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 name…
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 J…
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.