Hafr Al Batin, Saudi Arabia/Atlanta, US: More than a year after the emergence of a new virus that has killed dozens of people, mainly in Saudi Arabia, international health officials say they are concerned that Saudi officials may not be conducting — or aren’t providing findings from — some critical investigative work that could help answer basic questions about the disease.
At the same time, relatives of some Saudi victims are demanding that their government do more to warn the public about the potential danger.
With the rate of reported cases in the Middle East accelerating and so much still unknown, experts warn that the virus could easily spread to more crowded, poorer countries in the developing world. The World Health Organisation (WHO) held an emergency meeting late last month to discuss the disease.
“The No. 1 question remaining is ‘How do people get exposed?’” Anthony Mounts, the WHO’s point person on the disease, known as Middle East Respiratory Syndrome coronavirus or Mers-CoV, said.
While the Saudis are questioning those who become ill and testing people that victims had contact with, they aren’t indicating that they have questioned others who didn’t become ill, so-called case controls, Dr Mounts said in an interview.
Such comparisons are critical to sorting out what ill people might have done — what they might have eaten, or come in contact with — that caused them to become infected. “You have to have that comparison group,” Dr Mounts said.
Saudi officials denied that they were withholding critical information or failing to gather enough data. Rather, they said, the investigations in coordination with Western health experts are continuing.
“It’s very difficult to give all the details to the people when we don’t know all the details,” Ziad Memish, the deputy health minister, said in September at his office in Riyadh, the Saudi capital.
Dr Memish said that the Saudi government is sharing its data with the WHO, but keeping certain details from the public to protect patient privacy.
He also said the government is running Mers advisories on television and in newspapers.
But in Hafr Al Batin, a remote town in Saudi Arabia’s northeast, relatives of four recent victims complained that no one in the family had ever heard warnings about the new disease or how to avoid catching it. “We had no idea,” Jawal Al Sahly, who lost his 39-year-old brother Fahd Al Sahly, their mother and two other family members, said.
Hospital workers in the town — site of 11 confirmed cases — kept telling Fahd that “he’s not sick, ‘You’re making a big deal out of nothing,’” Jawal said.
Saudi and international health experts say they share many of those same frustrations about the disease, which is related to Sars, the respiratory disease that started in China and sickened some 8,000 people, killing 750, in 2003.
The first-known Mers cases were in Jordan in April 2012, and the virus was identified in September that year.
Doctors suspect one or more species of animals are hosting the virus, sporadically passing it on to humans.
The virus so far has tended to kill mostly those weakened by age or illnesses, and to peter out after affecting fewer than a dozen people in any one cluster. However, the number of new cases has jumped in recent weeks, Dr Mounts noted.
“It looks like the sporadic cases have increased lately, and that’s more troubling,” he said, because they point to possible increase of transmission from “non-human sources,” perhaps due to some still-undetected seasonal change.
Michael Osterholm, director of the Centre for Infectious Disease Research and Policy at the University of Minnesota, said the “satellite” cases in Europe were a warning of how easily the disease can spread.
Tackling the viral threat
Even though more than one year has passed since Mers-CoV was first reported and the pathogen remains mostly a puzzle, Saudi Arabia, the country that has reported the vast majority of cases, is optimistic about the Haj season in mid-October when millions of pilgrims congregate in Makkah.
Every Haj season, the Saudi government mounts an impressive public health response to possible diseases, and this year, the ministry of health said that efforts have been expanded to deal with the Mers threat.
Health Minister Abdullah Al Rabia said that 22,000 healthcare workers have been positioned at the facilities in Makkah, Madinah and other holy sites where pilgrims are scheduled to congregate.
Their role is to monitor the medical conditions and follow up on any case in a bid to ensure the safety of all pilgrims, he said.
The medical staff will be working in nine specialised hospitals in Madinah, eight in Makkah, four in Arafa and four in Mina. He added that 141 smaller preliminary health care centres have been set up Makkah, Madinah, Arafa, Mina and Muzdalifa. Special preparations to deal with the Mers-CoV included providing vaccines and medications and setting up isolation rooms in all hospitals, he said.
Saudi Arabia has urged old people, young children and those with chronic diseases to defer performing Haj this year.
— Zawya Dow Jones