Friday, May 2, 2014

MERS-CoV: It was matter of when, not if.

Full disclosure:  I am in no way, shape, or form an expert in any virus let alone the one that causes MERS. Not even a little.  If you want to know all of the available facts about MERS-CoV you'll want to check out Helen Branswell, the Centers for Disease Control and Prevention (CDC) MERS website, the World Health Organization MERS website, and the Center for Infectious Disease Research and Policy.  What I can do is tell you what MERS-CoV stands for and give you a little background.  No quiz at the end....I'd likely fail it anyway.

The reason I'm writing this is because MERS-CoV has landed in the United States.  See the CDC press release here.  MERS stands for Middle East Respiratory Syndrome and refers to the illness caused by a particular coronavirus or CoV.  Look at that, you're smarter already. Coronaviruses are just a group of viruses that can cause mainly respiratory diseases in humans and animals. Some coronaviruses cause mild illness, sort of like a really bad cold, while others can cause quite severe disease and death.  MERS is a pretty gnarly one.  It was first identified in humans in 2012 in Saudi Arabia and, including the case identified here in the US, there have been 401 laboratory-confirmed cases of MERS-CoV as of this afternoon with a fatality rate of approximately 30%.  All confirmed cases have come from 6 countries in the Arabian Peninsula with the vast majority occurring in Saudi Arabia and the United Arab Emirates (UAE).  If you check out any of the experts listed above, you'll note that there has been a massive increase in reported MERS cases in the past few weeks.  Last month gave us more cases than what had been reported in the previous two years. So, it really was only a matter of time before MERS-CoV found its way to the US.  International travel has us within 24 hours of each other, no matter where we live.  Our US case traveled from Riyadh, Saudi Arabia to London, England to Chicago, Illinois by airplane and then by bus to Indiana.  All in a day or maybe a little over a day.  Either way, before the case even began to feel sick.  It's daunting to think about the number of people that may have been exposed to this case.  MERS-CoV adds quite a layer of trouble in this, as we really don't know much about how it's spread.  There's talk of camels and bats and human to human transmission.  And it's all true, but to what extent any one of those routes adds to the spread of MERS-CoV  is unknown.  Sure, there have been cases that had contact with camels, and bats are really good at spreading viruses all over the place.  But not all cases have camel exposure and there have been a number of healthcare workers that have fallen ill after treating a sick patient.  So there's your human to human transmission.  But not everyone, or more accurately, not very many at all, that come into contact with a MERS-CoV infected person get ill themselves.  So it's not like a cold or influenza where the virus is readily passed between people on objects and in cough and sneeze droplets (Sidebar: Get your nerd fix and check out this stunning video of a sneeze courtesy of Science Friday).  We just don't know.  And by "we" I mean the infectious disease community as a whole.  Clearly, I'm not doing research to help answer any outstanding questions.  I'm sitting on my couch sipping wine and writing this post and stopping periodically to make sure I'm not telling you lies. It's nice to be able to lump myself in with the greater community without having to do any of the hard work. That's not to say that I'm out of it completely.  Had this case traveled to Minnesota, I'd likely still be at work helping with the contact investigation.  Thankfully that's being done here in the US by the CDC and Illinois and Indiana state health departments and by similar agencies overseas.

So what do you need to do?  Absolutely nothing.  Calm down, it's all good.  Have you:
1. Traveled to the Arabian Peninsula in the past two weeks?
2. Flown from Riyadh to London and/or London to Chicago in the past week?
3. Taken a bus from Chicago to Indiana in the past week?

If you answered no to these questions, congratulations!  You can go on with your evening, have a great weekend!
If you answered yes to #1, don't panic.  It's unlikely that you'll become ill.  But if you do experience a respiratory illness with high fever, go to a doctor and make sure to let them know of your recent travel.
If you answered yes to #2 and/or #3, also don't panic.  If you were on the travel manifesto of the case patient you will be, or already have been, notified by state or CDC officials.  Again, highly unlikely that you'll also come down with MERS.
If you're a healthcare worker that has had, or could potentially have had contact with the case patient you too have already been notified.  Also, what?!  I'm very happy to have you here at Death by UTI, welcome!

Ok, let's recap:  MERS is a bad respiratory illness caused by MERS-CoV, a virus.  There is a case in the US, but risk to the general public is extremely low.  Diseases in general move easily from one country/region to another.  More needs to be learned about MERS-CoV, but currently it doesn't appear to readily pass between humans.  Sneezes are pretty cool.  I like wine.

Good talk everyone.  Carry on.