Deadly Middle East coronavirus: Not yet a PHEIC

Medicine Matters - by Teodoro B. Padilla

Posted at Jul 26 2013 04:47 PM | Updated as of Jul 27 2013 01:58 AM

A few days ago, the Emergency Committee under the International Health Regulations of the World Health Organization (WHO) convened to deliberate if the novel coronavirus could be classified as a public health emergency with global repercussions.

The session that gathered infectious disease experts was also participated in by affected countries including France, Germany, Italy, Jordan, the Kingdom of Saudi Arabia, Qatar, Tunisia and the United Kingdom.

The Emergency Committee was unanimous in its decision that with the information available, the conditions for a Public Health Emergency of International Concern, or PHEIC, have not at present been met by the Middle East Respiratory Syndrome-Coronavirus (MERS-CoV).

First detected in April 2012, MERS-CoV had not been seen in humans before. It has caused severe illness and led to death in some cases. From September 2012, the WHO reported a total of 90 laboratory-confirmed cases of infection with MERS-CoV, including 45 deaths.

MERS-CoV belongs to the family of coronaviruses that could cause colds to Severe Acute Respiratory Syndrome (SARS). More than 24 countries, including the Philippines, reported SARS cases from 2002 to 2004. About 8,000 people were infected and 774 of them died.

The common MERS-CoV symptoms include acute, serious respiratory illness with fever, cough, shortness of breath and breathing difficulties. Most patients have had pneumonia, while many had gastrointestinal symptoms, including diarrhea. The WHO even indicated that some patients developed kidney failure.

While not declared as a PHEIC, experts agreed that “the current MERS-CoV situation is serious and of great concern.” The novel coronavirus was considered for PHEIC classification since it persists to cause severe infections specifically in the Middle East. Just this week, two additional laboratory-confirmed cases were reported in Riyadh and the Al-Ahsa governorate.

Since little is known about MERS-CoV, no specific medicine or vaccine is available to combat the fatal disease. At the center of drug or vaccine research and development is a deep understanding of the target disease. At the moment, health experts are yet to determine how widespread the disease is or where and how people can become infected with the virus.

At present, there remains the possibility that the virus could spread further in the future. Nevertheless, there is still not enough evidence for the WHO to declare PHEIC.

A declaration of a PHEIC would send a strong political signal to countries around the world to push MERS-CoV very high on the agenda. It would prompt countries to develop guidelines or restrictions aimed at preventing the spread of the disease.

So, what are the criteria for a disease to be considered a PHEIC?

WHO Assistant Director-General for Health Security and the Environment Dr. Keiji Fukuda explained that there is no specific menu or checklist. Instead, health experts find an answer to the question if the situation or event really poses a danger for the global community.

Important questions also need to be answered like: How serious or severe is the infection? How fatal is it? Is the event or situation spreading and growing? Will the declaration of a PHEIC help address the situation?

In answering these questions, the Emergency Committee also ensures that any of their recommendations would be balanced, appropriate and proportional to the situation or event. As mentioned, a declaration of PHEIC would signal the global community to give MERS-CoV its highest level of priority.

At the moment, there is still no restriction on international travel. Instead, people who have underlying medical conditions are advised to consult their physicians to protect themselves and others from getting infected.

Apart from guidelines for health workers, the WHO is expected to release travel recommendations in relation to MERS-CoV in the coming days given the large number of people that are on pilgrimage due to the Hajj and Umrah. Consequently the Saudi Ministry of Health recently announced their strong recommendation that those who fall under the following categories postpone their Hajj and Umrah pilgrimages this year in the name of public health and safety: elderly individuals or those above 65 years of age with chronic diseases (e.g. heart disease, kidney disease, respiratory disease, diabetes); pilgrims with immune deficiency, malignancy and terminal illnesses; and pregnant women and children below 12 years of age.

If necessary, the Saudi Ministry of Health announced that they would make additional preventive precautions to avoid the spread of infection during the pilgrimage or on return to their country of origin. Furthermore, Saudi health authorities advise all pilgrims to help prevent the spread of diseases through proper hand washing, covering the mouth when coughing or sneezing, avoiding direct contact with sick people, and wearing masks in crowded places.

The future of MERS-CoV remains uncertain. Health experts recommend close monitoring of the virus. Countries are likewise being encouraged to strengthen surveillance and laboratory capacity to detect infection. The people, on the other hand, are urged to stay informed and take necessary precautions to prevent the spread of MERS-CoV and other infections.

Email the author at [email protected]