Tuesday, October 29, 2013

MERS Coronavirus, is the next epidemic around the corner?


In 2003, the whole world was fretted by the emergence of SARS epidemic. Severe acute respiratory syndrome (SARS) was caused by SARS-CoV virus, which originally originated from Hong Kong and spread over 37 countries worldwide . According to WHO, a total of 8,098 people got infected with the virus, of these 774 people died worldwide. It was much talked about because, the emergence of the epidemic coincided with invasion of Afghanistan by United States, and many people feared Bioterrorism with this virus. That didn’t happen, and since 2004 no cases of SARS infection has been reported anywhere in the world.

However, a new infectious outbreak has emerged in Middle east, especially Saudi Arabia. A few cases have been reported in African and European countries too. The outbreak, Known as Middle east respiratory syndrome (MERS), is caused by a virus similar to Corona virus that caused SARS (SARS-CoV) a decade back. Caused by the infection of MERS-CoV, MERS patient was first identified in Saudi Arabia in September 2012. Since then, 144 cases of human infection have been reported worldwide, with 62 deaths. Lion's share of these deaths and infections have been reported in Saudi Arabia (121 cases of infection with 51 reported deaths).


MERS Coronavirus patients develop severe acute respiratory illness with symptoms of fever, cough, and shortness of breath. In the later stages of infection, pneumonia and renal failure has been reported. MERS Coronavirus is a zoonotic virus, originating from Bats. Since the chances of transmission from Bat to Human route is significantly low in realistic world, many scientists, including Stanley Perlman, believes that indirect route of infection through domesticated animals might have been followed in most of the cases reported so far. It is noticeable, that in April this year, WHO rejected the chances of Human to Human transmission of the viruses. However come August, cases of human to human transmission (in close proximity) have been documented. This leads to only one conclusion, the virus is adapting in human cells.

We have seen the world wide newspapers and news portals covering the news about MERS Coronavirus outbreak. In Fact, Margaret Chan, Director general of WHO went on to say, "MERS-CoV is a global threat". Yet, hardly more than a hundred people are infected with it. Then why is everyone talking about it?

First of all, people are just talking. No significant steps has been deployed to contain the infection in the country of its origin, Saudi Arabia, and it has already travelled to Europe, Africa and many countries of the Middle east. Now that the virus has already spread to Europe and Africa, it is likely  to spread throughout the world as people continue to travel throughout the world.

If we remember the SARS outbreak, the SARS virus (SARS-CoV) adapted to human cells to such an extent that it was unable to infect bat cells. In the case of MERS, human to human transmission was considered a minor component of disease development process, but human to human transmission has been documented in both attenuated  and healthy persons. Consider this, there are more than half a million migrant Nepali workers in Middle east (I didn’t stretch myself to find the exact number), imagine how hard it will hit Nepal if corona virus infection ever reach epidemic proportions.

Until this day, the infection of MERS coronavirus hasn’t reached any alarming state, and much like H7N9 infection, it can be controlled too. A close relation between, WHO, People where the virus is found and the government is required. However, so far, no substantial steps has been taken in controlling this outbreak. Focus needs to be on identifying the unique features of the virus, finding the source of the virus, quarantining the infected and those on close proximity among other. We aren't ready with the vaccines, neither do we have necessary medications to cure MERS, preventive approach is what we should be looking too.

Moreover, we from Nepal should be monitoring the situation with close eye, and be alert for any such infections happening in Nepal. I won't be amazed, if next case of MERS coronavirus is reported in Nepal, in a migrant worker coming to celebrate Dashain/Tihar. We need to be prepared for the worst.

(Data used here is from CDC and WHO)

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