

The Middle East Plague Goes Global - Rickasaurus
http://www.foreignpolicy.com/articles/2013/06/28/the_middle_east_plague_goes_global?page=full

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nakedrobot2
To avoid the hassle of signing up with a fake email address, here is the
article. Split into 3 parts to avoid the maximum comment length on HN.

Part 1:

When the Black Death exploded in Arabia in the 14th century, killing an
estimated third of the population, it spread across the Islamic world via
infected religious pilgrims. Today, the Middle East is threatened with a new
plague, one eponymously if not ominously named the Middle East respiratory
syndrome (MERS-CoV, or MERS for short). This novel coronavirus was discovered
in Jordan in March 2012, and as of June 26, there have been 77 laboratory-
confirmed infections, 62 of which have been in Saudi Arabia; 34 of these Saudi
patients have died.

Although the numbers -- so far -- are small, the disease is raising anxiety
throughout the region. But officials in Saudi Arabia are particularly
concerned.

This fall, millions of devout Muslims will descend upon Mecca, Medina, and
Saudi Arabia's holy sites in one of the largest annual migrations in human
history. In 2012, approximately 6 million pilgrims came through Saudi Arabia
to perform the rituals associated with umrah, and this number is predicted to
rise in 2013. Umrah literally means "to visit a populated place," and it's the
very proximity that has health officials so worried. In Mecca alone, millions
of pilgrims will fulfill the religious obligation of circling the Kaaba. And
having a large group of people together in a single, fairly confined space
threatens to turn the holiest site in Islam into a massive petri dish.

The disease is still mysterious. Little is understood about how it is
transmitted and even less regarding its origins. But we do know that MERS is
deadly, with a mortality rate of about 55 percent -- a remarkably higher
lethality than that posed by its close cousin, the severe acute respiratory
syndrome (SARS) virus, which in 2003 terrified travelers across the globe but
posed a fatality rate of only 9.6 percent. The MERS coronavirus is new to our
species, so mild and asymptomatic infections seem to be rare, but the human
immune response to infection is itself so extreme that it can prove deadly in
some cases.

Like SARS, the MERS virus spreads between people via close contact, shared
medical instruments, and coughing. Once inside the human lung, the MERS virus
sparks a series of reactions that all but destroy normal lung function.
Patients can descend into pneumonia so severe that they require machine-
assisted breathing to stay alive, in as little as 12 days. Unlike SARS, the
MERS virus is also capable of attacking the kidneys and can be passed on to
others via exposure to contaminated urine. And for some of those who survive
acute MERS, years of rehabilitation may be necessary, just like for some of
the 2003 SARS victims.

