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MERS discussion thread
- Thread starter Shannon Bennett
- Start date
Giuseppe
Emeritus
Re: MERS discussion thread
We can't say if there is true or not without an independent oversight of the situation on the ground.
It is also true that for SARS-CoV children were less affected, usually with minor disease.
The Italian secondary case last year involved the child of the first imported Jordan case's close contact (a co-worker), who developed a mild, self-limiting illneess. The case was listed as probable at the time (from my point of view, solely for public opinion calming down purpose).
But for the KSA the situation may be different, because the virus itself may be different, or belonging to another lineage or a enhanced h2h transmissibity version.
Without a virus isolation and sharing results with international research community is impossible to say something really definite about the extent of the possible mutated virology and epidemiology of MERS there.
We can't say if there is true or not without an independent oversight of the situation on the ground.
It is also true that for SARS-CoV children were less affected, usually with minor disease.
The Italian secondary case last year involved the child of the first imported Jordan case's close contact (a co-worker), who developed a mild, self-limiting illneess. The case was listed as probable at the time (from my point of view, solely for public opinion calming down purpose).
But for the KSA the situation may be different, because the virus itself may be different, or belonging to another lineage or a enhanced h2h transmissibity version.
Without a virus isolation and sharing results with international research community is impossible to say something really definite about the extent of the possible mutated virology and epidemiology of MERS there.
Shannon Bennett
Well-known member
Re: MERS discussion thread
I suspect most pediatric cases thus far are asymptomatic. The virus while being transmitted (in all likelihood) h2h still appears to be somewhat inefficient. A robust immune system is able to fight off the disease usually. Children have better immune systems than do their adult counterparts, hence their cases are mild or asymptomatic.
I suspect most pediatric cases thus far are asymptomatic. The virus while being transmitted (in all likelihood) h2h still appears to be somewhat inefficient. A robust immune system is able to fight off the disease usually. Children have better immune systems than do their adult counterparts, hence their cases are mild or asymptomatic.
Laidback Al
Well-known member
Emily
Editor, Senior Moderator
Re: MERS discussion thread
The 2-yr-old was reported to be suffering from "chronic pulmonary disease" so that was probably a big factor in the death. I don't think advanced age is such a big factor as far as basic immunity. It's seems more that these older patients are taking immune suppressing drugs due to having had transplants or autoimmune diseases.
The one paramedic reported to be in good health was misdiagnosed with bronchitis, so might have been given a corticosteroid. I'm wondering if that is the downfall of other basically healthy HCW's since they would have ready access to medical care. A study about a relationship between poor outcomes and early administration of corticosteroids during pH1N1 infection in China said that steroids are used as first line antipyretics in China. Could this be also be the case in the Saudi health care system?
The 2-yr-old was reported to be suffering from "chronic pulmonary disease" so that was probably a big factor in the death. I don't think advanced age is such a big factor as far as basic immunity. It's seems more that these older patients are taking immune suppressing drugs due to having had transplants or autoimmune diseases.
The one paramedic reported to be in good health was misdiagnosed with bronchitis, so might have been given a corticosteroid. I'm wondering if that is the downfall of other basically healthy HCW's since they would have ready access to medical care. A study about a relationship between poor outcomes and early administration of corticosteroids during pH1N1 infection in China said that steroids are used as first line antipyretics in China. Could this be also be the case in the Saudi health care system?
Re: MERS discussion thread
Is there any data on the numbers of serious cases vs secondary infections/ co-morbidities?
If (as it appears might be the case) serious disease only occurs in those with poor immune systems (due to whatever cause), then in the event of a global disseminated outbreak, advice must be to do all that is possible to improve the general health of the immune system: i.e healthy diet, exercise, and possibly some immune system health supplements could help?
Early intervention with antibiotics to remove threat from secondary infections in a susepcted MERS case?
Or??
Is there any data on the numbers of serious cases vs secondary infections/ co-morbidities?
If (as it appears might be the case) serious disease only occurs in those with poor immune systems (due to whatever cause), then in the event of a global disseminated outbreak, advice must be to do all that is possible to improve the general health of the immune system: i.e healthy diet, exercise, and possibly some immune system health supplements could help?
Early intervention with antibiotics to remove threat from secondary infections in a susepcted MERS case?
Or??
