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PANDEMIC ALERT LEVEL
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Tracking the next pandemic: Avian Flu Talk

14 more cases, 1 more dead

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    Posted: June 06 2015 at 4:55pm
South Korea has reported 14 more cases of MERS and 1 more death. As far as I can tell, the government has little control of the situation.
Now the pattern of cases looks like Fibonacci...

Fibonacci- 5, 8, 13
South Korea- 5, 9, 14
I estimate that on Sunday night there will be about 15-20 cases reported
Source- Dailymail
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Albert Quote  Post ReplyReply Direct Link To This Post Posted: June 06 2015 at 5:09pm
Thanks for the find.  That's close to 50 new cases in 6 days.  Looks like community spread and no end in sight.    Very doubtful these are all within a hospital.  Not sure how much I'm buying into that one anymore.    This is starting faster than SARS.


SEOUL (Reuters) - South Korean officials on Sunday reported 14 more cases of Middle East Respiratory Syndrome (MERS), bringing the total in the country's outbreak to 64, and said a fifth person infected with the virus had died.

South Korea's outbreak of the often-deadly virus, first reported on May 20, is the largest outside the Middle East. The patient who died was a 75-year-old man who had been in a hospital emergency room where another MERS patient was present, officials said.

(Reporting by Jack Kim; Editing by Tony Munroe
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Post Options Post Options   Thanks (0) Thanks(0)   Quote onefluover Quote  Post ReplyReply Direct Link To This Post Posted: June 06 2015 at 6:31pm


As you can see, the numbers shoot way up from there.
"And then there were none."
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Albert Quote  Post ReplyReply Direct Link To This Post Posted: June 06 2015 at 6:36pm
If Korea hits 300 cases in the short, in the next 2 weeks, we'll begin to see global spread, as what happened with SARS.  It would take a very long time to classify it as a pandemic by U.S. definition since all models are now based on a fast moving pandemic flu. 
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Albert Quote  Post ReplyReply Direct Link To This Post Posted: June 06 2015 at 6:55pm
I keep finding the Early Edition news in S. Korea to be quite informative.  To give you an idea of how large and fast this outbreak could be in the next few days, as we heard the virus was spread at the hospital through the Air Conditioning system, and they're asking anyone who has visited that hospital from May 15 - May 29th to report it to officials.  That's a lot of people in the community that could be infected right now by simply visiting the hospital.  It was also found on door knobs.  In addition, they have also quarantined an entire town.   Could see a very large explosion of cases in the next few days.  If they soon report dozens of "suspected" cases, stick a fork in it.





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Ok guys so if this blows up does anyone know how fast it will make it to the U.S.?

If it does make it to the U.S. what do we do? I would think we will have to SIP ASAP.

We need to be Prepared like the Girl Scouts taught me! Maybe we need a thread on what to do if MERS hits and put a sticky on it just in case.

What do you think guys?
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Post Options Post Options   Thanks (0) Thanks(0)   Quote jacksdad Quote  Post ReplyReply Direct Link To This Post Posted: June 06 2015 at 10:14pm
...and call it done.
The numbers after the weekend will be significant as the incubation period ends for the cases the quarantine was supposed to contain. More cases showing up into next week and it means they never had it under control.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote CRS, DrPH Quote  Post ReplyReply Direct Link To This Post Posted: June 06 2015 at 11:13pm
Originally posted by FluMom FluMom wrote:

Ok guys so if this blows up does anyone know how fast it will make it to the U.S.?

If it does make it to the U.S. what do we do? I would think we will have to SIP ASAP.

We need to be Prepared like the Girl Scouts taught me! Maybe we need a thread on what to do if MERS hits and put a sticky on it just in case.

What do you think guys?

I think we need to review our notes about the SARS pandemic.  Coronaviruses like SARS and MERS are primarily spread in healthcare settings vs. community settings, and that pattern seems to be true in South Korea.  

I don't have a great fear of the coronas, we've proven that we can control them in the Western world. 

When SARS was going through Toronto, I tried like hell to talk my wife into running up there for a vacation!  They were practically giving hotel rooms away, tickets to musicals etc.  I figured that as long as we stayed away from the healthcare settings and Chinatown (the only community setting with infections), we'd be OK. 

My wife had other thoughts, so we didn't go.  Pity. 

If I hear anything, I'll let everyone know.  I have new responsibilities and connections that I didn't have a year ago.  So far, quiet. 
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Albert Quote  Post ReplyReply Direct Link To This Post Posted: June 07 2015 at 4:37am
Another development that I found interesting is when they discovered the virus on a doorknob.   3 years ago we discussed that quite a bit, in terms of a coronavirus ability to survive in the environment outside the the human host (on general surfaces), and what impact the temperature would also have on the virus.  Of course I would always say we were in big trouble if the MERS virus ever found a cold climate, which it never did. 

