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Middle east respiratory syndrome

Feb 1st 2016

Middle East Respiratory Syndrome

This disease is breaking out in many parts of the warmer world.

And so it goes on, it is a constant battle to get on top of these outbreaks but with good reporting and vigilance they can be kept under control.

June 24th

Commentary By Siyao Li The Middle East Respiratory Syndrome (MERS) virus has spread to yet another Asian nation: Thailand. Malaysia and the Philippines were the first to report cases of MERS in early April, and China later confirmed one case. South Korea has experienced the largest outbreak of MERS. With the new MERS case in Thailand, there is growing concern that the disease will continue to spread. Though it is unlikely to spread to the U.S., we should be prepared. MERS first emerged in 2012 in Saudi Arabia. Originally from camels, the virus now infects humans and causes fevers and pneumonia-like symptoms. It is transmittable by respiratory droplets, and spreads through close contact with an infected person, which is the reason why the virus has been able to spread in South Korean hospitals. One hundred sixty-nine people in South Korea have been diagnosed with MERS and 25 people have died from the disease. In response to the outbreak, South Korea has placed 6,729 under quarantine. South Korea also temporarily closed down schools (schools have since reopened), quarantined entire clinics, and disinfected public spaces. The outbreak even prompted President Park Geun-hye to postpone her high-level visit to the U.S. in order to oversee efforts to contain MERS. Although the U.S. has only seen two cases of MERS before, there is still risk that MERS will come to the States through travelers. Ebola exposed weaknesses in the country’s infection-control policies, and the U.S. should learn from past experience in fighting Ebola to institute prevention policies that would preempt and deter the spread of MERS in the country. Steve Bucci, Director of The Heritage Foundation’s Douglas and Sarah Allison Center for Foreign and National Security Policy, lists recommendations to the Centers for Disease Control and the Department of Homeland Security to form an effective MERS prevention system:

  • Continue to actively monitor South Korea’s progress in dealing with the outbreak;
  • Ramp up credible awareness and education efforts for the general public;
  • Ramp up outreach to medical professionals to ensure they are completely prepared with the knowledge, supplies, and facilities to respond to any unexpected outbreaks in their areas;
  • Put fly-away teams of specialists on call to assist local authorities;
  • Review and rehearse screening procedures for points of entry and develop a tiered system of response at points of entry to minimize the chance of entry by an infected person; and
  • Coordinate across the U.S. government to ensure that other departments and agencies are ready to assist in the event of a MERS outbreak in the United States.

The World Health Organization has called the MERS epidemic in South Korea a “wakeup call” to the possibility of unanticipated outbreaks of serious infectious diseases. Countries, including the U.S., should all draw from past lessons of fighting epidemics to preempt viruses such as MERS and prevent them from spreading among the population.

Siyao Li is currently a member of the Young Leaders Program at The Heritage Foundation.

BANGKOK: -- A Thai resident who just returned from a trip to South Korea is suspected of being infected by the Middle East Respiratory Syndrome (MERS).

The resident was one of four tested for MERS. The other three, who have just returned from a trip to China, have already tested negative.

A thorough lab test on the fourth patient is expected later Friday, said a health official in Chiang Mai who insisted that there was no reason to be panic. He said measures are in place to handle the situation.

Prime Minister Gen Prayut Chan-o-cha said that 69 hospitals in Thailand specialised in SARS and bird flu are now assigned to be watchful for MERS cases.

Asked if he was confident in keeping the situation under control, he shot back at reporters. "Can I give order to the disease? It’s up to all Thais who have to be on alert and contact the authorities if something suspicious happens. I can’t give order to the disease."

BANGKOK: -- The Department of Disease Control says the 75-year-old Mers-infected Omani patient under isolation care at the Bamrasnaradura Infectious Diseases Institute (BIDI) can breathe and eat by himself while his sick son and brother are also getting better with no fever now.


Dr Rungruang Kijpati, spokesman of the Department of Disease Control, said the condition of the Omani patient now is improving with no fever.

He could eat mild food by himself while his three relatives also are getting well with no fever and no cough.

However they are still needed to be closely monitored separately, he said.

For the 175 people in risk group, all have good health, and are all located, he said.

For about 30 people who have close contact with the Omani patient, he said they were advised to stay in hospitals for close monitoring of their conditions for safety reason.

