The Middle East Respiratory Syndrome Coronavirus in Saudi Arabia: Geographical Distribution - Term Paper Example

MERS-CoV in Saudi Arabia: Geographical Distribution Studies Name: Tutor: Course: Date: Table of contents Table of contents 2 List of Figures 3 List of Tables 4 1.0 Introduction 5 2.0 Descriptive analysis 5 2.1 Geography of Saudi Arabia 5 Figure 1: Map of Saudi Arabia 6 2.2 Information about MERS-CoV in Saudi Arabia 7 Table 1: Study area rate of MERS-CoV in Saudi Arabia 7 Table 2: Health data from Ministry of Health, Saudi Arabia 8 Table 3: Spatial data table 8 Table 4: Compiled Aggregate data 8 Figure 1: Coronavirus in Saudi Arabia-2015 9 Figure 2: Coronavirus in Saudi Arabia 2016 10 2.3 Risk factors or explanatory factors for MERS-CoV virus 11 2.4 Healthcare system in Saudi Arabia 12 3.0 Further research 13 4.0 Conclusion 15 List of Figures Table of contents 2 List of Figures 3 List of Tables 4 1.0 Introduction 5 2.0 Descriptive analysis 5 2.1 Geography of Saudi Arabia 5 Figure 1: Map of Saudi Arabia 6 2.2 Information about MERS-CoV in Saudi Arabia 7 Table 1: Study area rate of MERS-CoV in Saudi Arabia 7 Table 2: Health data from Ministry of Health, Saudi Arabia 8 Table 3: Spatial data table 8 Table 4: Compiled Aggregate data 8 Figure 1: Coronavirus in Saudi Arabia-2015 9 Figure 2: Coronavirus in Saudi Arabia 2016 10 2.3 Risk factors or explanatory factors for MERS-CoV virus 11 2.4 Healthcare system in Saudi Arabia 12 3.0 Further research 13 4.0 Conclusion 15 List of Tables Table of contents 2 List of Figures 3 List of Tables 4 1.0 Introduction 5 2.0 Descriptive analysis 5 2.1 Geography of Saudi Arabia 5 Figure 1: Map of Saudi Arabia 6 2.2 Information about MERS-CoV in Saudi Arabia 7 Table 1: Study area rate of MERS-CoV in Saudi Arabia 7 Table 2: Health data from Ministry of Health, Saudi Arabia 8 Table 3: Spatial data table 8 Table 4: Compiled Aggregate data 8 Figure 1: Coronavirus in Saudi Arabia-2015 9 Figure 2: Coronavirus in Saudi Arabia 2016 10 2.3 Risk factors or explanatory factors for MERS-CoV virus 11 2.4 Healthcare system in Saudi Arabia 12 3.0 Further research 13 4.0 Conclusion 15 1.0 Introduction A viral respiratory disease called Middle East respiratory syndrome coronavirus (MERS-CoV) first identified in Saudi Arabia in 2012 is caused by a novel coronavirus. Characterized clinically by severe respiratory symptoms and fever, MERS-CoV infection is a zoonotic disease. The disease is transmitted through contact with camels and is heavily endemic in dromedary camel populations (Zumla & Hui, 2014). Areas at risk include the Arabian Peninsula in which the virus cases originate and where cases of outbreaks are reported after people come into direct contact with sick patients. Data from geographical distribution studies and stored dromedary camel serum suggest that several decades ago, the virus was present in dromedary camels. MERS-CoV is spread through contaminated surfaces such as sheets and pillows or through inhalation of respiratory droplets from the patient (Abroug et al., 2014). In Saudi Arabia, the disease is endemic because people keep dromedaries for milk, meat and urine. The incubation period of coronavirus is believed to be mostly 12 days, according to some studies, and retains its ability pathogenicity outside the human body for three hours on dry surfaces and six days in a liquid environment. According to Reusken et al. (2015) MERS-CoV has symptoms flu-like nasal mucous secretions, clogged sinuses, coughing and sneezing as well as inflammation in the upper respiratory channel. Saudi Arabian ministry of health, in partnership with other health bodies, has been vibrant in taking preventive measures and treatment for the coronavirus (Reeves et al., 2015). This study performs descriptive analysis of the coronavirus by considering Saudi Arabia as a geographical study area of interest for the years 2015 and 2016 in 14 regions. It provides health and spatial data about MERS-CoV through tables and visual presentations. The study also provides analysis of risk factors or explanatory factors that contribute to the spread of the coronavirus. Moreover, the study examines the Saudi Arabian healthcare system to understand its response and readiness to handle cases of coronavirus infections. Finally, this study provides recommendations for further research into the triangle of human ecology to understand transmissions between animals and humans. 