A matter of The Mers virus time before Mers hits S’pore · PDF fileFor Sars, less than...
1
Melissa Sim US Correspondent in Washington A growing number of people are being affected by the Middle East respiratory syndrome (Mers), but the international health authorities have yet to declare a worldwide emergency. On the face of it, there appears valid reason for concern. When compared to the severe acute respiratory syndrome (Sars), Mers is a far more effective killer. So far, about a third of all Mers patients have died. For Sars, less than one-tenth succumbed. There is currently no specific treatment for Mers, nor is there a vaccine. The best a person can do, experts say, is to seek medical ad- vice early so doctors can address any complications such as pneumo- nia, should that develop. Still, the health authorities have resisted pressing the panic button. “When all the countries were looked at... we don’t see any evi- dence of community infection sweeping through,” said Dr Keiji Fukuda, assistant director-general for Health Security at the World Health Organisation (WHO). Using the example of the flu, he added: “Typically, when we see an influenza season, for example, we will see a sharp rise and many peo- ple getting infected and it’s clear you get infection going through communities. We don’t see that.” The lack of a travel advisory against visiting Saudi Arabia and the Middle East, where Mers is be- lieved to have originated, means there is no clear indication yet whe- ther thousands of people heading to Saudi Arabia for the main Mus- lim pilgrimage season in October will be at risk by making the trip. When asked specifically about the haj, WHO spokesman Tarik Jas- arevic said that although there are no WHO travel restrictions, the Sau- di Ministry of Health has recom- mended that the elderly and those with chronic disease postpone go- ing on the pilgrimage. Echoing the WHO, the Centres for Disease Control and Prevention in the United States said it “does not recommend that travellers change their plans because of Mers”, as most instances of per- son-to-person spread have oc- curred in health-care workers and others such as family members of caregivers of those with the virus. Epidemiology professor Stephen Morse from Columbia University’s Mailman School of Public Health said the mass gathering during the pilgrim season could increase the spread of Mers due to close proximi- ty between people. But he added that more impor- tant than telling people to stay away, is telling people to be watch- ful for signs of the virus, as early de- tection can help save lives. At this point, medical experts say they are not yet certain how the virus spreads. Dr Fukuda adds that while the situation has become more serious, there is no evidence of sustained human-to-human transmission. In other words, it is not yet a pandem- ic. The best guess of doctors right now is that the virus is carried in water droplets, spreading through exposure to an infected person who is sneezing and coughing. Yet, it seems this only happens after prolonged exposure. People seem to have low risk of contract- ing the disease through casual con- tact. For example, although one in- fected American health worker trav- elled on a crowded flight from Sau- di Arabia to the US, no other per- son on the plane has been diag- nosed with Mers. Prof Morse said Mers is not yet more contagious than Sars, but that could change, especially if the virus mutates. “This is a dynamic picture... We don’t know enough of how people get it, it’s very unclear,” he said. Malaysia’s King and Queen will make a three-day state visit to Singapore from tomorrow. This is the first state visit that Yang di-Pertuan Agong Tuanku Alhaj Abdul Halim Mu’adzam Shah is making across the Cause- way since he assumed the throne in December 2011. The trip reciprocates Presi- dent Tony Tan Keng Yam and his wife Mary’s state visit to Ma- laysia last September, and under- scores the deep and longstand- ing ties between both countries, said the Ministry of Foreign Af- fairs in a media statement. The visit will see the Agong and his wife Raja Permaisuri Agong Tuanku Sultanah Hajah Haminah Haji Hamidun receiv- ing a ceremonial welcome at the Istana. They will pay a courtesy call on Dr Tan and Mrs Tan, who will host them to a state ban- quet. Prime Minister Lee Hsien Loong and his wife Ho Ching will also call on the couple. The Agong will visit local at- tractions such as Gardens by the Bay and the Night Safari. He will also stop by Reflec- tions at Bukit Chandu, a muse- um at the site of some of the worst fighting between soldiers of the Royal Malay Regiment and Japanese soldiers in the Bat- tle of Pasir Panjang during World War II. An orchid will be named in honour of the Agong and his wife when they visit the Botanic Gardens. Maryam Mokhtar Linette Lai It could simply be a matter of time before Singapore gets its first case of Mers. “Being an air travel hub, there is always the risk that eventually we will also report a case,” said Dr Jef- fery Cutter, director of the Health Ministry’s communicable