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MERS: A New Virus Challenge

Gp Capt Ajey Lele (Retd.) is a Consultant at the Manohar Parrikar Institute for Defence Studies and Analyses, New Delhi. Click here for detailed profile.
Gunjan Singh is Research Assistant at the Institute for Defence Studies and Analyses, New Delhi. Click here for detailed profile
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  • July 01, 2015

    East and Southeast Asia are known to get affected by various diseases routinely. Particularly, various waterborne and other diseases likely malaria and dengue fever commonly affect the regions. There is a concern that global warming may translate into explosive growth of mosquito-borne diseases. In addition to this, growing number of natural disasters are found escalating the health related challenges. All this eventually poses a threat to health, economic and human security. Currently, this region in general and South Korea in particular has come under the sway of a disease called Middle East Respiratory Syndrome (MERS) raising regional and international concerns. Till date, South Korea has reported about 32 deaths and around 3000 people are known to be infected and under treatment.1

    According to Centre for Disease Control and Prevention, “MERS is an illness caused by a virus (more specifically, a coronavirus) called Middle East Respiratory Syndrome Coronavirus (MERS-CoV). MERS affects the respiratory system (lungs and breathing tubes). Most MERS patients developed severe acute respiratory illness with symptoms of fever, cough and shortness of breath. About 3-4 out of every 10 patients reported with MERS have died”.2 During last few years the region has witnessed few deaths owing to the spread of the viruses like Severe Acute Respiratory Syndrome (SARS, 2003 with approximately 750 deaths, most in China) and H1N1 influenza (since 2009, with an estimated 284,000 deaths, most in SE Asia). Apart from these diseases, Ebola has also been responsible for claiming 11,020 lives, most of them in Africa.

    Most such diseases have a history of transmission from animals to humans. The H1NI spread from pigs to humans; while SARS was found in bats. The MERS-CoV was found in camels and is also known as Camel virus. Naturally, people who regularly handle these animals have high chances of contracting the disease. What we are witnessing today are cases of subsequent human to human transmissions. Presently, several cases of MERS-CoV in those who handle camels have been reported. This disease was first reported as affecting people in Saudi Arabia in 2012 and has so far led to approximately 450 deaths in the country.

    Global Spread of MERS

    The above map indicates that the spread of this disease is almost becoming global. However, after West Asia the spread is more in the Southeast Asian region. After Saudi Arabia and UAE, South Korea is witnessing many infections. The disease is also spreading in the countries around South Korea, but the reported rate of infection is very less.

    It is believed that the spread of this disease in South Korea has origins in the visit of a 68-year old person to West Asia. After his return back to Seoul, he was diagnosed with MERS on May 20, 2015. Since then, the virus has severely affected South Korea. This disease belongs to the same family as SARS and can quickly develop into pneumonia. As per some medical opinions, there exists a 40 per cent possibility of cases of serious infection turning fatal.

    Initially, South Korean authorities did not appreciate the possible impact of the spread of the disease. Interestingly, the heir of the Samsung Group, which has one of the largest hospitals in Seoul, publically apologized by saying, “(O)ur Samsung Medical Center has caused too big a pain and worry for the people by failing to prevent the infection and spread of MERS”.3 The 68 year old patient is known to have visited four different hospitals spreading the virus around when he was very sick and infectious.

    The spread of the disease also has serious economic implications. The South Korean tourism sector is expected to get affected the most. In the near future, Chinese tourists are likely to skip a visit to their most favorite tourist destination. The South Korean Ministry of Culture, Sports and Tourism has announced that over 100,000 people have cancelled their trips to South Korea which will result in a loss of $900 million.4 A major impact is also expected on the retail sector in South Korea. As per the New York Times, “Central Bank of Korea had announced that it would extend around 590 million dollars as funding to small and medium enterprises which have been affected by the outbreak.”5 Recent reports suggest that South Korea will have to spend an extra $9 billion in order to counter the MERS.6 The currency has depreciated in the international market owing to MERS. The South Korean Won has fallen by 1.7 per cent against the US dollar.

    There is an inherent suspicion about government health care facilities in many parts of Asia. People get attracted more to the ‘ambience’ of the hospitals than the quality of medical facility. There is also the practice of seeking a ‘second opinion’ and patients often shift from one doctor to other without completing the required treatment at one place. Also, people mostly approach large, renowned and overcrowded hospitals. It is important to note here that cultural predispositions could inadvertently play an important role in spreading infections and in this regard the South Korean case could find some parallels in South Asia too! There is a significant dependence on quacks and alternative medical system. At times religious beliefs also impact the approach towards the treatment. (Pakistani Taliban killed four polio vaccine workers in the Quetta region to stop the immunization drive.7) Too many people, relatives and friends, visit the patients and in case of communicable diseases like MERS, become carriers for the disease.

    The coming months are crucial for the Asian region. Hajj 2015 is likely to fall between September 20 and September 25. More than 2 million people are expected to undertake the Holy Pilgrimage to Mecca. From India, approximately 136,000 people are likely to visit the place. Every year, significant preventive medication regulations (including vaccination) are strictly followed before the pilgrimage. However there is no known vaccine available for MERS yet and hence the need for extreme caution. India should look at South Korea’s response and try and be more alert and ready in order to fight any possible outbreak. The high population density in India could make the situation worse in no time.

    Diseases could spread to different parts of the world owing to various natural and man-made reasons. Economic growth and massive urbanisation leading to unhygienic lifestyles also add to the possibility of their spread. Incidents like MERS bring to the forefront debates about human security and how vulnerable countries are in the face of epidemics. With increasing connectivity (rail, road and air), the global space is shrinking. It is also bringing in its wake concerns like the spread of diseases. The more people, economies and countries get connected, the more difficult it will be to contain and manage such outbreaks.

    Views expressed are of the author and do not necessarily reflect the views of the IDSA or of the Government of India