Middle East Respiratory Syndrome (MERS): A Deadly Coronavirus From Camels
Understanding the Virus That Emerged From the Desert
In June 2012, doctors in Saudi Arabia encountered a mysterious patient struggling to breathe, burning with fever, and rapidly deteriorating despite treatment. Laboratory tests revealed a virus never before seen in humans—a new coronavirus that would come to be known as Middle East Respiratory Syndrome Coronavirus, or MERS-CoV. Over a decade later, this deadly virus continues causing sporadic outbreaks, primarily in the Arabian Peninsula, with no vaccine or specific treatment available.
MERS-CoV is a viral respiratory illness first reported in Saudi Arabia that causes severe acute respiratory infection. According to the World Health Organization, approximately 35% of patients with MERS die from the infection, making it far deadlier than its coronavirus cousins like the common cold or even COVID-19. Since 2012, there have been approximately 2,600 laboratory-confirmed cases across 27 countries, with about 935 associated deaths—a sobering mortality rate that demands vigilance.
What Is MERS-CoV?
MERS-CoV belongs to the coronavirus family—a large group of viruses that can cause illnesses ranging from the common cold to severe acute respiratory syndrome (SARS). Under an electron microscope, coronaviruses appear crowned with spike proteins, giving them their name (corona means crown in Latin).
Key characteristics:
- Causes severe respiratory disease in humans
- Related to the SARS coronavirus that emerged in 2003
- Different from the coronavirus causing COVID-19 (SARS-CoV-2)
- Primarily transmitted from dromedary camels to humans
- Can spread between people in healthcare settings
- No vaccine or specific antiviral treatment exists
The virus emerged in the Middle East, hence its name, though cases have been detected worldwide among travelers returning from the Arabian Peninsula. The largest outbreak outside the Middle East occurred in South Korea in 2015, resulting from a single traveler returning from the region.
From Camels to Humans: Understanding Transmission
Unlike many human viruses, MERS-CoV didn’t evolve specifically to infect people. Research has shown that dromedary camels are the primary animal reservoir for MERS-CoV, meaning the virus lives naturally in these animals without necessarily making them sick.
Animal-to-human transmission occurs through:
- Direct contact with infected camels
- Consuming raw or undercooked camel meat
- Drinking unpasteurized camel milk
- Contact with camel urine or respiratory secretions
- Exposure in environments contaminated by infected camels
Studies show that camels across the Middle East, Africa, and South Asia carry MERS-CoV antibodies, indicating widespread infection among camel populations. Many infected camels show mild symptoms or remain asymptomatic, making it difficult to identify which animals pose transmission risks.
Human-to-human transmission is limited but dangerous:
- Does not spread easily between people in community settings
- Most human cases are isolated or occur in small family clusters
- Healthcare settings pose the highest transmission risk
- Patients with severe disease shed more virus and are more contagious
- Close contact is typically required for transmission
Like meningitis and other infectious diseases, MERS spreads through respiratory droplets when infected people cough or sneeze, and through contact with contaminated surfaces.
Recognizing MERS Symptoms
MERS-CoV infection causes a spectrum of illness, from no symptoms at all to severe respiratory disease and death. The incubation period—time from exposure to symptom onset—ranges from 2 to 14 days, with most people developing symptoms within 5 days.
Typical symptoms include:
- Fever (often the first symptom)
- Cough
- Shortness of breath
- Difficulty breathing
- Chills and body aches
- Sore throat
- Runny nose (less common)
Severe cases develop:
- Pneumonia (lung infection)
- Acute respiratory distress syndrome (ARDS)—severe breathing failure requiring mechanical ventilation
- Kidney failure
- Septic shock
- Multi-organ failure
Some infected people, particularly those with strong immune systems, develop mild respiratory symptoms or remain completely asymptomatic. However, they can still transmit the virus to others, though less efficiently than severely ill patients.
Who Is Most at Risk?
While anyone can contract MERS-CoV, certain groups face significantly higher risks of severe disease and death:
People with underlying conditions:
- Diabetes (present in over 50% of MERS patients)
- Chronic kidney disease
- Chronic heart disease
- Chronic lung disease (including asthma and COPD)
- Cancer and other immunocompromising conditions
Healthcare workers represent a vulnerable group, accounting for substantial proportions of MERS cases. Hospital-acquired infections occur when:
- Infection control measures are inadequate
- Healthcare workers don’t recognize MERS symptoms early
- Patients are not isolated promptly
- Personal protective equipment (PPE) is unavailable or improperly used
Older adults generally experience more severe disease than younger people, consistent with many respiratory infections.
People with occupational camel exposure face higher infection risk, including camel herders, slaughterhouse workers, and those handling camel products.
