Random Analytica

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

Tag: WHO

Random Analytica: A ‘Soldiers-Five’ [trans. Basic Reading Guide] on Mefloquine

An old ‘soldiers-five’ on Mefloquine. When I first thought I was given Mefloquine I wasn’t sure where to look first. I initially got some good and some bad information. I’m not the tree of knowledge on Mefloquine but here is a suggested reading list and resource guide concerning Mefloquine. I’ve focused on veterans because that is my lived experience. Remember, this is a guide only. Consult your doctor.

Last updated 7th October 2019

World Health Organisation

8th August 1989: World Health Organisation. The original warning from WHO way back in 1989.

Consumer Medicine Information

9th October 2017: The Consumer Medicine Information guide for Lariam (linked here: 171009_ConsumerMedicineInformation_Roche_Lariam). A veteran mate has underlined the important health warnings.

Mefloquine Articles (non-specific)

27th April 1996: New Scientist.  Malaria pill stands accused – Lariam fends off malaria more effectively than any other drug, but growing evidence of disturbing side effects may soon land its manufacturer in court (via 960427_Article_NewScientist_Mefloquine). Thanks to the veteran mate who sent this through. He was given Lariam in 1994 and 1999 without the serious side-effects.

Mefloquine Articles for Veterans

27th January 2003: CBS News. The Dark Side Of Lariam. How Dangerous Is It? One of the first ‘deep-dives’ into mefloquine by a news outlet. Discusses the Fort Bragg suicide cluster where mefloquine was a factor.

19th September 2013: CBS News. Elite Army units to stop taking anti-malarial drug. The US Army’s Special Forces banned from using mefloquine in 2013.

25th September 2013: Huffpost. Mefloquine: The Military’s Suicide Pill. Dr Remington Nevin writes about mefloquine including the 2013 FDA’s ‘black-box’ warning. The world is waking up to the dangers of mefloquine. Dr Nevin is one of the leading experts in the field.

12th October 2014: Army Technology. Mefloquine – the military’s deadly malaria treatment. Dr Remington Nevin discusses the downside to mefloquine including his own personal deployment experience with the drug.

11th August 2016: Military Times. Malaria drug causes brain damage that mimics PTSD: case study. A different take on mefloquine exposure from the USA.

22nd August 2016: Australian Broadcasting Corporation. Defence force admits soldier shouldn’t have been included in East Timor anti-malaria drug trial. One of the first articles I read. Also includes a link to a 2016 7.30 Report about the Australian mefloquine/tafenoquine trials.

30th August 2018: The Irish Times. Vivid nightmares and suicidal thoughts – ex-soldiers blame drug for destroyed lives. An Irish perspective. With a standing Army of approximately 10,000 they have still administered Lariam to approx. 5,500 – 6,000 over the years.

Podcasts

12th June 2019: The Medical Republic. TMR podcast: Can this anti-malarial drug really cause “brain damage”? Thanks to my GP, Dr Mary Lamond for sending this to me. Along with other subjects the podcast covers mefloquine/tafenoquine exposure and its risks in simple language.

Books

23rd January 2014: ‘The Answer to the Riddle Is Me’ by David Stuart MacLean. The Washington Post book review can be found here.

Official Mefloquine Sites (Information & Policy)

Last accessed 7th October 2019: Department of Defence (Australia). Mefloquine. An excellent resource. One of the first sites I visited. Mefloquine Loading Doses are also explained.

Experts

Dr Remington Nevin (USA). Possibly the leading expert in the field of Quinism in 2019 when I suspected my exposure. US Army (Major – Retired). A Vermont-based physician epidemiologist and expert consultant in the adverse effects of antimalarial drugs, particularly mefloquine and tafenoquine.

 

If you or someone you know needs help, please phone Lifeline on 131 114, Kids Helpline on 1800 55 1800, Beyond Blue on 1300 224 636 or Open Arms on 1800 011 046.

6. Mefloquine Dispatches: @WHO, 8th August 1989

When it was issued by the World Health Organisation I was still at school. I wasn’t interested in global issues. I should have read it but I don’t. I’m getting my final paperwork ready for the Army. I’m failing school. The Army accepts Year 10 and I have good grades to that point. School seems so pointless. Something is kicking off in the Middle East. We are going to smash Saddam Hussein in the fucking teeth. I don’t want to miss out on any action. I’m still too young in 1989 but I am slotted in for Basic Training early next year. I am 16-years old. I am so Green.

