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As a new strain of lethal coronavirus spreads further around the world, Oman has played a key part in helping to crack the primary source – camels. Tom Robertson and Kate Ginn put the latest health scare under the microscope
Earlier this month in Al Madinah Province, Saudi Arabia, a region snaking along the west of the country by the Red Sea coast, a two-year-old child was fighting for their life.
Stricken with symptoms of a cough and high fever, and struggling to breath, the infant’s parents were desperate.
In a laboratory, about 1,900km away in southern Oman, researchers were preparing to carry out more tests on camels to confirm previous results carried out a few months earlier.
The two events might not, at first glance, seem connected. But they were entwined, linked in a long chain of events that first began in June 2012. The young victim in the hospital in Saudi Arabia died of MERS, a new coronavirus that has infected 660 people worldwide, of which a third have died.
From the racing camels tested in Oman around the same time, five tested positive for the killer virus.
“We are not sure whether they caught the virus in Oman or from outside,” says Dr Fuad bin Ja’afar al Sajwani, Minister of Agriculture and Fisheries.
Symptoms of MERS: Coughing, shortness of breath, chest pain, fever, Diarrhoea, Kidney failure.
The Sultanate had, in fact, already played a big role in helping to solve the mystery of where MERS had come from. Results from tests in Oman and other parts of the world were able to prove conclusively that camels were the main source.
That was, in a sense, the easy part. The biggest battle is trying to stop the spread of the disease, which has cut a swathe through Saudi Arabia and spread across the borders into Oman, which has had two confirmed deaths, and the UAE, and crossed waters into Egypt and further afield to America and the Philippines, among other places.
The spread of the disease prompted the World Health Organization (WHO) to hold an emergency meeting last September. Still, the virus marches on unabated. Photographs of camel herders wearing surgical masks to cover their mouths and noses appeared. 
So how did all this start? And what led to Oman becoming involved in the hunt for the source?
On June 13, 2012, a 60-year-old man was admitted to a private hospital in Jeddah. For the previous seven days, he had suffered a fever, coughing and shortness of breath, classic symptoms of a then unidentified lethal virus. Despite being placed in intensive care, the patient tragically died just 11 days later.
It was the first-ever case of a new kind of coronavirus. And so began the scrabble by scientists around the world to understand the virus, as the cases and the fatalities of the little-known disease racked up a tally of victims.
Using statistics from WHO, a MERS Corona map charts in real time the growing spread of the disease. According to the latest figures, there have now been 660 cases of people infected with MERS CoV, of which 200 have died, some as young as nine months old. That’s a mortality rate of one-in-three registered cases. But while outbreaks have predominantly occurred in the Arabic peninsula, as the official name of the virus would suggest – Middle East Respiratory Syndrome coronavirus – the number of cases reported are increasing.
The virus has now struck in Greece, Germany, Italy, Malaysia, the Philippines and even as far afield as the U.S. Two Omani nationals have died in the past eight months as a result of the virus.
It’s Saudi Arabia that has proven to be not just the suspected origin of the first case but also the country witnessing the highest number of cases. The Kingdom, with 552 cases, now comprises four out of every five reported cases in the world.
In Hafr al Batin, a remote town in Saudi Arabia’s northwest, relatives of four victims say no one in their families had ever heard warnings about the disease.
“We had no idea,” says Jawal al Shaly, who lost his 39-year-old brother, Fahd al Shaly, his mother and two other family members.
He speaks of how his brother, a government employee and part-time camel trader, bought a young camel in August last year. The camel fell ill, with watery fluid streaming from its nostrils, and Fahd sold the animal. Three days later, he fell sick and died 10 days after that.
With the disease’s “Ground Zero” on the Sultanate’s doorstep, authorities here have rallied to get one step ahead and take preventative measures. And those working at the centre of the issue are adamant that the Sultanate is well prepared.
The Ministry of Health’s MERS-CoV Task Force was set up swiftly at the end of 2012. Task Force member Dr Amal Saif al Mani, a senior consultant in paediatric infectious diseases has said: “There is absolutely no need to press the panic button. The country is fully prepared to combat the deadly coronavirus. The task force, set up by the Ministry of Health after MERS hit Saudi Arabia in 2012, is monitoring the situation closely.”
More crucially, the Sultanate put into motion a speedy testing programme that allows doctors to verify whether a patient has the disease. With a special hotline that’s been set up for doctors to call the Public Health Laboratory in Darsait, patients’ samples can be collected, tested and the results delivered in 24 hours.
But while patients can be told whether they carry the virus, serious questions still remain. As yet, it’s unknown just what route the virus took into the country.
It’s this and other serious questions that led a group of experts convening in Muscat on May 20 and 21 to call for greater monitoring and reporting of cases in the Middle East.