Similar to how maternal health outcomes vary based on underlying conditions and access to care, MERS severity depends heavily on patient characteristics and healthcare quality.
Diagnosis and Treatment
Diagnosis requires laboratory testing:
- Molecular tests (RT-PCR) detect viral genetic material in respiratory samples
- Blood tests can identify antibodies indicating past infection
- Multiple samples from different sites improve detection accuracy
- Testing should occur promptly when MERS is suspected
Treatment remains supportive only:
- No specific antiviral medications proven effective against MERS-CoV
- No vaccine currently available
- Treatment focuses on supporting vital organ functions while the immune system fights the virus
- Supplemental oxygen for breathing difficulties
- Mechanical ventilation for respiratory failure
- Kidney dialysis for kidney failure
- Intravenous fluids and nutritional support
- Treatment of secondary bacterial infections with antibiotics
Experimental treatments including antiviral drugs, convalescent plasma (antibodies from recovered patients), and monoclonal antibodies have been tested but lack conclusive evidence of benefit. Like challenges developing treatments for emerging infectious diseases, MERS therapeutics require extensive research and clinical trials.
Prevention: Protecting Yourself and Others
Without vaccines or specific treatments, prevention becomes paramount:
General prevention measures:
- Practice good hand hygiene—wash hands frequently with soap and water for 20 seconds
- Avoid touching eyes, nose, and mouth with unwashed hands
- Avoid close contact with sick people
- Cover coughs and sneezes with tissues or elbows
- Stay home when sick
- Clean and disinfect frequently touched surfaces
Camel-related precautions in the Middle East and other regions with infected camel populations:
- Avoid contact with camels when possible, especially if you have chronic conditions
- Wash hands after touching camels
- Avoid consuming raw camel milk or urine
- Ensure camel meat is thoroughly cooked
- Avoid contact with sick camels
- Use protective equipment when working with camels occupationally
Healthcare infection control:
- Early identification and isolation of suspected MERS patients
- Healthcare workers using appropriate PPE (masks, gowns, gloves, eye protection)
- Implementing standard, contact, and airborne precautions
- Proper ventilation in healthcare facilities
- Safe handling and disposal of contaminated materials
- Screening travelers from affected regions for MERS symptoms
Like infection control measures preventing hospital-acquired infections and antimicrobial resistance, MERS prevention requires systematic implementation of evidence-based protocols.
MERS Outbreaks and Global Response
Since 2012, most MERS cases have occurred in Saudi Arabia, though cases have been reported across the Middle East including the United Arab Emirates, Qatar, Oman, Jordan, Kuwait, Yemen, Lebanon, and Iran. Sporadic cases in other countries almost always involve travelers from the Middle East or their close contacts.
The 2015 South Korea outbreak demonstrated MERS’s potential for rapid spread in healthcare settings:
- 186 confirmed cases resulted from a single imported case
- 38 deaths occurred
- Outbreak centered in hospitals with poor infection control
- Required massive response including hospital closures and contact tracing
- Economic impact exceeded $2 billion
WHO’s role in MERS response includes:
- Coordinating international surveillance and reporting
- Providing technical guidance on infection prevention and control
- Supporting research into vaccines, treatments, and diagnostics
- Issuing travel advice and health recommendations
- Monitoring for virus mutations or changing transmission patterns
- Preparing for potential pandemic scenarios
The WHO continues monitoring MERS-CoV as a potential pandemic threat, though sustained human-to-human transmission has not occurred.
Research and Future Directions
Scientific research continues seeking solutions to MERS:
Vaccine development: Several candidate vaccines are in development, targeting different stages of the virus lifecycle. Human trials are ongoing, though challenges include the relatively small number of cases making efficacy trials difficult and uncertain market demand affecting pharmaceutical investment.
Antiviral drugs: Researchers are testing existing antiviral medications and developing new compounds specifically targeting MERS-CoV. Some drugs showing promise in laboratory studies have disappointed in clinical use.
Understanding transmission: Studies continue investigating how MERS spreads from camels to humans and between humans, identifying risk factors, and developing interventions to break transmission chains.
Animal reservoirs: Research explores MERS-CoV in camel populations, investigating infection dynamics, virus evolution, and potential interventions like camel vaccination.
Diagnostics: Developing faster, more accurate, and point-of-care diagnostic tests would enable earlier case detection and isolation.
Living With MERS: Ongoing Vigilance
Over a decade after its emergence, MERS-CoV remains a persistent threat, particularly in the Arabian Peninsula. While it hasn’t caused the global pandemic initially feared, sporadic cases and occasional outbreaks continue.
