Middle East Respiratory Syndrome Outbreak Research Articles

COVID-19 and Gastrointestinal Tract Symptoms: Recognition, Containment, and Learning From the Past

COVID-19 and Gastrointestinal Tract Symptoms: Recognition, Containment, and Learning From the Past

Exploration of Superspreading Events in 2015 MERS-CoV Outbreak in Korea by Branching Process Models.

South Korea has learned a valuable lesson from the Middle East respiratory syndrome (MERS) coronavirus outbreak in 2015. The 2015 MERS-CoV outbreak in Korea was the largest outbreak outside the Middle Eastern countries and was characterized as a nosocomial infection and a superspreading event. To assess the characteristics of a super spreading event, we specifically analyze the behaviors and epidemiological features of superspreaders. Furthermore, we employ a branching process model to understand a significantly high level of heterogeneity in generating secondary cases. The existing model of the branching process (Lloyd-Smith model) is used to incorporate individual heterogeneity into the model, and the key epidemiological components (the reproduction number and the dispersive parameter) are estimated through the empirical transmission tree of the MERS-CoV data. We also investigate the impact of control intervention strategies on the MERS-CoV dynamics of the Lloyd-Smith model. Our results highlight the roles of superspreaders in a high level of heterogeneity. This indicates that the conditions within hospitals as well as multiple hospital visits were the crucial factors for superspreading events of the 2015 MERS-CoV outbreak.

Shell Disorder Analysis Suggests That Pangolins Offered a Window for a Silent Spread of an Attenuated SARS-CoV-2 Precursor among Humans.

A model to predict the relative levels of respiratory and fecal–oral transmission potentials of coronaviruses (CoVs) by measuring the percentage of protein intrinsic disorder (PID) of the M (Membrane) and N (Nucleoprotein) proteins in their outer and inner shells, respectively, was built before the MERS-CoV outbreak. With MPID = 8.6% and NPID = 50.2%, the 2003 SARS-CoV falls into group B, which consists of CoVs with intermediate levels of both fecal–oral and respiratory transmission potentials. Further validation of the model came with MERS-CoV (MPID = 9%, NPID = 44%) and SARS-CoV-2 (MPID = 5.5%, NPID = 48%) falling into the groups C and B, respectively. Group C contains CoVs with higher fecal–oral but lower respiratory transmission potentials. Unlike SARS-CoV, SARS-CoV-2 with MPID = 5.5% has one of the hardest outer shells among CoVs. Because the hard shell is able to resist the antimicrobial enzymes in body fluids, the infected person is able to shed large quantities of viral particles via saliva and mucus, which could account for the higher contagiousness of SARS-COV-2. Further searches have found that high rigidity of the outer shell is characteristic for the CoVs of burrowing animals, such as rabbits (MPID = 5.6%) and pangolins (MPID = 5–6%), which are in contact with the buried feces. A closer inspection of pangolin-CoVs from 2017 to 2019 reveals that pangolins provided a unique window of opportunity for the entry of an attenuated SARS-CoV-2 precursor into the human population in 2017 or earlier, with the subsequent slow and silent spread as a mild cold that followed by its mutations into the current more virulent form. Evidence of this lies in both the genetic proximity of the pangolin-CoVs to SARS-CoV-2 (∼90%) and differences in N disorder. A 2017 pangolin-CoV strain shows evidence of higher levels of attenuation and higher fecal–oral transmission associated with lower human infectivity via having lower NPID (44.8%). Our shell disorder model predicts this to be a SARS-CoV-2 vaccine strain, as lower inner shell disorder is associated with the lesser virulence in a variety of viruses.

CUPID COVID-19: emergency department attendance by paediatric patients during COVID-19 - project protocol.

