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1. MERS’s best friend is ignorance, so it’s time to wise up
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*MERS’s best friend is ignorance, so it’s time to wise up
<http://www.irinnews.org/report.aspx?reportid=101638>*
[image: lead photo]TORONTO, 16 June 2015 (IRIN) - The full story of Middle
East Respiratory Syndrome (MERS) is yet to be told. Would South Korea now
be in the grip of one of the disease’s largest ever outbreaks if more had
been done sooner to unravel its mysteries?
A key point about MERS was that it gave some warning of its arrival. This
was not the case with Severe Acute Respiratory Syndrome, which struck in
early 2003 after an infected Chinese doctor and travellers from Vietnam,
Singapore and Canada mingled in a Kowloon hotel. At the time, no-one knew a
disease was afoot.
The gravely ill doctor took his virus filled-lungs into Hong Kong’s
hospital system, touching off a massive wave of infections among health
care workers and their families. And after they went home and became sick,
the hotel guests seeded infections into their hospital systems.
By contrast, a full 33 months before a South Korean businessman was
confirmed to have brought the MERS virus his country, the discovery of a
new coronavirus appeared in a report from Saudi Arabia published in ProMED,
a disease and outbreak reporting system with broad international reach.
*Shooting the messenger*
Egyptian virologist Ali Zaki teamed up with the Netherlands’ renowned
Erasmus Medical Center to identify the virus that had sickened and killed a
Saudi Arabian man in June 2012. That it was Zaki, not the Saudi health
ministry, who revealed the existence of the new SARS-like virus turned out
to be impolitic. He was quickly stripped of his Saudi job and left the
country.
Looking back, that initial official reaction was perhaps a harbinger of
what was to come. Over nearly three years, information about MERS has
systematically either been hoarded, mishandled or perhaps not even
collected at all.
That has left the world still unable to answer key questions about MERS and
how it occasionally infects people. To complicate the situation, over the
past year MERS efforts sputtered, overshadowed by west Africa’s
catastrophic Ebola outbreak.
“The world’s attention has understandably shifted to managing that crisis,”
said Kamran Khan, an infectious diseases physician who researches the
global spread of diseases at the University of Toronto.
“Although MERS has continued to ‘simmer’ in countries across the Arabian
peninsula, it hasn’t - until now - evolved into an international outbreak
that has reminded us all that it’s still out there and continues to pose a
threat,” added Khan.
The virus is most prevalent in Saudi Arabia and the United Arab Emirates
<http://www.irinnews.org/report/100038/alert-over-spike-in-middle-east-flu-like-virus>.
And with millions of pilgrims flocking there annually and with its large
contingent of foreign workers, Saudi Arabia seems to pose the biggest risk
of exporting MERS to other parts of the world.
But these countries appear not to have fully grasped the dangers, or taken
on board their own responsibility to prevent precisely the kind of scenario
that is now playing out in South Korea.
The disease and death toll (which stands at 19 as of June 16), the social
and economic disruption as well as the fear and political strife South
Korea is experiencing will likely ratchet up the pressure on the source
countries – and the World Health Organization – to come up with more
answers about MERS as well as strategies for limiting its damage.
Peter Ben Embarek, WHO’s point person for the disease, knows what is
happening in South Korea could happen elsewhere. “So we should also use it
as an argument for doing more in the Middle East.”
*Next time could be worse*
But infectious diseases expert Michael Osterholm is worried the lesson the
world will take from the Korean outbreak will be the wrong one.
“What I fear is once we get through Korea people will say ‘See, we can
control this. Don’t worry.’ And they’re going to miss the point that we may
not be so lucky next time,’” said Osterholm, director of the Center for
Infectious Diseases Research and Policy at the University of Minnesota.
To date, 25 countries have reported cases of MERS. Most have had the
traveling kind: tourists who contracted the virus on trips to Saudi Arabia
or the United Arab Emirates, or infected wealthy Middle Easterners flying
out for care via air ambulance.