He also assured that all areas in the country can be visited with no concern of health safety as the department has high standard of disease control , adding that the people can inquire information at Hotline 1455 on a 24-hour basis.

June 20th

MORE than 80 people in Thailand have been exposed to the Middle East respiratory syndrome (Mers) virus, the health authorities revealed, as the kingdom rushed to stem any panic from its first such case.

The deadly disease, which was first identified in Saudi Arabia three years ago, has killed 24 and infected 166 people in South Korea since it was detected there last month, although the authorities there said the outbreak appeared to be levelling off.

Singapore's Health Minister Gan Kim Yong said yesterday that travellers from Thailand were not being screened at Changi Airport for Mers symptoms as the country had only one such case and the situation was contained. He added, however, that developments were being monitored closely.

Thailand's Ministry of Public Health revealed that the Mers virus was detected in a 75-year-old man from Oman on Thursday. Yesterday evening, it said in a press statement that 85 people had come into contact with him.

It was not clear though whether all 85, including a taxi driver, airline passengers and medical staff, have been traced and quarantined.

The man landed in Bangkok on Monday and sought treatment that night at Bangkok's Bumrungrad International Hospital for a cough, later running a fever. The private hospital kept him and his relatives in isolation quarters before they were moved to the state-run Bamrasnaradura Infectious Diseases Institute just outside Bangkok on Thursday.

The hospital called a press conference yesterday, saying it had quarantined 58 staff members.

Meanwhile, the Mers patient is "a little bit better", Dr Sopon Mekthon, director of the Health Ministry's disease control department, told The Straits Times. "He is out of the respirator."

Tests on the patient's two sons turned out negative yesterday.

Passengers at Bangkok's Suvarnabhumi Airport had to go through thermoscan machines yesterday and health warning cards were issued on flights connected to high-risk areas for Mers.

The airport is a major aviation hub for the region, while the city is one of the world's top tourism destinations.

Singaporeans, meanwhile, are not rushing to call off trips to Bangkok. Instead, they are monitoring the situation and are hopeful that it will not be a repeat of the South Korean case, travellers, travel agencies and airlines told The Straits Times. Hundreds of Singaporeans have cancelled their trips to South Korea.

Dynasty Travel has a number of clients going to the popular shopping destination over the National Day weekend. "We're keeping our fingers crossed," said its director of marketing communications Alicia Seah.

CTC Travel yesterday received some calls from concerned customers travelling to Chiang Mai in northern Thailand. "They are still monitoring the situation as the departures are mainly in August and September," said a spokesman.

Graphic designer Jason Fu, 26, does not plan to cancel his two upcoming holidays to Bangkok next month and in September for now. "I'll wait and see. The public should not be paranoid," he said.

June 19th

BANGKOK: -- Thai health officials Thursday said a 75-year-old man from the Middle East was confirmed to have MERS, the country's first case after a deadly outbreak of the virus hit South Korea.

"(The man) is from a Middle Eastern country. The (test) results confirmed that he has Middle East Respiratory Syndrome (MERS)," said Rajata Rajatanavin, Thailand's Public Health Minister, adding the patient had arrived in the kingdom with his family three days ago.

Thailand had investigated around 20 people for the virus, all of who tested negative.

MERS has spread at an alarmingly rapid pace in South Korea since the first case was diagnosed on May 20, infecting 165 in what is the largest outbreak outside Saudi Arabia and prompting a major public health scare.

Earlier on Thursday World Health Organization chief Margaret Chan had expressed guarded optimism over South Korea's ability to contain the MERS outbreak, saying it was now "on a very good footing" after an initially slow response to the virus which has killed 23 people.

June 18th

South Korean Hospital Scrutinized in MERS Outbreak

By JUNE 17, 2015

Photo Nearly half of all confirmed MERS cases in South Korea have been traced to the Samsung Medical Center in Seoul, regarded as the nation’s best hospital. Credit Jeon Heon-Kyun/European Pressphoto Agency Advertisement Continue reading the main story

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SEOUL, South Korea — It is the jewel of South Korea’s medical service: a 1,900-bed hospital of steel and glass owned by the Samsung conglomerate. It is also where a 35-year-old man whose symptoms were misdiagnosed as pneumonia languished for three days in an overcrowded emergency room and hallway, where he coughed up sputum teeming with the Middle East respiratory syndrome virus and exposed dozens.