diseases division. Already 18 countries have regis- tered at least one patient with the Middle East respiratory syndrome (Mers), although the Middle East re- mains the worst affected. From today, air travellers arriv- ing from hot spots Saudi Arabia and the United Arab Emirates, as well as other Mers-affected coun- tries from the Gulf region will have their temperature screened. But even if a case of Mers is de- tected in Singapore, the likelihood of a community outbreak is low, said Dr Cutter. This is because sustained trans- mission of the disease – when a per- son passes the virus to those be- yond his immediate circle – has not been observed. Instead the spread of Mers over- seas has been concentrated in hos- pitals, unlike the severe acute respi- ratory syndrome (Sars) outbreak here in 2003, which spread mainly in the community. That is why local hospitals have been urged to “stay vigilant”. They have already put in place plans to deal with patients suspected of car- rying the virus. At Tan Tock Seng Hospital (TTSH) and the Singapore General Hospital, for instance, all emergen- cy department patients will be screened and put in isolation rooms if they are suspected to have the virus. TTSH is one of the first places air travellers will be transferred to if they are suspected to have Mers. It also has plans to increase facilities for screening and admission “if and when the number of suspected pa- tients increases”, said a hospital spokesman. In the event of a confirmed Mers case here, contact tracing will be carried out by the Ministry of Health (MOH). Those identified will be quarantined for 14 days, which is how long the virus takes to incubate. While younger people were more susceptible to the Sars virus, Mers seems to target older people with chronic diseases. However, ex- perts say too little is known about the disease to come to firm conclu- sions. “It’s not that there’s not enough work being done, but it takes time for all this to be fully understood,” infectious disease expert Ng Oon Tek of TTSH said. Laboratories in Singapore are able to effectively test for the dis- ease. This means confirmed cases can be detected quickly. “When Sars emerged in 2003, we knew a lot less about the virus initially,” said Associate Professor Benjamin Ong, director of medical services at MOH. At the time, he re- called, suspected cases were identi- fied based on symptoms such as fe- ver. “But because fever is relatively non-specific, it also meant that we ended up with a lot of noise that we had to screen through.” Whether precautionary mea- sures are stepped up will depend on the Mers situation abroad, Prof Ong added. “The more we know, the more we will be able to calibrate our re- sponses,” he said. “Stepping up does involve a fair bit of resources and a little bit of inconvenience for people... so we have to make the de- cision carefully.” [email protected] Malaysian royals to visit Singapore Berlin – Wanted: Little green traf- fic light man with hat seeks little green traffic light woman – or girl – to join him as a Berlin icon. He is a symbol that outlasted communism and the Cold War in Berlin, but he may be about to get a female friend if the Social Demo- cratic Party (SPD) gets its way. The red and green Ampelmann which indicate stop or go on pedes- trian crossing lights is one of the enduring symbols of the German Democratic Republic, the former East Germany. Ampelmann spread through- out the city after the fall of the Ber- lin Wall in 1989, acquiring a cult status that reached far beyond the German capital’s limits. Other countries have experi- mented with alternatives to the walking man image. but the Am- pelmann is seen as a design classic. Designer Karl Peglau, a psychol- ogist in East Berlin’s transport ser- vice, conceived the mannequin more than 50 years ago as a “hu- man-like” figure the city’s citizens could identify with and trust, ac- cording to its tourism website. But now there is pressure to catch up with several other Ger- man cities and bring gender equali- ty to pedestrian symbols, by intro- ducing an Ampelfrau. “Women need to be more present in the appearances of our capital’s streets,” Ms Martina Mat- ischok-Yesilcimen, SPD Mitte dis- trict leader, said. “We’re a diverse city and that deserves to be seen.” She is not insisting on the Am- pelfrau being introduced in the main tourist areas, saying there is enough room to install female ver- sions elsewhere in Berlin. But the new signal should be “modern” and not wear ponytails and wide skirts, as is common in versions seen in eastern German cities such as Dresden and Fuer- stendwalde, the SPD says. Mini- skirts and high heels are also inap- propriate, it adds. Bloomberg PHOTOS: GETTY IMAGES A little green ponytailed girl (above) lights up a traffic light in Sonthofen, a south-western German town. Berlin, which so far only has little men (right) for its traffic lights, is seeking to put in place women as well – although preferably without the ponytail. MOH points out risks associated with being an air travel hub, but says hospitals are vigilant and