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Tracking the next pandemic: Avian Flu Talk

Can the MERS virus be contained in the US?

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inthesticks View Drop Down
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    Posted: May 13 2014 at 4:47pm
With three confirmed cases of MERS in the US (Indiana and Florida), and with the possible infection of upwards of 100 other people in two FL hospitals (the 20 hospital staff and approx. 80 waiting room patients), my question is can MERS be contained...or has it already spread beyond containment with new cases showing up within the next week or so.

I would imagine that it's quite difficult to contact, test, and even quarantine those 100 people who may be infected...along with everyone those people have been in close contact with. How many of these people boarded planes, trains, buses, etc. to points across FL and across the nation?

Could MERS be a potentially deadly epidemic in the US? I've got a map of the US on the wall, along with all suspected/confirmed MERS cases. It will be interesting to follow any spread of MERS from Orlando, FL across the nation.

IF events spiral out of control (which I don't suspect will happen). I've got a supply of N95 surgical masks to wear when I'm out and about where a lot of people will be present.

Unfortunately, I work at a hotel, and we get guests from various places around the globe. Hmm...
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Kyle Quote  Post ReplyReply Direct Link To This Post Posted: May 13 2014 at 5:50pm
I don't believe MERS has acquired pandemic H2H. If it had I have a feeling a lot of cases would have been diagnosed by now. Either way this thing needs constant watching as it's very close to possibly becoming the next pandemic. I'm not too worried about it as it doesn't seem to transmit effectively like the common cold or flu. Nevertheless, we all need to keep our guard up.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote CRS, DrPH Quote  Post ReplyReply Direct Link To This Post Posted: May 13 2014 at 6:49pm
World experience shows we can stamp these things out IF there is complete cooperation!  The response to the outbreak of SARS in Toronto is a case-in-point, it was textbook perfection.  

Case contact followup, strict isolation, draconian personal-protective equipment and infection control technique is all we have.  

SARS was snuffed out by ruthless Chinese PLA infection control (if you get my drift), if MERS spreads throughout the Islamic world, I think it will spread like wildfire.  Their governments don't have that kind of cold-steel discipline. 
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Elver Quote  Post ReplyReply Direct Link To This Post Posted: May 13 2014 at 7:37pm
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Post Options Post Options   Thanks (0) Thanks(0)   Quote arirish Quote  Post ReplyReply Direct Link To This Post Posted: May 13 2014 at 9:57pm
inthesticks- Hey neighbor, If you look at all the cases in Europe and now the US I think you will have an answer. We have the training and infection control to stop this! It isn't efficient at H2h yet and in my opinion if like SARS it was mostly spreading in the west it would not be a big deal. The problem is, unlike Chinese authorities who ordered all Civet Cats destroyed during the SARS event and many countries during Avian flu epidemics who ordered the destruction of bird flocks, the Bedouin are too closely attached to the Camel. For thousands of years it has been their beast of burden, source of food, and they even believe drinking camels milk and urine can cure disease. On top of all of that they are still in a different century and they're monarchs fear revolt. What exists right now does not scare me but the longer it circulates the more likely it will adapt to H2H. If and when it reaches the refugee camps or war torn Syria, Afghanistan, Pakistan or any other third world area, there will be no stopping it short of a miracle.             
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Dutch Josh Quote  Post ReplyReply Direct Link To This Post Posted: May 14 2014 at 5:32am
In my opinion MERS is H2H and OoC (Human to Human and Out of Control). Based on the Jeddah-cases I understand from Henry Niman that the new form of MERS is different from the form found in camels (bats goats). I understand that not only in KSA MERS is widespread, but signs are that MERS is spreading in Jordan, Indonesia and even in the US. 

For evere identified case I think there will be at least one unidentified. The infected person might not have any symptoms or get diagnosed as an Influenza Like Illness (ILI-case), pneumonia. 

For Muslims the KSA is their holy land. So one way of spreading is travellers for religious reasons. I do not know how many military (from what countries) there are in the KSA (KSA-army is repressing an uprising in Bahrein, "fighters" from KSA proberbly are involved in several wars. War always turn out to be a good spreader. 

The port-city of Jeddah, just east from Port Sudan, is in the middle of traderoutes. 

The WHO seems to be running behind the facts with still looking at camels as the main source. 

All in all the picture is bad ! The MERS-virus is more widespread than the SARS-virus and they are still discussing if it should be a priority !
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Howdy, neighbor! Like yourself, I am not worried about MERS...yet. This virus is too new in the US to determine how it will spread, and how fast.

