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.
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.
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.
Make of that what you will…