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May 29th, 2013

The New SARS-Like Coronavirus (MERS-CoV), and What To Do When You Don’t Know Anything About The Latest Outbreak

From one of my close friends — a non-MD — comes this alarming video (sorry, can’t remove the preceding ad).

And here’s his email:

Concerned? Terrified? I bet your department is buzzing about this.

Um, not quite — especially since, among the 49 cases in the world (apparently there are 5 more than the WHO reported), exactly zero have occurred thus far in the United States. As of May 29, 2013, it hasn’t even cracked the front page of the CDC site.

Is MERS-CoV potentially of great concern? Of course. The WHO response seems right, especially with the parallels to SARS.

But do we garden-variety ID specialists know how serious it will be on a global basis? Of course not. As with the first SARS cases, the first anthrax cases, the first West Nile cases, the first hantavirus cases, even the first AIDS cases — we really don’t have enough points on the graph yet to make any sort of confident predictions.

And from a practical perspective, the clinical unfamiliarity doesn’t help. If someone walked into our emergency room tomorrow with fever, cough, and respiratory symptoms, would we know how to distinguish MERS-CoV from the hundreds (OK, thousands) of other causes of similar illnesses?

Initially, not a chance. The denominator of people with these complaints is just too gargantuan. It will probably take someone with a particularly severe respiratory illness, along with the appropriate exposure (“He just returned from a 10-day business trip to Riyadh”) for an astute clinician to make the connection.

So how should we ID doctors, who are supposed to know everything, respond to these emails in the interim? Stay informed efficiently by consulting these sites:

  1. ProMed-mail (outbreak updates from your ID colleagues/friends around the world).
  2. The always-fascinating CDC Outbreaks page, plus it’s coronavirus-specific info.
  3. Some non-MD news source — I like Google News.

And in response to queries from friends, family, and media, break out those three magic words doctors are often so reluctant to say — “I don’t know” or, if you want company, “We don’t know.”

Because it’s the truth.

(Also posted on WBUR’s CommonHealth site.)

One Response to “The New SARS-Like Coronavirus (MERS-CoV), and What To Do When You Don’t Know Anything About The Latest Outbreak”

  1. Loretta S says:

    Loved the poker-playing dogs, Paul. :) It always amazes me that some of my patients will get all wide-eyed and breathless about some rare infectious disease that may or may not eventually become a threat, but are blase about the fact that their BMI is 42, their triglycerides are 450 and their A1c is 9.0%. Whoa, love the promedmail.org site. I might just hang out there a while. Where else will I learn about viral hemorrhagic septicemia in fish?

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HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

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