And like back in 2003, when health officials worried about airplane travelers
in confined spaces transmitting the virus across the globe, the hajj poses a
unique risk of transmission, one that could catapult this still-small outbreak
into a full-fledged pandemic. Containment will become nearly impossible as
millions of pilgrims flock from virtually every country on the globe to the
kingdom during the holy month. Indeed, MERS has already crossed continents;
two suspected cases were reported in France as recently as June 12, and
confirmed cases have been reported in Germany and Britain. The first patient
in each of these cases had traveled in the Middle East before reaching his/her
home destination, only then to be diagnosed with MERS.

~~~
nakedrobot2
Part 2:

When the Black Death exploded in Arabia in the 14th century, killing an
estimated third of the population, it spread across the Islamic world via
infected religious pilgrims. Today, the Middle East is threatened with a new
plague, one eponymously if not ominously named the Middle East respiratory
syndrome (MERS-CoV, or MERS for short). This novel coronavirus was discovered
in Jordan in March 2012, and as of June 26, there have been 77 laboratory-
confirmed infections, 62 of which have been in Saudi Arabia; 34 of these Saudi
patients have died.

Although the numbers -- so far -- are small, the disease is raising anxiety
throughout the region. But officials in Saudi Arabia are particularly
concerned.

This fall, millions of devout Muslims will descend upon Mecca, Medina, and
Saudi Arabia's holy sites in one of the largest annual migrations in human
history. In 2012, approximately 6 million pilgrims came through Saudi Arabia
to perform the rituals associated with umrah, and this number is predicted to
rise in 2013. Umrah literally means "to visit a populated place," and it's the
very proximity that has health officials so worried. In Mecca alone, millions
of pilgrims will fulfill the religious obligation of circling the Kaaba. And
having a large group of people together in a single, fairly confined space
threatens to turn the holiest site in Islam into a massive petri dish.

The disease is still mysterious. Little is understood about how it is
transmitted and even less regarding its origins. But we do know that MERS is
deadly, with a mortality rate of about 55 percent -- a remarkably higher
lethality than that posed by its close cousin, the severe acute respiratory
syndrome (SARS) virus, which in 2003 terrified travelers across the globe but
posed a fatality rate of only 9.6 percent. The MERS coronavirus is new to our
species, so mild and asymptomatic infections seem to be rare, but the human
immune response to infection is itself so extreme that it can prove deadly in
some cases.

Like SARS, the MERS virus spreads between people via close contact, shared
medical instruments, and coughing. Once inside the human lung, the MERS virus
sparks a series of reactions that all but destroy normal lung function.
Patients can descend into pneumonia so severe that they require machine-
assisted breathing to stay alive, in as little as 12 days. Unlike SARS, the
MERS virus is also capable of attacking the kidneys and can be passed on to
others via exposure to contaminated urine. And for some of those who survive
acute MERS, years of rehabilitation may be necessary, just like for some of
the 2003 SARS victims.

And like back in 2003, when health officials worried about airplane travelers
in confined spaces transmitting the virus across the globe, the hajj poses a
unique risk of transmission, one that could catapult this still-small outbreak
into a full-fledged pandemic. Containment will become nearly impossible as
millions of pilgrims flock from virtually every country on the globe to the
kingdom during the holy month. Indeed, MERS has already crossed continents;
two suspected cases were reported in France as recently as June 12, and
confirmed cases have been reported in Germany and Britain. The first patient
in each of these cases had traveled in the Middle East before reaching his/her
home destination, only then to be diagnosed with MERS.

~~~
nakedrobot2
Part 3:

Controlling the spread of the virus is only half the battle. There is no MERS
vaccine, drug, or simple diagnostic test available. And once MERS patients are
identified, caring for them presents its own set of complications. Not only is
the treatment for MERS intensive and complicated, but health-care workers must
carefully protect themselves so as to minimize the risk of contracting or
unwittingly spreading infection.

If in-hospital spread is occurring within state-of-the-art, high-tech
hospitals, the potential for MERS transmission inside squalid Syrian hospitals
and makeshift refugee clinics is significant. It would seem nearly impossible
to mitigate in-hospital spread of MERS in Syria, where over a third of public
hospitals are no longer in service and supplies of even the most rudimentary
medicines and equipment are scarce. Should the MERS virus get a foothold in
such settings, further international spread of MERS seems inevitable,
especially amid highly mobile populations fleeing political instability.

Although the WHO has publicly praised Saudi Arabia for "urgently taking
crucial actions" in this crisis, it is becoming clear that in spite of
officials' cooperation, there are some real practical problems facing Saudi
authorities.

First and foremost, the Saudi Ministry of Health is understaffed and in need
of assistance. At least one foreign laboratory collaborating with the Saudis
received samples of MERS that had deteriorated because they were packaged and
shipped incorrectly, rendering them unusable. International collaborators who
have been eager to aid the Saudis face staffing bottlenecks, causing delays
that are agonizing in an outbreak context.

But that one foreign laboratory was fortunate to get the samples sent to it at
all, since the Saudi Ministry of Health has also been embroiled in a "patent"
dispute surrounding MERS that has reportedly stymied research efforts by
foreign scientists. Last summer, a Dutch team from Erasmus Medical Center in
Rotterdam received two patient samples from an Egyptian scientist working then
in Jeddah, Saudi Arabia. The Dutch sequenced the MERS DNA and claimed
ownership of the samples. All scientists hoping to work on the MERS problem
must either obtain samples directly from the Saudi Ministry of Health or sign
legal agreements with Erasmus. For example, the U.S. Centers for Disease
Control and Prevention (CDC) is still waiting to receive samples of MERS for
testing that were collected in October 2012 because the legal teams from the
CDC and Erasmus cannot negotiate agreeable terms for a material transfer
agreement. These legal delays are unusual, especially during a disease
outbreak such as this, and Margaret Chan, director-general of the World Health
Organization, publicly criticized Erasmus for putting patent laws ahead of
protecting "your people."

