Middle East Respiratory Syndrome Outbreak Research Articles

Is Crisis and Emergency Risk Communication as Effective as Vaccination for Preventing Virus Diffusion? Measuring the Impacts of Failure in CERC with MERS-CoV Outbreak in South Korea.

This study measured the impacts of failure in Crisis and Emergency Risk Communication (CERC) during the outbreak of a contagious Corona viral disease. The study measured the impacts by the number of individuals and hospitals exposed to the virus. The 2015 Middle East Respiratory Syndrome (MERS) outbreak in South Korea was used to investigate the consequences of CERC failure, where the names of hospitals exposed to MERS‐CoV were withheld from the public during the early stage of virus diffusion. Empirical data analyses and simulated model tests were conducted. The findings of analyses and tests show that an early announcement of the hospital names and publicizing the necessary preventive measures could have reduced the rate of infection by approximately 85% and the number of contaminated healthcare facilities by 39% at maximum. This level of reduction is comparable to that of vaccination and of social distancing.

Infection Control in the Era of COVID-19: A Narrative Review.

COVID-19 quickly became a pandemic causing millions of infections and mortalities. It required real-time adjustments to healthcare systems and infection prevention and control (IPC) measures to limit the spread and protect healthcare providers and hospitalized patients. IPC guidelines were adopted and developed based on experience gained during the MERS-CoV and SARS-CoV outbreaks. The aim of this narrative review is to summarize current evidence on IPC in healthcare settings and patients with COVID-19 to prevent nosocomial infections during the actual pandemic. A search was run on PubMed using the terms (‘COVID-19’ [Mesh]) AND (‘Infection Control’ [Mesh]) between 2019 and 2021. We identified 86 studies that were in accordance with our aim and summarized them under certain themes as they related to COVID-19 infection control measures. All the guidelines recommend early diagnosis and rapid isolation of COVID-19 patients. The necessary precautions should be taken comprising the whole process, starting with an infectious disease plan, administrative and engineering controls, triage, and PPE training. Guidelines should target modes of transmission, droplet, aerosol, and oral–fecal, while recommending control precautions. Healthcare facilities must promptly implement a multidisciplinary defense system to combat the outbreak.

Healthcare-associated COVID-19 in England: A national data linkage study

ObjectivesNosocomial transmission was an important aspect of SARS-CoV-1 and MERS-CoV outbreaks. Healthcare-associated SARS-CoV-2 infection has been reported in single and multi-site hospital-based studies in England, but not nationally.MethodsAdmission records for all hospitals in England were linked to SARS-CoV-2 national test data for the period 01/03/2020 to 31/08/2020. Case definitions were: community-onset community-acquired, first positive test <14 days pre-admission, up to day 2 of admission; hospital-onset indeterminate healthcare-associated, first positive on day 3–7; hospital-onset probable healthcare-associated, first positive on day 8–14; hospital-onset definite healthcare-associated, first positive from day 15 of admission until discharge; community-onset possible healthcare-associated, first positive test ≤14 days post-discharge.ResultsOne-third (34.4%, 100,859/293,204) of all laboratory-confirmed COVID-19 cases were linked to a hospital record. Hospital-onset probable and definite cases represented 5.3% (15,564/293,204) of all laboratory-confirmed cases and 15.4% (15,564/100,859) of laboratory-confirmed cases among hospital patients. Community-onset community-acquired and community-onset possible healthcare-associated cases represented 86.5% (253,582/293,204) and 5.1% (14,913/293,204) of all laboratory-confirmed cases, respectively.ConclusionsUp to 1 in 6 SARS-CoV-2 infections among hospitalised patients with COVID-19 in England during the first 6 months of the pandemic could be attributed to nosocomial transmission, but these represent less than 1% of the estimated 3 million COVID-19 cases in this period.

