MERS could soon become global threat

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   Greetings folks.  I realize I may be beating a dead horse regarding this issue, regarding the possibility that MERS like other coronaviruses will thrive this fall and winter once the temperatures drop, but it could be more important than ever now to keep this in mind.   If South Korea does not eradicate MERS come October, it could very well become a "threat to the entire world" as their temperatures will begin to drop a that time.  Imported cases to a cold climate will also be a very large threat.    

I'm reposting a couple of study's on this thread regarding the impact of a reduced temperature for MERS, one by oneflu and by myself, along with a link from the top of the forum to bring a little awareness to this issue so we don't have any surprises come winter time.  Quite frankly, if MERS makes it's way to North America or Europe during the winter months, the world will have a mess on its hands.  At the moment it's confined to the "hot and dry"  climate of the Middle East, and it's picked up steam in a slightly cooler and wet climate in South Korea.   Like other cold viruses, it will spread in the winter.  

Anyway, I believe it's rather imperative for South Korea to fully eradicate MERS within the next 90 - 120 days.

STUDY 1:

Eurosurveillance: Environmental Stability Of MERS-CoV

Coronavirus – Credit CDC PHIL

Although viruses are generally pretty fragile, we know that under the right
environmental conditions, some of them can retain their integrity and infectivity
for hours, days, or even weeks outside of a host organism. Temperatures, UV exposure, pH, humidity, and other
factors can all effect how long a virus can remain viable in the environment.

We know, for instance, that temperature and
humidity greatly affect the spread of influenza (see Influenza Virus Survival
At Opposite Ends Of The Humidity Spectrum), which helps explain the seasonality
of flu.

Today, Eurosurveillance Journal has published our first good look at the
environmental stability of the MERS coronavirus,
both on surfaces (fomites), and as an aerosol. The researchers describe their
experiments thusly:

In this study, the stability of MERS-CoV (isolate HCoV-EMC/2012) was evaluated under
three different environmental conditions: high temperature
and low humidity, 30°C – 30% relative humidity (RH); high temperature and high humidity, 30°C – 80% RH and low temperature and low humidity, 20°C – 40% RH, to reflect
a wide range of environmental conditions including an indoor environment (20°C
– 40% RH). The stability of MERS-CoV under the
three tested environmental conditions was respectively compared with that of
influenza A virus A/Mexico/4108/2009 (H1N1) originating from a human isolate
obtained during the influenza A(H1N1)pdm09 pandemic in 2009 [9]. The stability
of the two viruses in aerosols at 20°C with 40% or 70% RH was also assessed and
compared.

Their results are striking. 

While the Influenza A virus became non-viable on steel and plastic surfaces in
less than 4 hours for all testing environments, the MERS
virus survived 48 hours in the 20°C – 40% RH environment. Survival of the
coronavirus at 30°C – 30% RH was 24 hours, and 8 hours at 30°C – 80% RH.

As an aerosol, the MERS virus remained very stable
at 20°C – 40% RH, while its viability decreased (89% – comparable to the
Influenza A virus) at 20°C – 70% RH.

The bottom line, under favorable temperature and
humidity conditions (such as you might find in an air conditioned hospital),
the MERS virus survives quite well on surfaces,
and in the air. This may help explain the high rate of nosocomial outbreaks
we’ve seen in the Middle East.

While the route of infection with this virus has not been determined, this
virus shows the kind of environmental hardiness that would be conducive for either
fomite or droplet/aerosol (contact) transmission.

********com/2013/09/eurosurveillance-environmental.html?m=1

STUDY 2:

Effects of air temperature and relative humidity on
coronavirus survival on surfaces.

Abstract

Assessment of the risks posed by
severe acute respiratory syndrome (SARS) coronavirus (SARS-CoV) on surfaces
requires data on survival of this virus on environmental surfaces and on how
survival is affected by environmental variables, such as air temperature (AT)
and relative humidity (RH). The use of surrogate viruses has the potential to
overcome the challenges of working with SARS-CoV and to increase the available
data on coronavirus survival on surfaces. Two potential surrogates were
evaluated in this study; transmissible gastroenteritis virus (TGEV) and mouse
hepatitis virus (MHV) were used to determine effects of AT and RH on the
survival of coronaviruses on stainless steel. At 4 degrees C, infectious virus
persisted for as long as 28 days, and the lowest level of inactivation occurred
at 20% RH. Inactivation was more rapid at 20 degrees C than at 4 degrees C at
all humidity levels; the viruses persisted for 5 to 28 days, and the slowest
inactivation occurred at low RH. Both viruses were inactivated more rapidly at
40 degrees C than at 20 degrees C. The relationship between inactivation and RH
was not monotonic, and there was greater survival or a greater protective
effect at low RH (20%) and high RH (80%) than at moderate RH (50%). There was
also evidence of an interaction between AT and RH. The results show that when
high numbers of viruses are deposited, TGEV and MHV may survive for days on
surfaces at ATs and RHs typical of indoor environments. TGEV and MHV could
serve as conservative surrogates for modeling exposure, the risk of
transmission, and control measures for pathogenic enveloped viruses, such as
SARS-CoV and influenza virus, on health care surfaces

