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New Research Into Middle East Respiratory Syndrome

Posted on Aug 09, 2013 by Ailee Slater ()  | Tags: coronavirus, Jordan, MERS, Middle East, Middle East Respiratory Syndrome, novel coronavirus, SARS, Saudi Arabia, The Lancet

When the novel coronavirus first came about in 2012, doctors and medical researchers feared that the SARS-like virus might turn into a pandemic. Now, one year later, the disease is in many senses under control - there has been no rapid spread of the coronavirus, and although nearly 100 infections have been reported, no pandemic has occurred. But, have we solved the problem of the novel coronavirus? According to a recent study published in specialty journal The Lancet Infectious Diseases: No.

The study, made public on 26th June 2013, provides important updates and research on the novel coronavirus. To begin, in terms of terminology, the novel coronavirus is now being referred to by a new name - Middle East Respiratory Syndrome, or MERS. With The Lancet study, researchers set out to collect more data about MERS, discover current gaps in knowledge about the disease and work to close those gaps.

MERS, as it is now known, probably began infecting people in the spring of 2012. That April, the Middle Eastern nation Jordan reported that six hospital workers were experiencing severe respiratory infections. Two eventually died. Doctors and the World Health Organization didn't realize it at the time, but those workers had contracted the MERS virus - laboratory samples from the two fatalities would later test positive for the virus.

Into the summer of 2012, other countries in the Middle East began reporting patients with respiratory symptoms similar to those experienced by the hospital workers in Jordan. In Saudi Arabia, a 60-year-old man suffered kidney failure after falling ill with an infection that was at first diagnosed as severe pneumonia, but later recognized to be the virus MERS.

Since September 2012, when Dr. Ali Mohamed Zaki identified the Saudi man's cause of death to be a new type of SARS-like coronavirus, MERS cases have been reported across the Middle East: In Jordan, Qatar, the UAE and especially Saudi Arabia, which has seen the lion's share of MERS cases (although some suspect this is due to Saudi Arabia's superior reporting procedures as opposed to the disease being truly more widespread in that nation). Rare patients of European origin have been reported, however each of these people traveled to the Middle East just before coming down with the virus, again indicating that MERS is, for the time being, contained within the Middle Eastern region.

Despite the fact that MERS has not turned into a pandemic and does not seem to be moving outside its current borders, medical scientists in the recent Lancet Infectious Disease study say that more research is necessary in order to achieve a greater understanding of MERS, and prevent it from becoming a killer virus on par with the SARS pandemic in the early 2000s.

For The Lancet publication, researchers looked at 47 cases of MERS in Saudi Arabia, examining the patterns and causes of the disease; in other words, its epidemiology. These researchers also looked at MERS demographics to determine which types of people in which types of social situations had developed MERS infections. Finally, researchers investigated too the characteristics of the virus and the symptoms of those affected.

All of this work lead to a number of interesting findings. First, there was the discovery that of the 47 patients evaluated, 28 had died as a result of either the respiratory condition, or another condition such as heart disease which was made worse due to MERS. From this small pool of cases, therefore, it would appear that MERS has a 60 percent fatality rate; quite shocking when we consider that the fatality rate of SARS was just 1 percent. However, The Lancet report does point out that this seemingly high rate of death may exist solely because patients with milder forms of MERS are less likely to come to the hospital, and may not even realize that they have the virus. Because researchers studied MERS patients who were already in a very poor condition, the high percentage of patients not surviving the disease is perhaps to be expected, and does not necessarily indicate that all MERS cases have a more than 50 percent chance of becoming fatal.

Despite these potentially worrying survival statistics, another study published this July in The Lancet found a number of facts suggesting that MERS will not turn into an uncontrollable epidemic. Researchers compared the patterns and medical records of SARS and MERS; looking into how easily both diseases appear to be transmissible. Scientists then ran hypothetical scenarios to determine the potential of MERS to reach pandemic status. Even in the most pessimistic scenarios, MERS was not found likely to become a pandemic. Indeed, unlike SARS, MERS has affected far fewer health care workers, demonstrating that the disease is not as easily transmissible as its Asian counterpart was in the 2003/2004 pandemic of SARS.

Of course, with all of these recent studies into MERS, new facts have lead to many answers but also to a great deal of new questions. Of the 47 patients in The Lancet's Saudi Arabia study, 96 percent had co-morbid disorders - diabetes, heart or kidney disease, for example. Now, medical researchers are curious if MERS is more likely to attack an already-weakened immune system, and to what extent a chronic condition such as renal problems might lead to MERS-related death. Also, unlike SARS, MERS is quite likely to affect the older male population, and the reasons for this demographics' susceptibility to the virus are as of yet unknown.

Perhaps most importantly, we still don't know where MERS came from. The prevailing theory at the moment is that this human variation of the disease originated in a bat, as bats do experience a similar coronavirus. However, more research is needed to understand how the virus came to affect humans, or if MERS might have in reality come from a different agricultural animal. In a commentary published in the August 2013 issue of The Lancet Infectious Diseases, the writer makes one more important point - that global awareness of MERS must be improved, especially amongst health care workers, so that if cases of the disease do begin to increase, a potential pandemic can quickly be stopped.

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