An Optimal Control Analysis of the MERS-CoV Outbreak in South Korea

MERS-CoV is a respiratory disease that originated in the Middle East. This disease is caused by a novel coronavirus which transmits from Dromedary camels to humans, then passed on to other humans through direct contact or droplets. Said to be the biggest to occur outside of Middle East with 186 cases, the outbreak in South Korea should be discussed further. By going through the chain of transmission, it was found that 44\% of the infected individuals were exposed to the virus in the healthcare facilities' environment. To reduce the risk of exposure to the virus, several efforts have been made such as restricting healthcare facilities visitors and increasing the number of isolated individuals in hospitals. The previous study has developed a mathematical model for the outbreak in South Korea and estimated transmission rates from the data provided by the government. In this study, both efforts will be added as control variables to form an optimal control problem to minimize the number of infected individuals and the costs incurred. The optimal control will be obtained using the Pontryagin maximum principle, then simulated using the fourth-order Runge-Kutta forward-backward sweep method for two scenarios to see the effectiveness of both controls. The simulation showed that restricting health facilities visitors to limit the chance of exposure was the most effective strategy to control the MERS-CoV outbreak in South Korea.

Medicinal plants as immune booster in the palliative management of viral diseases: A perspective on coronavirus

AbstractMedicinal plants are not only popular for their ample store of active ingredients but also boast of several pharmacological properties including the modulation of components of the immune system. An adequate immune response is vital in counteracting the unwanted activities of pathogens such as bacteria, protozoa, and viruses. Some diseases caused by viral pathogens such as measles, chickenpox, Ebola, and human immunodeficiency virus may result in death or dire consequences in mammals with inadequate immunity. Ever since coronavirus disease 2019 (COVID‐19) boisterously announced itself to the world in December 2019, there has been a surge in the number of researches targeting medicinal plants as candidates for a potent vaccine and antiviral drug. COVID‐19 is a member of a family of coronaviruses that have been responsible for past pandemics such as the Middle East respiratory syndrome and severe acute respiratory syndrome outbreaks. However, the nascent COVID‐19 defeated existing pharmaceutical advances and nonpharmacological measures such as high personal hygiene, physical distancing, and lockdown to stop the vicious mortality arising from the viral outbreak. Consequently, the battle against this virus relies majorly on a vibrant immune system. It is therefore imperative to promote interest in the use of medicinal plants that will significantly assist in the management of COVID‐19 infection by boosting body's immune responses or arresting symptoms/molecules associated with COVID‐19 pathogenesis. This review underscores the need for the exploration of plant‐based agents that may prove effective in fighting COVID‐19 based on scientific evidence of their positive immunomodulatory effects.

The Impact of COVID-19 Pandemic on Workplace Accidents in Korea.

(1) Background: Although the number of people infected with COVID-19 has increased over time, its effects on workplace accidents are still poorly understood. On the one hand, COVID-19 can reduce workplace accidents through contracted economic activities or changes in work methods. On the other hand, it can increase workplace accidents by spreading in the workplace. The main purpose of this paper is to examine how COVID-19 affected workplace accidents in Korea during the early part of the pandemic. (2) Methods: This paper utilizes the administrative data on workplace accidents in Korea collected by Korea Occupational Safety and Health Agency. In particular, we use monthly data from February 2016 to August 2020. This period was chosen to rule out the effect from the Middle East Respiratory Syndrome outbreak in 2015 and to include COVID-19 effects in 2020, given the available data. To examine the impact of COVID-19 on workplace injury and illness, we estimate fixed effects regression models, allowing us to control for group and time effects. (3) Results: COVID-19 was generally found to reduce workplace accidents in Korea, particularly through a reduction in occupational diseases. However, we also found that COVID-19 increased occupational injuries for males and workers in the transportation industry. We provide some evidence that these workers experienced an increase in workload and were unable to change work methods including working from home during the COVID-19 pandemic. (4) Conclusions: Our results indicate that to reduce workplace accidents, government interventions should be directed at workers who are unable to change work methods and who are likely to suffer an increase in work burden due to COVID-19.

Modelling the evolution of the coronavirus disease (COVID-19) in Saudi Arabia.

