MERS: An outbreak reveals vulnerabilities, gaps, another chance to build appropriate responses

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On his way to a Médecins Sans Frontières meeting in New York last week, Dr. Dan Lucey was looking forward to a reunion of sorts with physicians with whom he volunteered at a hospital in Liberia last fall.

“Not a hospital,” he corrected himself, “An Ebola treatment center.” The difference, he clarified, is that he was talking about a place where patients were accommodated with plastic mats on the floor and buckets for body waste.


Dr. Dan Lucey

That was the most recent of experiences over the last 30 years of the veteran infectious diseases physician’s experiences that adds to his concern about the world’s readiness to respond to the next global health threat.  A few days earlier the World Health Organization released some of its emergency committee’s findings on the current status of Middle East Respiratory Syndrome outbreaks in the Republic of Korea and China. It noted that challenges to controlling MERS had included lack of awareness of the virus on the part of both health workers and the public, lack of infection prevention and control measures in hospitals, and close and prolonged contact between infected and uninfected people in hospital settings.

On the same day WHO released that statement, a commentary by Lucey and Lawrence Gostin of the Institute of National and Global Health Law at Georgetown University in the Journal of the American Medical Association, Middle East Respiratory Syndrome, A Global Health Challenge, broke down the threat the virus presents by component. That included its means of transmission and effects — it is less easily spread, but more deadly than what Lucey has referred to as its “cousin” SARS — as well as policy, science and resources needed to control outbreaks. Travel restrictions, school closures and quarantines of uninfected but exposed people have been shown unwarranted and counterproductive, the piece noted. It concluded that like Ebola and SARS, MERS has shown accelerated transmission risks in healthcare settings that, in turn, highlight the urgency of building health care capacities.

The urgency is underscored once again, Lucey said Friday, by the likelihood of a MERS outbreak in a low-resource setting. “The potential is high, because there are so many low resource settings in the world.” Many people working in the Middle East now are citizens of countries unprepared to cope with a MERS outbreak. He sees little reason to hope the world is more prepared now, than it was at the beginning of the ongoing west Africa Ebola outbreak to avert a crisis.

“A lot of good things were said,” at the World Health Assembly last month, he acknowledged. But he added, “Is there an emergency global health task force? No, there’s not just like there wasn’t before.”

Also still lacking, since the emergence of the first MERS outbreak in 2012, is an effective treatment or vaccine. He allows those take time, but also notes that the SARS outbreak of 2003 did little to mobilize a lasting and buildable response.

“I don’t see where we’re much more prepared now, than we were two, three, ten years ago,” he said.

“Fear prevents us from doing what we need to do to respond to an outbreak. Use the fear to improve your vigilance and response.”

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