I did hear on the local news last night that the man ending up in FL with MERS initially arrived from Saudi Arabia to Chicago. Then he took a bus from Chicago to FL. How many potentially infected people will that produce (if any)? And it took a couple of days for that bus to travel all the way to Orlando.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote arirish Quote  Post ReplyReply Direct Link To This Post Posted: May 14 2014 at 12:53pm
I read somewhere that he waited in the ER for four hours and it then took the hospital another 8 hours to determine that he had been in the KSA. With the long plane trips, and time in the hospital he was around a lot of people so we should know in the next 10 days or so what we are up against.
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As we suspected the KSA have been covering up. 

Some of us discussed the virus spilling out to a first world nation post Hajj. It didn't happen. It seems this second wave is getting the spill we expected. 

This spill is good news to some extent. Finally we can work out exactly how communicable this virus is. If there is a cluster which forms from the US cases. Then we have reason to be concerned.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Kyle Quote  Post ReplyReply Direct Link To This Post Posted: May 14 2014 at 3:50pm
Great point cobber. This is why I believe we shouldn't be too worried just yet. If a decent cluster happens from the FL case that's the time to really get worried. I'm keeping a keen eye on this but I'm not avoiding public places just yet.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote arirish Quote  Post ReplyReply Direct Link To This Post Posted: May 14 2014 at 4:01pm
Also with it spilling out there will be better access to samples, proper case studies, etc.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote CRS, DrPH Quote  Post ReplyReply Direct Link To This Post Posted: May 14 2014 at 5:09pm
MERS could be contained in the US, but I have real doubts if it will ever be contained in the KSA or other developing nation:

“WHO experts urged Saudi Arabia, the main source of the infection, to do more to control the infection and to cooperate with experts to study it and understand it better.

“ 'Most urgent is the need to strengthen and improve infection practices in hospitals,’ WHO’s Dr. Keiji Fukuda told reporters after a meeting of WHO’s International Regulations Emergency Committee.

“ 'We saw many examples where infection control practices have broken down.’ ”

What a load of bullsh*t!  I work in hospital infection control in the USA, and we are among the leaders in this field.  However, achieving 100% compliance on hand hygiene, mask technique etc. proves to be impossible.  I really doubt that the Saudis will be able to peform better than we can. 

I'm just waiting for the superspreader, which seems to be guaranteed based upon the SARS experience.  
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CRS,DrPH,if MERS goes H2H easily,there is no way to control it in this country.This country seems to have forgotten what a quarantine is and how to enforce it.-----I have seen a couple of quarantines over the years and they are a joke.The people running things seem to think that all they have to do is say "this person or this building is under quarantine and it was magically stop the spread of something". It scares me.Johnray1
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3rd case of MERS suspected in Florida

OWWA chief confirms 3rd Pinoy MERS-CoV fatality


This is news from yesterday...MERS is going to spread. Johnray1 is correct these kids (Drs and nurses) have not seen quarantine for real. They have not seen thousands dying and not able to do something. Neither have many of us. We have an image in our heads what it may look like but know...heck no.

It could happen. I am going to look at razor wire and see what I need.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote CRS, DrPH Quote  Post ReplyReply Direct Link To This Post Posted: May 14 2014 at 10:54pm
I help train law enforcement, hospital management and the military in emergency response actions to bioterrorism events.  The USA is very capable to shutting down MERS, starting with surveillance in our airports:


The USA will be fine.  KSA, Kuwait, Iraq, Iran, etc., not so much.  
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Dutch Josh Quote  Post ReplyReply Direct Link To This Post Posted: May 15 2014 at 2:57am
To get a grip on MERS you may have to get a grip on travel to and from the KSA. Since this is the holy land for Islam and the main origine for MERS this is a big problem. An open society like the US or many European countries might put travel restrictions to countries where MERS is becoming a big problem. 

Any virus (or bacteria) can be contained when there is political will. For the moment that seems to be the problem.
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Making sure it doesn't get in is one thing, but infection control in healthcare settings is key and by all accounts the Saudis failed miserably at it. If we can prevent the hospitals becoming ground zero for outbreaks in the community, we can at least slow it's spread in a way that they've not been able to in the KSA. And without camels as a vector, we have an advantage right from the start (hopefully it's not able to move into livestock).
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Post Options Post Options   Thanks (0) Thanks(0)   Quote CRS, DrPH Quote  Post ReplyReply Direct Link To This Post Posted: May 15 2014 at 8:42am
Originally posted by jacksdad jacksdad wrote:

Making sure it doesn't get in is one thing, but infection control in healthcare settings is key and by all accounts the Saudis failed miserably at it. If we can prevent the hospitals becoming ground zero for outbreaks in the community, we can at least slow it's spread in a way that they've not been able to in the KSA. And without camels as a vector, we have an advantage right from the start (hopefully it's not able to move into livestock).

Good point about livestock, I hadn't considered that! 