The ongoing COVID-19 pandemic has claimed hundreds of thousands of lives around the world. Health planners are seeking ways to forecast the evolution of the pandemic. In this study, a mathematical model was proposed for Saudi Arabia, the country with the highest reported number of COVID-19 cases in the Arab world. The proposed model was adapted from the model used for the Middle East respiratory syndrome outbreak in South Korea. Using time-dependent parameters, the model incorporated the effects of both population-wide self-protective measures and government actions. Data before and after the government imposed control policies on 3 March 2020 were used to validate the model. Predictions for the disease's progression were provided together with the evaluation of the effectiveness of the mitigation measures implemented by the government and self-protective measures taken by the population. The model predicted that, if the government had continued to implement its strong control measures, then the scale of the pandemic would have decreased by 99% by the end of June 2020. Under the current relaxed policies, the model predicted that the scale of the pandemic will have decreased by 99% by 10 August 2020. The error between the model's predictions and actual data was less than 6.5%. Although the proposed model did not capture all of the effects of human behaviors and government actions, it was validated as a result of its time-dependent parameters. The model's accuracy indicates that it can be used by public health policymakers.

Origin, Pathogenesis, Diagnosis and Treatment Options for SARS-CoV-2: A Review.

Emerging viral infections are among the greatest challenges in the public health sector in the twenty-first century. Among these, most of the viruses jump from other species of animals to humans called zoonotic viruses. The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), by crossing species-barrier, has infected the human population for the third time in the current century and has caused the coronavirus disease-2019 (COVID-19) . Mutation and adaptation for years have greatly influenced the co-evolution and existence of coronaviruses and their possible hosts including humans. The appearance of SARS-CoV-2 in China thrust coronaviruses into the limelight and shocked the world. Presently, no coronavirus vaccines are clinically available to combat the virus's devastating effects. To counter the emergence of the COVID-19 pandemic, it is therefore important to understand the complex nature of coronaviruses and their clinical attributes. SARS and MERS outbreaks had ultimately led to socio-economic deprivation in the previous decades. In addressing the recent disastrous situation, the COVID-19 pandemic still needs some lessons from prior experience. In this review, we have highlighted the chronological order of coronavirus strains, their genomic features, the mechanism of action of SARS-CoV-2, and its disastrous repercussions on the world. We have also suggested some therapeutic options that could be effective against the COVID-19.

COVID-19 in Korea: Success Based on Past Failure*

Abstract This paper analyzes how the Republic of Korea (Korea) halted the massive transmission of COVID-19 in just two months. The quarantine was achieved successfully without any need for a national lockdown because, simply, Korean citizens actively followed quarantine guidelines. During the 2015 Middle East Respiratory Syndrome (MERS) outbreak, the country recognized the importance of an early response in the form of a systematic approach and adopted the necessary procedures. Comparing the spread of COVID-19 among different countries, Korea demonstrated several distinct characteristics. First, the duration of the coronavirus crisis was relatively short, and Korea was able to flatten the coronavirus curve in a brief period. Second, Korea blocked expanded transmission of the virus without implementing a national lockdown. Third, the coronavirus pandemic did not lead to economic panic. Korea, which had developed an institutional response to infectious diseases prior to COVID-19, used a strategy of balancing quarantine measures with economic policies. The paper summarizes the specific measures Korea implemented to overcome COVID-19, and discusses the sustainability of the economy after overcoming the virus.

SARS/MERS/SARS-CoV-2 Outbreaks and Burnout Syndrome among Healthcare Workers. An Umbrella Systematic Review.

The coronavirus-19 (COVID-19) pandemic is putting a severe strain on all healthcare systems. Several occupational risk factors are challenging healthcare workers (HCWs) who are at high risk of mental health outcomes, including Burnout Syndrome (BOS). BOS is a psychological syndrome characterized by emotional exhaustion, depersonalization, and low personal accomplishment. An umbrella review of systematic reviews and meta-analyses concerning BOS and coronavirus (SARS/MERS/SARS-CoV-2) outbreaks was carried out on PubMed Central/Medline, Cochrane Library, PROSPERO, and Epistemonikos databases. Data relating to COVID-19 is insufficient, but in previous SARS and MERS outbreaks about one-third of HCWs manifested BOS. This prevalence rate is similar to the figure recorded in some categories of HCWs exposed to chronic occupational stress and poor work organization during non-epidemic periods. Inadequate organization and worsening working conditions during an epidemic appear to be the most likely causes of BOS. Preventive care and workplace health promotion programs could be useful for protecting healthcare workers during pandemics, as well as during regular health activities.

