Coronavirus: Middle East Respiratory Syndrome(MERS) from the Arabian Peninsula

Middle East Respiratory Syndrome (MERS) has been reported in 27 countries since its first 2012 outbreak in Arabian Peninsula. It can affect people of all ages and its patients have ranged in age from a few months to 99 years old.

As of January 2020, 2 506 people got infected with MERS and 866 died, 34.3% fatality rate. More than 2 000 cases occurred in Saudi Arabia with a fatality rate of 37.1%.

It has been found that Middle East Respiratory Syndrome coronavirus/MERS-CoV causes Middle East Respiratory Syndrome. MERS-CoV is a betacoronavirus as the SARS-CoV virus (the “cousin” of SARS-CoV-2 causing COVID-19).

Middle East Respiratory Syndrome was first identified in a 60-year-old man in Saudi Arabia in April 2012. The patient with acute pneumonia died of kidney failure in June 2012.

All further cases have originated from the countries in or near the Arabian Peninsula or have been linked to somebody who got infected with MERS-CoV causing MERS there.

What countries are classified as in or near the Arabian Peninsula?

Countries such as Iran, Iraq, the West Bank, and Gaza, Syria, Yemen, Jordan, Lebanon, Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the UAE.

Symptoms of MERS

Middle East Respiratory Syndrome(MERS) is characterised by such symptoms as:

  • Fever

  • Cough

  • Shortness of breath

  • Diarrhea

  • Vomiting

that appear 2 to 14 days after the initial exposure. In severe cases pneumonia and kidney failure occur.

The fatality rate remains at approximately 35-40%.

Like SARS-CoV-2 causing COVID-19 and affecting people of all ages, MERS has the same ability. However, patients with underlying health conditions such as diabetes, cancer and chronic lung/heart/kidney disease are at a higher risk of contracting the MERS as in the case of SARS-CoV-2 causing COVID-19.

Some people who test positive for MERS-CoV are asymptomatic/do not display any symptoms of MERS despite being in contact with the infected person. Currently it is unclear why some people are asymptomatic to MERS-CoV(as is the case with SARS-CoV-2 causing COVID-19).

Transmission of MERS-CoV causing MERS

MERS-CoV is a zoonotic virus that is passed from animals to humans. Dromedary camel to human transmission of the virus was found to be taking place after in November 2013 a man who was caring for the sick camel was diagnosed with MERS and eventually died of the virus.

Camels are thought to have contracted the MERS virus from bats as briefly mentioned here.

The MERS-CoV is present in camels and therefore direct contact with camels is a risk factor for contracting MERS, especially for the people with underlying health conditions or chronic diseases.

Human-to-human transmission of MERS takes place via close contact. Research is still ongoing to fully understand how MERS-CoV spreads including how it jumped from animal to humans.

MERS Treatment

There is no vaccine to treat MERS and there is no specific drug for its treatment.

Supportive treatment is administered.

Spread of MERS around the world

Since the first case of MERS was identified in 2012 in Saudi Arabia there have been either clusters of cases reported or singular cases around the world including Europe and the United States.

As of 1 April 2020, 2 521 cases of MERS have been reported around the world, with the latest 15 cases taking place in Saudi Arabia.

MERS in Mecca, Saudi Arabia

The first case of MERS in Mecca was reported in April 2013.

The Saudi government then warned the elderly and chronically ill to avoid attending the hajj (Muslim pilgrimage to Mecca) in 2013 and as a result the hajj attendance in 2013 was lower than in previous years due to the fears over the spread of MERS.

In November 2013 though a Spanish woman attending the hajj was confirmed to have contracted the MERS.

MERS in South Korea

In May 2015 one of the largest outbreaks of MERS-CoV outside the Middle East took place in the Republic of Korea after a man who came back from the Middle East visited four hospitals in the Seul area in the attempt to treat himself. Some people contracted the disease from him and more than 3 000 were quarantined due to being in contact with those affected.

Even this outbreak, that does not look like a big deal to us now as the world is being ravaged by SARS-CoV-2 causing COVID-19, led to economic losses such as a cancellation of 100,000 tourist visits to the country, a 16.5% decline in department store sales and a decrease of 3.4% in retail shop sales.

This outbreak however led to the country’s better preparation for future disease outbreaks. The world has seen the effective testing and contract tracing that helped contain the spread of COVID-19 in Korea in 2020.

MERS in Europe

MERS cases were reported in France, Italy and Spain in 2013. Greece reported a case in 2014. The UK reported 4 cases of MERS in 2013 out of which 3 cases were fatal.


In February 2013 a man who had travelled to the Middle East and Pakistan tested positive for MERS in Manchester. His son, who had a brain tumour and therefore was in a vulnerable group, contracted MERS from his father and later died.

In September 2013 another man who had returned from Saudi Arabia tested positive for MERS. He died of kidney failure as the first patient in Saudi Arabia in October 2012.

The other fatal case of MERS was recorded in June 2013 in London.

The last reported case in the UK was in August 2018 when a Saudi Arabia national visiting the UK tested positive for MERS. He was found to have a direct contact with camels before the onset of MERS symptoms. Despite being symptomatic he travelled by plane to Manchester and then drove to Leeds where he initially received medical help before being transferred to Liverpool.

MERS in United States

Since May 2014 only 2 people have tested positive for the MERS-CoV in the United States.

Recent Cases of MERS

As of 1 April 2020, 15 cases and 5 deaths have been reported by the National IHR Focal Point of Saudi Arabia. The reported cases were from Riyadh (7 cases), Mecca (4 cases), Najran (3 cases), and Al Qassim regions (1 case).

Cases of MERS in 2018 Outside the Arabian Peninsula

In 2018 a few cases of MERS were identified outside the Arabian Peninsula.

In January 2018 a national of Malaysia who went on Umrah to Saudi Arabia tested positive for MERS. The man reported being in direct contact with a camel and drinking unpasteurized camel milk while on his visit to a camel farm in Riyadh at the end of December 2017.

In March 2018 a national residing in Oman tested positive for MERS-CoV. He was looking after sick camels before he fell ill.

In May 2018 a national residing in the UAE tested positive for MERS-CoV. He confirmed he had a contact with camels on a daily basis as he owned a camel farm in Saudi Arabia.

In August 2018 a Saudi Arabia national visiting the UK tested positive for MERS. He was found to have a direct contact with camels before the onset of MERS symptoms. Despite being symptomatic he travelled by plane to Manchester and then drove to Leeds where he received medical help initially before being transferred to Liverpool.

In September 2018 a Korean national visiting Kuwait and returning to Korea via Dubai tested positive for MERS.

Cases of MERS in 2019 Outside the Arabian Peninsula

In January 2019 five cases of MERS-CoV were reported in Oman. All who tested positive for MERS are family members. There was a regular contact with dromedary camels and other animals which were kept on their farm. 4 of these 5 confirmed cases are the result of human-to-human transmission.

In February 2019 additional eight cases of MERS-CoV were reported in Oman.

In October 2019 one case of MERS-CoV was reported in the UAE. The patient had a contact with dromedary camels before he started displaying the symptoms of MERS.

In December 2019 three confirmed cases of MERS-CoV were reported in Qatar. One of them died.

Prevention is better than cure that does not exist yet

As the number of cases of MERS increases each year and MERS-CoV can be fatal, it is important to be alert to its symptoms.

It is advisable to avoid contact with camels, especially if one has an underlying or chronic health condition.

If you visit countries near or in the Arabian Peninsula, it is important not to drink camel urine (yes, some people do that) or raw camel milk and avoid eating uncooked or poorly cooked camel meat, especially if you have an underlying or chronic health condition.