Middle East respiratory syndromeCamels and bats and MERS, oh my
WHEN a man with what looked like a nasty case of flu showed up at Community Hospital in Munster, Indiana on April 28th, the facility did what it always does with infectious-disease patients: it isolated him in a room with heavily filtered negative air-flow and treated him as if he had the plague. Which he did, or at least a modern-day equivalent. A health-care worker, the man had just flown in from Saudi Arabia—ground zero for the coronavirus that causes Middle East respiratory syndrome, or MERS. The hospital took extreme precautions in handling the patient, and used the RFID tags that all its staff wear to track those who had been near him. About 50 were put under home isolation, and a potential outbreak of MERS was contained (the patient also recovered).
Since then, America has seen another similar case in Orlando, Florida—in this instance a health-care worker who, although he had a fever and had worked with MERS patients in Saudi Arabia, did not warn the hospital he was admitted to, and then sat in an open waiting room for four hours. As many as 100 patients and staff came into contact with him, as did around 500 people on flights he took. Two hospital workers became ill, although initial tests for MERS proved negative.
Saudi Arabia, meanwhile, has done a lousy job at both containing and (until recently) sharing much information about MERS. Of the 600 or so cases reported in almost 20 countries since September 2012, just over 500 have been in the kingdom. Infections have recently picked up pace too, more than doubling in the past eight weeks. And although MERS is a cousin of severe acute respiratory syndrome (SARS), a coronavirus that from 2003 to 2004 infected some 8,500 people worldwide, it is far deadlier. SARS killed about 8% of those it infected; MERS is killing 27%. Like SARS, however, MERS appears quite hard to catch: an infected person must cough up a droplet that you then either breathe in or absorb via something aqueous (like an eye).
MERS is something of a medical mystery. The disease is widely found in dromedary camels, which have long carried the virus. In the Middle East camels are worked, raced and even kept as pets. Their milk is drunk unpasteurized and made into cheese, their meat cooked, and sometimes their urine is imbibed, as it is thought to have medicinal properties—all of which has been going on for centuries. But most MERS patients have had no contact with camels or camel products—and where did the camels get the virus?
Laurie Garrett, senior fellow for global health at the Council on Foreign Relations and a leading expert on pandemics, thinks the likely primary host—and cause of at least some of the recent surge in Saudi MERS cases—is a type of fruit bat known as the Egyptian tomb bat, which has been a host to the virus for centuries. The past few weeks is the time of year workers start pollinating date trees—which means clambering all over the bats’ roosts. And those roosts are covered with bat saliva, urine and droppings. Ms Garrett anticipates another surge in cases when the workers cover the date trees in nets (to protect the fruit from bats) in late June.
On May 14th, following a meeting of its International Health Regulations Emergency Committee, the World Health Organization (WHO) said that it was not, for now, declaring MERS a Public Health Emergency of International Concern (commonly known as a PHEIC). Given the acceleration and growing globalization of the virus, some health experts questioned that decision. Many wondered if it was politically motivated—having targeted one predominantly Islamic country (Pakistan) with polio-related travel restrictions, the WHO may be leery of offending a second. Instead it simply offered some guidelines: improve and implement national policies for infection prevention at health-care facilities; raise public awareness; share more information; and so on. The same day, signs warning travellers about MERS started appearing in some American international airports.
Anyone who believes a few hundred cases of MERS worldwide isn’t a Big Problem wasn’t paying attention when SARS roamed free. With the start of the vacation season, Ramadan events from late June to late July, and the gathering of millions of Muslims at the haj in early October, the number of cases may swiftly move into the thousands. Ms Garrett also worries about what might happen if the virus gets a foothold in institutions such as elementary schools or nursing homes—which, like hospitals, have a lot of people in close proximity, and where infections spread readily.
SARs demonstrated just how disruptive even a few thousand cases can be—not only in terms of the sick and dying, but also economically. Hospitals lost billions of dollars overhauling their procedures and delaying everything from routine admissions to surgeries. Tourism slumped in those regions hardest hit by the virus, with hotels and local businesses bearing the brunt. On one estimate, the global cost of SARS in 2003 alone was up to $54 billion. Given its deadlier (and hence scarier) nature, MERS could prove even more costly.
Worse, a MERS vaccine is unlikely to be available any time soon, optimistic press releases from drug companies and research labs notwithstanding. For one thing, it will take years for any effective vaccine to be tested and then approved by regulators. For another, recall that MERS is a close relative of SARS. Eleven years on, there is still no SARS vaccine in sight.