Dan Lucey, MD, MPH, 25 May 2015
Today the World Health Organization (WHO) reported that a 12th patient in Korea has been confirmed to be infected with the Middle East Respiratory Syndrome (MERS) virus. All 12 have been linked to the hospital where the Korean traveler infected with the MERS coronavirus in the Middle East returned May 4th to Incheon International airport and was hospitalized for the first time on May 15. The name and location of the hospital(s) has not been made public.
One of the 12 cases in Korea, even though in quarantine and with febrile symptoms, flew to Hong Kong and then took a bus to Shenzhen and then onward to Huizhou in Guangdong province, SE China. He thus was potentially contagious and may have exposed many people in the Hong Kong airport, bus station, and in his bus trips to and from Shenzhen.
Although this pattern of infected travelers to nations outside the Middle East has occurred in over a dozen nations since MERS was discovered in 2012, this outbreak in Korea is unique for two reasons:
- The size of the outbreak triggered by the traveler is the largest to date.
- This is the first time a traveler has been linked to infections in two nations (Korea and China)
How to stop this outbreak in Korea is an emergency matter. Due to the lack of experience with MERS in Korea, and limited experience with SARS in 2003 compared with China, Vietnam, Singapore or Canada the needed well-coordinated effective response will be more challenging.
Although not a strict analogy, this central theme of a new pathogen causing an outbreak, or an old pathogen (like Ebola in West Africa in 2013-2015, or West Nile Virus in the USA in 1999-onward) causing an outbreak for the first time in a new part of the world the critical practical knowledge-from-experience is lacking or at least limited.
A central innovation is needed for an effective and rapid global response to new outbreaks. One that distills and shares immediately the all-of-society coordinated response “best practices”. Most importantly, we must share how such “best practices’ were implemented in prior outbreaks of the identical (e.g., Ebola in Uganda, DRC or Gabon prior to West Africa) or similar (e.g., SARS and MERS in Asia or the Middle East) pathogens.
This comprehensive approach requires innovative leadership because “best practices” must be immediately transferred not only to public health officials and epidemiologists, but also hospital and outpatient settings, as well as political leadership and the media to optimize outbreak communications.
Such a whole-of-society immediate and coordinated response is likely best done via the United Nations.
Daniel R. Lucey MD, MPH