A second case of deadly MERS in the US

I’d written previously about the first case of MERS (Middle East Respiratory Syndrome) found in the US.  Now a second US case of MERS has been documented.

The first US case of MERS was an American health care worker who returned from Saudi Arabia. He traveled through London and Chicago, then took a bus to Indiana, where his symptoms caused him to seek medical care in a local hospital. There he was diagnosed with MERS and placed in isolation. He did well and was released from the hospital (MERS has proved fatal in 30+ % of cases that have been treated in the Middle East and other areas.)

So far none of those with whom he came in contact have developed MERS. MERS is spread human-to-human via close contact (e.g. taking care of someone with MERS) but the risk of transmission from casual contact (like traveling on a bus or plane with a MERS patient, is very low.) MERS usually develops within about two weeks of initial exposure. So far none of the people exposed to the first case are known to have become infected. The first case was diagnosed in early May, so, presumably, if none of those he traveled become ill with MERS within the next few days, they should be safe.

The second US case of MERS is also an American male health care worker who returned from Saudi Arabia.

Infection by Shutterstock

Infection by Shutterstock

The second patient started to experience some mild respiratory symptoms en route, but dismissed them. The symptoms continued to worsen, and he went to a local emergency department when he arrived home in Florida. Because of his respiratory symptoms, occupation and history of travel to the Middle East, he was admitted and placed in isolation in the hospital. People who were on flights with him are being contacted and told to watch out for any respiratory symptoms. The CDC reports that these two cases are not linked.

In other MERS news, two hospital workers who were exposed to the second US MERS case in an Orlando, FL, hospital have developed fever and respiratory symptoms. Both were tested, and came up negative.  Though AP reports that another 18 health care workers are awaiting test results.

The World Health Organization (WHO) is conducting an emergency meeting to see if this outbreak of MERS, should be classified as a public health emergency that is of concern throughout the world. If the consensus it that it is a significant problem, WHO can recommend that flights from affected areas, like Saudi Arabia, be halted, they may send WHO teams in to the area to beef up investigstions of cases, and/or send in investigators to get hands on clinical information and do some basic research. They can call on other agencies (like the CDC) to assist, they may ask governments to ban travelers from affected areas, and can take other measures to limit the spread of the disease.

When SARS (Severe Acute Respiratory Syndrome) struck in China, causing deaths and disase, the WHO, other agencies and governments put pressure on the Chinese government to destroy the caged marketable animals that were the source of SARS. The Chinese government did so and there have been no additional cases of SARS since then. Like SARS, MERS is also a coronavirus that can cause severe lung disease and show a high mortality rate. Some camels have been shown to have been infected with MERS and may be a reservoir for the disease.


Mark Thoma, MD, is a physician who did his residency in internal medicine. Mark has a long history of social activism, and was an early technogeek, and science junkie, after evolving through his nerd phase. Favorite quote: “The most exciting phrase to hear in science... is not 'Eureka!' (I found it!) but 'That's funny.'” - Isaac Asimov

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  • Mark_in_MN

    The symptoms listed for SARS and MERS sound pretty much identical to me. I’ve poked around and the only thing that seems different is the virus. How different the viruses are isn’t really described either. Is it more like different strains of influenza or are they more distinct than that while remaining in the same genus? Maybe I’m just not looking in the right places.

    How would a physician, apart from travel to the Middle East, know to suspect MERS instead of SARS, or even either of them? Indeed, if the disease spreads geographically, that might no longer be a good clue. Or would laboratory testing be not so targeted, and go for a general question of “What is in this sample?”rather than “Does this sample have X?” Why not just call it viral pneumonia and treat it thusly? Popular articles I find don’t seem to go into any details here.

    On the one hand, it’s a question of where categories are properly drawn and on what basis. Isolating disease causing organisms can be important for understanding disease, treatment, and prevention. But is it always clinically significant or useful? I’m sure it is sometimes. But I’ve also never had a physician use lab tests to determine what particular species of bacteria is causing the ear infection or infected finger.

