MERS demon­strates need for public health strate­gies

The China Post - - COMMENTARY -

The Mid­dle East Re­s­pi­ra­tory Syn­drome (MERS) virus is caus­ing alarm in neigh­bor­ing South Korea and China. As of Sun­day, 15 cases of the se­vere form of SARS have been di­ag­nosed in South Korea, in­clud­ing a man who went to main­land China via Hong Kong, de­fy­ing health au­thor­i­ties’ bor­der con­trol ef­forts and sub­se­quently lead­ing to dozens of oth­ers need­ing to be quar­an­tined.

With a fa­tal­ity rate of 30-40 per­cent, MERS is in­deed a deadly foe. Air travel re­mains a big prob­lem, as our quar­an­tine pro­ce­dures need to be re­in­forced for the in­evitable breach in de­fenses when a pa­tient comes through bor­ders with­out the dis­ease be­ing no­ticed — an event that some­times can­not be helped when symptoms de­velop af­ter­ward.

Fever, cough­ing, and ir­ri­tabil­ity in the re­s­pi­ra­tory tract are symptoms of the in­fec­tion. Be­cause so many con­ta­gious dis­eases share the same traits, it is now con­tin­gent on the public to re­in­force the pro­to­col for daily hy­giene, in­clud­ing wash­ing hands fre­quently and wear­ing a mask if cough­ing.

Health au­thor­i­ties have also iden­ti­fied con­sump­tion of un­cooked food and camel milk as high-risk fac­tors.

Com­pul­sory quar­an­tine for deadly dis­eases such as MERS is nec­es­sary for the well-be­ing of both the un­in­fected as well as the car­ri­ers. The Korean man who trav­eled to Guang­dong first lied to South Korean health per­son­nel about vis­it­ing his fa­ther, who was in hos­pi­tal for MERS, and then lied to Hong Kong bor­der in­spec­tors when he was ques­tioned for dis­play­ing a fever, say­ing that he did not have any con­tact with MERSre­lated pa­tients, ac­cord­ing to the United Daily News (UND).

Tai­wan has penal­ties of NT$10,000 to NT$150,000 fines that can be dished out to those who con­ceal their travel his­tory with re­spect to MERS con­tact. Fur­ther­more, de­nial of travel is legally man­dated. While the mo­ti­va­tions for con­tra­ven­ing safety pro­to­cols such as th­ese are var­ied, they tend to fall into cat­e­gories of self­ish in­ter­est in pre­serv­ing free­dom of move­ment.

MERS and Ebola are both trans­mit­ted through con­tact with body flu­ids. Once a break­out oc­curs, it be­comes an up­hill climb to cap the num­ber of car­ri­ers, not to men­tion the es­ca­lat­ing costs of panic and ap­pre­hen­sion in so­ci­ety. The best strat­egy, it would seem, is to build a hardy de­fense con­fig­u­ra­tion enough to with­stand oc­cur­rences of dis­ease that are out­side Tai­wan’s con­trol.

The fore­run­ner in the dis­cov­ery and fight against the Ebola virus, Dr. Jean-Jac­ques Myuembe, said in an AFP ar­ti­cle pub­lished on Satur­day that the deadly dis­ease, which shook the world with the 2014 epi­demic, “will re­turn.” Tak­ing the threat se­ri­ously re­quires in­vest­ment in in­fra­struc­ture, con­sist­ing of both a com­plete anti-dis­ease di­ag­no­sis­in­ter­cep­tion-quar­an­tine-treat­ment net­work in place, whose strength is determined by the de­gree of ad­her­ence to ef­fec­tive hy­giene stan­dards.

This is turn raises ques­tions about is­sues like understaffing in hos­pi­tals and re­ported lack of beds as well as proper spacing be­tween hos­pi­tal beds — 1 me­ter is nec­es­sary, but that stan­dard is not al­ways up­held, said Wang Ren-Hsien, pres­i­dent of the Tai­wan Counter Con­ta­gious Dis­eases So­ci­ety, in a let­ter to the UND. Wang at­trib­uted the cen­tral re­gion’s suc­cess in Tai­wan’s battle against SARS in 2003 to the pro­vi­sion of many empty hos­pi­tal beds in hos­pi­tals where there was an out­break. Ac­cord­ing to him, the cen­tral re­gion — con­sist­ing of six coun­ties and cities — achieved a sat­u­ra­tion of empty beds in a high ra­tio over beds where in­fected pa­tients were placed. Re­dun­dant ca­pac­ity ap­pears to be an in­sight here.

Tai­wan should re­dou­ble its in­vest­ment in in­fra­struc­ture in­no­va­tions, drawing on the in­ge­nu­ity that has long been one of the coun­try’s strengths, to boost de­fenses against contagion. While public space al­ways car­ries with it both the con­ve­nience of ef­fi­cien­cies of scale, to the ex­tent pos­si­ble we should in­vest in cre­ative tech­no­log­i­cal and er­gonomic so­lu­tions to mit­i­gate those costs.

As an inspiring an­ti­dote to the per­ils of com­fort and hy­giene in­her­ent in the con­fine­ment of flight cab­ins, a pos­si­ble im­prove­ment could be to en­cour­age the im­port of a fin­shaped air­flow di­rec­tion sys­tem de­signed by high school stu­dent Ray­mond Wang, re­ported by the Wash­ing­ton Post. The de­vice seeks to ad­dress the prob­lem of bod­ily flu­ids by cre­at­ing pock­ets of fresh air around each per­son — “per­son­al­ized ven­ti­la­tion space,” as Wang de­scribed. This would cost as lit­tle as US$1,000 per seat to in­stall on an air­plane, and it could re­duce germ-con­cen­tra­tion by as much as 55 times by Wang’s own es­ti­mates. Look­ing into in­no­va­tions like Wang’s could be an ef­fec­tive de­fense against the trans­mis­sion of danger­ous dis­eases.

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