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Dr. Rajesh Vandra
Chest Physician/ Pulmonologist


Middle East respiratory syndrome (MERS) is a respiratory disease. It is caused by a coronavirus, which can lead to mild to severe respiratory infection. The first case of MERS was identified in 2012, and it is reported to have killed 3 to 4 out of every ten patients. The World Health Organization (WHO) labelled MERS-CoV a global danger in May 2013. MERS can infect anyone, and it is highly contagious, spreading from patients to others. This year too, Saudi Arabia and the U.S. confirmed deaths due to MERS-CoV infection. Although the virus has not yet made its way to India, physicians advise that it is best to be informed of the disease and take precautions ahead of time.

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Coronaviruses include Covid-19, Middle East respiratory sickness (MERS), and severe acute respiratory syndrome (SARS).

Covid-19: The disease named coronavirus disease 2019 (COVID-19) spread globally in the year 2020. Nearly 1 million individuals were infected, and 50,000 died in the first three months after COVID-19 was discovered.

MERS- CoV: The World Health Organization states that MERS is a viral respiratory illness transmitted by a virus. The disease was first identified in September 2012 in Saudi Arabia and has since spread around the globe.

SARS: Reports of the disease first appeared in Asia in February 2003, though cases subsequently were tracked to November 2002.


The signs and symptoms of MERS-CoV range from being asymptomatic to chronic respiratory illness and death. The early symptoms of the disease include:

1. Fever
2. cough
3. Shortness of breath
4. Rhinorrhea
5. Pneumonia, in some cases.

The weak immune system of geriatric patients and people with chronic illnesses can be closely linked to the severity of the fast progression of the disease. Other symptoms like runny nose, sore throat, headache and chills may also occur. Some people also had gastrointestinal symptoms like diarrhoea, nausea and vomiting. Some of them developed serious complications like pneumonia and kidney failure [2]. According to statistics, nearly 35% of people with MERS died due to these complications. The symptoms of the disease might seem familiar to the common cold, dry or wet cough and viral fever. After an incubation period of between two to fourteen days, the symptomatic MERS-CoV is usually manifested.

Late symptoms of the disease include:

1. Hypoxemic respiratory failure (Shortness of breath).
2. Myalgia (muscle pain).
3. Acute kidney damage.

Observing any of these symptoms, patients should seek the help of doctors, as the virus only takes one week to progress from early respiratory symptoms to the late multiorgan system failure [3].


Severe acute respiratory syndrome and middle east respiratory syndrome are caused by coronaviruses, reports NIAID (National institute of allergy and infectious diseases) [4]. Based on recorded observations, the incubation period (the time between a person’s exposure to the virus and manifestation of the symptoms) for MERS is 2-14 days. A human-to-human transmission requires about five days of incubation [3]. SARS-CoV and MERS-CoV are likely to be bat-originated same as SARS-CoV-2, according to research. The disease is then reported to have progressed to dromedary camels and finally to humans [4].

The reasons for the virus causing an epidemic can be traced to an unreliable system for dealing with public health emergencies. To avoid a global pandemic, researchers and government health authorities must strengthen their role in terms of public safety.

Risk Factors

According to what experts have learned so far about the disease, people with pre-existing medical issues may be more prone to contract MERS and suffer difficulties [5]. The following individuals are at a greater risk of infection:

  • Cancer patients

  • Patients with diabetes

  • Patients who are suffering from chronic lung, heart and kidney disease.

  • Individuals with a weakened immune system

If a person develops a fever and signs of respiratory infection within 14 days after returning from the Middle East, they should inform their doctor about their recent travel. The chances of spreading an infection to others are significantly reduced if the person stays at home.


Poor management and a lack of preventive measures may lead to the disease spreading locally and worldwide. Saudi Arabia and the Middle East countries attract a large number of visitors and are a place of pilgrimage for Muslims from all over the world. It is critical to raise public knowledge of the disease and educate people on how to prevent it until an effective vaccine is discovered.

Reporting all the cases to healthcare settings is an essential step to managing and preventing the further spread of the infection.
Some simple measures can be taken to prevent the infection include the following:

1. Usage of face masks
2. Hand hygiene
3. Disinfection of surfaces for fomites
4. Covering the mouth with a tissue when coughing or sneezing
5. Avoiding direct contact with infected people, and other simple hygiene measures are required to prevent this disease.

Protection of healthcare workers is essential by using protective equipment to safeguard themselves from catching the virus [14].


Polymerase chain reaction (PCR): In vitro qualitative detection of respiratory viruses such as the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) and SARS-CoV is based on real-time RT PCR (RRT-PCR). With a variety of sensitivities, such as 45 to 60%, RT-PCR kits are currently available in the market. However, because of such low sensitivities, a repeat diagnosis is sometimes required for accurate results. In addition, studies have documented varied results for the same patients after one, two, or even three swabs [6].

CT Scans (computed tomography scans): Researchers have documented that molecular techniques can classify different pathogens and are better suited for reliable diagnosis than CT scans [7]. While these studies have found that CT scans do not produce good results compared to RT-PCR techniques, other researchers have found the opposite. Comparing RT-PCR and CT Scans, researchers at Johns Hopkins Aramco Healthcare have reported CT scans are more sensitive than PCR tests. Low PCR sensitivity can be caused by insensitive nucleic acid detection technologies, differences in test accuracies, low initial viral load, or inappropriate clinical sampling [6].