I’m good judoka. I’m not interested in black belts, I just love the training. I train twice during the week and on weekends if we get enough interest. My Sensei is amazing. He is a psychiatric nurse. He is tough. We laugh as he tells us the story of the bloke who tried to jump him in the supermarket. It supposed to be a joke but W* throws him. The checkout chick is terrified. It’s a great story. I meet him a year or two later. I’m home on leave. I’ve put on 15kg and I’m Army tough. As we train one of the kids clumsily kicks me in the balls as we practice sacrifice throws. It’s an accident but I’m in agony. W* tells the story to the other bouncers at the nightclub he is working at part-time that night. I’m still tender. We laugh. I get free entry and a drink voucher. I feel like a God in the early 90s but that hasn’t happened yet.

I’m working in a greasy Indian restaurant on weekends. The Indian family who own it treat me like one of their own. I get paid $10 per hour cash-in-hand (which is big money back then). I smell like sauce as I go to school on Mondays. The smell lingers till Wednesday. Indian food smells when you do the dishes. It takes me years to get coached into an Indian restaurant with my best friend and his girl. The food is amazing. I’m catching up with another friend and her man next week. We are eating Indian.

I’m so busy. I’ve been training for years to get this far. I’m an accomplished Venturer. I teach others how to abseil, orient a map or whatever. My Venturer leader is an amazing soldier. He is old but still fit. He smokes constantly. Under the stars one night he tells me how he started smoking. He is on patrol in Malaysia back in the day when his best mate cops the full blast of something. He is covered in his blood. Bits of flesh drip off him. When he gets in front of a medic they think he might be damaged. His mate cops the full blast, he walks away without a scratch. The medic puts a cigarette in his mouth and lights it. That was his first smoke. I’m sixteen and this amazing man is sharing his real story. We have a moment. I’ll meet other amazing soldiers in the future. Men and Women. We will share moments. I’ll forget it all.

It’s been 30-years since the World Health Organisation issued their warning.

1989_WHO_Mefloquine

I wonder why they never followed up on it?


WHO~Mefloquine

 

If you or someone you know needs help, please phone Lifeline on 131 114, Kids Helpline on 1800 55 1800, Beyond Blue on 1300 224 636 or Open Arms on 1800 011 046.

Ebola in the Democratic Republic of Congo 4 April – 22 May 2018

The World Health Organisation updated its Ebola virus disease – Democratic Republic of the Congo Disease Outbreak News on Wednesday with numbers to Tuesday. The DR Congo Ministry of Health updated its numbers today with data to Wednesday presenting some new numbers including the invalidation of eight previously reported community deaths which occurred pre-outbreak.

Ian Mackay has broken down the numbers for us in an easy tweet. They are:

#Ebola numbers for 22MAY2018 from DRC MOH…

  • total: 58 (+0 from last report)
  • confirmed: 30 (+2)
  • suspect: 14 (+5)
  • probable: 14 (-7)
  • fatal: 22 (38%; -5)
  • Wangata: 10 (+3 suspect; +2 deaths)
  • Iboko: 24 (+6 suspect)
  • Bikoro: 24 (+3 suspect)

Those numbers in a infographic which details the cases/fatalities by territory (rather than Health Zone). Iboko Health Zone lies within Bikoro Territory:

180524_Infographic_EbolaInDRC

The World Health Organisation data via its latest Disease Outbreak News. Ebola virus disease – Democratic Republic of the Congo. Excerpt:

On 8 May 2018, the Ministry of Health (MoH) of the Democratic Republic of the Congo declared an outbreak of Ebola virus disease (EVD). This is the ninth outbreak of Ebola virus disease over the last four decades in the country, with the most recent outbreak occurring in May 2017.

Since the last Disease Outbreak News on 17 May 2018, an additional fourteen cases with four deaths have been reported. On 21 May 2018, eight new suspected cases were reported, including six cases in Iboko Health Zone and two cases in Wangata Health Zone. On 20 May, seven cases (reported previously) in Iboko Health Zone have been confirmed. Recently available information has enabled the classification of some cases to be updated.

