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Worry About New 'World Threat' Virus? Specialist: We Just Don't Know

This article is more than 6 years old.

You may have seen this headline last week: "World Health Organization says new virus may be 'threat to entire world.'" And if you're like me, you may have been surprised by your own ho-hum reaction. Is this a crying-wolf situation? Have we been warned about too many potentially scary viruses over the last few years? Or are we just getting more used to living with viral uncertainty? Here, Dr. Paul Sax, clinical director of the Division of Infectious Diseases at Brigham and Women’s Hospital, writes about his own reaction to this latest outbreak in the face of insufficient information.

By Dr. Paul E. Sax
Guest contributor

From one of my close friends — a non-MD — comes this alarming video.

And here's his email:

Concerned? Terrified? I bet your department is buzzing about this.

Um, not quite — especially since, among the 49 cases in the world (apparently there are five more than the WHO reported), exactly zero have occurred thus far in the United States. As of May 29, 2013, it hasn't even cracked the front page of the CDC site.

Is MERS-CoV — short for Middle East Respiratory Syndrome Coronavirus -- potentially of great concern? Of course. The WHO response seems right, especially with the parallels to SARS.

Coronoviruses (this image is not of the new Middle East virus) are a group of viruses that have a halo, or crown-like (corona) appearance when viewed under an electron microscope. (Wikimedia Commons)
Coronoviruses (this image is not of the new Middle East virus) are a group of viruses that have a halo, or crown-like (corona) appearance when viewed under an electron microscope. (Wikimedia Commons)

But do we garden-variety infectious disease specialists know how serious it will be on a global basis? Of course not. As with the first SARS cases, the first anthrax cases, the first West Nile cases, the first hantavirus cases, even the first AIDS cases — we really don't have enough points on the graph yet to make any sort of confident predictions.

And from a practical perspective, the clinical unfamiliarity doesn't help. If someone walked into our emergency room tomorrow with fever, cough, and respiratory symptoms, would we know how to distinguish MERS-CoV — from the hundreds (OK, thousands) of other causes of similar illnesses?

Initially, not a chance. The denominator of people with these complaints is just too gargantuan. It will probably take someone with a particularly severe respiratory illness, along with the appropriate exposure ("He just returned from a 10-day business trip to Riyadh") for an astute clinician to make the connection.

So how should we infectious disease doctors, who are supposed to know everything, respond to these emails in the interim?

Stay informed efficiently by consulting these sites:

  1. ProMed-mail (outbreak updates from your ID colleagues/friends around the world).
  2. The always-fascinating CDC Outbreaks page, plus its coronavirus-specific info.
  3. Some non-MD news source — I like Google News.

And in response to queries from friends, family, and media, break out those three magic words doctors are often so reluctant to say — "I don't know." Or, if you want company, "We don't know."

Because it's the truth.

Paul E. Sax, MD, is the editor-in-chief of Journal Watch HIV/AIDS Clinical Care, clinical director of the Division of Infectious Diseases at Brigham and Women’s Hospital, and a professor at Harvard Medical School. This post also appears on his Journal Watch blog, HIV and ID Observations, which is a dialogue on HIV/AIDS, infectious diseases, all matters medical, and some not so medical.

[Posted by Carey Goldberg]

This program aired on June 3, 2013. The audio for this program is not available.

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