http://www.ncbi.nlm.nih.gov/pubmed?term=Casanova%20LM%5BAuthor%5D&cauthor=true&cauthor_uid=20228108
- Casanova LM,
http://www.ncbi.nlm.nih.gov/pubmed?term=Jeon%20S%5BAuthor%5D&cauthor=true&cauthor_uid=20228108
- Jeon S,
http://www.ncbi.nlm.nih.gov/pubmed?term=Rutala%20WA%5BAuthor%5D&cauthor=true&cauthor_uid=20228108
- Rutala WA,
http://www.ncbi.nlm.nih.gov/pubmed?term=Weber%20DJ%5BAuthor%5D&cauthor=true&cauthor_uid=20228108
- Weber DJ,
http://www.ncbi.nlm.nih.gov/pubmed?term=Sobsey%20MD%5BAuthor%5D&cauthor=true&cauthor_uid=20228108
- Sobsey MD.

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Albert Members Profile Send Private Message Find Members Posts Add to Buddy List Admin Joined: April 24 2006 Status: Offline Points: 47746	Post Options Post Reply Quote Albert Report Post Thanks(2) Quote Reply Topic: MERS could soon become global threat Posted: June 28 2015 at 9:42am
	Greetings folks. I realize I may be beating a dead horse regarding this issue, regarding the possibility that MERS like other coronaviruses will thrive this fall and winter once the temperatures drop, but it could be more important than ever now to keep this in mind. If South Korea does not eradicate MERS come October, it could very well become a "threat to the entire world" as their temperatures will begin to drop a that time. Imported cases to a cold climate will also be a very large threat. I'm reposting a couple of study's on this thread regarding the impact of a reduced temperature for MERS, one by oneflu and by myself, along with a link from the top of the forum to bring a little awareness to this issue so we don't have any surprises come winter time. Quite frankly, if MERS makes it's way to North America or Europe during the winter months, the world will have a mess on its hands. At the moment it's confined to the "hot and dry" climate of the Middle East, and it's picked up steam in a slightly cooler and wet climate in South Korea. Like other cold viruses, it will spread in the winter. Anyway, I believe it's rather imperative for South Korea to fully eradicate MERS within the next 90 - 120 days. STUDY 1: Eurosurveillance: Environmental Stability Of MERS-CoV Coronavirus – Credit CDC PHIL Although viruses are generally pretty fragile, we know that under the right environmental conditions, some of them can retain their integrity and infectivity for hours, days, or even weeks outside of a host organism. Temperatures, UV exposure, pH, humidity, and other factors can all effect how long a virus can remain viable in the environment. We know, for instance, that temperature and humidity greatly affect the spread of influenza (see Influenza Virus Survival At Opposite Ends Of The Humidity Spectrum), which helps explain the seasonality of flu. Today, Eurosurveillance Journal has published our first good look at the environmental stability of the MERS coronavirus, both on surfaces (fomites), and as an aerosol. The researchers describe their experiments thusly: In this study, the stability of MERS-CoV (isolate HCoV-EMC/2012) was evaluated under three different environmental conditions: high temperature and low humidity, 30°C – 30% relative humidity (RH); high temperature and high humidity, 30°C – 80% RH and low temperature and low humidity, 20°C – 40% RH, to reflect a wide range of environmental conditions including an indoor environment (20°C – 40% RH). The stability of MERS-CoV under the three tested environmental conditions was respectively compared with that of influenza A virus A/Mexico/4108/2009 (H1N1) originating from a human isolate obtained during the influenza A(H1N1)pdm09 pandemic in 2009 [9]. The stability of the two viruses in aerosols at 20°C with 40% or 70% RH was also assessed and compared. Their results are striking. While the Influenza A virus became non-viable on steel and plastic surfaces in less than 4 hours for all testing environments, the MERS virus survived 48 hours in the 20°C – 40% RH environment. Survival of the coronavirus at 30°C – 30% RH was 24 hours, and 8 hours at 30°C – 80% RH. As an aerosol, the MERS virus remained very stable at 20°C – 40% RH, while its viability decreased (89% – comparable to the Influenza A virus) at 20°C – 70% RH. The bottom line, under favorable temperature and humidity conditions (such as you might find in an air conditioned hospital), the MERS virus survives quite well on surfaces, and in the air. This may help explain the high rate of nosocomial