Pandemic and hospital avoidance: Evidence from the 2015 Middle East respiratory syndrome outbreak in South Korea

Existing literature shows that people exhibit disease avoidance behaviors in response to contagious disease outbreaks. We examine hospital avoidance behaviors during the 2015 Middle East respiratory syndrome (MERS) outbreak in South Korea. The outbreak provides an excellent setting for the analysis because unlike the coronavirus disease-19 (COVID-19) situation, no mandatory lockdown was imposed during the outbreak, and the economic impact was also not large. Hence, reduced hospital visits are likely to reflect the public’s intention to avoid hospitals to protect themselves from getting infected with MERS. Moreover, the outbreak did not spread to the entire country and vanished after a short period of time, allowing us to consider the affected regions as the treatment group and the other regions as the control group without much concern of confounding by other factors. The data come from a government agency, which assesses (national) health insurance claims made by hospitals, and hence cover all outpatient visits in the country. We find that people reduced outpatient visits by about 17% in response to the MERS outbreak, and the response was the most intense when new cases were reported most frequently.

Effectiveness of Intervention Strategies on MERS-CoV Transmission Dynamics in South Korea, 2015: Simulations on the Network Based on the Real-World Contact Data.

The MERS-CoV spread in South Korea in 2015 was not only the largest outbreak of MERS-CoV in the region other than the Middle East but also a historic epidemic in South Korea. Thus, investigation of the MERS-CoV transmission dynamics, especially by agent-based modeling, would be meaningful for devising intervention strategies for novel infectious diseases. In this study, an agent-based model on MERS-CoV transmission in South Korea in 2015 was built and analyzed. The prominent characteristic of this model was that it built the simulation environment based on the real-world contact tracing network, which can be characterized as being scale-free. In the simulations, we explored the effectiveness of three possible intervention scenarios; mass quarantine, isolation, and isolation combined with acquaintance quarantine. The differences in MERS-CoV transmission dynamics by the number of links of the index case agent were examined. The simulation results indicate that isolation combined with acquaintance quarantine is more effective than others, and they also suggest the key role of super-spreaders in MERS-CoV transmission.

Systematic assessment of South Korea’s capabilities to control COVID-19

South Korea’s COVID-19 control strategy has been widely emulated. Korea’s ability to rapidly achieve disease control in early 2020 without a “Great Lockdown” despite its proximity to China and high population density make its achievement particularly intriguing. This paper helps explain Korea’s pre-existing capabilities which enabled the rapid and effective implementation of its COVID-19 control strategies. A systematic assessment across multiple domains demonstrates that South Korea’s advantages in controlling its epidemic are owed tremendously to legal and organizational reforms enacted after the MERS outbreak in 2015. Successful implementation of the Korean strategy required more than just a set of actions, measures and policies. It relied on a pre-existing legal framework, financing arrangements, governance and a workforce experienced in outbreak management.

Convalescent plasma as a therapeutic agent for SARS-CoV, MERS-CoV and SARS-CoV-2

Severe acute respiratory syndrome coronavirus (SARS-CoV), Middle East respiratory syndrome coronavirus (MERS-CoV), and SARS-CoV-2 are three kinds of coronaviruses that are exceptionally pathogenic to humans via zoonotic infections. The outbreaks of SARS-CoV and MERS-CoV, and SARS-CoV-2, to some extent, posed a severe threat to human health, daily activities as well as the economic status of many countries. When faced with these emerging viruses and no accessible vaccines and drugs, convalescent plasma (CP) is required as passive immunotherapy, since CP has the potential to neutralize and eliminate the virus from blood circulation. The sources of CP are individuals who have recovered from the viruses. Currently, CP is administered as emergency use and investigational treatment. Some studies have shown that CP is effective to treat infected individuals with viral pandemics such as influenza A, Ebola virus, SARS-CoV, and MERS-CoV. Moreover, following the deadly outbreak of SARS-CoV-2 in 2019, plenty of non-randomized clinical studies have been done on the effectiveness of CP for the treatment of Coronavirus Disease 2019 (COVID-19), and most of these studies have indicated that CP therapy is promising and saved many critically-ill patients. Therefore, CP is a helpful immune therapeutic agent for the immediate response of such pandemics because of its clinical efficacy, immediate availability, cost-effectiveness, ease of production, delivery, and storage. This review aims to summarize the effectiveness of CP in the treatment of these three coronaviruses, i.e. SARS-CoV, MERS-CoV, and SARS-CoV-2.