As of 21 May 2018, a cumulative total of 58 Ebola virus disease (EVD) cases, including 27 deaths (case fatality rate = 47%), have been reported from three health zones in Equateur Province. The total includes 28 confirmed, 21 probable and 9 suspected cases from the three health zones: Bikoro (n=29; ten confirmed and 19 probable), Iboko (n=22; fourteen confirmed, two probable and six suspected cases) and Wangata (n=7; four confirmed and three suspected case). Of the four confirmed cases in Wangata, two have an epidemiological link with a probable case in Bikoro from April 2018. As of 21 May, over 600 contacts have been identified and are being followed-up and monitored field investigations are ongoing to determine the index case. Three health care workers were among the 58 cases reported.

Ebola in the Democratic Republic of Congo 4 April – 15 May 2018

The World Health Organisation has updated its Ebola virus disease – Democratic Republic of the Congo Disease Outbreak News which include Epidemic Curve chart and a map illustrating the Health Zones impacted.

Currently there are 40-cases in Bikoro Territory (2-confirmed, 20-probable & 18-suspect) and I’ve assumed that all 23 reported fatalities have occurred in that territory based on the most recent reporting although this has not been confirmed by the WHO in this update.

Note: If all the 23 fatalities have occurred in Bikoro Territory that puts the CFR at 57.5%. However, if all the fatalities have occurred in the smaller Bikoro Health Zone the CFR then spikes to 65.7%. There have also been four cases reported in Wangata Territory including two brothers who travelled to Bikoro for a wedding. This places those four within the environs of Mbandaka, a city of 1.2 to 1.5-million.

WHO are also reporting three Health Care Workers among the 44 infected without providing any further information.

All the cases to date have occurred in Equateur Province which is represented in the infographic below:

180515_Infographic_EbolaInDRC

The World Health Organisation data via Ebola virus disease – Democratic Republic of the Congo. Excerpt:

Since the last Disease Outbreak News on 14 May 2018, an additional five cases, including one laboratory-confirmed case from the city of Mbandaka, Wangata health zone, have been notified by the country’s Ministry of Health. Wangata health zone is one of three health zones in Mbandaka City, which has a population of approximately 1.5 million people. Recently available information has enabled the classification of some cases to be updated1.

From 4 April through 15 May 2018, a cumulative total of 44 Ebola virus disease (EVD) cases including 23 deaths (CFR = 52%) have been reported from three health zones in Equateur Province. The total includes three confirmed, 20 probable and 21 suspected cases from the three health zones, Bikoro (n=35; two confirmed, 18 probable and 15 suspected cases), Iboko (n=5; two probable and three suspect cases) and Wangata (n=4; one confirmed, and three suspect cases). Of the four cases in Wangata, two have an epidemiological link with a probable case in Bikoro from April 2018. As of 15 May, 527 contacts have been identified and are being followed-up and monitored. Three health care workers were among the 44 cases reported. Figure 1 shows the date of notification (date of illness onset not yet available for most cases) for 27 cases with available data from 5 May through 15 May 2018. Figure 2 shows the location of cases by health zone.

Ebola in the Democratic Republic of Congo 4 April – 13 May 2018

The World Health Organization has updated its Disease Outbreak News (DON) on the Ebola outbreak which has data updated to the 13th May 2018. I missed the initial DON but the most recent news is both good and bad. Good in that WHO has immediately ramped up efforts to stem this latest outbreak including deploying the Ebola vaccine but also bad because the two probable cases in the Wangata territory are on the outskirts of a large population centre (Mbandaka – population 1.2-million).

The DON breaks down the cases by Health Zones. Currently those cases listed in Bikoro and Ikoko Health Zones lie within Bikoro Territory while the Wangata Territory encompasses the city of Mbandaka and surrounds. The Case Fatality Rate for Bikoro Territory is 51.3%. All the cases so far have occurred in Equateur Province. Infographic below:

180513_Infographic_EbolaInDRC

The data for this infographic was supplied by the World Health Organization via Disease Outbreak News 14 May 2018 – Ebola virus disease – Democratic Republic of the Congo. Excerpt:

Since the publication of the first Disease Outbreak News on the Ebola outbreak in Equateur province, Democratic Republic of the Congo on 10 May 2018, an additional seven suspected cases have been notified by the country’s Ministry of Health. Importantly, since the last update, cases have been reviewed and reclassified, and some discarded.