outbreaks we’ve seen in the Middle East. While the route of infection with this virus has not been determined, this virus shows the kind of environmental hardiness that would be conducive for either fomite or droplet/aerosol (contact) transmission. ******com/2013/09/eurosurveillance-environmental.html?m=1 STUDY 2: Effects of air temperature and relative humidity on coronavirus survival on surfaces. Abstract** Assessment of the risks posed by severe acute respiratory syndrome (SARS) coronavirus (SARS-CoV) on surfaces requires data on survival of this virus on environmental surfaces and on how survival is affected by environmental variables, such as air temperature (AT) and relative humidity (RH). The use of surrogate viruses has the potential to overcome the challenges of working with SARS-CoV and to increase the available data on coronavirus survival on surfaces. Two potential surrogates were evaluated in this study; transmissible gastroenteritis virus (TGEV) and mouse hepatitis virus (MHV) were used to determine effects of AT and RH on the survival of coronaviruses on stainless steel. At 4 degrees C, infectious virus persisted for as long as 28 days, and the lowest level of inactivation occurred at 20% RH. Inactivation was more rapid at 20 degrees C than at 4 degrees C at all humidity levels; the viruses persisted for 5 to 28 days, and the slowest inactivation occurred at low RH. Both viruses were inactivated more rapidly at 40 degrees C than at 20 degrees C. The relationship between inactivation and RH was not monotonic, and there was greater survival or a greater protective effect at low RH (20%) and high RH (80%) than at moderate RH (50%). There was also evidence of an interaction between AT and RH. The results show that when high numbers of viruses are deposited, TGEV and MHV may survive for days on surfaces at ATs and RHs typical of indoor environments. TGEV and MHV could serve as conservative surrogates for modeling exposure, the risk of transmission, and control measures for pathogenic enveloped viruses, such as SARS-CoV and influenza virus, on health care surfaces http://www.ncbi.nlm.nih.gov/pubmed?term=Casanova%20LM%5BAuthor%5D&cauthor=true&cauthor_uid=20228108 - Casanova LM, http://www.ncbi.nlm.nih.gov/pubmed?term=Jeon%20S%5BAuthor%5D&cauthor=true&cauthor_uid=20228108 - Jeon S, http://www.ncbi.nlm.nih.gov/pubmed?term=Rutala%20WA%5BAuthor%5D&cauthor=true&cauthor_uid=20228108 - Rutala WA, http://www.ncbi.nlm.nih.gov/pubmed?term=Weber%20DJ%5BAuthor%5D&cauthor=true&cauthor_uid=20228108 - Weber DJ, http://www.ncbi.nlm.nih.gov/pubmed?term=Sobsey%20MD%5BAuthor%5D&cauthor=true&cauthor_uid=20228108 - Sobsey MD.
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Albert Members Profile Send Private Message Find Members Posts Add to Buddy List Admin Joined: April 24 2006 Status: Offline Points: 47746	Post Options Post Reply Quote Albert Report Post Thanks(1) Quote Reply Posted: June 28 2015 at 9:45am
	Now, if you don't believe myself and the senior members here at AFT - here it also is from THE CDC: About Coronavirus Q:What are coronaviruses? A: Coronaviruses are common viruses that most people get some time in their life. Human coronaviruses usually cause mild to moderate upper-respiratory tract illnesses. Human coronaviruses were first identified in the mid-1960s. The six coronaviruses that can infect people are: alpha coronaviruses 229E and NL63, and beta coronaviruses OC43, HKU1, SARS-CoV (the coronavirus that causes severe acute respiratory syndrome, or SARS), and MERS-CoV (the coronavirus that causes Middle East Respiratory Syndrome, or MERS). There are many coronaviruses that naturally infect animals. Most of these usually infect only one animal species or, at most, a small number of closely related species, but not people. However, SARS-CoV can infect people and animals, including monkeys, Himalayan palm civets, raccoon dogs, cats, dogs, and rodents. MERS-CoV has also been found to infect people and animals, including camels and bats. Q: How common are human coronavirus infections? A: People around the world commonly get infected with human coronaviruses 229E, NL63, OC43, and HKU1. Two exceptions are SARS-CoV and MERS-CoV. SARS-CoV was first recognized in China in November 2002. It caused a worldwide outbreak with 8,098 probable cases including 774 deaths from 2002 to 2003. Since 2004, there have not been any known cases of SARS-CoV infection reported anywhere in