2.0 Descriptive analysis 2.1 Geography of Saudi Arabia Saudi Arabia is a country situated in the Middle East bordering Yemen, Red sea, Jordan, Sultanate of Oman, UAE, Kuwait, Qatar and Bahrain. It is one of the key suppliers of crude oil and has one of the largest continuous sandy deserts in the world. Estimated at 2.2 million Km2, the country is predominantly desert climate with extreme high temperatures (540C) during the day and very cold nights (CIA, 2014). Much of the land is under nomadic pasture (56 percent) where farmers keep camels, goats, sheep and cattle. The country has six eco-regions; Arabian Gulf desert, Arabian Peninsula coastal desert, foothill savannah, high mountains, Red Sea tropical desert and Xerophytics desert and mountains of Sinai and Arabia. Figure 1: Map of Saudi Arabia The population of Saudi Arabia, as of January 2016, was estimated at 31.9 million people having increased by 2.31% from the previous year. In the predominatly Muslim country, there are more males than females with a life expectancy at birth standing at 73/76 years. Although there is rapid growth among children aged 0-14 years, the country’s population is stabilizing (WHO, 2014). The total expenditure on health is 4.7 percent of the Gross Domestic Product. Mortality and burden of disease are Malaria, Tuberculosis and other non-communicable diseases (Almalki et al., 2011). The risk factors are alcohol, road traffic injuries and tobacco. Total fertility rate is 2.17 babies per woman with a natural increase rate of 16.09 (CIA, 2014). Given the low death rates and high birth rates, the country is in the third and fourth stage of the demographic transition model. An economic boom from oil is diminishing meaning that Saudi Arabia will experience loss of income and increased child birth. 2.2 Information about MERS-CoV in Saudi Arabia Saudi Arabia is a host country for millions of Muslim pilgrims visiting the country each year. This makes is susceptible to various viruses and diseases originating from out of state. MERS-CoV is one of the viruses that have created a lot of concern to the medical profession having killed about 800 people between 2012 and 2016. The zoonotic origin of this virus is largely drawn from dromedary camels with herders, slaughterers and their immediate family members at high risk of infection (Poletto et al., 2016). Aggregate and spatial data was obtained from cases in 13 regions of Saudi Arabia in 2015 and 2016. As shown in the table below, case population rate for the two years was obtained by dividing the number of cases per region per year by the total number of population provided in the region. Table 1: Study area rate of MERS-CoV in Saudi Arabia From the table above, the case population rate was higher in Riyadh region in 2015 and Qaseem region in 2016. However, there were no reported cases in Baha in 2015 and Aljawf and Tabuk in 2016. Moreover, health data from Saudi Arabian Ministry of Health included 900 people with the coronavirous in the year 2015 and 2016. Dr. Paul aggregated the data using ID numbers for the 13 observation regions and cases in 2015-16. Population data from Saudi Arabian statistical yearbook were taken and added adjacent to the already created columns of infected cases. Table 2: Health data from Ministry of Health, Saudi Arabia The two columns were Cases Population Rat 2015 and Cases Population Rate 2016. After calculating the rat data, the result was a table with both health and population data. By adding the ID field into the health data, it was possible to spatial data with health data as shown in the table 3 and 4 below. Table 3: Spatial data table After obtaining all the data, the following procedure is undertaken; click ‘Arc Map’ → then ‘Region Shipfile’ → click ‘Join’. Finally, join attributes from the table were chosen. Initially, the data study chose ID field in the layer then made the Excel table to have a single shipfile containing all data as shown in the table below. Table 4: Compiled Aggregate data The table above shows the probability of the population being infected with the coronavirus as well as the actual cases infection for the two years. Saudi Arabia has the highest global coronavirus infections in the world. Ministry of health of Saudi Arabia provides most of the data through the statistical year book. In this case, the temporal range was two years; 2015 and 2016. The units of representation for MERS-CoV were 1 per 100,000 as indicated in the statistical year book. The observation ‘location’ was identified by city name and region. Moreover, the city data and shipfile data for the Saudi Arabian region made is possible to join the shipfile and data. Figure 1: Coronavirus in Saudi Arabia-2015 Based on data from the ministry of health shown in figure 1 above, the infection rates in the country is very high with the highest rate reported in Riyadh region. Although Najran and the Eastern region had high