MERS Coronavirus Redux
Last month, we talked about MERS (Middle East Respiratory Virus) that has been making for some disturbing headlines in the news. As we discussed, MERS (aka MERS-CoV) is a new coronavirus (like SARS and the common cold) that was first detected in September 2012, in Saudi Arabia. By mid-June, when I first wrote about it, the virus had infected and sickened at least 58 people and killed 33 of them--give or take--in seven countries. We concluded our discussion by saying that in its current form, MERS was unlikely to produce a pandemic that would kill millions of people around the world; and as we can see from the latest numbers (90 infected with 45 deaths), it's only been responsible for seven additional deaths in the five weeks since the original newsletter. So what's changed that warrants another newsletter devoted to it?
In fact, not much--at least not yet. However, there may be something coming in the fall that could change the equation. But even if it doesn't, some of the things happening "around" the virus now offer us a glimpse as to how the world is preparing to respond to the next real pandemic, when it inevitably does arrive--whenever that may be--and that is important.
Before we talk about the changing circumstances surrounding the MERS coronavirus, let's quickly elaborate on some of the things we covered in our last discussion of MERS.
- First, MERS is pretty much a mystery. Medical researchers still don't know:
- Where it came from. (Although it almost certainly originated with one or more people contracting the virus from animals -- probably bats -- but scientists do not know how many times that kind of spillover to humans has occurred, or how likely it is to keep happening.)
- Where it hides in nature. If bats are the source, are other animals such as camels, goats, sheep, and cats acting as intermediate hosts, picking up the virus from the bats and then infecting people? And if animals harbor the virus, does it make them ill? Do they infect people by coughing? Or do they pass the virus in urine or feces and infect people who clean their stalls?
- How infectious it is. Although it appears it can be spread by coughs and sneezes, or contaminated surfaces, how exactly does it transmit from person to person?
- How long it incubates before sickening a person. (Nine to ten days is beginning to look likely.)
- When and for how long it is most contagious.
- Whether or not it's becoming more contagious.
- Who is most vulnerable?
- We also know that MERS has shown the ability to jump from country to country. Countries outside of Saudi Arabia affected include Jordan, Qatar, Tunisia, and the United Arab Emirates, as well as Britain, France, Germany, and Italy. (Note: that list remains unchanged over the last five weeks.)
- It seems to affect people with chronic health conditions. And more men than women have fallen ill, possibly because women have been protected by their veils in Islamic countries--most notably Saudi Arabia.
- Clusters of cases have occurred in families and health facilities, indicating a limited capacity to spread among people in close contact with an infected person. In other words, there is no evidence that MERS has crossed the "sustainability" threshold when it comes to human to human transmission; it doesn't seem to transfer easily from one person to the next.
- There's no vaccine that is known to be effective in preventing MERS, and antiviral drugs don't appear to be of much use against existing infections.
- And unlike the other notable coronavirus, SARS, which faded away as the result of infection control in hospitals and eliminating animals like civet cats that were thought to be spreading the virus in food markets after having caught it from bats, there is no sign that MERS is going away.
MERS and the World Health Organization (WHO)
So how could a virus that hasn't even infected 100 people in nine months have scared the World Health Organization to take extraordinary action? That's right, for only the second time in the history of the organization, they called an emergency meeting about a virus (held on July 11th). Even though MERS hasn't yet reached pandemic levels, or even pandemic potential, the WHO is worried enough about the virus to call just its second-ever emergency meeting. The first emergency meeting, for perspective by the way, took place in 2009. The subject was the H1N1 bird flu virus, which, although it never turned into a pandemic, did at least sicken thousands. So why such an unusual call to action for the MERS coronavirus?
First, there is concern that the identified numbers for MERS may be just the tip of the iceberg, that, in fact, there may be a much larger number of milder infections possibly going undetected. And WHO also wanted to prepare in case things worsened, so that they could recommend measures to try to contain the spread of MERS--such as travel restrictions--if needed.
