Please Pay Attention to the MERS Warnings
Why the scary talk about the strange, deadly virus coming out of the Middle East? Kent Sepkowitz explains.
Margaret Chan, secretary-general of the World Health Organization, raised a few eyebrows and dropped a few jaws this week with her proclamation that the weird new corona virus circulating mostly in the Middle East posed a “threat to the entire world.”
She might be right, sort of. The virus is a close cousin of the contagion that caused SARS, the acronym for the severe acute respiratory syndrome that appeared dramatically in South China and Hong Kong in 2002, spread rapidly, and ended up causing more than 8,000 cases, including 775 deaths. The exact reason for the precipitous appearance of SARS (and even more precipitous disappearance) remains a hot topic of debate among virologists, public-health sorts, and those who specialize in predicting doom.
The new virus, dubbed MERS for Middle East Respiratory Syndrome, has appeared at a very different pace. About a year ago, a man in Saudi Arabia developed the infection and died of it. A few months later, a second man also became critically ill. At that time, concerns arose that the opportunity for transmission might be enhanced by the meeting of millions making the hajj—the traditional Muslim pilgrimage to Mecca—and the Centers for Disease Control and Prevention and other experts advised increased vigilance. Thankfully, no outbreak occurred and the virus, then still called SARS-like, fell away from people’s attention.
Until recently. This month, two cases were seen in France and the story regained momentum. The first patient had traveled to Dubai; alarmingly, the second case occurred in his roommate in the French hospital. In other words, the Dubai traveler had transmitted the infection. Of significance, both patients had weakened immune systems related to underlying medical conditions. The most recent MERS tally is 49 cases with 26 deaths, and cases have been reported from Saudi Arabia (about half of all cases), France, Tunisia, Qatar, the United Kingdom, Germany, Jordan, and the United Arab Emirates.
The plot thickened further this week, as evidence of transmission within a large family was reported. Specifically, four members of a family of 28 living in an extended household developed the disease. These included the first case, a 70-year-old patriarch with several medical problems who died of MERS, and his three younger (and healthier) relatives, who survived. All the cases occurred in men. It remains unclear why these three contacts of the original case developed the disease, while the 24 other members of the house—and the 124 health-care personnel caring for the patients—did not. However, this slow-moving, yearlong epidemic likely speaks to the relative noncontagiousness of this particular virus—the exact reason that MERS is very unlikely to become SARS the Sequel.
Why then the scare tactics? Well, Chan is someone with an interesting career. Trained as a doctor in Canada, she was a high-ranking public-health official in Hong Kong for both the 1997 H5N1 avian-flu outbreak and, relevant to MERS, for the 2002–03 SARS outbreak. Her avian flu performance initially was perhaps a little shaky—early in the outbreak, she made some headlines by publicly grinning and bearing it, telling the citizenry that she wasn’t afraid and was, in fact, planning to eat chicken that very night.
This blustering proclamation, however, came to resemble that of the seedy mayor in Jaws who, with equal swagger, told everyone that it was safe to go back into the water, hoping to preserve the steady flow of tourist dollars to his two-bit beach town, giant white mechanical shark be damned. A quick learner, Chan soon realized the seriousness of avian flu and is the one credited for forcing, against popular opinion, the culling of millions of chickens—perhaps the key intervention to interrupt transmission. And she learned that tough talk and tough action can be effective in the world of public health.
With the same tough approach, she is ready to take on MERS—though it is not so certain the enemy is quite so concerning. The problem is that it’s really noisy out there. Bloomberg has a ricin problem. Syria is a tinderbox. The European Union and its beloved euro are wobbling. Kim Jong-un admires Dennis Rodman. The new Superman movie is opening soon. Gays are getting married. How can a person be heard in a world where everyone already is screaming at the top of their lungs, where everyone seems to be juicing with deer antler spray or Viagra or personal trainers or life coaches?
It ain’t easy. But Chan has taken the only path available: scream really loud with eye-popping language to get a little notice. As predicted, the news media (including The Daily Beast) took the bait. Mission accomplished.
We shouldn’t begrudge her this bit of showmanship; her job is to prepare people for what might be ahead. That means overstating the threat more than once in a while, as she is with MERS. But her work will not be wasted, unfortunately. Sooner or later, we will indeed meet up with another truly scary epidemic and another reason to pay sober attention to the pronouncements of the WHO. And then their experience in corralling the world’s attention, sharpened by the likes of MERS, may make all the difference.