Are we aware of this respiratory disease called MERS (Middle East Respiratory Syndrome)?

You may not have heard of MERS before. But now, thanks to the COVID-19 pandemic, we are all very familiar with coronaviruses. MERS is also a member of the coronavirus family, but it is a slightly different, sometimes very serious respiratory illness. So, it is worth learning a little about it for you and your family, right? Let's talk about it simply.

What is MERS?

Simply put, MERS is a mild, severe, and difficult-to-breathe disease that affects our lungs. It is caused by a specific type of virus called Coronavirus . To be precise, the virus is called `MERS-CoV` (Middle East Respiratory Syndrome Coronavirus). This disease was first reported to the world in 2012 in Saudi Arabia. That is why it is called "Middle East Respiratory Syndrome".

Let's learn a little about Coronaviruses

Now you may be wondering what these coronaviruses are and why they are so dangerous. Actually, coronaviruses are not a single virus, but a large group of viruses. They usually infect birds, or mammals like dogs, cats, and cows. However, sometimes these viruses change and mutate, and there is a possibility that they can infect humans as well.

Scientists first discovered these coronaviruses in the mid-1960s. Since then, seven strains of coronavirus have been identified that can make people sick. Four of these cause mild symptoms, similar to the common cold. However, the other three are more severe and can sometimes be life-threatening. These three are:

• `SARS-CoV` (Severe Acute Respiratory Syndrome Coronavirus): This was identified in 2003. You may remember that at that time, there was a lot of panic around the world.
• `MERS-CoV` (Middle East Respiratory Syndrome Coronavirus): This is the one we are talking about now. It was identified in 2012.
• `SARS-CoV-2`: This is the virus that caused the `COVID-19` disease that we have all been battling recently.

How common is MERS?

So, how common is this disease called MERS? According to the World Health Organization (WHO), as of January 2020, only 2,519 MERS cases have been reported worldwide since 2012. Although these patients have been reported from 27 countries, 80% of these patients, that is, eight out of ten, have been reported from Saudi Arabia. Like everyone else, this has been contracted after traveling to countries in the Arabian Peninsula, that is, countries like Iraq, Iran, Israel, Saudi Arabia, and Syria, or after living there. Since our country is going to these countries for work, it is important to be aware of this. Even in the United States, only two MERS patients have been reported. Both of them are health workers, who have traveled to Saudi Arabia.

Who is most at risk of developing MERS?

So, let's take a look at who is most at risk of developing MERS. Consider these facts:

• For those who have recently traveled to the Arabian Peninsula (e.g. Saudi Arabia, Qatar, United Arab Emirates).
• For those who have traveled to the Arabian Peninsula and have been in close contact with someone who later became ill.
• For those who have been in close contact with someone who has been confirmed to be infected with `MERS-CoV`.
• If you are a healthcare worker , have worked closely with a MERS patient and have not followed proper infection control measures.
• For those who have come into direct contact with camels, or who have eaten uncooked camel meat, or who have drunk unpasteurized camel milk. (This is not particularly relevant for Sri Lanka, but is important for those traveling to the Middle East).

Where did the MERS virus come from?

Think about where these viruses come from. Researchers believe that diseases like MERS, SARS, and COVID-19 first started in bats, then spread to other animals, and finally to humans.

• It is currently believed that the MERS-CoV virus jumped from bats to camels and from camels to humans .
• The SARS-CoV virus came to humans through civets (a small mammal found in Africa and Asia).
• Scientists still don't know exactly from which animal the COVID-19 virus came to humans.

How is MERS transmitted?

Like some other infectious diseases, the MERS-CoV virus resides in our respiratory tract. So, it is mainly transmitted through respiratory droplets released when an individual coughs or sneezes.

MERS is a contagious disease. However, it did not spread as quickly around the world as COVID-19. MERS requires very close contact to spread. Like between family members or when caring for a patient in a hospital. Health officials have not seen community-wide spread.

Also, camels can transmit MERS. Camels in Saudi Arabia and surrounding countries have MERS strains that are similar to the MERS strains that cause disease in humans. This suggests that camels are actively transmitting MERS to humans.

What are the symptoms of MERS?

A person with MERS may not have any symptoms at all. Or, they may have mild symptoms similar to a common cold. However, it can sometimes progress to a more severe, life-threatening condition. MERS usually causes respiratory symptoms such as:

• Cough
• Fever (possibly high fever)
• Shortness of breath

Some people have also reported symptoms such as diarrhea, nausea, and vomiting. MERS symptoms usually begin within two to fourteen days after exposure to the virus.

What are the dangerous complications that can occur due to MERS?

Now let's look at what complications can occur if MERS becomes severe. This is where we need to focus the most. In severe cases, MERS can progress to pneumonia , respiratory failure, and the need for mechanical ventilation . It can also lead to kidney failure.

The mortality rate for MERS is said to be around 35%. That means that about one in three people who get MERS will die. However, this could be much lower. This number does not include patients with mild symptoms, who are not diagnosed or reported.

This disease is more likely to be severe in people who have other underlying conditions that weaken the immune system. For example:

• Cancer
• Chronic heart disease
• Chronic kidney disease
• Chronic lung disease (e.g. asthma, COPD)
• Diabetes (`Diabetes Mellitus`)
• Elderly people

How is MERS diagnosed?