Meanwhile, the WHO has its own institutional problems. The organization's
emergency-response system is bankrupt (though it only needs $10 million to
function for the rest of 2013). Despite these budgetary constraints,
surveillance must be ramped up, particularly in the region itself. The WHO has
also been trying to improve dialogue and information sharing about MERS, but
the organization's efforts have fallen short. Its most recent attempt -- a
three-day meeting in Cairo attended by 100 experts -- came up short; the
result amounted to little more than language that in essence just reiterated
pre-existing agreements about global standards for disease surveillance and
reporting that took effect after the International Health Regulations (2005).

Participants at the meeting did recognize the urgency of the situation,
however, and acknowledged that the world is at a critical point in the
trajectory of the MERS outbreak. As Keiji Fukuda, WHO assistant director-
general for health security and the environment, said: "We need to exploit
this chance to agree and implement the best public health measures possible
across the board, for in so doing, we stand the best chance of controlling
this virus before it spreads further."

It wouldn't be possible -- or even desirable -- to stop the flow of people in
and out of Saudi Arabia and the Middle East, be they migrant workers,
refugees, humanitarian volunteers, or religious pilgrims. The immediate
challenges are to identify the animal sources of MERS and stop its animal-to-
human spread. In lieu of knowing the virus's origin, human-to-human
transmission must be halted -- and the best first step to accomplishing this
is through radical improvements in hospitals' hygiene practices and through
swiftly identifying infected friends, family members, and co-workers of those
who develop the MERS disease.

But that's only a stopgap solution. Unless the many barriers to a transparent
international research and information-sharing system disappear, it will be
exceedingly difficult to reduce the risk of infection. Otherwise, the world
could be dragged into another Black Death, and MERS could easily spread far
beyond the bounds of the region for which it is named.

Laurie Garrett is senior fellow for global health at the Council on Foreign
Relations.

Maxine Builder is a research associate at the Council on Foreign Relations.

------
sounds
In case you missed it: (thanks, nakedrobot2, for providing the text)

This situation will hopefully influence patent debates about DNA everywhere:
(yeah, ok, maybe it might)

    
    
      But that one foreign laboratory was fortunate to get the samples
      sent to it at all, since the Saudi Ministry of Health has also been
      embroiled in a "patent" dispute surrounding MERS that has
      reportedly stymied research efforts by foreign scientists. Last
      summer, a Dutch team from Erasmus Medical Center in Rotterdam
      received two patient samples from an Egyptian scientist working
      then in Jeddah, Saudi Arabia. The Dutch sequenced the MERS DNA and
      claimed ownership of the samples. All scientists hoping to work on
      the MERS problem must either obtain samples directly from the Saudi
      Ministry of Health or sign legal agreements with Erasmus. For
      example, the U.S. Centers for Disease Control and Prevention (CDC)
      is still waiting to receive samples of MERS for testing that were
      collected in October 2012 because the legal teams from the CDC and
      Erasmus cannot negotiate agreeable terms for a material transfer
      agreement. These legal delays are unusual, especially during a
      disease outbreak such as this, and Margaret Chan, director-general
      of the World Health Organization, publicly criticized Erasmus for
      putting patent laws ahead of protecting "your people."

------
Flavius
Apocalyptic news from a site that needs your email? Sure, why not?

~~~
ak39
Yip, my thoughts exactly! :-(

Evernote Clearly for Chrome solves the need for a login quite nicely.

[http://evernote.com/clearly/](http://evernote.com/clearly/)

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itchitawa
The site asks for sign-in. Just invent any email address to read the article
immediately.

~~~
humbledrone
Alternatively, in Chrome, right click on the sign-in window, click "Inspect
element", scroll up a bit, highlight the <div> elements with ids TB_overlay
and TB_window, press delete, close the inspector window, and enjoy. (I'm sure
it's just as easy in other browsers.) ;)

~~~
diggan
Yeah, because you want to do all then when the website shows that they don't
care about you as a visitor on their site.

~~~
humbledrone
Well, 90% of the time I just hit "Back" when a canopy like that is thrown in
my face. Sometimes I want to read the content, though, and would prefer to do
so a bit subversively rather than giving in and signing up.

