Arrived in Asia and 98 minutes from Singapore: the Middle East Respiratory Syndrome-Corona Virus (MERS-CoV)

The Middle East Respiratory Syndrome-Corona Virus which was first identified in Saudi Arabia in 2012, appears to be less infective than SARs, but more lethal. Lab-confirmed cases of the virus are restricted to ten countries in the Middle East, Africa and Europe and the 238 cases includes 92 deaths [WHO, 16 Apr 2014].

In October 2013 we learnt the virus was believed to have co-evolved with bat hosts before jumping species, possibly through an intermediary, to infect humans. And earlier this year, tests of dromedary camels suggest they are a reservoir for the virus.

World map depicting the city level destinations of travellers and the national origins of foreign Hajj pilgrims: no region is isolated [Khan et al., 2013. ]

Potential for the International Spread of Middle East Respiratory Syndrome in Association with Mass Gatherings in Saudi Arabia – PLOS Currents Outbreaks

With mass gatherings and global travel, it was highly probable that that the virus would spread to Asia. In what has been a longer time than expected (perhaps due to lessons from SARS), the first cases in Asia have surfaced 19 months later.

A Filipino male health worker, returning from UAE to Manila on 14 April 2014, tested positive for MERS-CoV. He may have been infected by a fellow Filipino nurse (OFW or Overseas Filipino Worker) who died in the UAE. He is not showing any signs of the sort of severe acute respiratory illness which has killed about half of the MERS-CoV victims so far, and is in quarantine.

What appears to be the first death in Asia has been confirmed by Malaysia’s Health Minister, S. Subramaniam. A 54-year old Malaysian returning home after a pilgrimage to Mecca on 29 March 2014 died on 13 April 2014 at Hospital Sultanah Nora Ismail, Batu Pahat, Johor.

Suddenly, the far-flung MERS is 98 mins away from Singapore.

Suddenly, MERS is 98mins away from Singapore

WHO advises that:

“It is not always possible to identify patients with MERS-CoV early because some have mild or unusual symptoms. For this reason, it is important that health-care workers apply standard precautions consistently with all patients – regardless of their diagnosis – in all work practices all the time.”

As always, our health care workers will have to be vigilant. During the SARS outbreak in 2003, about 40% of cases were healthcare workers. When remembering SARS a decade later, Minister for Health Gan Kim Yong recalled, “Both our foreign and local healthcare workers stayed on to fight alongside one another.”

We should not forget the professionalism and uncommon valour of those who stood at the frontline of an epidemic.

As for the rest of us in our crowded urban environment? Simple practises may not heroic but are critical – “learning and practicing good personal hygiene habits and being socially responsible”. This includes frequent hand washing, covering our noses and mouths when coughing or sneezing and not exposing others when ill.

I’ll pay more attention, for sure. I am glad our students will be mostly away from campus now. Since they return for the exams, we will need to revisit the standing precautions and emergency procedures for health issues during the exams.

Be well everyone!