Friday 26 / April / 2024
Muscat: Countries such as Oman must be ready to deal with emerging viruses, according to experts. Even then, there will always be small outbreaks.
According to Dr. Skild Petersen, Senior Consultant for Infectious Diseases at The Royal Hospital, one can look at viruses spreading in other areas and, through screening, be prepared for what might come, but the real danger comes from not knowing the virus.
“If there are things we know, we can screen and perform surveillance. But there are patients, particularly in the early stages, who die without diagnosis and so we don’t know. I think that’s pretty scary. We need to have good surveillance, so we can pick up unusual things, and so they can be diagnosed,” he added.
This came during Petersen’s talk on the second day of the Oman Health Exhibition and Expo 2018.
When asked a question about prediction and surveillance, he said, “For the things that you do not know, you cannot do anything. But what about the things you discover? For example, we are screening migrants for HIV and malaria. And one of the things emerging is that Southeast Asia, particularly places such as Pakistan, India and Bangladesh, are hotspots for certain bacteria, and so we screen patients admitted to hospitals for these cases.”
Graphs and statistics presented by the doctor showed that after the first initial weeks, outbreaks from known diseases generally tend to claim far fewer lives. This, he explained, was because of swift efforts in combatting and containing them.
“In Yemen, you will see that war destroyed the medical infrastructure, particularly with cholera. We had a recent outbreak in Oman by the border. We gave approximately 1.5 million doses of a vaccine and Oman is still regarded as cholera-free. So you can see how even a known virus can cause a outbreak. Nobody expected an outbreak here to come in from Yemen. One of my personal interests is malaria. We can see that most places are free except in south-western areas. In Yemen, you will see malaria coming in through the Omani border at the time.”
He added, “Even when a disease is known, there is always the risk of an emerging virus. This is what happened in Mabela in 2015, when there was a flare-up of Plasmodium Vivax, and that was started at a construction site. Except for one case, all other cases were among migrants. So what we did was molecular tests, which concluded that the virus came from Iran. We didn’t have anyone from Iran so this is how we knew that this was a single outbreak and in two months, it was over.”
In this case, the illness was not transmitted through a person at all.
“The mosquito had been inside one of the tools that was brought over. This illustrates that when you have an outbreak of introduced Malaria, which you will have because you have so many people coming in from malaria-endemic areas such as East Africa and Southeast Asia, you know how to handle it, and it will be over quickly, and this shows how surveillance is also important.”
Viruses can travel very quickly, according to the doctor, and in ways that are unexpected. In some cases, nearby animals, a mutation, or even crowded places can cause an outbreak. “When you have something, it will travel. Viruses travel with bugs when people are travelling, and people travel a lot,” he said.
“MERS had a few cases in Saudi Arabia in 2012 and caused quite a concern because in 2004 we had the SARS outbreak, another coronavirus which was discovered in China and in some cases, Canada. So suddenly in 2012, we had a coronavirus, which was quite serious, you had a mortality rate of 30-40 per cent and we hadn’t really seen it in humans. The reservoir in that case was most likely camels and perhaps some bats, but camels and contact with camels was the real risk.”
“What also turned out to be a real risk was this virus being hospital-transmitted. So if you went to a crowded hospital in Saudi Arabia at the time, coughing for three hours, you were quite sure that you had effectively transmitted the virus to other people. So it turns out that the initial transmission came from camels but there was a strong component of hospital transmissions before people knew what they were up against.”
Another example was the SARS virus and how it travelled to Canada from China.
“Again, it was a new pneumonia. The Chinese admitted they had an outbreak of pneumonia but that there was nothing to really worry about. Months later, the term SARS was used quite frequently. Very early in the outbreak, we saw a cluster in Toronto and then a smaller cluster in Vancouver. That’s because there is quite a large Chinese community in Toronto. There was quite a close link between the two places, which illustrates how these infections can spread very rapidly.”
Petersen also illustrated how conflict can reintroduce viruses to an area.
“In Syria, you can see how vaccine coverage decreased. The war led to a decrease in vaccine coverage, which is something we are very concerned about. When it comes to an emerging virus, the ‘who, what, where’ cannot be predicted.”
