# 7986
On Wednesday of last week Kuwait announced one, then later in the day – two – MERS Coronavirus cases (see Kuwait MOH Announces Second MERS-CoV Case), but at the time the World Health Organization was waiting for additional testing before officially confirming these cases.
Those test results are in, and today the WHO posted the following DON (Disease Outbreak News) update on their GAR (Global Alert & Response) webpage.
Middle East respiratory syndrome coronavirus (MERS-CoV) - update
Disease outbreak news
18 November 2013 - WHO has been informed of an additional two laboratory-confirmed cases of infection with Middle East respiratory syndrome coronavirus (MERS-CoV) from Kuwait.
The first patient is a 47 year-old man who became ill on 30 October 2013 and was hospitalised on 7 November 2013. He is in critical condition. The second patient is a 52-year-old man with underlying medical conditions. He became ill on 7 November and was hospitalised on 10 November 2013. He is in critical condition.
Globally, from September 2012 to date, WHO has been informed of a total of 157 laboratory-confirmed cases of infection with MERS-CoV, including 66 deaths.
Based on the current situation and available information, WHO encourages all Member States to continue their surveillance for severe acute respiratory infections (SARI) and to carefully review any unusual patterns.
Not specified in this report are any details on the patient’s recent travel history or possible exposures (in hospitals, to animals, etc.), making it impossible to even hazard a guess how they became infected.
Meanwhile Kuwait’s Ministry of Health has been supplying their media with a daily assurances that they are on top of the situation, and that MERS-CoV is unlikely to pose a serious epidemic threat to that nation.
A translation of today’s reportage from KUNA (Kuwait News Agency) reads.
11/18/2013
14:24
The good: the chances of turning 'Corona' to a very small B
(KUNA) - The head of the Unit for Combating epidemics Ministry of Health and spokesperson for the disease (Corona) in Kuwait, Dr. Musab al-Saleh said the presence of two مصابتين the disease do not live up to the stage of the epidemic is not considered a disease Corona and B. stressing that the opportunity to turn it into a pandemic "very slim" because of the nature of the disease.
Saleh said in a press conference at the Department of Public Health today, "There are no reasons to limit the movement and visit public places, hospitals, and in order to avoid Coruna travel."
Saleh said that the cases are still shall receive the necessary treatments under intense medical supervision in the intensive care rooms noting that the first case, lying in a hospital communicable diseases either second-Adan Hospital because the situation suffered heart muscle problems and must use the expertise Adan Hospital for treatment.
Saleh stressed that there was no new cases, explaining that since the announcement of the first case of an infected total number of suspected cases and that 64 people have been checked and the results were negative.
Although the Kuwait MOH continues to stress that there have only been two cases – unless these patients recently traveled outside of the country - there would have to be some source for the virus within Kuwait.
Infection could come from direct contact with an infected animal or human (symptomatic or asymptomatic), or conceivably from environmental contamination left behind by an infected host.
But either way requires a local (perhaps temporary) source for the virus.
Last week we looked at a Lancet study (see Branswell: Transmission Estimates Of MERS-CoV – Lancet Infectious Disease) that estimated for every MERS case detected, there are probably 5 to 10 that go undetected. While based on a mathematical model – backed up by some high level statistical analysis - this does suggest that there are probably other (mild or asymptomatic) cases in Kuwait.
The real question is, does MERS-CoV transmit well enough to sustain an epidemic?
And so far, the answer appears to be `no, but it may be getting closer’.
The epidemiological yardstick by which human transmission of an infectious disease is measured is called the R0 (pronounced R-nought) or Basic Reproductive Number. Essentially, the number of new cases in a susceptible population likely to arise from a single infection.
With an R0 below 1.0, a virus (as an outbreak) begins to sputter and dies out. Above 1.0, and sustained human-to-human transmission can occur.
The lancet study from last week estimated the R0 of MERS-CoV to be `approaching 1.0’, or an efficiency high enough to provide for sustained human-to-human transmission.
The good news is, while an R0 of 1.0 or higher is thought to make an epidemic (or even a pandemic) possible – it does not mean that one is inevitable.
The SARS coronavirus is believed to have had an R0 of 2.0 or greater, and yet once the world awoke to the threat and began to react, the virus was eventually contained and apparently eradicated in humans.
With aggressive prospective testing, along with isolation and quarantine those infected and/or exposed, and stringent infection control procedures in hospitals, it may well be that MERS can be corralled in much the same way.
But for that to happen, public health officials – particularly on the Arabian Peninsula - must act quickly and decisively to find and isolate those cases that – for now – are sliding under the radar.
