MERS is no laughing matter, but camels sometimes are. Camels with MERS, however, can be a deadly serious matter, with major public health implications. Those fears increased today, when it was announced that camels have MERS, and that camel MERS is identical to the strain of MERS now circulating throughout the Middle East.
With the annual Haj – the Muslim pilgrimage to Mecca – coming up in October, there is some concern among public health officials about literally millions of travelers becoming infected with MERS and then dispersing the infection throughout the world. Other scientists have pointed out that MERS usually appears during the spring, and that the infections burn out rapidly, indicating that, unless there is direct contact with a continuing source of infection, there is little risk of the disease rising to the level of an epidemic.
Characteristics of MERS Infections
The Middle Eastern Respiratory Syndrome (MERS), a virulent, highly infectious coronavirus infection apparently native to the Arabian peninsula, is spread by direct contact with infected persons, and carries an alarming 50 percent death rate. The primary symptoms of the disease – fever, respiratory system congestion, and shortness of breath – are easily misdiagnosed as a half-dozen other diseases. That may be why the disease has a high infection rate among medical personnel, 72 of whom have been diagnosed with the condition, because they do not know they are dealing with MERS until they have already been infected.
Among other conditions, MERS mimics Chronic Obstructive Pulmonary Disease (COPD) which is itself a made up “disease” used to cover the overlapping conditions of chronic bronchitis and emphysema. People with COPD can have either of those conditions, or both at the same time. Unlike MERS, however, COPD is only controlled, never cured, and most people with COPD will die of the ailment unless something else gets them first, which is often the case because COPD weakens the victim’s immune system.
The fact that MERS mimics COPD is relevant, because COPD is widespread in cultures where smoking is prevalent, as it is through most of the Middle East, and where dust storms are common, also common to the Middle East. The silica in airborne sand dust irritates lung tissues and makes them more susceptible to damage from smoke inhalation.
Now, with the news that MERS may be spread by their camels, desert nomads have something else to worry about, in addition to being caught in the occasional cross-fires between rival political groups (the Bedouin are notoriously apolitical), stepping on the odd bomb here and there, or drinking contaminated water. This is especially worrisome for epidemiologists because Bedouin do not pay much attention to national borders. Where they go, their camels go, too, and, apparently, so does MERS.
MERS Infection Patterns
MERS has been identified in Jordan, Kuwait, Malaysia, Oman, Qatar, Saudi Arabia, Tunisia, and the United Arab Emirates, but it has also cropped up in Italy, France, and the United Kingdom. One case was reported in Canada. To date, 345 -365 cases of the disease, and 107 fatalities, have been identified, which would suggest a 31 percent mortality rate, but the U.S. Centers for Disease Control and Prevention (CDC) figures suggest that the mortality rate is increasing toward 50 percent. The rate of contagion is also increasing, with 60 of the 345 cases having been reported during the past 30 days for a 17.3 percent of the total reported cases, when an average month infection rate would have been around 14.4 cases per month.
First identified in camels in the early 1990s, the first human cases were not reported until 2012, but epidemiologists are concerned that earlier cases were not diagnosed correctly because of the disease’s similarity to other conditions.
The Camel Cometh
Long known as the “ships of the desert,” the camel is probably the only form of transportation that Federal Express does not use in its package delivery systems. Once the only reliable shipping system between Asia and Europe, the camel caravan has been both a sign of wealth, and a symbol of impoverishment.
When the camel was big, from the fall of Rome to the end of the Middle Ages, the number of camels one owned was a sign of one’s wealth. The more camels a Bedouin owned, the more caravans the Bedouin could put into the desert, carrying goods from one place to another. Today, camels are symbolic of the relative impoverishment of the Bedouin because, today, everything goes by Federal Express, leaving the camel caravans to shuffle from one oasis to another in a subsistence economy.
For those who have never had the pleasure, and few people have, camels are among the most cantankerous creatures on the planet, highly intelligent, irascible, arrogant,flatulent, difficult to control, difficult to ride, and dangerous. Hard to domesticate, hard to maintain, and hard to keep out of one’s tent at night, they are nevertheless essential for desert dwelling bedouins who still criss-cross the wastelands of the Middle East in places where they cannot drive their Toyotas and Range Rovers because there are no roads to drive upon and no gas stations within range of each other.
