Saudi MOH: 10 Additional MERS Cases In Riyadh

 

#10,426

 

The Saudi MOH website is having issues this morning, having posted an update on the English side with the title MOH: '10 New Confirmed Corona Cases Recorded', but that currently only leads to a blank page (now fixed). 

 

The page banner (below) shows 10 additional cases over yesterday, however, and the Arabic version (see map above) confirms they all hail from Riyadh.

 

If and when they get their English language page update, I’ll update this post with their line list graphic.

(UPDATED)

 

This brings the total number of cases over the past 15 days to 58, with 55 of those from Riyadh.   Earlier today, in WHO MERS Update – Saudi Arabia – August 18th, we looked at details on 12 recent cases, 10 of whom were linked simply to being treated at or admitted to a Riyadh hospital with MERS cases.

 

The pattern of nosocomial transmission in Riyadh is eerily similar to what we recently saw in South Korea, where direct contact with a known case isn’t necessarily required, only being housed or treated in a facility treating MERS cases.

Read More

WHO MERS Update – Saudi Arabia – August 18th

Credit WHO

 

# 10,425

 

While we await today’s MERS update from Saudi Arabia (spoiler alert, expect 10 new cases in Riyadh today), we have the most recent WHO GAR update, which chronicles 12 cases between the 10th and 12th of August.  Ten of these are either linked to ER visits, or being hospitalized, at facilities where MERS cases were being treated.

One other case is a contact of a previously identified case, while the other had camel contact.  

Most striking, of the 10 assumed nosocomial cases, no direct contact with an infected case is cited. Their exposure risk is simply listed as being treated in a facility where MERS cases have been hospitalized.

 

Middle East Respiratory Syndrome coronavirus (MERS-CoV) – Saudi Arabia

Disease outbreak news
18 August 2015

Between 10 and 12 August 2015, the National IHR Focal Point for the Kingdom of Saudi Arabia notified WHO of 12 additional cases of Middle East respiratory syndrome coronavirus (MERS-CoV) infection, including 1 death.

