[url]https://flutrackers.com/forum/forum/-2019-ncov-new-coronavirus/-2019-ncov-studies-research-academia/epidemiology/910115-travel-med-infect-dis-severe-respiratory-syndrome-coronavirus-2-sars-cov-2-and-middle-east-respiratory-syndrome-coronavirus-mers-cov-coinfection-a-unique-case-series[/url] or https://flutrackers.com/forum/forum/-2019-ncov-new-coronavirus/-2019-ncov-studies-research-academia/epidemiology/910115-travel-med-infect-dis-severe-respiratory-syndrome-coronavirus-2-sars-cov-2-and-middle-east-respiratory-syndrome-coronavirus-mers-cov-coinfection-a-unique-case-series ;Results: During the study period from March 14, 2020 to October 19, 2020, there was a total of 67 SARS-CoV-2 ICU admitted patients who underwent simultaneous SARS-CoV-2 and MERS-CoV testing. Of those patients, 8 (12%) tested positive for both SARS-CoV-2 and MERS-CoV. There were 6 (75%) males, the mean age + SD was 44.4 + 11.8 years, and 7 (87.5%) were obese. Of the patients, 7 (87.5%) were non-smokers, 1 (12.5%) had diabetes mellitus, 1 (12.5%) had heart failure, and 1 (12.5%) had been on anti-platelet therapy. The mean hospital length of stay (LOS) was 21.1 + 11.6 days and the average ICU LOS was 10.9 + 6.03 days. All patients received supportive therapy and all were treated with corticosteroid. Of all the patients, 4 (50%) were discharged home and 3 (37.5%) died.
Conclusion: This case series is an important addition to the medical knowledge as it showed the interaction of the coinfection of SARS-CoV-2 and MERS-CoV.

[url]https://www.sciencedirect.com/science/article/pii/S1477893921000673?via%3Dihub[/url] or https://www.sciencedirect.com/science/article/pii/S1477893921000673?via%3Dihub ;

Recently, there had been few reports of coinfection of different micro-organisms with SARS-CoV-2. Coinfections with SARS-CoV-2 were reported with influenza, other respiratory pathogens, herpes simplex virus (HSV) and human immune deficiency virus (HIV) [[10], [11], [12], [13], [14], [15]]. In the Kingdom of Saudi Arabia (KSA), the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is of particular concern as KSA is the country where MERS-CoV had been initially identified in 2012 [[16], [17], [18]]. One particular characteristic of MERS-CoV is the ability to cause healthcare associated outbreaks [[19], [20], [21]].

In addition, MERS-CoV is of particular importance as it has about 35% case fatality rate [22].

DJ-I understand the two virusses did not mix in those 8 patients. Of them 3 died, 4 recovered and one went to other care facility. 

[url]https://flutrackers.com/forum/forum/novel-coronavirus-ncov-mers-2012-2014/united-arab-emirates-uae-coronavirus/910155-who-middle-east-respiratory-syndrome-coronavirus-mers-cov-united-arab-emirates-march-17-2021[/url] or https://flutrackers.com/forum/forum/novel-coronavirus-ncov-mers-2012-2014/united-arab-emirates-uae-coronavirus/910155-who-middle-east-respiratory-syndrome-coronavirus-mers-cov-united-arab-emirates-march-17-2021 and [url]https://en.wikipedia.org/wiki/Middle_East_respiratory_syndrome#Epidemiology[/url] or https://en.wikipedia.org/wiki/Middle_East_respiratory_syndrome#Epidemiology  

(I have no idea how the risks are of Covid19 and MERS mixing and creating a new CoViDisease.)

Co-infection of MERS-CoV and SARS-CoV-2 in the same host: A silent threat

Buket Baddal^⁎

Nedim Cakir

Author information Article notes Copyright and License information Disclaimer

Dear Editor,

The novel coronavirus, SARS-CoV-2, emerged in late 2019 in Wuhan City, Hubei Province, China. Travelers carried the virus to many countries, sparking memories of previous coronavirus epidemics such as severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS). As of 1 June 2020, SARS-CoV-2 has infected 6,057,853 people and taken 371,166 lives across the globe [¹].

Recombination has been a powerful tool for emerging viruses to get innovative genetic configuration that supports host adaptations and facilitate the course of cross-species diffusion. Numerous recently emerged RNA viruses which were involved in human diseases exhibited active recombination or reassortment events. In coronaviruses (CoVs), a high recombination rate has been reported which can be attributed to the large genome size, discontinuous transcription, and sub- or fully transcriptionally active genomic length of RNA. Under experimental conditions, the recombination frequency of CoVs can be as high as 25% for the entire genome. In comparison with other single-stranded RNA viruses, the estimated mutation rates in CoV are moderate to high with average substitution rates reported as ∼10⁻⁴ substitutions per year per site [²].

CoVs have in the past demonstrated a marked capacity to employ homologous recombination, a process by which viruses exchange genetic material in the context of a coinfection. Indeed, studies have generated substantial evidence that SARS-CoV genome exhibited signs of a mosaic ancestry, and showed that there are at least seven potential regions of recombination in the SARS-CoV genome in the replicase- and spike-coding regions [³]. Further investigation of SARS-CoV origin suggested that SARS-CoV emerged following a recombination event of bat SARS-related coronaviruses (SARSr-CoVs) [⁴]. Similarly, the epidemic MERS-CoV experienced recombination events between the different lineages, which occurred in dromedary camels in Saudi Arabia [⁵]. Unsurprisingly, SARS-CoV-2 was also shown to use recombination as a crucial strategy in different genomic regions including the envelope, membrane, nucleocapsid, and spike glycoproteins to become a novel infectious agent, impacting virus reproductive adaptability, allowing for genotype adjustment [⁶]. Single-nucleotide variation analysis of 84 SARS-CoV-2 genomes have revealed that SARS-CoV-2 has been undergoing active recombination [⁷]. Moreover, latest reports on SARS-CoV-2 evolution provide compelling evidence that SARS-CoV-2’s entire receptor binding motif (RBM) was introduced through recombination with CoVs from pangolins [⁸].