Giuseppe
Emeritus
Re: MERS discussion thread
Antibiotics are currently used in empirical treatment for CAP, at least initially. The issue is the progressive and unresponsive anoxia when ARDS developed, even in the case of ECMO use. Also, secondary liver & kidney failure must be monitored and supported; liver failure leads to encephalopathy and further elevation of LDH & CPK which damages further kidneys.
Vasculopathy and blood vessels leakages are the subsequent complications, with formation of blood clots, pulmonary embolism, Diffuse intravascular coagulation (DIC), hemorrhages.
The complexity of the clinical picture warrants the strict isolation of infected patients, with co-horting, and proper use of barrier methods to protect both HCWs and other inpatients.
Since there are not specific treatment, the guidelines are the same we are seeing in the management of other highly pathogenic emerging viruses, with tracing close contacts, that needs medical surveillance for the maximum incubation period duration.
Isolation, cohorting, quarantine: these are the pivotal measures if the purpose is to slow the spread of MERS, since there are not other medical countermeasures available so far.
Antibiotics are currently used in empirical treatment for CAP, at least initially. The issue is the progressive and unresponsive anoxia when ARDS developed, even in the case of ECMO use. Also, secondary liver & kidney failure must be monitored and supported; liver failure leads to encephalopathy and further elevation of LDH & CPK which damages further kidneys.
Vasculopathy and blood vessels leakages are the subsequent complications, with formation of blood clots, pulmonary embolism, Diffuse intravascular coagulation (DIC), hemorrhages.
The complexity of the clinical picture warrants the strict isolation of infected patients, with co-horting, and proper use of barrier methods to protect both HCWs and other inpatients.
Since there are not specific treatment, the guidelines are the same we are seeing in the management of other highly pathogenic emerging viruses, with tracing close contacts, that needs medical surveillance for the maximum incubation period duration.
Isolation, cohorting, quarantine: these are the pivotal measures if the purpose is to slow the spread of MERS, since there are not other medical countermeasures available so far.
Re: MERS discussion thread
Thanks Giuseppe for a precise summary of the clinical side of things.
However, if this is told to the average person on the street, reporters or anyone else, they will be simply become the 'terrified well' as opposed to the 'worried well'. Here on this board, those of us who have tracked and analysed serious disease threats for many years have become slightly immune to things. i.e on the whole, we dont get too worried about things unless or until certain 'red flags' have occurred. We have had time to think and adjust to what problems a serious pandemic would mean - whether flu, MERS or anything else.
Shortly, one way or the other, this story will hit the mainstream media in a big way, especially if cases continue to emerge overseas with increasing frequency...
I am trying to get at what reasonable advice could be given to individuals, that would not be harmful but could be helpful - i.e guidance for the 'worried well' and I dont have a lot of faith in DoH guidance on this matter. The CDC is better on the whole in thier communications.
I have faith in the clinical protocols and actions that are required. The under developed issue is what information should be given to people at large, because as we know only too well, the recent KSA line of 'dont worry, be happy, no problem here, its under control' just isnt good enough and would not work in a widespread disseminated outbreak. They need practical advice.
We need to be able to answer standard questions about home disinfection, transmissibility, what measures people can take that may be helpful. What to do and when if people start to develop flu like symptoms... how are they going to know if its a nasty respiratory virus vs MERS (they wont). So many issues, but many of these we have covered in the past in relation to H5N1, but I think these need revisiting for MERS.
I am going through all the clinical papers I can find on MERS to try and put together a 'composite' state of knowledge about the virus so far.
Thanks Giuseppe for a precise summary of the clinical side of things.
However, if this is told to the average person on the street, reporters or anyone else, they will be simply become the 'terrified well' as opposed to the 'worried well'. Here on this board, those of us who have tracked and analysed serious disease threats for many years have become slightly immune to things. i.e on the whole, we dont get too worried about things unless or until certain 'red flags' have occurred. We have had time to think and adjust to what problems a serious pandemic would mean - whether flu, MERS or anything else.
Shortly, one way or the other, this story will hit the mainstream media in a big way, especially if cases continue to emerge overseas with increasing frequency...
I am trying to get at what reasonable advice could be given to individuals, that would not be harmful but could be helpful - i.e guidance for the 'worried well' and I dont have a lot of faith in DoH guidance on this matter. The CDC is better on the whole in thier communications.
