Public health advisories like the one above have been posted by the U.S. Centers for Disease Control and Prevention in public facilities around the country, including airports. Source: CDC
The last time you went to an airport, did you see signs inquiring if you have been to the Middle East? No, they are not covered in cliché images of camels, enticing tourists to visit the region. Rather, they are uninspiring health advisories from the Centers for Disease Control and Prevention (CDC) warning travelers about potential symptoms of Middle East Respiratory Syndrome (MERS). “Watch for fever with cough or difficulty breathing,” the poster says, and “if you get sick within 14 days of leaving, call a doctor.” The CDC is obviously paying attention to MERS, but what sort of threat does it pose to the United States? While MERS seems to have little public health risk, it could have a significant negative impact on international science collaboration and transparency.
The first MERS case was reported in Saudi Arabia in 2012 and generally manifests in humans with flu-like symptoms. As of July 2014, 834 cases had been reported to the WHO in over a dozen countries (including two in the United States in May 2014), but all of the cases so far have been linked to countries in and around the Arabian Peninsula. MERS has resulted in 288 deaths, making the case fatality rate close to 35 percent, although most of the deaths occurred in patients with pre-existing health issues. MERS’s origin and route of transmission to humans are still unknown, but researchers are investigating animal sources, including camels. The extent of the symptoms, as well as the timeline of when infected people begin displaying symptoms, varies. As a result, the virus is difficult to track and identify, which could be problematic in the potential, but low probability, event that the virus mutates to become more contagious.
According to the CDC, “MERS represents a very low risk to the general public in [the United States].” Both reported cases involved health care workers who had recently come to the United States from Saudi Arabia, and they recovered without anyone else contracting the disease. The CDC’s “Travel Notices” categorize MERS at the second (of three) alert levels. As a point of reference, the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak in Asia, which resulted in eight confirmed U.S. cases, was Alert Level 3. The CDC maintains that the threat of a global pandemic is very low. It even states that MERS should not affect travel plans to the region, although travelers would be wise to take certain precautions, such as washing hands and avoiding interactions with certain animals — not far beyond common sense provisions.
With such low risks of contraction, the medical implications of MERS are outweighed by more serious issues regarding international transparency and collaboration in infectious disease research and response. To date, the epidemiological and clinical data on MERS have been inadequate. Despite being discovered two years ago, relatively little is known about the virus, MERS-coronavirus (MERS-CoV). The virologist who discovered MERS-CoV claims that soon after reporting his findings internationally, he was dismissed from his position at a Saudi hospital in Jeddah under pressure from the Saudi Ministry of Health (MOH). Interestingly, the Saudi MOH recently made two unexpected changes in major personnel, suggesting an internal political battle and leading some scientists to question the MOH-affiliated minimal research. Adding to the speculation, the Saudi government has been accused of maintaining tight control and rejecting international offers of collaboration and research assistance. In line with this, the epidemiological and clinical data collected and analyzed under Saudi supervision has been criticized for lacking robustness.
From an infectious disease standpoint, MERS does not appear to be a major threat, especially to locations geographically distant from the Arabian Peninsula and as long as the rate of human-to-human infection remains low. While the United States is halfway around the world from the epicenter of the virus, MERS is still highly relevant. MERS has demonstrated the case for academic freedom in medicine and knowledge sharing among governments, institutions, and researchers about infectious diseases. Leaving critical knowledge gaps can affect entire populations, so the international community needs policies from governments to ensure the best steps are being taken to prioritize safety and awareness. Whether or not one travels to the Middle East, we should care about MERS not for the health advisories but for the sake of science policies and public health.
Monica Matsumoto, a 2014 Rice graduate, is a research analyst for Kirstin Matthews, Science and Technology Policy fellow at the Baker Institute. She is a 2014-15 Fulbright Scholar and plans to study stem cell policy in Jordan before beginning at University of Chicago’s Pritzker School of Medicine in fall 2015.