the world. More about SARS-CoV. MERS-CoV was first reported in Saudi Arabia in 2012. It has caused illness in hundreds of people from several countries. All cases to date have been linked to countries in and near the Arabian Peninsula. CDC continues to closely monitor the MERS situation globally and work with partners to better understand the risks of this virus, including the source, how it spreads, and how infections might be prevented. More about MERS-CoV. Q: Who can get infected? A: Most people will get infected with one or more of the common human coronaviruses in their lifetime. Young children are most likely to get infected. However, people can have multiple infections in their lifetime. Q: How do I get infected? A: The ways that common human coronaviruses spread have not been studied very much. However, it is likely that human coronaviruses spread from an infected person to others through— the air by coughing and sneezing, and close personal contact, such as touching or shaking hands. These viruses may also spread by touching contaminated objects or surfaces then touching your mouth, nose, or eyes. Q: When can I get infected? A: In the United States, people usually get infected with common human coronaviruses in the fall and winter. However, you can get infected at any time of the year. Q: What are the symptoms? A: Common human coronaviruses usually cause mild to moderate upper-respiratory tract illnesses of short duration. Symptoms may include runny nose, cough, sore throat, and fever. These viruses can sometimes cause lower-respiratory tract illnesses, such as pneumonia. This is more common in people with cardiopulmonary disease or compromised immune systems, or the elderly. MERS-CoV and SARS-CoV can cause severe illness. To learn more, see MERS Symptoms and Complications and Symptoms of SARS. Q: How can I protect myself? A: There are currently no vaccines available to protect you against human coronavirus infection. You may be able to reduce your risk of infection by— washing your hands often with soap and water, not touching your eyes, nose, or mouth, and avoiding close contact with people who are sick. Q: What should I do if I get sick? A: If you have an illness caused by a human coronavirus, you can help protect others by— staying home while you are sick, avoiding close contact with others, covering your mouth and nose with a tissue when you cough or sneeze, then throwing the tissue in the trash and washing your hands, and keeping objects and surfaces clean and disinfected. Q: How do I get diagnosed? A: Laboratory tests can be done to confirm whether your illness may be caused by common human coronaviruses. However, these tests are not used very often because people usually have mild illness. Also, testing may be limited to a few specialized laboratories. Specific laboratory tests may include: virus isolation in cell culture, polymerase chain reaction (PCR) assays that are more practical and available commercially, and serological testing for antibodies to human coronaviruses. Nose and throat swabs are the best specimens for detecting common human coronaviruses. Serological testing requires collection of blood specimens. Also see MERS Information for Laboratories and SARS-CoV Laboratory Testing. Q: Are there treatments? A: There are no specific treatments for illnesses caused by human coronaviruses. Most people with common human coronavirus illness will recover on their own. However, some things can be done to relieve your symptoms, such as— taking pain and fever medications (Caution: Aspirin should not be given to children), and using a room humidifier or taking a hot shower to help ease a sore throat and cough. If you are sick, you should — drink plenty of liquids, and stay home and rest. If you are concerned about your symptoms, you should see your healthcare provider. http://www.cdc.gov/coronavirus/about/
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onefluover Members Profile Send Private Message Find Members Posts Add to Buddy List Admin Group Joined: April 21 2013 Location: Death Valleyish Status: Offline Points: 20151	Post Options Post Reply Quote onefluover Report Post Thanks(0) Quote Reply Posted: June 28 2015 at 11:36am
	Thanks Albert. The link I posted to Study 1 appears to be broken so here is the link to the study from which the article derives. http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20590
	"And then there were none."