I have faith in the clinical protocols and actions that are required. The under developed issue is what information should be given to people at large, because as we know only too well, the recent KSA line of 'dont worry, be happy, no problem here, its under control' just isnt good enough and would not work in a widespread disseminated outbreak. They need practical advice.
We need to be able to answer standard questions about home disinfection, transmissibility, what measures people can take that may be helpful. What to do and when if people start to develop flu like symptoms... how are they going to know if its a nasty respiratory virus vs MERS (they wont). So many issues, but many of these we have covered in the past in relation to H5N1, but I think these need revisiting for MERS.
I am going through all the clinical papers I can find on MERS to try and put together a 'composite' state of knowledge about the virus so far.
Giuseppe
Emeritus
Re: MERS discussion thread
You want a short advice for people where a MERS case will be spotted:
''Social distancing measures''
ie, same things happened at Hong Kong & Toronto during SARS crisis.
This, if the sustained h2h transmission is confirmed by an independent international panel dispatched on the ground in KSA.
You want a short advice for people where a MERS case will be spotted:
''Social distancing measures''
ie, same things happened at Hong Kong & Toronto during SARS crisis.
This, if the sustained h2h transmission is confirmed by an independent international panel dispatched on the ground in KSA.
Shannon Bennett
Well-known member
Re: MERS discussion thread
Lessons from SARS
If this disease becomes more efficient at spreading, we did learn some valuable lessons from the SARS epidemic.
For healthcare workers, the keys to containment are tracking the clusters, identifying the infected, appropriate protective gear, and monitoring the health of all medical workers, other patients and visitors. Failure to adopt those protocols initially led to 3 super-spreaders. Hospitals in Singapore established a practice of taking the temperature of everyone involved 3 times a day. They also called everyone who had any access to any persons who had contracted SARS 3 times a day asking them to take their temperatures. After instituting these practices SARS was contained in ten days in one hospital.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3322797/
For those who are not healthcare workers the protocol should be social distancing. Wash your hands frequently, especially before and after eating. Do not touch your face. STAY AWAY FROM WORK if you have a temperature. Clean all surfaces with undiluted vinegar or diluted bleach.
Lessons from SARS
If this disease becomes more efficient at spreading, we did learn some valuable lessons from the SARS epidemic.
For healthcare workers, the keys to containment are tracking the clusters, identifying the infected, appropriate protective gear, and monitoring the health of all medical workers, other patients and visitors. Failure to adopt those protocols initially led to 3 super-spreaders. Hospitals in Singapore established a practice of taking the temperature of everyone involved 3 times a day. They also called everyone who had any access to any persons who had contracted SARS 3 times a day asking them to take their temperatures. After instituting these practices SARS was contained in ten days in one hospital.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3322797/
For those who are not healthcare workers the protocol should be social distancing. Wash your hands frequently, especially before and after eating. Do not touch your face. STAY AWAY FROM WORK if you have a temperature. Clean all surfaces with undiluted vinegar or diluted bleach.
Re: MERS discussion thread
Giuseppe and Sharon - yes and yes, thankyou.
My thinking is simply this. If MERS has further adapted and is becoming more transmissible, as a threat, it is very different to SARS in that the intermediate vector was a civet cat. Fairly rare animals with little animal/human interface, and therefore moderately easy to break the transmission chain.
MERS on the other hand appears to have an intermediate vector of camels, which are the backbone of the middle eastern local economies. You cant cull all the camels, not can you reasonably remove the camel/human interface. This means that the opportunities for novel human transmission chains being generated are numerous i.e even if the current transmission chains are arrested, you still cant stop the novel ones arriving. MERS unfotunately would not appear to be likely to 'die out'. For now, there is no camel NCOV vaccine.
Therefore, there is a high risk or probability that sooner or later MERS will go global, given the high levels of international travel from the region. So the world has to face how it will manage such outbreaks, and if they occur in sufficient numbers, containment and control (as things currently stand, and at some point) will not be an option.
When the world is in crisis mode, everyone will all be too busy coping with the volume of news, rather than thinking things through and finding/ developing information that may be both valid and useful for individuals and visitors to this board at every level.
MERS was not considered enough of a threat for govts to enact such action plans in advance. I just think we could make a positive difference here in the event that MERS becomes a SARS level problem.