In fact, at the time of the meeting, of the last 16 new laboratory-confirmed cases of MERS reported by Saudi Arabia, eight of them turned out to be asymptomatic. Of the eight asymptomatic cases four were female health care workers from Saudi Arabia. The other four were children aged seven to 15 who had contact with confirmed cases. As WHO stated, "The recent mild and asymptomatic cases raise concerns about the possibility of large numbers of milder cases going undetected. While it is clear that human-to-human transmission does occur, it is not clear whether transmission is sustained in the community. The currently observed pattern of disease occurrence could be consistent either with ongoing transmission in an animal reservoir with sporadic spillover into humans resulting in non-sustained clusters, or unrecognized sustained transmission among humans with occasional severe cases."1
The other purpose of the meeting was to prepare for a possible worsening of the SARS-like virus and to assess whether the outbreak constituted a "public health emergency of international concern." Measures to contain its spread, such as travel restrictions, were considered but not yet implemented.
Which brings us to the real reason the WHO called its emergency meeting on MERS: the potential game changer looming just a few months off in October, the Hajj.
The Hajj and MERS
The Hajj, for those of you who don't know, is one of the five pillars of Islam. It is the Muslim pilgrimage to Mecca that takes place in the last month of the year (Islamic calendar). It is a religious duty that must be carried out by every able-bodied Muslim who can afford to do so at least once in their lifetime. Last year nearly four million people made the pilgrimage to Mecca to participate. And there's the problem. Mecca is located in Saudi Arabia, the center of the MERS outbreak, and four million pilgrims, crowded together for several days on end, with a nine to 10 day incubation period, could potentially be the vehicle for taking MERS worldwide on a massive scale, in one fell swoop.
According to Dr. Kamran Khan, an infectious disease specialist and the founder of Bio.Diaspora, a web-based technology that uses global air traffic pattern to predict the spread of infectious disease, "With millions of foreign pilgrims set to congregate in Mecca and Medina between Ramadan and the Hajj, pilgrims could acquire and subsequently return to their home countries with MERS, either through direct exposure to the as-of-yet unidentified source or through contact with domestic pilgrims who may be infected."2 Furthermore, as Dr. Khan points out, since many of these pilgrims come from countries with limited resources, "They may have difficulty quickly identifying imported MERS cases, implementing rigorous infection control precautions and responding effectively to newly introduced cases." And in fact, so far, MERS has essentially been found in nations with health services capable of tracing and tackling such diseases--thus its limited impact. But the Hajj draws a broad spectrum of Muslims, including vast numbers from poor countries which struggle to cope with even commonplace diseases.
In May, Margaret Chan, the head of WHO, raised the war flag at the agency's annual congress in May. "We need to get the facts clear and get the appropriate advice to all your countries where your pilgrims want to go to Mecca. It is something quite urgent," she insisted.
However, before anyone panics, it's worth noting that the Hajj is not the only time pilgrims come to Saudi Arabia and Mecca. They also come as part of the Umrah, which is ongoing. And since MERS was first detected, almost five million pilgrims have performed the Umrah in Mecca with no sign of initiating any form of worldwide pandemic.3 Then again, with 3-4 million people crowded together all at one time, the Hajj is several orders of magnitude more challenging.
Health Officials and MERS
In Mideast countries in general, health officials have requested their citizens to regularly wash their hands, keep their homes and work areas clean, and be cautious about coming in contact with an ill person or when returning from crowded places such as animal markets and hospitals. In Saudi Arabia in particular, health officials have asked pilgrims visiting its holy sites to wear masks in crowded places to stop the spread of the MERS coronavirus. They also urged people taking part to maintain personal hygiene standards, use a tissue when sneezing and coughing, and have the necessary vaccinations. Incidentally, they were not referring to a MERS vaccine in this case since no such vaccine exists. Instead, they have a constantly changing list of required vaccinations, dependent on your country of origin that includes things like meningococcal meningitis, yellow fever, and seasonal flu vaccinations.4
Starting in 2006, proof of vaccination for polio was also required after fears of a resurgence of the virus. Now, the Saudi government reinforces that by giving all Hajj pilgrims leaving from Pakistan, Afghanistan, and Nigeria two drops of the oral polio vaccine upon arrival in Saudi Arabia.5 This is because of the resurgence of polio in these countries and resistance by militants to the vaccine, which they claim is part of a conspiracy to sterilize and reduce the world's Muslim population. In fact, over the last year, nearly 20 health workers from the anti-polio campaign have been murdered in Pakistan.6 Incidentally, polio cases rose by 37% in Pakistan in 2011.7 And for similar reasons, it rose 220% in Afghanistan and 185% in Nigeria.8 (Incidentally, on May 13, 2013, the Afghan Taliban ended its war on polio vaccination workers and declared that immunization was the only way to protect children from the disease.9 (For more on the pros and cons of vaccines, check out Anatomy and Physiology of the Immune System, Part 3.)