Details of the cases

1. A 57-year-old male from Riyadh city developed symptoms on 8 August while admitted to hospital for an unrelated medical condition since 2010. This hospital has been experiencing a MERS-CoV outbreak. The patient, who has comorbidities, tested positive for MERS-CoV on 11 August. Currently, he is in critical condition in ICU. Investigation of possible epidemiological links with the MERS-CoV cases admitted to his hospital or with shared health care workers is ongoing.
2. A 56-year-old female from Riyadh city developed symptoms on 7 August while admitted to hospital for an unrelated medical condition since 29 July. This hospital has been experiencing a MERS-CoV outbreak. The patient, who has comorbidities, tested positive for MERS-CoV on 9 August. Currently, she is in critical condition in ICU. Investigation of possible epidemiological links with the MERS-CoV cases admitted to her hospital or with shared health care workers is ongoing.
3. A 78-year-old female from Riyadh city developed symptoms on 7 August while admitted to hospital for an unrelated medical condition since 26 July. The patient, who has comorbidities, tested positive for MERS-CoV on 8 August. Currently, she is in critical condition in ICU. Investigation of possible epidemiological links with the MERS-CoV cases admitted to her hospital or with shared health care workers is ongoing.
4. A 58-year-old male from Abha city developed symptoms on 6 August and was admitted to hospital on 10 August. The patient, who has comorbidities, tested positive for MERS-CoV on 12 August. He has a history of contact with camels and consumption of their raw milk. The patient has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. Currently, he is in critical condition in ICU.
5. A 63-year-old male from Riyadh city developed symptoms on 29 July and, on 3 August, was admitted to a hospital that has been experiencing a MERS-CoV outbreak. The patient, who has comorbidities, tested positive for MERS-CoV on 5 August. He visited the emergency room of the same hospital due to his chronic conditions in the 14 days prior to the onset of symptoms. The patient has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. Investigation of possible epidemiological links with the MERS-CoV cases admitted to his hospital or with shared health care workers is ongoing. Currently, the patient is in critical condition in ICU.
6. A 45-year-old male from Riyadh city developed symptoms on 4 August while admitted to hospital for an unrelated medical condition since 30 July. This hospital has been experiencing a MERS-CoV outbreak. The patient, who has comorbidities, tested positive for MERS-CoV on 6 August. Currently, he is in critical condition in ICU. Investigation of possible epidemiological links with the MERS-CoV cases admitted to his hospital or with shared health care workers is ongoing.
7. A 56-year-old male national from Riyadh city developed symptoms on 4 August while admitted to hospital for an unrelated medical condition since 23 July. This hospital has been experiencing a MERS-CoV outbreak. The patient, who has comorbidities, tested positive for MERS-CoV on 5 August. Currently, he is in critical condition in ICU. Investigation of possible epidemiological links with the MERS-CoV cases admitted to his hospital or with shared health care workers is ongoing.
8. A 99-year-old male from Riyadh city developed symptoms on 6 August while admitted to hospital for an unrelated medical condition since 23 May. This hospital has been experiencing a MERS-CoV outbreak. The patient, who has comorbidities, tested positive for MERS-CoV on 8 August. Currently, he is in critical condition in ICU. Investigation of possible epidemiological links with the MERS-CoV cases admitted to his hospital or with shared health care workers is ongoing.
9. A 65-year-old male from Riyadh city developed symptoms on 8 August and, on the same day, was admitted to hospital. The patient, who has comorbidities, tested positive for MERS-CoV on 9 August. He is a contact of a laboratory-confirmed MERS-CoV case (see DON published on 12 August – case n. 3). Investigation of history of exposure to other known risk factors is ongoing. Currently, the patient is in stable condition admitted to a negative pressure isolation room on a ward.
10. A 57-year-old male from Riyadh city developed symptoms on 1 August and, on 4 August, was admitted to hospital that has been experiencing a MERS-CoV outbreak. The patient visited the emergency room of the same hospital due to unrelated medical conditions in the 14 days prior to the onset of symptoms. He has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. The patient, who has comorbidities, tested positive for MERS-CoV on 6 August. Currently, he is in critical condition in ICU. Investigation of possible epidemiological links with the MERS-CoV cases admitted to his hospital or with shared health care workers is ongoing.
11. A 57-year-old male from Riyadh city developed symptoms on 29 July and, on 30 July, was admitted to a hospital that has been experiencing a MERS-CoV outbreak. The patient visited the emergency room of the same hospital due to unrelated medical conditions in the 14 days prior to the onset of symptoms. He has no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. The patient, who has comorbidities, tested positive for MERS-CoV on 2 August. Currently, he is in stable condition in ICU. Investigation of possible epidemiological links with the MERS-CoV cases admitted to his hospital or with shared health care workers is ongoing.
12. A 73-year-old female from Riyadh city developed symptoms on 31 July and, on 2 August, was admitted to a hospital that has been experiencing a MERS-CoV outbreak. The patient visited the emergency room of the same hospital due to unrelated medical conditions in the 14 days prior to the onset of symptoms. She had no history of exposure to other known risk factors in the 14 days prior to the onset of symptoms. The patient, who had comorbidities, tested positive for MERS-CoV on 4 August and passed away on 11 August. Investigation of possible epidemiological links with the MERS-CoV cases admitted to her hospital or with shared health care workers is ongoing.

Contact tracing of household and healthcare contacts is ongoing for these cases.

The National IHR Focal Point for the Kingdom of Saudi Arabia also notified WHO of the death of 1 MERS-CoV case that was reported in a previous DON on 12 August (case n. 14).

Read More

Annals : Needed - An Orchestrated Scientific Response To MERS

Coronavirus – Credit CDC PHIL

 

#10,424

 

We are just shy of three years since we first heard of a previously unidentified novel coronavirus discovered to be circulating in Saudi Arabia. News which came from a September 2012 letter posted in ProMed Mail (NOVEL CORONAVIRUS - SAUDI ARABIA: HUMAN ISOLATE) by Dr. Ali Mohamed Zaki - an Egyptian Virologist working In Saudi Arabia.

When it was first announced, MERS (then nCoV) seemed more a scientific curiosity than a public health threat.

 

Retrospective analysis showed the MERS coronavirus to have been involved in a pneumonia outbreak at a hospital in Jordan in April of that year (see Serological Testing Of 2012 Jordanian MERS Outbreak), and we saw a small handful of sporadic cases that fall.

 

Still, 2012 closed out with fewer than 10 confirmed cases (see WHO Coronavirus Update).

That number would increase 20-fold over the next twelve months – in part due to better surveillance and testing -  with the global tally sitting at 187 cases by the end of 2013. The global tally would grow again to 960 by the end of 2014, and so far in 2015 we’ve added roughly 500 more cases.