Giuseppe and Sharon - yes and yes, thankyou.
My thinking is simply this. If MERS has further adapted and is becoming more transmissible, as a threat, it is very different to SARS in that the intermediate vector was a civet cat. Fairly rare animals with little animal/human interface, and therefore moderately easy to break the transmission chain.
MERS on the other hand appears to have an intermediate vector of camels, which are the backbone of the middle eastern local economies. You cant cull all the camels, not can you reasonably remove the camel/human interface. This means that the opportunities for novel human transmission chains being generated are numerous i.e even if the current transmission chains are arrested, you still cant stop the novel ones arriving. MERS unfotunately would not appear to be likely to 'die out'. For now, there is no camel NCOV vaccine.
Therefore, there is a high risk or probability that sooner or later MERS will go global, given the high levels of international travel from the region. So the world has to face how it will manage such outbreaks, and if they occur in sufficient numbers, containment and control (as things currently stand, and at some point) will not be an option.
When the world is in crisis mode, everyone will all be too busy coping with the volume of news, rather than thinking things through and finding/ developing information that may be both valid and useful for individuals and visitors to this board at every level.
MERS was not considered enough of a threat for govts to enact such action plans in advance. I just think we could make a positive difference here in the event that MERS becomes a SARS level problem.
sharon sanders
Editor-in-Chief & President
Re: MERS discussion thread
So far no cases announced today under the leadership of the new Minister.
A big communication mistake. Big.
So far no cases announced today under the leadership of the new Minister.
A big communication mistake. Big.
Shannon Bennett
Well-known member
Re: MERS discussion thread
There is an apparent disconnect between the old entrenched and the younger socially connected Saudi. Circumventing the Minister is easy, regaining trust is difficult. Every case that gets reported through tweets and not reported by the MOH, lessens the trust of the Ministry and the government in general. At some point given the worsening situation, there is going to be hell to pay for the Saudi government. At the least they should assign someone who is tech savvy to keep their own countrymen updated if no one else.
There is an apparent disconnect between the old entrenched and the younger socially connected Saudi. Circumventing the Minister is easy, regaining trust is difficult. Every case that gets reported through tweets and not reported by the MOH, lessens the trust of the Ministry and the government in general. At some point given the worsening situation, there is going to be hell to pay for the Saudi government. At the least they should assign someone who is tech savvy to keep their own countrymen updated if no one else.
sharon sanders
Editor-in-Chief & President
Re: MERS discussion thread
I sent this out today to a few people who use this list in their reporting: CIDRAP, Michael Coston, Ian Mckay, Crof. I wanted them to know before the reporting day started.
Subject: Coronavirus case list will no longer have totals
Date: Apr 23, 2014 7:15 AM
Hi everyone!
Ok - well we can not keep count anymore. Today the WHO announced 9 new UAE cases. We have already 1 one on our list. So that leaves 8. Last week the UAE government announced 12 additional cases without any details. Probably most, if not all, of the 8 WHO newly announced cases that we initially had no detail about are in the UAE gov 12 from last week.
But that leaves 4 cases out there. Who are they? And what if the new 8 is in addition to the old 12?
So we have permanently suspended reporting any totals. It is just impossible now.
We are still maintaining the list with MoH/WHO data as a reference guide.
We are still publishing a daily thread.
fondly,
Sharon
-------------------------------
The UAE is still quarantining people who were in contact with the 16 paramedics. So how do these 8 additional people fit in? :banghead:
I sent this out today to a few people who use this list in their reporting: CIDRAP, Michael Coston, Ian Mckay, Crof. I wanted them to know before the reporting day started.
Subject: Coronavirus case list will no longer have totals
Date: Apr 23, 2014 7:15 AM
Hi everyone!
Ok - well we can not keep count anymore. Today the WHO announced 9 new UAE cases. We have already 1 one on our list. So that leaves 8. Last week the UAE government announced 12 additional cases without any details. Probably most, if not all, of the 8 WHO newly announced cases that we initially had no detail about are in the UAE gov 12 from last week.
But that leaves 4 cases out there. Who are they? And what if the new 8 is in addition to the old 12?
So we have permanently suspended reporting any totals. It is just impossible now.
We are still maintaining the list with MoH/WHO data as a reference guide.