I find it to be a significant development after a few years now, that they discovered it on a doorknob in the hospital.  That means that you don't have to be near a patient to get it.  The temperature in a hospital setting is also usually a little cooler.  Therefore, the difference in the climate and temperature does in fact have an impact on the situation.  For MERS to survive on surfaces like that is bad news.   When it spreads in the community and inside a home or places like a hotel (SARS had a huge outbreak at a hotel in the past), it will be similar to what we see inside a hospital.  And when the temperatures drop in the winter, it will survive on surfaces outside of homes, hospitals, hotels, etc....  

Because of all of this, MERS may be unstoppable now that it has left the hot climate in the middle east, and they should start working on a vaccine asap before winter. 

I personally believe we're going to have another SARS-like event very soon, the difference being that MERS is a lot more robust and won't burnout in the summer, like SARS did when summer arrived. 

Here is more about what I'm talking about:

Effects of air temperature and relative humidity on coronavirus survival on surfaces.

http://www.ncbi.nlm.nih.gov/pubmed?term=Casanova%20LM%5BAuthor%5D&cauthor=true&cauthor_uid=20228108 - Casanova LM, http://www.ncbi.nlm.nih.gov/pubmed?term=Jeon%20S%5BAuthor%5D&cauthor=true&cauthor_uid=20228108 - Jeon S, http://www.ncbi.nlm.nih.gov/pubmed?term=Rutala%20WA%5BAuthor%5D&cauthor=true&cauthor_uid=20228108 - Rutala WA, http://www.ncbi.nlm.nih.gov/pubmed?term=Weber%20DJ%5BAuthor%5D&cauthor=true&cauthor_uid=20228108 - Weber DJ, http://www.ncbi.nlm.nih.gov/pubmed?term=Sobsey%20MD%5BAuthor%5D&cauthor=true&cauthor_uid=20228108 - Sobsey MD.

Abstract

Assessment of the risks posed by severe acute respiratory syndrome (SARS) coronavirus (SARS-CoV) on surfaces requires data on survival of this virus on environmental surfaces and on how survival is affected by environmental variables, such as air temperature (AT) and relative humidity (RH). The use of surrogate viruses has the potential to overcome the challenges of working with SARS-CoV and to increase the available data on coronavirus survival on surfaces. Two potential surrogates were evaluated in this study; transmissible gastroenteritis virus (TGEV) and mouse hepatitis virus (MHV) were used to determine effects of AT and RH on the survival of coronaviruses on stainless steel. At 4 degrees C, infectious virus persisted for as long as 28 days, and the lowest level of inactivation occurred at 20% RH. Inactivation was more rapid at 20 degrees C than at 4 degrees C at all humidity levels; the viruses persisted for 5 to 28 days, and the slowest inactivation occurred at low RH. Both viruses were inactivated more rapidly at 40 degrees C than at 20 degrees C. The relationship between inactivation and RH was not monotonic, and there was greater survival or a greater protective effect at low RH (20%) and high RH (80%) than at moderate RH (50%). There was also evidence of an interaction between AT and RH. The results show that when high numbers of viruses are deposited, TGEV and MHV may survive for days on surfaces at ATs and RHs typical of indoor environments. TGEV and MHV could serve as conservative surrogates for modeling exposure, the risk of transmission, and control measures for pathogenic enveloped viruses, such as SARS-CoV and influenza virus, on health care surfaces.



  


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Post Options Post Options   Thanks (0) Thanks(0)   Quote Albert Quote  Post ReplyReply Direct Link To This Post Posted: June 07 2015 at 4:52am
We also have an additional MERS case bringing the total to 65, but they failed to mention this one to avert a possible panic.  Also never realized that the virus is possibly in 24 different hospitals.  S Korea is about to have a huge explosion of cases in a matter of days.


S Korea to track citizens as fifth MERS death recorded

South Korea is to track the mobile phones of hundreds of people under quarantine as part of measures to contain the spread of Middle East Respiratory Syndrome (MERS), as the country reported its fifth death from the virus.

Choi Kyung-hwan, the country's acting prime minister, held a briefing on Sunday morning and announced new measures to control the virus, as fears grew among South Koreans over the outbreak.

Choi also named 24 hospitals where the infections took place or confirmed MERS patients visited, reversing a previous policy of not naming the hospitals after public criticism.

"There are a total of 24 hospitals, where infections took place or MERS patients visited. Six hospitals among them, including Pyeongtaek St Mary's Hospital and Samsung Medical Center, are where the confirmed cases occurred. The remaining 18 are hospitals where MERS patients have visited," Choi said.

The number of infections in the country rose to 64 after 14 new cases were confirmed on Saturday night, the health ministry said.

