MERS: no reason to stay home

 People in the Asian region have unpleasant memories of the 2002/03 Severe Acute Respiratory Syndrome (SARS) outbreak that affected more than 8,000 people causing about 800 deaths and badly affected regional economies as well as air travel. Will MERS follow that path? 

Middle East Respiratory Syndrome is caused by a newly identified virus in humans. This belongs to the coronavirus family, which includes numerous strains from benign common cold viruses to the SARS virus.

The first MERS cases were diagnosed in 2012 in Saudi Arabia and Jordan and most human cases have so far been found in the Arabian Peninsula or in people who have travelled in Middle East countries. The disease was initially referred as the camel flu because it is believed that the virus originated from camels. 

Since 2012, the World Health Organisation (WHO) has reported more than 1,000 confirmed MERS infections with around a 36-per-cent death rate. A significant outbreak outside the Middle East has recently emerged in South Korea transmitted by individuals who have returned from Middle East countries. As of Sunday, 150 cases in Korea had been confirmed and 14 had died, giving a mortality rate of 10 per cent. 

Contamination from the MERS virus (also known as MERS-CoV) seems to occur through respiratory droplets either airborne or from touching surfaces sullied by these secretions. Most infected cases result from close contacts with patients such as caregivers or family members. Unlike highly contagious flu or the common cold, the MERS-CoV doesn’t spread easily in the general population. The relatively small number of cases over the last three years then suggests a low risk of massive human contamination. In fact, the US Centres for Disease Control is not advising travellers to modify their overseas trips because of MERS but recommend seeing a doctor if suspected symptoms occur within two weeks of returning from an area where the virus has been reported.

Following a two to 14-day silent period, the MERS virus typically triggers acute flu-like symptoms that include high fever, cough, shortness of breath, and sometimes headache, vomiting and diarrhoea. Although some infections are mild, most patients develop severe respiratory manifestations that require prompt hospitalisation in a specialised centre to limit the risk of contamination. Complications arise mainly in people who already suffer from chronic disease (diabetes, heart or lung illness) or have low immunity status, and include severe lung infection, kidney failure and subsequent life-threatening respiratory distress.

Interestingly, contrary to the 36-per-cent death rate reported in the Middle East, the 10-per-cent fatality rate observed in South Korea shows that with proper medical care, the MERS infection appears no more fatal than SARS. 

Treatment aims to prevent or correct the disorders of bodily functions that could result from lung and kidney impairment. Severe cases are treated in an intensive care unit with intravenous fluids, medications and possibly assisted ventilation. 

No vaccine against the MERS-CoV is available at the moment. Like other viral infections such as the common cold and flu, prevention relies on good hygiene practices. You can reduce your risk of infestation by frequently washing your hands, disinfecting areas possibly contaminated by infected droplets, avoiding touching your face, mouth and eyes with unclean hands, using disposable tissues to cover your mouth and nose when coughing and avoiding sharing food and drinks with possibly sick individuals.

Asian governments that have gained substantial experience from the bird flu containment policies in 2003 should be able to effectively handle any threat with adequate measures directed at travellers from the infected areas. 

Despite the need to remain vigilant about the spread of any new viral illness, MERS appears today a moderate health concern for the ordinary Thai population.

 

DR GERARD LALANDE is managing director of CEO-Health, which provides medical referrals for expatriates and customised executive medical check-ups in Thailand. He can be contacted at [email protected].