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Protocol kept MERS from spreading

State, hospital, CDC worked to isolate single case

– The man walked into the emergency room at Community Hospital in Munster on the evening of Sunday, April 28, with a cough and a fever.

Staffers directed him to a private room – one that by chance was a negative air pressure room, meaning the deadly virus he was carrying in his body was less likely to spread through the air and ventilation system.

Hospital officials didn’t know it then, but they were about to be faced with the first case of MERS – Middle East Respiratory Syndrome – found in the United States.

All the protocols in place would be tested. And the system – from local doctors to state epidemiologists to federal services – would come through.

“At this point in time, MERS picked the wrong hospital and the wrong state to try and get a foothold,” said Dr. William VanNess, Indiana state health commissioner. “Thus far, we have hit it out of the park.”

April 28: Admitted

The patient was admitted that evening with respiratory symptoms, including shortness of breath.

The next morning, the hospital’s infectious disease specialist met with him and his family and it became clear that the man, a health care professional, had returned a few days earlier from Saudi Arabia.

He was immediately placed in isolation as the doctor suspected MERS.

So far, all MERS patients have been linked to seven countries in the Arabian Peninsula. This virus has spread from ill people to others through close contact, such as caring for or living with an infected person.

About 30 percent of those infected have died. Health officials don’t know the original source of the virus, nor do they have any specific treatment or vaccine.

April 30: Sample

Dr. Alan Kumar, chief medical information officer at Community, said that because the virus was new to the United States, hospitals don’t have their own kits to test for it. The Munster hospital contacted the Indiana State Department of Health on April 29 and sent a sample to the state lab on April 30.

Pam Pontones, the state’s epidemiologist, was the point person for the state on the case. The State Health Department received a preliminary positive test result late on the evening of Thursday, May 1.

“We contacted the hospital and said, ‘You’re on the right path,’ ” VanNess said. “Isolation is key.”

May 2: The feds

The Indiana State Health Department contacted the Centers for Disease Control and Prevention, which tested the sample in Atlanta and confirmed the diagnosis May 2.

Within hours, the federal agency hastily put together a conference call about the new development. Reporters from around the nation were on the call, and the CDC refused to specify where in Indiana the case was found.

They gave details of the man flying April 24 from Saudi Arabia to London and then to Chicago before catching a bus into Indiana.

“There is a very low risk to the broader general public,” said Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases

VanNess, the state health commissioner, said his department decided it was imperative to release the location of the victim.

“This is something people could panic over,” he said. “That’s why we identified the hospital, so not every hospital in the state got 1,000 concerned calls.”

A team of six from the CDC was deployed Friday, May 2. It included Epidemic Intelligence Service officers, a medical epidemiologist and public affairs specialist.

They traveled to Munster along with three field epidemiologists from the State Department of Health.

Meanwhile, Community Hospital took extra precautions concerning its staffers.

May 2: Home isolation

Kumar, the hospital’s chief medical information officer, said 50 staffers were put in home isolation within an hour of the confirmatory CDC testing on May 2. All of those people had had some sort of contact with the patient in the 20-hour period – from doctors and nurses to someone simply dropping off a menu or taking out the trash.

“We took no chances,” he said, even though the CDC said they could continue to work with masks as long as they had no symptoms.

All staffers have had an initial negative test for the virus. A few have some allergylike symptoms that are believed to be unrelated, and all will be retested next week at the end of the 14-day incubation period. Their pay has continued during their home isolation.

VanNess said the man’s family also has tested negative so far.

“There has been a significant amount of concern from the community about possible exposure,” Kumar said, especially among those who were in the hospital during that time.

He said there is video of the patient showing his entire path from the moment he walked into the door until he was settled in a room. That has helped identify possible exposure, but officials stress that the virus spreads only through close, sustained contact.

VanNess said his agency was largely the coordinating agency for the state, including updating Gov. Mike Pence every few hours and working with the CDC and the Department of Homeland Security to find anyone who might have been infected on the plane or bus. The bus posed the most difficult task because there is no complete manifesto.

The state used its health alert network to let physicians and hospitals around Indiana know about the case. And the agency set up a hotline in Munster for people concerned about exposure.

May 5: No Masks

On Monday, May 5, a news conference was held at the hospital with Pence, partly to show that it was safe to be there. No masks or gowns were worn.

CDC staffers monitored the case closely, collecting surveillance data that can be used for future outbreaks.

“They are the experts on this virus. They have data from multiple organizations around the world and are experts on global migration,” Kumar said.

May 9: Released

The patient was released Friday after health officials determined that he “poses no threat to the community.”

The patient is considered fully recovered and has been cleared by health officials to travel, if necessary.

The time for a full post-mortem analysis is later, officials said. But so far, the response was near perfect.

“It’s great to see how well we all performed. Collaboration and communication has been key,” VanNess said. “The A Team used to say you love it when a plan comes together.”

nkelly@jg.net

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