Months after the first cases - and the alert was sounded- of the new strain of Mers Coronavirus, a new wave of fresh cases in the past 15 days seems to point to possible person to person transmission of the dangerous pathogen.
In the past fifteen days a few clusters of cases have been confirmed in the laboratory. The latest report by the WHO shows that a cluster of 10 cases, all confirmed, has been documented among previously healthy hospital workers that were caring for a man who has died of a laboratory confirmed case of Mers on April 10 of this year in the UAE.
Some of the ten cases show mild symptoms, with two showing little symptoms, but two of the cluster patients are seriously ill, one with pneumonia.
All the cases, including the man who died on April 10, were detected and confirmed in the United Arab Emirates. The man who died however, was not an Arab National but a Filipino national.
More importantly, Mers has now been found in the Philippines, thereby canceling the notion that it was a disease relegated to the Saudi peninsula and neighboring Arab States.
A nurse, who was tending to the man in the United Arab Emirates who died, contracted the disease and carried it home to the Philippines. Although he had been tested before he left the UAE, he was not told the results until he landed back in the Philippines. Since the nurse had traveled with his family, all five members were quarantined upon his arrival. Since the incubation period for Mers is quite long and can exceed 2 weeks, the family will have to be secreted until the danger is over.
However, the people in the plane that were seated close to the nurse and his family are now the subject of a search to see if any of them have been infected. 12 passengers have been targeted as possible candidates for exposure to the virus according to the seating arrangement near the infected nurse.
Since there are many Filipino health workers in the MIddle East, and some of them have been exposed to the virus before, a better plan for the contrast to the possible spread of the disease must be put in place.
Another Filipino nurse died in August of last year in the UAE after caring for an infected patient.
What this latest incident highlights however, is how the virus is undeniably becoming more apt at person to person transmission, something that the Health authorities in the Saudi peninsula and neighboring countries were quick to dismiss all along. Now however, that comfort has all but been erased. Although it seems that only people in close contact with infected patients can become infected, the latest clusters of cases indicate that indeed the virus is contagious between people, and not just from exposure to vector animals such as the camel or the bat.
What is becoming clearer too, is the mortality rate for the virus. First pinned at a staggering 90%, it has been revised down to a much lower percentage, and the observation of those cluster patients who have been exposed will provide additional data on how many people actually contract the virus but do not go on to become critically ill or die.
Another isolated case of Mers being exported from its hotspots is the death of a Malaysian man who had returned from Mecca. The man died on April 13 after returning to his country on March 29.
Although the WHO has not recommended travel bans or even checkpoints at airport receiving passengers from areas that are known to have MERS cases, the time might soon come when stricter measures could be adopted. The case of the man who returned to Malaysia has also caused a chain-of-infection investigation to see if anyone on the flight from Mecca on a Turkish airliner has been exposed to the virus. However, the screening is still on a voluntary basis, with the authorities asking that those passengers contact the health authorities.
However, some in the MIddle East are becoming uneasy at the apparently faster transmission of the MERS virus. Until recently, the health authorities stressed that man-to-man transmission was unconfirmed. But the recent surge of cases is making a lot of people in the Middle East weary.
One Saudi doctor voiced his concern just this week, at King Fahd hospital. In his words the Health Authorities do not have a clear picture of the magnitude of the problem. One examples he cites is the fact that the hospital that treated or received a MERS patient should shut down for a while and not merely for the short time it takes to do a quick disinfection of the emergency room.
In fact, the last two weeks has seen an unprecedented surge of the disease. That, to epidemiologist, is a warning sign, because it shows a possible change in the strain and its behavior. Most of the victims now are health workers, unlike before when most cases were unrelated to each other.
The fear people have at this point is that either the virus has become more virulent or the measures to contrast the spread of the disease are insufficient. The Saudi authorities have denied that their prevention measures are inadequate.
The range of the virus, however, keeps widening. On April 13, the first ever case of Mers was recorded in Yemen. The case was detected in Sanaa.