Infectious disease specialists from around the world began probing South Korea’s outbreak of Middle East respiratory syndrome coronavirus amid criticism that officials took too long to implement infection-control measures.
Nearly a month after MERS-Cov arrived in a traveler returning from Qatar, Acting Prime Minister Choi Kyung Hwan said Tuesday the government will begin an aggressive response to end the outbreak this week. One patient under quarantine orders from South Korea flew to Hong Kong and traveled to Huizhou and Shenzhen while sick, risking spreading the infection in southern China.
“They missed opportunities to contain the virus at the very beginning,” said Leo Poon, an associate professor at the University of Hong Kong’s School of Public Health. The first infected “patient was not diagnosed with MERS for a long time, which means he had opportunities to shed MERS for quite a while and could have infected more people in that period.”
An eight-person team convened by the World Health Organization began studying on Tuesday how 95 people were infected with the virus -- seven of them fatally -- and will offer recommendations to contain the epidemic, said Alison Clements-Hunt, a WHO spokeswoman in Manila.
“This mission should bring us a step closer to having a better understanding of the nature of the virus,” she said.
Mission participants, invited by South Korea’s health ministry, include Keiji Fukuda, WHO’s assistant director-general for health security; Abdullah Assiri, a health official from Saudi Arabia; Martin Cetron, director of global migration and quarantine at the U.S. Centers for Disease Control and Prevention; and Malik Peiris, director of the University of Hong Kong’s School of Public Health.
The health ministry added 8 new MERS-CoV cases Tuesday, after reporting 23 on Monday and 22 on Sunday. That suggests government infection-control efforts are working, Clements-Hunt said. With more than 2,500 people being monitored for symptoms, more infections are likely. It may take as long as 14 days for symptoms to appear after exposure to the virus, she said.
“Infection control has dramatically improved,” said Michael Osterholm, director of the University of Minnesota’s Center for Infectious Disease Research and Policy in Minneapolis, who has had discussions with South Korean investigators though isn’t part of the mission.
Health officials need to continue tracking down and checking everyone in contact with an infected person, he said.
While the South Korean response to MERS-CoV is “very encouraging,” the initial response was mishandled, said Benjamin Neuman, a virologist at the University of Reading’s School of Biological Sciences.
“It took 11 days from the announcement of the first case until the major effort to find and isolate contacts of infected people got under way,” Neuman said. “Eleven days is a long time for a virus like MERS -- enough time to infect a second wave of cases and begin a third, as we have seen.”
WHO was notified on May 20 by South Korea of its first MERS-CoV case -- which occurred in a 68-year-old man who’d traveled to Bahrain, United Arab Emirates, Saudi Arabia and Qatar from April 18 to May 4, according to a May 24 statement. The man fell ill on May 11, sought medical care the following day, was hospitalized on May 15 and discharged two days later.
That evening, he sought treatment in the emergency room of another hospital and was tested positive for MERS-CoV three days later, when he was transferred to another facility for isolation. The following day, someone in contact with the man at home and a patient who shared his hospital room were confirmed to have the virus also, setting off the outbreak in South Korea.
All of the cases in South Korea have been linked to exposure to MERS-CoV in a hospital or clinic, suggesting the virus is spreading among patients and health-care workers rather than more broadly in the community.
Patients were treated in more than 20 South Korean hospitals, which weren’t immediately identified by authorities so as to alert doctors to patients potentially exposed to the virus, Poon said.
“If that information had been shared, people there would have been on higher alert and health-care workers could have paid particular attention to potential cases,” he said.
Previous MERS-Cov outbreaks were all subdued by implementing WHO guidelines around infection control and finding and monitoring everyone in contact with infected people, WHO’s Clements-Hunt said.
The mission will assess South Korea’s infection control measures and determine whether guidelines need to be amended, she said, adding that the first case in South Korea wasn’t picked up straight away and that doctors, epidemiologists and lab technicians there hadn’t seen the virus before.
After some initial problems, the government is now complying with WHO guidelines and will make changes to its public health response procedures, said Song Dae Sub, a professor of pharmacy at Korea University in Seoul, who is assisting the investigation.
Regulations for managing infectious diseases in hospitals will be “amended extensively,” he said, adding that, unlike China, which has battled highly pathogenic bird flu and SARS, South Korea hasn’t had as much experience with emerging pathogens.
“It seems to have taken the country by surprise,” said Raina MacIntyre, head of the school of public health and community medicine at the University of New South Wales in Sydney. “This highlights the need for countries to have good preparedness plans in place and not just ones that sit in a ministerial office -- it needs to be communicated right down to the people working on the front line.”