From 4 April through 13 May 2018, a total of 39 Ebola virus disease cases have been reported, including 19 deaths (case fatality rate = 49%) and three health care workers. Cases were reported from the Bikoro health zone (n=29; two confirmed, 20 probable and 7 suspected cases), Iboko health zone (n=8; three probable and five suspected cases) and Wangata health zone (n=2; two probable cases). To date, 393 contacts have been identified and are being followed-up. Wangata health zone is adjacent to the provincial port city of Mbandaka (population 1.2 million). Response teams on the ground are in the process of verifying information on reported cases. Case numbers will be revised as further information becomes available.

Random Analytics: Top 10 Ebola Outbreaks and West Africa

After a six month sabbatical I’m dipping my toe back into Random Analytics (and by default my passion for amateur epidemiology).

Last week the World Health Organisation released its latest Ebola Situation Report – 15 July 2015 which has demonstrated that although the disease has stopped it momentous attrition within West Africa it hasn’t entirely gone away. As we learnt from the initial outbreak in late 2013 one case can turn into many hundreds, then many thousands and finally some tens of thousands in a very short space of time.

The WHO notes:

There were 30 confirmed cases of Ebola virus disease (EVD) reported in the week to 12 July: 13 in Guinea, 3 in Liberia, and 14 in Sierra Leone. Although the total number of confirmed cases is the same as the previous week, there has been a shift in the foci of transmission. For the first time in several months, most cases were reported from Conakry and Freetown, the capitals of Guinea and Sierra Leone, respectively. All 9 of the cases reported from Conakry and all 10 of the cases reported from Freetown were either registered contacts of a previous case or have an established epidemiological link to a known chain of transmission. One of the 30 cases reported in the week to 12 July arose from a yet unknown source of infection. However, a substantial proportion of cases (7 of 30: 23%) continue to be identified as EVD-positive only after post-mortem testing. This suggests that although improvements to case investigation are increasing our understanding of chains of transmission, contact tracing, which aims to minimise transmission by identifying symptoms among contacts at the earliest stage of infection, is still a challenge in several areas.

As the following chart demonstrates the 2013-15 West African Ebola Zaire outbreak has eclipsed all previous Ebola events.

1 - Ebola_Top10Outbreaks_150717

Even as the disease has left the pages of most Western newspapers and television screens the scale of the event and the ongoing transmission is still frightening. Consider just these three data points:

  1. Based on current Case Numbers alone the West African outbreak is 65-times greater than the next largest outbreak (the Ebola Sudan outbreak in Uganda in 2000);
  2. The West African outbreak currently is 11-times greater than ALL previous outbreaks combined (total cases prior to the West African plus the 2014 DRC outbreak totalled 2470 while the current outbreak cases total 27,678);
  3. In the past week of reporting the total case count (30) was just under half of the 10th worst outbreak of Ebola recorded in Gabon back in 2001 and greater than the 13 of the 30 historical outbreaks/events across the world to date.

Not all of us have forgotten West Africa.

 

Data Sources

[1] WHO. Ebola Situation Report – 15 July 2015. Accessed 17 July 2015.

Random Analytics: West African Ebola Outbreak (to 5 Nov 2014)

The World Health Organisation (WHO) has updated it latest advice on the Ebola Outbreak. Ebola Response Roadmap Situation Report 7 November 2014. Summary:

A total of 13 268 confirmed, probable and suspected cases of Ebola virus disease (EVD) have been reported in six currently affected countries (Guinea, Liberia, Mali, Sierra Leone, Spain, the United States of America) and two previously affected countries (Nigeria, Senegal) up to the end of 4 November 2014. There have been 4960 reported deaths.

Following the WHO Ebola Response Roadmap structure, country reports fall into two categories: 1) those with widespread and intense transmission (Guinea, Liberia, and Sierra Leone); and 2) those with or that have had an initial case or cases, or with localized transmission (Mali, Nigeria, Senegal, Spain, and the United States of America).

Here are three charts/infographics of the West African Outbreak with data confirmed by WHO to 5 November 2014.

01 - Ebola_WAfricaOutbreakTableau_141108

The West African Ebola Outbreak (2013-2014) infographic details the cases, fatalities, provisional Case Fatality Rate (CFR) and health spend per capita in 2012 $USD.

