MERS not yet a global health emergency, WHO says after reviewing situation

The World Health Organization says the sense of urgency over the ongoing outbreak of a SARS-like virus in the Middle East has risen, but the situation does not currently constitute a global public health emergency.

The Geneva-based agency said that was the conclusion of its so-called emergency committee on MERS, the Middle East respiratory syndrome virus.

The committee of international experts advises the WHO on the MERS coronavirus. Dr. Theresa Tam, head of the Public Health Agency of Canada's health security infrastructure branch, is vice-chair of the committee.

The committee met Tuesday to consider whether the outbreak should be declared a public health emergency of international concern under the International Health Regulations.

Dr. Keiji Fukuda, the WHO's assistant director-general for health security, said the main reason the committee stopped short of recommending an emergency declaration was that sustained person-to-person spread of the virus is still not occurring outside hospital settings.

"When all of the evidence was looked at, what became clear is that there is no convincing evidence right now for an increase in the transmissibility of this virus," Fukuda said during a teleconference.

Fukuda said the emergency committee will reconvene in a few weeks to again take stock of the situation.

The WHO has been notified of 571 lab confirmed cases of MERS to date, Fukuda said. The WHO's numbers trail behind those of affected countries, which have now reported nearly 600 cases of the infection, and roughly 175 deaths.

As the emergency committee's decision was being announced media reports revealed that the Netherlands has detected a case of MERS in a man who had returned from Saudi Arabia. It is the 19th country to report a case of MERS and the 10th outside the Middle East to detect an imported case.

Fukuda noted that scientists in Germany and the United States have recently analyzed the sequences of five MERS viruses — three from Saudi Arabia, one from a case detected in Greece and one from the first MERS case found in the United States — and they did not show any significant changes that might hint at increased transmissibility of the virus.

The Greek man and the man from the United States both contracted MERS in Saudi Arabia.

Much of the sharp increase in cases this spring appears to be driven by hospital outbreaks in Saudi Arabia and to a lesser degree the United Arab Emirates. Other factors potentially adding to the substantial uptick in numbers include the possibility that the spring may be high-season for MERS transmission, and the fact that affected countries are finding more cases because they are testing more people, Fukuda said.

A WHO team that recently travelled to Saudi Arabia to study the situation saw that conditions in hospitals there were facilitating spread of the virus, he noted. Infection control practices were "sub-optimal" and overcrowding in some hospitals was allowing the virus to spread more easily among health-care workers and patients.

The emergency committee said infection control practices have to improve, especially in MERS-affected countries.

They also called urgently for key studies to be done to answer pressing questions about the virus, such as how people catch it from camels — if camels are the only animal reservoir — and how it spreads from one infected person to another person.

The committee, the WHO and a chorus of international scientists have been calling for these studies to be done for over a year, to no avail.

Though the reason remains unclear, Saudi Arabia — which has had the most cases and is best positioned to do this work — has consistently resisted calls to conduct these necessary studies.

Fukuka acknowledged that the WHO has been asking for this work for some time, and has even staged three meetings to help affected countries plan the studies. But he expressed optimism that now the work may finally get underway.

"What's different now is that the sense of urgency about them is stronger — much stronger — than in the past," he said

"Our sense is that this sense of urgency is not lost on the (MERS-affected) countries ... and so I am really hopeful that we will begin to see these critical studies get initiated and completed as soon as possible."

Infectious diseases expert Dr. Michael Osterholm said he supported the WHO's decision not to declare MERS a global public health emergency.

But he cautioned that the MERS saga is far from over. He noted that it will be impossible in the near term to stop transmission of the virus from camels — thought to be the principle reservoir of the virus — to people. Camels play a major role in Middle Eastern life.

"We have to understand that we are now living with MERS," said Osterholm, the director of the Center for Infectious Diseases Research and Policy at the University of Minnesota.

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