking measures to keep all possibly infectious materials
from leaving the room.
"You put on gowns and gloves before you go in the room. You take
them off before you leave. You pay a lot of attention to washing
your hands afterwards with alcohol gel or soap and water," Bell
said.
Finally, because tear ducts in the eyes are connected to the throat,
healthcare workers wear goggles or face shields to prevent any
droplets from entering the eyes.
All of these measures are part of standard hospital protocols for
treating various infectious diseases. People with tuberculosis are
placed in airborne isolation rooms. With diarrheal diseases,
healthcare workers use contact prevention measures.
"None of this is different from what the hospital is already
accustomed to doing. We're just making sure the implementation in
this case is absolutely meticulous," Bell said.
Bell said current hospital control measures became common practice
during the HIV epidemic, when hospital workers had to assume anyone
coming in the doors could be infected with the virus that causes
AIDS.
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"I think it's safe to say every healthcare worker, even in an
outpatient setting, understands that whatever comes in the doors,
they could be exposed to something infectious," Bell said.
"That ranges from something as common as seasonal influenza, or, if
you work in a pediatric facility, there any number of diarrheal
diseases," he said.
Despite the best efforts, however, hospitals remain a major source
of infection. In March, the CDC reported that roughly one of every
25 U.S. hospital patients contracts an infection during their stay.
DISEASE POORLY UNDERSTOOD
Standard procedures for patients walking into the emergency
department with a fever and respiratory complaints, as the MERS
patient did in Indiana, are to put a mask on the patient and place
them in room with a closed door.
"My understanding is the patient was placed in a private room very
quickly," Bell said of the Indiana patient.
As for treatments, there are no specific drugs that can treat MERS,
but there are basic treatments that can help the patient fight off
the infection, including oxygen, which can reduce the burden on the
lungs.
In addition to disease prevention experts, the CDC has sent a team
of virologists to the hospital to study the MERS virus, which is
still poorly understood. Although the virus first surfaced in 2012,
its presence in the United States will give U.S. scientists the
opportunity to study it up close.
Currently, it is not clear how the virus is transmitted, but it
is clear that it can pass among individuals who have close contact
with infected patients.
"The good news is that it's a group of viruses that have a very
delicate envelope or membrane on the outside. Because of that, the
virus tends to be rapidly inactivated by disinfectants," Bell said.
Since March of 2014, there has been a spike in the number of cases
reported in Saudi Arabia. Bell said it is not clear whether that
represents a change in the virus that makes it easier to spread, or
an increase in the number of cases being reported to health
officials.
"That is completely unknown at the moment. It's still rather early
in terms of the viral characterization. Since this has all been
happening outside the U.S., it's not something we've had a lot of
time to work on."
At this point, the CDC has not issued any restrictions on air
travel, but Bell said the case makes clear just how easily
infections can spread. He recommends that people traveling through
airports try to limit what they touch, and wash their hands
frequently.
(Editing by Eric Walsh)
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