Background: Measures introduced to delay the spread of COVID-19 may result in avoidance of emergency departments (EDs) for non-COVID related illness. Clinicians and medical representative bodies such as the Irish Association for Emergency Medicine (IAEM) have expressed concern that some patients may not seek timely urgent medical intervention. Evidence from previous epidemics found that hospital avoidance during outbreaks of MERS and SARS was common. While ED attendance returned to normal following SARS and MERS, both outbreaks lasted 2-3 months. As the COVID-19 pandemic is forecast to extend into 2021, little is known about the impact COVID-19 will have on paediatric attendance at EDs as the pandemic evolves. Aims: This project aims to assess the impact of COVID-19 on paediatric emergency healthcare utilisation, to understand how the health seeking behaviour of parents may have altered due to the pandemic, and to identify how any barriers to accessing care can be removed. Methods: Administrative data records from five EDs across Ireland and one Urgent Care Centre will be analysed to identify temporal trends in attendances for emergency care. Qualitative inquiry will be utilised to capture the experience of staff providing emergency healthcare to paediatric patients during COVID-19, and their feedback on identified trends will inform the interpretation of findings. A cross-sectional survey of parents will capture experiences, concerns and decision-making on accessing healthcare for their children during the pandemic. Results and Conclusion: This information will help decision makers respond rapidly to meet the clinical needs of paediatric patients as the circumstances of the pandemic unfold and reduce the disruption to normal paediatric ED services during the onset of COVID-19. As the health of a child can deteriorate more rapidly than that of an adult, any delay in seeking care for an acutely ill child may have serious consequences.

Vaccine Candidates against Coronavirus Infections. Where Does COVID-19 Stand?

Seven years after the Middle East respiratory syndrome (MERS) outbreak, a new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) made its first appearance in a food market in Wuhan, China, drawing an entirely new course to our lives. As the virus belongs to the same genus of MERS and SARS, researchers have been trying to draw lessons from previous outbreaks to find a potential cure. Although there were five Phase I human vaccine trials against SARS and MERS, the lack of data in humans provided us with limited benchmarks that could help us design a new vaccine for Coronavirus disease 2019 (COVID-19). In this review, we showcase the similarities in structures of virus components between SARS-CoV, MERS-CoV, and SARS-CoV-2 in areas relevant to vaccine design. Using the ClinicalTrials.gov and World Health Organization (WHO) databases, we shed light on the 16 current approved clinical trials worldwide in search for a COVID-19 vaccine. The different vaccine platforms being tested are Bacillus Calmette–Guérin (BCG) vaccines, DNA and RNA-based vaccines, inactivated vaccines, protein subunits, and viral vectors. By thoroughly analyzing different trials and platforms, we also discuss the advantages and disadvantages of using each type of vaccine and how they can contribute to the design of an adequate vaccine for COVID-19. Studying past efforts invested in conducting vaccine trials for MERS and SARS will provide vital insights regarding the best approach to designing an effective vaccine against COVID-19.

COVID-19: pathophysiology, diagnosis, complications and investigational therapeutics.

The novel coronavirus disease 2019 (COVID-19) outbreak started in early December 2019 in the capital city of Wuhan, Hubei province, People's Republic of China, and caused a global pandemic. The number of patients confirmed to have this disease has exceeded 9 million in more than 215 countries, and more than 480 600 have died as of 25 June 2020. Coronaviruses were identified in the 1960s and have recently been identified as the cause of a Middle East respiratory syndrome (MERS-CoV) outbreak in 2012 and a severe acute respiratory syndrome (SARS) outbreak in 2003. The current SARS coronavirus 2 (SARS-CoV-2) is the most recently identified. Patients with COVID-19 may be asymptomatic. Typical symptoms include fever, dry cough and shortness of breath. Gastrointestinal symptoms such as nausea, vomiting, abdominal pain and diarrhoea have been reported; neurologically related symptoms, particularly anosmia, hyposmia and dysgeusia, have also been reported. Physical examination may find fever in over 44% of patients (and could be documented in over 88% of patients after admission), increased respiratory rate, acute respiratory disease and maybe decreased consciousness, agitation and confusion. This article aims at presenting an up-to-date review on the pathogenesis, diagnosis and complications of COVID-19 infection. Currently no therapeutics have been found to be effective. Investigational therapeutics are briefly discussed.

