Is Uganda prepared for Middle East Respiratory Syndrome?
Posted Tuesday, October 15 2013 at 01:00
This year’s Hajj which started in Saudi Arabia over the weekend will end on October 18 and 2 million pilgrims from more than 100 countries will return home. And that is when the nightmare may begin. Some unfortunate pilgrims might unknowingly bring home the deadly MERS coronavirus and spark off another epidemic.
Since 2012, the Middle East Respiratory Syndrome Coronavirus (MERS virus), similar to severe acute respiratory syndrome coronavirus (SARS) but deadlier, has silently ravaged the Middle East. Saudi Arabia has had the highest number of cases and deaths; two deaths just days before the Hajj brought the total MERS deaths in the kingdom to 51. The UK and France have registered three (two died) and two cases (one died), respectively; all are linked to travel to the Middle East.
MERS causes coughing, fever and pneumonia and has proven fatal in 43 per cent of cases; SARS killed only 10 per cent of affected people. MERS is spread through the air by coughing or sneezing. This is the climate in which about two million pilgrims have converged and will stay in close contact for a week. An ideal hotbed for respiratory diseases and any doctor’s nightmare.
The related SARS spread to two dozen countries, infected 8098 people worldwide, and killed 774 people before it was contained in 2003. All these originated from a doctor in Room 911 on the 9th floor of the Metropole Hotel in Hong Kong. A hotel guest who never came in contact with the index case caught the disease and died; his room was across the hall opposite Room 911.
Imagine a Kikubo businessman returning to Uganda. Family members would be the first victims. The children would go to school and infect fellow pupils; the exposed children return home and infect their family members. Fellow traders and customers who come in contact with the businessman would get infected and infect others. It is a chain reaction of horrible proportions.
Our fragile public health system is already stretched enough; we cannot afford to overburden it with MERS. What steps can be undertaken to avert a disaster?
With Saudi Arabia having 80 per cent (114 of 136) of MERS cases reported worldwide, Uganda government should have forbidden travel to the Hajj. It did not. Now it has a golden opportunity to show leadership by taking firm, tough, and decisive steps to ensure that MERS is halted in its tracks when the pilgrims return home.
Hajj returnees with severe respiratory illness should be promptly identified and isolated for two weeks.
But what about infected returnees who do not show any signs for two weeks while unknowingly infecting others. A draconian measure would see all returning pilgrims isolated under medical observation. This may impinge on civil liberties but an outbreak would be averted.
Medical teams should be placed at the airport and at each border point to screen Hajj arrivals for signs of fever and severe respiratory illness. Suspicious cases should be identified and isolated irrespective of their position in Ugandan society. Viruses do not respect social class. Health questionnaires is a complete oxymoron in the circumstances.
The Uganda Virus Research Institute should be prepared to provide prompt diagnosis when samples arrive. Medical staff nationwide should be prepared to recognise the clinical picture of MERS to improve outbreak reporting. The government should begin procuring protective equipment and wear for medical staff. The public should be sensitised about the virtue of hand washing and avoiding handshaking for now.
There is no vaccine or antiviral treatment. The time for leadership and action is now.
Dr Egwang holds a postdoctoral qualification in molecular biology and is a former Executive Director of African Academy of Sciences.