Numbers coming out of Saudi Arabia for the novel Sars strain, MERS-Cov, are beginning to worry researchers and health authorities worldwide. 

In just the past month, the cases of MERS have seen a sudden spike, one that some are interpreting as a possible mutation of the dangerous virus.  

Much criticism has been levied against Saudi authorities in the management of MERS, from the investigation into its source and natural reservoirs, to what some deem as a reckless response in the care of infected patients.  In some hospitals, the patients suspected or confirmed as suffering from MERS do not prompt a shutting down of the emergency quarters, leading many to believe that the Saudis are playing Russian roulette with their health care and prevention.  A triage station and other special measures have still not been adopted for suspected and confirmed MERS cases. 

The latest news, that the cases have now reached 336 total confirmed and 102 deaths by the weekend, has sent a wave a panic in some.  In a Saudi hospital four doctors have refused to care for MERS patients.  That is because some perceive the Saudi authorities as unnecessarily secretive, and that in the end, they are telling the truth on the true nature of the virus. 

Another, not unfounded, criticism has been levied against the Saudi authorities in their handling of the viral material collected from deceased or ill patients and sent to the Netherlands for the development of the vaccine.  The Saudis have also declined requests to share in all the genetic material collected from deceased MERS patients.

And that brings us to the latest controversy: the vaccine, which is so hastily being cobbled together, has aroused potent criticism from the medical community. 

The 'creation' of the vaccine, in fact, seems to be more a pr campaign, especially in consideration of the great movements of faithful from abroad for pilgrimage to the country soon to occur, than a bona fide effort to stem the disease.  

However, many are criticizing the fact that Saudi Arabia is developing the vaccine to immunize the population en masse, raising even more questions as to its purpose.  It is to quell fear?  will the vaccine be reliable? Will it be thoroughly tested? 

What the medical community is more interested in, is investigating the sources of the disease, which 2 years on still seems to be baffling the Saudis and worrying the international health monitoring agencies.  They contend that it is more important to identify the host animal and to block the movement and transmission of the disease by putting in place plans to block the spread from its natural reservoir than to tamp down on the patients and rushing to develop a vaccine.  In addition, vaccinating the Saudis would not stop the many travelers to Saudi Arabia from contracting it, if it is allowed to circulate and be transmitted from its natural reservoir to human beings. 

With the suspicion that the virus may have mutated to acquire the ability to jump from human to human, the vaccine may come too late to pre-empt a wider spread of the virus.  Although the virus is frightful, only a few hundred people in a population of millions has been infected, making mass vaccinations a palliative rather than a solution.  The small number of people infected do not give clues as to who should be vaccinated, making mass vaccination the only, and unnecessary, solution. 

To most, the development of the vaccine seems to be political expedient, to show that the house of Saud is preoccupied with the welfare of its subjects, but also to quell the increasing fears that pilgrimage to the holy sites might result in an infection. A loss of traffic in the pilgrimages could translate into a great economic loss for the country, and the dimming of its prestige.

The other problem is that the number of people infected so far, or at least confirmed cases, are so low that vaccine makers may not think a vaccine is viable commercially for development. 

One of the things that is missing in the published reports for MERS cases from Saudi Arabia is the lack of assessment of its virality.  As far as the WHO is concerned, there is still no evidence that the virus has acquired the ability to transmit from person to person, but the majority of the 93 new case, all of them occurring in the past few weeks, have been in the majority in people who tended or cared for the infected patients.  However, the WHO has expressed concern at the spike. 

This divergent narrative points to a possible lack of information or research on the newer cases, which is imperative if a larger epidemic is to be avoided. What the WHO has done, at least in the last published bulletin, is to redraw the care guidelines to include a more thorough protocol for the prevention of infection in those caring for the suspected infected patients.  They also advise hospitals and medical structures to investigate all suspected cases, even when the nasopharyngeal swabs are negative for the virus.  The constant reassurance and minimizing from the Saudis is in net contrast with the somewhat alarmed tone that even the most even keeled health agencies are expressing in their bulletin. There is, both in Saudi Arabia and abroad, the overwhelming sense that more information is needed, but it is not forthcoming from the source country.

Another behavior that puzzles the scientific community is the near refusal of the Saudis to prohibit close contact with camels, which have been proven to be, if not the natural reservoir of the virus, at least one of the carriers and possible vehicle for transmission to humans.  In fact, the latest foreign case of infection, detected in Egypt on the weekend, was from a man who had traveled to Saudi Arabia and had contact with camels.  The disease could be controlled in camels, if an effort was made, and avoid the transmission altogether.  In fact, the Ssudis remain all but mum when it comes to addressing the control of the disease in the camel themselves, which would and should be one of the first steps in tackling the disease. 

Camels are very prized, and loved in Saudi Arabia. They are both a symbol of beauty and of survival.  Some of the most valuable specimens are valued in the millions.  Talk of somehow distancing the camels from humans has probably a very negative cultural connotation. 

Just this weekend, King Abdullah has traveled to Jeddah, the epicenter of the last cluster of cases, to reassure his people, and posited that people not listen to all the 'hype' on Mers. However, just recently, the Health MInister, Abdullah al-Rabiah was fired by King Abdullah, suggesting that the epidemic might not be dealt with appropriately.

The Hajj however, is upon us.  Only a few months separate the present spike of cases from the pilgrimage attended by millions.  The Saudi authorities however, have pointed out that last year's Hajj was completely unscathed by the Mers virus. 

A recent study has revealed that the virus might be endemic in camels and has been so for at least two decades.  In fact, it is believed to be extremely common in the animal, and that because it has been present latently for so long, it might now have acquired the ability to infect humans due to the very assiduous and close contact with humans.

Sources: WHO/Globe and Mail/ Tribune/ 4.28.14


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