We are still publishing a daily thread.
fondly,
Sharon
-------------------------------
The UAE is still quarantining people who were in contact with the 16 paramedics. So how do these 8 additional people fit in? :banghead:
Shannon Bennett
Well-known member
Re: MERS discussion thread
Who knew that a veil had the equivalent protection of an N-95 mask? What utter and complete garbage. They must think all the women in Saudi Arabia are stupid, gullible and ignorant. A virus would pass through a cloth mask like water through a window screen.
http://www.flutrackers.com/forum/showthread.php?t=222059
Who knew that a veil had the equivalent protection of an N-95 mask? What utter and complete garbage. They must think all the women in Saudi Arabia are stupid, gullible and ignorant. A virus would pass through a cloth mask like water through a window screen.
http://www.flutrackers.com/forum/showthread.php?t=222059
sharon sanders
Editor-in-Chief & President
Re: MERS discussion thread
In response to a journalist query I sent this with links to source documents to keep load down on the server. These articles are posted on the site with the titles below:
Date: Apr 23, 2014 8:17 AM
Coronavirus is not specifically mentioned in these hospital stories:
Saudi Arabia - Lack of medical staff causing "congestion" in emergency department of Abu Arish hospital, Jizan province - April 23
http://www.al-jazirahonline.com/news/2014/20140422/17564
Saudi Arabia - Congestion at pediatric clinics and hospitals in Tabuk - April 23
http://www.okaz.com.sa/new/Issues/20140423/Con20140423694354.htm
-----------------------------------------
Saudi Arabia - Medical convoy at Kherma, Taif area on Friday, April 21, to provide exams and medicines (Sometimes Saudi does this as regular outreach. Can mean nothing or something. Don't know. s.s.)
http://www.al-madina.com/node/525995/«زمزم»-الصحية-التطوعية-تعالج-مرضى-الخرمة.html
Saudi Arabia - Allocation of a uniform code number for armed forces medical evacuation - Jeddah - April 12
http://www.bab.com/Node/219254
Saudi Arabia - Ministry of Health punishes 4 doctors working in emergency department in Qassim for falsifying patient reports - March 20
http://www.al-madina.com/node/519102/معاقبة-4-أطباء-طوارئ-منحوا-تقارير-مزوّرة-للمراجعين.html
In response to a journalist query I sent this with links to source documents to keep load down on the server. These articles are posted on the site with the titles below:
Date: Apr 23, 2014 8:17 AM
Coronavirus is not specifically mentioned in these hospital stories:
Saudi Arabia - Lack of medical staff causing "congestion" in emergency department of Abu Arish hospital, Jizan province - April 23
http://www.al-jazirahonline.com/news/2014/20140422/17564
Saudi Arabia - Congestion at pediatric clinics and hospitals in Tabuk - April 23
http://www.okaz.com.sa/new/Issues/20140423/Con20140423694354.htm
-----------------------------------------
Saudi Arabia - Medical convoy at Kherma, Taif area on Friday, April 21, to provide exams and medicines (Sometimes Saudi does this as regular outreach. Can mean nothing or something. Don't know. s.s.)
http://www.al-madina.com/node/525995/«زمزم»-الصحية-التطوعية-تعالج-مرضى-الخرمة.html
Saudi Arabia - Allocation of a uniform code number for armed forces medical evacuation - Jeddah - April 12
http://www.bab.com/Node/219254
Saudi Arabia - Ministry of Health punishes 4 doctors working in emergency department in Qassim for falsifying patient reports - March 20
http://www.al-madina.com/node/519102/معاقبة-4-أطباء-طوارئ-منحوا-تقارير-مزوّرة-للمراجعين.html
sharon sanders
Editor-in-Chief & President
Re: MERS discussion thread
Sent this in response to a journalist query:
Date: Apr 23, 2014 12:23 PM
Can't find anything specific on school closures. But since April 18th (5 days) there have been 3 school age children who have tested positive:
#293 - 13 years old, Jeddah
#344 - 11 years old, Medina
#350 - 13 years old, Jeddah
All asymptomatic. The schools are probably being cleaned and further contact screening is being conducted. This would get some talk instigated locally for sure.
