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This award-winning blog supplements the articles in Hospital Infection Control & Prevention.

MERS and Korea's Eccentric Healthcare System: “Every System is Perfectly Designed to Produce the Results that it Gets.”

The rapidly expanding MERS outbreak in Korea – today at 164 cases with 24 deaths – has raised questions about airborne transmission, lack of immunity in a population rarely exposed to camels, and the “Pig-Pen” of infectious diseases: super spreaders.

But after the index case went to three or four hospitals we started to get a glimpse of the vulnerability and eccentricity of the Korean health care system, where it is apparently the norm to go to several different facilities in search of the best doctor and then have family members heavily involved in direct patient care.

“[Under these] circumstances you cannot possibly have rigorous infection control, particularly to the level that you need for a MERS case,” says William Schaffner, MD, chairman of preventive medicine at Vanderbilt University Medical Center in Nashville.

MERS is difficult to diagnose, particularly in the early part of an outbreak when awareness is relatively low and the coronavirus presents like many other influenza-like illnesses. The index case also did not report his recent travel history to the Middle East when he first sought treatment, the World Health Organization reported. It is not clear whether health care providers asked.

“Conditions and cultural traditions specific to Korea have likely also played a role in the outbreak’s rapid spread,” the WHO noted. “The accessibility and affordability of health care in Korea encourage ‘doctor shopping.’ Patients frequently consult specialists in several facilities before deciding on a first-choice facility. Moreover, it is customary in Korea for many family members and friends to visit loved ones when they are in the emergency room or admitted to hospital. It is also customary for family members to provide almost constant bedside care often staying in the hospital room overnight, increasing the risk of close exposures in the health care setting.”

A large outbreak of MERS under such conditions seems to fulfill the adage that “every system is perfectly designed to produce the results that it gets.” If changes are not made after the MERS outbreak, the Korean healthcare system could certainly be vulnerable to future emerging infections, possibly even amplifying the etiologic agent involved.

“When you look at it you think, ‘Wow -- that is a good way to spread infections,” says Stanley Perlman, MD, PhD, a microbiology professor who studies coronavirus pathogenesis at the University of Iowa in Iowa City.

For more on the this story see the July 2015 issue of Hospital Infection Control & Prevention.