MERS-CoV not an emergency, experts tell WHO

The MERS-CoV (Middle East respiratory syndrome coronavirus) situation is "serious and of great concern" but doesn't rise to the level of a global public health emergency, an international committee of experts organized by the World Health Organization (WHO) decided today.

The committee felt that the "dramatic action" of declaring an emergency would be disproportionate and might do more harm than good, said Keiji Fukuda, MD, the WHO's assistant director-general for health security and environment. The panel's recommendation was unanimous.

At a press conference, Fukuda also said the WHO does not plan to recommend any travel restrictions over MERS-CoV, but it will issue some travel-related advice within a few days.

The WHO announcement came hours after Saudi Arabia reported two more confirmed MERS-CoV cases, both of them mild. They involve a 26-year-old Saudi man and a 42-year-old female "resident," both of them living in the southwestern province of Asir.

The man had contact with a previous case-patient, and the woman works in the health sector, the Saudi Ministry of Health (MOH) said in a statement. Neither patient was hospitalized.

A previous MERS case in Asir involved a 66-year-old man and was reported by the MOH on Jul 8. The MOH said it has tested 1,460 people for the virus in the past few weeks.

The two newest cases raise the global count to 84 cases, with 45 deaths, according to the US Centers for Disease Control and Prevention (CDC). (The WHO has not yet acknowledged the two cases.) Of the total, 68 cases and 38 deaths have occurred in Saudi Arabia.

Four-hour teleconference

The WHO's emergency committee on MERS-CoV concluded that "the conditions for a Public Health Emergency of International Concern have not at present been met," the WHO announced in a statement.

The decision came after a 4-hour teleconference. It was the second meeting of the panel, which was convened under the International Health Regulations (IHR).

While ruling out an emergency declaration, the panel did offer technical advice for the WHO and member countries on various issues, the agency said. The advice relates to:

  • Improvements in surveillance, lab capacity, contact tracing, and serologic studies
  • Infection prevention and control and clinical management
  • Travel-related guidance
  • Risk communications
  • Epidemiologic, clinical, and animal research
  • Improved data collection and the need to ensure full and timely reporting of all confirmed and probable cases of MERS-CoV

The WHO statement said Director-General Margaret Chan, MD, "accepted the Committee's assessment that the current MERS-CoV situation is serious and of great concern, but does not constitute" an international health emergency.

MERS-CoV emerged last year in Jordan and Saudi Arabia, and the vast majority of cases have occurred in the Middle East. The United Kingdom, Germany, France, Italy, and Tunisia have had a few cases, but all of them were directly or indirectly related to cases in Middle Eastern countries.

The virus has shown an ability to spread among people in close contact in families and hospitals, but it has not achieved any sustained transmission in communities.

In considering an emergency declaration, Fukuda said, the committee weighed three main questions: the severity of the illness, whether the virus is spreading, and whether a declaration would yield net benefits.

"If the director-general goes ahead and declares a public health emergency of international concern, is that on balance going to be helpful?" he asked.

"In general, this is quite a heavy declaration," he added later. "Making such a declaration under the IHR would send a very strong political signal around the world, that this is something that needs the highest level of attention. You want to make those declarations when they are proportional to the event." Doing otherwise would endanger the WHO's credibility, he said.

Sending the wrong signal?

When he was asked if there was any concern that not declaring an emergency would wrongly signal that the MERS threat isn't serious, Fukuda said, "The emergency committee did a really good job in landing where I think many of us assess the situation to be. In essence they're not saying this is unimportant. They're saying you need to keep us updated, and there are a number of actions that you can countries should take. I think they're sending out a pretty balanced message."

Fukuda said the committee extensively discussed the travel issue, in part because of the upcoming Umrah and Hajj pilgrimages, which are expected to draw huge numbers of visitors to Saudi Arabia.

"WHO at this time does not have any plans to restrict travel, no plans to issue advisories for people not to go anywhere and not travel," he said. "But we recognize that it's a risk for people and there are steps that individual countries can take. For instance, people who have medical conditions should seek medical counseling or guidance from their physicians."

He promised that the WHO will issue some MERS-related travel recommendations "in the next few days."

Unanswered questions

In other comments, Fukuda allowed that major questions about MERS-CoV are still unanswered.

The incidence of mild and asymptomatic cases remains unclear, he said. "When we look at contacts of cases, we don't find that many people who are infected. On the other hand, we're pretty early in that kind of testing, and we don't have the kind of serologic studies we'd like to see."

The animal source of the virus also remains a mystery, though research teams in the Netherlands, the United States, and possibly elsewhere are testing samples from animals, he said.

Also unexplained is why travel-related cases have been detected in Europe but not in Latin America or most other parts of the world, he said. It's not clear whether cases elsewhere are escaping detection or if something else is going on.

Fukuda also was asked what the committee learned about the hospital outbreaks of MERS-CoV in Jordan and Saudi Arabia.

"Investigators talked about how difficult it was to tease out what might've come in from the community and what was person-to-person transmission taking place within hospitals," he replied.

"A second observation was that when infection control is applied, you can bring these hospital facility outbreaks under good control, and it doesn't take extraordinary measures to do that."

He also commented that four or five serologic tests for MERS-CoV have been developed, but it's unknown whether they are detecting the same things and can be meaningfully compared.

See also:

Jul 17 WHO statement on committee decision

Jul 17 Saudi MOH statement

Saudi MERS-CoV overview page with case count

CDC MERS-CoV page

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