“After the change of minister they involved people more in preventative methods. There were text messages on hand washing, the public has been more involved,” said a Saudi public health expert who was critical of the ministry earlier this year. He, like some others interviewed for this article, spoke on condition of anonymity because he was not authorized to comment.
But some international scientists still complain that data published online by Saudi authorities, which includes daily updates on confirmed new infections and deaths in different cities, is not comprehensive enough to allow them to research the disease.
The European Centre for Disease Prevention and Control (ECDC), for example, said it was not clear whether the new cases listed by Saudi authorities met the World Health Organisation’s definition of confirmed cases. The ECDC also noted the absence of detail such as age, gender, residence, probable place of infection and other information.
Madani said the ministry only published information it considered immediately relevant to the public. He said more detailed data, collected on all patients since the first confirmed case in June 2012, could be made available to scientists who wanted it and had already been given to the World Health Organization.
A spokesman for the WHO confirmed the organization had received detailed information which it was now verifying with Saudi authorities to ensure there was no double counting of cases in the WHO’s global tally.
“We collect extensive data on demographics, location of the patient, their nationality. Then we collect…data in terms of clinical manifestations, complications that happened to the patients while they are in hospital, and the outcome,” Madani said. Officials also follow up contacts of known MERS cases daily for 14 days, he added, asking them to stay home in isolation and admitting them to hospital if they show symptoms.
Michael Osterholm, director of the Center for Infectious Diseases Research and Policy at the University of Minnesota, said Saudi authorities should be congratulated on their pledge to be more open. “From talking to people inside the Kingdom right now, I’d say there is a very new sense of transparency in the last few weeks,” he said.
DOCTORS NOT INFORMED
However, challenges remain. The problems are evident in the case of one kidney patient who fell ill in Jeddah in April, a main location of the outbreak.
The man was transferred from another hospital to the King Faisal Specialist Hospital (KFSH), but doctors there were not officially informed by medical staff who had previously cared for him that they suspected he might have contracted MERS, said a city health source.
As a result, King Faisal Specialist Hospital staff took no extra precautions and within a week the head of the intensive care unit and other staff, including a pregnant nurse, fell ill. Both the nurse and ICU head have now recovered.
The problem was that suspicions of MERS were only communicated verbally, rather than being put on paper in a patient’s file, said Sabah Abuzinadah, a former head of nursing for a government commission on healthcare workers.
The King Faisal spokesman declined to comment.
Such problems were familiar to people inside Saudi Arabia who had been involved in cases of MERS over the previous two years.
“At first the government would only accept that those patients already in intensive care had MERS. Even when cases were coming to the emergency room with severe respiratory symptoms they were told to go home and not investigated,” said the head of a private hospital where some MERS cases occurred last year.
He denied that there was any deliberate attempt to hide MERS cases, but said officials – and sometimes emergency room doctors – found it hard to accept that a new disease had raised its head in their hospital. The hospital declined to comment.
He said the extent of the outbreak in Jeddah in April and May showed that complacency had set in after the rate of infection slowed throughout last summer, autumn and winter, and when there were no confirmed cases during last year’s pilgrimage season. “We did not learn from the outbreak last year. The Health Ministry did not get the severity of the issue. But it was not just them who underestimated it. Even in the best private hospitals there were cases,” he said.
