Monday, September 9, 2013

The SARS like opportunity MERS-CoV is waiting for

Courtesy- CDC
The Middle East Respiratory Syndrome caused by the MERS-CoV has claimed 50 lives out of the 108 reported cases in eight countries as of September 6, 21013. It has not spread as rapidly as SARS but it appears to be more dangerous due to its high fatality rate. In comparison the Severe Acute Respiratory Syndrome caused 750 deaths amongst about 8,000 people who contracted it.

Viruses spread when conditions are favorable, such as the right temperature, a weak immune system and most of all, proximity.
Why MERS-CoV has not been given its rightful place in the viral kingdom is because perhaps it has not had the same opportunities as SARS. A virus gets serious attention when it jumps between species, such as from
animals to humans but it gets real respect only when it starts to spread within the new species. SARS was just another virus until it was carried by an infected doctor from mainland China to Hong Kong who was believed to have given it to at least 7 individuals at the Metropole Hotel.
While international hotel guests carried the infection to their home countries over airlines, it got some real attention, when someone brought it into Block E of the Amoy Gardens Complex of 19 apartment buildings housing 19,000 people. SARS was ready for center stage. It raged through the apartment building’s 33 floors and hopped over to surrounding buildings as well.
In scenes reminiscent of the 1995 movie ‘Outbreak’ Block E became the Cedar Creek of Hong Kong as it was placed under clamp down with residents not allowed to leave. Those who had left were brought back and the building was quarantined.

Health officials including, at the WHO, agree it was quite likely one person who happened to be a ‘ super spreader’, someone who infects 10 or more people. Based on that criterion, this person could be deserving of the ‘mother of all super spreaders’ title. Ultimately more than 300 people were infected and 42 died from the virus, in Amoy Gardens alone. Traditionally the super spreader works from his or her airway, spraying large amounts of oral droplets in presence of others, who inhale or rub their nose or eyes after having been sprayed and thus becoming infected.
But in the case of the Amoy Gardens resident, it was his excrement did most of the work. As the feces unloaded from the toilets into sewage pipes the virus was spread as an aerosolized contagion picked by an exhaust fan that vented out foul air into the atmosphere. That is when SARS went viral, so to speak.

A similar and even more perfect opportunity awaits the unwelcome explosion of MERS-CoV in Mecca. The annual pilgrimage, the Hajj, is performed by over 3 million muslims from virtually every corner of the world by visiting the holy city which swells to almost 3 times its population during this period, expected to be from the 13th to 18th of October for this year. But pilgrims will start arriving in mid September which is within days from now, and will be departing through November after a month of the Hajj being concluded.
Even for Saudi Arabia’s ultra modern facilities, far more advanced than many western cities, that many people cramped into close quarters during rituals and prayers is the moment health organizations are anxiously dreading.

This will be the first real opportunity for the MERS-CoV’s to spread through direct human contact. It has already proven it can do that, even though it’s origins too are believed to be bats, and may have been transmitted by dromedary camels to humans. The potential for exponential viral spread is very realistic this year. With an incubation period of 3 to 5 days, even those visitors who remain symptom less upon departure may be carrying the virus when they return to their native countries.

MERS-CoV causes severe acute respiratory illness with symptoms of fever, cough, shortness of breath, and may also cause renal failure. No vaccine has been found to be effective including un satisfactory results from Ribavirin, but a cocktail of Ribavirin and Interferon has been found to prevent symptoms in monkeys. This treatment was not effective in Saudi Arabian patients possibly because they were already in a later stage of infection.

Understanding Evolution. "Tracking SARS back to its source." Accessed September 9, 2013. http://evolution.berkeley.edu/evolibrary/news/060101_batsars

Centers for Disease Control and Prevention. "CDC-MERS-Frequently Asked Questions." Accessed September 9, 2013. http://www.cdc.gov/coronavirus/mers/faq.html

National Library of Medicine - National Institutes of Health. "Severe acute respiratory syndrome (SARS): MedlinePlus Medical Encyclopedia." Accessed September 9, 2013. http://www.nlm.nih.gov/medlineplus/ency/article/007192.htm

NPR.org. "Tracing the Spread of SARS : NPR." Accessed September 9, 2013. http://www.npr.org/templates/story/story.php?storyId=1265956

Wikipedia, the free encyclopedia. "Hajj." Accessed September 9, 2013. http://en.wikipedia.org/wiki/Hajj#Number_of_pilgrims_per_year

National Center for Biotechnology Information. "Environmental transmission of SARS at Amoy ... [J Environ Health. 2006] - PubMed - NCBI." Accessed September 9, 2013. http://www.ncbi.nlm.nih.gov/pubmed/16696450

BBC News. "Sars legacy still felt in Hong Kong, 10 years on." Accessed September 9, 2013. http://www.bbc.co.uk/news/world-asia-china-21680682

The New York Times - Breaking News, World News & Multimedia. "Drug Cocktail That Protects Monkeys From Deadly Virus May Aid Humans - NYTimes.com." Accessed September 9, 2013. http://www.nytimes.com/2013/09/09/health/drug-cocktail-used-to-treat-mers-in-monkeys-may-aid-humans.html?ref=health&_r=1&

#MERSCoV #SARS #Infection #AmoyGardensHongKong #China #SaudiArabia #Mecca #Hajj #2013Hajj #CoronaVirus #CDC #WHO #Outbreak



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