There is presently no vaccination or specific therapy for MERS-CoV. However, various vaccines and medicines are being developed. Therefore, treatment is supportive and tailored to the patient's specific needs [1].

According to WHO, early detection of patients with a severe acute respiratory infection is essential to improve clinical management of the disease. Therefore, supportive therapy and monitoring are done by supplementary oxygen and intravenous fluids for patients with severe conditions. In addition, empiric antimicrobials are prescribed for pathogens that are likely to cause bacterial infections [8].

Although no licensed antiviral agents are available to combat the MERS-CoV outbreak, antiviral agents like ribavirin, lopinavir, and ritonavir have emerged as therapeutic alternatives. Other therapeutic options include repurposing current clinically FDA-approved pharmaceuticals, convalescent plasma, intravenous immunoglobulin, and monoclonal antibodies [9]. Studies have documented that prophylactic treatment with monoclonal antibodies has resulted in less severe respiratory disease and reduced viral lung loads [10].

How to take self-care during the ongoing treatment?

1. Taking maximum rest
2. Monitor temperature daily
3. Using a pulse oximeter, check your oxygen saturation daily.
4. If you detect any deterioration in your symptoms, contact your treating physician right once.


Management of patients with acute infections is a significant challenge in cases of MERS. Primary care physicians are expected to play a vital role in recognising and managing MERS-CoV cases and following preventative strategies.

MERS-CoV cases that are asymptomatic or subclinical in the community or healthcare settings can pose a serious hazard to public health. As a result, healthcare employees are at a high risk of contracting an infection or passing it on to patients or coworkers. Therefore, the prevalence of MERS-CoV among healthcare personnel emphasises the significance of ongoing physician education on infection-control measures. This education can improve knowledge and practice in diagnosing and controlling MERS-CoV infections and slow the spread of the virus [11].

For the management of the infection at home, fruits and vegetables should be washed before cooking or eating them raw. Foods rich in nutrients, as well as a healthy and well-balanced diet, should be administered to strengthen the immune system. Legumes, whole grains, vegetables, fruits and nuts can be eaten to boost immunity.

Prognosis And Complications


Non-Human to Human transmission: Since the virus is predominantly found in the middle east, the dromedary camels are the primary reservoir host and an animal origin for MERS-CoV. All of the cases that have been recorded were related to nations in and around the Arabian Peninsula, mainly in Qatar, Saudi Arabia, Oman and Egypt. MERS-CoV strains that are genetically identical to human strains have been obtained from dromedaries in these nations.

Human to Human transmission: If sufficient care is not followed, the virus can spread from one patient to another, and intimate contact is unavoidable, such as being exposed to the patient while caring for them. Even if no sustained infection has been recorded for MERS-CoV, clusters of cases have been found frequently in healthcare environments when infection prevention and control practices have been poor or inappropriate.[1].


The major complication of MERS is respiratory failure followed by other organs like kidneys. People with underlying illnesses are more likely than healthy people to progress an infection quickly. Studies have documented that severe MERS CoV onfection can lead to death [12]. An outbreak of MERS can significantly lead to pneumonia, a condition that can fill the air sacs in the lungs with fluids and complicate the already worsened respiratory system [13].



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3. Ramadan, N., et al. (2019). Middle East respiratory syndrome coronavirus (MERS-CoV): A review. Germs, 9(1), p39.

4. Covid- 19, MERS and SARS. NIH. Available at:

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7. Ezhilan M, et al.. SARS-CoV, MERS-CoV and SARS-CoV-2: a diagnostic challenge. Measurement. 2021 Jan 15;168:108335.

8. World Health Organization. (2019). Clinical management of severe acute respiratory infection when Middle East respiratory syndrome coronavirus (MERS-CoV) infection is suspected: interim guidance. World Health Organization. Available at:

9. Maurya VK, Kumar S, Bhatt ML, Saxena SK. Therapeutic Development and Drugs for the Treatment of COVID-19. Coronavirus. 2020 Apr 29:p116.

10. de Wit E, et al.. Prophylactic and therapeutic efficacy of mAb treatment against MERS-CoV in common marmosets. Antiviral research. 2018 Aug 1;156:64-71.

11. Al-Amri S, et al.. Knowledge and practices of primary health care physicians regarding updated guidelines of MERS-CoV infection in Abha city. Journal of family medicine and primary care. 2019 Feb;8(2):p457.

12. Ashok N, et. al. Knowledge and apprehension of dental patients about MERS-A questionnaire survey. Journal of clinical and diagnostic research: JCDR. 2016 May;10(5):ZC p58.

13. Ko JH, et. al. Predictive factors for pneumonia development and progression to respiratory failure in MERS-CoV infected patients. Journal of Infection. 2016 Nov 1;73(5):468-75.

14. Alyami MH, et. al. Middle East respiratory syndrome (MERS) and novel coronavirus disease-2019 (COVID-19): from causes to preventions in Saudi Arabia. Saudi Pharmaceutical Journal: SPJ. 2020 Sep 24. p1488


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