The rise of MERS Co-V

ITIJ 162, July 2014

Middle East Respiratory Syndrome Corona Virus (MERS Co-V) can be fatal, but how worried should travel and medical insurance companies be about the risks posed to insureds travelling and working in areas where there have been outbreaks? Charlie Easmon looks into the issue

A new disease has a life-like trajectory – starting at birth, passing through infancy, adolescence and then adulthood or some form of maturity and eventually, perhaps in our life time, it may suffer something like old age and wither away or die out. Severe Acute Respiratory Syndrome (SARS) did just that after nine months (November 2002 to July 2003), after 8,273 known infections in 37 countries and 775 deaths (9.6 per cent), along with an estimated cost to the global economy of tens of billions of dollars.
This article is about a new disease in its infancy, whose known origins from birth will be traced, followed by speculation about its future and the potential implications of that for the insurance industry. So, will it be a stroppy adolescent, or jump that stage to safe and staid ‘pipe and slippers’ middle age before withering on the vine?

Back to basics

The new disease is a viral respiratory illness – MERS – caused by MERS-CoV. MERS-CoV is from the same group of viruses that cause the common cold, and that caused SARS. They are called corona viruses (CoV) because of crown-like projections seen under the microscope.
Those infected may have no symptoms or may develop sudden and severe acute respiratory illness with symptoms of:

  • Fever
  • Cough
  • Shortness of breath, which may lead to complications of pneumonia (secondary bacterial infection), kidney failure and death.

Some infected people have also had gut symptoms including diarrhoea and nausea or vomiting. The incubation time is up to 14 days.


MERS cases were first observed in Saudi Arabia in September 2012 following genome sequencing of a virus isolated from sputum samples from patients who fell ill in an outbreak of a new flu. As ITIJ went to press, there had been 701 laboratory confirmed infections in 17 countries (Jordan, Kuwait, Oman, Qatar, Saudi Arabia, the United Arab Emirates, and Yemen; France, Germany, Greece, Italy, and the United Kingdom; Tunisia and Egypt; Malaysia and the Philippines; and the US), with 249 deaths (35 per cent), according to the World Health Organization. Most infections have been in the Kingdom of Saudi Arabia in communities or hospitals. The numbers for the five countries in the European region, including the UK, are in single digits and all cases had travelled from the Arabian Peninsula.
Those most at risk of infection are healthcare workers, due to their proximity to patients, while those most at risk of death are those with pre-existing medical conditions such as diabetes or heart disease, as well as the elderly. Males are twice as likely to be affected as females, and the median age affected is 49, with a range from nine months to over 90 years.


The confirmed cases are probably just the tip of the iceberg since we now know many are infected without having symptoms, and these people can act as a carrier to pass the infection on to others. In the one year and eight months since it appeared, however, MERS does not appear to be as aggressive as SARS was, and despite it having so far been around for twice as long as SARS, it has only infected 10 per cent of the number of people SARS did – although it has a death rate more than three times higher.
Its geographical focus is the Arabian Peninsula, rather than China/Hong Kong as was the case with SARS, and it has not yet been exported to other countries in large numbers. There is always the risk that this could change, though.
The key risks to MERS turning into a stroppy adolescent rather than fading away are:

  • The Iraq/Syria rebel fighting may allow the spread of the disease with inadequate public health measures.
  • The two million people who attend the Hajj/Umrah in the last quarter of 2014 could be an amplification opportunity for viral spread, and the Saudi authorities are taking this risk very seriously (having already sacked two health ministers over the handling of MERS).  
  • The Arabian Peninsula has large numbers of overseas workers, some of whom reportedly live in crowded camps which could act to amplify and spread the virus, especially as the workers return home.

Implications for the insurance industry

The Saudi authorities have provided sensible recommendations regarding the Hajj/Umrah and have advised elderly people, pregnant women, children, and those with chronic diseases, such as heart diseases, kidney diseases, respiratory diseases, nervous system disorders, diabetes, and immune deficiency to postpone their pilgrimage. Apart from this advice, there are currently no specific travel restrictions in place for MERS, but once a case is identified in a new country, those who may have had contact with the case have to be tracked via flight or ship manifests – a process that sadly remains very inefficient.
The advice to travellers is the same as always: be vigilant, know what is happening where you are going, always use great personal hygiene in terms of hand washing, and sensible precautions with raw meats and unpasteurised milk products.