The data point of interest for me in the past fortnight has been the revision in numbers that WHO has provided. In the most recent update case numbers in Sierra Leone have been significantly revised down, while in Liberia where cases are on the apparent wane the numbers were revised upwards. Data for Mali has been included in this update.

02 - Ebola_WAfricaOutbreakChart_141108

The West African Ebola Outbreak (by Nation) chart looks at the split between those recovered or still in treatment (highlighted by flag) and those deceased (in red).

A data point of interest here is the case difference between Sierra Leone and Guinea yet a similar amount of deaths. Provisional CFR is Sierra Leone is 23.2% compared to Guinea which is a much higher 59.9%. Surely that can’t be correct?

03 - WestAfrica_Cases~FatalitiesMonth_141108

The West African EVD Outbreak – All Cases/Fatalities by month details the epidemiological curve of the outbreak from March 2014 when the first cases and deaths became apparent. Each column is visualised by the flag of the eight impacted countries. Note: Due to revisions in late October as provided by WHO I have finalised the October numbers as at 2 November.

The data point of interest in the last chart is the epidemic curve differences between cases (still rising) and deaths (decreasing). I would have expected that both should increase or decrease in tandem. I suspect missing data would account for the anomaly.

Summary

I’ll update and post my charts again when the data becomes available for the entirety of November. In the meantime if you want to keep across the West African outbreak detail via some alternate sources then I would recommend Crawford Kilian and for more regular epidemiological posts Maia Majumder, MPH and Ian Mackay, PhD.

 

Data Sources

[1] World Bank. Health expenditure per capita (current US$). Accessed 8 November 2014.
[2] World Health Organisation. WHO: Ebola Response Roadmap Situation Report 7 November 2014. Accessed 8 November 2014.

Random Analytics: West African Ebola Outbreak (to 18/19 Oct 2014)

The World Health Organisation (WHO) has updated it latest advice on the Ebola Outbreak. Ebola Response Roadmap Situation Report 22 October 2014. Summary:

Summary

A total of 9936 confirmed, probably, and suspected cases of Ebola virus disease (EVD) have been reported in five affected countries (Guinea, Liberia, Sierra Leone, Spain, and the United States of America) and two previously affected countries (Nigeria and Senegal) up to the end of 19 October. A total of 4877 deaths have been reported.

The outbreaks of EVD in Senegal and Nigeria were declared over on 17 October and 19 October 2014, respectively.

EVD transmission remains persistent and widespread in Guinea, Liberia, and Sierra Leone. All but one administrative district in Liberia and all administrative districts in Sierra Leone have now reported at least one confirmed or probably case of EVD since the outbreak began. Cases of EVD transmission remain lowest in Guinea, but case numbers are still very high in absolute terms. Transmission remains intense in the capital cities of the three most affected countries. Case numbers continue to be under-reported, especially from the Liberian capital Monrovia.

Of the countries with localized transmission, both Spain and the United States continue to monitor potential contacts. On 21 October the single patient with EVD in Spain tested negative for the disease for a second time. Spain will be declared free of EVD 42 days after the date of the second negative test unless a new case arises during that period.

On 22 October 2014, WHO convened the third Emergency Committee on Ebola under the International Health Regulations (2005).

Here are three charts or infographics of the West African Outbreak with data confirmed by WHO to 18/19 October 2014.

01 - Ebola_WAfricaOutbreakTableau_141023

 

The West African Ebola Outbreak (2013-2014) infographic details the cases, fatalities, the provisional Case Fatality Rate (CFR) and health spend per capita in 2012 $USD.

Midway through October the biggest data find for me has been the difference between the index cases in Senegal and the United States. Lots of similarities but IMO four very important differences:

  1. Both cases entered the country without disclosing the possibility that they may have been exposed to Ebola;
  2. Both cases presented to hospital shortly after arrival in the destination country;
  3. Difference One: In the case of Thomas Eric Duncan who travelled to the USA he presented at hospital but was released back into the community. He presented again three days later (interestingly a key and important fact left out of the official CDC Overview) with more extreme symptoms. In the Senegal case the patient sought treatment in Dakar giving no indication he may have Ebola but was not released and a day later Senegalese authorities linked him to other cases. He was subsequently quarantined;
  4. Difference Two: In the USA contract tracing was slow to be implemented while PPE protocols were inadequate which resulted in the spread of the disease amongst Health Care Workers (HCW). In Senegal no HCW were infected.
  5. Difference Three: The USA index case died of the disease; potentially due to those critical days where he was without care while in Senegal the patient recovered and has returned to Guinea.
  6. Difference Four (and this is the key one which you can see in the infographic): The average health spend per capita in the USA is $8,895 (in 2012 $USD money) while Senegal makes do with just $51 per person. That’s 174 times less than the USA.

