Kevin Schofield's writings, observations, and other pointless distractions
You may have seen articles about Middle East Respiratory Syndrome, or MERS, pop up in the news in the last couple of weeks. You’re going to see it more often going forward, as both the CDC and WHO are tracking it very closely.
Scientists are highly confident that MERS originated in the Arabian Peninsula. Somewhat like SARS, the MERS virus jumped from animals (in this case, probably camels) to humans. It is a coronavirus, which in itself is notable for two reasons: one, pretty pictures of it that look like a crown (thus the name), and two, because it is a family of viruses that infect both humans and animals and as such increase the likelihood that a mutation might cause it to jump from one to the other. SARS is also a coronavirus.
In humans, the primary symptoms of MERS are fever, cough, and shortness of breath. The good news is that at this point MERS seems only to pass between humans through very close contact: having an infected person cough or sneeze directly on you, or shaking hands with an infected person who practiced poor sanitary habits. The first human case of MERS was detected in 2012, and so far only about 500 people have been diagnosed — almost all of them in the Middle East.
The bad news is that it has a high mortality rate — about 30%. We’ll come back to that.
MERS has just begun to spread outside the Arabian peninsula. As of last week, the WHO had seen cases in the UK, France and Tunisia. This week we have had confirmations of two isolated cases in the United States, one in Florida and one in Indiana, both of whom were individuals who had been involved in healthcare in the Middle East and who had just travelled to the US, and neither of whom seems to have spread it to others here. There have also been isolated cases in Greece, Italy, Malaysia, and Turkey, again with no further documented spread. The WHO and CDC are hesitant to declare a health emergency for MERS at this point for fear of causing panic, but they are of course watching this very carefully and convening regular working group sessions to track MERS worldwide. Their most recent report from those working groups is an interesting read; it discusses how site visits in the Middle East to MERS hotspots seem to point to most of the cases there being hospital-acquired infections, and the sanitary conditions in those hospitals being “sub-optimal.” To be clear, they did not make a blanket statement about all hospital facilities in that region being sub-optimal, and the fact that MERS has not spread more widely suggests that most hospitals are doing a capable job of controlling the spread of infections within their facilities. The WHO task force also sees no evidence at this point that MERS has mutated into a form that would spread more easily, nor have they seen evidence of seasonality of the infection rate, as many similar viruses have shown.
Looking toward the future, there is always the chance that MERS may further mutate into a form that spreads more easily. However, if it does so, it is likely to become less severe; at least that is generally what has been observed in the past. So may people may get it, but the symptoms will be milder and fewer will die. Still, the human toll could be quite severe if it spreads widely. There is no “cure” for MERS; those infected need to let it run its course, treat the symptoms, and hope for the best.
The MERS virus has been detected in both bats and camels in the Arabian peninsula. In fact, as a of a recent research study released in April, three quarters of the camels in Saudi Arabia are infected with MERS, and it has been detected in archived samples of camel blood dating back to 1992. So it has been around for decades at this point and most likely has just recently mutated into a form that affects humans. This isn’t conclusive prof that MERS jumped from camels to humans, but given the large presence of domesticated camels and camel meat in the area, it’s a strong indicator. It also suggests that developing a vaccine for camels may be as important as developing one for humans if we want to control the spread of MERS.
If you live here in the United States, there is no immediate health crisis. The two isolated cases have been fully contained; in fact, one of the patients has already fully recovered and has been released. But with global air travel today, you can rest assured that there will be more cases. Don’t panic, but make sure you are following good sanitary practices, and be careful if you need to travel to the Middle East. Here is the CDC FAQ on MERS.
Stay tuned for more, and make sure to wash your hands.