The vast majority of cases have occurred in Saudi Arabia, which claims
roughly 1,030 infections, more than 450 of which were fatal. The WHO puts
the global MERS count close to 1,300, with at least 455 deaths.
*Read: Preparing for MERS virus ahead of hajj pilgrimage*
<http://www.irinnews.org/report/98889/preparing-for-mers-virus-ahead-of-hajj-pilgrimage>
While MERS is believed to have originated in bats, camels are now known to
play a role in its spread. Multiple studies have confirmed dromedary
(single hump) camels can become infected with the MERS virus, though it
doesn’t make them noticeably ill.
*Don’t kiss your camel *
In Saudi Arabia and other parts of the Middle East, the beasts are
ubiquitous and beloved. They provide meat and milk, are kept as pets, and
are raced. Warnings to be careful around camels (Don’t consume their raw
camel milk or undercooked meat; Wash your hands after contact) have not
always worked. Defiant camel owners have insisted their own animals are
disease-free and have, in front of cameras, drunk fresh-from-the-udder
milk, or received slobbery camel kisses, to press home their point.
<http:///Photo/Details/201209260742410964/Beloved-but-dangerous>
Photo: Jaspreet Kindra/IRIN <http://www.irinnews.org/photo/>
Beloved but dangerous
Is that how people become infected with MERS? We don’t know. What about
the myriad people who contracted MERS but said they had no contacts with
camels? The world still does not have the answer, a fact Khan describes as
surprising this late in the game.
The way to answer those questions is through conducting a case control
study, where epidemiologists quiz people who have and have not been
affected by MERS and then compare data on their movements, animal and human
exposures, and food and drink consumption. It is frustrating to scientists
who study emerging diseases that there still isn't a published case control
study on MERS.
*Read: Lessons from the last outbreak
<http://www.irinnews.org/report/100542/lessons-to-be-learned-from-the-mers-outbrea>*
That may be about to change. A study, the product of a collaboration with
US Centers for Disease Control and Prevention scientists, is said to be
somewhere in the publication pipeline. Whether it provides the needed
answers about how MERS comes to infect people, though, remains unclear.
But why has it taken so long? Was it a lack of local ability to do the
work? If so, there were multiple outside researchers offering to help with
the study.
Defiant camel owners have insisted their own animals are disease-free and
have, in front of cameras, drunk fresh-from-the-udder milk, or received
slobbery camel kisses, to press home their point.
In off-the-record conversations a number of scientists complained the Saudi
deputy health minister in the early days of MERS, Ziad Memish, was keen to
maintain control over data, specimens and access, and to be named a
prominent author of any scientific papers that emerged. In the first couple
of years of MERS research, the publications section of Memish’s CV
mushroomed.
He and his boss were fired in the spring of 2014 when MERS cases in Saudi
Arabia skyrocketed due to spread within hospitals that practiced poor
infection control. But those who hoped the search for answers would gear up
after Memish’s departure were disappointed.
*They drink what?*
Ben Embarek suggests some of the problem is cultural. “They're not used to
sharing private things outside of the family environment,” he explained.
"People tend to be very evasive and not terribly precise in the way they
answer. They don't understand what is expected."
A case in point: The WHO MERS team first learned some people in Saudi
Arabia drink camel urine - believing it has medicinal properties - about a
year and a half after they started working on the virus. The WHO team
didn’t think to ask. And when MERS avoidance advice related to camel
contact was originally drafted, their Saudi contacts didn’t offer the
information.
When the South Korean outbreak started to take off, some scientists who
follow MERS closely noted there had been large hospital outbreaks in the
Middle East too. But they often were not recognized as such because the
affected countries don’t report them in the detail South Korean officials
have released. And they are rarely reported in the scientific literature.
“The willingness and or the ability to share detailed scientific
information about an outbreak is often based on the culture in which that
outbreak occurs. We’ve seen that in countries like China,” Osterholm said.
“But I think that here [in the Middle East] that has become an acute
problem.”
He and others suggest the answer to the MERS problem has to be a vaccine
that blocks the infection in camels, thereby stopping the virus from
jumping to people. “There is nothing right now to support that this is
going to go away in camels,” Osterholm explained.