Meanwhile, in the United States, the CDC response team is working with other countries and with medical facilities in the US to make sure procedures are in place to combat MERS. Hospitals have received guidelines for assessing and isolating patients to keep the virus contained. "If there are cases that come to the US, we want to be well prepared to address them," said CDC director Dr. Thomas Frieden.
MERS and the Pharmaceutical Industry
On July 16th, after urging by the CDC, the FDA published its approval of an emergency diagnostic test developed by the CDC to detect the presence of MERS coronavirus antibodies.10
Meanwhile, Novavax Inc., Rockville, Md., announced on June 6th that it has developed a vaccine designed to provide protection against MERS-CoV.11 As the company announced in its press release, the vaccine is based on the virus's major surface spike protein and was made using recombinant nanoparticle technology. At the same time, it should be noted that the company did not cite any testing of the vaccine in either animals or humans.
And not to be outdone, earlier this month NanoViricides, signed a "confidential disclosure agreement" with Public Health England, Britain's equivalent of the U.S. Centers for Disease Control to develop a specific proposal for the testing of different nanoviricides, such as FluCide®, against the MERS-CoV virus.12
So what conclusions can we draw from everything we've discussed about MERS in the two newsletters we devoted to it?
- Well, first and foremost, as I noted at the beginning of the newsletter, MERS is not yet the killer pandemic destined to wipe out millions of people around the world. In fact, the emergency panel convened by the WHO concluded just days ago that MERS is not yet a "public health emergency of international concern."
- Again, there is some concern that it could become much more widespread as a result of October's Hajj pilgrimage. But in truth, until such time as the virus mutates and becomes much more easily transmissible between people, it is unlikely to ever be a true global threat. Consider how few cases there are outside of Saudi Arabia with almost five million pilgrims having already visited. If 3 million people visit all at once during the Hajj, that still means less than 100 new cases outside of Saudi Arabia as a result.
- Make no mistake, at some point, a deadly, pandemic capable virus, such as the flu virus of 1918, will emerge that will test the ability of the world's health officials to prevent the deaths of tens of millions of people. But like Armageddon, that may not happen during your lifetime.
- Ever more crowded third world cities with large sections of substandard housing, sanitation, and medical care are a ticking time bomb when it comes to promulgating pandemics.
- The mass farming of pigs and chickens--especially in third world countries--both of which serve as natural laboratories for the viruses themselves to mutate into a more deadly form and infect humans certainly increases the risk.
- On the encouraging side is the fact that most countries and health officials are much better prepared to handle such an emergency than they were back in 1918.
- Pharmaceutical companies all over the world, sensing the financial opportunity of a lifetime, will throw all their considerable resources into developing a vaccine and finding a cure in the event a pandemic truly emerges. Novavax and NanoViricides are already acting on just on the hint of such a scenario.
- Yes, I know vaccines are a controversial issue. But in truth, although they are not quite the safe cure-all claimed by the medical industry, they are not quite as dangerous as claimed by many in the natural health community. The bottom line is that vaccines are a mixed bag. Yes, some like the flu vaccine are virtually useless (despite claims of 90% effectiveness), but others actually work. Make no mistake, despite claims to the contrary, the smallpox vaccine truly did eliminate smallpox from the face of the earth--an epic achievement. And the polio vaccine, despite a number of early, deadly missteps, has turned things around and is about to do the same for polio. Heck, even the Taliban has done a 180 in support of the vaccine. The bottom line is that when that great pandemic finally strikes and there's a vaccine that even modestly helps, you'll want to take it. Until that time, though:
- You want to optimize your immune system.
- And keep pathogen destroyers on hand at all times, just in case. You can be pretty much guaranteed that if you wait until the pandemic hits, they'll be sold out when you try and purchase them. Who could find iodine on the shelves in the days immediately after the Fukushima disaster?