    But the thing that really bugs me is the alarming alarm over these things. Why label it as a new disease that can be so hyped as the latest mysterious thing that can kill you instead of a nasty viral pneumonia (or at least something we’ve seen before)? It seems to play into a possible hysteria. If there is something here, beyond the microorganism in a lab test, that’s truly different, the distinction would make more sense.

  • http://www.rebeccamorn.com/mind BeccaM

    Thanks! Might be helpful for future entries to call more attention to the link and/or this excellent description of exactly what it seems to be.

  • docsterx

    It was first detected and isolated in the Middle East. I believe all cases in other areas have been traced back to the Arabian Peninsula. Camels in that area have been shown to have been infected with MERS. The Coronavirus Study Group decided that since it’s been so closely associated with that area it should be called MERS.

  • docsterx

    Part of the answer to your question is contained in my reply to Becca’s question, below.

    The coronavirus that causes SARS is different from the coronavirus that causes MERS. But both produce pneumonias and have similar symptoms. It;s not unusual for closely related viruses to produce the same diseases. There are a number of “cold” viruses that produce the typical cold symptoms. And the different forms of influenza

    SARS spread fairly quickly and cases were found in Asia, Europe, North and South America. In total there were about 8,000 cases with about 1,000 deaths. Before the 2003 outbreak, SARS was unknown. Work had ro be done quickly to isolate and identify it. It’s important to find the source of teh virus. IF the reservoir can be found, there is a chance that it can be eliminated. If not, at least people can be warned of the hazard that exists in the reservoir.

  • Indigo

    Exactly. Remember “GRID”? That was nasty.

  • docsterx

    The symptoms were listed in the fact sheet link in the 1st MERS article. Basically they are: cough, shortness of breath, fever (temperature usually over 38 degrees C). Some patients develop diarrhea and some may get kidney failure. Though other patients seem to get a milder form of the disease.

    Diagnosis depends to a degree on travel history and specific testing for MERS via lab studies. Only a few labs (e.g. some state health department labs, the CDC and some others) can confirm that a patient is MERS positive currently. They use a polymerase Chain Reaction (PCR) test to identify MERS. If a patient hasn’t been in the Middle East within the last few weeks, or hasn’t been taking care of a MERS patient, MERS would be highly unlikely. Most bacterial pathogens that cause pneumonias can be cultured in just about any hospital lab. Often, chest X-ray will show changes that are characteristic of a pneumonia. But the definitive test would be to do a PCR for MERS.

  • Mark_in_MN

    I’m somewhat concerned about the name here. It may now be geographically connected with the Middle East, or first described there, but it may not always be so connected. And if it does become a major concern globally, the name may lead to inappropriate blame, stigma, or even more problematic action.

  • Mark_in_MN

    What I find most alarming here is the alarm, including the WHO emergency meeting and the potential disruptions that are mentioned above. (I do see in other news reports that WHO did not declare it a global health emergency, so that’s good, I think.) Likewise, it was the alarm about the disease that I found most distressing and alarming about the SARS outbreak more than a decade ago.

    That SARS was such a flash in the pan, not only in its sudden appearance but particularly in its basically disappearing makes me wonder about some things, and if we might be too microscopic, for lack of a better word at the moment, in our contemporary approach to new or emerging disease if not disease in general. Not that I would halt microbiology research and the like, or even slow it down, but in terms of diagnostics, clinical medicine, and health care system responses.

    What clinical or symptomatic differences are there between SARS and MERS. Might the absence of SARS cases be a result of a) people not checking because it isn’t on their minds, or b) being too focused on the particular strain of virus rather than grouping similar coronaviruses together as causing the same disease? Might we not be missing something (or making too big a deal about something) because we focus in too quickly and too narrowly on a particular virus and/or source instead of stepping back to look at a broader picture?

  • Indigo

    Can’t help but wonder about that. It’s Middle Eastern until proven otherwise. That’s not the scientific method we learned back in the ’50s.

  • Indigo

    Agreed. There’s plenty of yellow journalism over at HuffPo, we don’t need to multiply it here.

  • http://www.rebeccamorn.com/mind BeccaM

    Twice now Mark you’ve posted interesting articles about MERS, and this one’s front page summary line says it’s about ‘how to identify MERS’ — but neither time did you actually describe what this disease’s symptoms are and how one can identify it versus, for example, bacterial or viral pneumonia.

