Saudi MERS response hobbled by institutional failings




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  By Angus McDowall and Kate Kelland

RIYADH/LONDON – When announced last week it had found 113 more cases of the deadly Middle East Respiratory Syndrome (MERS), it didn’t just force a rethink of the threat the virus poses, it exposed institutional failings.

  Saudi health sources and international virologists said poor communication and a lack of accountability in government departments, inadequate oversight and a failure to learn from past mistakes have all hindered Saudi Arabia’s battle against the SARS-like virus.

    They say it is too soon to tell if reforms introduced by a new acting health minister can overcome what they see as underlying problems.

    Some top Saudi health officials say they accept that delays in reporting MERS cases were caused by poor communication between hospitals, laboratories and government departments, but they stress things have significantly since the appointment of the new minister in late April.

    The health ministry “has put in place measures to ensure best practices of data gathering, reporting (and) transparency are strictly observed”, it , and “to ensure that from now on, case information will be accurate, reliable and timely”.

    Saudi Arabia has been host to the vast majority of cases of MERS – a viral infection which can cause coughing, fever and pneumonia – since it was first found in humans two years ago.

    International concerns over Saudi Arabia’s handling of the outbreak grew last week when it said it had under-reported cases by a fifth and revised the case numbers to 688 from 575.

    People in the kingdom are still becoming infected with and dying of MERS every day, and sporadic cases have been found outside Saudi Arabia as infected people travel. The worldwide death toll from MERS now stands at more than 313 people.

    International scientists have complained of a lukewarm response from Saudi authorities to offers to help with the scientific research needed to get a handle on the outbreak, and have questioned the quality of data collection and distribution that could help reveal how the disease works.

    UNREPORTED CASES

 Tariq Madani, head of the scientific advisory board at the health ministry, said 58 of the 113 cases added last week had been confirmed as positive in government hospitals and laboratories, but the results had simply not been passed by those institutions to the ministry.

 Another 22 cases tested positive at the King Faisal Specialist Hospital in Jeddah, but duplicate samples were not sent to government laboratories and the institution did not communicate the results to the health ministry, he said.

  A spokesman for King Faisal Specialist Hospital declined to comment further and referred all queries back to the health ministry.

 The remaining 33 cases had tested positive in laboratories but showed as negative in government ones, Madani said.

 Madani said he did not believe the under-reporting had been deliberate and he thought a 20 percent shortfall in reported cases was not unusual in a disease outbreak.

 “This can happen anywhere in the world, that 20 percent of patients may not be reported. This is within the limit. It’s actually less than 20 percent,” he said.

 However, Ian MacKay, an associate professor of clinical virology at Australia’s University of Queensland who has been tracking the MERS outbreak since the virus was first identified in 2012, is skeptical about the notion that it is normal for 20 percent of cases to go unreported.

 “I know of no scientific norms that define a threshold below which it is normal to under-report cases of any viral cluster, outbreak or epidemic,” he said.

 Madani said in some cases patients intermittently shed the virus, so it is not caught in a test. The ministry’s policy, he said, had been to say that if there was a discrepancy between test results, only government laboratory results should stand.

 The new acting health minister Adel Fakieh has changed that policy, Madani said, and from now on positive tests from any laboratory accredited by the health ministry will count as confirmed cases.

 The appointment of Fakieh has also led to other changes, he said. Authorities have brought in tighter infection procedures in hospitals and are trying to be more transparent about how they are tackling MERS.