Indiana MERS patient improving, hospital workers isolated

Tribune reporters

The man authorities cite as the nation’s first confirmed case of Middle East Respiratory Syndrome and dozens of hospital workers who first came into contact with him are being isolated from the general public, an effort by officials and public health experts to contain the potential spread of a deadly new pathogen.

Medical workers at an Indiana hospital who now have contact with the man are required to wear gloves, masks, gowns and eye protection. He’s being held in a room designed especially for patients with respiratory infections, segregated from the hospital’s air circulation system.

The patient needed oxygen during the first part of his stay, officials at Community Hospital said Monday, but was never admitted to intensive care. Doctors said he’s now breathing regular air, is in good spirits and has a good appetite.

As the man’s condition appears to improve and nobody else has shown evidence of infection, officials provided the most detailed account to date of the seriousness of care with which public health and Centers for Disease Control and Prevention have taken to investigate and contain the potential spread of MERS in the United States.

Roughly 50 hospital nurses, clerks, aides, dietary experts and other workers who came into contact with the patient before his infection was confirmed are on paid leave — isolated inside their homes as experts watch for signs of symptoms and test for infection during the virus’ known incubation period.

The patient’s family members are in the same predicament. Those isolated at home have been asked to wear face masks if they leave the building, officials said.

At a briefing with Indiana and federal officials Monday, officials said the Saudi Arabian health care worker, who has not been identified but whom experts refer to as the “index patient,” is expected to return to home isolation with his family “very soon.”

But it’s unclear when the man, who officials said crossed the U.S. border through O’Hare International Airport while en route to a planned visit with Indiana relatives, will be able to travel or leave the country.

No one who has been isolated because of their contact with the patient has tested positive for the virus, officials said. Its incubation period lasts an estimated two to 14 days, and the patient first reported his illness at an Indiana hospital on April 28.

“We think this is well-contained, but we are exercising an abundance of caution,” said Dr. Daniel Feikin, a CDC epidemiologist and head of an agency response and investigation team sent to Indiana.

“I think it is promising that the staff that have had contact with him have already tested negative,” he said.

Feikin said the patient lives in Saudi Arabia and was working in a Riyadh hospital that housed MERS patients, though Feikin said the patient did not recall working directly with infected persons.

The patient has family in the United States and came for a planned visit, officials said, but cited confidentiality rules when they declined to provide additional details about him. A Monday update on the case from the World Health Organization, however, described the patient as a U.S. citizen in his 60s.

“This is still a fluid situation,” said Dr. William VanNess II, Indiana’s state health commissioner.

MERS is a new type of what scientists call “coronaviruses,” a widespread group of diseases that includes the common cold and pneumonia. The highly contagious SARS virus, which killed hundreds in Asia and North America in the early 2000s, is another kind of coronavirus.

First discovered in a Saudi Arabian patient in summer 2012, some experts believe MERS originated from an animal source because it's been detected in camels and bats in the Middle East.

MERS symptoms — fever, cough and respiratory problems — resemble those of influenza. Unlike the flu, however, there is no available vaccine or specific treatment recommended for the virus.

Health officials around the world have been particularly concerned about MERS because it is a new virus that scientists still have much to learn about, but has already proven to be quite lethal, with a recent CDC estimate showing it has killed nearly one quarter of the people who contracted it.

 U.S. health experts aren't certain where MERS originated, but say they’ve long expected the virus’ arrival to the country. Still, they say it currently poses low risk to the general public.

CDC officials said the patient flew from Riyadh to London, then onto Chicago before boarding a bus to Indiana on April 24. Roughly 100 people were on the patient’s flight to Chicago, officials said. Another 10 were on the bus.

The CDC has quarantine stations located at ports of entry across the country, including one inside the international wing of O’Hare airport. But the patient did not identify himself as being ill when he cleared customs, Feikin said. His symptoms did not develop until after his arrival, Feikin said.

There is no active screening for passengers arriving from the Arabian Peninsula, Feikin said, nor are there currently any travel restrictions to countries in the region.

Nearly three-quarters of the patient’s fellow air travelers had been contacted, Feikin said, and none had exhibited any symptoms. State officials were working to identify bus passengers and officials in London are probing the Riyadh to Heathrow leg of the journey, Feikin said.

“We do know that he had limited exposure to the community once he arrived. He went directly to his family’s house,” Feikin said.

The patient arrived with family members at the hospital on the evening of April 28, said Dr. Alan Kumar, Community Hospital’s chief medical information officer. He was admitted to a private triage room, practitioner’s room and bed within three hours of his arrival.

But after confirming the man had contracted MERS, and considering the virus’ mysterious nature, officials pulled hospital workers from duty, Kumar said.

Officials used a variety of surveillance and recordkeeping tools to locate hospital workers who might have been exposed. They reviewed security camera footage to track the patient’s movements through the building and examined medical records to determine who was near him and when. The hospital’s health care workers are also tracked by a radio-frequency identification system, a hospital official said, which tells officials exactly where workers are at during a given time.

“If you think about it, you would think ‘Wow, that’s a ton of people,’ but we actually have 3,500 people who work on this campus on a daily basis,” Kumar said. Other workers have been called in to fill vacant shifts, Kumar said, and the hospital has been running its normal operations.

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