Out of the Middle East

Screen Shot 2014-04-11 at 1.44.43 PMAn often fatal respiratory virus has made the leap from the Middle East to south-east Asia, spurring governments across the region to swing into action to contain the disease. The Middle East Respiratory Syndrome, or MERS, has similar characteristics to the SARS virus that emerged in China a decade ago, killing 750 people and bringing Hong Kong to a standstill. Symptoms of MERS include fever, a cough and shortness of breath, generally culminating in severe pneumonia.

According to the World Health Organisation, at least 93 people have died of MERS since it emerged in 2012. Over the past month there has been a sharp escalation of infections in Saudi Arabia, including a further 17 cases announced on Monday.

Earlier this month, the first south-east Asian MERS death was confirmed in Malaysia, leading to the continuing close surveillance of an entire village, and another case was suspected in the Philippines. The Malaysian, from Johor, returned to Malaysia from a pilgrimage to Mecca, rapidly fell ill and died.

A Filipino male nurse, in contact with another Filipino health worker who recently died of MERS in Abu Dhabi, returned to his home in the Philippines in recent weeks. He first tested positive to the disease, but later tested negative, although officials said that didn’t necessarily mean he is free of the disease. Now health authorities in the Philippines are urgently tracing all 418 passengers on the nurse’s flight to Manila, but according to local reports fewer than half have so far been found.

Hundreds of thousands of contract workers from Indonesia and the Philippines are employed in Saudi Arabia and the United Arab Emirates and the potential of the virus moving into the densely populated cities of south-east Asia has alarmed health authorities across the region. Incubating in the human body for as long as two weeks, the virus has a high mortality rate – as many as a third of those infected will die of the disease. There is no cure.

Hard lessons were learned from the SARS epidemic in Asia, and regional authorities are taking all precautions. Dr Ben Cowling, head of the Hong Kong University’s School of Public Health, this week told The Edge Review that the world was better prepared than ever before for an epidemic of this type. “In the past 10 years there have been massive improvements in access to laboratory testing, so that in many parts of the world, patients admitted to hospital with pneumonia can be tested for a range of pathogens,” he explained.

The MERS virus is thought to have originated with bats, and then adapted to camels and then humans. Dr Cowling said a number of infectious diseases come from animals, adding that these diseases continue to be a major threat.

While originally from animals, the MERS virus can now be passed from human to human, but to date it appears restricted to close contact transmission, between family members or from patient to health worker.

Medical specialists say the emerging disease will be closely monitored to assess whether it is evolving to transfer more rapidly through human populations but, as yet, the disease appears to be a slow mover. “MERS is still not a major concern because it cannot easily spread between humans,” Dr Cowling noted.

Meanwhile, south-east Asian health authorities are caught in a bind. No-one wants to spread panic or alarm, but travelling nationals must be warned to take proper precautions. Malaysian Health Ministry director-general Noor Hisham Abdullah has warned Malaysians travelling to the Middle East to wear face masks and wash their hands regularly. In the Philippines, airport officials have been told to start screening incoming passengers for MERS symptoms, especially those arriving from the Middle East.

In Saudi Arabia, the government this week fired the health minister in an attempt to quell growing panic. The big test, though, will come in October, when the Hajj season begins and two million Muslims – including many from Indonesia and Malaysia – make the pilgrimage to Mecca.