Days after returning home to the Republic of Korea in May 2015, a 68-year-old man felt a bad cold coming on. He went to a local clinic where the doctor assured him that it was a minor ailment. But his fever and cough worsened, so the man went to other doctors at other medical facilities – including a crowded hospital emergency room in the capital of Seoul – in search of a proper diagnosis and cure. Nothing seemed unusual about the case, except that he had just returned from the Middle East.
On 20 May, nine days after his first doctor’s visit, he was diagnosed with Middle East respiratory syndrome (MERS), a viral respiratory disease caused by a novel coronavirus. The virus was first identified in Saudi Arabia in 2012, where it was passed to humans through contact with infected dromedary camels or camel-related products. Because MERS is not common outside the Middle East, medical facilities in the Republic of Korea were not prepared to diagnose it quickly or prevent its spread. In the 10 days before he was correctly diagnosed, the man had unwittingly transmitted the potentially deadly virus to more than 30 people, including hospital staff, patients and visitors.
In contrast, a case of MERS detected in September 2018 in the Republic of Korea was diagnosed in a day, triggering the rapid response measures established after the 2015 outbreak to prevent spreading the deadly disease.
MERS has been detected in more than two dozen countries, but the 2015 outbreak in the Republic of Korea was the largest outside the Middle East. In all, there were 185 confirmed cases and 38 deaths. China, Malaysia, the Philippines and the Republic of Korea are the only countries in the Region that have experienced imported cases of MERS. “In the face of a newly emerging disease like MERS, the first challenge is always recognizing it,” explains Dr Shin Young-soo, WHO Regional Director for the Western Pacfic. “This outbreak reminded us that even a sophisticated health system with high capacity can be caught off guard.”
Once the disease was identified, the Republic of Korea immediately notified WHO as required under the International Health Regulations (2005). WHO quickly put its Emergency Operations Centre on alert and established an event management team that produced daily situation updates. A joint mission was conducted by the Korean Ministry of Health and Welfare and WHO to assess the risks posed by the outbreak and make recommendations on response measures. The mission was followed by a visit by Dr Shin and then-WHO Director-General Margaret Chan to support the country. Recommendations for the Government included: strengthened infection prevention and control in health facilities; improved guidance for health workers regarding questions to ask patients with fever or respiratory symptoms; improved reporting measures; and continued monitoring of suspected cases and close contacts.
“The MERS outbreak demonstrates the importance of investing in preparedness, even in high-income countries,” says Dr Shin, WHO Regional Director for the Western Pacific. “WHO will continue to work with national authorities to control outbreaks and monitor emerging infectious diseases in the Region.”