Incidence of psychological illness after coronavirus outbreak: a meta-analysis study

BackgroundThe COVID-19 has had an enormous impact worldwide and is still spreading. Globally confirmed infections have surpassed 41.1 million, of which more than 1 million resulted in deaths. Considering the...

Coronavirus Disease 2019 (COVID-19) Pandemic and Pregnancy

(Am J Obstet Gynecol. 2020;222:521–531) Caring for vulnerable populations is a critical component of pandemic management. Pregnant women are susceptible to respiratory illness with an increased infectious morbidity and mortality. While clinical information is limited on the effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on the pregnant population, both the SARS-CoV and MERS-CoV outbreaks of the last 2 decades resulted in approximately one third of infected pregnant women dying from the illness. The purpose of this paper was to summarize the clinical features of coronavirus disease 2019 (COVID-19) in pregnant women, and present a pragmatic and integrated framework for handling complex intricacies involved in disease management.

EACTA/SCA Recommendations for the Cardiac Anesthesia Management of Patients With Suspected or Confirmed COVID-19 Infection: An Expert Consensus From the European Association of Cardiothoracic Anesthesiology and Society of Cardiovascular Anesthesiologists With Endorsement From the Chinese Society of Cardiothoracic and Vascular Anesthesiology

The European Association of Cardiothoracic Anaesthesiology (EACTA) and the Society of Cardiovascular Anesthesiologists (SCA) aimed to create joint recommendations for the perioperative management of patients with suspected or proven severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection undergoing cardiac surgery or invasive cardiac procedures.To produce appropriate recommendations, the authors combined the evidence from the literature review, reevaluating the clinical experience of routine cardiac surgery in similar cases during the Middle East Respiratory Syndrome (MERS-CoV) outbreak and the current pandemic with suspected coronavirus disease 2019 (COVID-19) patients, and the expert opinions through broad discussions within the EACTA and SCA. The authors took into consideration the balance between established procedures and the feasibility during the present outbreak. The authors present an agreement between the European and US practices in managing patients during the COVID-19 pandemic.The recommendations take into consideration a broad spectrum of issues, with a focus on preoperative testing, safety concerns, overall approaches to general and specific aspects of preparation for anesthesia, airway management, transesophageal echocardiography, perioperative ventilation, coagulation, hemodynamic control, and postoperative care.As the COVID-19 pandemic is spreading, it will continue to present a challenge for the worldwide anesthesiology community. To allow these recommendations to be updated as long as possible, the authors provided weblinks to international public and academic sources providing timely updated data.This document should be the basis of future task forces to develop a more comprehensive consensus considering new evidence uncovered during the COVID-19 pandemic.

How lessons learned from the 2015 Middle East respiratory syndrome outbreak affected the response to coronavirus disease 2019 in the Republic of Korea.

The Republic of Korea (ROK) experienced a public health crisis due to Middle East respiratory syndrome (MERS) in 2015 and is currently going through the coronavirus disease 2019 (COVID-19) pandemic. Lessons learned from the disastrous MERS outbreak were reflected in the preparedness system, and the readiness capabilities that were subsequently developed enabled the country to successfully flatten the epidemic curve of COVID-19 in late February and March 2020. In this review, we summarize and compare the epidemiology and response of the ROK to the 2015 MERS outbreak and the COVID-19 epidemic in early 2020. We emphasize that, because further COVID-19 waves seem inevitable, it is urgent to develop comprehensive preparedness and response plans for the worst-case scenarios of the COVID-19 pandemic. Simultaneously strengthening healthcare capacity to endure the peak demand and implementing smart strategies to sustain social distancing and public hygiene are necessary until safe and effective therapeutics and vaccines against COVID-19 are available.