prepared A matter of time before Mers hits S’pore 520 163 Saudi Arabia 67 9 United Arab Emirates 7 4 Qatar 9 4 Jordan 2 2 Oman 3 1 Kuwait 1 0 Egypt 1 1 Yemen 1 0 Lebanon 2 1 Germany 2 0 The Netherlands 4 3 Britain 1 0 Italy 2 1 France 3 1 Tunisia 1 0 Greece 1 1 Malaysia 1 0 Philippines 2 0 United States The Mers virus Middle East respiratory syndrome Mers-CoV What we know about Mers virus Main symptoms Acute, serious respiratory illness Coronavirus: Family of common viruses that affect humans and animals, including the severe acute respiratory syndrome (Sars) virus which killed nearly 800 people around the world in 2003. Shortness of breath Fever Cough Breathing difficulties Pneumonia Gastrointestinal symptoms, including diarrhoea Kidney failure ■ Camels are a likely source of infection in humans. ■ In February, an analysis of blood samples from dromedary camels dating from 1992 to 2010 found evidence of Mers. ■ The virus can be passed between people in close contact. ■ Clusters of human-to-human transmission have been found, but no sustained community transmission observed so far. ■ The elderly, people with chronic medical conditions (such as diabetes and lung disease) and weakened immune systems are the worst affected when the virus hits. ■ The first recorded death was in June 2012 in Saudi Arabia. ■ Likely has its origins in bats. ■ Not seen in humans before. First detected in April 2012. ■ Incubation period: 14 days. ■ No cure or vaccine exists. Virus lethal in about 27 per cent of cases. ■ The flu-like virus has killed more than 190 people since its emergence in Saudi Arabia two years ago. Distribution of confirmed cases* of the virus by reporting country Cases outside the Middle East 19 Cases within the Middle East 611 Deaths within the Middle East 184 Deaths outside the Middle East 7 Sources: WHO, EUROPEAN CENTRE FOR DISEASE PREVENTION AND CONTROL ST GRAPHICS NOTE: *Since April 2012 and as of May 17, 2014 Country No. of cases No. of deaths Middle East country Non-Middle East country A more effective killer than Sars Wink: Berlin eyes little green traffic girl 12 top news thesundaytimes May 18, 2014
Transcript of A matter of The Mers virus time before Mers hits S’pore · PDF fileFor Sars, less than...
Melissa Sim
US Correspondent
in Washington
A growing number of people arebeing affected by the Middle Eastrespiratory syndrome (Mers), butthe international health authoritieshave yet to declare a worldwideemergency.
On the face of it, there appearsvalid reason for concern.
When compared to the severeacute respiratory syndrome (Sars),Mers is a far more effective killer.
So far, about a third of all Merspatients have died. For Sars, lessthan one-tenth succumbed.
There is currently no specifictreatment for Mers, nor is there avaccine. The best a person can do,experts say, is to seek medical ad-vice early so doctors can addressany complications such as pneumo-nia, should that develop.
Still, the health authorities haveresisted pressing the panic button.
“When all the countries werelooked at... we don’t see any evi-dence of community infectionsweeping through,” said Dr KeijiFukuda, assistant director-generalfor Health Security at the WorldHealth Organisation (WHO).
Using the example of the flu, headded: “Typically, when we see aninfluenza season, for example, wewill see a sharp rise and many peo-
ple getting infected and it’s clearyou get infection going throughcommunities. We don’t see that.”
The lack of a travel advisoryagainst visiting Saudi Arabia andthe Middle East, where Mers is be-lieved to have originated, meansthere is no clear indication yet whe-ther thousands of people headingto Saudi Arabia for the main Mus-lim pilgrimage season in Octoberwill be at risk by making the trip.
When asked specifically aboutthe haj, WHO spokesman Tarik Jas-arevic said that although there areno WHO travel restrictions, the Sau-di Ministry of Health has recom-mended that the elderly and thosewith chronic disease postpone go-ing on the pilgrimage.
Echoing the WHO, the Centresfor Disease Control and Preventionin the United States said it “doesnot recommend that travellerschange their plans because ofMers”, as most instances of per-son-to-person spread have oc-curred in health-care workers andothers such as family members ofcaregivers of those with the virus.
Epidemiology professor StephenMorse from Columbia University’sMailman School of Public Healthsaid the mass gathering during thepilgrim season could increase thespread of Mers due to close proximi-ty between people.
But he added that more impor-tant than telling people to stayaway, is telling people to be watch-ful for signs of the virus, as early de-tection can help save lives.
At this point, medical expertssay they are not yet certain how thevirus spreads.
Dr Fukuda adds that while thesituation has become more serious,there is no evidence of sustainedhuman-to-human transmission. Inother words, it is not yet a pandem-ic.
The best guess of doctors rightnow is that the virus is carried inwater droplets, spreading throughexposure to an infected personwho is sneezing and coughing.