If you have respiratory symptoms such as fever, cough, and difficulty breathing, your doctor will ask you about your medical history. Be sure to tell your doctor if you have recently traveled anywhere, especially in the Middle East, or been in contact with sick people or camels.

Special laboratory tests can be done to determine if you have an active or past MERS infection. Your doctor may take several samples, such as:

• Lower respiratory tract sample: You may be asked to collect sputum (or phlegm) in a container. Alternatively, your doctor may insert a thin, flexible tube (bronchoscope) down your throat to take a sample of sputum from your lungs.
• Upper respiratory tract sample: This involves taking a sample from inside the nose or upper throat using a swab.
• Serum sample: Serum is the liquid part of your blood. The doctor takes a sample of your blood and spins it in a high-speed machine (centrifuge). The serum is then separated from the red blood cells, white blood cells, and platelets. This serum is then tested for antibodies that have been made against the virus.

Not all laboratories are authorized to test for MERS-CoV. Your doctor may send the sample to your state health department's laboratory or to a specialized facility, such as the Centers for Disease Control and Prevention (CDC).

How is MERS treated?

There is currently no approved specific antiviral treatment for MERS. That is, there is no specific medicine that can kill the virus. So, medical treatment is supportive care, which helps control your symptoms while your body fights the infection.

• If you have mild symptoms , you can rest at home and take medication like paracetamol for pain and fever.
• However, if the disease is severe, you may need to be hospitalized. In that case, you can do things like:
• Give IV fluids (prevent dehydration).
• Providing supplemental oxygen (for breathing difficulties).
• If breathing is impossible, mechanical ventilation is used.
• If the kidneys fail, dialysis can also be performed.

How can you prevent MERS from spreading to others? (If you have MERS)

If you know or think you have MERS, you should definitely do these things to prevent spreading it to others:

• Stay home immediately. Stay in a separate room from other people. If possible, use a separate bathroom.
• Wash your hands often with soap and water (for at least 20 seconds). If you use a hand sanitizer, it should contain at least 60% alcohol.
• Wear a face mask when in a room with other people.
• Cover your mouth and nose with a tissue when you cough or sneeze. Throw the used tissue into a closed trash can immediately and wash your hands again.
• Call your doctor before you go to see them and tell them you may have MERS so they can take the necessary precautions.
• If your symptoms get worse, for example, if you have increasing difficulty breathing, call your doctor immediately.

When can normal activities resume?

If you feel well now, talk to your doctor about when you can resume normal activities. Your local health department or provincial health department will give you guidance on how long you should stay home to prevent spreading MERS to others. This is usually until your symptoms have gone and you have tested negative for the virus.

How to protect yourself from MERS? (Prevention methods)

There is currently no vaccine for MERS. The ways to protect against MERS are largely the same as those for all other respiratory illnesses:

• Always wash your hands thoroughly with soap. Be sure to wash your hands after going out, before eating, and after using the toilet.
• When coughing or sneezing, cover your mouth and nose with a tissue or the inside of your elbow.
• Avoid touching your eyes, nose, and mouth with your hands as much as possible.
• Avoid close contact with people who are sick.
• Keep frequently used surfaces (doorknobs, tables, phones) clean and use disinfectant.

To prevent MERS infection, especially from camels, do the following (for those traveling to countries like the Middle East):

• Be sure to wash your hands after handling camels. Avoid contact with sick camels at all costs.
• Avoid eating unpasteurized camel milk and undercooked camel meat.
• If you have a chronic medical condition (e.g. diabetes, heart disease), or a weakened immune system, avoid going to areas where camels are present or interacting with camels.

How can you protect yourself when caring for someone with MERS?

If you live with or care for someone with MERS, health officials recommend taking these extra precautions:

• Be sure to wear a face mask, gown, and gloves when coming into contact with that person's body fluids (e.g., mucus, saliva) or secretions.
• Wear gloves when washing dishes, towels, bedding, and clothes. Wash them separately from other people's items. Wash your hands thoroughly after removing gloves.

What happens if MERS occurs? (Prognosis)

If you haven't been to the Arabian Peninsula, or if you've been there and haven't been in close contact with someone who has symptoms, your chances of getting MERS are very low. Don't worry.

However, if you get MERS, you are at high risk of developing a serious condition, especially if you have other underlying health problems, as mentioned earlier. Your doctor will monitor you closely and provide supportive care to manage your symptoms.

When should I see a doctor?

If you have symptoms of MERS (fever, cough, difficulty breathing) and think you may have been exposed to the MERS-CoV virus (e.g., recently traveled to the Middle East, had contact with someone who had, had contact with camels), you should see a doctor immediately.

MERS symptoms can be very severe and life-threatening. So, if your symptoms get worse, call your doctor or go to a hospital right away without delay.

Things we should remember from this story (Take-Home Message)

Okay, so, there are a few things we definitely need to remember from this long story:

• MERS is a rare but potentially serious respiratory illness. It is unlikely to be contracted without travel to the Arabian Peninsula or close contact with someone who has been there and is symptomatic.
• If you are planning to visit the Arabian Peninsula, be sure to practice basic hygiene. Wash your hands frequently, avoid touching your face, and be careful around camels. Avoid raw camel milk and undercooked camel meat.
• If you suspect you have MERS, call a doctor immediately. They can perform the necessary tests and give you guidance on how to manage the disease and prevent it from spreading to others.
• Awareness is the best defense. Knowing about these diseases helps us protect ourselves from them.

So, I hope this information is useful to you. Stay healthy!

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