Respiratory fluid specimens were taken from the patient and sent to the Indiana State Health Department on April 30 for a polymerase chain-reaction test. The test, provided by the CDC, can identify a small piece of DNA or the distinct signature of the MERS virus. On May 1, the State Health Department confirmed the test was positive and isolates of the virus were overnighted to CDC headquarters in Atlanta.
As the infectious disease team waited for results from the CDC, hospital leaders were notified. They looked at electronic health records and pulled surveillance video from the ED for the 24-hour period before the patient was placed in isolation to find out who else might have been exposed. They also pulled logs of tracer tags worn by staff from a GPS system installed in 2009 to monitor workflow. The system enables the hospital to identify the location of individual staff members.
The logs showed that nearly 50 staffers had come into contact with the patient and tracked how much time each person had spent with him. Those staffers were placed on home isolation on May 2 as soon as MERS was officially confirmed by the CDC. They are being followed for the 14-day incubation period. None have tested positive for the virus, and they are expected to return to work by May 16.
“Operationally, it was hugely important to be able to understand workflow,” said Don Fesko, CEO of the hospital. “We could easily take anyone who was on duty out of duty, and quickly explain to them what was going on.”
As soon as the CDC confirmed the case as MERS and alerted the hospital, six CDC investigators were dispatched to Munster. “Honestly, we've been expecting this to happen for over a year,” Feikin said.
The viral respiratory disease was first reported in Saudi Arabia in 2012. Little is known about the condition, but it tends to spread through close contact. Patients develop fever, cough and shortness of breath within 14 days following exposure. There have been a total of 496 laboratory-confirmed cases, according to the World Health Organization, including 229 reported between April 11 and May 4. The number of deaths is estimated at more than 110. All cases have originated from six countries in the Arabian Peninsula, according to the CDC. There is no definitive treatment. MERS has been most prevalent among the elderly, healthcare workers and those with other comorbidities. Research into potential antivirals and vaccines is underway, the CDC said.