How concerned is the World Health Organization about the Middle East respiratory syndrome coronavirus, which by early July had infected 79 known cases, 42 of them fatal? Concerned enough to set up an Emergency Committee to assess and advise about the infection, a move the WHO announced on July 5 in Geneva. It’s the second time the organization has convened an Emergency Committee for a health threat since the global public-health community established the Emergency Committee option in 2005.

"We are doing this to be ready for any possibility, any direction this virus could take," said Dr. Keiji Fukuda, WHO’s assistant director general for Health Security and Environment. "We want to make sure we can move as quickly as possible if we need to in the future. We want to be as ready as possible."

The WHO is preparing to deal with a possible future ‘explosion’ of cases of MERS-CoV, although the disease does not pose an immediate threat, said Dr. Keiji Fukuda.

Dr. Fukuda stressed that currently the Middle East respiratory syndrome (MERS)–coronavirus (CoV) did not pose an acute, immediate threat, but there was a low, steady drumbeat of 62 cases identified during April, May, and June. This drip, drip, drip of new cases was enough to ratchet concern to the next level, with the WHO preparing to deal with a possible future "explosion" of cases, a development that Dr. Fukuda said was a real possibility.

An explosion is no more or less likely than a continuation of the low, steady rate of new cases, or a third scenario, that MERS-CoV just fades out and disappears. All three outcomes are equally likely right now, he said.

Among other things, the WHO will ask its new Emergency Committee of experts when they conference by phone on July 9 and 11 whether the current MERS-CoV situation constitutes "a Public Health Emergency of International Concern," he said. The emergency-panel members will also be asked whether there is anything more that WHO should do now or in the immediate future regarding MERS-CoV. "The committee will do a risk assessment and tell us how to respond."

Another sign of the status MERS-CoV carries right now is that some WHO staffers work on the virus 100% of their time, Dr. Fukuda said. Others at WHO work full-time on the second infectious disease of the moment, H7N9 influenza, which caused 132 confirmed cases in China as of early June. "Both are urgent situations," he said.

"We will continue with surveillance and case control studies until we have a better handle" on both pathogens.

MERS-CoV first became apparent in "early 2012," said Dr. Fukuda, "At the start, we weren’t sure what we were dealing with, but we now have a virus that continues to be there, the numbers are steady, and we simply don’t know what’s going to happen. So we decided to pull together these people now and have deliberations rather than wait until an emergency. Having gone through big events with SARS and H1N1, we did not want to wait until we were in the midst of an emergency."

The H1N1 pandemic of 2009 was the first time the WHO assembled an Emergency Committee under the International Health Regulations. The WHO already monitors and assesses MERS-CoV daily in meetings at the organization’s Strategic Health Operations Center in Geneva. WHO does not yet think H7N9 influenza warrants an Emergency Committee, in large part because infections by that virus have died down for the summer, a typical influenza pattern, Dr. Fukuda said.

H7N9 "has not disappeared. We are very mindful that when it gets colder again next fall and winter, we may see new H7N9 cases, possibly in new countries. It is premature for an Emergency Committee for H7N9, but we are focused on detecting new cases."

Dr. Fukuda also warned against presuming that the course of MERS-CoV will track the precedent set by Severe Acute Respiratory Syndrome (SARS) a decade ago.

MERS-CoV "is similar to SARS in some respects, and different from SARS in some respects," he said. One lesson SARS may provide is a way to control infections. As with MERS-CoV, "we had no vaccines or medicines" specific for SARS, Dr. Fukuda recalled. "SARS was brought under control by basic public-infection control methods," isolation, and other ways of stopping infections. But that won’t work unless the WHO has a better idea of what it needs to stop. For the moment, the contacts that transmit MERS-CoV remain unknown.

--By Mitchel L. Zoler

mzoler@frontlinemedcom.com

On Twitter @mitchelzoler

WHO ratchets up its MERS coronavirus response