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May 2014

MERS Risk to General Public Is Low

Frontline health care workers can help contain virus

Middle East Respiratory Syndrome Coronavirus — MERS-CoV for short — has been making headlines across the United States since the first U.S. case was confirmed May 2.

Yet, despite its notoriety, the virus doesn’t currently pose a significant threat to the general U.S. population, says Steven Lawrence, MD, Washington University infectious disease specialist at Barnes-Jewish Hospital.

“Overall, the threat to public health is extremely low at this time,” says Dr. Lawrence. “There is no indication that the virus can spread uncontrollably, and every single case thus far has had a direct, or indirect, link to the Arabian Peninsula, with the vast majority diagnosed there.”

Dr. Lawrence says the virus was first reported in Saudi Arabia in 2012. “About 100 or so cases were confirmed in the first year and a half,” he says. “But cases have increased dramatically in the past couple of months.”

As of mid-May, there were 572 laboratory-confirmed cases of MERS in 15 countries. Most of those affected developed severe respiratory illness, with fever, cough and shortness of breath, and 173 have people died.

The first reported case of Mers-CoV in the United States involved an Indiana resident who had traveled by plane from Riyadh, Saudi Arabia, to London April 24, and then from London to Chicago, where the patient boarded a bus to Indiana. The patient began to experience respiratory symptoms, including shortness of breath, coughing and fever, April 27 and went to an Indiana hospital’s emergency department April 28. The U.S. Centers for Disease Control and Prevention (CDC) confirmed Mers-CoV infection in the patient May 2.

The second reported case of Mers-CoV in the U.S. involved a Florida resident living in Saudi Arabia who traveled to the U.S. to visit family. On May 1, the patient traveled by plane from Jeddah, Saudi Arabia, to London, Boston, Atlanta, and then to Orlando, Fla. The patient first reported feeling unwell during the flight to London and developed symptoms that included fever, chills and a slight cough. On May 9, the patient went to the emergency department of a Florida hospital, and the CDC confirmed Mers-CoV infection in the patient May 11.

“Both of these MERS cases were health care workers who recently worked in and traveled from Saudi Arabia. Both have been discharged from the hospital and reportedly are doing fine,” says Ashleigh Goris, RN, BSN, MPH, CIC, BJC occupational health and emergency preparedness infection prevention consultant.

Goris adds that ongoing investigation of the first reported case of MERS-CoV infection in the United States identified evidence of past MERS-CoV infection in an Illinois resident who had close contact with the Indiana patient. “The Illinois resident did not seek or require medical care,” Goris says. “But local health officials have monitored this person’s health daily since May 3 as part of the investigation. And, at this time, the Illinois resident is reported to be feeling well.”

“We’ve anticipated for a year or more that we would see cases in the U.S.,” says Dr. Lawrence. “And we will see more cases. But what does that mean for us?

“The bad news is that there is no vaccine or specific anti-viral treatment yet available. And the mortality rate has been estimated at about 30 percent. However, some mild cases probably go unrecognized, so the actual mortality rate is likely to be lower,” Dr. Lawrence says.

“The good news is that this virus doesn’t seem to be as contagious as the SARS (Severe Acute Respiratory Syndrome) Coronavirus, despite the similar-sounding name,” Dr. Lawrence says.

The SARS virus originated in Asia in late 2002, eventually spreading to more than 8,000 people and causing 775 deaths in 37 countries before being eliminated in 2003. “Another similarity between SARS and MERS-CoV,” Dr. Lawrence adds, “is that MERS-CoV thus far seems to be relatively easy to contain with appropriate prevention measures.”

That’s why, Dr. Lawrence says, health care workers should be especially vigilant for any potential Mers-CoV cases. “The key now is for the U.S., in particular, to be vigilant,” he says. “And most important is for those of us in the health care field — especially those on the frontlines who are the first point of contact with patients, such as in the emergency department — to be cognizant of anyone who’s been in the Middle East during the prior 14 days and has symptoms of fever, cough and shortness of breath.

“Health care workers need to be aware of this, to be able to identify a case quickly, put the patient in negative pressure isolation immediately to minimize the chance of spreading the virus and begin testing,” Dr. Lawrence says.

Health care workers also need to take extra precautions to protect themselves, Dr. Lawrence says. “That includes N-95 respirators, gowns, gloves and eye protection,” he adds. “We’re being overly cautious to protect health care workers as much as possible because there is no vaccine or treatment for this virus.”

“We hope this strategy will contain this virus in the same way that the SARS virus was contained — and eliminated — with rapid case identification and proper prevention measures,” Dr. Lawrence adds. “Eliminating SARS was a public health triumph. Our hope is that the same will occur with MERS.”

In the meantime, Dr. Lawrence says, there are no special precautions that the general public needs to take — other than simple, common-sense measures to reduce the risk of any illness. “Wash your hands often and avoid touching your face with unwashed hands, don’t go to work or school if you’re sick with fever, and avoid close contact with sick people, if possible,” he says. “You might even protect yourself from getting a cold.”

Mers-CoV — What should BJC employees be aware of?

According to CDC director Tom Frieden, MD, MPH, close contact — such as caring for or living with an infected patient with symptoms — is the primary route of Mers-CoV transmission. Clusters of human-to-human spread have been seen most frequently in health care workers caring for infected patients. Therefore, meticulous infection prevention must be initiated, including:

  • rapid detection and screening in suspected Mers-CoV patients
  • placement of surgical/isolation mask for suspected patients in transport
  • sign displayed at key points of entry, most notably the Emergency Department
  • placement of suspected Mers-CoV patients in negative pressure room
  • airborne isolation (N-95 or PAPR) for employees entering patient room
  • contact isolation with eye protection for employees entering patient room (gown, gloves, eye wear)
  • immediate reporting of suspected cases (Patient Under Investigation form from CDC)
  • appropriate collection of specimens for submission to State Laboratory

What about employee exposures to Mers-CoV?

  • Employees should notify occupational health if they had unprotected close contact with a Mers-CoV case (including household contact, health care worker contact without personal protective equipment and face-to-face contact).
  • Exposures will be reviewed on a case-by-case basis.
  • Health care workers who care for patients with MERS-CoV should be advised to monitor and immediately report any signs or symptoms of acute illness to their supervisor and occupational health services for 14 days after the last known contact with the sick patient.
  • Work restrictions for unprotected exposure may include exclusion from work for 14 days from the last high-risk exposure to monitor for signs and symptoms of respiratory illness and fever.

“BJC will continue to monitor the current situation and keep employees informed of any updates,” says Ashleigh Goris, BJC occupational health and emergency preparedness infection prevention consultant.

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