rate compared to Riyadh, they were still high. This may lead to increase in the number of patients given the patient density and population density. In the map above, it is evident that five regions; Al Jouf, Hail, Tabuk, Al Baha and Jazan are the lowest corona cases reported. However, Al Qaseem which had low infection rates in 2015 surpassed Riyadh to be the most infected region in Saudi Arabia in 2016. This could be a result of high camel movement within Qaseem. Figure 2: Coronavirus in Saudi Arabia 2016 As shown in figure 2 above, the intensity of MERS-CoV infections moved from Riyadh to Qaseem, the rate of disease spread on the northern part of Saudi Arabia increased including Riyadh and Najran. On the other hand, Tabuk, Jazan and Al Jawf continued to record low rates of infection. Reusken et al. (2015) took some serum samples from persons with and without dromedary contact in Qatar were tested for MERSCoV virus by determining the presence of neutralizing antibodies. Using two-level based cohorts of non-animal contact and animal contact persons, study found that MERS-CoV neutralizing antibodies were detected in persons with daily contact with dromedaries and not those without contact. This shows that habitats with continuous flow of dromedaries from different immune statuses and places of origin expose dromedary handlers to MERS-CoV infection. Similarly, Alradaddi et al. (2016) conducted an experimental study of laboratory-confirmed MERS-CoV cases. The authors made observations that were aggregated according to case-patients, level of exposure and the control group. The study found that MERS-CoV illness was directly associated with contact with dromedaries 2 weeks before the onset of illness. The study did not find positive association of MERS-CoV illness with zoonotic origin from exposure to sheep, horses, goats and bats. In another study, Reeves et al. (2015) investigated MERS-CoV infections and the interplay between camels and humans in being disease victims and reservoirs for further transmission in Jordan, Saudi Arabia, Oman and the UAE. The data aggregated as persons with existing co-morbidities, healthcare workers, and exposed persons to domestic animals (camels). Although exposure patterns were rather unreliable and uneven, the study found that MERS-CoV case-occurrence was more concentrated in Saudi Arabia and circumscribed portions of the Arabian Peninsula. Just like Alradaddi et al. (2016b), Reeves et al. (2015) did not find any evidence of bat or sheep transmissions of the virus across human populations. Moreover, Assiri et al. (2013a) investigated 47 cases of patients and healthcare workers for MERS-CoV infections reported from 10 regions in Saudi Arabia. The study found that the case-fatality rates of MERS-CoV rose with increasing age and that transmission in two health-care facilities were a result of readmissions and transfer of patients. All the above studies agreed that there was limited evidence of MERS-CoV transmission in sheep, bats and other domestic animals. A general understanding of MERS-CoV was made to the extent that it is associated with milk and meat of dromedary camels likely to affect middle aged men, especially those with existing comorbidities such as diabetes, respiratory infections and chronic renal diseases. 2.3 Risk factors or explanatory factors for MERS-CoV virus Spread of MERS-CoV is attributed to behavior, habitats and population characteristics among the nomadic population and abattoirs in handling the risk factors of MERS-CoV virus. Saudi Arabian farmers keep camels and their social organization is hinged on camel and sheep for economic, social and religious reasons (Alvarez et al., 2015). With zoonotic origin from dromedary camels, it implies that camel farmers, barn workers and slaughterers of these dromedaries come into contact with camels at various stages and get infected. MERS-CoV is prevalent in camel milk and meat which is consumed by majority of the population (Azhar et al., 2014). Being nomadic animals suitable for desert habitats, a large section Saudi population breeds camels of which its uncontrolled movement across the desert leads to exposure of a large section of the population. Alraddadi et al. (2016) argued that risk factors of MERS-CoV were incompletely misunderstood and explanatory factors like environmental exposures and medical conditions may explain the disease. The authors affirmed that medical conditions such as smoking, heart disease and diabetes mellitus as well as direct exposure to dromedary camels 2 weeks prior to illness were independently associated with MERS-CoV illness. Consumption of raw camel milk and use of camel urine as traditional