Doctors of the renowned hospital, the Samsung Medical Center in Seoul, were the first to confirm the disease, known as MERS, in another patient a week earlier but failed to make the connection between the two cases. Investigators now say the misdiagnosed patient, awaiting a vacant bed in a general ward upstairs, wheezed and expectorated in common areas with no oversight, turning into a MERS “superspreader.”

Continue reading the main story Related Coverage Experts Fault South Korean Response to MERS OutbreakJUNE 13, 2015 South Korean Hamlet, Under MERS Quarantine, Symbolizes Weaknesses in SystemJUNE 10, 2015 South Korean Leader Postpones U.S. Trip Amid MERS OutbreakJUNE 9, 2015 MERS Virus’s Path: One Man, Many South Korean HospitalsJUNE 8, 2015

The mistakes by the Samsung Medical Center are now the focus of much that has gone wrong to escalate the MERS crisis in South Korea, the worst outbreak beyond Saudi Arabia, where the disease first appeared in 2012. As of Thursday, nearly half of all 165 confirmed MERS cases in South Korea have been traced to Samsung, historically regarded as the nation’s best hospital.

News Clips By Reuters 00:28 South Korea Fights MERS Outbreak

Continue reading the main story Video South Korea Fights MERS Outbreak

Gimpo International Airport in Seoul is being disinfected while heat-detecting cameras monitor passengers. The number of Middle East Respiratory Syndrome cases in the country continues to rise. By Reuters on Publish Date June 17, 2015.

Several hundred of its patients are under quarantine in the hospital or elsewhere, either because their infections have been confirmed or they are under observation for symptoms. Nearly 300 of its 3,900 medical and other staff members are under similar quarantine. Other hospitals have refused to accept patients from Samsung for fear of infection. By Sunday, it stopped taking new patients as it struggled to prevent the virus from further spreading beyond its gleaming compound.

“We offer our deep apologies to all MERS patients and those quarantined because of our employees,” said Song Jae-hoon, the medical center president, bowing before television cameras.

Until now, Samsung’s reputation for quality had gone unchallenged. South Koreans looked no further than its list of patients: Lee Kun-hee, the country’s richest man and the chairman of the Samsung conglomerate, has been hospitalized there, in a 20th-floor V.I.P. room, since his heart attack last year.

Nobody was surprised when Samsung diagnosed the country’s first case of MERS on May 20, attributing the discovery to its medical skills.

Calling Samsung a general hospital hardly explains its place in South Korea’s system.

In South Korea, when a parent gets sick, it is widely considered a filial duty for the children to mobilize all connections to secure a bed in Samsung or in a few other megahospitals, including one run by another family-controlled conglomerate, Hyundai, that they believe provide the best care.

When that strategy fails, patients are often taken into the hospitals’ emergency rooms, where they can wait for days for a bed in a general ward.

The Samsung hospital beds were usually filled, with 1,800 patients, and a long waiting list. Each day, 8,500 outpatients passed through.

Photo Workers on June 9 outside the closed emergency room at the Samsung Medical Center in Seoul. Credit Jeon Heon-Kyun/European Pressphoto Agency

But it was not just the fame of Samsung that attracted patients. Medical service is so affordable under the country’s universal medical insurance system that “there is no threshold at hospitals,” said Kwon Jun-wook, a senior Heath Ministry official.

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“Patients go to hospital as if they go shopping,” Mr. Kwon said, referring to the practice of hospital hopping to get a second opinion or to get a referral to one of the megahospitals, some of them with more than 2,000 beds.

Low medical fees also mean that hospitals must treat as many patients as possible to stay profitable. The big hospitals get more crowded as family members and private nurses they hire stay with patients. It is also important to social etiquette for South Koreans to visit hospitalized relatives, friends and colleagues, often with gifts like fruit boxes. Church members cluster around a patient’s bed, praying and singing.

The overall scene looks, as Koreans like to say, like a “flea market.”

It is this overcrowded hospital condition that a World Health Organization mission said had made the otherwise modern South Korean hospitals particularly vulnerable to MERS. All those in the country who have the virus were infected in hospitals. Of them, 65 were relatives, friends or family-hired caretakers who contracted the disease while they were visiting or looking after hospitalized patients.