Where we missed? Middle East Respiratory Syndrome (MERS-CoV) epidemiology in Saudi Arabia; 2012–2019

MERS-CoV first case was reported on 23rd November 2012 in Saudi Arabia, Since, then MERS has remained on World Health Organization (WHO) Blueprint list and declared pandemic. This study was conducted on MERS lab confirmed cases reported to Ministry of Health, Saudi Arabia and WHO for year 2012–2019. The epidemiology was investigated based on infection rate, death rate, case fatality rate, Gender, Age group, and Medical conditions (Comorbid and Symptomatic). The overall median age of infected male was 58 years and of female was 45 years. While average mortality age in male was 60 years and of female was 65 years which is greater than the global average of 50 years. The results also report that specially after age of 40 years in both men and women, chances of infection are more while comorbidities increase the infection rate. The men are more susceptible to infection than women. In case of asymptomatic distribution trend was vice versa with 69.4% women and 30.6% in men. Second, most infected age group was reduced by 20 years in case of men with 47.37% infection for age group of 20–39 years. This was also observed in age-group of 20–39 years for no comorbid cases (men (50%) & women (79%)). This explains MERS-CoV prevalence in Saudi Arabia, as young and healthy population were infected, and acted as carrier and on coming in contact with vulnerable population (Elderly, chronic and comorbid) transferred the infection. Hence, MERS-CoV outbreak kept on happening from time to time over past years. This finding might very well explain the exponential spread of Novel CoV-19 globally, as initial control measures required older people to stay indoors while younger generation brought infection from outside. Further studies are required for epidemiology analysis based on clusters, travel history and specific disease related mortality.

Environmental pollution and COVID-19 outbreak: insights from Germany.

The impact of environmental pollutants and climate indicators on the outbreak of COVID-19 has gained considerable attention in the recent literature. However, specific investigation of industrial economies like Germany is not available. This provides us motivation to examine the association between environmental pollutants, climate indicators and the COVID-19 cases, recoveries, and deaths in Germany using daily data from February 24, 2020, to July 02, 2020. The correlation analysis and wavelet transform coherence (WTC) approach are the analytical tools, which are used to explore the association between variables included in the study. Our findings indicate that PM2.5, O3, and NO2 have a significant relationship with the outbreak of COVID-19. In addition, temperature is the only significant climate indicator which has significant correlation with the spread of COVID-19. Finally, PM10, humidity, and environmental quality index have a significant relationship only with the active cases from COVID-19 pandemic. Our findings conclude that Germany’s successful response to COVID-19 is attributed to environmental legislation and the medical care system, which oversaw significant overhaul after the SARS and MERS outbreaks. The current study implicates that other industrial economies, especially European economies, that are still facing COVID-19 outbreak can follow the German model for pandemic response.

CUPID COVID-19: emergency department attendance by paediatric patients during COVID-19 - project protocol

Background: Measures introduced to delay the spread of COVID-19 may result in avoidance of emergency departments (EDs) for non-COVID related illness. Clinicians and medical representative bodies such as the Irish Association for Emergency Medicine (IAEM) have expressed concern that some patients may not seek timely urgent medical intervention. Evidence from previous epidemics found that hospital avoidance during outbreaks of MERS and SARS was common. While ED attendance returned to normal following SARS and MERS, both outbreaks lasted 2-3 months. As the COVID-19 pandemic is forecast to extend into 2021, little is known about the impact COVID-19 will have on paediatric attendance at EDs as the pandemic evolves. Aims: This project aims to assess the impact of COVID-19 on paediatric emergency healthcare utilisation, to understand how the health seeking behaviour of parents may have altered due to the pandemic, and to identify how any barriers to accessing care can be removed. Methods: Administrative data records from five EDs across Ireland and one Urgent Care Centre will be analysed to identify temporal trends in attendances for emergency care. Qualitative inquiry will be utilised to capture the experience of staff providing emergency healthcare to paediatric patients during COVID-19, and their feedback on identified trends will inform the interpretation of findings. A cross-sectional survey of parents will capture experiences, concerns and decision-making on accessing healthcare for their children during the pandemic. Results and Conclusion: This information will help decision makers respond rapidly to meet the clinical needs of paediatric patients as the circumstances of the pandemic unfold and reduce the disruption to normal paediatric ED services during the onset of COVID-19. As the health of a child can deteriorate more rapidly than that of an adult, any delay in seeking care for an acutely ill child may have serious consequences.

