In our increasingly interconnected world, diseases can jump from one country to another with alarming ease despite all the advances of modern medicine. However, what is more alarming is that many governments have yet to learn that a preference for secrecy and a lack of transparency can prove fatal, politicians are ready to fuel public fear with ill-conceived proposals, and people are more than willing to disregard sound medical advice.
Despite all that the medical world and governments discovered from the SARS epidemic more than a decade ago, the initial outbreak of Middle East respiratory syndrome (MERS) in Saudi Arabia in 2012 and 2013, and last year’s outbreak of Ebola in several West African nations show that those lessons have not yet been learned — the biggest of which is that openness and exchange of information are crucial.
It was not until June last year that the Saudi Ministry of Health admitted that it had under-counted the number of cases by 20 percent because many hospitals and labs were not reporting to the government. The kingdom wasted two years that could have provided more information about the origins and transmission of the disease.
Now the disease has spread to East Asia. The outbreak of MERS in South Korea has raised concern not just in that nation, but also among its neighbors. South Korea has 41 confirmed cases of MERS and four deaths, the largest outbreak in the world outside of Saudi Arabia, since the first case was confirmed on May 20.
Secrecy on the part of that nation’s “patient zero” was the first misstep that led to the current situation — the 68-year-old man did not tell medical staff at the four facilities where he sought treatment that he had traveled to Saudi Arabia and two other Middle Eastern countries the previous month. That failure meant he was not isolated, leaving medical staff, other patients and hospital visitors exposed.
The second misstep was that the South Korean government tried to downplay concern about the disease and refused to identify the medical facilities the man visited or where he was being treated. However, that refusal not only fueled the rumor-mill: People who might have been exposed did not know, while others who needed medical treatment became fearful of going to a hospital or clinic. All the reported cases so far have been among the staff, patients or visitors at six hospitals. The four who died all suffered from previous respiratory illnesses.
A third misstep was the unwillingness of some people to follow quarantine procedures. The 44-year-old son of South Korea’s third confirmed case traveled — despite doctors’ advice — to China, via Hong Kong, where he fell ill and is now hospitalized. His trip widened the international pool of people who have to be tracked for possible exposure to the disease. A woman under home quarantine went on a golfing trip to another city with 10 friends. A doctor with MERS-related symptoms went to a symposium that was attended by more than 1,000 people in Seoul late last month.
South Korea’s president “has demanded a halt to the disease.” Seoul’s mayor yesterday declared the city was “going to war” against MERS, vowing to take “swift and stern measures” to protect the public. However, such announcements might be another misstep.
MERS, unlike SARS, is not an airborne virus. It is transmitted through close contact, and the vast majority of cases in South Korea are linked to a single hospital. So the government’s shuttering of hundreds of schools “to prevent the spread of the disease” makes little sense from an epidemiological standpoint, but does fuel public fear about the chances of contamination.
South Korea is offering yet another lesson to the world about how secrecy raises the risks of disease, not curtails it. The first line of defense in an epidemic must be full and complete transparency — from members of the public, between government agencies and among nations.
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