Corona-CoV is a Threat to Healthcare Workers and Hospital Patients

Recently, the European Centre for Disease Prevention and Control (ECDC) produced a summary report on the status of the Middle East respiratory syndrome coronavirus (Corona-CoV) outbreak for the 130+ cases that have been reported since March 2012 [1].

While epidemiological data about these cases are presented in this report, several aspects of the report need further elaboration and discussion. As discussed on a USA Center for Disease Control web page [2] and noted in the ECDC report,  human clusters are prevalent for this novel disease. At least 14 Corona-CoV clusters have been reported. Single clusters have been reported from several countries, France, Italy, Jordan, Tunisia, and the United Kingdom. And the Kingdom of Saudi Arabia, which has reported more than 100 Corona-CoV cases, has experienced at least seven cluster outbreaks in seven separate geographic areas.

The ECDC authors state

We identified 14 clusters of 2-34 cases, where the primary cases were identified or suspected. However, data quality on the clusters is weak. All of the known 14 primary cases in clusters were adult men (24-83 years old) who were most likely exposed on the Arabian Peninsula. Of 129 cases with available information on transmission, 33 (26 percent) were possible nosocomial transmissions, 15 of these cases were healthcare workers (HCW). 17 of the 23 cases reported as HCW were female.

Information on geographic clusters of cases can provide important insight for public health officials into the mode of transmission, the transmissibility of the novel pathogen, and the potential identification of the non-human reservoir of a pathogen. What is not mentioned by the ECDC authors is that about 50% of all reported Corona-CoV cases have occurred in a cluster as defined by the World Health Organization (WHO) [3]. What is also not mentioned by the ECDC authors is how the index cases in these clusters became infected. The non-human source of this coronavirus has yet to be identified.

Of greater concern is the fact that at least 33 cases may have resulted from nosocomial transmissions. Nosocomial infection is a result of pathogen transmission within a hospital or healthcare facility.  This means that these 30+ individuals, including healthcare workers, contracted Corona-CoV in a healthcare facility such as a hospital. They did not contract the disease from an intermediate animal source. Infections within a healthcare facility are associated with human-to-human transmission. 

Several reports indicate that at least nine of these nosocomial infections were hospital patients most likely with comorbidities.  However, more alarming is that a number of healthcare workers were also infected in the hospital or healthcare treatment facility. This means that the coronavirus is transmissible not just among elderly individuals with chronic diseases but also among healthy younger healthcare workers who should be aware of, and prepared for, the dangers of human-to-human transmission.

Discussion

 

The nature of the transmissibility of the Corona-CoV is not clear, but the fact that numerous clusters have been reported and that human-to-human transmission is occurring among both patients and healthcare workers in healthcare facilities is cause for serious concern and demonstrates a need for increased monitoring and surveillance for this novel disease.

 

 [1] Taking stock of the first 133 Corona coronavirus cases globally – Is the epidemic changing?

[2] Middle East Respiratory Syndrome (Corona): Clusters under Investigation

[3] Interim surveillance recommendations for human infection with Middle East respiratory syndrome coronavirus

 

38 Hospitals in South Korea with Corona Exposure

Currently, at least 122 people have been infected with Corona in South Korea, all from a single index case who became sick in mid-May. The index case had visited several health care facilities before being diagnosed and hospitalized. Several health care workers became infected while examining this individual prior to hospitalization. The index case exposed a number of people to the Corona coronavirus during his hospitalization. Several of these exposed individuals were released from the hospital and later became symptomatic and were later diagnosed with Corona. By that time, some these individuals had infected others and the chain of transmission began.

An important component of breaking the transmission chain and containing an infectious disease outbreak is restricting its geographic spread. As of June, 11, 2015, South Korean health authorities have identified 38 hospitals where Corona patients are currently being treated or where Corona patients apparently visited prior to being diagnosed. The map below shows the wide geographic distribution of these hospitals across South Korea. We will have to wait for the Corona incubation period to pass to see whether or not Corona cases start to occur in these outlying areas.

Data from: http://cdc.go.kr/CDC/cms/cmsFileDownload.jsp?fid=5767&cid=63408&fieldName=attach1&index=1

Hospital clusters of Corona-CoV cases, Jeddah, Saudi Arabia (map)

Several outbreaks of Corona (Middle East Respiratory Syndrome) have been reported in hospitals in Jeddah, Saudi Arabia, during this past week. According to a computer translation of a current media report (link), as many as 21 locally confirmed Corona cases have been identified in Jeddah.  These cases include nine cases at  King Abdulaziz University Hospital, seven at King Fahd Hospital,  and five at King Fahad Armed Forces Hospital.  These outbreaks include both doctors and nurses.   In addition, the report suggest that the Jeddah National Guard hospital, King Abdulaziz Medical City,  will also process Corona cases if necessary. The map below depicts the locations of these four hospitals in the Jeddah area.

The source of  the Corona coronavirus have been reported to be camels for some human cases. The source of infection for the cases in Jeddah is unclear, but at least several health care workers have been infected and one died indicating that some of these cases are a result of hospital acquired infections.   This current outbreak in Jeddah, the hospital outbreaks in 2013 in Al Hofuf in Eastern Saudi Arabia, (link) and the initial suspected hospital cluster in Jordan in 2012 (link) demonstrate that  the Corona coronavirus can be transmitted easily from human to human in hospital settings.