KiwiMum Members Profile Send Private Message Find Members Posts Add to Buddy List Chief Moderator Joined: May 29 2013 Status: Offline Points: 29670	Post Options Post Reply Quote KiwiMum Report Post Thanks(0) Quote Reply Posted: June 28 2015 at 1:10pm
	Do we know the incubation period of MERS? Are people contagious before they show symptoms?
	Those who got it wrong, for whatever reason, may feel defensive and retrench into a position that doesn’t accord with the facts.

CRS, DrPH Members Profile Send Private Message Find Members Posts Add to Buddy List Expert Level Adviser Joined: January 20 2014 Location: Arizona Status: Offline Points: 26660	Post Options Post Reply Quote CRS, DrPH Report Post Thanks(0) Quote Reply Posted: June 28 2015 at 1:21pm
	Like its cousin SARS, it is possible that MERS is spread via fecal matter and aerosols: Intense diarrhea from one of the patients -- a 33-year-old Shenzhen resident in Hong Kong for kidney treatment and identified only as patient YY -- was believed to have spread the disease through defective piping in the building. According to the Department of Health, a break in E block's flush-water system earlier that month had meant the water-sealed S-bend in some of the apartments' toilets had been dry for an extended period, allowing virus-laden droplets to collect from the system's soil pipe. Bucket flushing by residents may have disturbed and released contaminated droplets, government agencies said. Similarly, exhaust fans may have sucked droplets into bathrooms where the virus was deposited on floor mats, towels, toiletries and toothbrushes. http://www.cnn.com/2013/02/21/world/asia/sars-amoy-gardens/
	CRS, DrPH

Albert Members Profile Send Private Message Find Members Posts Add to Buddy List Admin Joined: April 24 2006 Status: Offline Points: 47746	Post Options Post Reply Quote Albert Report Post Thanks(0) Quote Reply Posted: June 28 2015 at 2:48pm
	Interesting information Chuck, thanks. Hi Kiwi, incubation is 2 - 14 days, and 5-6 on average. They are not believed to be contagious during incubation. Clinical Course The median incubation period for secondary cases associated with limited human-to-human transmission is approximately 5 days (range 2-14 days). In MERS-CoV patients, the median time from illness onset to hospitalization is approximately 4 days. In critically ill patients, the median time from onset to intensive care unit (ICU) admission is approximately 5 days, and median time from onset to death is approximately 12 days. In one series of 12 ICU patients, the median duration of mechanical ventilation was 16 days, and median ICU length of stay was 30 days, with 58% mortality at 90 days. Radiographic findings may include unilateral or bilateral patchy densities or opacities, interstitial infiltrates, consolidation, and pleural effusions. Rapid progression to acute respiratory failure, acute respiratory distress syndrome (ARDS), refractory hypoxemia, and extrapulmonary complications (acute kidney injury requiring renal replacement therapy, hypotension requiring vasopressors, hepatic inflammation, septic shock) has been reported. http://www.cdc.gov/coronavirus/mers/clinical-features.html
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guest Members Profile Send Private Message Find Members Posts Add to Buddy List Guest Group	Post Options Post Reply Quote guest Thanks(0) Quote Reply Posted: June 30 2015 at 2:19pm
	Everything you say makes sense but.... The virus has already been the wild for 3 years. As far as I know it has not significantly mutated in that time. So two questions.... Why haven't we seen a major outbreak yet? What would it take to make that outbreak happen? Have we so far just been so lucky that it hasn't been introduced to a suitable environment?

onefluover Members Profile Send Private Message Find Members Posts Add to Buddy List Admin Group Joined: April 21 2013 Location: Death Valleyish Status: Offline Points: 20151	Post Options Post Reply Quote onefluover Report Post Thanks(0) Quote Reply Posted: June 30 2015 at 2:42pm
	I'm sure many of the known pamdemics began as a slow festering bug before the right combination of events set them off. It would seem unlikely to me that any of them went from nonexistent to encircling the globe in just a few seasons.
	"And then there were none."

jacksdad Members Profile Send Private Message Find Members Posts Add to Buddy List Executive Admin Joined: September 08 2007 Location: San Diego Status: Offline Points: 47251	Post Options Post Reply Quote jacksdad Report Post Thanks(0) Quote Reply Posted: June 30 2015 at 3:26pm
	Totally agree, A. It would be easy to look at the gradual reduction in new cases in South Korea and assume it's over, but the danger is having it smoulder until the cooler weather arrives. Now we've seen how much more contagious it is away from the heat of Saudi, we should definitely be mindful of the possibility of a resurgence and further spread when our fall/winter arrives.
	"Buy it cheap. Stack it deep" "Any community that fails to prepare, with the expectation that the federal government will come to the rescue, will be tragically wrong." Michael Leavitt, HHS Secretary.

MERS could soon become global threat

About Coronavirus

Q:What are coronaviruses?

Q: How common are human coronavirus infections?

Q: Who can get infected?

Q: How do I get infected?

Q: When can I get infected?

Q: What are the symptoms?

Q: How can I protect myself?

Q: What should I do if I get sick?

Q: How do I get diagnosed?

Q: Are there treatments?

Clinical Course