Majoring in English at Columbia in the 1950s doomed me to a career in teaching. But it also taught me the rudiments of close textual analysis, a then-fashionable style of literary criticism. (If only I'd gone to Toronto to study at the feet of Northrop Frye! I might have made something of myself.)
Infection prevention and control measures are critical to prevent the possible spread of MERS-CoV in health care facilities. It is not always possible to identify patients with MERS-CoV early because like other respiratory infections, the early symptoms of MERS-CoV are non-specific. Therefore, health-care workers should always apply standard precautions consistently with all patients, regardless of their diagnosis.
[Three years into its MERS outbreak, the KSA has failed to apply standard precautions, despite three years' worth of such WHO advice.]
Droplet precautions should be added to the standard precautions when providing care to patients with symptoms of acute respiratory infection; contact precautions and eye protection should be added when caring for probable or confirmed cases of MERS-CoV infection; airborne precautions should be applied when performing aerosol generating procedures.
[This poor woman was presenting with symptoms of acute respiratory infection, while her Saudi and expatriate caregivers blithely ignored them.]
Until more is understood about MERS-CoV, people with diabetes, renal failure, chronic lung disease, and immunocompromised persons are considered to be at high risk of severe disease from MERS‐CoV infection. Therefore, these people should avoid close contact with animals, particularly camels, when visiting farms, markets, or barn areas where the virus is known to be potentially circulating.
[In Saudi Arabia, 17.6% of the population has diabetes, and the International Diabetes Federation estimates 1.244 million undiagnosed cases in adults. Saudi Arabia has 15,000 cases of renal failure, and most Saudi nosocomial outbreaks are traced to hospitals' dialysis machines. About 14% of Saudis suffer from chronic obstructive pulmonary disease, caused by tobacco or domestic cooking. So anyone admitted to a Saudi hospital with such ailments should indeed be considered at risk of nosocomial infection.]
General hygiene measures, such as regular hand washing before and after touching animals and avoiding contact with sick animals, should be adhered to. Food hygiene practices should be observed.
[If you can't get even American HCWs to wash their damn hands, it's a waste of time to warn Saudi camel fanciers not to pet their beasts.
People should avoid drinking raw camel milk or camel urine, or eating meat that has not been properly cooked.
[Easy advice for westerners to offer, but some of us like our steaks rare enough to bleed.]I understand the problems WHO and other agencies face in telling the truth to their national patients. Like the South Koreans who went "doctor shopping" during the MERS outbreak there, and thereby worsened the outbreak, WHO's member states don't like to be told they're unsanitary wretches whose slovenly habits threaten the world. And while they have criminally underfunded WHO for decades, they're quite prepared to further reduce their almsgiving.