Noticable Vaugeness in MERS Case Reportings – Should You Be Concerned?
The vagueness surrounding the reporting of MERS cases in Saudi Arabia offers a precautionary note, certainly for international travelers but also for everyone in an increasingly connected world. There is no single reason for underreporting of a novel disease. The sophistication of national health systems varies greatly. The global health community provides international support in terms of advice, diagnostic laboratory services and investigation, but these activities rely on local identification of potential and actual cases and the willingness of the host nation to invite outside assistance.
Not every nation allows the free flow of information. This can be a matter of national policy or cultural influences. It can also reflect strong economic considerations. If you are the mayor of a major tourist destination, do you risk reporting that one case of SARS or MERS seen in the local clinic? Will tourists – the source of your city’s income – stay away? While it is easy to say one should always take this high road, a major drop in a season’s income can have a significant negative impact on the residents of your city. Similarly challenging is the identification of a novel disease in a particular patient. The WHO and health ministry can announce the emergence of a new respiratory syndrome. How do you screen for it if you, as a provider, have never before seen that syndrome? More vexing; what do you do about that pneumonia case from last month? Could it have been this new disease? The complexities of investigating a new disease are myriad.
The International Health Regulations call for prompt reporting of emerging diseases. These regulations are voluntary, however, and the WHO has no enforcement capability. Transparency is important; it allows the mounting of countermeasures. The epidemiological investigation does not only include where a disease has travelled, but also how is has been detected and where it was missed. This is the stage the Saudis now find themselves in.
What, then, is the relevance of this issue? The spread of a novel disease poses unseen dangers until the mechanism of that spread is understood. Anyone travelling to a nation where MERS has been seen should be aware of the potential for exposure. Equally important but far more subtle a threat, you should be aware of anyone visiting you who has been in an impacted region. At least one case of MERS seen in the United States was acquired here from a person who had been in the Middle East.
This is not to say you should avoid all contact. The nature and pace of the world is now such global travel is routine. A degree of awareness is warranted, however. While MERS may seem an affliction in a faraway land, the reality is it could be in your office, classroom or living room this afternoon. Symptoms of MERS include fever, cough and shortness of breath, and emerge two – 14 days after exposure. If you develop these symptoms after interacting with someone who has been in the impacted area, seek medical advice. Stay current on the progress of this disease and what locations have reported cases by visiting the CDC’s MERS web page. Awareness is the key to wellness.