To date, there are 133 deaths and nearly 500 confirmed cases of MERS-cov in Saudi Arabia alone. This means that there is not a major ED in KSA that has not seen at least one case. The risk is real. Presentations range. Talking to residents in our program, most have seen a case some have seen a few, this exceeds any other area in the world with a country as big as USA for example only having two.
The emergency department numbers over the past few months are quieter in the capital, Riyadh. With the worry of the same patient, one may ask is this corona or not?! Even the frequent flyer elderly who has had the same presentation of her pulmonary edema for the past 5 years due to her non-compliance to medication wants to know if this time it is corona or not! In April, as shown in the graph below from WHO, the majority of cases has been diagnosed. Could it be because we are screening more people?
Epidemic curve of 536 patients worldwide lab-confirmed cases of MERS-cov by outcome as of 8 may 2014
The biggest danger seems to be us, health care professionals. Sadly, we have lost consultants, residents and nurses to this disease. Precaution is vital. Person-to-person transmission has been documented. WHO as does the Saudi Authority M.OH, recommend droplet precautions as the disease. So wearing of a mask is important. All our triages give surgical masks to patients with a respiratory complaint. Anyone who may get in contact with secretions as for example those nurses and RTs doing suctioning or residents intubating should be more careful. This may include gowns in addition to gloves. Instruct family members who have accompanied the patient to do the same. The incubation period of the virus is 14 days.
Patients with MERS-cov may present with a mixture of upper and lower respiratory tract infection. This includes fever, cough, sputum, coryza. There are cases that presented with diarrhea in addition to above. Patients then go to acute renal failure. The mean age was 48.5 years but the youngest case in KSA was 9 months. Health care workers are more likely to be younger, female and milder disease. However, 15% of health care workers have been affected by a severe course of the disease, resulting in ICU admission or death. One confirmed case was a middle aged diabetic who came with altered mental status and a fever. The altered mental status turned to be due to a third degree heart block from a potassium of 7.5 from her acute renal failure from her MERS-cov! So presentations vary!
As for management and treatment, hospitals are requesting all admitted patients with suspicision to be swabbed. Some hospitals such as KFSH have opened itsPCR for twice daily due to the influx. Treatment is supportive care and symptom relieve.