Yet, it seems this only happensafter prolonged exposure. Peopleseem to have low risk of contract-ing the disease through casual con-tact. For example, although one in-fected American health worker trav-elled on a crowded flight from Sau-di Arabia to the US, no other per-son on the plane has been diag-nosed with Mers.
Prof Morse said Mers is not yetmore contagious than Sars, butthat could change, especially if thevirus mutates.
“This is a dynamic picture... Wedon’t know enough of how peopleget it, it’s very unclear,” he said.
Malaysia’s King and Queen willmake a three-day state visit toSingapore from tomorrow.
This is the first state visit thatYang di-Pertuan Agong TuankuAlhaj Abdul Halim Mu’adzamShah is making across the Cause-way since he assumed thethrone in December 2011.
The trip reciprocates Presi-dent Tony Tan Keng Yam andhis wife Mary’s state visit to Ma-laysia last September, and under-scores the deep and longstand-ing ties between both countries,said the Ministry of Foreign Af-fairs in a media statement.
The visit will see the Agongand his wife Raja PermaisuriAgong Tuanku Sultanah HajahHaminah Haji Hamidun receiv-ing a ceremonial welcome at theIstana.
They will pay a courtesy callon Dr Tan and Mrs Tan, whowill host them to a state ban-quet.
Prime Minister Lee HsienLoong and his wife Ho Chingwill also call on the couple.
The Agong will visit local at-tractions such as Gardens by theBay and the Night Safari.
He will also stop by Reflec-tions at Bukit Chandu, a muse-um at the site of some of theworst fighting between soldiersof the Royal Malay Regimentand Japanese soldiers in the Bat-tle of Pasir Panjang duringWorld War II.
An orchid will be named inhonour of the Agong and hiswife when they visit the BotanicGardens.
Maryam Mokhtar
Linette Lai
It could simply be a matter of timebefore Singapore gets its first case ofMers.
“Being an air travel hub, there isalways the risk that eventually wewill also report a case,” said Dr Jef-fery Cutter, director of the HealthMinistry’s communicable diseasesdivision.
Already 18 countries have regis-tered at least one patient with theMiddle East respiratory syndrome(Mers), although the Middle East re-mains the worst affected.
From today, air travellers arriv-ing from hot spots Saudi Arabiaand the United Arab Emirates, aswell as other Mers-affected coun-tries from the Gulf region will havetheir temperature screened.
But even if a case of Mers is de-tected in Singapore, the likelihoodof a community outbreak is low,said Dr Cutter.
This is because sustained trans-mission of the disease – when a per-son passes the virus to those be-yond his immediate circle – has notbeen observed.
Instead the spread of Mers over-seas has been concentrated in hos-pitals, unlike the severe acute respi-ratory syndrome (Sars) outbreakhere in 2003, which spread mainlyin the community.
That is why local hospitals havebeen urged to “stay vigilant”. Theyhave already put in place plans todeal with patients suspected of car-rying the virus.
At Tan Tock Seng Hospital(TTSH) and the Singapore GeneralHospital, for instance, all emergen-cy department patients will bescreened and put in isolation
rooms if they are suspected to havethe virus.
TTSH is one of the first places airtravellers will be transferred to ifthey are suspected to have Mers. Italso has plans to increase facilitiesfor screening and admission “if andwhen the number of suspected pa-tients increases”, said a hospitalspokesman.
In the event of a confirmed Merscase here, contact tracing will becarried out by the Ministry ofHealth (MOH). Those identifiedwill be quarantined for 14 days,which is how long the virus takesto incubate.
While younger people weremore susceptible to the Sars virus,Mers seems to target older peoplewith chronic diseases. However, ex-perts say too little is known aboutthe disease to come to firm conclu-sions.
“It’s not that there’s not enoughwork being done, but it takes timefor all this to be fully understood,”infectious disease expert Ng OonTek of TTSH said.
Laboratories in Singapore areable to effectively test for the dis-ease. This means confirmed casescan be detected quickly.
“When Sars emerged in 2003,we knew a lot less about the virusinitially,” said Associate ProfessorBenjamin Ong, director of medicalservices at MOH. At the time, he re-called, suspected cases were identi-fied based on symptoms such as fe-ver.
“But because fever is relativelynon-specific, it also meant that weended up with a lot of noise thatwe had to screen through.”
Whether precautionary mea-sures are stepped up will depend onthe Mers situation abroad, ProfOng added.
“The more we know, the morewe will be able to calibrate our re-sponses,” he said. “Stepping updoes involve a fair bit of resourcesand a little bit of inconvenience forpeople... so we have to make the de-cision carefully.”