MERS-CoV seasonal outbreaks still occur in the Middle East (peaks observed in spring season), particularly in the Kingdom of Saudi Arabia (KSA), concurrently to SARS-CoV-2 outbreaks. Between 1 December 2019 and 31 January 2020, 19 new cases of MERS-CoV have been reported in KSA [⁹], while monthly number of cases were 18 and 15 for February and March 2020 [¹⁰], respectively, indicative of ongoing circulation. WHO reports on 1 June 2020 show 85,261 total cases of SARS-CoV-2 in KSA alone [¹]. Although SARS-CoV-2 has appeared more transmissible, it is less deadly than MERS-CoV which has a fatality rate of 34%. Considering the evolutionary trajectories of CoVs, the current co-circulation of SARS-CoV-2 and MERS-CoV represents a threat to public health where a possible co-infection in a human host may result in the emergence of a both highly transmissible and highly fatal new CoV. Emergence of such recombinant CoV would require development of diagnostic assays for continuous surveillance in endemic areas, and would have implications for treatment and immunity as neutralizing antibodies in CoV-infected individuals are raised against the spike protein and would not provide protection against re-infection with a novel recombinant CoV.

Source:    2020 Article US National Library of Medicine National Institutes of Health 

[Technophobe's translation:  COVID and MERS are well able to combine. - Sorry folks!]

[url]https://en.wikipedia.org/wiki/Middle_East_respiratory_syndrome#Epidemiology[/url] or https://en.wikipedia.org/wiki/Middle_East_respiratory_syndrome#Epidemiology ; Between 2012 and 2020 Saudi Arabia reported 1029 cases of MERS-452 of rhem died. #2 on that list is South Korea with 184 cases/38 deaths-MERS is around the globe.

[url]https://en.wikipedia.org/wiki/Middle_East_respiratory_syndrome%E2%80%93related_coronavirus#Tropism[/url] or https://en.wikipedia.org/wiki/Middle_East_respiratory_syndrome%E2%80%93related_coronavirus#Tropism see also [url]https://en.wikipedia.org/wiki/2015_Middle_East_respiratory_syndrome_outbreak_in_South_Korea[/url] or https://en.wikipedia.org/wiki/2015_Middle_East_respiratory_syndrome_outbreak_in_South_Korea ;

The Korean Ministry of Health and Welfare initially withheld details from the public,^[11] as identifying the medical institution treating a MERS patient might cause unnecessary anxiety to its other patients. This policy lacked public acceptance,^[12] and was heavily criticized as preventing the Ministry from properly notifying hospitals and municipal governments. On 3 June, it was found that the Ministry had not notified the Incheon municipal government of the transfer of an infected patient to its local medical institution.^[13] The following day the Seoul municipal government announced that it had learned by chance, through an official attending a meeting, that a hospital doctor, who began to show symptoms on 29 May and tested positive on 1 June, had been moving freely within the city and had attended a gathering of 1,565 people in Gaepo-dong on 30 May.^[14] The municipal government obtained a list of the 1,565; the Ministry proposed to undertake "passive surveillance"; the municipal government rejected this as "lukewarm" and intervened directly: initially by contacting those listed.^[14]

On 7 June, after 2,361 people were isolated, 64 patients were confirmed infected and 5 had died,^[15] the central government finally disclosed the names of MERS-exposed medical institutions.^[16]

[url]https://en.wikipedia.org/wiki/Middle_East_respiratory_syndrome%E2%80%93related_coronavirus#Transmission[/url] or https://en.wikipedia.org/wiki/Middle_East_respiratory_syndrome%E2%80%93related_coronavirus#Transmission ;

On 13 February 2013, the World Health Organization stated that "the risk of sustained person-to-person transmission appears to be very low."^[24] The cells MERS-CoV infects in the lungs only account for 20% of respiratory epithelial cells, so a large number of virions are likely needed to be inhaled to cause infection.^[22]

Anthony Fauci of the National Institutes of Health in Bethesda, Maryland, stated that MERS-CoV "does not spread in a sustained person to person way at all," while noting the possibility that the virus could mutate into a strain that does transmit from person to person.^[25] However, the infection of healthcare workers has led to concerns of human to human transmission.^[26]

The Centers for Disease Control and Prevention (CDC) list MERS as transmissible from human to human.^[27] They state that "MERS-CoV has been shown to spread between people who are in close contact. Transmission from infected patients to healthcare personnel has also been observed. Clusters of cases in several countries are being investigated."^[27][28]

However, on the 28th of May, the CDC revealed that the Illinois man who was originally thought to have been the first incidence of person-to-person spread (from the Indiana man at a business meeting), had in fact tested negative for MERS-CoV. After completing additional and more definitive tests using a neutralising antibody assay, experts at the CDC concluded that the Indiana patient did not spread the virus to the Illinois patient. Tests concluded that the Illinois man had not been previously infected. It is possible for MERS to be symptomless, and early research has shown that up to 20% of cases show no signs of active infection but have MERS-CoV antibodies in their blood.^[29]

DJ-Some other questions; Why only infection in camels and humans-may we be missing other hosts ? Why if cases of MERS and SARS-2 are that high, chances of recombination is high-did it not yet recombinate ? 

We keep underestimating corona virusses !