All of the 14 new cases were among a group of 1,820 people quarantined after being exposed to those diagnosed earlier, it added.

Most of those under quarantine had been told to stay home and strictly limit their interactions with others, while some had been isolated in state hospitals.

However, Busan city authorities reported an additional case in the country's southern port and second-largest city, sparking alarm that the outbreak might have spread nationwide.

The Busan case was not included among the 14 new infections confirmed by the health ministry on Saturday.

http://www.aljazeera.com/news/2015/06/korea-track-citizens-mers-death-recorded-150607060913538.html



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Post Options Post Options   Thanks (0) Thanks(0)   Quote onefluover Quote  Post ReplyReply Direct Link To This Post Posted: June 07 2015 at 6:32am
More details:

Town quarantined in South Korea as Hong Kong expert blasts WHO on Mers response
South Korea reported its fifth death from MERS and number of infections rose to 64
ELIZABETH CHEUNG , DANNY LEE AND ANDREW SALMON IN SEOUL
PUBLISHED : Sunday, 07 June, 2015, 1:46am
UPDATED : Sunday, 07 June, 2015, 2:32pm

Police outside a village that was quarantined in South Korea's Mers outbreak. Photo: SMP Pictures
An entire town has been quarantined in South Korea in a fresh scare over Middle East respiratory syndrome (Mers), as the World Health Organisation comes under renewed criticism from a leading Hong Kong infectious diseases expert.

The number of infections rose to 64 after 14 new cases, including one death, of Middle East Respiratory Syndrome (MERS) were confirmed last night, the country's health ministry said.

With public health and infection protection experts due to arrive in Seoul today and tomorrow to discuss ways to control the outbreak, Dr Ho Pak-leung, a microbiologist at the University of Hong Kong, said the WHO's response to the Mers crisis in South Korea showed it was not fit to "tackle emergencies."

In a test for the South Korean government and WHO's ability to resolve the crisis, Ji-hye, a town in the southwestern county of Sunchang, was placed under the control of health authorities and put under quarantine on Friday.

A 72-year-old woman who tested positive for the virus in South Korea ignored an order to stay at home in isolation and travelled into the town, where she is believed to have come into contact with more than 100 people.

The incident raised fresh questions over Seoul and the WHO's handling of the outbreak.

"WHO is not positioned for tackling emergencies, but rather promulgating macro measures," Ho said.

It relied on individual countries to report outbreaks, meaning it can't respond until it had possession of that information, he said. Also, WHO experts travel to the affected area from all over the world, as opposed to local response teams that Ho said would better understand the situation.

Ho described the organisation's response as weak in comparison to the severe acute respiratory syndrome (Sars) epidemic in the city 12 years ago. "Hong Kong has been handling the incident rather well," Ho said, as the city's Centre for Health Protection has taken enhanced precautionary measures, such as mandatory quarantines for people with respiratory symptoms.

"Quarantine and contact tracing are all effective [measures] in Hong Kong now," he said.

The United Nations global public health body last Wednesday urged Hongkongers who come into contact with infected patients to isolate and monitor themselves. But it recommended no mandatory quarantine.

Some 3,000 people are now quarantined across South Korea as the police consider forced detention to help overcome the virus. On Saturday, nine more new Mers cases emerged, raising the total infected to 50, including one citizen who exported the outbreak to mainland China through Hong Kong.

Secretary for Food and Health Dr Ko Wing-man said South Korea was sharing some case information, but urged the government to be fully transparent.

He said if the number of third-generation cases kept growing in South Korea, the risk of an outbreak in the community would increase. So far, most cases have come from hospital infections.

Ko said he would pay close attention to the incident, and would not exclude the possibility of urging people to avoid travel to South Korea in future.

With the WHO-led delegation expected to start work in Seoul for a week, Ho said he expected further measures would follow after the experts had done their investigative work in Seoul.

Ho said the global health watchdog lacks enforcement strength. "Regulations of the WHO [on quarantine] are rather vague," he said, as the interpretation of the regulations depends on each country's understanding of infection control.

He cited the case of an American nurse, who ignored a quarantine order last October when she returned to the United States from the Ebola-hit Sierra Leone, as an example of the WHO's less stringent stance on quarantine. The nurse, who showed no symptoms but was asked to stay in isolation, said the order violated her human rights.

Meanwhile, the WHO maintains no "special procedures" for travel restrictions into South Korea. The United Arab Emirates became the first country to warn its citizens not to travel there.