Credit ECDC RRA July 31st, 2015

While 1400 cases and 500 deaths in three years pales in comparison to the Ebola crisis in West Africa, MERS-CoV – as a respiratory virus – has more built in  `pandemic potential’  than do hemorrhagic fevers.  

 

Also, MERS produces a wider spectrum of illness than Ebola, with both severe and mild (even asymptomatic) cases, which suggests documented cases may represent a fraction of the total burden of the disease.  In November of 2013, we looked at a study that calculated  that for every case identified, there were likely 5 to 10 that went undetected.

The origins of the virus are not fully understood, but serum analysis of dromedary blood samples going back 30 years shows the virus present in that species for decades (see EID Journal: Three Decades Of MERS-CoV Antibodies In Camels), while experiments by Colorado State University (see Back To The Camel `Shed’) show camels shed copious amounts of virus.

 

While likely only responsible for a small fraction of the total number of human cases, camel contact likely re-seeds the virus back into the community regularly.  How often, and under what circumstances that happens, remains unknown.

And that’s the problem.  After three years, we still know surprisingly little about the ecology and epidemiology of the MERS coronavirus.   Deficits we’ve looked at often, including last May in WHO EMRO: Scientific Meeting Reviews MERS Progress & Knowledge Gaps.

While many cases have been linked to hospital spread, and camels are presumed to play some part in introduction of the virus to humans, for most community acquired cases the source of infection remains unknown.

 

Also unexplained are the lopsided demographics of infection (skewing predominately older, and male), with those under the age of 20 (40% of the Saudi Population) only representing about 2% of the cases.

 

Normally we’d get answers to these questions from a well mounted case-control study, where epidemiologists would compare laboratory-confirmed cases to a large number of controls, matched for age, sex, and by neighborhood. By examining their respective exposures against their outcomes, patterns of risk are often revealed.

 

But despite repeated promises (see KSA Announces Start To Long-Awaited MERS Case Control Study), for whatever reason, we’ve yet to see the results.

 

The recent exportation of a single MERS case to South Korea, where it precipitated 185 additional infections, along with the current outbreak in Riyadh just five weeks before the start of the Hajj, is a strong reminder that what we don’t know about MERS can hurt us.

The Koreans have promised a `white paper’ on their recent MERS outbreak, and I expect we’ll see a number of other papers published.  After a shaky start, the Koreans showed commendable openness regarding their outbreak.

Sadly, the same cannot be said for the country at the epicenter of the MERS outbreak; Saudi Arabia.   

 

Scientific papers have been slow to emerge, daily reporting on cases is both erratic and devoid of much needed detail, and without a proper case-control study, our understanding of the dynamics of MERS disease transmission remains murky at best. 

 

While MERS doesn’t appear ready for pandemic prime time, it has also shown no signs of going away.

 

All of which leads up to an opinion piece, published online today in the Annals of Internal Medicine, arguing for better international scientific collaboration on MERS while its threat remains limited.   I’ve only excepted the first paragraph, so follow the link to read it in its entirety.

 

Ideas and Opinions | 18 August 2015

Orchestrated Scientific Collaboration: Critical to the Control of MERS-CoV

Trish M. Perl, MD, MSc; and Connie Savor Price, MD

Ann Intern Med. 2015;163(4):313-314. doi:10.7326/M15-1395

This article was published online first at www.annals.org on 23 June 2015.

With the public riveted to the Ebola virus disease epidemic this past year, it is not surprising that the Middle East respiratory syndrome (MERS) has fallen off the radar. Time (1) identified the spread of the MERS virus as one of the top 10 underreported stories in 2013 and cited the low number of known reported cases as grossly understating the potential threat. Now, almost 3 years after the World Health Organization announced the first recognized human case of MERS, it has reemerged in the Middle East; however, it is overshadowed by Ebola and other new emerging infectious diseases. But with a rapidly evolving and new cluster of at least 172 cases in Korea—including 3 generations of transmission and 27 deaths as of 23 June 2015—it is imperative that we assess our progress to date in containing and understanding MERS (2).

(Continue . . .)

Read More

RESEP HATI AYAM TUMIS BUMBU KECAP

Resep tumis hati ayam kecap dimasak enak dengan bumbu sederhana. Sebagai salah satu makanan favorit masyarakat Indonesia pada umumnya, hati ayam biasa dijadikan bahan utama atau pelengkap dalam berbagai macam kreasi cara memasaknya.