“The Samsung Medical Center is a national hospital in the sense that there are no regional boundaries in medical service in the country and everyone wants treatment there,” said Kim Woo-joo, head of the Korean Society of Infectious Diseases. “The MERS outbreak was a stress test of our medical system, revealing its problems.”

At Samsung, the system began faltering when the 35-year-old man, whom investigators called Patient No. 14, arrived at its emergency room on May 27, a week after Samsung discovered the first case.

Patient No. 14 had been infected by the first patient when both were in the same hospital south of Seoul in mid-May. But neither he nor Samsung doctors had any clue that he was infected. Unlike the first case, he had no record of having visited the Middle East.

Photo Hospital workers with a patient suspected of having MERS last week at Samsung Medical Center in Seoul. Credit Yonhap, via Associated Press

Samsung doctors diagnosed his case as pneumonia. But with no room in wards upstairs immediately available, he waited in the overcrowded emergency room for three days and sometimes loitered outside, investigators say.

It was not until May 29, when the Korean Centers for Disease Control and Prevention told them about the man’s possible link to the first case, that the emergency room doctors were alarmed, according to Samsung officials. By then, the man had become the biggest superspreader in the outbreak, infecting people in South Korea’s best hospital.

“It’s the nation that was penetrated,” Chung Doo-ryeon, a Samsung doctor, responded during a parliamentary hearing last week, when lawmakers criticized the hospital for failing to control the outbreak. But blunders continued.

After Patient No. 14 tested positive on May 30, the hospital listed 893 people who may have come in contact with him in the emergency room and placed them in quarantine or in self-isolation at home. But it failed to trace many visitors who had been in the room.

About half of the 81 cases that were traced to the Samsung hospital were found outside that list. Not bound by quarantine, they had gone about their lives, riding subways and visiting saunas. Some visited other hospitals when fever and other symptoms occurred. A Samsung doctor continued to work until he developed symptoms last week. An employee at Samsung carried 76 patients, some in wheelchairs, before he tested positive on Friday.

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The breach in the quarantine at Samsung complicated the national battle against the disease.

So far, a total of 165 MERS cases have been found in 14 hospitals, including 23 deaths. But before the disease was diagnosed, the patients also passed through 69 other hospitals, raising fears that they may have infected people there. In some train stations, the local authorities have used heat-detecting cameras to stop potential MERS carriers from entering their towns. More than 6,700 people are in quarantine or in self-isolation at home, many of them after visiting the Samsung hospital.

“What pains us the most is our failure to contain Patient No. 14 at the Samsung hospital,” said Kwon Deok-cheol, a senior official at the government’s MERS response headquarters.

Mr. Kwon said the government planned to overhaul the country’s “hospital culture,” such as unrestrained visits. But critics also blamed a “Samsung-style management” for the crisis.

The mass-circulation daily newspaper Chosun Ilbo said of Samsung Medical Center in an editorial this week, “It’s fair to say that their tendency to put profit and efficiency before public health prevented them from taking more decisive pre-emptive steps to contain the virus.”

The Samsung conglomerate, the biggest among the enormous South Korean corporate empires that have been compared to “tentacles of an octopus,” moved into the hospital business when it opened the Samsung Medical Center in 1994. Opening a modern hospital was said to reflect the wish of Mr. Lee, the conglomerate’s chairman, who used to travel to the United States for cancer treatment.

June 12th

South Korea has sealed off two hospitals that treated people with a deadly respiratory disease, officials said, even as the outbreak that has been spreading through health facilities could have peaked, with just four new cases on Friday.

Middle East Respiratory Syndrome has infected 126 people in South Korea and killed 11 since it was first diagnosed just over three weeks ago in a businessman who had returned from a trip to the Middle East.

The outbreak is the largest outside Saudi Arabia, where the disease was first identified in humans in 2012, and has stirred fears in Asia of a repeat of a 2002-03 scare when Severe Acute Respiratory Syndrome (SARS) killed about 800 people worldwide.

The 68-year-old man who brought the virus back from the Middle East visited several health centers for treatment of a nagging cough and fever before he was diagnosed, leaving a trail of infection in his wake.