Complicating the current outbreak is the fact Mers - which has neither a vaccine nor a cure - features such common flu-like symptoms as fever, coughing, shortage of breath and sometimes nausea, diarrhoea and or vomiting. Moreover, its exact transmission mechanism is unknown, though it is believed to spread by coughing.

http://m.scmp.com/news/hong-kong/article/1817810/town-quarantined-south-korea-hong-kong-expert-blasts-who-mers
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Post Options Post Options   Thanks (1) Thanks(1)   Quote Albert Quote  Post ReplyReply Direct Link To This Post Posted: June 07 2015 at 7:06am
Originally posted by onefluover onefluover wrote:



He cited the case of an American nurse, who ignored a quarantine order last October when she returned to the United States from the Ebola-hit Sierra Leone, as an example of the WHO's less stringent stance on quarantine. The nurse, who showed no symptoms but was asked to stay in isolation, said the order violated her human rights.


The ol' Ebola hero, Hickox .... she never could see beyond her ego with the problems she would cause down the road during the next outbreak. 
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Post Options Post Options   Thanks (0) Thanks(0)   Quote cobber Quote  Post ReplyReply Direct Link To This Post Posted: June 07 2015 at 7:20am
Hi Albert, 24 hospitals %$%&#@! WTF   6 hospitals with confirmed cases!! Alarm bells! Alarm bells!

I remember discussions around cold environments and corona virus. This virus should theoretically spread the same as the seasonal cold. However MERS did come from a hot environment, so it might be less adapted to the the cold. 

One prime bit of info from the news. They found MERS in the air conditioning, which suggests to me that they suspect aerosol spread. Why else where they testing the air con. 

Has anyone worked out gestation/death time lines yet. I can run some data



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Due to deaths happening up to a week after the disease sets in. 1 week ago, there were 18 infected. 5/18 is more like 30% than 10%.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote jacksdad Quote  Post ReplyReply Direct Link To This Post Posted: June 07 2015 at 10:09am
Three things - Why would something that we're told is not a threat affect the South Korean economy? What's with the yellow jackets? And they have 7-Elevens over there?
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Post Options Post Options   Thanks (0) Thanks(0)   Quote LOPPER Quote  Post ReplyReply Direct Link To This Post Posted: June 07 2015 at 10:10am
When and if they quarantine the US military bases in SK, then you know it's out of control in SK.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Albert Quote  Post ReplyReply Direct Link To This Post Posted: June 07 2015 at 10:20am
Originally posted by jacksdad jacksdad wrote:

And they have 7-Elevens over there?


Big time.  We couldn't expect them to deal with MERS without a morning Big Gulp.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote jacksdad Quote  Post ReplyReply Direct Link To This Post Posted: June 07 2015 at 10:26am
Makes sense LOL
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Post Options Post Options   Thanks (0) Thanks(0)   Quote onefluover Quote  Post ReplyReply Direct Link To This Post Posted: June 07 2015 at 11:01am
I noticed the swift effects on their economy as well. One of the early indicators of how serious this may be is by watching how seriously the locals take it when shopping. Obviously they are getting the point.

Watch out for the advent of Camel Flu Talk over there. Lopper can sign up as Oneloppedaround. Hey Lopper, does your name come from how you shift? I lop my Harley all the time. If I open it up around here they'll put the Danites on me.
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A treatment for respiratory diseases and conditions is the use of Nebulizers which aresolize the medication into the lungs. The problem is as this does help the ability to breathe when the patient exhales the virus is then also aresolized. All ventilation in respiratory disease and in those parts of hospitals that treat respiratory disease should have separate HVAC units. No one in cardiac ICU or a baby in a NICU need to be exposed via the HVAC system aresolized virus. I believe that many hospitals do this, but I also know that many hospitals do not even have separate wings or floors for respiratory disease. In a pandemic I would use a hotel as a make shift hospital that had all individual HVAC units, more comfort for patients, and less ability to spread. IMO just guessing
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Kay Quote  Post ReplyReply Direct Link To This Post Posted: June 07 2015 at 12:37pm
Some cases are not confirmed until post-mortem

 
Patient No. 64, a 75-year-old man, died Friday and tested positive for MERS the following day, marking it the third death in which the disease was detected post-mortem. As of Sunday, the virus’ fatality rate in the country was 7.8 percent.

The increase also puts Korea on the heels of the United Arab Emirates (UAE) in terms of overall MERS cases. The UAE currently has the second-highest number of MERS patients at 76, behind Saudi Arabia with 1,019.

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Post Options Post Options   Thanks (0) Thanks(0)   Quote hachiban08 Quote  Post ReplyReply Direct Link To This Post Posted: June 07 2015 at 3:19pm
Originally posted by Albert Albert wrote:

Originally posted by jacksdad jacksdad wrote:

And they have 7-Elevens over there?


Big time.  We couldn't expect them to deal with MERS without a morning Big Gulp.


When I was in Japan, 7-eleven was literally all over the place. Tasted better too haha. They even had popcorn chicken in a USA cup. #merica lol
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