02 - Ebola_WAfricaOutbreakChart_141023

The West African Ebola Outbreak (by Nation) chart looks at the split between those recovered or still in treatment and those deceased. As per the latest update from WHO there is an element of underreporting going on in the worst impacted countries (Liberia, Sierra Leone and Guinea).

03 - WestAfrica_Cases~FatalitiesMonth_141023

The West African EVD Outbreak – All Cases/Fatalities by month details the epidemiological curve of the outbreak from March 2014 when the first cases and deaths became apparent. Each column is visualised by the flags of the seven impacted countries.

The mid-month data-find from this chart is that the epidemic curve in relation to deaths continues to increase month on month yet the case load seems to be pulling back. All the anecdotal evidence coming out of West Africa points to an increasing, rather than a decreasing case load as individuals, families and population centres avoid health care facilities. In past months, the case load mid-month would be approximately equal to the previous month. Best case scenario would be that West Africa is getting on top of the disease but the facts-on-the-ground don’t support this. I’d expect to see some revisions to the data in coming weeks and months.

Summary

I’ll update and post my charts again when the data becomes available for the entirety of October. In the meantime if you want to keep across the West African outbreak detail via some alternate sources then I would recommend Crawford Kilian and for more regular epidemiological posts Maia Majumder, MPH and Ian Mackay, PhD.

 

Data Sources

[1] World Bank. Health expenditure per capita (current US$). Accessed 23 October 2014.
[2] World Health Organisation. WHO: Ebola Response Roadmap Situation Report 22 October 2014. Accessed 23 October 2014.

Random Analytics: Ebola in the USA? Time for some context

Back at the end of September when the Thomas Eric Duncan Ebola case was first diagnosed in Texas and hit the headlines Ebola went from being an African issue to become an American problem. Social media exploded on the subject, Twitter mentions on Ebola tripled overnight and news agencies across the Western world struggled to keep up with the renewed interest.

Most of the analysis has been very good but some of the commentary has been downright crazy.

CNN did a story on how some US Republicans are calling for stronger border controls by linking Ebola with ISIS. As crazy as the idea of mixing the Ebola and ISIS narrative is CNN itself asked the same question prompting The Independent to write ‘The Isis of biological agents?’: CNN is asking the stupid Ebola questions.

1 - CNN_Ebola~ISIS

Stupid is as stupid does is not just reserved for the United States. In my own country of Australia a recently returned nurse was hospitalised on fears she may have contracted the disease after registering a mild fever. This incident had Bob Katter, the federal member for Capricornia suggesting a ban on people travelling to Australia from West Africa and calling for all returning Health Care Workers to be put into government isolation upon their return (the nurse in question was actually in self-imposed home isolation).

Anyway, I thought the debate on the one case in the United States against the 8,398 in Western Africa (as per the most recent WHO update) was worth putting in context. An infographic:

2 - EbolaCasesbyFlagSize_8Oct2014

The West African Ebola Outbreak – Cases by Country is a look at the six countries impacted by the disease with data to 7/8 October 2014. Each individual country is represented by their flag and the size of their flag is a percentile proportion of total cases.

As you can see Liberia has 48.5% of all cases, followed by Sierra Leone (35.1%), Guinea (16.1%) and Nigeria (0.2%). Both the USA and Spain have one case each which equates to 0.000119% of all cases and too small to be represented by a flag.

The story of Thomas Eric Duncan is tragic and the entry of a disease like Ebola into the West is scary but we need to get some context on how bad the situation is.

 

To the Lost

 

Data Sources

[1] Hooten, C. ‘The Isis of biological agents?’: CNN is asking the stupid Ebola questions. The Independent. 7 October 2014. Accessed 12 October 2014.
[2] World Health Organisation. WHO: Ebola Response Roadmap Situation Report 10 October 2014. Accessed 12 October 2014.

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…