An official with the hospital caring for the first US MERS-CoV (Middle East respiratory syndrome coronavirus ) patient confirmed today that the man had some illness symptoms before he flew from Saudi Arabia to the United States, though they were not respiratory.

The patient, a US citizen who works in a healthcare job in Riyadh, Saudi Arabia, flew from Riyadh to Chicago on Apr 24. After experiencing respiratory symptoms, he was admitted to Community Hospital in Munster, Ind., on Apr 28 and tested positive for MERS-CoV on May 2.

The patient was reported to be in good condition and improving yesterday.

Hospital and local and federal health officials initially said he didn't get sick until after he arrived in Indiana, where he went to visit relatives. But the World Health Organization (WHO), in a May 5 statement about the case, said the man first came down with a fever on Apr 14.

Alan Kumar, MD, chief medical information officer for Community Hospital, said in an interview today that he wasn't sure about the source of the WHO's information, but added, "The part that I can verify is that the patient didn't have any respiratory symptoms prior to or during travel; they started after his arrival. Prior to travel the patient did feel unwell; it was difficult to nail him down on what that meant. The patient did have some low-grade, intermittent fever."

The presence of symptoms during travel implies a potentially greater risk of transmission of the virus to others who traveled with him. The man flew from Riyadh to Chicago by way of London and then took a bus to Indiana, officials have said.

Experts say it is unclear whether those infected with MERS-CoV can pass it to others before they themselves have symptoms, but the possibility hasn't been ruled out.

No suspicious symptoms in contacts

Jason McDonald, a spokesman for the Centers for Disease Control and Prevention (CDC), said today that the CDC has contacted most of the airline and bus passengers who traveled with the patient and that no illnesses have been reported among them.

Also, no symptoms strongly suggesting MERS have been reported in healthcare workers and family members who had contact with the Indiana patient, Community Hospital officials said today. The hospital reported earlier that 50 employees were put in home isolation for 14 days because of their exposure to the patient.

Andrea Farmer, a hospital spokeswoman, told CIDRAP News today, "None of the healthcare workers who are on home isolation have reported symptoms that are classic for the MERS virus, including fever or shortness of breath. It is spring allergy season and a few of the hospital's employees are dealing with seasonal allergies, which are typical for them during this time of year.

"We have reviewed these symptoms with the CDC, which does not believe these symptoms are consistent with MERS at this time. As you already know, these employees have tested negative for MERS."

Kumar said none of the employees have had any fever or shortness of breath. All of those employees have been tested for MERS-CoV at least once, and those with any symptoms have been tested more than once, with no positive results, he reported.

First hospital steps

Kumar also gave a few more details today on how long it took for doctors to suspect MERS-CoV in the patient and for the hospital to implement recommended infection control precautions.

He said the patient has been in negative-pressure rooms for his entire time in the hospital, meaning rooms in which air is drawn in and then exhausted to the outside (typically through protective filters), without being circulated to other rooms in the hospital.

Kumar said the suspicion of MERS-CoV arose on the afternoon of Apr 29, the day after the patient's admission (on the evening of Apr 28), when infectious-disease specialists discussed the case with the patient and his family.

For infection control, respiratory precautions for those in contact with the patient were instituted that afternoon, and contact precautions were added that evening, Kumar said.

The CDC recommends a full range of infection control precautions—standard, contact, and airborne—for known and suspected MERS-CoV cases.

See also:

May 5 WHO update

May 2 CIDRAP News story

CDC infection control recommendations for MERS-CoV