Without a camel vaccine, South Korea’s experience will be repeated. And
next time the virus may turn up somewhere without the system capacity and
economic resources to respond effectively.
**Helen Branswell is the medical reporter for the Canadian Press*
hb/am
*MERS timeline*
*2012*
April: A cluster of undiagnosed respiratory illnesses occurs at a hospital
at Zarqa, Jordan, claiming two lives. (MERS is confirmed in late November.)
June 13: A man is hospitalized in Jeddah, Saudi Arabia and later dies.
Egyptian virologist Ali Mohamed Zaki and experts at Erasmus Medical Center
in Rotterdam, the Netherlands confirm the infection was caused by a new
coronavirus.
Sept. 20: Zaki reports the new virus to ProMED Mail, an infectious diseases
online alert operation. Zaki is later fired. The yet unnamed virus is known
as “novel coronavirus” or NCov for short; it is from the same family as the
SARS virus.
Sept. 22: Britain reports to the World Health Organization that a London
hospital is treating a Qatari citizen infected with the new virus. The man
dies nine months later.
Nov. 23: Saudi Arabia reports a cluster of cases in a family.
*2013*
February: A UK resident who had traveled home from Pakistan via Mecca,
Saudi Arabia, is diagnosed with MERS. In Britain he infects his son, who
dies, and another family member. This is the first known transmission
outside of the Middle East.
March 26: A man from the United Arab Emirates dies in a German hospital
where he sought care for MERS. The man kept racing camels, which raised
suspicions the animal may be a source of MERS.
May: Infections that spread among dialysis patients at a hospital in
Al-Ahsa, in northeastern Saudi Arabia triggered a large hospital outbreak.
May 15: The International Committee on Taxonomy of Viruses’ Coronavirus
Study Group reveals an agreement to rename NCoV. It becomes the Middle East
Respiratory Syndrome Coronavirus or MERS-CoV.
July 9: WHO convenes an emergency committee under the provisions of the
International Health Regulations. The advisers say MERS does not constitute
a Public Health Emergency of International Concern. The Emergency Committee
has met seven times since, each time confirming that view.
Aug. 9: International researchers report finding antibodies to MERS or a
MERS-like virus in dromedary (one hump) camels from Oman and the Canary
Islands. Multiple studies have since found viruses or antibodies in camels
from Arabian Peninsula and African countries.
Aug. 21: U.S. and Saudi researchers say they found an RNA fragment that is
a perfect match for the corresponding part of the MERS virus in droppings
from an Egyptian tomb bat.
*2014*
April 14: Malaysia confirms MERS infection in a Muslim man who had recently
been on pilgrimage in Saudi Arabia. No cases have to date been connected to
the Hajj, the major annual pilgrimage to Mecca.
May: A massive surge in MERS cases in Saudi Arabia and the United Arab
Emirates is caused by outbreaks in hospitals. The Saudi health minister and
deputy health minister are replaced and outside management experts are
brought in to help improve the Saudi response.
*2015*
May 20: A South Korean businessman who had travelled to Bahrain, Qatar, UAE
and Saudi Arabia who became sick after he returned home is diagnosed with
MERS after visiting three medical facilities. He infects more than two
dozen people, igniting the largest MERS outbreak outside the Middle East.
May 29: A man from South Korea tests positive for MERS in China. The man
flew to Hong Kong then travelled by bus to Huizhou, in China’s Guangdong
Province. Alerted by Korean officials, authorities in Huizhou detain and
isolate him on May 27. He appears not to infect anyone in China.
June 9: A joint WHO-South Korean mission, with experts from Hong Kong,
Saudi Arabia and the US Centers for Disease Control and Protection, begin
investigating the South Korean outbreak. They conclude though the outbreak
is large the virus is not behaving differently.
June 16: The WHO’s MERS Emergency Committee meets for the ninth time. The
outbreak has claimed 19 lives.
hb/am
Access report online <http://www.irinnews.org/report.aspx?reportid=101638>
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