COVID-19 in Kidney Transplantation: Outcomes, Immunosuppression Management, and Operational Challenges.

The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2, has led to the death of hundreds of thousands of people worldwide. If infected, older individuals and those with diabetes, hypertension, cardiovascular disease, and compromised immune systems are at higher risk for unfavorable outcomes. These comorbidities are prevalent in patients with kidney disease, hence the significant burden of COVID-19 on kidney transplant programs. Multiple case series of kidney transplant recipients with COVID-19 have shown increased mortality compared to nontransplant patients. To date, we do not have high-level evidence to inform immunosuppression minimization strategies in infected transplant recipients. Most centers however have adopted early antimetabolite withdrawal in addition to other interventions. This review summarizes the published COVID-19 literature as it relates to outcomes and immunosuppression management in kidney transplant recipients. It also discusses challenges pertaining to pretransplant evaluation and wait-listed patients.

Emerging Coronavirus Disease (COVID-19), a pandemic public health emergency with animal linkages: Current status update

After the appearance of first cases of ‘pneumonia of unknown origin’ in the Wuhan city, China, during late 2019, the disease progressed fast. Its cause was identified as a novel coronavirus, named provisionally 2019-nCoV. Subsequently, an official name was given as SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2) by the International Committee on Taxonomy of Viruses (ICTV) study group. The World Health Organization (WHO) named the Coronavirus disease-2019 as COVID-19. The epidemics of COVID-2019 have been recorded over 113 countries/territories/areas apart from China and filched more than 4,292 humans, affecting severely around 1,18,326 cases in a short span. The status of COVID-2019 emergency revised by the WHO within 42 days from Public Health International Emergency (January 30, 2020) to a pandemic (March 11, 2020). Nonetheless, the case fatality rate (CFR) of the current epidemic is on the rise (between 2–4%), relatively is lower than the previous SARS-CoV (2002/2003) and MERS-CoV (2012) outbreaks. Even though investigations are on its way, the researchers across the globe have assumptions of animal-origin of current SARS-CoV-2. A recent case report provides evidence of mild COVID-2019 infection in a pet dog that acquired COVID-2019 infection from his owner in Hong Kong. The news on travellers associated spread across the globe have also put many countries on alert with the cancellation of tourist visa to all affected countries and postponement of events where international visits were required. A few diagnostic approaches, including quantitative and differential real-time polymerase chain reaction assays, have been recommended for the screening of the individuals at risk. In the absence of any selective vaccine against SARS-CoV-2, re-purposed drugs are advocated in many studies. This article discourse the current worldwide situation of COVID-2019 with information on virus, epidemiology, host, the role of animals, effective diagnosis, therapeutics, preventive and control approaches making people aware on the disease outcomes.

The Asian Approach to the Management of Gastrintestinal Cancer Patients During the COVID-19 Pandemic Era

The Asian Approach to the Management of Gastrintestinal Cancer Patients During the COVID-19 Pandemic Era

Factors Associated with Burnout among Healthcare Workers during an Outbreak of MERS.

Objective Although healthcare workers (HCWs) experienced significant stress during the 2015 outbreak of Middle East Respiratory Syndrome (MERS), the factors associated with this stress remain unknown. Thus, the present study assessed burnout among HCWs during the MERS outbreak to identify the influential factors involved in this process. Methods This study was a retrospective chart review of the psychological tests and questionnaires completed by 171 hospital employees from two general hospitals that treated MERS patients. The tests included the Oldenburg Burnout Inventory, Positive Resources Test, the questionnaires assessed exposure to the MERS outbreak event and perceptions about MERS. Results Of the 171 HCWs, 112 (65.5%) experienced disengagement and 136 (79.5%) suffered from exhaustion. Disengagement was associated with lower levels of purpose and hope, a higher perception of job risk, and exposure to the media. Exhaustion was associated with lower levels of purpose and hope, a higher perception of little control of the infection, a higher perception of job risk, prior experience related to infections, and being female. Conclusion Our results revealed the risk and protective factors associated with burnout among HCWs during an outbreak of MERS. These findings should be considered when determining interventional strategies aimed at ameliorating burnout among HCWs.

