Impact of Middle East respiratory syndrome outbreak on the use of emergency medical resources in febrile patients

Jeong, Hyunho; Jeong, Sikyoung; Oh, Juseok; Woo, Seon Hee; So, Byung Hak; Wee, Jeong Hee; Kim, Ji Hoon; Im, Ji Yong; Choi, Seung Pill; Park, Kyoungnam; Cho, Byul Nim Hee; Hong, Sungyoup

The Middle East respiratory syndrome (MERS), caused by MERSassociated coronavirus (MERS-CoV), a family of viruses that infect mammals such as camels, is an airborne disease. 1 The animal source and mode of transmission of MERS-CoV to human beings is not well known. However, transmission is enhanced in the healthcare setting and 42% of all cases of transmission were found to be healthcare-associated. 2 An epidemic outbreak of MERS occurred in the Republic of Korea between May and July 2015, causing the second largest number of confirmed MERS cases since 2012, following the Kingdom of Saudi Arabia. 3 The outbreak of MERS in Korea can be characterized by intra-hospital transmission and hospital-to-hospital spread, due to easy hospital accessibility and the lack of restrictions on inter-hospital transfers or referrals. In most cases, transmission of MERS-CoV occurred in crowded tertiary emergency centers and due to vector patients moving across the country. 4 For several decades, emergency department (ED) crowding has been extensively discussed and various interventions to reduce the ED crowding were suggested. 5 Overcrowding in EDs occurs when the number of patients exceeds the physical or staffing capacity of the department. Overcrowding occurs in developed countries and has been well documented over the past decade. 6 Although the causative agent and mode of transmission of MERS have been examined in detail, the effects of the epidemic outbreak of an acute transmittable respiratory illness on the operation of the emergency services and the crowding of emergency centers have not been evaluated. We performed a large retrospective observational study comparing the demographic and What is already known It has been suggested that emergency department (ED) crowding is associated with adverse outcomes such as increased mortality rates. Previous studies have reported the adverse impact of Ebola on the health system in Sierra Leone, with a strong decrease in the use of healthcare facilities among pediatric and maternity patients. Preventive actions for increased uses of emergency resources such as pre-hospital emergency counseling service, diversion of ambulance transportation, and hospital admission, are needed promptly after disease outbreaks in the ED.