Speaking from the two-day Regional Technical Meeting on MERS-CoV, the UN Food and Agriculture Organization’s chief veterinary officer, Juan Lubroth, warned: “It is vitally important for the international community to increase our understanding of ‘where’ and ‘how’ the virus is transmitted, ‘who’ the source is – whether animal or human – and ‘when’ and ‘why’ certain people are spreading the virus.”
Doctors suspect one or more species of animals are hosting the virus, sporadically passing it on to humans. Tests on goats and sheep have found no evidence of the virus. Evidence points to Dromedary camels being the key carriers of the disease, although to date there has been no registered cases of camels with the virus dying. However, scientists are now turning their attention to domestic animals too, and plan to test cats, dogs and even rats.
Dromedary camels in Jordan, Saudi Arabia, Egypt, Qatar and the Canary Islands have all tested positive for the virus.
Now the disease may be more widespread in camels than originally thought, seeping into African countries.
According to the Emerging Infectious Diseases Journal, recent findings show that MERS-CoV was found in nearly all blood samples from 358 camels in Nigeria and 188 in Ethiopia. In a strange twist, it has now emerged that the samples were collected from 2009 to 2011, suggesting that the virus had existed well before it struck tragically in Saudi Arabia in 2012.
Recent findings in Oman have provided evidence that some of the Sultanate’s finest camels, an animal synonymous with the country’s culture and history, are playing host to the virus.
“A few weeks back, we conducted a series a polymerase chain reaction (PCR) tests on 76 sampled camels to detect if they carried MERS-CoV. These samples were sent to Vienna in Austria and results showed five camels had tested positive,” Dr Hadi Mohsin al Lawati, the Director of the Ministry of Agriculture and Fisheries’ Animal Health department, is reporting as saying.
These findings helped scientists and doctors to pinpoint the camel as the primary host of MERS. To date though, Oman has been unable to identify any cases of camel to human transmission.
With camels testing positive in the Sultanate for the disease, the UN’s Lubroth said public education should be a priority: “Participants in the MERS consultation agreed that there is also a vital need to raise awareness among the public at large about the importance of seeking medical attention, the nature of the disease and ways to avoid it.”
Recent information distributed by the WHO highlighted that it’s humans who are being subjected to the fatal consequences of MERS-CoV, but are also mostly responsible for spreading the disease to one another.
According to their most recent advice, experts now believe that as much as 75 per cent of recently reported cases appear to be secondary cases, meaning that they are believed to have acquired the infection from another infected person.
Furthermore, it’s the Middle East that may be proving the hotspot for catching the disease. While the cases of infected people are now being registered worldwide, the WHO believes that all cases recorded outside of the Middle East recently travelled to the region.
Although the WHO has decided against declaring MERS a global health emergency, it expressed concern that cases will continue to be exported to other countries through tourists and temporary workers who might acquire the infection following exposure to the animal or environmental source.
And it’s hospitals that are also being cited as high-risk places for picking up the infection
A person infected with the virus can be a carrier for up to 14 days without showing symptoms – that’s more than enough time for a worker to fly home with the infection having contracted the virus in their place of work. It’s believed that up to 15 per cent of physicians working in Saudi Arabia are from Europe and the U.S. and could fly home after contracting the virus in a healthcare setting.
Here in Oman, hospitals and clinics routinely advertise for expertise from abroad.
This is no time, then, to be complacent. The threat of MERS is very real for anyone and everyone.
“People might think (WHO) is crying wolf because MERS is still primarily a problem in the Middle East,” says Michael Osterholm, an American infectious disease expert who has worked in the Middle East.
“But if one of those infected people gets on a plane and lands in London, Toronto, New York or Hong Kong and transmits to other people, everyone will have a different view.”
MERS: Quick Facts
Officially known as Middle East Respiratory Syndrome, abbreviated to MERS-CoV.
A viral respiratory illness, it’s caused by a coronavirus. These are common viruses that most people will have at some point in their life.
MERS has been shown to spread between people in close contact.
The incubation period of the virus is two to 14 days, but the exact duration of infectivity is unknown.
There is currently no vaccine for the virus.
The Who is currently not recommending any travel or trade restrictions.
*Source, WHO and US Centre for Disease Control and Prevention.
Precautions to protect yourself
Avoid people with flu-like symptoms
Practise good hygiene by washing hands with soap and sanitisers containing 60 per cent or more alcohol.
Avoid close contact with camels. When visiting a farm or a barn, follow general hygiene measures, such as regular hand washing before and after touching animals, and avoiding contact with sick animals.
Camel milk should be sterilised before consumption and eating raw camel meat should be avoided.
Avoid touching your eyes, nose and mouth with unwashed hands.
Avoid contact (kissing or sharing a mug, for example) with people who are sick.
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