Interferon-beta: treatment option against COVID-19

In December 2019, an increasing number of cases of novel coronavirus (2019-nCoV) that were linked to seafood wholesale market have identified in Wuhan, China. Taxonomist declared 2019-nCoV as severe acute respiratory syndrome coronavirus- 2 (SARS-CoV-2) and the disease termed as COVID-19. Importantly, there is no approved drugs or vaccine against SARS-CoV-2. Current review is related to address treatment option for COVID-19. Interferon-β have shown significant activity against previous outbreak of SARS-CoV and MERS-CoV. Faced with an ongoing pandemic of SARS-CoV-2 and lack of effective treatment options, identifying compounds with antiviral activity has become a high priority. Efficacy of these treatments is still unclear. Therefore, final analysis is important to develop better treatment strategies for ongoing pandemic.

An Analysis of the Effectiveness of the National Prevention System: Response to the MERS Outbreak in 2018

As international exchanges have become more active, the inflow of new infections has become easier and the damage from these new infections has increased. It is an important task for a nation to protect its people from disease. Therefore, in order to look at the governance of the national prevention system that was reorganized in 2015, we aimed to analyze how well the governance system was implemented by taking the MERS outbreak into account. We use the three aspects of prevention of domestic inflow, initial response site, and epidemic response based on four criteria: responsiveness, expertise, transparency, and connectivity. The analysis showed that the expertise and transparency have significantly improved and the responsiveness of the immigration control sector and the connection of the initial response site were insufficient. If these analyses make up for the deficiencies, it is expected to be resolved quickly and accurately even if there are new viruses in the future.

내·외부적 충격 요인이 신용카드 서비스품질에 미치는 영향: 2014년 개인정보 유출 사건과 2015년 MERS를 중심으로

The subject of this study is the effect of internal and external impact on card service quality. In particular, it analyzed what affects service quality, focusing on the leakage of personal information from credit card companies in 2014 and the MERS outbreak in 2015. To that end, KS-SQI credit card data were analyzed between 2012 and 2019. There are four main analysis results. First, the quality of credit card service affected customer loyalty, and the impact was great through unexpected additional services. Second, internal and external shocks also affected the decline in credit card customer loyalty. Third, internal shocks also led to a decline in customer loyalty, which was higher in the customer group that rated service quality high. Fourth, external shocks also showed a decline in customer loyalty among customers who rated service quality low. Therefore, we could see the importance of preparing companies for such shocks.

Minireview of progress in the structural study of SARS-CoV-2 proteins.

A severe form of pneumonia, named coronavirus disease 2019 (COVID-19) by the World Health Organization, broke out in China and rapidly developed into a global pandemic, with millions of cases and hundreds of thousands of deaths reported globally. The novel coronavirus, which was designated as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified as the etiological agent of COVID-19. On the basis of experience accumulated following previous SARS-CoV and MERS-CoV outbreaks and research, a series of studies have been conducted rapidly, and major progress has been achieved with regard to the understanding of the phylogeny and genomic organization of SARS-CoV-2 in addition its molecular mechanisms of infection and replication. In the present review, we summarized crucial developments in the elucidation of the structure and function of key SARS-CoV-2 proteins, especially the main protease, RNA-dependent RNA polymerase, spike glycoprotein, and nucleocapsid protein. Results of studies on their associated inhibitors and drugs have also been highlighted.

Coronavirus disease 2019 (COVID-19): latest developments in potential treatments.