The virus reminds us that new infectious diseases can emerge unpredictably from animal reservoirs, potentially threatening global health. Like lessons learned from COVID-19, MERS highlights the importance of robust disease surveillance, rapid response capacity, strong infection control in healthcare settings, and international cooperation in fighting infectious diseases.
For travelers to affected regions, awareness and simple precautions significantly reduce risk. For healthcare workers, vigilance in recognizing symptoms and implementing infection control measures protects both themselves and patients. For researchers and public health officials, continued monitoring and research prevent complacency and prepare for potential future threats.
Though MERS hasn’t fulfilled worst-case scenarios, its high fatality rate and pandemic potential demand continued respect, research, and readiness. In our interconnected world, diseases emerging in one region can spread globally within days, making MERS everyone’s concern and global health security everyone’s responsibility.
Frequently Asked Questions (FAQs)
No, MERS, COVID-19, and SARS are caused by three different coronaviruses, though they’re related. SARS-CoV caused the 2003 SARS outbreak, MERS-CoV emerged in 2012, and SARS-CoV-2 causes COVID-19 (emerged 2019). All three cause respiratory illness but differ in transmission ease, severity, and geographic distribution. MERS has the highest fatality rate (~35%) but spreads less easily between people than COVID-19. SARS was eliminated in 2004 and hasn’t recurred. Understanding one coronavirus helps scientists study others, but each requires specific vaccines, treatments, and control measures.
No, there’s no risk of contracting MERS from Middle Eastern food, restaurants, or products outside the Middle East region. MERS transmission requires direct contact with infected camels or camel products (unpasteurized milk, undercooked meat) or close contact with infected people. Commercially prepared Middle Eastern foods, whether in restaurants or packaged products, don’t pose MERS transmission risk. The virus doesn’t survive long outside hosts and cannot be transmitted through properly prepared or processed foods.
WHO does not recommend travel or trade restrictions related to MERS. The risk to travelers remains very low. Most MERS cases occur among people living in the region with camel contact or underlying health conditions. Travelers can further minimize already-low risk by: avoiding camel contact, not consuming raw camel products, practicing good hand hygiene, avoiding contact with sick people, and seeking medical care if developing respiratory symptoms during or after travel. People with chronic conditions should take extra precautions and discuss travel plans with healthcare providers.
MERS-CoV doesn’t spread efficiently between humans compared to SARS-CoV-2 (COVID-19). Most MERS transmission requires close contact, and infected people generally don’t transmit the virus unless they’re severely ill. Additionally, MERS typically causes more severe symptoms faster, meaning infected people seek medical care and become isolated before spreading the virus widely. COVID-19, in contrast, spreads easily through respiratory droplets, can be transmitted by mildly symptomatic or asymptomatic people, and had global spread before being recognized as a new disease. However, MERS-CoV could potentially evolve greater transmissibility, which is why continuous monitoring is essential.
Healthcare workers globally should maintain awareness of MERS as a potential diagnosis in patients with severe respiratory illness and recent Middle East travel or camel contact. However, actual risk depends on local epidemiology. In countries without ongoing MERS transmission, risk is minimal but not zero—imported cases can occur. Healthcare facilities should have protocols for identifying suspected MERS cases, implementing appropriate isolation precautions, and using proper personal protective equipment. Workers in Middle Eastern countries face higher occupational risk and require sustained infection prevention training and resources. The 2015 South Korea outbreak demonstrated that healthcare-associated MERS transmission can occur anywhere when infection control is inadequate.
References
- World Health Organization. (2024). Middle East respiratory syndrome coronavirus (MERS-CoV). Retrieved from https://www.who.int/health-topics/middle-east-respiratory-syndrome-coronavirus-mers
- World Health Organization. (2024). Middle East respiratory syndrome coronavirus (MERS-CoV) – Fact Sheet. Retrieved from https://www.who.int/news-room/fact-sheets/detail/middle-east-respiratory-syndrome-coronavirus-(mers-cov)
- World Health Organization. (2024). Disease Outbreak News – MERS-CoV. Retrieved from https://www.who.int/emergencies/disease-outbreak-news
- World Health Organization. (2023). MERS-CoV Disease Outbreak News. Retrieved from https://www.who.int/emergencies/disease-outbreak-news/item/2023-DON498
- Observer Voice. Meningitis: The Brain Infection That Can Kill in Hours. Retrieved from https://observervoice.com/meningitis-symptoms-prevention-vaccination/
Disclaimer: This article is an adaptation of publicly available information from WHO’s Middle East Respiratory Syndrome (MERS) health topic page (WHO, Geneva. Licence: CC BYNC-SA 3.0 IGO). WHO is not responsible for the content or accuracy of this adaptation. This content is for informational and educational purposes only and does not constitute medical advice. ObserverVoice.com is a news and information platform — not a healthcare provider.
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