Malaysianroyals tovisitSingapore
Berlin – Wanted: Little green traf-fic light man with hat seeks littlegreen traffic light woman – or girl– to join him as a Berlin icon.
He is a symbol that outlastedcommunism and the Cold War inBerlin, but he may be about to geta female friend if the Social Demo-cratic Party (SPD) gets its way.
The red and green Ampelmannwhich indicate stop or go on pedes-trian crossing lights is one of theenduring symbols of the GermanDemocratic Republic, the formerEast Germany.
Ampelmann spread through-out the city after the fall of the Ber-lin Wall in 1989, acquiring a cultstatus that reached far beyond theGerman capital’s limits.
Other countries have experi-mented with alternatives to thewalking man image. but the Am-pelmann is seen as a design classic.
Designer Karl Peglau, a psychol-ogist in East Berlin’s transport ser-vice, conceived the mannequinmore than 50 years ago as a “hu-man-like” figure the city’s citizenscould identify with and trust, ac-cording to its tourism website.
But now there is pressure tocatch up with several other Ger-man cities and bring gender equali-ty to pedestrian symbols, by intro-ducing an Ampelfrau.
“Women need to be morepresent in the appearances of ourcapital’s streets,” Ms Martina Mat-ischok-Yesilcimen, SPD Mitte dis-trict leader, said. “We’re a diversecity and that deserves to be seen.”
She is not insisting on the Am-pelfrau being introduced in themain tourist areas, saying there isenough room to install female ver-sions elsewhere in Berlin.
But the new signal should be“modern” and not wear ponytailsand wide skirts, as is common inversions seen in eastern Germancities such as Dresden and Fuer-stendwalde, the SPD says. Mini-skirts and high heels are also inap-propriate, it adds.Bloomberg
PHOTOS: GETTY IMAGES
A little greenponytailedgirl (above)lights up atraffic light inSonthofen, asouth-westernGermantown.Berlin, whichso far onlyhas little men(right) for itstraffic lights,is seeking toput in placewomen aswell –althoughpreferablywithout theponytail.
MOH points out risksassociated with beingan air travel hub, butsays hospitals arevigilant and prepared
A matter oftime beforeMershits S’pore
520 163
Saudi Arabia
67 9
United Arab Emirates
7 4
Qatar
9 4
Jordan
2 2
Oman
3 1
Kuwait
1 0
Egypt
1 1
Yemen
1 0
Lebanon
2 1
Germany
2 0
The Netherlands
4 3
Britain
1 0
Italy
2 1
France
3 1
Tunisia
1 0
Greece
1 1
Malaysia
1 0
Philippines
2 0
United States
The Mers virusMiddle East respiratory syndrome
Mers-CoV
What we know about Mers virus
Main symptomsAcute, serious respiratory illness
Coronavirus: Family of common viruses that affect humans and animals, including the severe acute respiratory syndrome (Sars) virus which killed nearly 800 people around the world in 2003.
Shortnessof breath
Fever
Cough
Breathingdifficulties
Pneumonia
Gastrointestinal symptoms,including diarrhoea
Kidneyfailure
■ Camels area likely source of infection in humans.
■ In February,an analysis ofblood samples from dromedary camels dating from 1992 to 2010 found evidence of Mers.
■ The virus can be passed between people in close contact.■ Clusters of human-to-human transmission have been found, but no sustained community transmission observed so far.■ The elderly, people with chronic medical conditions(such as diabetes and lung disease) and weakened immune systems are the worst affected when the virus hits.■ The first recorded death was in June 2012 in Saudi Arabia.
■ Likely has its origins in bats.■ Not seen in humans before. First detected in April 2012.■ Incubation period: 14 days.
■ No cure or vaccine exists. Virus lethal in about 27 per cent of cases.■ The flu-like virus has killed more than 190 people since its emergence in Saudi Arabia two years ago.
Distribution of confirmed cases*of the virus by reporting country
Cases outsidethe Middle East
19Cases withinthe Middle East
611
Deaths withinthe Middle East
184
Deaths outsidethe Middle East
7
Sources: WHO, EUROPEAN CENTRE FOR DISEASE PREVENTION AND CONTROL
ST GRAPHICS
NOTE: *Since April 2012 and as of May 17, 2014
Country
No. of cases No. of deathsMiddle East countryNon-Middle East country
in Saudi Arabia two years ago.
A more effective killer than Sars
Wink: Berlin eyes little green traffic girl
12 top newsthesundaytimes May 18, 2014
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