Many viral respiratory infections can cause severe acute respiratory symptoms leading to mortality and morbidity. In the spring of 2003, the severe acute respiratory syndrome (SARS) outbreak caused by SARS-CoV spread globally. In the summer of 2012, the Middle East respiratory syndrome (MERS) outbreak caused by MERS-CoV occurred in Saudi Arabia. In the winter of 2019, the coronavirus disease 2019 (COVID-19) outbreak caused by a novel coronavirus SARS-CoV-2 occurred in China which rapidly spread worldwide causing a global pandemic. Up until 27 May 2020, there are 5.5 million confirmed cases of COVID-19 and 347,587 COVID-19 related deaths worldwide, and there has also been an unprecedented increase in socioeconomic and psychosocial issues related to COVID-19. This overview aims to review the current developments in preventive treatments and therapies for COVID-19. The development of vaccines for SARS-CoV-2 is ongoing and various clinical trials are currently underway around the world. It is hoped that existing antivirals including remdesivir and lopinavir-ritonavir might have roles in the treatment of COVID-19, but results from trials thus far have not been promising. COVID-19 causes a mild respiratory disease in the majority of cases, but in some cases, cytokine activation causes sepsis and acute respiratory distress syndrome, leading to morbidity and mortality. Immunomodulatory treatments and biologics are also being actively explored as therapeutics for COVID-19. On the other hand, the use of steroidal and nonsteroidal anti-inflammatory drugs (NSAIDs) has been discouraged based on concerns about their adverse effects. Over the past two decades, coronaviruses have caused major epidemics and outbreaks worldwide, whilst modern medicine has been playing catch-up all along.

Nosocomial outbreak of the Middle East Respiratory Syndrome coronavirus: A phylogenetic, epidemiological, clinical and infection control analysis

BackgroundMiddle East Respiratory Syndrome coronavirus (MERS-CoV) continues to cause intermittent community and nosocomial outbreaks. Obtaining data on specific source(s) and transmission dynamics of MERS-CoV during nosocomial outbreaks has been challenging. We performed a clinical, epidemiological and phylogenetic investigation of an outbreak of MERS-CoV at a University Hospital in Riyadh, Kingdom of Saudi Arabia. MethodsClinical, epidemiological and infection control data were obtained from patients and Healthcare workers (HCWs). Full genome sequencing was conducted on nucleic acid extracted directly from MERS-CoV PCR-confirmed clinical samples and phylogenetic analysis performed. Phylogenetic analysis combined with published MERS-CoV genomes was performed. HCWs compliance with infection control practices was also assessed. ResultsOf 235 persons investigated, there were 23 laboratory confirmed MERS cases, 10 were inpatients and 13 HCWs. Eight of 10 MERS inpatients died (80% mortality). There were no deaths among HCWs. The primary index case assumed from epidemiological investigation was not substantiated phylogenetically. 17/18 MERS cases were linked both phylogenetically and epidemiologically. One asymptomatic HCW yielded a MERS-CoV genome not directly linked to any other case in the investigation. Five HCWs with mild symptoms yielded >75% full MERS-CoV genome sequences. HCW compliance with use of gowns was 62.1%, gloves 69.7%, and masks 57.6%. ConclusionsSeveral factors and sources, including a HCW MERS-CoV ‘carrier phenomenon’, occur during nosocomial MERS-CoV outbreaks. Phylogenetic analyses of MERS-CoV linked to clinical and epidemiological information is essential for outbreak investigation. The specific role of apparently healthy HCWs in causing nosocomial outbreaks requires further definition.

Betacoronavirus Genomes: How Genomic Information has been Used to Deal with Past Outbreaks and the COVID-19 Pandemic.

In the 21st century, three highly pathogenic betacoronaviruses have emerged, with an alarming rate of human morbidity and case fatality. Genomic information has been widely used to understand the pathogenesis, animal origin and mode of transmission of coronaviruses in the aftermath of the 2002–2003 severe acute respiratory syndrome (SARS) and 2012 Middle East respiratory syndrome (MERS) outbreaks. Furthermore, genome sequencing and bioinformatic analysis have had an unprecedented relevance in the battle against the 2019–2020 coronavirus disease 2019 (COVID-19) pandemic, the newest and most devastating outbreak caused by a coronavirus in the history of mankind. Here, we review how genomic information has been used to tackle outbreaks caused by emerging, highly pathogenic, betacoronavirus strains, emphasizing on SARS-CoV, MERS-CoV and SARS-CoV-2. We focus on shared genomic features of the betacoronaviruses and the application of genomic information to phylogenetic analysis, molecular epidemiology and the design of diagnostic systems, potential drugs and vaccine candidates.