Resep masakan hati ayam yang ditumis enak dan sederhana perpaduan bumbu kecap berikut ini bisa kita coba untuk menambah variasi olahan menu berbahan dasar ati ayam yang dimasak secara praktis.

Hati ayam sebagai salah satu organ jeroan ini merupakan makanan yang sehat karena beragam nutrisi penting dan tingginya gizi yang dikandungnya memang sangat diperlukan oleh tubuh kita selama tidak dikonsumsi terlalu sering atau dengan porsi secara berlebihan, bahkan untuk kondisi kesehatan tertentu justru sebaiknya menghindarinya dulu.

RESEP TUMIS HATI AYAM KECAP

Hati ayam juga bisa dimasak bersama pasangannya ampela atau aneka jeroan lainnya. Pada kesempatan kali ini kita hanya memakai hanya ati ayam sebagai bahan utamanya, akan tetapi kita juga bisa menggunakan ati ayam beserta ampelanya.

Bahan dan bumbu :

• 4 buah hati ayam
• 1 batang daun bawang dipotong kecil-kecil
• 1 buah tomat diiris-iris kecil
• 3 buah cabe merah besar
• 4 butir bawang merah diiris tipis
• 3 siung bawang putih diiris tipis
• 2 lembar daun salam
• 3 cm lengkuas digeprek
• 2 cm jahe digeprek
• 1 sendok teh gula merah disisir
• 3 sendok makan kecap manis atau sesuaikan
• 1/2 sendok teh garam
• 1/2 sendok teh kaldu ayam bubuk atau penyedap
• 100 ml air
• minyak secukupnya untuk menumis

CARA MEMBUAT TUMIS HATI AYAM :

1. Cuci hati ayam dengan air mengalir (air keran) kemudian rebus dengan air bersih secukupnya hingga matang. Angkat dan tiriskan lalu potong-potong kecil atau berbentuk dadu, sisihkan sementara.
2. Panaskan minyak secukupnya, setelah cukup panas masukkan bawang merah, cabe merah, bawang putih, bawang daun, daun salam, lengkuas dan jahe lalu tumis hingga harum.
3. Masukkan potongan hati ayam, aduk-aduk rata kemudian masukkan air, tomat, gula merah, garam, penyedap dan kecap manis.
4. Aduk rata lalu masak hingga matang dan kuah menyusut, matikan api lalu angkat dan siap untuk disajikan.

Read More

Saudi MOH Reports 9 More MERS Cases In Riyadh

 

 

# 10,423

 

Although they telegraphed today’s new total several hours ago in an updated banner, the Saudi MOH has just published today’s update with the largest one-day tally of  MERS cases since May 11th; nine new patients, 2 deaths, and 1 recovery – all from the capital city of Riyadh.

 

One Healthcare worker is cited, but all 9 are listed as contacts of previously identified cases.  The individual details of their exposures are not provided, but many in recent days have been listed as nosocomial in nature.

 

Over the past 14 days Saudi Arabia has reported 48 MERS infections, with 45 of those from from Riyadh.  Cases in the capital city have been attributed to a large familial cluster, a large number of hospital acquired cases, a couple with recent camel exposure, and the rest are either unknown or unspecified.

Although cases have been reported during every month of the year, in the short history of human MERS detections, we typically see fewer cases during the summer. (August 2013=20, August 2014=5).

 

Over the past couple of years we’ve seen several high profile MOH campaigns to improve hospital infection control protocols, yet the effective control of MERS in Saudi Hospitals remains an elusive goal.

For more on this you may wish to revisit MERS, HCWs, And Infection Control.

Read More

Korean Patient Remains MERS-CoV Positive After 11 Weeks

# 10,423

 

Although there have been no new MERS cases reported in South Korea over the past 6 weeks, the official 28 day countdown clock to declare the end of their outbreak doesn’t begin until the last patient under treatment either dies or clears the virus.

Normally, patients clear the virus in a matter of a couple of weeks, but patient #80, a 35-year old afflicted with malignant lymphoma, continues to test positive more than 11 weeks after he became infected.

 

While outliers, prolonged carriage and shedding of viruses (like MERS, Ebola, and Influenza) has been documented fairly often, particularly in immunocompromised patients.

 

S. Korea to delay declaration of official end of MERS crisis

 English.news.cn | 2015-08-17 15:44:59 | Editor: huaxia

SEOUL, Aug. 17 (Xinhua) -- South Korea's health authorities are expected to delay the declaration of the official end of the Middle East Respiratory Syndrome (MERS) crisis as one patient, who had suffered from the immunity-weakening disease before infection, was tested positive.

