key: cord-0858928-rcugsf06 authors: Waseem, Rabia; Ullah, Irfan; Irfan, Muhammad; Dominari, Asimina; Elmahi, Osman Kamal Osman; Tahir, Muhammad Junaid title: MERS and COVID‐19: A double burden for the healthcare system of Saudi Arabia date: 2022-02-18 journal: Health Sci Rep DOI: 10.1002/hsr2.515 sha: 53c4a7b4fde532ff1e15b44d34223acb809380a7 doc_id: 858928 cord_uid: rcugsf06 nan MERS-CoV, can vary from completely asymptomatic to the development of respiratory tract disease of varying severity, which can potentially be fatal. 1 Saudi Arabia has been in the epicenter of the MERS outbreak since 2012, when the first case, that of an adult male who expired due to a severe lower respiratory tract infection, was officially reported. 2 The first few cases of COVID-19 were recognized in Wuhan, China, in January 2020 and its rapid worldwide spread led to the World Health Organization (WHO) declaration of the COVID-19 pandemic on 11 March 2020. 1 The latter then raised alarm among the public health authorities across the globe. 3 Saudi Arabia reported its first case of COVID-19 in March 2020, 3 MERS-CoV has a very high mortality rate (34.77%), much higher than SARS-CoV-2 (10.87%), but the latter is much more contagious. 1 Among the aforementioned five MERS cases, unfortunately three have expired. 4 MERS-CoV presents with nonspecific symptoms in the early stages of the disease, making it difficult to detect. 7 Asymptomatic infection, which is far more prevalent in SARS-CoV-2, 8 is also a serious cause of concern, as it can silently lead to propagation of the infection. Both SARS-CoV-2 and MERS-CoV cause more severe disease in adult males and those with comorbidities 8 ; patients with congestive heart failure (CHF) and chronic kidney disease are also known to deteriorate much more rapidly. 9, 10 The presenting symptoms of both pathogens are similar, including fever and cough, which may or may not progress to more severe manifestations, such as pneumonia. 11 MERS and COVID-19 exhibit similarities in terms of diagnosis and management. 9 The many overlapping characteristics of these diseases make education of the susceptible population extremely critical, and they additionally pose a challenge upon the healthcare workers in the country to identify early and to differentiate among the two diseases, while taking adequate measures to secure their own safety. The question regarding a possible interaction between the two viruses also arises here, as they can both infect an individual if present in the same environment. However, there are less data available on the subject and a recent study revealed lack of concurrent MERS-CoV and SARS-CoV-2 infection. 8 Coronaviruses are known to have a seasonal variation; the outbreak of MERS-CoV has been reported mainly in the summer period Despite the recent re-allocation of healthcare resources to the treatment of COVID-19 patients, specifically in areas at high risk for a MERS outbreak like Saudi Arabia, more attention should be paid to providing testing facilities for both SARS-CoV-2 and MERS-CoV. In order to minimize the spread of MERS-CoV via adult dromedary camels, healthcare authorities should devise a special health surveillance system for camel workers and others exposed to these animals. Targeted preventions and intervention in the form of physical distancing, smart lockdowns, and vaccinations should be administered to the population and areas more likely to be affected by the viruses. Furthermore, the conduction of more research focusing on viral interactions and risk of transmission will assist the healthcare workers to effectively protect themselves and control disease spread. Having experienced MERS-CoV before, the Kingdom has made commendable attempts in controlling COVID-19, especially through emphasizing the value of educating the general population through public awareness campaigns, which have led to better and safer practices. 17 However, a lot still needs to be done to the direction of informing and educating the population, and adherence to infection prevention and control measures also within healthcare facilities is required in order to prevent further nosocomial and community outbreaks. In conclusion, it is important to highlight that both SARS-CoV2 and MERS-CoV are deadly pathogens that can infect the Saudi population and deteriorate the Saudi healthcare system, especially in the case of a combined outbreak. Raising awareness among the masses regarding the severity of the current situation will lead to better practice of social distancing and maintenance of good hygiene. 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The authors declare that there is no conflict of interests.