Location of the UAE in the Middle East
#16,414
Although many people were surprised when a novel coronavirus emerged in 2019 to spark our current pandemic, we've been following coronaviruses intently for years, and they've been viewed as having pandemic potential for nearly two decades.
In 2002-2003, the world narrowly avoided a SARS-CoV pandemic (see SARS And Remembrance). While deadlier than COVID, the original SARS virus lacked much of the transmissibility of our current pandemic threat, and was successfully contained.
In 2012 another coronavirus threat emerged in the Middle East, even deadlier than SARS, that has infected at least 2,583 people, resulting in 888 deaths. Dubbed MERS-CoV, this virus - which is endemic in camels - is even less transmissible than SARS-CoV, but roughly 3 times deadlier.But not before roughly 8,000 people were infected, and 800 died.
All of these numbers are expected to be massive undercounts, as we've seen estimates (see EID Journal: Estimation of Severe MERS Cases in the Middle East, 2012–2016) that only a fraction of cases are captured by surveillance.
Before COVID-19, we routinely saw hundreds of cases reported each year on the Arabian peninsula - primarily from Saudi Arabia - but since the pandemic began, reporting on MERS-CoV has dried up.
This year, Saudi Arabia has only reported 13 cases, while in 2019 the Saudis reported 205.
Today the the WHO reports on a recent case in the UAE. First their announcement, then I'll return with a postscript.
Middle East respiratory syndrome coronavirus (MERS-CoV) – United Arab Emirates
13 December 2021
On 17 November 2021, the National IHR Focal Point of the United Arab Emirates (UAE) notified WHO of one laboratory-confirmed case of Middle East respiratory syndrome coronavirus (MERS-CoV) in UAE.
The case is a 60-year-old male from the Abu Dhabi region, UAE. He developed fever, sore throat, shortness of breath, and a runny nose on 3 November and presented to hospital on 5 November. On 6 November, he was admitted to hospital where a computerized tomography (CT) scan confirmed the diagnosis of pneumonia. On 11 November, a nasopharyngeal swab was collected and tested positive for MERS-CoV by reverse transcriptase-polymerase chain reaction (RT-PCR). SARS-CoV-2 testing was also performed, and the results were negative. The patient has diabetes, hypertension, and dyslipidemia as co-morbidities. He owns a dromedary camel farm in Abu Dhabi and had a history of close contact with dromedary camels at his farm in the 14 days prior to the onset of symptoms. No travel history was reported during the same period. The patient has recovered and was discharged following two negative tests for MERS-CoV.
Since July 2013, a total of 93 cases including the current case of MERS-CoV have been reported from UAE.
Public health response
Upon identification, an incident report, case investigation and contact tracing were initiated. The investigation is currently ongoing and includes screening of all close contacts at the patient’s household, his camel farm and healthcare facilities. Fifty-one contacts were identified and were monitored daily for the appearance of respiratory or gastrointestinal symptoms for 14 days after their last exposure to the confirmed case.
All samples from close contacts of the patients tested negative for MERS-CoV. One health care worker who identified as a close contact is currently outside of UAE and has been notified and advised to self-monitor. He is asymptomatic.
The veterinary authorities have been notified and an investigation of animals is ongoing.
WHO risk assessment
Middle East respiratory syndrome (MERS) is a viral respiratory infection of humans and dromedary camels which is caused by a coronavirus called Middle East Respiratory Syndrome Coronavirus. Infection with MERS-CoV can cause severe disease resulting in high mortality. Approximately 35% of patients with MERS-CoV have died, but this may be an overestimate of the true mortality rate, as mild cases of MERS-CoV may be missed by existing surveillance systems and until more is known about the disease, the case fatality rates are counted only amongst the laboratory-confirmed cases.
Humans are infected with MERS-CoV from direct or indirect contact with dromedaries who are the natural host and zoonotic source of MERS-CoV infection. MERS-CoV has demonstrated the ability to transmit between humans but it has, so far, mainly occurred in health care settings and to a limited extent among close contacts.
The notification of this additional case does not change the overall risk assessment. WHO expects that additional cases of MERS-CoV infection will be reported from the Middle East and/or other countries where MERS-CoV is circulating in dromedaries, and that cases will continue to be exported to other countries by individuals who were exposed to the virus through contact with dromedaries or animal products (for example, consumption of camel’s raw milk), or in a healthcare setting. WHO continues to monitor the epidemiological situation and conducts risk assessments based on the latest available information. However, with the ongoing COVID-19 pandemic, the testing capacities for MERS-CoV have been severely affected in some countries since most of the resources are redirected to prevent and control the pandemic.From September 2012 until 18 November 2021, the cumulative number of laboratory-confirmed MERS-CoV infection cases reported globally to WHO is 2,583 with 888 associated deaths. The majority of these cases have occurred in the Arabian Peninsula, with one large outbreak outside this region in the Republic of Korea in May 2015, when 186 laboratory-confirmed cases (185 in Republic of Korea and one in China) and 38 deaths were reported. The global number reflects the cumulative number of laboratory-confirmed cases reported to WHO under the International Health Regulations (IHR 2005) to date. The number of deaths includes the deaths that WHO is aware of to date through follow-up with affected Member States.
(Continue . . . )
There are plenty of other potentially dangerous coronaviruses in the wild - hosted by bats (see PNAS: SARS-like WIV1-CoV Poised For Human Emergence), pigs (see Nature: Fatal Swine Acute Diarrhoea Syndrome Caused By An HKU2-related Coronavirus Of Bat Origin), rodents (see A Novel Potentially Recombinant Rodent Coronavirus with a Polybasic Cleavage Site in the Spike Protein), and many other mammals,
And SARS-CoV-2 has already found new hosts, including North American deer (see COVID Reservoir Roundup: Cambodian Bats, Farmed Mink In Utah & North American Deer), where it could someday potentially evolve and mutate into a new emerging threat.
Not quite 4 months ago, in PNAS Research: Intensity and Frequency of Extreme Novel Epidemics, we looked at a paper that suggested that the probability of novel disease outbreaks will likely grow three-fold in the next few decades.
Like it or not, COVID-19 won't be the last - and perhaps not the worst - pandemic we'll face in the years ahead. Two very good reasons why we need to get much better at dealing with them.
Otherwise we could someday look back at 2021, and call it `the good old days'.
