Random Analytica

Random thoughts, charts, infographics & analysis. Not in that order

Tag: UAE

Random Analytics: 100-days of MERS

Given that we are now half-way through the annual Hajj I thought I might spend some time looking at the Middle Eastern Respiratory Syndrome Coronavirus (MERS-CoV) which has been with us for some years now but seems to have fallen off the radar in favour of the maladie de jour, Ebola.

What publically sourced data is available is limited. In the past 100-days there have only been 25-notified cases (23 in Saudi Arabia, 1 in the United Arab Emirates and an exported case to Austria). The Kingdom’s updates are as brief as ever, the World Health Organisation (WHO) has clumped together a monthly update with only high-level data while the world’s attention is completely focussed on Texas and West Africa. Not only is the data limited but the Saudi’s have again reviewed their data and found a further 17 cases prior to 3 June that were missed. Ian Mackay wrote an excellent open letter to the KSA Ministry of Health in relation to that oversight (recommended reading).

For lots of reasons I haven’t updated my rudimentary MERS-CoV Db in a couple of months and what I found during my data-entry this morning I thought was intriguing enough to do an infographic with MERS notifications going back just 100-days.

1 - MERSbyCity_141005

The 100-days of MERS infographic details the 25-cases that have been notified between the 29th June to the 6th October 2014. The Riyadh count includes the young lady who travelled from Afif to Austria and one case where the KSA Ministry of Health provided no details (thus the figure is represented as a man).

Just to cover off the basic points in the infographic, there have been 25-cases since 29 June and two notified deaths (assuming that FluTrackers case number #863 is the 76-year old male from Najran who died on 25 September, thus a provisional Case Fatality Rate (CFR) of 8%, which is extremely low compared to the current 42.4% during the outbreak in the KSA. Of the 24-cases with details, four were female, the ages ranged from 27 to 76 and the average age was 54.1

Now to the really interesting data-points, some queries and a counter-factual.

  • A quick look at my Db tells me that during the period July – September 2013 there were approximately 56-cases of MERS (not including any that formed part of the 113 that were belatedly added without details). My first question: Is MERS on the decline given that the epidemiological curve seems to have declined by half since last year?
  • Even though the cases are very low the spread of the disease is extremely widespread. Over the past 100-days MERS has cropped up in Abu Dhabi (882km west from Riyadh via Route 10), Najran (974km south via Route 10), Taif (994km south-east via Route 40) and Arar (1,157km north-east via Route 65). My next question. Can someone explain why the cases are so low but seem to be so widespread?
  • There have been seven confirmed cases in Riyadh which has a population of 4-million and six cases in Taif, population approximately 500,000. Is there any reason why Taif is currently overburdened with the limited amount of cases?
  • The provisional CFR over the past 100-days seems very low at just 8%. Is that due to better care, less cases, better surge capacity, declining potency or another reason?
  • My last data point is really a counter-factual on the data that has been presented over the past three-months. The release of a second tranche of non-notified cases (this time 17 as compared to the previous 113) has to be questioned more deeply. You can always allow for a mistake but two is either a conspiracy or a cock-up. If it is a conspiracy are the Saudi’s ‘juking the stats’ in order to protect travellers from the Hajj? Are the Saudi’s using the current Ebola outbreak to limit the amount of information they are sharing? If it’s a cock-up why was it allowed to happen a second time in the lead up to the Hajj.

In Summary

Looking at the previous 100-days of data has me asking a number of questions. Is MERS on the decline? Why is the CFR so low? Why are the cases so widespread? Why has one small city got as many cases as the capital?

There are two incontestable facts. One: During the past 100-days MERS-CoV has been widespread across Saudi Arabia and the United Arab Emirates. Two: I also know where it hasn’t officially been.

Mecca.

Make of that what you will…

QuikStats: MERS-CoV (September 2013)

“I think the take-home message is: MERS is not SARS” (Zaid Memish, Deputy Health Minister, Kingdom of Saudi Arabia, 30th August 2013).

1 - MERS_Infographic_131001

***** Please note that this infographic of the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) was updated with public source information to 1200hrs 1 October 2013 EST *****

The above infographic shows the distribution of MERS-CoV by onset country. The Kingdom of Saudi Arabia (KSA) has had the most cases and the numbers are reflective of the latest KSA Ministry of Health figures. The most recent fatality outside of the KSA that I have included in my data was from Tunisia. Some countries, such as France and the UK have had fatalities that are not shown above due to the fact that the onset occurred elsewhere in the Middle East. The Tunisia index case seems to have occurred in Qatar or the KSA but at this time is still included under that countries flag. Italy initially reported two cases but these were later amended to probably by WHO due to testing issues. A number of fatalities are not shown as their details have not been made public.

Ian M. Mackay, via his VDU blog has been discussing the spike in case numbers during the month of September. To emphasise his point here is the index chart that I published on the 4th September 2013 (110-cases & 50-deaths).

1 - MERS_Infographic_130904

Data can be many things to many people. For health investigators it is a critical resource to build a story about new or emerging diseases, for medical professionals it is a tool to inform while for the public it is a way to tell a complex epidemiological story in a more manageable format.

It has its drawbacks though. Data alone often tells a non-contextual story only.

Reading the back story on MERS-CoV I couldn’t help but reflect on the story of Abid Hussain (case number 10). Abid had travelled to his former home of Pakistan then visited Mecca to pray for his 39-year old son who had been diagnosed with cancer and was in the process of receiving chemotherapy. Upon his return to the UK he became unwell with severe flu like symptoms and either prior to being hospitalised or during his hospitalisation managed to pass on the disease to both of his adult children. The daughter only showed mild symptoms, did not require hospital admission and made a full recovery. The son, Khalid, a father of two and in the battle of his life could not stop a second assault on his system by MERS-CoV and succumbed to the disease just eight days after being admitted to hospital.

What terrible luck.

Acknowledgements: Data for this infographic was sourced largely from CIDRAP, H5N1, FluTrackers and the WHO. Background reading supplied mainly via Pandemic Information News, Ian at Virology Down Under and Helen Branswell.

Updates

  • Case numbers and fatalities have been updated regularly by multiple agencies. Here are the CIDRAP daily overviews which included case updates for the 3rd – 4th – 6th – 9th – 11th – 17th18th – 20th and the 30th of September 2013.