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MERS-CoV: Dispatches from Korea

19 Jun, 2015

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The spread of Middle Eastern Respiratory syndrome coronavirus (MERS-CoV) highlights the urgent need to improve how we prepare for and tackle emerging infectious diseases. The current outbreak in Korea is the largest outside of the Middle East, with 166 cases confirmed and 24 deaths. Helen Jamison, Head of Media Relations at the Trust travelled to Seoul for the World Conference of Science Journalists at just the time the city became the focus of a global public health alert. She shares her thoughts from the conference…

It was particularly prescient that South Korean president Park Geun-Hye opened the 2015 World Conference of Science Journalists by remarking how important the media are to informing the public during times of challenge, given that the country is currently experiencing the biggest outbreak of MERS outside of the Arabian Peninsula. Her comments came as the Korean Ministry of Health continued to confirm new cases and fatalities in what has been a rapidly developing situation.

MERS2Hot on the heels of the Ebola epidemic that has devastated and continues to impact West Africa, this latest infectious disease outbreak underlines yet again how crucial it is that the world is prepared for the emerging health threats it faces.

For Seoul, which is only a matter of weeks into the outbreak, there have already been lessons that could have been learned sooner. The initial opportunity to contain the outbreak efficiently was missed, with reports from science journalists and Korean health experts in Seoul suggesting the first case was not identified or isolated anywhere near quickly enough.

Simple but effective infection control measures – from history taking of potentially affected patients, to ensuring that healthcare workers consistently employ simple procedures like hand-washing – were not enforced. More efficient diagnostics and data sharing at the outset may also have helped prevent the outbreak get as far as it has. But the reality is that even in highly developed healthcare settings in rich countries, infectious disease outbreaks like this are incredibly difficult to prevent or contain once they get established.

“Defending against infectious diseases is a wicked problem. It is in the nature of germs that spill over from animals, or evolve greater virulence, or drug resistance, that they pose great uncertainty. But while we cannot know which disease will threaten next, we know a lot about which ones pose the greatest danger and how to prepare.”

Jeremy Farrar on tackling infectious disease

Fear and misinformation amongst the public also led to panic, resulting in the widespread use of facemasks and temporary shutting of many schools, despite the risk of spread in the community actually being very low. The importance of timely and accurate communication in times of crisis, including in the media, was indeed a recurrent theme of the journalism conference in Seoul.

So far, evidence suggests this particular coronavirus may not be as virulent or transmissible as its distant cousin SARS, which caused over 8000 cases and almost 800 deaths twelve years ago, and the WHO has said that MERS is not a global public health emergency.

The virus does not yet appear to have changed in a way that would enable sustained human to human transmission. Infections are largely restricted to over-crowded emergency rooms in hospitals and close contact, mostly in older patients and those who already have underlying health problems. Fatality rates in otherwise healthy younger people, such as most healthcare workers, may be as low as 5%.

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Beyond the initial spread, South Korea has made significant strides towards bringing the outbreak under control, through detailed contact tracing, quarantine and improved data sharing. The number of cases looks like it may be peaking if it has not already done so. Trials have also now launched in hospitals for an experimental treatment using blood plasma from recovered patients.

This does not mean there is not concern. There are still many unknowns about this virus and whether it may develop to become more easily transmissible. New cases in other countries suggest that similar outbreaks may easily spring up elsewhere (there are just today reports of a patient in Thailand) and the events in South Korea are a stark warning for what might happen if this were to occur in countries with much more fragile and over-stretched health systems. With major gaps in our understanding of this infection and no vaccines or proven treatments three years on from the emergence of this novel respiratory infection, there remain huge amounts of work to be done.

Global collaboration, including partnerships across governments, industry, NGOs, academia and funders like the Trust, is essential to tackling these challenges. Proposals at the recent G7 meeting in Germany, to establish a global task force of infectious disease experts and reform the WHO to give it the resources and flexibility it needs to coordinate emergency responses, are also critical. The world must act now, and do so together, so we are better prepared to face such threats in future.

 

Q&A – MERS CoV

What is MERS?

Middle Eastern Respiratory Syndrome coronavirus (MERS-CoV) is a viral disease that causes acute respiratory illness in infected patients. Symptoms can include fever, cough and shortness of breath, with gastrointestinal symptoms also being reported.

When was it first discovered?

MERS was first identified in Saudi Arabia in 2012, with health officials determining that the first case was in Jordan in April 2012.  Since then all cases have in some way been linked back to the Arabian Peninsula. 25 countries have reported cases.

Why has it emerged now? And where from?17053986812_6ce031c9a2_z

The exact source of the virus is not entirely clear, although it is thought that it is transmitted to humans through contact with infected dromedary camels (it is zoonotic). Other animals have been tested to try to locate other reservoirs of the virus (which may, for example, be in bats), but currently only camels have been found to be infected with a strain of the virus similar to that found in humans.

How does it spread between humans?

The virus can pass between humans – but researchers have found that it doesn’t appear to do this unless there is close contact with an infected person. Human to human transmission has occurred between patients and healthcare workers and within families, but currently it is not easily spread without this close contact.

For more information and FAQs about MERS-CoV please visit the World Health Organisation website.

Image credits: Provided by author; MERS-CoV Investigation by CDC Global via Flickr CC-BY

One Comment leave one →
  1. 25 Jun, 2015 6:22 am

    Why did this outbreak occur now? Why didn’t it occur one or two years back?

    In the past 3 years, thousands of Koreans and other travelers visiting Korean hospitals would have passed through Saudi Hospitals prior to their visit to the Korean hospital. Then, why did the outbreak occur now? Can it be true that the disease had reached Korea earlier itself and that the current discovery is just by chance?

    There is no change in climate too to account for the current spread of this air-borne virus in Korea (or in Thailand).

    If MERS CoV had reached Korea in the past, then, the sick persons would have visited the hospitals. Consequently, staff would have been exposed. Serological investigation of the Staff for past exposure to this virus (IgG antibody against MERS CoV) in the Emergency wards, Dialysis units and Respiratory ICUs of the main urban hospitals can give important clue.

    There remains an additional tactic in patient management and dissemination prevention which is not yet utilized.. Those staff who recovered from the disease (both symptomatic and the asymptomatic) are the greatest resource to face the current crisis. They are immune due to prior exposure to the virus. I have elaborated this concept in more detail in my article. Link: http://www.ncbi.nlm.nih.gov/pubmed/25811387 (doi:10.1057/jphp.2015.9.)

    Countries which have not yet reported any MERS CoV cases need to adopt alternative strategies for situation assessment. Waiting for the first virologically confirmed case to start preventive measures would be too late. The potential of limited serological surveillance at sentinel sites (eg: urban large hospitals) should be explored.

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