Camels are essential for three reasons. They can go for days without water, which is convenient in places where there is no water. They can eat almost any kind of vegetable matter, including nettles and brambles that no self-respecting horse would deign to nibble on. Their unique selling proposition, however, is that they are the only form of mass transportation (no one really uses horses much for transportation any more) that reproduces itself free of charge to the owners. In that sense, camels are also a source of wealth.
Camels as a Source of MERS
They are dangerous for three reasons: They bite and kick, if someone is stupid enough to stand close enough to one, and they may be a source of the MERS contagion.
Because of their irascible nature, the only safe place to be when around camels is on one. Unlike angry horses, however, they don’t buck, but they will swivel their necks around and take a bite out of an incautious rider’s leg. Horses bite, and kick, but they are not a source of MERS. On the other hand, camels are a lot smarter, and a lot faster over most terrain.
Epidemiologists have noticed that the instances of new cases of MERS increase during the spring, which is when camels deliver their offspring. Newborn camels have a higher viral load than adult camels and, since camels have been domesticated, they often need help from humans when giving birth, putting humans in direct contact with the newborns. Camel defenders, however, point out that very few of the identified cases of MERS can be backtracked to direct contact with camels.
Infectious Disease Analogies
Like milkmaids, however, who were immune to smallpox because of their previous exposure to cattle pox from infected cattle, people who are around camels on a regular basis may have developed an immunity to the disease. British physician Dr. Edward Jenner noticed that milkmaids were immune to smallpox in 1798 and developed his theory of infectious disease control that led to the smallpox vaccine.
While cattle were not directly sources of the smallpox bacillus, camels appear to have a bio-identical form of the MERS virus that could potentially infect human beings. This is why it is actually quite important that camels spit, because that is a likely path for the disease to infect humans. Many people also drink camel milk, and Kumis, a potent alcoholic beverage, is sometimes made from camel milk when horse milk is not available. In Egypt, an effective anti-dysentery cure is made from distilled camel urine.
At present, the connection between the camel and MERS outbreaks is anecdotal at best, but Canada’s public health department has warned travelers to avoid contact with camels and advised them not to drink unpasteurized camel’s milk. The World Health Organization has not yet gone to the extent of issuing a travel advisory, but has warned health organizations worldwide to increase their surveillance processes to investigate all serious respiratory illness quickly, to detect and quarantine MERS cases.
People who already have COPD or a related ailment would get a pass, but anyone suddenly developing severe cough, wheezing, or other breathing issues will get a second look, especially after the world’s Muslim pilgrims return home from the Haj.
Unlike sheep, which have been unjustly accused of having been the source of syphilis, when, in fact, the Native People of the New World probably were the actual culprits, the camel will have a lot more to answer for if the MERS link is proven. (Native People of the New World were largely immune to the syphilis disease from long exposure to it, but it syphilis became rampant upon its arrival in Europe because Europeans did not have a built-up natural immunity to the disease. In return, the Europeans in Colombo’s crew gave the natives smallpox, three hundred years before Jenner would discover his vaccination for the disease.)
Three Proverbs Come to Mind
Three proverbs come to mind here. “Trust in Allah, but also tie the knees of your camel,” is an ancient canard used to suggest that one should not take God’s grace for granted and to embrace protective measures against potential infection.
The second proverb, “It is better for keep your camel in the tent, pissing out, than to leave your camel outside the tent, pissing in,” suggests that it is better to keep camels under close observation and to control their contact with unprotected humans, those who have not had the ability to build up an immunity.
It is the third proverb, however, that summarizes the worst case scenario. “How does a camel get into a tent? First, it puts its nose in through the flap.” In a world with almost instantaneous transportation around the globe, in hermetically sealed aircraft, MERS contracted in the deserts of Saudi Arabia might very well find itself in an ideal breeding environment on its way to virgin territories where no one is immune to the disease.
MERS is no laughing matter. Saudi Arabia has reported 60 new cases in April alone, with six deaths resulting from the infections. Egypt has now identified its first cases. More may be on the way. The connection between MERS and the camel remains a crucial part of this cautionary tale. Sometimes the most familiar creatures can be the most dangerous to your well-being.
The bottom line? If you are going to visit Saudi Arabia, or any other country on the list above, do not kiss any camels you meet on the lips, or kiss anyone who has been kissing a camel because that person might have been kissing a camel with MERS.
By Alan M Milner
Look for me on Twitter:@alanmilner