MERS: What You Should Know

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As the number of cases of Middle East Respiratory Syndrome (MERS) in South Korea approaches 100 (with 7 deaths), the virus has begun to receive serious attention. The World Health Organization has begun a joint mission with the Korean government to analyze the virus and formulate an organized and effective response to it.

First identified three years ago, MERS is caused by a coronavirus called MERS-CoV. This virus comes from the same family that caused the SARS (Severe Acute Respiratory Syndrome) epidemic in Asia some years back. MERS originated in the Middle East and has been linked to respiratory disease in camels: A recent study reports that 75% of camels in the area have evidence of past exposure to the virus. Little, however, is known about methods of transmission. To date, there have been about 1200 cases of MERS in 25 countries, almost all in the Middle East or in travelers from that area.

(Note: When I wrote about MERS last year, there were 572 total cases in 15 countries)


Once infected with Middle East Respiratory Syndrome, the patient begins to show signs of the disease in 10-12 days. Symptoms of MERS-CoV infection include fever, productive cough, nasal congestion, and shortness of breath. Some cases present with gastrointestinal symptoms like nausea, vomiting, and diarrhea. If the patient worsens, pneumonia (an infection of the lung) and kidney and other organ failures occur.

The disease carries with it a 30% death rate. In comparison, the mortality from SARS, in comparison, was 9-12%. Clearly, it’s a disease to be reckoned with. The question is: How likely is MERS to become a widespread epidemic?


In South Korea, the disease is evoking a similar response to the Ebola epidemic of last year. Healthy people are wearing face masks in public, and even fashionable weddings feature them as accessories. Neighboring territories are cautioning its citizens against travel to affected areas, and school closures number in the thousands.

First, the good news: Most of the severe cases and deaths have occurred in the elderly or infirm, such as those with diabetes or heart conditions. Healthy young people have, for the most part, been immune although one teenager was recently found to be infected.

Almost all cases have traveled to Saudi Arabia recently or have had close contact with someone who has. If you’re not in this group, the odds of contracting the infection are minimal. Right now, the highest risk occurs in people who work or are currently admitted as a patient in certain South Korean hospital wards.

Now, the bad news: The MERS virus is a concern because it originates from an area where there are many overseas foreign workers. As a result, it is popping up in places far from the Middle East (like South Korea) due to commercial air travel. This includes the United States, where there have been 3 documented cases in the past. Not an encouraging sign for an infection for which there is no known treatment or cure.

Another issue is that MERS-CoV virus has been identified in people who had no any symptoms whatsoever. A lack of symptoms makes it difficult to identify who is carrying the disease and who can pass it to others. Also, few physicians outside the area of origin easily recognize the illness. The original MERS victim in South Korea went to four different medical facilities with symptoms (that is, contagious) before he was finally diagnosed.

The last concern is that, because we know so little about the illness, there’s no set of guidelines certain to be effective against spread of the virus. You might remember the trial-by-error process employed by the Center for Disease Control (CDC) when an Ebola patient turned up in Texas last year. Eventually, we figured out the best way to prevent contagion, but not before some health workers were infected.


How can you protect yourself from MERS? We don’t really know as of yet, but general precautions against respiratory infections are a good start:

• Wash hands often with soap and water. If soap and water are not available, use an alcohol-based hand sanitizer.
• Cover your nose and mouth with a tissue during coughs or sneezes; dispose of used tissues safely.
• Avoid touching eyes, nose, and mouth with your hands.
• Avoid close contact with sick people.
• Clean and disinfect counters, doorknobs, and other frequently touched surfaces.

It’s too early to tell if MERS will be the next great pandemic. I doubt it, personally, but it’s certainly worth monitoring the outbreak’s progress. It’s even more important to be ready to deal with any infectious disease that might invade your neighborhood. Knowledge of good respiratory hygiene and having supplies like N95 masks and gloves in your medical kit will give you a head start on staying healthy.

For my article on face masks as protection against contagious illness, click the link below:

Joe Alton, MD

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