medicine, as has been the Arabian culture, may be the source of infection for possible zoonotic transmission which its incubation period remains unknown. The hallmark of MERS-CoV is nosocomial transmission in Europe and the Middle East which caused an upsurge of cases in UAE (Al Ain) and Saudi Arabia (Jeddah) in the spring 2014. In healthcare settings, outbreaks involved hospitalised patients, family members and healthcare workers (WHO, 2014). Secondary cases identified are mildly symptomatic and asymptomatic cases. Transmission in hospitals has been documented in on medical wards, intensive care units and haemodialysis units (Cotton et al., 2013). However, strict and systematic implementation of control measures and infection prevention has limited onward transmission to hospitalized patients and healthcare workers (Assiri et al., 2013). People with high exposure and risk to MERS-CoV infection are: people with exposure to camels, recent travelers from the Arabian Peninsula, healthcare workers not observing recommended infection control precautions, close contacts of a confirmed case of MERS and close contacts of ill travelers from the Arabian Peninsula. 2.4 Healthcare system in Saudi Arabia Saudi Arabian Ministry of Health is tasked with the provision of preventive, curative and rehabilitative health care to the citizens. With a broad base of 220 general and specialist hospitals, Saudi Arabia has adopted a referral system that has advanced technology specialist curative services to care for all members of society at all levels. Primary care is provided by the National Health Service (NHS) while secondary and tertiary care are financed and delivered by the Saudi Arabian National Guard (SANG), the Ministry of Interior (MOI) and the Ministry of Defense and Aviation (MODA). All non-Saudi Arabian nationals are required to have a health insurance cover. Although Saudi Arabian government has opened nursing schools and medical studies to substitute expatriate workforce, Ajlan et al. (2014) observes that the resources are thinly spread across health care facilities which decrease future expansion. New technology is highly priced and puts considerable cost pressure on the government that offers free-of-charge public health services to its citizens. According to Memish et al. (2013) the Ministry of Health allocation of 35million Riyals per year including treatment and health promotion against MERS-CoV has been exceeded. In partnership with Center for Disease Control (CDC) and World Health Organization (WHO), Saudi Arabian government has created public awareness on basic sanitation, provided essential drugs, immunization of children and the prevention and control of MERS-CoV. The Ministry of Health has created quarantine centers have been constructed along the national boundaries to conduct health check-ups and vaccinations against coronavirus. With most hospitals located in Riyadh and Jeddah, they have been able to conduct convalescent plasma therapy for MERS-CoV and routinely advise people on proper sanitation. Fortunately, medical services in Saudi Arabia are accessible by 99 percent of the population and all patients suffering from MERS-CoV illness are assured of diagnosis and treatment. Hospitals in Saudi Arabia have capabilities such as ICU, laboratory and research into MERSCoV infections. Common ICU treatment therapies include plasmapheresis, hemodialysis, and extra-corporal membrane oxygenation (Hemida et al., 2014). Such hospitals conduct laboratory testing and screening of blood-borne viruses after testing blood cultures, urine bacterial antigen testing and pneumonia. In promoting local clinical research initiatives, Saudi Arabian healthcare system conducts retrospective observational studies, trials and prospective studies, and randomized clinical trials (Al-Tawfiq & Memish, 2015). Healthcare workers are required to wear gowns, surgical masks, gloves and observe hand hygiene to support infection control measures (Zumla & Hui, 2014). Some of the known treatment methods for MERS-CoV are; oxygen therapy, pain relievers, fluids and rest. Sterilization and epidemiological surveillance are common prevention methods and controls outbreak of coronavirus. 