The danger of the virus in hospitals had led to two being sealed off with at least 133 people - patients and staff - inside. They would be sealed for at least the next 11 days, given the incubation period of the virus, officials said.

"No patients can get out of their rooms," said a city government official in the capital, Seoul, where one of the hospitals is located, declining to be identified.

"Nurses in protective gear are giving them food. No one can get in from outside."

All but one of South Korea's cases have been confirmed as originating with the businessman, who was diagnosed with MERS on May 20, and occurring in health-care centers, and the last one is likely to be confirmed as such too, the health ministry said.

Related Coverage › South Korea reports 11th death in MERS outbreak


MERS is caused by a coronavirus from the same family as the one that caused SARS. It is more deadly than SARS but does not spread as easily, at least for now. There is no cure or vaccine.

World Health Organization (WHO) experts are in South Korea working with the government and Saudi Arabian health officials are meeting authorities on Friday.

The four new cases reported on Friday marked the lowest daily increase in 11 days, raising hope the worst might be over.

"The signs are beginning to look promising," Stephen Morse, a professor of epidemiology at Columbia University Medical Center in New York, told Reuters. "I’m hopeful it’s beginning to decline, but there are still patients."

The number of people in quarantine, either at home or in medical facilities, also declined for the first time, by 125 to 3,680, the ministry said.

The incubation period for many people exposed to infected patients is ending, which should mean a decline in new cases, said Jacob Lee, an infectious disease expert at Kangnam Sacred Heart Hospital in Seoul.

"There may be a third wave from hospitals that MERS patients had stayed at but it won't spread as much as it has," Lee said.

The central bank cut interest rates on Thursday in the hope of softening the blow to an economy already beset by slack demand and plunging visitor arrivals.

Alarm has spread throughout the region even though only one case has been reported outside South Korea in this outbreak, that of a South Korean man who traveled to China via Hong Kong after defying a suggestion from health authorities that he stay in voluntary quarantine at home.

U.S. President Barack Obama telephoned President Park Geun-hye, who has postponed a visit to Washington to manage the outbreak, to say he was prepared to lend all support to help fight the disease, her office said.

South Korea's new cases bring the total number of MERS cases globally to 1,275, based on WHO data, with at least 450 related deaths.

June 10th

SEOUL, South Korea (AP) — South Korea believes its MERS virus outbreak may have peaked, and experts say the next several days will be critical to determining whether the government's belated efforts have successfully stymied a disease that has killed nine people and infected more than 100 in the country.

The biggest outbreak of Middle East Respiratory Syndrome outside the region where it was first seen in 2012 was introduced to South Korea last month by a 68-year-old man who had traveled to Saudi Arabia and other nearby countries.

When he got sick after his return to South Korea, he visited several hospitals and clinics, where dozens of other patients and hospital workers were infected before officials determined he had MERS. Gradually, the government began isolating victims and quarantining those who'd had contact with them.

There has been widespread fear here of the poorly understood disease, which has no vaccine and as much as a 40 percent mortality rate. There also had been growing criticism over failures by health workers and the government to initially recognize and quickly contain the disease.

Nearly 3,000 people have been placed in isolation and 2,470 schools closed in South Korea. Although MERS spreads through close contact with sick people, not through the air, many people here have avoided going to crowded places like baseball parks and movie theaters. Travel agencies report a sharp increase in the number of foreigners canceling plans to visit South Korea.

The outbreak, however, has so far been contained in hospitals and there's no evidence, the U.N. health agency says, of "sustained transmission in the community."

Authorities say the first MERS patient didn't reveal his Saudi Arabia trip to doctors until he arrived at the Seoul-based Samsung Medical Center after being treated at three other hospitals, including St. Mary's Hospital in Pyeongtaek, south of Seoul.

Samsung and St. Mary's have seen most of the country's 108 cases of infections, 13 of them announced Wednesday.

The initial patient's wife, who was the country's second MERS case and is now out of the hospital, recently told a local TV station that her husband didn't intend to hide information about his travels, but simply had trouble talking to doctors because of his high fever.

Because the virus' incubation period is estimated at five to six days on average, extending up to about two weeks, experts believe there won't be any more cases directly infected by the first patient. The Health Ministry said that no more MERS cases have originated from St. Mary's Hospital.

