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MERS: Another Lesson in Quarantine and Health Disparity

by Craig Klugman, Ph.D.

At the G7 meeting this week, the developed nations which compose the Group of 7 pledged to “wipe out Ebola.” With over 11,000 Ebola-related deaths worldwide since March 2014, this certainly is worth public health efforts and funding.

While the “world leaders” focus on Ebola, which of course made small incursions in to the U.S. and Europe, a new epidemic lurks on the horizon—MERS. Middle East Respiratory Syndrome was first reported in September 2012 in Saudi Arabia. It can infect anyone of any age and its method of transmission is not well understood. The primary methods appears to be animal to human. Exposure to camel products and meat may be involved. Human-to-human transmission is limited, requiring very close contact. Caregivers of infected patients, thus, are at higher risk

Over one-third of people infected with MERS die from the disease. Worldwide there have been close to 1,236 cases reported with 445 deaths in 25 countries according to the World Health Organization. Saudi Arabia has reported 689 cases with a death toll of 283. On May 20, South Korea became the latest country hit with this disease and now reports 87 cases with 6 deaths. The United States had 2 cases, both health care workers who had worked in Saudi Arabia. Both were treated and discharged.

Although neither the WHO nor the CDC are proposing a travel ban, travel seems to be the method of transmission to new regions. The first case in South Korea was caused by a man who became ill after a business trip to the Arabian peninsula.

The most recent uproar in this disease occurred when a South Korean man disregarded the request for self-isolation and flew to China. He landed in Hong Kong and then traveled to the Chinese mainland. The man is being kept under quarantine and the other passengers of his flight are being sought.

South Korea is taking this threat very seriously. They have quarantined over 2,300 people and closed 1,800 schools. 1,500 of those were people who attended a symposium alongside an infected doctor.

South Korea has so far used self-isolation, asking people to stay at home and away from others, in an attempt to limit spread of the infection. As I have discussed previously, isolation and quarantine are very old and effective tools of preventing the spread of disease. But in a society where individualism and individual rights are revered, it is difficult for people to willingly give up the freedom of leaving their homes in order to help other people.

Thus, in a radio interview in an English-language station in Busan, South Korea, the host asked me about quarantine efforts—forcing people to remain away from others to prevent spread of a disease. This version includes the use of police powers. Such a more punitive arrangement is often used after a person has proven unwilling to self-isolate.

South Korea is asking a more interesting question though. Rather than just punish people for violating isolation, what about offering rewards for those who obey? Perhaps they could get free video services? Free food delivery? Guarantees that your job will be waiting afterwards? What about cash? A focus on positives (i.e. carrots) might make individuals more likely to comply.

Another challenge of isolation is making sure that they are where they are supposed to be. This is often tracked by regular visits from health care officials, and random phone calls to the home throughout the day. But South Korea may be doing one better—using cell phones to track those under isolation. By tracking cell phones, South Korea can know where people are, assuming that people usually have their cell phones on them.

Quarantine and isolation will work, especially with limited human-to-human transmission of the virus. To be effective though, people need to take self-isolation seriously and quarantine must be strictly enforced. Yes, tracking cell phones means a temporary loss of privacy and isolation/quarantine is a loss of autonomy and liberty. In public health threats, the needs of the many (i.e. community) outweigh the needs of the few. The goal is to prevent the number of new cases by decreasing morbidity and mortality.

Health Disparities
Once Ebola started reaching the developed world, it received a lot of attention. MERS has simmered in the Middle East for the last 2 years with little attention. But now that it has reached more industrialized countries with stronger ties to the West, the battle against MERS is coming to light. It is a shame that in the 21st century, attention is paid to diseases only after they pose threats to the West and to more socioeconomically developed nations. This same story plays over and over as it did in Ebola.

At some point, the socioeconomic, racial, and geographic health disparities that such diseases take advantage of suggest that the answer is not chasing after a disease, but rather, providing needed health infrastructure to prevent such diseases in the first place. Otherwise will this same story will repeat again and again and again and….

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