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April 29, 2014

As MERS Infections Rise, Asia Reflects on SARS

by Rebecca Valli

The deadly Middle East Respiratory Syndrome (MERS) has killed more than one hundred people so far, but many questions remain about its origins and method of transmission.

In Hong Kong, analysts say lessons learned eleven years ago with Severe Acute Respiratory Syndrome (SARS) — a genetically similar pandemic that killed almost 300 people in 2003 — can be applied to slow MERS infections.

A respiratory disease caused by a type of coronavirus, MERS is a common virus that infects animals and humans, causing fever and coughing and, in serious cases, pneumonia and kidney failure.

First reported in Saudi Arabia in 2012, MERS has proven fatal in 102 of the kingdom's 339 confirmed cases reported since that time.

Although the disease has since spread to other spots in the Middle East — Egypt recently reported a handful of cases — reports are also turning up in Malaysia, the Philippines and Indonesia.

According to Malik Peiris, the director of the center for influenza research at Hong Kong University, the comparison between MERS and SARS is striking.

“When SARS started, in the November-December period of 2002, what we were seeing was also clusters of cases, clusters of human patients with severe pneumonia, [and] at that time nobody knew what it was," said Peiris, who leads the Hong Kong laboratory that was responsible for isolating the SARS virus in 2003.

Scientists only later confirmed the SARS pandemic was caused by a virus that originated from Chinese bats and jumped across species to humans.

"Each of those clusters [would die] out and then a fresh cluster of cases [would appear] somewhere else, all within Guangdong in Southern China," he said. "And then, a few months later, by January-February, the virus started to transmit in a sustained fashion from human to human.”

Within months, Peiris says, SARS spanned more than 25 countries, touching all five continents.

A turning point

For China, the epidemic that went on to claim nearly 800 lives worldwide represented a turning point for national health policy.

At first, Beijing authorities downplayed the seriousness of the virus and barred new outlets from reporting new cases.

Prompted by the leaks of a doctor in Beijing, however, Chinese health officials eventually admitted they had covered up information to avoid panic, and then notified the World Health Organization about the real magnitude of the situation.

According to analysts, the delays exacerbated the epidemic. In retrospect, the cover up only underscores the high cost of secrecy on matters of public health.

When MERS first appeared in Saudi Arabia, Peiris says, there was also a delay in releasing information.

“There was some time lost during that early phase, 2012-2013, in which much more could have been learned," he said. "But over the recent months, I think there really has been significant awareness and action in this regard.”

On Monday, Saudi Arabia's health minister was fired after he told a news conference that the April surge in MERS cases could be seasonal and that his office was not about to order additional preventative measures.

Health professionals at risk

Like SARS, MERS spreads rapidly within hospitals with a high percentage of infection among health-care workers.

According to Professor Nelson Lee, a specialist in infectious diseases, Hong Kong's hospitals are now much better prepared to handle respiratory epidemics.

A medical officer at Prince of Wales Hospital, the medical center at the forefront of Hong Kong's SARS outbreak, Lee says that, in 2003, the city's public hospitals had inadequately trained staff and lacked isolation facilities, causing many of his colleagues to develop pneumonia.

“Airborne isolation facilities are now present in all of the major hospitals in Hong Kong," he said. "We learned the proper triage is important, so every patient who gets admitted to the hospital with a respiratory illness and pneumonia will be asked some risk factors for acquiring emerging infection disease.”

Patients are now asked about travel history, recent contact with sick people and whether they have noticed clusters of illness within their family or at work, he says.

“If a patient now comes into the hospital with a travel history to the Middle East and signs of pneumonia for example, we will test him or her for the MERS coronavirus.”

Despite the improvements, Hong Kong's SARS survivors still face difficulties.

“Because of the heavy use of drugs during the treatment, [SARS patients] have developed some problems within their bones," said Hong Kong lawyer Alex Lam. "They had to replace the joints and they have to use walking stick. Some may even need to use wheelchairs. Other people are facing mental difficulties, so there is a trauma.”

Diagnosed with SARS in 2003, Lam was given a mix of drugs including steroids, only to receive further blood testing that proved his initial diagnosis a mistake.

Now chairman of the Hong Kong SARS Mutual Help Association, Lam leads the group that helps former SARS patients overcome the consequences of illness.

“Looking at the positive side, we did learn a lesson, although we paid a very heavy price for this,” Lam said.

Like SARS, the virus behind MERS has also been detected in a number of animals, including bats and camels. While scientists believe camels might be the primary source, they have not found convincing evidence to confirm the link, nor explain how it may have jumped from animals to humans.

Until they do, those faced with the threat of MERS can only look to other regions that survived a threat of such mysterious origins.