Has the mushrooming outbreak of the new MERS coronavirus reached the point where it is an international public health emergency?
That is the question a panel of outside experts will reconsider today as the World Health Organization's so-called emergency committee on the MERS virus convenes for the fifth time. Dr. Theresa Tam, head of the Public Health Agency of Canada's Health Security Infrastructure Branch, is vice-chair of the committee.
Each previous time the group has expressed concerns about the Middle East respiratory syndrome coronavirus, a cousin of the SARS virus that has been causing sporadic and often severe or fatal illnesses in several countries on the Arabian Peninsula for the past two years.
But each previous time the group said the outbreak did not meet the definition of a public health emergency of international concern as set out in the International Health Regulations, legally binding rules that are designed to protect the world from disease threats that can cross borders.
The cumulative global case count, which only crossed the 200 mark in late March, is fast approaching 600 now. Of those cases, more than 150 have died. (The WHO's count lags behind the tally announced by governments; the global health agency said Saturday it had been informed of 536 cases and 145 deaths.)
Preben Aavitsland, Norway's former state epidemiologist and one of the drafters of the International Health Regulations, believes the emergency committee will advise director general Margaret Chan to declare MERS a global emergency or PHEIC (pronounced "fake") in the jargon of the WHO.
Under the International Health Regulations, a public health emergency of international concern is a disease event that poses a health risk to other states because of the potential for cross-border spread and is one that requires a co-ordinated international response.
"Already from the start it was clear that this was a disease that could be exported. And just now we got a new example from Florida," says Aavitsland, referring to Monday's announcement that the United States had detected its second case of MERS, in a health-care professional who travelled from Jeddah, Saudi Arabia, to Orlando, Fla., on May 1 via London, Boston and Atlanta.
In recent weeks Malaysia, the Philippines, Greece, Egypt and Jordan have diagnosed MERS in people who were infected abroad. In the case of Jordan, which has also had locally acquired cases, a MERS patient from Saudi Arabia infected three health-care professionals who treated him. Two of them have since died.
The WHO has only declared a public health emergency twice since the International Health Regulations came into effect in 2005. The first time was the 2009 H1N1 flu pandemic. The second came last week, when the embattled polio eradication effort was declared a public health emergency.
The emergency committee only advises; if it recommends that MERS be declared an emergency, the WHO's director general still has to decide if she will follow the advice. But it seems unlikely Chan, who set up the committee, would reject its advice.
Aavitsland says if a public health emergency is invoked for MERS, it would give the WHO more leverage with which to deal with the situation.
In a short report published online over the weekend in the International Journal of Infectious Diseases, several leading Saudi scientists said a recent review of the MERS situation leads to the conclusion that the virus does not pandemic potential "or even local epidemic potential." The lead author was Dr. Ziad Memish, the country's deputy minister of health. Memish is a member of the emergency committee.
But infectious diseases epidemiologist Marc Lipsitch, a professor at Harvard University, says the claim MERS doesn't have pandemic potential should have come with provisos. While Lipsitch thinks it is likely MERS currently doesn't spread well enough to transmit person to person in an ongoing fashion, he says that could change if the virus's genetic makeup mutated or it was introduced into a health-care setting where it couldn't be controlled.