As of Monday, the total MERS contagion number has been unchanged at 186 for 43 days since July 6, according to the Ministry of Health and Welfare. The death toll has made no change at 36 for 37 days since July 12.

Despite the de-facto end of the viral disease spread, the official end had yet to be declared as the World Health Organization advised the country to announce the end officially, 28 days after the last patient is tested negative.

The South Korean government declared the de-facto end of the MERS crisis last month. Patient 80 was still tested positive for the MERS virus as the 35-year-old suffered from malignant lymphoma, which weakens the immunity system.

To eradicate the blood cell tumors, anti-cancer agents should be injected, but the cure cannot be applied to the patient as the injection deteriorates the immunity system further.

Read More

MJA: Ethical Considerations In The Management Of Ebola Virus Disease

Full PPE – Credit Emory University

 

# 10,422

Up until 18 months ago, Ebola was viewed as a rarely seen, usually self-limiting, disease outbreak threat relegated to a few very remote regions of interior Africa. Between 1976 and 2013, fewer than 2000 deaths had been attributed to its various incarnations, and the only doctors and HCWs likely to encounter it were stationed in Uganda, the DRC, or a handful of other African nations.

The events of the past 18 months – with roughly 28,000 cases and more than 11,000 deaths, and a geographic expansion of the virus to Western Africa and the export of cases to several non-African nations -  means the number of health care facilities around the world that either have - or will be -  called upon to treat Ebola has expanded greatly.

With our increasingly mobile society, it is no longer inconceivable that an Ebola (or MERS, Lassa Fever, or Avian Flu) patient could show up – unannounced – at the door of any hospital, clinic, or doctor’s office in the world.  Moving forward, the risks are considered high enough that this summer the HHS Launched a National Ebola Training & Education Center to prepare HCWs for that possibility.

While most well equipped hospitals should – in theory – be able to safely care for highly infectious patients, the reality has been less than reassuring. As a result, earlier this summer the HHS announced they had Selected 9 Regional Ebola & Special Pathogens Treatment Centers to provide specialized care for Ebola, MERS, and Avian flu cases.

 

Saudi Arabia continues to struggle with nosocomial MERS outbreaks, South Korea saw 1 imported case lead to 185 additional cases this summer (including 23 doctors and nurses), and two nurses were infected with the Ebola virus at a Dallas hospital last fall. 

 

While their working conditions are far less exacting that those found in modern medical facilities, the Ebola outbreak in Western Africa has also resulted in the infection of more than 800 Healthcare Workers, and 500 deaths.

 

It is hard to argue that both the perception, and the reality, of treating exotic infectious disease cases (like Ebola, MERS, Avian flu, etc.) is that it is not without some personal risk, even in modern hospital settings.

 

Through proper infection control practices, those risks can be greatly reduced,  but not 100% eliminated.

 

Add in the lack of a vaccine, and few if any specific treatment options, and a heightened level of concern among healthcare providers is to be expected.

 

All of which leads up to an article, appearing last night in the MJA (Medical Journal of Australia) that looks at some of the ethical dilemmas surrounding the treatment of Ebola Virus Disease (EVD) cases. 

 

The full article is worth reading in its entirety, so follow the link below.  When you return I’ll have a bit more on how these considerations might also apply in a future pandemic.

 

Ethical considerations in the management of Ebola virus disease

Thomas Solano, Gwendolyn L Gilbert, Ian H Kerridge, Vineet Nayyar and Angela Berry

Med J Aust 2015; 203 (4): 193-195.

doi: 10.5694/mja15.00168

Summary

• Is it ethically appropriate in some circumstances for HCWs to decline to care for patients with EVD?
• How should treatment decisions be made regarding limitation of therapy for patients with EVD?
• There are two main ethical questions regarding the critical care of patients with EVD in an Australian setting:
  • Is it ethically appropriate in some circumstances for HCWs to decline to care for patients with EVD?
  • How should treatment decisions be made regarding limitation of therapy for patients with EVD?
• The key concern is ensuring that no patient is denied therapy that should be provided, while preventing unnecessary risk to HCWs.
• It is imperative to develop an approach that facilitates rigorous, evidence-based and ethically justifiable decision making, which should include a predetermined, institutionally endorsed process for assessing difficult clinical scenarios as they arise.

