The very steep rises in Middle East respiratory syndrome coronavirus (MERS-CoV) cases seen in the graph below are not due to overwhelming numbers of new exposures to infected camels. 

Those upwards inclines are mostly because humans are just numbskulls.

The source of the problem is human

We propagate epidemics. We create our headaches in this arena. Many viruses wouldn’t break out if we didn’t create the circumstances for an outbreak. The biggest headache…infected patients who spread the virus to uninfected patients and health workers when they are in unprotected close contact in a healthcare setting.

We can go on and on bemoaning the many knowledge gaps in our understanding of MERS-CoV – we did and listed some recently – but that’s really an academic endeavour in the short term. Three years later (not really short term), we are still seeing the basic problem of hospitals becoming hubs for MERS-CoV transmission, MERS disease and the death of some of those most vulnerable to MERS-CoV infection. Hospitals. Places filled with already sick people.

Sick people can be made much, much sicker by a MERS-CoV infection. 

In the case of MERS cases – as we have seen over and over again in the short space of time since 2012 – one or a few cases get into a hospital environment and catch the hospital completely unprepared for such a…poorly transmitting respiratory virus infection. 

We could do more to prevent new cases

It really doesn’t matter if the earliest cases acquired the virus from a camel or a community case or a family member – the containment of that infection is what matters to prevent a subsequent outbreak. 

And so they fail to contain it. We should look afresh from an engineering perspective at the way we receive patients. Mainly though, this is a people problem. Those people receiving, managing and working in the hospital create the circumstances by which this opportunistic virus can spread well beyond what its capability suggests it should.

To stop transmission in hospitals, basic protocols of personal hygiene and personal protective equipment seem to work.

So, from a complete non-expert, here are my simplistic thoughts: 

1. Wash off an infected patient’s virus (which includes constant cleaning of surfaces around the patient and constant mindfulness about one’s personal hygiene extending to those not caring for a patient-e.g. cleaning, ward, transport and administration staff
2. Protect upper airway (mouth, nose and eyes) mucous membranes from exposure to infectious droplets from an infected patient. If that isn’t working (but past fixes suggest it has) there are stepped up precautions to try to prevent airborne transmission by floaty clouds of infectious virus (if it can remain infectious in such clouds).

Once that protection is a standard procedure in the hospital, perhaps others could pick up their feet on trying to sort out the specifics of how the virus transmits and which mucous membranes we need to cover up. 

Let’s not forget this is all just as relevant to infections by much better studied pathogens, including the measles virus, respiratory syncytial virus, human metapneumovirus, adenoviruses, influenza viruses, other coronaviruses and rhinoviruses. They’re all spread in healthcare settings – more efficiently than MERS-CoV, it seems. They can also have a big impact on vulnerable patients.

But baby steps.

*Imported Post

1. This post from 23AUG2015 was posted over on my old blog platform virologydownunder.blogspot.com.au. It has now been moved to here and lightly edited for grammar and to add subheadings.