And speaking of the pharmaceutical industry, let me finish with a final rant. I'd like to return for a moment to the press release from Novavax in which they announced a vaccine designed to provide protection against the MERS coronavirus--but offered no testing of any kind in either animals or humans to support that claim. I'm not saying their claim is untrue; for all we know it may actually help. But is anyone else "concerned" by the double standard invoked here? A pharmaceutical company can make unsubstantiated claims, but if I were to say that my anti-pathogen formula sold by Baseline Nutritionals actually provided "protection against MERS," is there any doubt as to how fast Federal regulators and the medical community would be all over this site to shut it down--and yet, not a peep about Novavax's unsubstantiated claims? In fact, the press picked up the release and publicized it widely in news stories about MERS carried throughout the world.
And for whatever it's worth, after the announcement, and thanks to the press, Novavax's stock jumped to its highest level in a year…just sayin.
- 1. Global Alert and Response. "MERS-CoV summary and literature update -- as of 09 July 2013." World Health Organization." 9 July 2013. (Accessed 21 July 2013.) http://www.who.int/csr/disease/coronavirus_infections/update_20130709/en/index.html
- 2. Leslie Shepherd. "Researchers describe potential for MERS coronavirus to spread internationally after mass gatherings in the Middle East this summer and fall." 91 July 2013. St. Michael's Hospital. (Accessed 21 July 2013.) http://www.stmichaelshospital.com/media/detail.php?source=hospital_news/2013/20130719_hn
- 3. "Saudi Arabia sees 4.8mn pilgrims in 2013 so far." Arabian Travel News.com. (Accessed 22 July 2013.) http://arabiantravelnews.com/travel/2013/jul/18/337017/#.Ue26i3bn9aQ
- 4. "Saudi Ministry of Health Requirements." Ministry of Hajj, Kingdom of Saudi Arabia. (Accessed 21 July 2013.) http://www.hajinformation.com/main/p3001.htm
- 5. Our Correspondent. "Hajj precautions: Pakistan pilgrims to receive polio drops in Jeddah" 19 Sept 2012. The Express Tribune. (Accessed 21 July 2013.) http://tribune.com.pk/story/438923/hajj-precautions-pakistan-pilgrims-to-receive-polio-drops-in-jeddah/
- 6. Associated Press. "Pakistani militants shoot dead two polio vaccination workers." The Guardian. 16 June 2013. (Accessed 21 July 2013.) http://www.guardian.co.uk/world/2013/jun/16/pakistan-militants-kill-health-workers
- 7. Kounteya Sinha (15 May 2012). "WHO to declare polio global health emergency." The Times of India. 15 May 2012. (Accessed 21 July 2013.) http://articles.timesofindia.indiatimes.com/2012-05-15/india/31711170_1_bivalent-bopv-oral-polio
- 8. David Smith, "Polio workers in Nigeria shot dead." The Guardian, 8 February 2013. (Accessed 21 July 2013.) http://www.guardian.co.uk/world/2013/feb/08/polio-workers-nigeria-shot-dead
- 9. "Taliban renounces war on anti-polio workers." The Telegraph. 13 May 2013. (Accessed 21 July 2013.) http://www.telegraph.co.uk/news/worldnews/asia/afghanistan/10053981/Taliban-renounces-war-on-anti-polio-workers.html
- 10. Samantha Olson."FDA Approves Diagnostic Test For MERS At CDC's Emergency Request, As Death Toll Hits 66." Medical Daily. 16 July 2013. (Accessed 21 July 2013.)
- 11. Ryan Parrish. "Novavax creates MERS-CoV vaccine candidate." Vaccine News. Published on June 7, 2013. (Accessed 21 July 2013.) http://vaccinenewsdaily.com/vaccine_development/325407-novavax-creates-mers-cov-vaccine-candidate/
- 12. GEN News Highlights. "Public Health England to Test Nanoviricides Against H7N9, MERS." 8 July 2013. Genetic Engineering & Biotechnology News. (Accessed 21 July 2013.) http://www.genengnews.com/gen-news-highlights/public-health-england-to-test-nanoviricides-against-h7n9-mers/81248567/