(Continue . . . )

 

While the ethical decisions surrounding the admission of an Ebola patient to a hospital are considerable, they would pale in comparison to a truly severe pandemic; one caused by a virus without a vaccine or effective treatment. 

 
Over the past year we’ve seen updated guidance on PPE (Personal Protective Equipment) standards, and procedures, for dealing with Ebola and other highly infectious diseases (see CDC Ebola Guidance: Web Based PPE Training, Video: The Emory Ebola PPE Doffing Protocol,  The Ebola PPE Demonstration Video) and the takeaway is that protecting HCWs against these types of dangerous pathogens is both complex, and resource intensive.

 

While it seems probable that the majority of HCWs - when provided with the proper PPEs - would be willing to provide care to a limited number of Ebola, MERS, or Avian flu patients, that equation could very well change in times of a major outbreak, particularly one exacerbated by equipment shortages.

 

Ebola is an unlikely candidate to spark the kind of outbreak that would severely tax our national supplies of PPEs, but respiratory viruses like avian or swine flu, SARS, or MERS could conceivably spread quickly and affect millions of people.  

 

• During the opening months of the relatively mild 2009 H1N1 pandemic, sporadic PPE shortages were reported (see California Nurses Association Statement On Lack Of PPE), and would likely happen again.
• In 2009 the Minnesota Center for Health Care Ethics and University of Minnesota Center for Bioethics  released draft ethical pandemic guidelines on the rationing of scarce resources, where they estimated their were only enough PPE’s in the state of Minnesota to last 3 weeks into a severe pandemic.
• Just last year, in NIOSH: Options To Maximize The Supply of Respirators During A Pandemic, we looked at strategies to try and cope with  the expected shortfall in PPEs during a severe pandemic.

Even were Healthcare workers to agree to work without adequate protection, their attrition rate from infection would likely reduce their numbers quickly, rendering any noble gesture on their part short-lived. 

 

And it isn’t just doctors and nurses who at risk. Non-medical (and often low paid) employees such as housekeeping, food service, laundry, security, lab, and even clerical workers are vitally important to the operation of any healthcare facility.

 

Two years ago, in Study: Willingness of Physicians To Work During A Severe Pandemic, we looked at a study  published in the Asia Pacific Family Medicine journal, that polled Canadian doctors to try to determine under what circumstances they would be unwilling to work during a pandemic.

 

Although limited by only a 22% response rate to the poll, under certain scenarios, fewer than half of the doctors who responded would be willing to report for work during a severe pandemic.

 

The numbers from this Canadian poll are not out of line with previous studies we’ve seen, including a 2010 report (See Study: Willingness Of HCWs To Work In A Pandemic) that polled 18,612 employees of the Johns Hopkins Hospital from January to March 2009, and found:

 

Demographic and professional distribution of respondents was similar to all hospital staff. Overall, more than one-in-four (28%) hospital workers indicated they were not willing to respond to an influenza pandemic scenario if asked but not required to do so. Only an additional 10% were willing if required. One-third (32%) of participants reported they would be unwilling to respond in the event of a more severe pandemic influenza scenario.

 

While there are a lot of personal factors that could influence an individual HCWs decision to work or not (severity of the virus, personal health, family obligations, safety & security of the workplace,  etc.) the number one deal breaker would almost certainly be a lack of PPEs. 

 

Our Strategic National Stockpile has hundreds of millions of N95 and surgical masks in reserve, but the numbers needed as envisioned last April in the CID Journal report Potential Demand for Respirators and Surgical Masks During a Hypothetical Influenza Pandemic in the United States run into the billions.

 

From their Results and Conclusions:

Assuming that 20% to 30% of the population would become ill, 1.7 to 3.5 billion respirators would be needed in the base case scenario, 2.6 to 4.3 billion in the intermediate demand scenario, and up to 7.3 billion in the maximum demand scenario (for all scenarios, between 0.1 and 0.4 billion surgical masks would be required for patients). For pandemics with a lower attack rate and fewer cases (eg, 2009-like pandemic), the number of respirators needed would be higher because the pandemic would have longer duration.

Providing these numbers of respirators and surgical masks represents a logistic challenge for US public health agencies. Public health officials must urgently consider alternative use strategies for respirators and surgical masks during a pandemic that may vary from current practices.

 

The take away from all of this is that many of the same ethical dilemmas discussed in the MJA article above – particularly `a duty to treat’ - could just as easily arise in a moderate to severe influenza pandemic.

The time to face those dilemmas is now, before the next flu falls.

Read More