By: Helen Branswell 

The full story of Middle East Respiratory Syndrome (MERS) is yet to be told. Would South Korea now be in the grip of one of the disease’s largest-ever outbreaks if more had been done sooner to unravel its mysteries?

So far, 175 cases have been reported in South Korea, 27 persons have died, more than 13,000 people have been quarantined and 10,718 people have been released from isolation after they showed no signs of infection during the maximum incubation period of 14 days.  Another, a 75-year-old traveling from Oman, was reported infected in Thailand.

A key point about MERS is that it gave warning of its arrival. This was not the case with Severe Acute Respiratory Syndrome – SARS – which struck in early 2003 after an infected Chinese doctor and travelers from Vietnam, Singapore and Canada mingled in a Kowloon hotel in Hong Kong. At the time, no one knew a disease was afoot.

The gravely ill doctor took his virus filled-lungs into Hong Kong’s hospital system, touching off a massive wave of infections among health care workers and their families. And after they went home and became sick, the hotel guests seeded infections into their hospital systems.

By contrast, a full 33 months before a South Korean businessman was confirmed to have brought the MERS virus his country, the discovery of a new coronavirus appeared in a report from Saudi Arabia published in ProMED, a disease and outbreak reporting system with broad international reach.

Shooting the messenger

Egyptian virologist Ali Zaki teamed up with the Netherlands’ renowned Erasmus Medical Center to identify the virus that had sickened and killed a Saudi Arabian man in June 2012. That it was Zaki, not the Saudi health ministry, who revealed the existence of the new SARS-like virus turned out to be impolitic. He was quickly stripped of his Saudi job and left the country.

Looking back, that initial official reaction was perhaps a harbinger of what was to come. Over nearly three years, information about MERS has systematically either been hoarded, mishandled or perhaps not even collected at all. 

That has left the world still unable to answer key questions about MERS and how it occasionally infects people. To complicate the situation, over the past year MERS efforts sputtered, overshadowed by west Africa’s catastrophic Ebola outbreak. 

“The world’s attention has understandably shifted to managing that crisis,” said Kamran Khan, an infectious diseases physician who researches the global spread of diseases at the University of Toronto.

“Although MERS has continued to ‘simmer’ in countries across the Arabian peninsula, it hasn’t – until now – evolved into an international outbreak that has reminded us all that it’s still out there and continues to pose a threat,” Khan said.

The virus is most prevalent in Saudi Arabia and the United Arab Emirates. And with millions of pilgrims flocking there annually and with its large contingent of foreign workers, Saudi Arabia seems to pose the biggest risk of exporting MERS to other parts of the world. 

But these countries appear not to have fully grasped the dangers, or taken on board their own responsibility to prevent precisely the kind of scenario that is now playing out in South Korea.