    Or this another of those, “They have pneumonia, but we have no clue what is actually causing it, so we’ll refer to it as Middle East Respiratory Syndrome until we can find something” situations, like it was with AIDS in the early 80s?

  • 4th Turning

    Saudi Arabia is the country by far most affected by Mers, with 133 deaths since the virus was detected in 2012. Nearly 500 people in the kingdom have been infected.

    http://www.bbc.com/news/blogs-news-from-elsewhere-27393045

  • 4th Turning

    From my inbox this a.m.

    “For Americans worried about whether they’ll continue to have slices of banana floating in their cereal bowls, the question is when the disease will hit Latin America, which grows the bananas we consume. Mozambique brings disturbing news on that front: Farm managers there didn’t just get assistance from the Philippines, but also from Costa Rica and several other Central American nations. Those workers moved repeatedly between their home countries and Africa through 2011.

    With an incubation period of about two to three years, it is possible that the same mechanism that likely caused the African outbreak—infected dirt, carried inadvertently—is already at work in our hemisphere. “The workers who set up those plantations are now back home,” says Randy Ploetz, the Florida-based plant pathologist who first identified Foc-TR4 in the 1980s. “So if we assume it is fairly easy to move this thing and soil from wherever it is—Southeast Asia or Jordan or Mozambique—then it is possible it is already in Latin America. Only time will tell.”

    http://www.popsci.com/article/science/has-end-banana-arrived?dom=PSC&loc=slider&lnk=2&con=end-of-the-banana&utm_source=digg&utm_medium=email

  • 4th Turning

    “Patient Zero and the Early North American HIV/AIDS Epidemic explores the historical precedents and emergence of this phenomenon. It also traces the closely interlinked development of one enduring popular origin tale for the North American HIV/AIDS epidemic: namely, that AIDS could be traced to a single, gay, French-Canadian flight attendant named Gaétan Dugas. What factors gave rise to the widely disseminated and disturbing depiction of this individual as the original “Patient Zero” of the American AIDS epidemic? Upon what historical precedents did this tale draw? How did this tale affect how people understood HIV/AIDS and subsequent disease epidemics? Students will have the opportunity to discover the answers to these questions and reflect on the historical and present-day challenges raised by outbreaks of infectious disease.”

    http://www.nlm.nih.gov/exhibition/survivingandthriving/education/higher-education-patient-zero.html

  • BlueIdaho

    OT: U.S. Magistrate Judge Candy W. Dale has struck down Idaho’s anti-gay marriage law. Unless a stay in issued by the 9th Court of Appeals, same-sex marriages will begin at 9:00 AM Friday.

    Read more here: http://www.idahostatesman.com/2014/05/13/3183291/judge-rules-idaho-gay-marriage.html#storylink=cpy

  • bkmn

    A reminder about good hygiene (disposing of used tissues, covering your cough/sneeze and good handwashing) would also be a big help in educating the public how to avoid catching MERS.

  • http://heimaey.us/ heimaey

    I agree. These headlines always make me freak out and so far for no good reason.

  • http://musephotos.wordpress.com/ GarySFBCN

    As a former 25-year employee in a public health department, I wince at this ‘headline’ (deadly MERS).

    It is irresponsible to incite hysteria.

    It is sufficiently scary just to write “A second case of MERS in the US; officials concerned” or something.

    Each time the news is ‘spun’ like this, public health departments across the nation are flooded by calls from the ‘worried well’, sucking limited resources and sometimes slowing the progress of life-saving work.

    But if you are going to write an article like this, you should always include what our relative risk is for being infected with the virus, and if that risk is high, the risk factors (ie reservoir), the incubation period, symptoms and known treatments, and what measures we should take to prevent getting infected, and, if we have MERS, how to prevent infecting others.

    I haven’t been keeping up with MERS, but I remember very well how the case fatality rate was (initially) greatly overstated from the H1N1 outbreak in Mexico in 2009. I hope those same mistakes aren’t being made with the case fatality rates with MERS.

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