In the past month, Middle East respiratory syndrome has morphed from a little-known disease in the Arabian Peninsula to a major global health concern, with more than 300 cases in Saudi Arabia in April, 54 of them fatal.
Two cases have been reported in the U.S. as well — one in Indiana and one in Florida. Both men had worked in Saudi Arabia hospitals. So far, neither has spread the respiratory disease to others.
In a news conference today, the World Health Organization in Geneva stopped short of declaring MERS an international public health emergency.
But health officials expect to see more cases imported into the States. American hospitals are now working to recognize the flu-like disease early and keep it from spreading.
Although MERS doesn't appear to be highly infectious in people's homes or in airplanes, it's clearly spreading in hospitals. That's where many of the Saudi infections occurred.
"This is not like measles ... not like chickenpox — which are [both] highly communicable diseases," says epidemiologist Trish Perl at Johns Hopkins Hospital in Baltimore. "But the reality is that there is something in health care [centers] where the communicability is much more prominent."
It's not clear what makes hospitals so risky. Some medical procedures — breathing treatments, certain exams — might propel more virus into the atmosphere.
Or it could be human error. A WHO team in Saudi Arabia last week saw breaches of infection control.
Perl says the protocols are actually quite simple. "It's about separating sick people from nonsick people," she says. "And it's about wearing the appropriate gear."
By gear she means standard hospital gloves, masks and gowns. Staff need to be shown how to use this gear properly — for instance, changing their surgical gowns every time they enter or exit isolation units.
"Every single person in this emergency room or any emergency will tell you they're super, super busy. They're too busy to do this or that and whatever," she says. "How do they prioritize in their list of business what are the most important things to do?"
Getting all hospital workers to comply with standard infection control procedures — all the time — was a key to stopping an outbreak of SARS in 2003, says Georgetown University infectious disease specialist Daniel Lucey, who worked in a Toronto hospital at the time.
When hospital personnel donned personal protective equipment, Lucey recalls, "someone stood there and monitored you to make sure you followed, step by step by step, putting it on properly and taking it off."
WHO is calling for Saudi hospitals to tighten infection control measures. Hospitals worldwide need to be equally vigilant, since a MERS patient could fly anywhere in the world before being diagnosed.
AUDIE CORNISH, HOST:
From NPR News, this is ALL THINGS CONSIDERED. I'm Audie Cornish.
MELISSA BLOCK, HOST:
And I'm Melissa Block. Today, the World Health Organization in Geneva stopped short of declaring the Middle East Respiratory Syndrome, or MERS, an international public health emergency. But the WHO did express concern about the potential for it to spread globally. Hundreds of new cases of the virus appeared in April alone. More than 50 of those were fatal. Many of these infections occurred in hospitals in Saudi Arabia. The WHO's Dr. Keiji Fukuda told reporters one thing driving the MERS outbreak is poor infection control in the Saudi health facilities.
DR. KEIJI FUKUDA: When you break down with infection control, you have an outbreak in your hospital and you have an outbreak of a disease which can kill people.
BLOCK: Patients with the disease have ended up in hospitals in Europe, Asia, Africa and North America. Fukuda says facilities everywhere need to tighten infection control in response to MERS. NPR's Jason Beaubien reports that technically that's not very difficult but it can be hard to implement.
DR. TRISH PERL: We're standing in a triage area. There are patients that are waiting to be seen.
JASON BEAUBIEN, BYLINE: Dr. Trish Perl is in the emergency room at Johns Hopkins Hospital in Baltimore. Perl says that proper infection control starts right here in the waiting room.
PERL: If you turn around, there's a guy who's wearing a mask, which is ideally what you would want. If they identify someone with respiratory symptoms, that they would mask them.
BEAUBIEN: MERS is a new, emerging disease. And health officials are watching it closely because there's no cure, no vaccine, and they worry that it could get out of control. And there is something strange about MERS. While it doesn't appear to be highly infectious in people's homes or in airplanes, it's clearly spreading in hospitals.
PERL: This is not like measles. This is not like chickenpox, which are highly communicable diseases. But the reality is that there is something in health care where the communicability is much more prominent.
BEAUBIEN: That might be because some medical procedures - breathing treatments, or certain exams - may propel more virus in to the atmosphere. It's not exactly clear, however, what makes hospitals more risky. But numerous health care workers in Saudi Arabia have gotten sick after coming in to contact with MERS patients. And both the MERS cases in the U.S. were in people who work - and it's assumed were infected - in Saudi Arabian hospitals. A team from the World Health Organization that was in Saudi Arabia last week reported that they saw breaches of infection controls. Perl at Johns Hopkins says the protocols are actually quite simple.
PERL: It's about separating people, sort of sick people from non-sick people, and it's about wearing the appropriate gear.
BEAUBIEN: By gear she means just standard hospital gloves, masks and gowns. And it means making sure that the staff use this gear properly, for instance changing their surgical gowns every time they enter or exit isolation units.
PERL: Every single person in this emergency room or any emergency room is going to tell you they're super, super busy. And they're too busy to do this or that and whatever. And so how do they prioritize in their list of busy-ness? You know, what are the most important things to do?
BEAUBIEN: Dr. Daniel Lucey worked in a hospital in Toronto during the 2003 outbreak of another emerging respiratory disease called SARS. He says getting everyone in a hospital to comply with standard infection control procedures all the time was one of the keys to stopping SARS.
DR. DANIEL LUCEY: When I put on personal protective equipment, as did anyone else, you did it as part of a team. So, someone stood there and monitored you to make sure you followed step by step by step putting it on properly and taking it off.
BEAUBIEN: The WHO is calling for hospitals in Saudi Arabia to tighten infection control measures. But given that a MERS patient could arrive by plane just about anywhere in the world, the WHO today also stressed that health care providers around the globe should batten down the hatches in case MERS shows up in their facilities. Jason Beaubien, NPR News, Washington. Transcript provided by NPR, Copyright NPR.