In 2012, a novel coronavirus was isolated from an old man in Saudi Arabia who arrived to the hospital suffering from shortness of breath, fever, and chest pain. While efforts were made to characterize and understand the nature of this virus, several cases of acute to severe respiratory illness continued to appear in hospitals throughout the Kingdom, and transmission between patients and hospital workers added to the burden of the outbreak. The pathogen was later classified as Middle East Respiratory Syndrome Coronavirus (MERS-CoV), and by early 2013; this deadly virus had already spread through the Arabian Peninsula, resulting in 9 countries with lab-confirmed cases. As of February 5, 2015, 971 laboratory-confirmed cases of human infection with MERS-CoV have been reported to WHO, including at least 356 deaths.
There are many who have condemned the Ministry of Health on its lack of containment measures in response to the MERS outbreak. However, Tariq Madani, the head of the scientific advisory board at the Saudi Ministry of Health, emphasizes that most positive confirmed results of MERS, which were tested in government hospitals and laboratories, have simply not been passed by those institutions to the ministry. The ministry’s policy regarding discrepancies between two test results meant that only the government laboratory result would be considered, whether positive or negative. Adel Fakieh, the new health minister, has changed that policy and implemented a new policy, which requires positive MERS test results from any laboratory accredited by the health ministry, and not just government laboratories, to be considered as a confirmed cases and immediately reported to the ministry.
This new policy allows for more laboratory testing to be done in hospitals, which means more confirmed cases could be identified and isolated. A policy requiring laboratories, whether private or public, to report all positive confirmed cases of MERS to the ministry allows for better communication between hospitals and ministry officials.
The slowing rate of MERS infection indicates that such a policy of transparency in tackling this epidemic is clearly effective and should be enforced with complete cooperation by healthcare providers and laboratory technicians.
Tags: Advocacy
Social, Cultural & Behavioral Issues in PHC & Global Health 
March 7, 2015 at 7:06 pm |
I agree that a transparency as a policy is key in tackling the spread of MERS-CoV. I, myself was working in a university hospital when the virus first spread. The former minister of health, while no doubt put many efforts in fighting this virus, was not very transparent in the policies mandated for this virus. Much of the information needed to understand the virus by the public (and a lot of times by medical staff) was not distributed, leaving many in the dark. In my opinion this lead to the exaggerated spread of this virus that could have been stopped much earlier. This is further proven by the vast slowing in spread of the virus due to the new minister’s transparent policies.
March 7, 2015 at 8:41 pm |
I think MERS-CoV is a very good example of the speed a new virus or a mutation of a known virus can spread around the world. As this blog post depicts very accurately, how important transparency in effectively controlling the outbreak that happened in the Middle East.
One of the major problems was the lack of proper source identification. It took a while until there was a unambiguous identification of the same virus genome in a patients and his camels. Until then, cattle or camels or even bats were suspected to be the source of MERS-CoV.
I was working during the time of the outbreak in the infectious diseases department in Zurich, Switzerland. I remember how unaware the staff in the ER was regarding MERS-CoV… even though media were continuously reporting… it seemed too far away for many of the people in Switzerland, even though nowadays there are no distances anymore… in couple of hours one can cross continents… if we can do it, the virus can do it as well
March 11, 2015 at 3:44 pm |
Great post. I’m curious, what are the punishments if a hospital does not report MERS-CoV cases? Or maybe a better way to put it is what are the incentives for the hospitals to report the cases? I wonder what fueled the government to only trusts the results obtain in its own lab. Did they send out officials to hospitals only to find that they were not performing or reading the MERS-CoV test correctly? Perhaps this was carry over from the reporting of other infectious diseases where there were often discrepancies. Anyway, I agree that greater transparency results in a swifter and more informed response to outbreaks. I think an approach where too much data that requires double-checking is better than insufficient data leading to missed opportunities, although the downside is the increase manpower and cost this may require.
March 11, 2015 at 9:02 pm |
Thanks for your comment! With this new policy, the MOH is able to institute fines and even jail time on health providers or hospital personnel if they don’t report cases of MERS (you can read more about this penalty here: https://flutrackers.com/forum/forum/novel-coronavirus-ncov-mers-2012-2014/saudi-arabia-coronavirus/725737-saudi-arabia-media-report-moh-institutes-fines-and-jail-time-on-healthcare-providers-for-not-reporting-coronavirus-mers-cases-hospitals-in-eastern-province-fined-march-2-2015 ). I’m not really sure why the MOH prefers to trust only government lab results over the results of other private labs, however, I’m assuming it’s due to the possibility of bribes or alterations of lab results by private labs if payments are made by a patient. It can also simply be because of no available standard or unified diagnostic tool for MERS testing , which can cause the testing procedures to differ between labs and the MOH may only acknowledge one of them.
I hope I was able to answer your questions!
March 11, 2015 at 10:44 pm |
While the underreporting of MERS cases was staggering based on the false positives/false negatives and essentially the disregard of all non-government validated test results, I have to wonder what role the private hospitals played in monitoring and tracking the disease. Were potential cases highlighted and tracked in patient files? Were there special precautions taken in treatment of those with respitory illness? Fakeih has introduced more rigid guidelines to facilitate the tracking of cases; however, it is interesting that so many cases would also be missed within the hospitals when MERS is such a tangible risk. Perhaps the ministry’s lack of previous emphasis on the severity of the illness (based on complacency regarding test results) resulted in hospitals underestimating the disease. Either way, the health ministry needs to continue to play an active part in also enforcing change regarding systematic problems in hospitals and rectify the lack of government insight. I have read recently that there has been another surge in MERS cases in Saudi Arabia, despite all the recent changes to better regulate reporting and diligence in alerting the public to the prevention of the sickness. It will be interesting to see what trajectory follows in the next few months as Saudi Arabia continues to fight the prevalence of the outbreak.