MERS-CoV Infection Via Diarrhea & Eastern Toilet Habits, What You Need To Know

The best translatability guide we have for the MERS-CoV  outbreak is likely the SARS-CoV outbreak in China. In that regard, it has been "found that SARS case-patients may have high concentrations of virus in stools during the 2nd week of illness and continue to shed the virus in feces until at least 26 days after onset of symptoms."

Its important to note that feces and bathrooms were noted as a being a source for SARS-CoV spread, and that the CDC lists diarrhea as one of MERS-CoV's key symptoms.  It is also important to note that in the Eastern world, where MERS is most prevalent, toilet hygiene is very different from the Western world. One key difference (as explained in the video below) which is likely to cause the spread of MERS-CoV is the Eastern method of  using water and a bare hand to remove feces from the posterior.

The Eastern method of cleaning one's posterior of feces is prone to aerosolize CoV, and it also leads to direct contamination of the hand, which leads to CoV spread to surfaces via fomites. This vector may explain why CoV is seemingly readily being spread among health care workers in Saudi Arabia.

In that regard its plausible to assume that as MERS spreads from the Eastern world to the Western world, one is most likely to become infected in restrooms and food handling facilities. The obvious most dangerous common places for MERS-CoV infection would be Aircraft and Hospital restrooms. 

Overall we see the deadly pandemic risk from MERS as being low, especially given that MERS has had at least two HAJJ cycles to spread across the world. HOWEVER when one combines poor hospital infection control and MERS tendency to infect and kill health care workers, it is possible that MERS-CoV could end up shutting down hospitals. The worst case scenario is an overlapping H7N9 and MERS-CoV outbreak. Edited to add that MERS is most likely to be spread Globally during the HAJJ cycle starting in October, which in turn means that Hospitals could be shutting down from MERS-CoV infections right as the Flu season starts to kick off.

If you are concerned about MERS-CoV (and we're not yet concerned) one of the best countermeasures is to wash with a CHG containing surgical wash/scrub such as Hibiclens. CHG will protect your hands from contagion for at least 6 hours after use.

Sources:

http://www.cdc.gov/coronavirus/mers/interim-guidance.html

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3322913/

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