Sent this in response to a journalist query:
Date: Apr 23, 2014 12:23 PM
Can't find anything specific on school closures. But since April 18th (5 days) there have been 3 school age children who have tested positive:
#293 - 13 years old, Jeddah
#344 - 11 years old, Medina
#350 - 13 years old, Jeddah
All asymptomatic. The schools are probably being cleaned and further contact screening is being conducted. This would get some talk instigated locally for sure.
Shannon Bennett
Well-known member
Re: MERS discussion thread
Where is an epidemiologist when you need one? That was said tongue in cheek. But the idea is valid. How and where are all these people getting sick? Fourteen more today. Four were working in the medical field.
http://www.flutrackers.com/forum/showthread.php?t=222195
Four are listed as having died. Three were elderly and one was only 30. All of the fatalities had medical issues of one kind or another. The thirty-year-old had been in an accident. I am going to presume he contracted the disease while undergoing care after the accident. So potentially we have 5 people who were infected while in a hospital. That speaks volumes about the lack of discipline needed regarding sanitation and personal protection. These hospitals are failing miserably at containing the virus once it enters a hospital setting. There should be zero subsequent infections at any of these hospitals. But what about the nine other victims? How they are getting sick in the first place? Rarely are they healthy children, and if they are the cases are usually subclinical. Where does this put us? It suggests to me that the disease is still not completely acclimated to a human body. We have not seen sustained infection as of yet. If you are young and have a healthy immune system you can probably fight off the disease. Unfortunately, asthma was reported a few days ago to affect 20% of Saudis'. Asthma has often been listed as one of the chronic conditions among the sick and dead. That doesn't bode well for the nation as a whole, especially as we still don't know how most of these people are becoming infected. Which brings me back to the snarky remark about epidemiologists.
How are all these people getting sick? Do we have a couple of super-spreaders out there? Is it in camel dairy products? Do we really have a huge number of sub-clinical cases that only rarely infect others? This should be a burning question in every person working on MERS-CoV. Because, if we don't answer this question fast, then the virus is going to finish its already swift progress to make humans its preferred host. We are sitting on the brink of pandemic, and I for one, would really love to see the nation of Saudi Arabia flooded with epidemiologists and medical geographers.
While I was typing this the caseload was upped to 21 with five deaths throughout the region.
Where is an epidemiologist when you need one? That was said tongue in cheek. But the idea is valid. How and where are all these people getting sick? Fourteen more today. Four were working in the medical field.
http://www.flutrackers.com/forum/showthread.php?t=222195
Four are listed as having died. Three were elderly and one was only 30. All of the fatalities had medical issues of one kind or another. The thirty-year-old had been in an accident. I am going to presume he contracted the disease while undergoing care after the accident. So potentially we have 5 people who were infected while in a hospital. That speaks volumes about the lack of discipline needed regarding sanitation and personal protection. These hospitals are failing miserably at containing the virus once it enters a hospital setting. There should be zero subsequent infections at any of these hospitals. But what about the nine other victims? How they are getting sick in the first place? Rarely are they healthy children, and if they are the cases are usually subclinical. Where does this put us? It suggests to me that the disease is still not completely acclimated to a human body. We have not seen sustained infection as of yet. If you are young and have a healthy immune system you can probably fight off the disease. Unfortunately, asthma was reported a few days ago to affect 20% of Saudis'. Asthma has often been listed as one of the chronic conditions among the sick and dead. That doesn't bode well for the nation as a whole, especially as we still don't know how most of these people are becoming infected. Which brings me back to the snarky remark about epidemiologists.
How are all these people getting sick? Do we have a couple of super-spreaders out there? Is it in camel dairy products? Do we really have a huge number of sub-clinical cases that only rarely infect others? This should be a burning question in every person working on MERS-CoV. Because, if we don't answer this question fast, then the virus is going to finish its already swift progress to make humans its preferred host. We are sitting on the brink of pandemic, and I for one, would really love to see the nation of Saudi Arabia flooded with epidemiologists and medical geographers.
While I was typing this the caseload was upped to 21 with five deaths throughout the region.
Last edited:
Giuseppe
Emeritus
Re: MERS discussion thread
Without a ground concerted international investigation, it will not be possible to elucidate the exact nature of exposure in health care settings, as well as the extent of community transmission.
At least, until a cluster of cases will materialize in some W Countries: when & where this will happen, it will be clear how things are going to go.
Three years: despite many calls for an independent investigation performed by an internationally formed team, we remain with disturbing gaps in knowledge about MERS.