3.0 Further research MERS-CoV illness is fairly a new risk factor globally that is being taken seriously by the Saudi Arabian government, CDC and WHO. The studies by several authors have shown that MERS-CoV has zoonotic origin from dromedary camels and easily transmitted through human contact. The coronavirus is more prevalent among middle aged men who operate abattoirs, barns and grazing grounds of camel. From the geographical distribution of infected persons, this study has shown that Riyadh and Qaseem were the most affected regions in Saudi Arabia respectively. The study area rate shows that Riyadh has high probability for the population to be infected with MERS-CoV viruses and that it is at risk. Given that the city and the country are visited by foreigners for religious tourism purposes, the country is likely to be the center of an endemic disease that can spread to other countries. MERS-CoV infections takes advantage of the interplay between camel habitats and human population exposed to camel urine, meat and milk (Memish et al., 2013). Moreover, the disease is more likely to affect people existing comorbidities such as diabetes, respiratory infections and chronic renal diseases through human to human transmission. Yet, potential outbreaks are experienced in medical wards, intensive care units and haemodialysis units. With Saudi Arabian Ministry of Health tasked to control the spread of the disease, the government is under intense pressure to increase funding into research, prevention and treatment of MERS-CoV infections. I have learned that MERS-CoV is an endemic disease that spreads through animal to human transmission from people in constant contact with the dromedary camels. Besides, disease outbreaks in hospitals necessitate human to human transmission which could affect healthcare workers, other patients suffering from respiratory diseases and even family members visiting their loved ones in hospitals. I have known that the Ministry of Health in Saudi Arabia has invested in randomized clinical studies, superior diagnostic equipments, human resources, and expansion of hospitals to cater for rising cases of MERS-CoV viruses. There is need to conduct further research on environmental exposures and medical conditions. This area is still misunderstood by both medical practitioners and the patients. As it has been mentioned earlier that the zoonotic origin of coronavirus is dromedary camels, it is important to understand; Do persons coming into contact with the camels have other illness which could render them susceptible to the disease? This implies that the studies mentioned in this document did not specify the duration of exposure by persons coming into contact with the camels in areas like camel racing tracks, slaughterhouses and barns. Further studies should be done on in-between camel transmissions to understand the magnitude of disease uptake within the dromedary habitats. Possible experimental studies should be done on the Triangle of Human Ecology to understand whether habitats, animal/human behavior or the population independently or jointly contribute to higher prevalence in the disease spread. By doing so, it is possible that appropriate vaccines are made for camels as well as humans to reduce spread or control movement of people and dromedary animals. 4.0 Conclusion This study investigated the zoonotic transmission of MERS-CoV into humans and found that coming into contact with dromedary camels is a risk factor among the residents of Saudi Arabia. The findings from data wrangling of health and spatial cases data of 2015 and 2016 found that Riyadh and Quseem regions in the country had the highest reported cases of MERS-CoV infections. The disease is endemic and is likely to be an outbreak in hospitals and healthcare facilities through human to human transmission. People at risk are middle aged men, their immediate family members and healthcare workers treating patients with the coronavirus. If health safety and hygiene are not observed in hospitals and homes, the disease potentially spreads and harms a large section of the population. Saudi Arabian ministry of health, although constrained financially, has been able to diagnose and treat patients with the coronavirus. However, research effort is still required in understanding the habitat and behavior of dromedaries as well as humans to create appropriate vaccines and prevention mechanism. There is no known method of treating coronavirus but medics are tasked with critical care, pediatrics, blood banking and delivery of internal medicine to infected persons. Treatment processes for coronavirus include intubation, bronchoscopy, sputum induction, and nebulizer treatment airway suction. Moreover, citizens and healthcare workers are required to run environmental and hand hygiene programs. This study recommends that there is need for further research in animal/human behavior to understand their movement and the effect of their symbiotic relationships. References Abroug, F., Slim, A., Ouanes-Besbes, L., Kacem, M., Dachraoui, F., & Ouanes, I. et al. (2014). 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