Associations Between General Perceptions of COVID-19 and Posttraumatic Stress Disorder in Korean Hospital Workers: Effect Modification by Previous Middle East Respiratory Syndrome Coronavirus Experience and Occupational Type.

ObjectivesThis study investigated associations between perceptions of coronavirus disease 2019 (COVID-19) and the prevalence of posttraumatic stress disorder (PTSD) in workers at hospitals designated to treat COVID-19, as well as the difference in the magnitude of these associations by occupational type and previous Middle East respiratory syndrome coronavirus (MERS-CoV) experience.MethodsThe participants were workers at hospitals designated to treat COVID-19 who completed a questionnaire about their perceptions related to COVID-19, work experience during the previous MERS-CoV outbreak, and symptoms of PTSD ascertained by the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders. Participants’ characteristics were compared using the chi-square test. Multivariable logistic regression was performed to evaluate the associations between perceptions and the prevalence of PTSD, stratified by occupational type and previous MERS-CoV experience.ResultsNon-medical personnel showed stronger associations with PTSD than medical personnel according to general fear (odds ratio [OR], 6.67; 95% confidence interval [CI], 1.92 to 23.20), shortages of supplies (OR, 1.29; 95% CI, 1.07 to 1.56), and issue-specific fear (OR, 1.29; 95% CI, 1.05 to 1.59). Those with prior MERS-CoV quarantine experience were more prone to PTSD than those without such experience in terms of general fear (OR, 1.70; 95% CI, 1.22 to 2.37), shortages of supplies (OR, 1.24; 95% CI, 1.10 to 1.40), and issue-specific fear (OR, 1.21; 95% CI, 1.06 to 1.38). ConclusionsDuring the COVID-19 pandemic, non-medical personnel tended to have higher odds of being categorized as having PTSD. Workers with prior MERS-CoV experience were more susceptible than those without such experience. These findings suggest the need for timely interventions to manage human resources for a sustainable quarantine system.

Identification of (2R,3R)-2-(3,4-dihydroxyphenyl)chroman-3-yl-3,4,5-trihydroxy benzoate as multiple inhibitors of SARS-CoV-2 targets; a systematic molecular modelling approach.

Coronavirus disease of 2019 (COVID-19) is a zoonotic disease caused by a new severe acute respiratory syndrome (SARS-CoV-2) which has quickly resulted in a pandemic. Recent anti-COVID-19 drug discoveries are leaning towards repurposing phytochemicals which have been previously reported for SARS and MERS-CoV outbreaks. However, they have been either virtually screened or tested so far against mono targets and the potent derivatives of virtually sorted lead molecules remain elusive. We aimed to identify the phytochemicals having potentials to inhibit SARS CoV-2 infection via multiple targets. The selected 132 phytochemicals were virtually screened using a structure based in silico technique against main protease (Mpro) which is a potential target of SARS CoV-2. Six compounds were selected based on the LibDock scores and further subjected to induced fit docking using the CDOCKER module of DS. Two compounds namely cinnamtannin-B and gallocatechin gallate were identified as top HITS against main protease (Mpro). Based on the Lipinski rule of five (L-ROF) and synthetic feasibility, gallocatechin gallate was taken for our further studies. Six analogues of gallocatechin gallate were screened against the next important targets such as RNA-dependent RNA polymerase (RdRp), angiotensin converting enzyme-2 (ACE2), transmembrane protease serine -2 (TMPRSS2) and interleukin-6 (IL-6) along with main protease (Mpro). Our molecular docking results reveal that a gallocatechin analogue (GC-2) namely (2R,3R)-2-(3,4-dihydroxyphenyl)chroman-3-yl-3,4,5-trihydroxy benzoate has shown potential to inhibit multiple targets of SARS CoV-2. Further, the molecular dynamics study was carried out to ascertain the stability of the GC-2 and RdRp complex.