MERS–COV: An Introduction

1 What is MERS–COV?

MERS is a Middle East Respiratory Syndrome, which is a viral respiratory syndrome that is caused by a novel coronavirus and was first identified in Saudi Arabia in 2012. The Coronaviruses are a large family of viruses that can cause diseases ranging from the common cold to Severe Acute Respiratory Syndrome (SARS). The symptom of MERS includes fever, cough and shortness of breath; gastrointestinal symptoms consist of diarrhoea and pneumonia. The respiratory failure that is caused by severe illness requires the aid of mechanical ventilation and support in an intensive care unit. MERS is contagious, but to a limited extent only. Unless there is close contact between the patient and caretaker, the virus does not seem to pass easily from person to person. The suspected source of MERS virus was discovered in camels, which comes from Egypt, Qatar, and Saudi Arabia.

2 Outbreak of MERS-CoV

The first outbreak case of MERS-CoV was reported in 2012 and has affected up to 9 countries to this date. Countries that have been infected include Italy, United Kingdom, Germany, Greece and France (Europe); Philippines and Malaysia (Asia); United States of America (Americas); Egypt and Tunisia (Africa) and the United Arab Emirates, Qatar, Kuwait, Jordan, Oman, Yemen, and Saudi Arabia (Middle East). In Saudi Arabia alone, the total number of confirmed cases alone exceeds 300 with over 100 deaths. Approximately 27% of patients diagnosed with MERS have departed. The virus appears to cause more severe disease in people with chronic conditions such as cancer, diabetes, and lung diseases, weakened immunity system, and the elderly. There is a sharp incline in cases of MERS-CoV in some parts of Saudi Arabia, and it has led to several questions on whether the virus has mutated to become more efficient at transmitting it. The increase in cases of MERS-CoV could be the result of inadequate hygiene and infection control measures and not due to the changes in their genome.

In June 2015, according to the World Health Organization, South Korea had the highest number of cases of Middle East Respiratory Syndrome (MERS).

3 How is the World Reacting to MERS-CoV?

Firstly, Saudi Arabia proposed preventive measures to prevent hospital transmission, launched awareness campaigns to educate the public, increased observation for MERS-CoV, investigated sources of infection and invited international experts to help. According to the local media report, Saudi Arabia has set up a new centre to kerb the outbreak of Middle East Respiratory Syndrome (MERS) in the country. The new facility would consist of a control tower, a scientific committee, and an advisory board while ensuring cross-ministry coordination. It would also have adequate epidemiology support and infection prevention capacity along with clinical operations.

Secondly, World Health Organization (WHO) is working with scientists and clinicians to gather and share more evidence to get a better understanding of the virus. This action will result in a better understanding of the disease and eventually determine the outbreak response priorities, treatment strategies, and management approaches.

Thirdly, there are currently no cases of the outbreak in Singapore, and the risk remains low. However, the Government remains vigilant and is stepping up its operational readiness in the event of an imported case. The Ministry of Health (MOH) works in close collaboration with tour agencies to organise a pre-departure talk for Umrah pilgrims, including knowledge on MERS-CoV, advice for preparation before the pilgrimage, particularly the control and prevention measures to be taken during and after the pilgrimage. For Hajj pilgrims, MOH works with the Hajj Pilgrimage Fund Board, a government agency committed to providing medical examinations, lectures and vaccines to Hajj pilgrims. In the Hajj period, medical teams are deployed to Saudi Arabia to stay throughout the entire Hajj period to provide medical needs to the Hajj pilgrims whenever needed. In 2013, the medical teams consisted of a total of 250 medical personnel and these were organised by MOH through the Hajj Pilgrimage Fund Board.

4 How to Prevent MERS-CoV?

WHO encourages all member states to enhance their surveillance for severe acute respiratory infections (SARI) and to review any unusual patterns of SARI or pneumonia cases carefully. WHO urges the Member States to notify or verify with them if there are any probable or confirmed infection cases with MERS-CoV. WHO also encourages countries to raise awareness of MERS and provide information to travellers.

Healthcare facilities that provide care for patients suspected or confirmed to be infected with MERS-CoV infection should take suitable measure to decrease the risk of transmission of the virus. Usually, this transmission is from an infected patient to other patients, visitors, and healthcare workers. Healthcare workers should be trained, educated, and refreshed with skills in infection prevention and control.

5 How to Treat MERS-CoV?

There is no specific treatment for MERS-CoV. The only recommended management is symptomatic treatment. Treatment of symptoms includes vitamins to strengthen the immune system and anti-inflammatory medication for pain and symptom relief. Severe cases can be provided isolation and acute respiratory and intensive care support in the hospital.