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Paradigm Shift Intervention Monitoring
Mystery MERS Meeting Predicts More Indiana
Just in conclusion, our contact investigation indicates that there may have been some spread in the Indiana -- from the Indiana patient.
The above comments from the introduction and conclusion in prepared CDC presser remarks on the Riyadh health care worker (HCW), who traveled to Munster, Indiana via London and Chicago to attend a medical conference in Chicago (10th Annual Meeting of American Physician Scientists Association). When he went to the conference he had a 30-40 minute face to face discussion with a colleague (described as a “business associate” above) on the first full day of the conference and had a shorter, 10-20 minute discussion on the second day. The conference ended in the early afternoon of the next day, Sunday, April 27, when he drove back to Munster. The contact with the family in Munster on Sunday afternoon and evening, as well as Monday morning prior to his arrival at the Emergency Department at Community Hospital, represents the most at risk period for the Munster family contacts.
The above scenario is supported by the times of the flights, media reports indicating the he came to Chicago for a “conference” and he “went” to the family in Indiana on April 27 when his medical condition deteriorated. The dates and itinerary of the conference, in downtown Chicago about 30-45 minutes from Munster, match the travel descriptions of the CDC and Indiana Department of Health, as well as associated media reports.
The full travel log prior to the conference includes British Airways Flight 262 from Riyadh, RUH, to London, LHR, followed by American Airlines Flight 99 from London, LHR, to Chicago, ORD with a scheduled arrive of 10:50 AM CDT on April 24. He then took a bus from O’Hara to Munster, Indiana, a Chicago suburb, and arrived in the early afternoon. He then drove to the conference that afternoon/evening for meet and greet events in the evening of April 24, or drove to the conference on April 25, where he had the face to face conversation with a colleague who was an Illinois resident. He had a briefer talk with his colleague on April 26, and then returned to Munster on the 27, when the conference ended and when his symptoms became more severe.
The risk to the family was greatest on Sunday and Monday, because he was more contagious due to more severe symptomns, and an antibody test indicated he had already infected his colleague on Friday and/or Saturday via casual contact that included a handshake.
Thus, it is likely that one of more family members were infected in Indiana, which also is also true for HCWs at Community Hospital. Although all of the contacts were PCR negative, including the colleague in Illinois, detectable antibodies take several weeks to develop, so it is likely that several Indiana contacts will sero-convert and test positive this week, as indicated in closing remarks.