There are still concerns about Samsung Medical Center, where at least 47 people have been infected. Fewer cases have been reported from there in recent days, but the Health Ministry on Wednesday reported 10 additional cases associated with the Samsung hospital.

The initial patient was eventually isolated on May 20 after doctors at Samsung, where the man ended up, suspected he had MERS and alerted the government, which moved him to a government-run facility. But a week later, another so-called "super-spreader" — a man who'd been infected by the initial patient at St. Mary's Hospital — checked into an overcrowded Samsung Medical Center, where he was forced to stay for several days in the emergency room. He spread the disease among doctors, visitors and other patients there, according to health officials.

The maximum incubation period for those infected by the second "super-spreader" ends around this Friday, experts said, which raises hopes that the outbreak could weaken soon.

"I cautiously predict (MERS) will peak today" and be stabilized in the next few days, Health Minister Moon Hyung-pyo told lawmakers Monday.

The prospects for the virus weakening this week depend on whether there are many people who have evaded government quarantine measures and infected other people in various places, said Jacob Lee, an infectious disease expert at Kangnam Sacred Heart Hospital in Seoul.

Visiting World Health Organization experts are jointly investigating the outbreak with South Korean officials.

There are concerns that South Korea's economy could suffer as tourism and business travel drop because of MERS fears.

Hong Kong has issued a red travel warning for South Korea, the second highest of three levels, and advised residents against unnecessary travel there. Hong Kong has been hypersensitive to infectious diseases since the outbreak of SARS in 2003, which killed hundreds of people.

MERS has mostly been centered in Saudi Arabia. It belongs to the family of coronaviruses that includes the common cold and SARS, and can cause fever, breathing problems, pneumonia and kidney failure.

The MERS menace is upon us.

Now that the EBOLA African outbreak is finally getting less critical we really should take a closer look at MERS.

I have taken the following information from a national geographic article and I give them many thanks for their publication.

As MERS Virus Spreads, Key Questions and Answers

The disease has infected dozens in South Korea. Here's how MERS works—and why it's so difficult to fight

The Middle East respiratory syndrome coronavirus—commonly known as MERS—has killed nearly 40% of the 1,179 people it's sickened since emerging in Jordan in 2012. Many more people may have unknowingly had less serious bouts of the disease, which is believed to spread from bats to camels to people.

Key questions and answers about MERS:

How is MERS spread?

So far, the respiratory virus has had a hard time spreading from person to person. Most of its victims had direct contact with camels, or caught the virus in a healthcare facility that was caring for a MERS patient.

Theoretically, it should be easy to stop person-to-person transmissions by wearing masks and washing hands. But MERS spread at a dialysis clinic in Saudi Arabia last year and more recently at a clinic and hospital in South Korea, where a man who returned from Saudi Arabia two weeks ago spread the virus to 34 others.

One of those exposed in South Korea traveled to China, flying and riding a bus while likely contagious. It’s not yet clear whether that man passed the virus on.

More than 200 schools were closed in South Korea to try to prevent the spread of the MERS virus.

It's starting to feel like the year of infectious diseases. Just as Ebola is winding down in West Africa, another potentially fatal illness has jumped from the Middle East to South Korea and China, spreading fears of a global pandemic.

The Middle East respiratory syndrome coronavirus—commonly known as MERS—has killed nearly 40% of the 1,179 people it's sickened since emerging in Jordan in 2012. Many more people may have unknowingly had less serious bouts of the disease, which is believed to spread from bats to camels to people.

Key questions and answers about MERS:

How is MERS spread?

So far, the respiratory virus has had a hard time spreading from person to person. Most of its victims had direct contact with camels, or caught the virus in a healthcare facility that was caring for a MERS patient.

Theoretically, it should be easy to stop person-to-person transmissions by wearing masks and washing hands. But MERS spread at a dialysis clinic in Saudi Arabia last year and more recently at a clinic and hospital in South Korea, where a man who returned from Saudi Arabia two weeks ago spread the virus to 34 others.

One of those exposed in South Korea traveled to China, flying and riding a bus while likely contagious. It’s not yet clear whether that man passed the virus on.

China’s first MERS patient is being treated at the Huizhou Central People's Hospital in Guangdong province.

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