Camels seem to be the carriers of the virus, and some other regions in Africa & ME are likely affected.
How many cases there are around? Hundreds? Thousands? Ten thousands?
No words about situation in Palestine (home of some of the expatriated workers in KSA), Gaza Strip, Refugee Camps in Jordan and Lebanon, where the sanitation and very poor health condition may serve as flashpoint for an emerging disease.
There's a persisting attempt to cover the situation for reasons that are of difficult comprehension.
Clearly a virus that are possibly infecting unnoticing for years thousands of people in a wide region of the world would change the assessment against a relatively rare infection localized in a couple of countries.
Without a ground concerted international investigation, it will not be possible to elucidate the exact nature of exposure in health care settings, as well as the extent of community transmission.
At least, until a cluster of cases will materialize in some W Countries: when & where this will happen, it will be clear how things are going to go.
Three years: despite many calls for an independent investigation performed by an internationally formed team, we remain with disturbing gaps in knowledge about MERS.
Camels seem to be the carriers of the virus, and some other regions in Africa & ME are likely affected.
How many cases there are around? Hundreds? Thousands? Ten thousands?
No words about situation in Palestine (home of some of the expatriated workers in KSA), Gaza Strip, Refugee Camps in Jordan and Lebanon, where the sanitation and very poor health condition may serve as flashpoint for an emerging disease.
There's a persisting attempt to cover the situation for reasons that are of difficult comprehension.
Clearly a virus that are possibly infecting unnoticing for years thousands of people in a wide region of the world would change the assessment against a relatively rare infection localized in a couple of countries.
Shannon Bennett
Well-known member
Re: MERS discussion thread
http://www.flutrackers.com/forum/showthread.php?t=222290 <HR style="COLOR: #cccccc; BACKGROUND-COLOR: #cccccc" SIZE=1> <!-- / icon and title --><!-- message -->
What hasn't changed over the last month? We are still primarily seeing the same victims we saw last month- those are older patients with comorbidities. What has changed? More patients and slightly longer transmission chains. We are testing more people who came into contact with the sick, and are seeing more infected with little or no symptoms. In all probability the sequencing reflects what we are seeing. Small incremental changes but no major shifts. Apparently those small changes may be enough to increase the number of victims and the slightly longer chains but, if you are still young and healthy you can fight off the disease. Where does that leave us?
Longer chains and more victims tells me that the virus is still adapting to humans. It isn't doing it by leaps and bounds but by tiny changes. If that continues, it does mean that eventually the virus will achieve the goal of becoming a human virus rather than a zoonotic virus. It also means that this will happen over time rather than say next Tuesday. Sadly, we can't count on the virus for anything. It may just make tiny changes or it may make a giant leap in one change. Or, it could cease to be a threat at all. Although that isn't the direction it appears to be moving in at the moment. It all depends on random chance. Which means we have to stay vigilant. We have not been let off the hook of pandemic. It just means that we aren't going to expect a pandemic in the very near future.
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http://www.flutrackers.com/forum/showthread.php?t=222290 <HR style="COLOR: #cccccc; BACKGROUND-COLOR: #cccccc" SIZE=1> <!-- / icon and title --><!-- message -->
What hasn't changed over the last month? We are still primarily seeing the same victims we saw last month- those are older patients with comorbidities. What has changed? More patients and slightly longer transmission chains. We are testing more people who came into contact with the sick, and are seeing more infected with little or no symptoms. In all probability the sequencing reflects what we are seeing. Small incremental changes but no major shifts. Apparently those small changes may be enough to increase the number of victims and the slightly longer chains but, if you are still young and healthy you can fight off the disease. Where does that leave us?
Longer chains and more victims tells me that the virus is still adapting to humans. It isn't doing it by leaps and bounds but by tiny changes. If that continues, it does mean that eventually the virus will achieve the goal of becoming a human virus rather than a zoonotic virus. It also means that this will happen over time rather than say next Tuesday. Sadly, we can't count on the virus for anything. It may just make tiny changes or it may make a giant leap in one change. Or, it could cease to be a threat at all. Although that isn't the direction it appears to be moving in at the moment. It all depends on random chance. Which means we have to stay vigilant. We have not been let off the hook of pandemic. It just means that we aren't going to expect a pandemic in the very near future.
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