We are close to a "perfect storm" in the KSA:

a) a rigid, closed, and paranoid society who need outside help but have many cultural barriers to allowing non-believers onto their soil

b) a lack of homegrown expertise in medicine and infection control (I think the best Saudi physicians probably head out to London, NYC etc. to make big bucks)

c) poor pubic health infrastructure with lack of training in even the basics.  I'm sure the nurses must be slathered in robs/veils, which will slow down the disinfection procedures, gown changes etc. 

I wish them luck. 

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Post Options Post Options   Thanks (0) Thanks(0)   Quote jacksdad Quote  Post ReplyReply Direct Link To This Post Posted: May 15 2014 at 9:05am
Agreed, Chuck. The Saudis refusal to accept outside help and instead rely on their own people working within the confines of their internal politics has been a complete and utter failure. While other countries have seen a few cases, the virus is spreading completely unchallenged on Saudi soil.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: May 15 2014 at 9:18am
Robes....

It seems to me that they would just about thwart all efforts at disinfection/infection control.  Apart from the efects produced by swirling and flowing robes moving air and droplets about, the (sorry I have no idea how to spell these words) birka and jilbab restrict vision.  If you can't see the mess you can't disinfect/clean it. 

In our own hospital wards I have often wondered about the viral/bacterial load on curtains.  I can not help but notice that most have blood (and worse) stains on them.  Yet they only swish once on opening and closing, whereas material that is worn is in constant movement.  I am aware that some US/UK hospitals ban ties as an infection control measure.  This is so much more total.


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Post Options Post Options   Thanks (0) Thanks(0)   Quote CRS, DrPH Quote  Post ReplyReply Direct Link To This Post Posted: May 15 2014 at 10:01am
Originally posted by Johnray1 Johnray1 wrote:

CRS,DrPH,if MERS goes H2H easily,there is no way to control it in this country.This country seems to have forgotten what a quarantine is and how to enforce it.-----I have seen a couple of quarantines over the years and they are a joke.The people running things seem to think that all they have to do is say "this person or this building is under quarantine and it was magically stop the spread of something". It scares me.Johnray1

JR, this what I train people to do.   This is a full-scale bioterrorism exercise at a major US hospital, directed by the National Guard CBRN (chemical, biological, radiological, nuclear) response teams.  This photo shows the decontamination procedure.

It was blazing hot, but our teams wore full suits/respirators, double-gloves, the whole 9 yards....completely functional and realistic.   USA will be fine, other countries, not so much. 


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CRS,DrPH, I have no doubt that you trained 100s possibly thousands of people in different government agencies and I also have no doubt that you gave high quality training. The problem is that if a true,fast moving and deadly epidemic started in this country,the only people that would get this proper technics used on them will only be the people that you trained. The government will treat the people in their organizations and then go to their shelters of safety,food,water, and guns. That will leave the other 300 hundred million plus Americans to do the best that we can.The government  employees will not help the rest of us,when they all get in a safe place. There may be a few exceptions,but not many. Many government employees have told me that if anything bad happens like the SHTF for what ever reason,to NOT expect any help from the government.----- It is kind of like when everyone thought that H5N1 was going to tear across the nation,government officials of all kinds, stopped the delivery of Tamiflu to Pharmacies and they had cases of it stacked in the offices for them,their familes, and their friends. Wheather you or anyone else believes this is beside the point,it is true.-----I also read last night that some government agency that should not even need guns,have ordered thousands of .40cal sub-machines  with 30 rounds magazines. 40 cal is the cal that DHS has stocked 1.6 Billion rounds for. These people did not order these sub-machine guns to shoot each other with,they ordered them to shoot us with.They have more bullets than they will need or can even use.Sub-machines were designed and made to issue to people so they could spray lead,because they did not know how to aim and shoot accurately.I am sure that you have good intentions and you might even believe that the people that you taught will help other people,but they will not.This information is straight from very high ranking government officials.The government has gotten so big and so entrenched that they are a society of themselves,the rest of us are just here to pay their salaries.                                                                The hospital that is near me runs emergency drills every couple of years. Every one that has been connected to the military or to proper training know that in a mass casualty  situation a dieing man is a dead man. You treat the people that can be saved,first.This hospital staff all know this,but they are all of one certain religious group and they decided that the protocol  for treating mass casualties was a sin,so they basically turned the protocol on its head ,because of religious beliefs. Johnray1
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Originally posted by Johnray1 Johnray1 wrote:

CRS,DrPH, I have no doubt that you trained 100s possibly thousands of people in different government agencies and I also have no doubt that you gave high quality training. The problem is that if a true,fast moving and deadly epidemic started in this country,the only people that would get this proper technics used on them will only be the people that you trained. The government will treat the people in their organizations and then go to their shelters of safety,food,water, and guns. That will leave the other 300 hundred million plus Americans to do the best that we can.The government  employees will not help the rest of us,when they all get in a safe place. There may be a few exceptions,but not many. Many government employees have told me that if anything bad happens like the SHTF for what ever reason,to NOT expect any help from the government.----- It is kind of like when everyone thought that H5N1 was going to tear across the nation,government officials of all kinds, stopped the delivery of Tamiflu to Pharmacies and they had cases of it stacked in the offices for them,their familes, and their friends. Wheather you or anyone else believes this is beside the point,it is true.-----I also read last night that some government agency that should not even need guns,have ordered thousands of .40cal sub-machines  with 30 rounds magazines. 40 cal is the cal that DHS has stocked 1.6 Billion rounds for. These people did not order these sub-machine guns to shoot each other with,they ordered them to shoot us with.They have more bullets than they will need or can even use.Sub-machines were designed and made to issue to people so they could spray lead,because they did not know how to aim and shoot accurately.I am sure that you have good intentions and you might even believe that the people that you taught will help other people,but they will not.This information is straight from very high ranking government officials.The government has gotten so big and so entrenched that they are a society of themselves,the rest of us are just here to pay their salaries.                                                                The hospital that is near me runs emergency drills every couple of years. Every one that has been connected to the military or to proper training know that in a mass casualty  situation a dieing man is a dead man. You treat the people that can be saved,first.This hospital staff all know this,but they are all of one certain religious group and they decided that the protocol  for treating mass casualties was a sin,so they basically turned the protocol on its head ,because of religious beliefs. Johnray1

Thanks, JR.  As I said, US citizens will be safe.  There are thousands of trained professionals just like me, waiting for the balloon to go up.  We know what to do and how to do it. 

No machine guns, I promise.  

The best thing that US citizens can do now is to prepare per US government guidelines....stock up on recommended supplies of critical pharmaceuticals, have a written family emergency plan, rehearse and know what you are going to do.  http://www.ready.gov/pandemic

If there is no natural reservoir, a bug like MERS burns out very quickly when susceptible hosts isolate themselves, SARS proved that.  The Chinese were pretty ruthless on the civet cat hosts.  

In a place like Saudi Arabia, it looks like the environment is filthy with the stuff, whether it is from Egyptian tomb bat poop, camel spit etc.   They will have real problems until (unless) a vaccine is developed.

In the US, I have my faith in my guys & gals.   They won't let you down, nor will I.  




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CRS,DrPH,thanks for the reassurance. But I will not be in any line waiting to get food,water,or shelter from any government truck. I looked at site that recommended what preps to have. I have that and much more. I will not be a burden on the people that do need help. I will also watch any government trucks from a long ways off, with Binoculars, before I would venture any where even close to one.I hope that you are correct.I will not be taken to a FEMA camp either. Johnray1
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Originally posted by Johnray1 Johnray1 wrote:

CRS,DrPH,thanks for the reassurance. But I will not be in any line waiting to get food,water,or shelter from any government truck. I looked at site that recommended what preps to have. I have that and much more. I will not be a burden on the people that do need help. I will also watch any government trucks from a long ways off, with Binoculars, before I would venture any where even close to one.I hope that you are correct.I will not be taken to a FEMA camp either. Johnray1

You are speaking about a catastrophe vs. infectious disease outbreak.  In the case of a catastrophic incident, ie. nuclear assault, believe me, head for the government trucks. 

Infectious disease outbreaks are like slow-moving trains, we can see them coming from miles off if we know what to look for.   Rarely are these things as explosive as SARS was, they are usually more of a slow-burn, like HIV AIDS.   The government won't "round anyone up" or "knock on doors."  They are too busy with other things, and aren't concerned with individual deaths.  

I think we'll start to see the world shut down transportation to & from the Arabian peninsula long before the US government has to do anything that would impact any of us.  
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Johnray1 Quote  Post ReplyReply Direct Link To This Post Posted: May 15 2014 at 10:48pm
CRS,Dr.PH,we have prepped for a number of reasons. I know that if we get hit by a Nuke,the ones of us who survive will immediately be soldiers again either officially or unofficially. But we decided to prep as if we wake up in the 18th century tomorrow morning due to an EMP either natural or man made.We are ready. The crops are already in the ground to harvest and feed us for a year.We have food to last until then. I know several engineers and they all tell me that our electrical grid is in terrible shape and it could collapse on its own or with very little help about any time. Some of these engineers will be with us. If some disease is creeping across the country killing people,they are pretty hard to hide from.Johnray1
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Post Options Post Options   Thanks (0) Thanks(0)   Quote LewisAHoffman Quote  Post ReplyReply Direct Link To This Post Posted: May 16 2014 at 2:51am
Fact: the current strain of MERS has not demonstrated any ability to spread from human to human to human. 

Prediction: if it does, it's pandemic time. How bad a pandemic is pure conjecture at this point.  We all know that throughout history pandemics have been of greatly varying impact on humanity.  
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