Random Analytics: MERS-CoV in the Middle East (to 3 Jun 2014)

by Shane Granger

1 - MERSinMidEast_Infographic_140603

***** Please note that this infographic of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) was updated with public source information to 1800 4 June 2014 EST *****

I was always planning on updating my MERS-CoV infographic at the end of May but the own-goal by the Saudi Ministry of Health, having suppressed the details of at least 113-cases and 92-deaths and the sacking of the deputy Health Minister Professor Ziad A. Memish made this update an absolute necessity.

The MERS-CoV in the Middle East infographic displays cases and deaths according to each reporting country (rather than onset country which has become confused over the course of the disease). The primary data source is the latest ECDC update and the most recent figures released by the Saudi Arabian MoH (to 3 June 2014).

Many journalists and flublogists have already started to comment on the deeper meanings behind the ‘exemption’ of Professor Memish from work and the suppression of data over a very long period. One of the best articles I have read on it today came from Crawford Kilian via H5N1. How MERS Could Topple the House of Saud, and Beyond. Excerpt:

A recent book argues that Saudi Arabia and its Gulf neighbours are “rentier states,” living off the revenues from oil. Some of the oil money is distributed in a kind of ethnic socialism: native-born Saudis and Emiratis get cheap housing, education and fuel, as well as undemanding government jobs. In return, they allow the monarchies to do as they please.

Part of this “ruling bargain” is to import cheap labour in vast numbers, for everything from housecleaning to business management. The money and working conditions are atrocious, but usually better than those available at home. One of the benefits of the ruling bargain is a good health-care system, and the Saudis have an extensive one. In many ways, it is indeed good. The previous health minister, Abdullah Al-Rabiah, is a Canadian-trained surgeon who recently separated conjoined twins.

But that was after he got the sack. As health minister, Al-Rabiah had presided over the rise and spread of MERS as a Saudi disease. While cases were seen in Jordan in March and April of 2012, the virus was first identified in a Saudi patient a few months later. Ever since then, the vast majority of cases have affected either Saudis or visitors to the Kingdom; the other Gulf monarchies have seen cases too, but far fewer.

Al-Rabiah’s strategy was to say as little as possible about the cases and to spin what he couldn’t conceal. While the World Health Organization and other agencies worried about what was going on, the Saudi Ministry of Health stonewalled them. But the minister couldn’t conceal the fact that cases were breaking out right inside Saudi hospitals.

I would agree with most of what Crawford is saying with the exception that the previous health Minister Abdullah Al-Rabiah wasn’t spinning the data, he was ‘Juking the Stats’.

So, what is the difference between spinning the data and juking the stats and why is this important in our understanding of MERS?

The answer is that when a government, organisation, company or individual spins the data what they are doing is looking at relatively ‘clean’ data and then using that information to either spin the results or emphasise a point for a positive or negative outcome. You might not realise this but most Western governments spend a lot of time and treasure on doing this as they try to drive home a political message. A fair amount of my time as a Workforce Planner was spent spinning data (aggressive forecasting of human resources in future quarters as an example).

What the House of Saud has been doing is the authorisation and implementation of ‘Juked Stats’ policy.

In my humble opinion, what this effectively means is that the Minister, the deputy Minister, various minions, governmental hospitals and private hospitals that receive government funding were given a number of MERS reports to state for official publication and that the World Health Organisation would not be informed of the real numbers (which would then become a Disease Outbreak Notification).

Two key points:

Point 1: The fact that we now find that 20% of cases and >30% of deaths went unreported since May 2013 is a clear indication that the Saudi’s had a clear policy of underreporting for political reasons. The fact that Professor Memish got sacked a day after the juked figures were revised was (again IMO) a way to quietly point the figure at the patsy so the regime could say it had cleaned house.

Yet, even as a doctor, Professor Memish was a very highly placed bureaucrat who had been politically vetted by the regime who asked him to deliver a result. When the disease spun out of his control and Memish couldn’t deliver the requirement the regime quietly ‘exempted’ him from the story. Having myself been involved in the ‘Juking of Stats’ I can state without qualification that if my numbers had of been bad my boss would have been quietly let go (with a decent payout) and the CEO would have moved on. That’s the game.

Point 2: The data errors go back as far as May 2013 yet it is interesting that the Saudi’s have ‘come clean’ on their data errors just a month after the first case hit America. That detail alone might be worthy of some deeper investigative journalism.

To finalise, the Saudi’s are telling us that they have now come clean on their data errors. Given they have never been clean to date I still don’t believe them.

Post Note: As Ian Mackay just reminded me, I should also state that I don’t believe the new Saudi data because of a conspiracy theory, because conspiracies require a brain-trust and this looks like just an ongoing cock-up!